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2013 LARGE STORM RESPONSE PAPER FORM CHECKLIST <br /> "liPittY°-1 <br /> Fv <br /> t 1 / <br /> Date of inspection: 1 /f/ / 14-t' Inspected By: /36.7 Pcio(AE'"t <br /> Address: 10 /L- thiy/ Service Request Number: <br /> // <br /> Resident: e jt-(c i✓ (}�l L t1 Owner? BYES ❑NO <br /> Phone Number: `--711 0 c44 Email: <br /> General Building Details: <br /> Is this building within the combined sewer area? ES ❑NO Does the building have a basement? ❑-1�ES D NO <br /> Does the building have a backwater valve(BWV)? ❑YES 12/N-0 (If yes)Was BWV installed through City program 0 YES ❑NO <br /> Does the building have a sump pum ? D YES ❑`NO Does the building have a grinder pump? ❑YES <br /> 2j-NO <br /> Storm Event Details: <br /> Where did water entering building come from? ❑SURFACE FLOW ❑GROUNDWATER SEWER BACKUP-FIXTURES ❑UNKNOWN <br /> Details: rip( 1„� G '} r� ( ������ r tea(' <br /> (.�+ cr-zd, �=-r,�Jrf�..�i e cr <br /> Where did water go within the building? E"BrASEMENT PERIMETER ❑BASEMENT NEAR FIXTURES ❑OTHER <br /> Details: <br /> Site Observations: /� ,r <br /> Downspout i site grading issues noted: f/r v-n.s?„rr� i:1179 ” tJG�^`7/ {71 T 'Qa/(fr c <br /> Building elevation relative to sewer and surrounding area issues noted: 0 ' /" '.A-C . /' am J'/. t, tS" fl/to <br /> Site pump issues noted: l <br /> Historical Information I Other Information: <br /> Previous"flooding"issue Service Requests at address: <br /> Previous"flooding"issues noted by homeowner: <br /> Recent stormwater I sewer projects completed in area: Propose stormwater/sewer projects in area: <br /> Property owner interested in beginning City Backwater Valve Program at address:LJ YES ❑NO Details: <br /> Notes: i_)a Ito 'i j ` '' (/°• m '6' r(1 t !t 1 D-41- <br /> t1 " 1 it 7 5 VOP Co tA T1 <br /> o_ <br /> Revision:3 TRW 1 Thursday,September 05, 2013 <br />