ClaimFormNote (type: esriFieldTypeString, alias: An individual who has sustained property damage or has been injured as a result of a sewage disposal system event must provide written notice of the event within 45 days after the date the damage or injury occurred, or in the exercise of reasonable diligence should have been discovered. Failure to provide proper notice may bar your claim., SQL Type: sqlTypeOther, length: 255, nullable: true, editable: true)
DescrClaim9 (type: esriFieldTypeString, alias: Description of Claim (continued, if needed). If additional space needed, submit as an attachment., SQL Type: sqlTypeOther, length: 255, nullable: true, editable: true)
CostAmount (type: esriFieldTypeDouble, alias: Total Amount of Claim, SQL Type: sqlTypeOther, nullable: true, editable: true)
PropertyType (type: esriFieldTypeString, alias: Does this claim involve flooding of your home or business?, SQL Type: sqlTypeOther, length: 255, nullable: true, editable: true, Coded Values: [Home: Home], [Business: Business])
Basement (type: esriFieldTypeString, alias: Do you have a basement?, SQL Type: sqlTypeOther, length: 255, nullable: true, editable: true, Coded Values: [yes: Yes], [no: No])
SewerBackUp (type: esriFieldTypeString, alias: If you had flooding from a sewer backup, did it rain that day?, SQL Type: sqlTypeOther, length: 255, nullable: true, editable: true, Coded Values: [yes: Yes], [no: No])
SewerBackUpExplain (type: esriFieldTypeString, alias: If you had flooding for reason other than a sewer backup, explain:, SQL Type: sqlTypeOther, length: 255, nullable: true, editable: true)
ContactDWSD (type: esriFieldTypeString, alias: Did you contact DWSD about the incident?, SQL Type: sqlTypeOther, length: 255, nullable: true, editable: true, Coded Values: [yes: Yes], [no: No])
ContactDWSDNote (type: esriFieldTypeString, alias: If Yes, provide date, time, and phone number, SQL Type: sqlTypeOther, length: 255, nullable: true, editable: true)
ContactDWSDDate (type: esriFieldTypeDate, alias: Date & Time, SQL Type: sqlTypeOther, length: 255, nullable: true, editable: true)
InsuranceType (type: esriFieldTypeString, alias: Type of Coverage, SQL Type: sqlTypeOther, length: 255, nullable: true, editable: true)
InsuranceDamages (type: esriFieldTypeString, alias: Have you filed a claim with your insurance company for damages?, SQL Type: sqlTypeOther, length: 255, nullable: true, editable: true, Coded Values: [yes: Yes], [no: No])
InsuranceDamagesNo (type: esriFieldTypeString, alias: If No, give reason, SQL Type: sqlTypeOther, length: 255, nullable: true, editable: true)
InsuranceDamagesYesPaid (type: esriFieldTypeString, alias: If Yes, has the insurance company paid any portion of the damage?, SQL Type: sqlTypeOther, length: 255, nullable: true, editable: true, Coded Values: [yes: Yes], [no: No])
InsuranceDamagesYesAmt (type: esriFieldTypeDouble, alias: If Yes, indicated the amount the insurance company paid, SQL Type: sqlTypeOther, nullable: true, editable: true)
InsuranceClaimNo (type: esriFieldTypeString, alias: What is the insurance claim number?, SQL Type: sqlTypeOther, length: 255, nullable: true, editable: true)
InsuranceDamagesNoPaid (type: esriFieldTypeString, alias: If No, what reason did they give you for turning down your claim?, SQL Type: sqlTypeOther, length: 255, nullable: true, editable: true)
SubSRN (type: esriFieldTypeDouble, alias: Service Request Number as provided by DWSD, SQL Type: sqlTypeOther, nullable: true, editable: true)
Certify (type: esriFieldTypeString, alias: I hereby certify that the information provided on this form is true and accurate to the best of my knowledge., SQL Type: sqlTypeOther, length: 255, nullable: true, editable: true, Coded Values: [yes: Yes])
PropDamChoices (type: esriFieldTypeString, alias: Choose the following to provide attachments, SQL Type: sqlTypeOther, length: 255, nullable: true, editable: true)