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2013 LARGE STORM RESPONSE PAPER FORM CHECKLIST <br /> Date of inspection:(/1/ / / Inspected By:frze2,1 Cal--(40.1 <br /> Address: ds--- CAK- Service Request Number: <br /> Resident: P•0-66(1 Owner? E1 YES ❑NO <br /> Phone Number: Email: <br /> General Building Details: <br /> . <br /> Is this building within the combined sewer area? ❑YES 0 Does the building have a basement? ❑YES Er 0 <br /> Does the building have a ckwa valve(BWV)? ❑YES ❑NO (If yes s BWV installed through Cit ogram ❑YES ❑ NO <br /> Does the building have a su p p ? ❑YES ❑ NO Does the building have a r er pump. S ❑ NO <br /> Storm Event Details: <br /> Where did water entering building come from? SURFACE FLOW ❑GROUNDWATER El SEWER BACKUP-FIXTURES ❑UNKNOWN <br /> Details: v-G.,/ roKt rm./ (/x�4L <br /> Where did water go within the building? ❑ BASEMENT PERIMETER CI BASEMENT NEAR FIXTURES ❑OTHER <br /> Details7 1/'(,t„4 5G'Y /` /"4,941— la/lAv"1t (-//./I,04O -' <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 I Other Information: <br /> Previous"flooding"issue Service Requests at address: I _ <br /> Previous"flooding"issues noted by homeowner: /s'C� f ( Ur L �5 ��A 7- C O/N . - Pe la LL-- <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: ❑Y ❑ NO ,1 etails: <br /> Notes:COS on d ST/ <br /> 4s?i,i40 -(i? Ciotti- Q- <br /> Revision: 3 TRW 1 Thursday,September 05,2013 <br />