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2013 LARGE STORM RESPONSE PAPER FORM CHECKLIST <br /> Eirr <br /> Date of inspection: —13•`113, — g 3 Inspected By: MIt T 4 i <br /> Address: ��`fi ( � U�C�a'� r Service Request Number: (') <br /> Resident: $c Z:5 CA-Q..Ck- Owner? ❑YES ❑ NO <br /> Phone Number: lv"14 t "a S t Email: <br /> General Building Details: <br /> Is this building within the combined sewer area? ❑YES NO Does the building have a basement? YES ❑NO <br /> Does the building have a backwater valve(BWV)? ❑YES ❑ NO (If yes)Was BWV installed through City program ❑YES ❑ NO <br /> Does the building have a sump pump? ❑YES [ 0 Does the building have a grinder pump? ❑YES S'NO <br /> Storm Event Details: <br /> Where did water entering building come from? ❑SURFACE FLOW GROUNDWATER ❑SEWER BACKUP-FIXTURES ❑ UNKNOWN <br /> Details: C 0.413 � rJ Too s 1,f//. 'J f c citrcgi w 4i e, 1074 <br /> Where did water go within the building? ❑BASEMENT PERIMETER ❑BASEMENT NEAR FIXTURES ❑OTHER <br /> Details: e-toDOV0 9/Ail&S- / 0IJ O V- crS;t'I4re c—/fri i c l 1_>'f!:lia ao o" e.c c-ae, c C,6-1- <br /> Site Observations: <br /> Downspout/site grading issues noted: Co C..bA 4/1 Vb r S Nod I,I'N 1- Op !� a '1� r� +-v / Ja v L:voL <br /> Building elevation relative to sewer and surrounding area issues noted: ftzUSe ; 5 u vt1 ( c*.AIk o r® s rZ tQ 1 ` <br /> Site pump issues noted: <br /> Historical Information I Other Information: <br /> Previous"flooding"issue Service Requests at address: <br /> Previous"flooding"issues noted by homeowner: St; / 4)c Q R 4 0 4 r <br /> Recent stormwater/sewer projects completed in area: Proposed stormwater/sewer projects in area: <br /> Property owner interested in beginning City Backwater Valve Program at address:❑YES ❑ NO Details: <br /> Notes: C c to" ( ;S euc-1" Oprst'`* I A LA45 r, L;f �'.�,fat.. 1 a i <br /> b(1 emt~` `QAsa, (Le 0 A,t( �/Cn. ✓ '7�a� <br /> A4 L: y'.k S ; fiJ cos Li P a'yus fLLt;,91 tutor t )-tAs clad" Pow . <br /> Revision: 3 TRW 1 Monday,September 09,2013 <br />