HomeMy WebLinkAboutSump Pump~~ pRI~~' City of Prior Lake
~ ~
~ ~ Sump Pump and I/I Reduction
~
lNNE5~~ Inspection Form
ANNUAL CERTIFICATION RE-INSPECTION
Name: T~ 4' ~ 1.~r1.r ~e ~
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Address: ~~ C~ ``fJ ~C./ I~/~
Prior Lake, MN 55372 Phone: -11~
Date: ~~ 1 ~ ~!~ Time: ~~am/~.
Inspection: ^ Fzrst ^ Second ~ (~
^ Own p Rent Age of Home:
~ Residential ~ Non-Residential
A.
B.
BASEMENT ~Yes O No SUMP BASKET p 0 ^ 1 ^'2 ^ 3 p
WATER IN BASKET ^ Yes O No SUMP PUMP p0 ^ 1 p:2 ^ 3 ^
WATER IN BASEMENT ^ Yes p No CISTERN O Yes 0 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 J
t
Discharge Point ^ Laundry tub ^ Sanitary sewer ~ Outside
at Inspection: p Floor drain p Other
Prior to Inspection: t
~
When was sqstem installed, or most recently modified? (Date) ` " and why?
^ Home came with system p Response to inspection programt p Other
^ Water in basement ^ Previous system failed
ROOF LEADERS ^ Yes ^ No
C. YARD DRAINS ^ Yes ^ No
- BEAVER SYSTEM O Yes ^ No
DISCHARGE ; p Near p Away
WINDOW WELLS ^ Yes p No ~
D. PROPERTIES WITH SUMP PUMPS
When does pump run? ^ Fall ^ Summer
(check all that apply) How often does pump run?
Where does pump discharge to outside? ^ Front
NOTES:
^ Spring ^ Winter
~ Back O Side
; SUMP PUMP SYSTEM: ~ PASS ~ FAIL Y01! HGYL' 3O (I8~/S !O AYli7j,' y01IY.fJ~BlBlll %fll0 CO/If~lUOl7CB WI/II G7IIIC'Iil
regala~ions. Whr~i yov nre ready jor re-insneclinn, cnll 952/447-9833,/or mi nppniidu~eui.
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: Date: ~~~~ 2- ~~ ~
Resident: (/ CeM. \ Date: ~~/ ~ Z-' ~~
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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C~ity of Pr~~or Lake
Sump Pump and I/I Reduction
Inst~ection Form
~
Name: ~P ~'C ~~ ~+~-,~"~ fil,r~ w,~,~: ~ D~ r' 1 P v~ ~
Address: l~ 7 Q r ~'~ ~~ v t. ~VJ
~
Prior Lake, MN 55 7~ Phone: ~/~~ ~- 7~,~ ~
Date: 6- I- 99 Time: ~!J 4 a.m./p.m.
First Inspection~r Second ~
Own: L~ Rent: ~ Age of Home:~
Residential: ~''
Non-Residential: ~
~~ ~ ~ ~~~ ~
A. BASEMENT I~Yes ~ No SiJMP BASKET Q 0 I~ 1~2 ~ 3 O
WATER IN BA5KET I~ Yes L~'N~o SIJMP, PUMP ~ 0 Q 1 I'J'~2 ~? 3 O
WATER IN BASEMENT (flow over floor) ~ Yes I~o CI5TERN ~ Yes L~'TQ"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.)
. .~T~
Discharge Point ~ Laundry tub ~ Sanitary sewer ~ Outside
at Inspection: ~ Floor drain ~ Other
Prior to' Inspection:
y ~) When wa`'js s stem ins lled or most recently modified? (Date)_
~K"'! uH Ln/. ~;;~/e-1/ ~~wy~C. ~/~~w~.~ .
~ .e'" Home came with system ~ Response to inspection program
~~Water in basement ~ Previous system failed
~ ~ .•,
f)v, .~, ,f~ dn ~~ J~~(' v,,,K.J ~ a' ~'~i. fl G~ ~/ -i~ i'~S ~ 1~
~ Other
and why
B. ROOF LEADERS: ~es ~ No DISCHARGE: Q Near ~way
,.. __.;:
C. YARD DRAINS ~ Yes ~io WINDOW WELLS ~ Yes C~'iQo
BEAVER SYSTEM ~' Yes t~io
D. PROPERTIES WITH SUMP PUMPS
When does pump run? ~ Fall ~ Summer ~ Spring ~ Winter
(check all that apply) How often does pump run? ~•~ ~,.//y ~ r/r'' `~_ ~J. .= ~`~P
V~here does pump discharge to outside? Q~ront ~' ~ Back Side ~~`, .: :~ P
~
NOTES:
SUMP PUMP SYSTEM: D'YASS Q FAIL You have 30 days to bring your system into compfiance with current
regulations. When you are ready far reinspection, call 651/644-1469 for an appointment.
Is there another place where clear water enters the sanitary sewer system? ~ Yes L~''l~fo
Where is this location?
This area will need to be fixed so the clear water discharges to the storm sewer system.
Inspector: ~ Date: - y~ S y
Resident: Date: ~ - p - ~ 9
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: Ciry
Pink: HRG
.~
r.,;? ,
~ :.
,2~~ 130~ ioJ ,~~o~~o~ ~ o
~ity of Pr~or Lake
Sump Pump and I/I Reduction
Insnection Form
., , ; , -) ~~-'
Name: .~i~,.~~~~/~ ~ f`! `~.~:~JCJ~C'.- Dafie:~~..~-~~ Tim~'~~a.m./p.m.
..~- -~ First Inspection ~cond ~ .^
Address:~~' ~~~ ~~~ ~/~ .~C~ Own: 19~"'"Rent: ~ Age of Home:
Residential: L~~
Prior L ke, MN 55....~ ~~ Phone~~~~ ~r~ ~ Non-Residential: Q
_~ ~~~~~?~~ ~f '
A. BASEMENT es ~ " SUMP BASKET ~ 0 ~~ ~2~ 3 ~
WATER IN BASKET es ~ No SUMP P~ ~ 0 Q'' 1~ 2 Q 3 ~
WATER IN BASEMENT (flow over floor) ~ Yes L~#' N o CISTERN ~ Yes ~1.~6~
(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 tu6 ~'Sanitary sewer -~ Outside
at Inspection: ~ Floor drain ~ Other
and why
~ Other
~ Near A@~ wa
Y
r
~
C. YARD DRAINS ~ Yes ~ WINDOW WELLS ~~ No
BEAVER 5YSTEM ~ Yes No
D. PROPERTIES WITH 5UMP PUMPS~ /~~
When does um run? ~ Fall ~~'~ummer rin `~ ' ter
P P
(check all that apply) How~ often does pump run? ~~C~ r~ ~~~ ~~C ~~
V~here does pump discharge to outside? ~ Front ~ Baek O Side
NOTES:-------'~V-~•-•---.7-= ~~7 ~J -•-•~---~.-~ •-•3----•-------•-•-•-----------•-•-•-•-•-•-•-•-
s o ~-~
SUMP PUMP SYSTEM: Q PASS AIL You have 30 days to bring your system into compliance with current
regulations. When you are ready jor reinspection, call 651 /644-1469 for an appoi .
_,«.....
Is there another place where clear water enters the sanita sewer system? ~ Yes o
Where is this location? E'G~- ~~3 -~/ 7
This area will need to be fi so ar water d' ar to the storm sewer system.
Inspector: i Date: ~ 3U ~
Resident: . ,: ; r ~ u~-~; 1" Q~ r~ Date; 3- O~
Prior to Inspection:
When was system installed, or most recently modified? (Date)
O~Home came with system I~ Respo o inspection program
Q Water in basement ~ Pr 'ous system failed
B. ROOF LEADERS: Yes ~ No DISCHARGE:
~
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