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2013 LARGE STORM RESPONSE PAPER FORM CHECKLIST <br /> av <br /> Date of inspection: 9 ks/&DI? Inspected By: � ? <br /> Address: De. Service Request Number: €, 2 Q01 e5663 <br /> Resident: J ae l/)r 0i t Owner? EYES ❑ NO <br /> Phone Number: ( - g ) Email: <br /> General Building Details: <br /> Is this building within the combined sewer area? ❑YES [ j NO Does the building have a basement? WYES ❑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?EYES ❑ NO Does the building have a grinder pump? ❑YES UrNO <br /> Storm Event Details: <br /> Where did water entering building come from? ►_+ SURFACE FLOW ❑GROUNDWATER ❑SEWER BACKUP-FIXTURES ❑ UNKNOWN <br /> Details: C....,,r r � �� -T4-L®nc I �- �-��7 i 7nr Alv�l C]f7l�x==�,`),✓��/ I/UT Z� <br /> Where did water go within the building?jgr BASEMENT PERIMETER ❑BASEMENT NEAR FIXTURES ❑OTHER <br /> Details: C .-F't"19 L \J L X1XX2ox eoo -ti r ��AP <br /> Site Observations: <br /> Downspout/site grading issues noted: ta.)p i )zPa_71— tG O ) <br /> Building elevation relative to sewer and surrounding area issues noted:Suudousib IA),E,_t, 664..c1.0 <br /> Site pump issues noted: j Dcy-) _ <br /> Historical Information I Other Information: <br /> Previous"flooding"issue Service Requests at address: J .3C .j g- <br /> Previous"flooding"issues noted by homeowner: niIr xT FLnDob YEAS _ <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: IVt-3 <a,pia c -rti-f C.JA-re - IZt )t3 (2)F /L J <br /> C ra,.f0 DC2par\) L-i ry r., c UD(0P.ADeD 1 1D <br /> ci_nroopI 6 1-110--uoQ. 17)6nr s> <br /> Revision:3 TRW 1 Thursday,September 05, 2013 <br />