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2013 LARGE STORM RESPONSE PAPER FORM CHECKLIST <br /> Date of inspection: 21.o S f3F-4L '7--0 Inspected By: Nei uc I�l� iz� fSoPS Soc_10&13 <br /> Address: i- OS kWVvt-2.D ArVG— Service Request Number: <br /> Resident: -J PrtAjz..S F4-6-A1\ Owner? I24ES ❑ NO <br /> Phone Number: 4Z5". 2ZS. 062.1(9 Email: G34Pc-2.G. Sr&C... e..14O AAA1L. CzAA. <br /> General Building Details: <br /> Is this building within the combined sewer area? ❑YES ❑ NO Does the building have a basement? ❑YES [ 0 <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 [a-NO Does the building have a grinder pump? ❑YES ❑ NO <br /> Storm Event Details: <br /> Where did water entering building come from? [SURFACE FLOW ❑GROUNDWATER ❑SEWER BACKUP-FIXTURES ❑ UNKNOWN <br /> Details: C.Act-t ( Sid OU - O(A) Pttiv►n H.o,AM? 4 tZuiJ Off Of--16tlf30R <br /> Where did water go within the building? ❑BASEMENT PERIMETER ❑ BASEMENT NEAR FIXTURES ❑-eTHER <br /> Details: WA►Fzt'i.._ ig-.00O1 z-I '0owiJ Sr A•c Cz-/ Pftp cuhl 6 (9t - 4 S 73fVfYG-- l44 <br /> Site Observations: <br /> Downspout/site grading issues noted: Onw N s?ovTS Pe1wevvt 4?vo rr L rJ 4) o ni SETS- Sits rn) <br /> Building elevation relative to sewer and surrounding area issues noted: t . j zCL ( ,gw17zC_ op f3►.nlr <br /> Site pump issues noted: <br /> Historical Information I Other Information: <br /> Previous"flooding"issue Service Requests at address: yam' SfL D to4 3(VZ_ <br /> Previous"flooding"issues noted by homeowner: \J5.-S <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: t-61..uR(Lb 1, (N2-trACYLAM ? O17.4kit l IV 4- (-tot.toi tnl *f2AlNS F (SUtt-DOJ <br /> 0�1 t�bL RA D 4 imio ®d i,J Di-Lae- uJ a tA/Po l a F.(L- (.9 A-WA-6-ra_ <br /> f=�ovDirJ Fn..inn N oaIM ePta.,Qrza-`Y ' 614 -s-0,_ <br /> Revision: 3 TRW 1 Monday, September 09,2013 <br />