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2013 LARGE STORM RESPONSE PAPER FORM CHECKLIST <br /> 4ETT <br /> Date of inspection: (( /�//? Inspected By: 4)r� Doff/A' <br /> Address: 2-g 67 1740kt_11" -e Service Request Number: <br /> Resident: Owner? ❑YES ❑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? S ❑NO <br /> Does the building have a backwater valve(BWV)? ❑YES EiNO (If yes)Was BWV installed through City program ❑YES ❑NO / <br /> Does the building have a sump pump? ❑YES 'NO Does the building have a grinder pump? ❑YES 1;1'40 <br /> Storm Event Details: <br /> Where did water entering building come from? SURFACE FLOW ❑GROUNDWATER ❑SEWER BACKUP-FIXTURES ❑UNKNOWN <br /> Details: %'---5--- `7Z/' 44/a i, h Qi 4 fl 1 S A,j h S J c I/i/o S--fir-ti <br /> Where did water go within the building? [ ASEMENT PERIMETER BASEMENT NEAR FIXTURES ❑OTHER <br /> Details: [ `/t/S � / A.Cri't— . <br /> Site Observations: <br /> Downspout/site grading issues noted: le- D I Gym . ?b s --e/h ��— ✓ Z! l 1A—ek elevation relative to sewer and surrounding area issues noted: iat, <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 I sewer projects completed in area: Proposed stormwater/sewer projects in�v®area: <br /> Property owner interested in beginning City Backwater Valve Program at address:0 YES ❑NO Details: ,/ 7 )'L.SLQdPd1 <br /> Notes: <br /> Revision:3 TRW 1 Thursday,September 05,2013 <br />