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2013 LARGE STORM RESPONSE PAPER FORM CHECKLIST <br /> 477 <br /> Date of inspection: 9 J /2r)13 Inspected By: 5-f---,SYY1ec <br /> Address: f eIn 2 I I' Service Request Number: 001 t Dose <br /> Resident: An'IQ Owner? !'YES ❑ NO <br /> Phone Number: ( -W_, -.) 1 '5- 1(-, 1<J Email: <br /> General Building Details: <br /> Is this building within the combined sewer area? BYES ❑NO Does the building have a basement? fa YES ❑NO <br /> Does the building have a backwater valve(BWV)? ❑YES„i 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? ❑YES ❑ NO <br /> Storm Event Details: <br /> Where did water entering building come from? ❑SURFACE FLOW ❑GROUNDWATER 14 SEWER BACKUP-FIXTURES ❑UNKNOWN <br /> Details: E Jt c 'i N P.[)c)c-7t-( FLc2 C-.)Pa ,04Q0 APA `rv) <br /> Where did water go within the building?;Si BASEMENT PERIMETER ❑ BASEMENT NEAR FIXTURES ❑OTHER <br /> Details: 0P 7-0 in C-OUPLs✓ i, c -iG—S /., � 0trY) L UaC <br /> Site Observations: <br /> Downspout/site grading issues noted: i.3 <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: <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: �,L — <br /> 11\1(-)Prr5r"►tDvJ <br /> � vP S �r +p f or. vto� 1 0 Peo <br /> Kevision 3 ameoiPT-1 ' c c.�it'vt��' ' NIA. Thursday,September 05, 2013 <br />