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2013 LARGE STORM RESPONSE PAPER FORM CHECKLIST <br /> 0,10.‘ <br /> vdge <br /> � `j—l 3 Inspected By: r41 4i t( Uouct;VW/4 4/VC SA4LtV <br /> Date of inspection: f" <br /> Address: is,),5 w t.T Mo Service RequestXI Number: 6 d i a a ��d / c��i d y a 3 <br /> Resident: (,o2aC,v 5flArto v Owner? 111'YE//S ❑NO <br /> Phone Number: — )1p I Email: Slim-ors,],3r tbo o/ <br /> General Building Details: <br /> Is this building within the combined sewer area? EKES ❑NO Does the building have a basement? RYES ❑NO <br /> Does the building have a backwater valve(BWV)? R<ES ❑NO (If yes)Was BWV installed through City program ❑YES EKI0 <br /> �_NsiALLit aoa7 £4cor" NdY i}ev t�.a,v(n<,vi o s,,✓c <br /> Does the building have a sump pump? ❑YES [�NO Does the building have a grinder pump? ❑YES �10 <br /> Storm Event Details: <br /> Where did water entering building come from? SURFACE FLOW GROUNDWATER [2 SEWER BACKUP-FIXTURES ❑UNKNOWN <br /> o <br /> j A,.- ® .A!aft �MoS1 L:(L�-t�• ,fn.h. po,,,n,S ,�T <br /> Details: �w,���=.�' ray�ad5 c 4� • a� �.v r.+� �'�r.i� tN'C � / i° <br /> Where did water go within the building? []BASEMENT PERIMETER [ ASEMENT NEAR FIXTURES 3 tTHER <br /> Details: 5bA.►cr 4 coa,r_pi:t {✓Arfeel :Q(Z l;6 t ;Clin4G i -ti,vto t, <br /> Site Observations: <br /> Downspout/site grading issues noted: o f.T. r3l S d s�'"'`'` s° '' t o ILE p'M; <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: <br /> Previous"flooding"issues noted by homeowner: o,o/a e S cA.," >>u� .2 Q 0 o 0 7 <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: <br /> Revision: 3 TRW 1 Thursday,September 05,2013 <br />