Regions 4 & 2 Planning and Development Councils - Survey of Private Water Crossings
Regarding June 22-29, 2016 Flood Event (DR-4273-WV)
Name
First Name
Last Name
Phone Number
Please enter a valid phone number.
Email
example@example.com
Address
Street Address
Street Address Line 2
City
State / Province
Postal / Zip Code
County
For your specific location of residence, please answer the following questions:
The location of the private water crossing can be best described as: (check all that apply)
Bridge
Low Water Crossing
Concrete Box Culvert
Pedestrian Crossing
Pipes
Other
If pipe, please list diameter of pipe below if known:
If other, please describe:
Is the crossing the only access to your residence?
Yes
No
Do you use the crossing daily?
Yes
No
How many households does the crossing serve?
How many school-aged children live past the crossing?
Does a school bus pass over the crossing?
Yes
No
How many residents over the age of 65 live past the crossing?
Are there individuals at your residence with special medical needs?
Yes
No
In the event of a life-threatening emergency, can an emergency vehicle reach your home?
Yes
No
Is there a fire hydrant past the crossing?
Yes
No
Are there any businesses past the crossing?
Yes
No
If yes, please provide details on number and type of businesses:
To your knowledge, over the last 10 years, how often has the crossing flooded to the point that it was unpassable?
None
1-3
4-6
7+
Does the crossing currently have damage and need repair?
Yes
No
If yes, please provide details:
Do you own the location of the crossing or have a right-of-way at the crossing?
Yes
No
Submit
Should be Empty: