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0 2013 LARGE STORM RESPONSE PAPER FORM CHECKLIST <br /> Date of inspection: /a!� 13 Inspected By: (../c G r�A Noe <br /> P 1 <br /> Address: 4y 17 A " v (' ^K A l Service Request Number: <br /> Resident: .\^r\IC c, �1 e oL44 i0 Owner? ❑YES ❑NO <br /> y <br /> Phone Number: Email: <br /> General Building Details: <br /> Is this building within the combined sewer area? 'YES ❑ NO Does the building have a basement? ❑YES [ 1 NO <br /> Does the building have a backwater valve(BWV)? YES L'NO (If yes)Was BWV installed through City program ❑YES NO <br /> Does the building have a sump pump? ❑YES NO Does the building have a grinder pump? M<ES ❑ NO <br /> Storm Event Details: <br /> Where did water entering building come from? SURFACE FLOW ❑GROUNDWATER ❑SEWER BACKUP-FIXTURES ❑UNKNOWN <br /> Details: CCc'"L,* S'2,,.,5t Cist-e—, GJeAN-T'o -k 1'0 5-0,-v te) S,-Xckre I tu_i - ND<)V <br /> t-ou re- , <br /> Where did water go within the building? ❑ BASEMENT PERIMETER ❑ BASEMENT NEAR FIXTURES lt6THER <br /> Details: .,s,P G`) Se Vc") Q e_P ksr,Or ) ILK 1 (roof Ae.e ,/, 'IL r'-. �;4J <br /> Site Observations: t Nk Poi <br /> Downspout/site grading issues noted: SOr\.,e_ a()\,-, 5 <br /> r0J\- s ` ^Cd rrQ0-t Li ck ISCo 1.,^Ct eh -to 1(3 <br /> _ve-r‘f <br /> Building elevation relative to sewer and surrounding area issues noted: <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: Q.1'E \ r c o 1"1 c 6 f dj.ec CS • 1J e V er f e er-)A /Lc <br /> JaerZ , <br /> Recent stormwater/sewer projects completed in area: P0',Q Proposed stormwater/sewer projects in area: L.)��v0-4 N <br /> Property owner interested in beginning City Backwater Valve Program at address: ❑YES p-NO Details: No fin. , 'iI\ e <br /> Notes: L& e- `t" 00 r 402^r•c.^A 0\)S r 1GiCA &V•z. At) J ,s- ' 6`t• Q,-/ cye <br /> .60\-f(kk \ 't 0 SeocSe f-k� <br /> Revision: 3 TRW 1 Thursday,September 05,2013 <br />