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2013 LARGE STORM RESPONSE PAPER FORM CHECKLIST <br /> #1111;::‘ <br /> Date of inspection: 5 l e/7 Inspected By: "3 eV/7e,-- <br /> Address: Zo Service Request Number: <br /> Resident: L2Owner? LaS'ES ❑NO <br /> Phone Number: Email: <br /> General Building Details: <br /> Is this building within the combined sewer area? YES Does the building have a basement? ES ❑ NO <br /> Does the building have a backwater valve(BWV)? YES ❑NO f yes)Was BWV installed through City program § El NO <br /> Does the building have a sump pump? RS ❑ NO Does the building have a grinder pump? ❑YES L-kO <br /> Storm Event Details: <br /> Where did water entering building come from? la<RFACE FLOW ❑GROUNDWATER El SEWER BACKUP-FIXTURES El UNKNOWN <br /> Details: <br /> Where did water go within the building? ❑ BASEMENT PERIMETER ❑BASEMENT NEAR FIXTURES ❑'tSTHERl �Cf <br /> , L, b� C <br /> Details: ® <br /> Site Observations: ��/w difaA� �� G � 6 <br /> Downspout/site grading issues noted: <br /> Building elevation relative to sewer and surrounding area issues noted: <br /> Site pump issues noted: &c- /411/ .2 GSA <br /> Historical Information/Other Information: Oce Ctiv4+r C <br /> f-lam <br /> Previous"flooding"issue Service Requests at address: <br /> Previous"flooding"issues noted by homeowner: �'1!✓L-'" <br /> Recent stormwater/sewer projects completed in area:GwIA- i Proposed stormwater/sewer projects in area: <br /> Property owner interested in beginning City Backwater Valve Program at address: f❑YES ❑NO Details: <br /> Notes: ei_w`iLU"" C/kikte 1,D ,p P,ti✓'urLix-dc ✓ wa-eo- . f-cp-14-e- <br /> IA'dt,Avvcti. _34 161A KA) ( a vv\ <br /> g � JVP <br /> Revision: TRW 1 Thursday,September 05,2013 <br />