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2013 LARGE STORM RESPONSE PAPER FORM CHECKLIST <br /> Date of inspection: III 1'I / 2C)I'_� cxj ',( )�PfYI Inspected By:.nr--i►v,e_Q/ ( l A21L4-I.AVY) <br /> Address: `Lg°Z) OP t) Service Request Number: / 3('-- �Q <br /> Resident: 15 Owner? ❑YES NO <br /> Phone Number: ((ZOO 2 9 act 2p) 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 NO (If yes)Was BWV installed through City program ❑YES ❑NO <br /> Does the building have a sump pump? ❑YES StNO Does the building have a grinder pump? ❑YES'YES IRINO <br /> Storm Event Details: <br /> Where did water entering building come from? ❑SURFACE FLOW ❑GROUNDWATER XSEWER BACKUP-FIXTURES ❑UNKNOWN <br /> Details: ' -Dpc o P 'i�lQ e9�t--j f Y)U l,-i""i 'j�-iPr7c..)(e -tic 5`i <br /> 2Gm PNYC) A C-ooPc 6 SI N tC <br /> Where did water go within the building? ❑BASEMENT PERIMETER ❑BASEMENT NEAR FIXTURES MOTHER <br /> Details: 115 <br /> 1 <br /> ansro fie, cDp4.Le u rx AN30 cA.7Q-1-0(reg ow it .. <br /> Site Observations: <br /> Downspout/site grading issues noted: ---- <br /> Building elevation relative to sewer and surrounding area issues noted:` uf-x& .-, (:;Pact r"t7 Ae,cjac G, .)C-42 rYtArkI <br /> Site pump issues noted: <br /> Historical Information I Other Information: <br /> Previous"flooding"issue Service Requests at address: Ni cv.,Nr� <br /> Previous"flooding"issues noted by homeowner: /V Ivor. <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: ❑YES ❑ NO Details: <br /> Notes: <br /> € c cr() i y-y)m EQ v r >I l� 't � /-4 p() racy, <br /> P2t7Ct-Gff Cti c t_a j1 C'A. <br /> Revision: 3 TRW 1 Thursday,September 05, 2013 <br />