City of Madison Engineering Division Backwater Valve Eligibility Survey

Question Title

1. Please provide your contact information for potential follow-up questions from City staff.

Name

Address

Address 2

City/Town

State/Province

ZIP/Postal Code

Email Address

Phone Number

Question Title

2. Is this property located in the City of Madison?

Yes

Question Title

3. Is it a single-family or two-family home?

single-family household

two-family household

more than two-family household

Other (please specify)

Question Title

4. Do you own this property?

Yes

Question Title

5. Was the house built more than 5 years ago?

Yes

Other (please specify)

Question Title

6. To your knowledge, does the property have an existing sewer backwater valve?

Yes

I don't know

Question Title

7. To your knowledge, have you ever experienced a sewer backup in your basement?

Yes

I don't know

Question Title

8. If you have experienced a sewer backup in your basement before, please provide how many backups you have experience and what year(s) these occurred.

City of Madison Engineering Division Backwater Valve Eligibility Survey

Question Title

* 1. Please provide your contact information for potential follow-up questions from City staff.

Question Title

* 2. Is this property located in the City of Madison?

Question Title

* 3. Is it a single-family or two-family home?

Question Title

* 4. Do you own this property?

Question Title

* 5. Was the house built more than 5 years ago?

Question Title

* 6. To your knowledge, does the property have an existing sewer backwater valve?

Question Title

* 7. To your knowledge, have you ever experienced a sewer backup in your basement?

Question Title

* 8. If you have experienced a sewer backup in your basement before, please provide how many backups you have experience and what year(s) these occurred.

1. Please provide your contact information for potential follow-up questions from City staff.

2. Is this property located in the City of Madison?

3. Is it a single-family or two-family home?

4. Do you own this property?

5. Was the house built more than 5 years ago?

6. To your knowledge, does the property have an existing sewer backwater valve?

7. To your knowledge, have you ever experienced a sewer backup in your basement?

8. If you have experienced a sewer backup in your basement before, please provide how many backups you have experience and what year(s) these occurred.