Exit this survey Basement Flooding Survey 1. Question Title * 1. Where is your home or building located? Please note, Name, e-mail address, and phone number are optional. Name: Address: * Address 2: City/Town: * ZIP: Email Address: Phone Number: Question Title * 2. Does the building have a basement? Yes No Question Title * 3. Does the building have a crawl space? Yes No Question Title * 4. Does the building have a sump pump (water from the basement is pumped outside)? Yes No Question Title * 5. Does the building have any of the following sewer back up protection devices? Back Flow Check Valve Stand Pipe (open pipe coming up from the basement floor drain) Over Head Plumbing (first floor sewage exits the basement above the basement floor) Drain Plug for basement floor drain Manual Shut Off Valve For Sewer Service Question Title * 6. Has your basement flooded in the past? Yes No Question Title * 7. If Yes, where did the water or sewage come from? (Check all that apply) Floor Drain, Shower, Sink, Toilet Sewage Ejector Pit Wall or Floor Seepage Basement Window Sump Pump Question Title * 8. Please list approximate flooding dates and how deep the water or sewage was from the basement floor. Question Title * 9. If your basement sewer backs up does it only happen when it is raining? Yes, the basement sewer only backs up when it is raining No, the basement sewer backs up when it is not raining Question Title * 10. If you have experienced basement sewer back ups in the past do you have an idea what caused the problem? Question Title * 11. How often do you have your private sanitary service cleaned/rodded? Done
