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2013 LARGE STORM RESPONSE PAPER FORM CHECKLIST <br />/ < �� <br />Date of inspection: � �/ Z 3 Inspected By: ��� bil'-Jla <br />Address: �l S� I �� f� /�/� Service Request Number: <br />c <br />Resident: j��,vl/ — Li ' Owner. ❑ YES 2/NO (L <br />Phone Number: Email: <br />General Building Details: <br />Is this building within the combined sewer area? YES ❑ NO Does the building have a basement? ❑ YES NO <br />Does the building have a backwater valve (BWV)? ❑ YES 2 0 (If yes) Was BWV installed through City program ❑ YES DINO <br />Does the building have a sump pump? ❑ YES NO Does the building have a grinder pump? ❑ YES I -NO <br />Storm Event Details: ,/aAj g44- Q7' rv1Cfi/� 0 AS TIZ216 <br />Where did water entering building come from? SURFACE FLOW ❑ GROUNDWATER ❑ SEWER BACKUP - FIXTURES ❑ UNKNOWN <br />Details: �Q/1� l�t(l�ir► , �/Ol� Dyt b %% D a—d4�/,eell ►, , l am? <br />Where died water go within the building? ❑ BASEMENT PERIMETER ❑ BASEMENT NEAR FIXTURES ❑ OTHER <br />Details: , ��Lfil'1 azd - -C nlrm <br />Site Observations: <br />Downspout / site grading issues noted: // <br />Building elevation relative to sewer and surrounding area issues noted: J Z 1/`�i` 4/ <br />Site pump issues noted: <br />Historical Information 1 Other Information: <br />Previous "flooding" issue Service Requests at address: <br />Previous "flooding" issues noted by homeowner: <br />Recent stormwater / sewer projects completed in area: Proposed stormwater / sewer projects in area: <br />Property owner interested in beginning City Backwater Valve Program at address: El YES �NO Details: <br />I Notes: �G�2%/l pi/� 6 oIL,-;/cm 1� 12 o P�v� Pbs-�T v 'S <br />Revision: 3 TRW <br />1 Thursday, September 05, 2013 <br />