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2013 LARGE STORM RESPONSE PAPER FORM CHECKLIST <br /> #110/,C1 <br /> ar <br /> Date of inspection: et-/a- /,'OO—!'30 Inspected By: i-m2ic.,OoX %i' e4.00141 <br /> Address: ak:r12, /4 Z .,v-e V ; t ' c2 Service Request Number: c7 c i a t 0 9 <br /> Resident: OD o(3 fLA j 6A Owner? ❑YES ❑ NO <br /> Phone Number: Cid.5�- `'� `F�-!-3�1 1 Email: <br /> • <br /> General Building Details: <br /> Is this buildingwithin the combined sewer area? ES ❑NO Does the buildinghave a basement? ❑YES [VIVO <br /> Does the building have a backwater valve(BWV)? ❑YES (If yes)Was BWV installed through City program ❑YES ❑NO <br /> Does the building have a sump pump? ❑YES LTNr 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: CAtt Jf i;A) j'tob/& /J2tk°°A) l Sin Du '/(/ tbt'le-F Gott, PA <br /> Where did water go within the building? ❑ BASEMENT PERIMETER ASEMENT NEAR FIXTURES ❑OTHER <br /> Details: gkoo u elo �,��.`�e CI✓-kt ,1 tkc es..0 Re P l t6 C_& L Pk"i) D-AcJ $(bov ego Pfis.ic AA/ <br /> Site Observations: <br /> Downspout/site grading issues noted: 6L' -TO 6/20t?,u <br /> Building elevation relative to sewer and surrounding area issues noted: <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: 60 a. a 9,nociv-- ark 1- TO tki S 1( ....rx.)lt <br /> Recent stormwater/sewer projects completed in area: Propo ed stormwater/sewer projects in area: <br /> Property owner interested in beginning City Backwater Valve Program at address: YES ❑ NO Details: <br /> Notes: CAti � a c1H A {itow++,j /1,i..4 Fcoo.° /J OfF,c Y / ,cIx erc ("fi4ct e.a�(e i <br /> c arti e v f, -ftbokc -A;&A;Ai ,/1) f i 2C4- ,6Ay AIF NCO-- A/ 4 <br /> Revision: 3 TRW 1 Thursday,September 05,2013 <br />