Village of Roanoke- Flash Flooding Survey
Email address *
Full Name *
Phone (Daytime) *
Phone (Evening) *
Address *
Type of Structure *
Occupancy *
Water Depth Basement (in inches) *
Water Depth First Floor (in inches) *
Identify Essential Basement Living Area (i.e., required bedroom, apartment, etc.)
Types of Insurance *
Required
Structural Damage *
Briefly Describe the Structural Damage *
If water in your house, what date?
MM
/
DD
/
YYYY
If water in your house, was it? (please check all that apply):
Was your sump pump able to keep up? *
If none of the above, did you have surface water that entered your home? *
How did the water get in your house?
Was your street flooded? *
Street Name *
Was your garage flooded? *
Have you ever previously had flood water in your house? *
If you've previously had flood water in your house, please explain (include date and what occurred):
Do you have photos of the flooding? *
If yes for photos, may we get copies?
What are your immediate needs (please check all which apply)?
A copy of your responses will be emailed to the address you provided.
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