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2013 LARGE STORM RESPONSE PAPER FORM CHECKLIST
<br /> 471277
<br /> Date of inspection: c(—I '7i—j '.1 j ' b c) iPrv1 Inspected By: f/t 44K 00 u CET T,i 4 1 i,-,, ,#,Q2tcftat,,-1
<br /> Address: :Z I S Hot /`lvt . Service Request Number:,L ,v E.-
<br /> Resident: kAN,-.1 OA y Owner? 'YES ❑ NO
<br /> Phone Number: L{dS—34 -- -3a'17 Email:
<br /> General Building Details:
<br /> Is this building within the combined sewer area? ❑YES IJ NO Does the building have a basement? ''ES ❑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? ❑YES <O Does the building have a grinder pump? ❑YES ❑.fQO
<br /> Storm Event Details:
<br /> Where did water entering building come from? g<URFACE FLOW ❑GROUNDWATER ❑SEWER BACKUP-FIXTURES ❑UNKNOWN
<br /> Details: C fton2 5A,,p 60-1;t2s 6se2F►DwtO 0v—o Mctc PA1,'J
<br /> Where did water go within the building? 'ASEMENT PERIMETER ❑BASEMENT NEAR FIXTURES EKITHER
<br /> Details: ?)R>Er.t/i i,vc\.OD`f.A'S fDRvcA.S C16s>:- e Ld,,0oo.C•i,e00•--►
<br /> Site Observations:
<br /> Downspout I site grading issues noted: Lnle/L AC A P a SA..)S 0/S Ate. £ A j Lf'esc-,-✓r,p
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<br /> Building elevation relative to sewer and surrounding area issues noted: F.Lc:vA—iit,A, p',.. ti J20'1. Z bAt0t4jA y
<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: Pmen Service Igf98 Nt•T 5l✓44' ?' }tt:II-v CMJ,Ne
<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—/vik Details:
<br /> Notes: 13ivsg(4(u PA A 1.o se✓ c_tiA,,,oLL , Gvs4 op, Ih pc,eS /LGs- Kam...; ,,,,L„Lr Laj,i le/2 CAw.b $'/2oI' .
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<br /> Revision:3 TRW 1 Thursday,September 05, 2013 `
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