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2013 LARGE STORM RESPONSE PAPER FORM CHECKLIST <br /> 'A✓ <br /> .4 ,'ris <br /> Date of inspection: l /3 Inspected By: A—-Cat <br /> Address: //r/ 7" — vefit{c,—/ Service Request Number: <br /> Resident: Fl y-+- `BLS Owner? ❑YES ❑NO frib#0 <br /> Phone Number: /46 Email: <br /> General Building Details: � <br /> '�/oe+t /e v <br /> Is this building within the combined sewer area? YES ❑NO Does the building have a basement? ❑YES ❑NO oris-br <br /> Does the building have a backwater valve(BWV)? LT'E5 ❑NO (If yes)Was BWV installed through City program ❑YES RIC <br /> Does the building have a sump pump? 0 YES 0 NO ? Does the building have a grinder pump? ❑YES 0 NO 9 <br /> Storm Event Details: <br /> Where did water entering building come from? ErgITIRFACE FLOW 0 GROUNDWATER 0 SEWER BACKUP-FIXTURES 0 UNKNOWN <br /> Details: <br /> Where did water go within the building? 0 BASEMENT PERIMETER 0 BASEMENT NEAR FIXTURES El-erTFfER <br /> Details: <br /> Site Observations: <br /> / n <br /> Downspout/site grading issues noted: bi tv t.-S,O t fAet cod if6.c-r'4 ' o da e^- h h0✓7 7 <br /> Building elevation relative to sewer and surrounding area issues noted: /kit - Avf f e , i1 t -lOt. 1404 <br /> / ff <br /> Site plinp.issues noted: ? '1""'Y <br /> Historical Information I Other Information: s.f 6'L 2/a 2/av, 9 f 6 Z Z% k Q <br /> ?-3 l tm Deg ei <br /> Previous"flooding"issue Service Requests at address: <br /> Previous"flooding"issues noted by homeowner: d.£,e, % ; <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:0 YES ❑NO Details: <br /> Notes: °`` .' I C es;cQ L J ✓ 9 5 , - 2,,,0 w ct.u/J f►ten". �c e.r(-c�cf "e /` ►^'C3 Apr- tea ,/ <br /> /raw /d. /J 0 / i t Y�/ '{? ff 0✓ �uijzt Crcr+J fj Ik v;04.-- fi+/ S 7�t)voc / d-0 reaetaic-/ <br /> /` <br /> The dr i co ,e,p4 .._ ; (ate s�cr01c ileg A pr.( 5-7 c <br /> OA I we-S - 4a, , ' v 41 ,6G ? / SG�✓c-�t,a rrc�.e <br /> Revision:3 TRW „ G`" 1 A Thursday,September 05, 2013 <br /> 47bSev✓ - S4,t //' <br /> ✓ l2 A-8 71- (t�-) <br /> f�,(ed i,,I 3 7'00a Pe l( 540,4/ , bG mP �; .. d o <br />