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2013 LARGE STORM RESPONSE PAPER FORM CHECKLIST <br /> Date of inspection: 4 Oc DTI Inspected By: Kt 6Vz t77. t e' k-kAm.w <br /> Address: S122— Sour.I> Avi- Service Request Number: 51~D o 12 D4 <br /> Resident: T AtJtF:,L_ 4 A2w Owner? OYES ❑ NO <br /> Phone Number: 1-17-6-. Sl3. 2 '47_ Email: DPrt It . 1-11:02wtz t Lro(V1C4'1 . AAT <br /> General Building Details: <br /> Is this building within the combined sewer area? ❑YES ❑ NO Does the building have a basement? El 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: 12.ta1Jocc• F-flc v STf 'vv( 'Date N.UJ_ lhS Firzai D2ivre- 4 li ib flAS +n,tia->f <br /> Where did water go within the building? ❑ BASEMENT PERIMETER ❑ BASEMENT NEAR FIXTURES [ETHER <br /> Details: LAWFPa_ LiuJViL. (° _. ,,. -FX I"-MLA-G <br /> Site Observations: <br /> Downspout/site grading issues noted:_ChUAL.7tt.1 L-t t%J l LLL t J J T7- 911 Dun OF 624t t <br /> Building elevation relative to sewer and surrounding area issues noted: <br /> Site pump issues noted: <br /> Historical Information I Other Information: <br /> Previous"flooding"issue Service Requests at address: tit U <br /> Previous"flooding"issues noted by homeowner:• 17--4FAivs Mot.) 6Avvt&- 1S5t1fy c_cr-c tt Th.I. D D Pukt_i`Lt7 <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: T-LooO►tJl w\ fn uv". ,TV-WST `xr(Lf ( Fz Gt,Dtni <br /> v►J -talc D + 1 C t(-L P t 3 T/34%. FrinWk pW <br /> Revision: 3 TRW 1 Monday,September 09,2013 <br />