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2013 LARGE STORM RESPONSE PAPER FORM CHECKLIST <br /> gir <br /> Date of inspection: ( ((( (/ Inspected By: e Cen DOA <br /> Address: L U I S S eet lr�t ,-r (fit(/-� Service Request Number: <br /> Resident: 0 evtr,di 1=%Le/ Owner? 12I<ES ❑NO <br /> Phone Number: Email: <br /> General Building Details: <br /> td <br /> Is this building within the combined sewer area? ❑YES EtNO Does the building have a basement? EYES ElNO ri- <br /> Does the building have a backwater valve(BWV)? ❑YES n NO (If yes)Was BWV installed ugh City program ❑YES 0 NO <br /> Does the building hav sump pump? ❑YES ❑NO Does the building have a grinder pump? YES ❑NO <br /> A i'f )16c p T3 LI fo S,/,t4crr/ - <br /> Storm Event Details: 'C(C 21 T 1^h S 2oar <br /> Where did water entering building come from? 0 SURFACE FLOW ❑GROUNDWATER 0 SEWER BACKUP-FIXTURES 0 UNKNOWN <br /> Details: r k/`s ,S f'Ceo'e <br /> Where did water go within the building? ElBASEMENT PERIMETER ElBASEMENT NEAR FIXTURES [OTHER <br /> Details:(/TG/w L S?A.L e_ <br /> Site Observations: // // q <br /> Downspout/site grading issues noted: PG t Sao Ye s0 —o V' / ,ok-h_ ?r'io- ( I., 7Z /14! .T4'- trCGn9 o <br /> Ito- I n /`r—n r a F kw.- • <br /> Building elevation relative to sewer and surrounding area issues noted: 4-f44/2.-- cko b' h ? ;/a %e Toe <br /> Site pump issues noted: Ar r- 1 ""? AM 4 4h3 "- / 1" ?1 - ' r 4,/ <br /> Historical Information I 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:❑YES ❑NO f�7ff Details: <br /> Notes: S`7 (p& c I`'fC1 /ACri (4 �3 J�7 Ay / 2/a., ��� d eA - <br /> CY �Er;�-C �,�cll rti ..-PQ ptr <br /> Revision:3 TRW 1 Thursday,September 05,2013 <br />