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2013 LARGE STORM RESPONSE PAPER FORM CHECKLIST <br /> Date of inspection:pe7 ((/l 4 /i' Inspected By: Or Gi h l�Do(fl41 <br /> fi <br /> Address: 5 It 6ZZ,y t /e Service Request Number: <br /> Resident: Owner? ❑YES ❑NO <br /> Phone Number: Email: <br /> General Building Details: <br /> Is this building within the combined sewer area? ❑YES f 0 Does the building h e a base ent? ❑YES ❑NO <br /> Does the building have a backwat va e(BWV)? ❑YES ❑NO (If yes)Was BWV inst e through City program ❑YES ❑NO <br /> Does the building have a sump pum ? YES ❑NO Does the building e a g er pump? ❑YES ❑NO <br /> Storm Event Details: <br /> Where did water entering building come from? adiJRFACE FLOW ❑GROUNDWATER ❑SEWER BACKUP-FIXTURES ❑UNKNOWN <br /> Details: Imo`►%A Pro,,-, (2 Do !/Q t eir <br /> Where did water go within the building? ❑BASEMENT PERIMETER ❑BASEMENT NEAR FIXTURES ElOTHER <br /> Details: rh/�/ /n �� Q,/pC_ -/ 6-1- • <br /> Site Observations: <br /> Downspout/site grading issues noted: <br /> Building elevation relative to sewer and surrounding area issues noted: 1-fc1,1,...e_ I c van ) /,u /U r Lew <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: <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:❑YESJ DI NO Details: <br /> Notes: f�LG� �U &>��e of 72A�� L?,✓.� G�G� lV-h%Rc iffry,e f c— <br /> ra4Vt- - P �� ��� /tea n�� - Fer how f <br /> 60\r f--v—i4 ovr-- I-445 p�ei i " <br /> Revision:3 TRW 1 Thursday,September 05,2013 <br />