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2013 LARGE STORM RESPONSE PAPER FORM CHECKLIST <br /> 4:77. <br /> Date of inspection: l'OO —I°30 Inspected By: pt#arc.I . 'Cart / I n "40{-1,f- <br /> Address:a Lv Oa_ Service Request Number: c5 o i a et o y <br /> Resident: 9r)oq P_ 6A- Owner? ❑YES ❑NO <br /> Phone Number: CO 5— `tc-1-3-01 1 Email: <br /> General Building Details: <br /> Is this buildingwithin the combined sewer area? ES ❑NO Does the buildinghave a basement? ❑YES ❑'IVO <br /> Does the building have a backwater valve(BWV)? ❑YES Li (If yes)Was BWV installed through City program ❑YES ❑ NO <br /> Does the building have a sump pump? ❑YES Does the building have a grinder pump? ❑YES 0 NO— <br /> Storm Event Details: <br /> Where did water entering building come from? ❑SURFACE FLOW ❑GROUNDWATER SEWER BACKUP-FIXTURES ❑UNKNOWN <br /> Details: GAS UP t'A) +1o0K Of.,' iv `',ws(of ,, "Tot",el- (,c i'- PIO t`tIt00 k <br /> Where did water go within the building? ❑ BASEMENT PERIMETER ASEMENT NEAR FIXTURES ❑OTHER <br /> Details: ttoogia n�fz+. e t�t-kt it he-eels,4 y KeiPl 46to CAICpk" D-PS ritb.o*ISA! <br /> Site Observations: <br /> SIACANV\ a S Se( <br /> Downspout/site grading issues noted: <br /> toad it a"- cur <br /> Building elevation relative to sewer and surro <br /> Site pump issues noted: _ �Q i,,c Y'AtO I" <br /> Historical Information I Other Information: �V�� <br /> Previous"flooding"issue Service Requests a <br /> Previous"flooding"issues noted by homeowr, I<ti.aLJ/(1=p8 k <br /> Recent stormwater/sewer projects complete :wer projects in area: <br /> Property owner interested in beginning City ra!vc oureUTFCR aoUlcs5—M T CO uwcr Details: <br /> Notes: CA"1 a 60-t+1 /S l/io."..i /l4.4 Fcoo.oe A ()F'(',c.Y / rus-cwtert 19)04cc (—A/c/2c <br /> c Arte - ip -C-tbOY. A<-'A i A) 1/V I Iri AAl/ ;NCO, cL^J 1 Alt <br /> Revision: 3 TRW 1 Thursday,September 05, 2013 <br />