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2013 LARGE STORM RESPONSE PAPER FORM CHECKLIST <br /> 4-77. <br /> Date of inspection: q(I <br /> 1�� ein/ 3 Inspected By: � �ii�1 Do ( • <br /> Address: -�"�`i t Pik/ Service Request Number: <br /> Resident: Owner? 'ES ❑NO <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 ha a b kwater valve(BWV)? ❑YES ❑ (If yes)Was BWV i tall through City program ❑YES ❑N <br /> Does the building have s pump? ❑YES El Does the buildin ave rinder pump? ❑YES ❑NO <br /> f7. <br /> Storm Event DetpIs: <br /> Where did water entering building come from? SURFACE FLOW ❑GROUNDWATER 0 SEWER BACKUP-FIXTURES ❑UNKNOWN <br /> Details: 1 o fid._ fl�� <br /> Where did water go within the building? BASEMENT PERIMETER ASEMENT NEAR FIXTURES ❑OTHER <br /> Details: <br /> Site Observations: TT <br /> Downspout/site grading issues noted: (J lc- GD,f/c,, feli - <br /> 1 <br /> Building elevation relative to sewer and surrounding area issues noted: 1//1/V <br /> Site pump issues noted: <br /> Historical Information!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:CIYES ❑NO Details: <br /> f Notes: V �i -1-4 4 ? a/6 ! �P ,�- �i''7 //� d7 A4 9D <br /> Revision:3 TRW 1 Thursday,September 05,2013 <br />