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2013 LARGE STORM RESPONSE PAPER FORM CHECKLIST <br /> j� <br /> Date of inspection: F/3 6//3 Inspected By: f?(7`ayi 10 (JO h <br /> Address: 4E0 6 ‘-eot n 41/ s Service Request Number: 00 ( 2-2-" 1 <br /> Resident: / ►tqi ft O( ? r +[a Owner? YES In NO <br /> J Phone Number: 49- - 2 1o4 t Email: <br /> General Building Details: <br /> Is this building within the combined sewer area? In YES 2 ) Does the building have a basement? ❑YES 12 NO <br /> Does the building have a backwater valve(BWV)? ❑YES 3 NO (If yes)Was BWV installed through City program In YES NO <br /> Does the building have a sump pump? in YES 0‘ Does the building have a grinder pump? ❑YES CIO <br /> Storm Event Details: <br /> Where did water entering building come from? ErLFACE FLOW ❑GROUNDWATER ❑.SEWER BACKUP-FIXTURES ❑ UNKNOWN <br /> Details: DI T C� �i��i l t l� [J Gs.( / 1/ d, n.ohe 1s 1- (4 13C,e.n b-,' p (-Zeviel � <br /> Where did water go within the building? In BASEMENT PERIMETER ❑BASEMENT NEAR FIXTURESETHER <br /> Details: giVi et/Mokor 'Y'G' )w.'V-e et??rim C4!!ed L c p - <br /> Site Observations: c� / <br /> Downspout/site grading issues noted: J k �/2 l LS S-t(/t'tcn r ta/en <br /> Building elevation relative to sewer and surrounding area issues noted: Va'1r-di ►`S S i^-t0-- e- V4 A4 C1 ,. <br /> Site pump issues noted: <br /> Historical Information I Other Information: l� <br /> Previous"flooding"issue Service Requests at address: �� (`e//t-ei <br /> 9by `'t ?� 1: ✓�U(, S V-4'6. - ,D ��8 Qom. <br /> Previous"flooding" noted homeowner: <br /> p4te- 4s ( b �� 1 p { <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 In NO / (01 Details: <br /> Notes: 1i ( f<,�I l )1 1) F CrT'1/ (e s poYa g ft/Ak. €a- tod <br /> praALe.74- <br /> Revision: 3 TRW 1 Thursday,September 05, 2013 <br />