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,4„,_ 2013 LARGE STORM RESPONSE PAPER FORM CHECKLIST <br /> Date of inspection: �,��� l 3 Inspected By: f?(i Ail 1 • / /'t /1/1‘l' ' <br /> Address: 0. 0e el-e9 �t'i Service Request Number: <br /> Resident: Owner? ❑YES E1 O �f7. <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 ❑NO (If yes)Was BWV installed through City program Er4S ❑NO <br /> Does the building have a sump pump? ❑YES,NO Does the building have a grinder pump? ❑YES [ NO <br /> Storm Event Details: <br /> Where did water entering building come from? SURFACE FLOW 0 GROUNDWATER 0 SEWER BACKUP-FIXTURES ❑UNKNOWN <br /> Details .1/`-4-¢/c/ // o 7Pl`r77 /-yr" T L•Uf1'7 02, tip 7// % /-iP,-, . <br /> Where did water go within the <br /> ��buildiingg? 0 BASEMENT PERIMETER 0 BASEMENT NEAR FIXTURES ❑OTHER <br /> Details:/ )(014 (v ,° 'l- / C`"� � e, <br /> Site Observations: /J <br /> Downspout/site grading issues noted: (,/)//1 9(,_ bo i,- Pe S l re..„... 0 , <br /> Building elevation relative to sewer and surrounding area issues noted: O /14 077 7 /c-S �giril p L Q/-` ., %/ 'U��l <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:0 YES ❑NO Details: <br /> Notes:r<e41C h DreVAI Rr(A1 V'ay vv C e di grpd( tU s Ta,(M 2 <br /> .41-1 r,0) ,//t k,/, 19 on 57-6 2 Dr k--at i/I )4 ell ,c-fzi.re- 410 ara 4/*1 <br /> If . T 1/ -ot 4t -e41 �3c�'-� -art9-- D(/02-1/N-1 - - - <br /> Revision:3 TRW 1 Thursday,September 05,2013 <br />