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2013 LARGE STORM RESPONSE PAPER FORM CHECKLIST <br /> Date of inspection: 1(�( ��/ � 1�,� Inspected By: G S DOD 4i4't <br /> Address: ,) � 2-.Z S 01,!(p, 41/L.- Service Request Number: <br /> Resident: f:. OM Owner? 'ES ❑NO <br /> Phone Number:LF C1r3 . - Email: <br /> General Building Details: <br /> Is this building within the combined sewer area? ❑YES l21 NO Does the building have a basement? ZYES ❑NO <br /> Does the building have a backwater valve(BWV)? ❑YES 12K0 (If yes)Was BWV installed t��hroug` ityprogram El YES El NO <br /> Does the building I ye a sump pump? ❑YES 0 NO Does the building have a grirl r pump? 0 YES El NO <br /> Storm Event Details: /�� <br /> Where did water entering building come from? 12111RFACE FLOW ❑GROUNDWATER ❑ISEWER BACKUP-FIXTURES ❑UNKNOWN <br /> Details: �//�nd %'& i V f,P.S 4 �� G✓L /I1L S [ /415in . 2 . <br /> Where did water go within the building? ❑BA/SSEMENT PERIMETER .'BASEMENT NEAR FIXTURES ❑OTHER <br /> Details: V 4 A Gt 1 4 ,-r! p. 4/l/- v.i-A eii 414..2 r <br /> Site Observations: �+' l_ .• / / J <br /> Downspout/site grading issues noted: V i, - c )ves OVA .45?A G/r r 1 7 (ck^&'l/Vim— i4 / j)A de. <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: NiProperty owner interested in beginning City Backwater Valve Program at address: ►�. ' / NO Details: A <br /> Notes: (1 ` 1 14/40A4 !i Wahl Ct 1L k.A ee-- kjA 0 Yl (04, <br /> ejf ,ppf n <br /> Revision:3 TRW 1 Thursday,September 05, 2013 <br />