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2013 LARGE STORM RESPONSE PAPER FORM CHECKLIST <br /> grr <br /> Date of inspection: 1/3�//4Inspected By: ( �i.✓1 <br /> l <br /> Address: ��r)- (,/ Service Request Number: <br /> Resident:/I/1" l l U d�� Owner? E<ES El NO <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 El NO <br /> Does the building have a backwater valve(BWV)? ❑YES L10 (If yes)Was BWV installe ugh City program ❑YES ❑NO <br /> Does the building have a sump pump? El YES ❑NO Does the building have grinder pump? ❑YES/ NO <br /> hi noLoF fop, <br /> Storm Event Details: <br /> Where did water entering building come from? El SURFACE FLOW El GROUNDWATER El SEWER BACKUP-FIXTURES El UNKNOWN <br /> Details: ✓Y ci ro /•`112- <br /> Where did water go within the building? 'EMENT PERIMETER ASEMENT NEAR FIXTURES Z OTHER <br /> Details: <br /> Site Observations: C� <br /> Downspout/site grading issues noted: re-- 1DJ ed- cre � - 7 d ��( 4A- • <br /> rte. "�Building elevation relative to sewer and surrounding area issues noted: 'L .(Ccfria''/ <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: V a 5 cA^i2 Li fa(- ,L,1 (JJ i roziofr 0116'2 � <br /> Recent stormwater/sewer projects completed in area: Proposed stormwater/sewer projects in area: (i 1''(/►4 / <br /> Property owner interested in beginning City Backwater Valve Program at address: YES ❑NO Details: <br /> Notes: . <br /> (.(.n 10 1 tl . /I�o AA-ut,j c( �$8�. 1 r� 441114 77s2e 'io611-,, <br /> OLy A?? 1 „5 T -oh —/=-6 , , <br /> Revision:3 TRW 1 Thursday,September 05,2013 <br />