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2013 LARGE STORM RESPONSE PAPER FORM CHECKLIST tg;? Date of inspection: Zlo Pr 4'1 CC.- 2- 13 Inspected By: ki l t .S TY ba77- E.-/.)AUG ±o Address: 5l IPF_ _$L_ 1t . Service Request Number: 12 !,D t Z31`S" T Resident: J Pc-k)IGtz_ t zi -i t��Z-Sor. Owner? �ES ❑NO Phone Number: 4Zc. '553. $43 Email: _3 Prt.1tU72-c2-OS3aca. V prl-h . C oAA General Building Details: Is this building within the combined sewer area? ❑YES ❑ NO Does the building have a basement? ❑YES ❑NO Does the building have a backwater valve(BWV)? ❑YES ❑ NO (If yes)Was BWV installed through City program ❑YES ❑ NO Does the building have a sump pump? ❑YES ❑ NO Does the building have a grinder pump? ❑YES ❑NO Storm Event Details: Where did water entering building come from? SURFACE FLOW ElGROUNDWATER ❑SEWER BACKUP-FIXTURES ElUNKNOWN Details: tM t4 AA-emt d 5 lL) al ritAfFn 4 2A-I3 I IJco 'pity E„ l RD u sue. Where did water go within the building? ❑ BASEMENT PERIMETER ❑ BASEMENT NEAR FIXTURES OTHER Details: WA i Q__ ei DID �eJILF�f1. T�P 6/VOA-CD-re--- Site Observations: Downspout/site grading issues noted: Sl Tt; Tb M ouSi_ oeuhUSPOU S . vn 12DincS m Df -o _- Building elevation relative to sewer and surrounding area issues noted: Lac FLIk( - F R-U.ot,J Site pump issues noted: Historical Information/Other Information: Previous"flooding"issue Service Requests at address: '1 SAS CO 1139q 3 D D 0 231:319-1`/ OD 9-y 3(o t Previous"flooding"issues noted by homeowner: v - Recent stormwater/sewer projects completed in area: Proposed stormwater/sewer projects in area: Property owner interested in beginning City Backwater Valve Program at address:❑YES ❑NO Details: Notes: Loup rglfisWS 1.1) 1 t.4T DP N-OuS 4, IkIZnSc srart OD D Po,Jt r Ito 4, fizSAI'rt-b. tikiro 1f.z v - 4 I tvro C..enJt _TRD L-A-1 -t.,a_ 1.S PA-4lti tAt ` uc3& Revision: 3 TRW 1 Monday, September 09,2013