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2013 LARGE STORM RESPONSE PAPER FORM CHECKLIST <br /> 4ETT <br /> Date of inspection: I000/! 3Inspected By: / A D/5,4,1 <br /> Address: 9-7 ( e 41,E-/`/ Service Request Number: <br /> Resident: l?9/ if. s?z<T,. /1r6 Owner? ❑YES ❑NO ia. <br /> Phone Number: Email: <br /> 0 U-h ec Oa M ✓ �'���`/ 4 2 r . -1 G 275'- <br /> General Building Details: <br /> Is this building within the combined sewer area? YES ❑NO Does the building have a basement? ❑YES WINO <br /> Does the building have a backwater valve(BWV)? 0 YES E NO (If yes)Was BWV inst lied th ugh City program 0 YES 0 NO <br /> Does the building ha�mp pump? El YES ❑NO Does the building have ' der pump? 0 YES 0 NO <br /> Storm Event Details: <br /> Where did water entering building come from? SURFACE FLOW 0 GROUNDWATER 0 SEWER BACKUP-FIXTURES 0 UNKNOWN <br /> Details: Fit/In-- /lil v' /3a.(ik ?(,vrh(sS Co f el--rat---- `-e-41 1- c-zee 14-faGj /kr(ideci . <br /> Where did water go within the building? 0 BASEMENT PERIMETER ElBASEMENT NEAR FIXTURES 0 OTHER <br /> Details: (3 0-it 6z ,4i O I 1 c4;16 - <br /> Site Observations: <br /> Downspout/site grading issues noted: i UL'7! S?oa/ ('n,'--ea-e6- ' G t �,1 <br /> Building elevation relative to sewer and surrounding area issues noted: /9.4764 'A-, /4 �-/'r/ <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 arep: <br /> Property owner interested in beginning City Backwater Valve Program at address: NO Details: U <br /> Notes: 2 C[sS' 1 r- (�(,�,e t/ /r 'i Ai p(.[ -k Cry; r3 42A go Usair- d ha-- /S <br /> Fur <br /> Revision:3 TRW 1 Thursday,September 05, 2013 <br />