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2013 LARGE STORM RESPONSE PAPER FORM CHECKLIST <br /> (477- <br /> Date of inspection: q'111)?1>>3 Inspected By: 'Door-Pyre, , inge4 J <br /> Address: a.001 \}v T Service Request Number: <br /> Resident: LoG{-}t (� t47 i/`} Owner?WES ❑NO <br /> Phone Number: C'2) Srev dq R 7 ) Email: <br /> General Building Details: <br /> Is this building within the combined sewer area? 'YES ❑NO Does the building have a basement?RYES ❑NO <br /> Does the building have a backwater valve(BWV)? YES ❑NO (If yes)Was BWV installed through City program ❑YES XNO <br /> Does the building have a sump pump? YES ❑NO )N aPearlEiPT Does the building have a grinder pump? ❑YES, NO <br /> 5' FeQY) <br /> Storm Event Details: )ctri0r MAI)•37-PIN1 7, GYDLAmieD 01Aus 'r. <br /> Where did water entering building come from?Nr SURFACE FLOW ❑GROUNDWATER SEWER BACKUP-FIXTURES ❑UNKNOWN <br /> Details: `I j.-tP.! . 1-t �-'� cc-cc-V 1T,QA;^j j l _UUND2'-) f bJ Y i Foul.)%m AYire.) GP-AU[ <br /> k.leac C v our; <br /> Where did water go within the building? ❑BASEMENT PERIMETER''BASEMENT NEAR FIXTURES ❑OTHER <br /> Details: (' 117)i i j-0i 3 FLc Z S:OADrJ. L?N F1N 11,-tEfl ReY-- smE.c V. <br /> Site Observations: <br /> Downspout!site grading issues noted: 0e II t Av new) Hem 6r, ivo -ri O y tV. NOOTA <br /> sc'cor , ce,tX'1 b r 1 ) C.rs) 6(DLrr'►1 Tt �=-s��rucr-c oepito. <br /> Building elevation relative to sewer and surrounding area issues noted: <br /> Site pump issues noted: <br /> Historical Information I Other Information: <br /> Previous"flooding"issue Service Requests at address: ki l 6 <br /> Previous"flooding"issues noted by homeowner: MO CjING+8 2c�� <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: /*�1 <br /> Notes: C J'r 71 S) t...1 Y_ P-1 t 1.0c13 OP: G L ni.-! Ft 1 1U ) �.t✓ <br /> IiraPE[ riON, <br /> Revision:3 TRW 1 Thursday,September 05,2013 <br />