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0 2013 LARGE STORM RESPONSE PAPER FORM CHECKLIST <br /> Date of inspection: /6/// 3 Inspected By: L rt <br /> Address: 6"l al vvz el Service Request Number: <br /> Resident: /""' 6 444 / 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 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? ❑YES0� <br /> Storm Event Details: <br /> Where did water entering building come from? ElSURFACE FLOW�❑GROUNDWATER Er SEWER BACKUP-FIXTURES ❑ UNKNOWN <br /> Details: VV1& rA�ft ' prG�i�- o6 `► • it c( " 5‘\ A.-1:Nil <br /> Where did water go within tk building? ❑ BASEMENT PERIMETER Di BASEMENT NEA FIXTURES I-0T'FIER 7 ci <br /> Details: 7144 40C l d oei/c �` <br /> t. <br /> Site Observations: hs�<c-13" 041:-C ce. .- <br /> -44 <br /> Downspout/site grading issues noted: — f'i Gfre,,PIA--- 41.-- 44- <br /> g'(---- <br /> Building elevation relative to sewer an surrounding area issues noted: 7 e-a `"i ecc g Gcdcd <br /> Site pump issues noted: Oz-.A- -- <br /> Historical Information I Other Information: r <br /> Previous"flooding"issue Service Requests at address: 2 1 t c _ f <br /> Previous"flooding"issues noted by homeowner: We 1 4--c: 1,.."..`'- <br /> Recent stormwater/sewer projects completed in area: fr <br /> Proposed stormwater/sewer projects' . <br /> Property owner interested in beginning City Backwater Valve Program at address: ❑YES ❑NO Det 'Is: TOO <br /> Notes: ` e%7i43lna1/4,v-e_..5 fYida_.. f L-"' <br /> Revision: 3 TRW 1 Thursday, September 05,2013 <br />