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2013 LARGE STORM RESPONSE PAPER FORM CHECKLIST <br /> 4-77 <br /> Date of inspection: ((/14//3 Inspected By:(J(7 (pir'1 <br /> Address: (17—/—t HD(--(?(2 Service Request Number: <br /> Resident: ( —"6 ( t— I told Owner? [V�YES El NO (, d <br /> Phone Number: l.�/l(l.3 S Inie_ /t Email: <br /> General Building Details: <br /> Is this building within the combined sewer area? ❑YES <C Does the building have a b..ement7 ErYES ❑NO <br /> Does the building have a b water valve(BWV)? ❑YES El NO (If yes)Was BWV installed thro•s City program El YES ❑NO <br /> Does the building have su pump? El YES El NO Does the building have a gri,der pum. El YES El NO <br /> Storm Event Details: <br /> Where did water entering building come from? SURFACE FLOW ❑GROUNDWATER El SEWERBACKUP-FIXTURES ❑UNKNOWN <br /> Details: 770--0- 0 f (7,A41✓✓ ��rir"?�2nt Siv , a/8,940 / p & <br /> Where did water go within the building? ❑BASEMENT PERIMETER El BASEMENT NEAR FIXTURES OTHER <br /> Details: /)t(/r(�� /(Mil ai - Ill/O 5Ci i (.�-�P� <br /> Site Observations: <br /> Downspout/site grading issues noted: (vim 9/t ct lit piig/ ! �-�-& lam' G�i 'tr <br /> Building elevation relative to sewer and surrounding area issues noted: 0 0 t-/I 1T/� / �/�►l� <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:El YES <br /> �[�NO Details: <br /> Notes: 43 phG,/%tdi LUG/ ) �/h Gi//P � �r�b ��� rl/l�t�Y s�0 / <br /> v&n l (,�ty ✓✓ <br /> Revision:3 TRW 1 Thursday,September 05,2013 <br />