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2013 LARGE STORM RESPONSE PAPER FORM CHECKLIST <br /> 477" <br /> Date of inspection: q ! 6(I,) Inspected By: lD�/Gfs� oo I , ( 1 /?t2L--Address: /0 -it�,wt Service Request Number: <br /> Resident: ID1 4 GG Z Q n Owner? DYES ❑NO <br /> Phone Number: Email: C.44" (0L e itndt e -�G•'� <br /> General Building Details: <br /> Is this building within the combined sewer area? EcES ❑NO Does the building have a basement? DIES ❑NO F 7 A <br /> IDS f1 (? �ekAAda fa <br /> Does the building have a backwater valve(BWV)? ZYES ❑NO (If yes)Was BWV installed through City program IFFYES ❑NO <br /> CatSrrr <br /> Does the building have a sump pump? 0 YES IQ NO Does the building have a grinder pump? ❑YES 106 pry bl t -L <br /> Storm Event Details: <br /> Where did water entering building come from? ❑SURFACE FLOW ❑GROUNDWATER SEWER BACKUP-FIXTURES ❑UNKNOWN <br /> Details: (4 / 1r0i4-6I, �/>i L 2 r 92 (Ti"/-4 ) <br /> Where did water go within the building? agASEMENT PERIMETER [a'BASEMENT NEAR FIXTURES ❑OTHER <br /> Details: c6//6"-b r `Sf-4r1 -tac.ro O.)P (1,t' -rp &t 97 o t " 13 <br /> Site Observations: <br /> Downspout/site grading issues noted: Ar0 L oht-P. _/ -e- t S.e k,R� <br /> Building elevation relative to sewer and surrounding area issues noted: IS 41. V" ° ' i S S <br /> Site pump issues noted: A V7A <br /> Historical Information I Other Information: <br /> Previous"flooding"issue Service Requests at address:y <br /> Previous"flooding"issues noted by homeowner: �rkr,ns S Q Iv evd S'frkLr/avt y - 9-6V e, 11I0 ls( <br /> Recent stormwater/sewer projects completed in area: V- 21968 Proposed stormwater/sewer projects in area: <br /> Property owner interested in beginning City Backwater Valve Program at address:❑YES ❑NO Details: <br /> Notes: (T(G4-0--- 1`S do ).0 fooh <br /> ne-4.G,ts <br /> km41— . 0/1 72 0 f1 - / Lv-V I`s es? 4b1‘2__ <br /> Revision:3 TRW 1 Thursday,September 05,2013 <br />