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2013 LARGE STORM RESPONSE PAPER FORM CHECKLIST <br /> '4/4OY.-1 <br /> ar <br /> Date of inspection: VC( l 3 Inspected By: pr! %iin Doa (Gtin <br /> Address: ga 2-I iA 4 r Service Request Number: <br /> Resident: f j _by) S. Owner? 2KES ❑NO <br /> Phone Number: 4 2-s" 9--S5 13 SAS Email: <br /> General Building Details: <br /> Is this building within the combined sewer area? ❑YES 12 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 ❑YES ❑ 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 ❑GROUNDWATER ❑SEWER BACKUP-FIXTURES ❑UNKNOWN <br /> Details:ridM )143 0 1/'n lr✓t S / t. 4e#L //Alai(Pl i'i?1-e) <br /> Where did water go within the building? ❑BASEMENT PERIMETER ❑ BASEMENT NEAR FIXTURES ❑OTHER <br /> Details: <br /> Site Observations: <br /> Downspout/site grading issues noted: <br /> Building elevation relative to sewer and surrounding area issues noted: <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: ❑YES ❑ NO Details: <br /> Notes: Pliti-ek (�h 14- -- A 2- &�1`Gc- .- e- <br /> Revision: 3 TRW 1 Thursday,September 05,2013 <br />