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• <br /> 2013 LARGE STORM RESPONSE PAPER FORM CHECKLIST <br /> Date of inspection: (V( 1 �` Inspected By:(77 " De:30/4h <br /> Address: 3 ( a'(, /76a,P`_ i Service Request Number: <br /> Resident: Owner? ❑YES ❑NO <br /> Phone Number: Email: <br /> General Building Details: 1.)cA/ /;4 eG,�� <br /> Is this building within the combined sewer area? YES 0 NO Does the building have a basement? YES ❑NO f'4SiG<P <br /> Does the building have a backwater valve(BWV)? 0 YES NO (If yes)Was BWV installed through City program >r<_1\10ff,l, <br /> Does the building have a sump pump? 0 YES 12(N-0 Does the building have a grinder pump? 0 YES 2f1-0 <br /> Storm Event Details: <br /> Where did water entering building come from? SURFACE FLOW ❑GROUNDWATER ❑SEWER BACKUP-FIXTURES ❑UNKNOWN <br /> Details: n1 c I GC G-eyUP) l-gvi 641 liC,xt-Aae' <br /> Where did water go within the building? BASEMENT PERIMETER [�ASEMENT NEAR FIXTURES 0 OTHER <br /> Details: J r PGA% 0 IL 11 — LJ4e 11-2-71l <br /> Site Observations: /_^ / L !�� <br /> Downspout/site grading issues noted: ,�l G �i/ (i1 S��7 (�jG�,'P-CT ��/�/G r� c) 6 Y <br /> Building elevation relative to sewer and surrounding(area issues noted: [e'l/s-¢-vim 7 /` <br /> Site pump issues noted: <br /> Historical Information I Other Information: <br /> Previous"flooding"issue Service Requests at address: <br /> Previous"flooding"issues noted by homeowner: <br /> Recent stormwater I 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: /VG T,/V-Q Q 2 <br /> r� /t d <br /> Notes: r/f t� G,yl a'S7h4� Y�iS f A-4 6Yt 14r ;4 I/1-4 ��� c n <br /> ` 1 Arbr dda6 A See&tat C CS <br /> Revision:3 TRW 1 Thursday,September 05, 2013 <br />