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2013 LARGE STORM RESPONSE PAPER FORM CHECKLIST <br /> Date of inspection: 2V9i) 0I' 0 Inspected By:(?(-f`c " Do 0 L <br /> Address: 17 Ifv-1 rMOr e_ Service Request Number: 00 2-3 O o <br /> Resident: Far pSta, ,4/hk Owner? 'YES ❑NO <br /> Phone Number: 4'_5" (4 G 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)? 0 YES ❑ NO (If yes)Was BWV installed through City program IS ❑ NO <br /> Does the building have a sump pump? ❑YES 0 NO Does the building have a grinder pump? ❑YES Erri6 <br /> Storm Event Details: <br /> Where did water entering building come from? ❑SURFACE FLOW ❑GROUNDWATER SEWER BACKUP-FIXTURES ❑ UNKNOWN <br /> Details: o t" � ^ ill? � <br /> Where did water go within the building? B SEMENT����PERIMETER O'�A-SEMENT NEAR FIXTURES El OTHER <br /> Details: T)/tiM ( 13 Qi re u a" iY�C�--IA_by <br /> Site Observations: <br /> Downspout/site grading issues noted: 5 (,P1 p S a/lniay OM 1,vir42 a- Eli 13 4}/t <br /> Building elevation relative to sewer and surrounding area issues noted: <br /> Site pump issues noted: <br /> Historical Information I Other Information: rr r� Q <br /> Previous"flooding"issue Service Requests at address: 6n/o J f OOD $6"a 50 <br /> Previous"flooding"issues noted by homeowner: tkQ-- 4 OV <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: ElYES ElNO Details: <br /> Notes: I LvV 1,- -�S r yeer- (/1 F�-� ( <br /> ff/t � f 9 f (? l3� € -'It <br /> 1 ot2. rrt Q`1 i ' r !— [n Gcrr�tr'" pis fi-fdn �A/'c4. `�r-40 Fi A4 <br /> rwoir <br /> FL, <br /> Revision: 3 TRW 1 Thursday,September 05, 2013 <br />