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2013 LARGE STORM RESPONSE PAPER FORM. CHECKLIST <br /> #11144%/*/-1‘ <br /> ar <br /> 6 Piny, <br /> Date of inspection:9/IT1)?c)is Inspected By:-3-e Ee f MAP k -t y n <br /> Address: 2s 2c3 (x�a Service Request Number: 1Jc <br /> Resident: ( te, T 26 -.(57,&i i" -C i�1-r Owner?BYES ❑ NO <br /> Phone Number: (L-12.. ) 1 (-5531 1 Email: `6G 't.-t't ®C 'C'YIC-T:cov✓n <br /> L4-12. ) u22.- 3 -J 3 <br /> General Building Details: <br /> Is this building within the combined sewer area? 12f YES ❑NO Does the building have a basement? YES ❑ NO <br /> Does the building have a backwater valve(BWV)? ❑YES I'NO (If yes)Was BWV installed through City program ❑YES ❑ NO <br /> Does the building have a sump pump? JT YES ❑NO Does the building have a grinder pump? ,YES' NO <br /> Storm Event Details: <br /> Where did water entering building come from? g SURFACE FLOW ❑GROUNDWATER ❑SEWER BACKUP-FIXTURES ❑UNKNOWN <br /> Details: i r Q I,' l Is_-1"O 1i- O 1-f Inc x 1- r.JA.i.t . <' L i--t. i N3 'ra,�N I <br /> 01--rt Li•-h06 ovctL rc.wc,J►nXo 0 UcLW 'CAWSdJt' <br /> Where did water go within the building? BASEMENT PERIMETER ❑ BASEMENT NEAR FIXTURES ❑OTHER <br /> Details: 3h-1 r- 'Y i br5' P. f 1 i ig DEPTI-) <br /> of p Z" <br /> Site Observations: <br /> Downspout/site grading issues noted: 1)©rJ� <br /> Building elevation relative to sewer and surrounding area issues noted: <br /> Site pump issues noted: Su to aNi\-Yr )rY1 I/•' at L O) GI-sc x V41I_Vr -, <br /> 33 Foto Cri©N+I\ b 22OPC't„) o eomx.."ro <br /> Historical Information I Other Information: <br /> Previous"flooding"issue Service Requests at address: i J o/0e <br /> Previous"flooding"issues noted by homeowner: Zt_ �/ taco, <br /> C� ���w <br /> moon) i�(2f a __ rr� Febnf;' ( iv ceev' -1 At a ' /0 '/6A ` , <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 addressYES l (NO Details: <br /> Notes: ' _ Tt7 xT cvi m.i <br /> OP N 0 , -1 -Ll`J <br /> LAPC-i--i.C) -i r-c®cy CIrc t ,i ,xr.r Iry 1c. -ara o,.�� c7c c,cxzego t '3 't e : 46 PM <br /> Revision: 3 TRW 1 Monday,September 09, 2013 <br />