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2. Name*
3. Phone Number
5. House Number*
6. Street Name*
8. Email Address
10. 1. Have you observed flooding on your street?*

    1. Yes
    2. No
12. If yes, please explain:
14. 2. Have you experienced flooding in your yard?*

    1. Yes, pockets of standing water/soggy yard
    2. Yes, flowing water
    3. Yes, due to stream/ditch overflow
    4. No
16. 3. Have yard drains been installed on the property?*

    1. Yes
    2. No
18. 4. Has the soil/landscaping around your home been graded to slope away?*

    1. Yes
    2. No
    3. Partially
20. 5. Does your home have gutters/downspouts?*

    1. Yes, they are splashed
    2. Yes, they are tied in
    3. No
22. 6. Does this property have a drain in the driveway?*

    1. Yes
    2. No
24. 7. Has a backflow preventer/check valve been installed on the property?*

    1. Yes
    2. No
26. If yes, please explain:
28. 8. Does this property have a working sump pump?*

    1. Yes
    2. No
29. If yes, how many:

    1. 1
    2. 2
    3. 3 or more
31. 9. Has any waterproofing been done at this property?*

    1. Yes
    2. No
33. If yes, please explain:
35. 10. Does your home have a basement?*

    1. Yes
    2. No, concrete slab
    3. No, crawl space
37. 11. Does your home have a "depressed driveway" that slopes down to a garage/lower level?*

    1. Yes
    2. No
39. 12. During the rainstorm events in July, did you experience water in your basement?

    1. Yes
    2. No
41. * The remaining questions relate to basement flooding. If you didn't experience basement flooding, please continue to the end of the form and click "Submit."
43. 13. Where did the water enter your home?

    1. Sump pump crock
    2. Floor drain, shower, or toilet
    3. At a window
    4. Through the basement floor
    5. Through the basement wall
    6. At the edge of the floor and wall
    7. Other, explain below:
45. Other water entry:
47. 14. Was the water generally:

    1. Clear
    2. Mixed with sewage
49. 15. What was the depth of the water?

    1. Damp
    2. Less than 1"
    3. 1" to 3"
    4. 3" to 6"
    5. 6" or more
51. 16. Approximate number of times you have experienced water in your basement since 2015:
53. 17. Approximate dates (month/year) you have experienced water in your basement since 2015:
55. 18. Since experiencing water in your basement, have you hired a contractor/plumber to investigate the incident(s) or make repairs at your property?

    1. Yes
    2. No
57. If yes, approximate dates:
59. 19. Has the reason for the water in your basement been identified and/or explained?

    1. Yes
    2. No
61. 20. Have the storm and sanitary laterals from the house to the main been snaked?

    1. Yes
    2. No
63. 21. Did you receive video/photo verification of the condition of the laterals?

    1. Yes
    2. No
64. Are they free of damage/debris?

    1. Yes
    2. No
66. If they are not free of damage/debris, please explain:
68. Additional comments
70. Thank you for completing the survey!
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72. 1. Receive an email copy of this form.
73. Email address

    This field is not part of the form submission.

74. Submit

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