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2013 LARGE STORM RESPONSE PAPER FORM CHECKLIST <br /> #114*/NE-ii <br /> Date of inspection: Q 'S > / ! Inspected By: Gm-a- <br /> Address: /9 6 2— Yrd 74-LAQ--- Service Request Number: <br /> Resident: i i idbir ®i-u Owner? ❑YES ❑NO <br /> Phone Number: 9 b `7 -- !O Email: /1 IU pies SYtI&L4JJ Gi1 k <br /> General Building Details: <br /> Is this building within the combined sewer area? E'YES ❑ NO Does the building have a basement?,g YES ❑NO <br /> Does the building have a backwater valve(BWV)? ❑YES c'NO (If yes)Was BWV installed through City program El YES I]NO <br /> Does the building have a sump pump? 12 YES ❑NO Does the building have a grinder pump? Cl YES NO <br /> Storm Event Details: <br /> Where did water entering building come from? ❑SURFACE FLOW ❑GROUNDWATER%SEWER BACKU <br /> P-FIXTURESI ❑ UNKNOWN <br /> Details: -t VN CO v�"N t L�cD r f ti, c c>` k \ f��(�'J�C 1 i.Ns c .�� CT/ t t i'— . '�i <br /> Where did water go within the building? IX1 BASEMENT PERIMETER [.BASEMENT NEAR FIXTURES ❑OTHER <br /> Details: (Pv-.&C_\ 2- iee �.eep Cov) Iovei'' \eve4 <br /> Site Observations: `A 461- <br /> 1l C6 n\ fides <br /> Downspout/site grading issues noted: Do'�)C0 j 1 CO r e� e • 5 L 5 io fed TJw L t rOJ � <br /> Building elevation relative to sewer and surrounding area issues noted: "`Fe"44 be to r0‘,) 5413 e' <br /> ,c,kJej <br /> Site pump issues noted: t-.0 - Se--e," <br /> Historical Information I Other Information: <br /> Previous"flooding"issue Service Requests at address: <br /> Previous"flooding"issues noted by homeowner: 6v^A S eC 20) 0 6-o `c i St^Ce- Le.^) <br /> Recent stormwater/sewer projects completed in area: ��6 ` c ) Proposed stormwater/sewer projects in area: MO <br /> Property owner interested in beginning City Backwater Valve Program��jj at address,°]YES El NO Details: U 1 <br /> Notes: 0 L r C��J G,s . ?(c re �`1 1 Q SC?CO A i eA '1 ou <br /> Revision: 3 TRW 1 Thursday,September 05, 2013 <br />