HomeMy WebLinkAboutSump Pump Inspection~
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City of Prior Lake
Sump Pump and I/I Reduction
Insnection Form
(If no pump, place sticker across edge of sump cover and basement floor so any removal of cover will
break seal. Skip to Part B of this form.)
Discharge Point ~ Laundry tub ~ Sanitary sewer I~ Outside
.. at Inspection: ~ Floor drain ~ Other
Prior to Inspection:
When was systern installed, or most recently modified? (Date) and why
~ Home came with system ~ Response to inspection program ~ Other
~ Water in basement ~ Previous system failed
B. ROOF LEADERS: O Yes ~ No DISCHARGE: Q Near Q Away
C. YARD DRAINS ~ Yes ~ No WINDOW WELLS O Yes ~ No
BEAVER SYSTEM ~ Yes ~ No
D. PROPERTIES WITH 5UMP PUMPS
When does pump run? ~ Fall ~ Summer
(check all that apply) How often does pump run?
V~here doe ump discharge to outside? ~ Front
NOTES: ~-----~--//.1p.. ~rt ~ ~~ `"""` ~li?~.G..
~ Spring ~ Winter
~ Back ~ Side
~-v- f~~_•-•_•---•-•---•_•_'_•-•_--°--•---•-
SUMP PUMP SYSTEM: PASS ~ FAIL You have 30 days to bring your system into compliance with current
regulations. When you are ready for reinspection, call 651 /644-1469 for an appointment.
Is there another place where clear water enters the sanitary sewer system? Q Yes ~ No
Where is this location?
This area will n to e fi~ so the clear water ~iarges to the storm sewer system.
Inspector: { /~ ~ (jp!„~,~~,..~'""~rSL.....z,5/ Date:
Resident: ~"'-~~ Date:
Disclaimer: This visual inspection is done with due diligence to find obvious clear water cross-connections
and does not imply the structure meets all City Codes.
White: Homeowner ' Yellow: City Pink: HRG
A. BASEMENT O Yes ,'~1 No SiJMP BASKET ~ 0 ~ 1 O 2 ~ 3 I~
WATER IN BASKET ~ Yes ~ No 5UMP PUMP ~51 0 ~ 1 ~ 2 ~ 3 Q
WATER IN BASEMENT (flow over floor) ~ Yes ~1Vo CISTERN Q Yes IJ No
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City of Prior Lake
Sump Pump and I/I Reduction
Insuection Form
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Name~~i~f~i~ ,~~.~~f .~,~'//~ Dat~~='~ ~ ~/ Timef~~~m./p.m.
,yC~n ~' First In,s~p ~'on EY Second O
Address:~~ / ./ ',~"~~'~`'~ ~% ~~ Own: ~" Rent: ~ -~Age of Home:~~
~ ~~ ~,/~'/ ~ Residential: C~.i'~ ~
Pnor Lake, MN 55 Phone::>"7~ ~~~=~~on-Residential: ~
f~~~~ G.._.
A. BASEMENT es C7 No SUMP BASKE~ ~ ~~ 1 ~ 2 D 3 ~
WATER IN BASKET ~ Yes o SiJMP P ~'0 ~ 1 ~ 2~~ ~/~ ~
WATER IN BASEMENT (flow over floor) O Yes ~~ CISTERN ~ Yes ~7Tio
(If no pump, place sticker across edge of sump cover and basement floor so any removal of cover will
break seal. Skip to Part B of this form.)
Discharge Point ~ Laundry tub ~ Sanitary sewer C] Outside
at Inspection: ~ Floor drain ~ Other
Prior to Inspection: ,~.--~`'
When was system installed, or most recently modified? (Date) and why
~ Home came with system ~ Response to inspecti on program Q Other
Q Water in basement d Previous syste iled
B. ROOF LEADERS: 7 Yes o
' DISCHARGE: O Near ~ Away
C. YARD DRAINS ~ Yes EN
N~ WINDOW WELLS ~ Yes o
BEAVER SYSTEM ~ Yes ~y~1Vo `
D. PROPERTIE5 WITH SUMP PUMPS
When does pump run? ~ Fall ~ Summer O Spring,.._ L~ Winter
(check all that apply) How often does pump run?
V~here does pump discharge to outside? a Front ~ Back ~---- O Side
NOTES:
SUMP PUMP SYSTEM: l'D~ASS O FAIL You have 30 days to 6ring your system into compliance with current
regulations. When you are ready for rein.spection, ca11651/644-1469 for an app nt.
Is there another place where clear water enters the sanitary sewer system? L"a Yes tCL~ICIo ~
Where is this location?
This area will need to be f' so ear wate isc ges to the storm sewer system.
Inspector: Date: ~
Resident: .,l ,' ~ F ~ ; ----~ Date: -
Disclaimer: This visual inspection is done with due diligence to find obvious clear water cross-connections
and does not im 1 the structure meets.all Ci Codes.
White: Homeowner Yellow: Ciry Pink: HRG