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2013 LARGE STORM RESPONSE PAPER FORM CHECKLIST <br /> grr <br /> Date of inspection: cp..-/l 3 Inspected By: ! 'Gift Aa(klr ( G -el') <br /> Address: 6 3/ i i t T/ 1/)r— Service Request Number: <br /> Resident: t(..Ae.t .9"- l'l -1L Owner? l YES ❑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? I26S 0 NO <br /> Does the building have a ckwa r valve(BWV)? 0 YES [E (If yes)Was BW 'nstall rough City program 0 YES 0 NO <br /> Does the building have a su ump? ❑YES ❑NO Ai <br /> Does the building a grinder pump? 0 YES ❑NO <br /> Storm Event Details: <br /> Where did water entering building come from? S'URFACE FLOW 0 GROUNDWATER 0 SEWER BACKUP-FIXTURES ❑UNKNOWN <br /> Details: S%!/rM litir�G�� CZ 1.D l�d, {'lp fr blifryviZe (-- <br /> /0 1^/ 9) 1"z:t 4 d- d <br /> Where did water go within the building? ❑BASEMENT PERIMETER 0 BASEMENT NEAR FIXTURES EfOTHER Pc-vVe_ 0-ay <br /> Details:at Y/I- C l,.r c I/.-12- V 6/ p 4--/ ey l/"rjoi <br /> Site Observations: <br /> Downspout/site grading issues noted: AM f ((')40-'�--eA' <br /> Building elevation relative to sewer and surrounding area issues noted: f""?-L s 4 LA41 )74 r44-7 f �O i/ 9 A(47- <br /> Site pump issues noted: <br /> Historical Information 1 Other Information: <br /> Previous"flooding"issue Service Requests at address: <br /> Previous"flooding"issues noted by homeowner:)t7a'u 04 '5 /3 icS ��i_O) eS. <br /> Recent stormwater I sewer projects completed in area: Proposed stormwater/sewer projects in area: <br /> Property owner interested in beginning City Backwater Valve Program at address:0 YES ate) Details: <br /> Notes: <br /> Revision:3 TRW 1 Thursday,September 05,2013 <br />