HomeMy WebLinkAboutSump Pump InspectionO
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~ ~ ~`~ ~' Cit of Prior Lake
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tJ Sump Pump and I/I Reduction
Inspection Form ~~P ~~-
Name:~/~~~TM~ ~ ~ I'~us7~ Date:.~ ~~' ~~ Time:~3~a.m./p.m.
Ad •~~ ~~ ~ l~ j~ '~''~ ~~ First Inspe~c ' rr"~" Second L7
dress. / ~u~=~ Own: I~ Rent: ~ Age of Home: `'"`!
Residential: ~
Prior Lake, MN 55 ~~.Z Phone:'~~~0'~9~1v Non-Residential: ~
A. BASEMENT d Yes C~'No ~ SUMP BASKE ~ 1 Q 2 ~ 3 ~
WATER IN BASKET 17 Yes o SiJMP P 0~ 1 ~ 2~~ f~
WATER IN BASEMENT (flow over floor) ~ Yes o CISTERN ~ Yes o
(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 O Laundry tub Q Sanitary sewer Q Outside
at Inspection: ~ Floor drain ~ Other
....-----
Prior to Inspection:
When was system installed, or most recently modified? (Date) and why
B.
C.
D.
~ Home came with system ~ Response to inspection program 17 Other
~ Water in basement ~ Previous syst failed
ROOF LEADERS: ~ Yes o: DI5CHARGE: Q Near ~ Away
YARD DRAINS Q Yes la'N WINDOW WELLS ~ Yes ~ i l V o
BEAVER SYSTEM Q Yes o
PROPERTIES WITH 5UMP PUMPS
When does pump run? Q Fall ~ Summer ~ Spring
(check all that apply) How often does pump run? '-
Where does pump discharge to outside? 17 Front l7 Bac~
-•-•- - - - --- - - - - - - - -•~ ~- - - - - - ----- - -•- - -•-•-•---..
~ Winter
NOTES: ~ ~(//~ l ~'~~ / E,D ~~Y! ,4 T~U "7'^
Q Side
Date: ti C"~
Date: ~ v~ -
SUMP PUMP SYSTEM: ~ASS ~ FAIL You have 30 days to bring your system into compliance with cu ent
regulations. When you are ready for reinspection, ca11651/644-1469 for an intment.
Is there another place where clear water enters the sanitary sewer system? O Yes o
Where is this location?
This area will need to b~'xed~the clear }drater~harges to the storm sewer system.
Inspector:
Resident:
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