HomeMy WebLinkAboutSump Pump Inspection~~~ PRI~'~'~, City of Prior Lake
~ ~ Sump Pump and I/I Reduction
~jNN E 5 ~~~
Inspection Form
ANNUAL CERTIFICATION RE-INSPECTION
~ ~ ~ _ ~'LU ~_pm
Name: ~ ~ ~D Date: ~ ~0 ~l Time: -~> > ~'/
Inspection: ^ First ^ Second X 71-1 /~?~
Address: ~~(~ ~ ~~ ~' ~•~.~~ ~ Own p Rent Age of Home: i~
Prior Lake, MN 55372 Phone: ~ Residential ~ Non-Residential
A. BASEMENT (/~~'~-pU~-;~Yes
WATER IN BASKET O Yes
WATER IN BASEMENT ~ Yes
(If no pump, place sticker acrqss edge of sump a
Discharge Point p Laundry tub
at Inspection: p Floor drain
O No SUMP BASKET
O No SUMP PUMP
~No CISTERN
rver and basement floor so any removal
^ Sanitary sewer
p Other
p0 p~ 1 p2 ^ 3 ^_
O 0 ,~" 1 O 2 ^ 3 O
^ Yes ~ No
of cover will break seal. Skip to Part B.)
~ Outside
Prior to Inspection:
When was system installed, or most recently modified? (Date) ancFwhy?
^ Home came with system ^ Response to inspection program ^ Other
p Water in basement ~ Previous system failed
B. ROOF LEADERS ~ Yes p No DISCHARGE ^ Near ~Away
C. YARD DRAIIYS p Yes ~.No WINDOW WELLS ^ Yes ,~No
BEAVER SYSTEM p Yes ~ No -
D. PROPERTIES WITH SUMP PUMPS
When does pump run? ^ Fall O Summer O Spring p Winter
(check all that apply) How often does pump run?
Where does pump discharge to outside? O Front "^ Back ^ Side
NOTES:
SUMP PUMP SYSTEM: ^ PASS O FAIL Ynti hure 30 days ~n hrrng ynarsy.veiu i~uo co~upliw~ce wilh currenl
re~,nduriais. W{~ex ynt~ ure mudyfor re-iu.+~ecJinn, cnl! 9521447-9833.~ir un uppni~uureir~.
Is there another place where clear water enters the sanitary sewer system? ~ Yes ~ No
Where is this location?
This area will need to be fixed so the clear water discharges to the storm sewer system
Inspector: x ~ ' Date: ~~I~ /4/
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.
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~~ ~ ~.7+ ~!~ "~~~ ~"_ ~~1./
C~t of Pr~~~r ~Lake
~
Sump Pump and I/I Reduction
Insnection Form
Name: ,,~,~//jy/~/~ f~Dirl~ ~~//~i~,,~~' ~/ Date:~G~ /~=~ 9 Time:,,S',~~ a.m.~.m
~,.~ First Inspection ~ Second
Address:~~ ~~( ,~'7' .,S .~ Own:~ Rent: ~ Age of Ho e:~
Residential~
Prior Lake, MN 55 Phone: Non-Residential: Q
A. BASEMENT YeOW~ No ~v~ ~ SiJMP BASKET ~ 0~1 la 2~ 3 ~
WATER IN BA~KET~ Yes ~ No SUMP PUMP ~ 0~ 1 ~ 2 ~ 3 ~
WATER IN BASEMENT (flow over floor) ~ Yes No 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 ~ Laundry tub ~ Sanitary sewer ~ Outside
at Inspection: ~ Floor drain ~ Other
B.
C.
D.
Prior to Inspection:
When was system installed, or most recently modified? (Date) and why
Home came with system ~ Response to inspection program ~ Other
~ Water in basement `~Previous system failed
ROOF LEADERS: ~ Yes ~ No DISCHARGE: ~ Near~Away
YARD DRAINS ~ Yes ~ No WINDOW WELLS ~ Yes~1 No
BEAVER SYSTEM ~ Ye~ No ~ ~
PROPERTIES WITH SUMP PUMPS
When does pump run? ~ Fall ~ Summer Spr'
~ i~ter
(check all that apply) How offen does pump run?
V~here does pump discharge to outside? ~ Front Back ~ Side
NOTES:
SUMP PUMP SYSTEM: ~l PASS ~ FAIL You have 30 days to bring your system into compliance with current
~`• regulations. When you are ready for reinspection, ca11651/644-1469 for an appointment.
Is there another place where clear water enters the sanitary sewer system? O Yes No
Where is this location?
This area w' ee to f ed so the clear ate discharges to the storm sewer system.
I Inspecto~:~-~~~~~_ I ^~-~-~'~ Date: ~D--//-~~_ I
Resident: ,,.a~, ,~~,~~,;~ , ~~,,~,, / Date:
Disclaimer: This~visual inspection is done with'due diligence to find obvious clear water cross-connections
and does not imnlv the structure meets all Citv Codes.
White: Homeowner Yellow: City Pink: HRG
~;,, ,
~~
~\
~
WATER IN BASEMENT (flow over floor) ~ Yes I~'IQ"o CI5TERN ~ Yes
(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 L~l Sanitary sewer t7 Outside
at Inspection: ~ Floor drain ~ Other
Prior to Inspection:
When was system installed, or most recently modified? (Date) and why
~me came with system ~ Response to inspection program ~ Other
~ Water in basement ~~evious system failed
B. ROOF LEADERS:
C. YARD DRAINS
BEAVER SYSTEM
~'"~ ~~
( C'J'~Yes O No DISCHARGE: ~ Near L~''t~way
~ Yes L~'N~o WINDOW WELLS 17 Yes ~-'IQ~o
~ Yes ~f"l~o
D. PROPERTIES WITH SUMP PUMPS ~ _,,.-~-~
When does purnp run? ~ Fall C~umrner ~'''Spring ~ Winter
(check all that apply) How often does pump run? ,~-~',~~r ~ ~~~% k'u :~ S
Wthere does pump discharge to outside? ~ Front Q Back ~ Side
NOTES: .~/C ~ ...S~.r' i.-7`~~`~ -•-•-•---•-•-•------- -•-•-•-•-•- - -•-~-•-•-•--- ----- -•-•--
SUMP PUMP SYSTEM: ^ PASS AIL You have 30 days to bring your system into compliance with current
regutations. When you are ready for reinspection, call 657 /644-1469 for an appointment.
Is there another place where clear water enters the sanitary sewer system? ~ Yes ~'1Q~o
Where is this location?
This area will need to be fixed so the clear water discharges to the storm sewer system.
Inspector: Date: ~'=/ 7 - ~ 9
Resident: Date: - /v1 - % `~
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