HomeMy WebLinkAboutSump Pump Inspection~~~ PRI~~~ City of Prior Lake
~ ~
U ~ Sump Pump and I/I Reduction
~
jNNE5~~ Inspection Form
ANNUAL CERTIFICATION RE-INSPECTION
Name: ~ ~ ~1~~' ~~
~ddress: ~-~~~ ~~~ l,~lil(C~.
Prior Lake, MN 55372 Phone: ~o
BASEMENT ,~.Yes ^ No SUMP BASKET ^ 0 ^ 1 p 2 p 3 p_
WATER IN BASKET ^ Yes O No SUMP PUMP p 0 ^ 1 p 2 ^ 3 p
WATER IN BASEMENT ^ Yes p No CISTERN O Yes ^ No
(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.)
A.
B.
C.
Discharge Point p Laundry tub
at Inspection: ^ Floor drain
Prior to Inspection:
Date: (i ~ ~ Time: ~ ~pm
Inspection: -o First ^ Second ?~~t~-IIP--~
'~Own p Rent Age of Home: ~~~,
~ Residential ~ Non-Residential
^ Sanitary sewer
^ Other
When was system installed, or most recently modified? (Date} and why?
p Home came with system p Response to inspection program ^ Other
p Water in basement p Previous system failed
ROOF LEADERS ^ Yes p No DISCHARGE p Near ^ Away
YARD DRAINS p Yes ^ No WINDOW WELLS p Yes p No
BEAVER SYSTEM - ^ Yes ^ No
D. PROPERTIES WITH SUMP PUMPS
When does pump run? ^ Fall ^ Summer ^ Spring ^ Winter
(check all that apply) How often does pump run?
Where does pump discharge t~ outside? ^ Front ^ Back ^ Side
NOTES: ._._ ._.~1_~~"._. ~I~-~ ~/._._._._......._._._._._._..._..._._._._._._._._._._._._._._._._._._._._._._._._._._._._._..._._._._._._._._._._._._....._._._._._....._._
SUMP PUMP SYSTEM: "~ PASS ^ FAIL Yo~~ hure 30 deyS ro hring your sy.~•leni iiNO coniplinuce wilh curnn~
re~nilu~iax~•. When you are readY.fnrre-in.~~ec~inn. adl 9521447-9833 j~,r an appoinm~e~ii.
Is there another place where clear water enters the sanitary sewer system? ~ Yes 0 No
Where is this location?
This area will need to be fixed so the cleaz water discharges to the storm sewer systemi-
Inspector:
Resident:
p Outside
Date: (~'~'D j
Date: l~1 ~4 ~~91
I Disclaimer: This visual inspection is done with due diligence to find obvious clear water cross-connections I
and does not imply the structure meets all Citv Codes.
e
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2
A.
B.
C.
BASEMENT ~ Yes ~ No SUMP BASKET ~ 0 O 1 ~ 2 ~ 3 ~
WATER IN BASKET ~ Yes O No SUMP PUMP ~ 0 ~ 1 Q 2 O 3 ~
WATER IN BASEIIZENT (flow o~er #loor) ~ Yes ~ No CI5TERN ~ Yes D No
(If no pump, plaee 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.J'
at Inspection: ~ Floor drain ~ Other
Prior to Inspection:
When was system installed, or most recently modified? (Date) and why
~ Home came with system
~ Water in basement
ROOF LEADERS:
YARD DRAINS
BEAVER SYSTEM
~ Response to inspection program ~ Other
~ Previous system failed
~ Yes ~ No DI5CHARGE: ~ Near ~ Away
~ Yes Q No WINDOW WELLS ~ Yes ~ No
~ Yes ~ No
D. PROPERTIES WITH SUMP PUMPS
When does pump run? ~ Fall Q Summer Q Spring
(check all that apply) How often does pump run?
V~here do ump discharge to outside? ~ Front O Back
NOTES: -•---•- -~-~,-.5 •- --~~ :-".~i~-~~~~~- G ~- - -•------ /C
O pGe ~i O L,~'"
SUMP PUMP SYSTEM: ¢YYA55 Q 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? ~ Yes ~A-i'~"'~
Where is this location?
This area will need to be f d s clear wate isc s to the storm sewer system.
Inspector. , Date:
Resident: „ /~+ ,~ ri 7 _ _ ~'T~! Date: - ~-
Disclaimer: This visual i~nspection is done with due diligence to find obvious clear water cross-connecHons
and does not impl_y the s~+ucture meets all City Codes.
~ Winter
~ Side
------.~
White: Homeowner Yellow: City Pink: HRG
~s _
,.,~: . ;„~~.
.tt
~ , ~ ~~~
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~~~ity ~ ~~~of ~ Pr~or ~Lake
Sump Pump and I/I Reduction
Inst~ection Form
,~ •~ ; -c~~Q /~~~j
Name: ~~r'~'~ r~^-'~ ~~ ~. ~~~'~"` Date~-~">~'~ ~J/ Time•l ~~-fi1./p.m.
, /,y~ ~ /'~~~,.~~ ~ ~ ~ ~ ~ ~r ~' First In~sp~e n ~econd ~ /
Address: ~~~ / ~°~~ Own: ~'" Rent: ~ Age of Home: / ~ ~
~/ ~ Residential: L~/~~ ~
Prior Lake, MN 55~~~' Phon~?' ~~ ~~ l~' ~° Non-Residential: ~
A. BASEMENT l~'~es d A SUMP BASKET O 0 I~~" ~1 2~ 3 ~I
WATER IN BASKET. ~No SUMP P ~~ ~ 0 Q' 1~ 2~ ~~,~''~
WATER IN BASEMENT flow over floor ~ Yes IIYiUCfo CISTERN ~ Yes L-4'No
~ )
(If no pump, place sticker across edge of sump cover and basement r so any removal of cover will
break seal. Skip to Part B of this form.)
Discharge Point Q Laundry tub Sanitary sewer 17 Outside
at Inspection: I~ Floor drain ~ Other
Priar to I pection: _--
When s system installed, or mo st recently modified? (Date) and why
Home came with system I~ Response to inspection program Q Other
Q Water in basement ~ Previous sys failed
B. ROOF LEADERS: ~ Yes No DISCHARGE: ~ Near ~ Away
"
C. YARD DRAINS ~ Yes ~N WINDOW WELLS ~ Yes~
No
BEAVER SYSTEM ~ Yes CtYNo
D. PROPERTIES WITH SUMP PUMPS
When does pump run? ~ Fall ummer S rm ~ Winte )
(check all that apply) How often does pump run? ~~ ~A U ~A /-1/
V~here does pump discharge to outside? ~ Front I~ Back ~' e
NOTES: -•-•~~ ~-•-•~•~-~.----- •=~•~ ~ --- ~ ~C --•-~~---~~ ~ •-•~•~ -~•-----•-
i~ j
,
SUMP PUMP SYSTEM: ~ PASS L Yote have~ days to bring your system into comptiance with current
regulations. When you are ready for reinspection, ca11651 /644-1469 for an appo' ent.
Is there another place where clear water enters the sanitary sewer system? ~ Yes o
Where is this location?
This area will need t fix the cleary/ater~charges to the storm sewer system.
~
Inspector: • £ 4' Date: - 5 "'
Resident: Q ~ ~j' . _ _ _ _ / Date: S - ~ ~'/'
Disclaimer: This visual inspecti n is done with due diligence to find obvious clear water cross-connections
and does not imulv the structure meets all Citv Codes.
White: Homeowner
Yellow: City ; ,
Pink: HRG