WET WEATHER QUESTIONNAIRE City of Brunswick Division of Permits and Inspections 4095 Center Road 330-558-6830 This questionnaire is used to help identify problem areas throughout the City of Brunswick during wet weather conditions. Thank you for your input.

SECTION 1: CONTACT INFORMATION Fields marked with an asterisk MUST be filled out.

Date *

MM / DD / YYYY

Name *

Prefix

First *

Last *

Suffix

House number *

Street *

Email *

Phone *

### - ### - ####

Cell phone

### - ### - ####

SECTION 2: GENERAL

Approximate date of occurrence:

MM / DD / YYYY

Check any of the problems that you have observed:

Street flooding (please go on to complete Section 3)   Stream flooding (please go on to complete Section 4)   Yard flooding (please go on to complete Section 5)   Dwelling or interior flooding (please go on to complete Section 6)

SECTION 3: STREET FLOODING DO NOT JEOPARDIZE YOUR SAFETY TO ANSWER THE FOLLOWING QUESTIONS.

Intersection closest to the street flooding Street #1

Intersection closest to the street flooding Street #2

OR the address of the issue: House number & street

Approximately how deep does the water get during each occurrence?

Less than 6"   More than 6"

Do you think the problem is due to a blocked culvert or ditch?

Yes   No

To your knowledge, how long has this problem existed?

Less than 1 year   1 to 5 years   More than 5 years

SECTION 4: STREAM-RELATED ISSUES

What is the issue with the stream or creek? (Check all that apply.)

Stream erosion   Stream blockage   Water is at a high level or overflowing

Is the water issue endangering any structures?

Yes   No

SECTION 5: YARD FLOODING DO NOT JEOPARDIZE YOUR SAFETY TO ANSWER THE FOLLOWING QUESTIONS.

Where is the yard flooding?

Front yard   Back yard   Side yard

Approximately how deep does the water get during each occurrence?

Less than 6"   More than 6"

To your knowledge, how long has this problem existed? (Choose one.)

Less than 1 year   1 to 5 years   More than 5 years

Describe the problem (Check all that apply.)

Flowing water that occurs during a storm   Standing water that occurs after a storm   Yard flooding due to a ditch   Yard flooding due to a stream (Please also complete Section 4.)   Blocked catch basin or yard drain   Other

SECTION 6: DWELLING OR INTERIOR FLOODING

Does your home have a basement?

Yes   No

In what rooms did the water enter your home? (Check all that apply.)

Basement   Crawl space   Living area   Garage   Slab on grade

Describe the appearance of the water: (Choose one.)

Clear with minimal odor   Muddy with minimal odor   Muddy with strong sewer odor   Other

Describe how the water entered the dwelling:

Floor drains   Cracks in the floor/walls   Sump pump crock   Toilet or sink   Windows or doors   Don't know

Approximately how deep does the water get when the problem occurred?

Less than 3 inches   3-5 inches   Over 5 inches

To your knowledge, how long has this problem existed? (Choose one.)

Less than 1 year   1 to 5 years   More than 5 years

Is your home is equipped with any of the following devices? (Pick as many as applicable.)

Sump pump   Battery back-up sump pump   Backwater valve in your sanitary lateral   Backwater valve in your storm lateral   Emergency bypass (inverter) installed outside and located on discharge line with sump pump   Rain barrels