HomeMy WebLinkAboutSump Pump Inspection~~~ PRI~~'~, City of Prior Lake
U ~ Sump Pump and I/I Reduction
~
rNNES°`~ Inspection Form
ANNUAL CERTIFICATION RE-INSPECTION
Name: ~ ~~~ ~ Date: ( 8 b ~ _ Time: ~~~~~ ~pm
~_'_'_.,_T -
Inspection: ^ First ~ Second, X T4{12,p _
J
Address: ~~ ~J3U ~t~~~y ~~ ~~• I~' Own ^ Rent Age of Home:
Prior Lake, MN 55372 Phone: ~ Residential ~ Non-Residential
A. BASEMENT '1~Yes O No SUMP BASKET p 0~ 1 p 2 ^ 3 ^
WATER IN BASKET ,~`il Yes ^ No SUMP PUMP p 0 1^ 2 ^ 3 p
WATER IN BASEMENT ^ Yes ~No CISTERN O Yes ~No
(If no pump, place sticker across edge of sump cover and basement floor so any removal of cover wiit break ~eat. Skip to Part B.) `
Discharge Point p Laundry tub p Sanitary sewer `~Q Outside
at Inspection: p Floor drain ^ Other
Prior to Inspection: ~
When was system installed, or most recently modified? (Date) `- and why7"
^ Home came with system ~p Response to inspection program ^ Other 's
^ Water in basement ~I'revious system failed
B. ROOF LEADERS ~ Yes p No DISCHA RGE ^ Near ^ Away; ;
C. YARD DRAINS p Yes ~No WINDOW WELLS ^ Yes ~No ~
BEAVER SYSTEM ^ Yes ~1No
D. PROPERTIES WITH SUMP PUMPS
When does pump run? ^ Fall ^ Summer
(check all that apply) How often does pump run?
~Jhere does pump discharge to outside? O Front
NOTES:
^ Spring O Winter
O Back ^ Side
SUMP PUMP SYSTEM: ~ PASS O FAIL r~,,, nu~~~ sa days ~~, n,,,,x y~»~r.~y.t~~,,, ;,~~~, ~•,,,,~r~~~,»~•~ w;~n ~•u.,~„r
re~Juiio~~s. When you ure ready fnr re-iii.~neainn, ccdl 952/447-9833,/or nn uppoi~uure~a.
Is there another place where clear watec enters the sanitary sewer system? ~ Yes ~ No
Where is this location?
This area will need to be fixed so the clear waterdischarges to the storm sewer system.
Inspector ' Date: ~I V ~I
Resident: ~ ~ Date: J~~ ~
Disclaimer: This visual inspection is done with due diligence to ~nd obvious clear water cross-connections
and does not imply the structure meets all City Codes.
res`~ ~°~°Y ma.~~ '~a .~v
:''.~~
r~+
~• ' i
,.
i
(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
at Inspection:
~ Laundry tub ~ Sanitary sewer ~ Outside
O Floor drain ~ Other
Prior to Inspection:
When was system installed, or most recently modified? (Date)
and why
17 Home came with system ~ Response to inspection program ~ Other
O Water in basement ~ Previous system failed
B. ROOF LEADERS: ~ Yes (~ No DISCHARGE: ~ Near ~ Away
C. YARD DRAINS ~ Yes ~ No WINDOW WELLS ~ Yes ~ No
BEAVER SYSTEM O Yes ~ No
D. PROPERTIES WITH SUMP PUMPS
When does pump run? ~ Fall ~ Summer l7 Spring ~ Winter
(check all that apply) How often does pump run? ;
Where does pump discharge to outside? Q Front I~ Back ~ Side
NOTES: ~---~ iP ~-----•~-~-~•-•-•~~ •-•-•-•-•~•-•-•-•-~G ~ ~c ----~-/ c/' --Q ~; ------ ~ u 1 P -•-•-•-
/ V (~_
SUMP PUMP SYSTEM: PASS ~ FAIL You have 30 days to bring your system into compliance with current
regulaao~rs. When you are ready jor reirupection, ca[[ 651 /644-1469 for an appointment.
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: ..~,. ~1---1~=-~:~ Date: _.,,l~ /.,1 9y
Resident: , ~,b /, Date: ! _ /„1 - 9 y
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 ~Yes ~ No 5UMP BASKET ~ 0~ 1 ~ 2 ~ 3 ~
WATER IN BA KET ~ Yes ~ No 5UMP PUMP ~~ 1 ~ 2 ~ 3 ~
WATER IN BASEMENT (flow over floor) d Yes ~ No CI5TE ~ Yes ~ No
r,r;. _~ . , •,'.r.. ~ ! f
,.A .
a~"
~~
~U
~
~
City of Prior Lake
Sump Pump and IiI Reduction
Inst~ection Form
,~J~~'r
~' ,~!~/ ~,~,/
-~ 0 ~
Name: l,~ o~ // ~/ ~'L' ~/~~ Date: %~ r~~ Tim~z-3 ~a.m./p.m.
s~
~~ ~~~~2 / ~ First Inspe 'on L9-~ond ~ 2 /
Address /~~ ~/~.D Own: Rent: Age of Home: ~A
Residential: ~ ~
Prior Lake, MN 55 ~~~ Phone'`~~7 //O ? Non-Residential: ~
A. BASEMENT [9'Yes~~~ SUMP BASKET d 0 ~ 2 D 3 ~
WATER IN BASKET es [7 No SiJMP PiJM O 0 1~ 2 ~ 3
WATER IN BA5EMENT (flow over floor) ~ Yes CISTERN O 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
at Inspection:
Prior to Inspection:
When was system installed, or most recently modified? (Date)
and why
~ Home came with system ~ Respons to inspection program ~ Other
~ Water in basement ~ Pr ' us system failed
B. ROOF LEADERS: Yes ~ N DISCHARGE: Q Near way
C. YARD DRAINS ~ Yes N~~ WINDOW WELLS Q Yes ~~No
BEAVER SYSTEM ~ Yes ~~~iVo
D. PROPERTIES WITH SUMP PUMPS
When does pump run? ~ Fall urrun ~r ~~~~ ~ Wint
(check all that apply) How often does pump run. A~
V~here does pump discharge to outside? 17 Front ~C~ ~ Side
- ~-.-.--.
NOTES: ~ S
~ Laundry tub 17 Sanitary sewer utside
~ Floor drain ~ Other
---•~-•-------•-•- -• • •-~•-•-•-•-•-•-•-•-•-
- --~ s-- f„~ ~.X - -c _ ~ _ _.Q. u ~S~ ~
5UMP PUMP SYSTEM: ~ PASS Q~/F~IL You have 30 days to bring your system into comp[innce 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? O Yes
Where is this location?
This area will need to fix so the clea~ter i~harges to the storm sewer system.
.
u-~- ~•,....,._,.,.-
Inspector: _....--~ Date: - ~
Resident (~, A,,-"`~"" 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
Y
•r