HomeMy WebLinkAboutSump Pump Inspection~~ PRI~1P City of Prior Lake
~ c''
~ ~ Sump Pump and I/I Reduction
~
rNNEs°`~ Inspection Form
ANNUAL CERTIFICATION RE-INSPECTION
Name: ~~~~~~y~ Date: _~ I I I I~ /~_~ Time: ~`~ ,~ am/~
~' ~
Inspection: ^ First ^ Second x~{~~
Address: ~~p'~~ ~~~ ~-/ ~ Own ^ Rent Age~of Home:
Prior Lake, MN 55372 Phone: ~~~~ ~ Residential ~ Non-Residential
A. BASEMENT ~[ Yes O No SUMP BASKET ^ 0 ~j 1^ 2 ^ 3 ^
WATER IN BASKET O Yes ~ No SUMP PUMP p 0 ~g 1^ 2 ^ 3 p
WA'~ER Il~ BASEMENT O Yes ~ No CISTERN ^ Yes ~ No
(If no pump, pl~ce sticker across edge of sump cover and basement floor so any removal of cover will break seal. Skip to Part B.)
Discl~arge Point ^ Laundry tub p Sanitary sewer ~ Outside
at Inspection: p Floor drain p Other
Prior to Inspection:
When was system installed, or most recently modified? (Date)
^ Home came with system ^ Response to inspection program
^ Water in basement ~ Previous system failed
B. ROQF LEADERS ~ Yes p No DISCHARGE
and why?
~ Near ^ Away
C. YARD DRAINS ^ Yes ~No WINDOW WELLS ^ Yes ^ No
BEAVER SYSTEM ^ Yes ~No -
D. PROPERTIES WITH SUMP PUMPS
When does pump run? ^ Fall O Summer
(check all that apply) How often does pump run?
Where does pump discharge to outside? ' O Front
NOTES:
O Spring O Winter
^ Back ^ Side
SUMP PUMP SYSTEM: ~ PASS ^ FAIL You hure 30 deys lo bring your ay.+•leni inlo complicnice wifh cnrrenl
reg+dulim~.s. Whes you ure ready fi~r re-in.~neciinn, cul! 952144I-9833./i~r rni nppninin~en/.
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: ~
Resident: Date:
Disclaimer: This visual inspection is done with due diligence to fiad obvious clear water cross-connections
and does not imply the structure meets all City Codes.
p Other
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A. BASEMENT ?~ Yes ~ No SUMP BASKET ~ 0~ 1 ~ 2 Q 3 ~
WATER IN BA`SKET 17 Yes ~ No S P P P ~ 0 1~ 2 ~ 3 ~
~
WATER IN BA5EMENT (flow over floor) ~ Yes No CISTERN a 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 of this form.)
Discharge Point ~ Laundry tub ~ Sanitary sewer ~ Outside
at Inspection: ~ Floor drain ~ Other
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
B. ROOF LEADERS: ~ Yes ~ No DISCHARGE: ~ Nea~ Away
C. YARD DRAINS ~ Yes~ No WINDOW WELLS ~ Yes ~ No
BEAVER SY5TEM ~ Yes~No
D. PROPERTIES WITH SUMP PUMP5
When does pump run? ~ Fall C7 Summer D Spring ~ Winter
(check all that apply) How often does pump run? ~
V~here does pump discharge to outside? ~ Front Q Back Side
NOTES:
regulat~ons. When you are ready for reuupechon, ca[[ 651 /644 469 for an appotntment.
Is there another place where clear water enters the sanitary sewer system? ~ Yes No
Where is this location?
This area w' ne~e to b~ed so the c~ar ater di charges to the storm sewer system.
;
SUMP PUMP SYSTEM: ~ PASS ~ FAIL You have 30 days to bring your system into comp[iance with current
I Inspec r: '' ~`• Date: ~-~~~ ~ I
Reside~\: , _.,,.-~'''' Date: l~-~- Q~f
Reduction
I Disclaimer: This visual inspection is done with due diligence to find obvious clear water cross-connections I
and does not imnly the structure meets all City Codes. ~
White: Homeowner
Yellow: City
Pink: HRG
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City of Prior Lake
Sump Pump and I/I Reduction
ction Form
Name: _..:%~~./a h ~,-?n } ~ ~~ ~~' ~- ~/~-~ ~,'~
Address: ~'~~ b ~ ~~ 7~~',: ..:,-{ . : ~
Prior Lake, MN 55 ,_',~?~~ Phone: 4/tjv - S~? l
Date: ~ f~- y9 Time: / oc~a.m./p.m.
First Inspection ~~'' Second ~
Own: C~''"Rent: ~ Age of Home: /~~.
Residential: ~"
Non-Residential: ~
L,. o ~,n.irf 4 ~
A. BASEMENT ~~ No 5UMP BA5KET ~ 0 I~'f D 2 ~ 3 ~
WATER IN BASKET ~s ~ No SUMP PUMP ~ 0 I~ ~ 2 ~ 3 ~
WATER IN BASEMENT (flow over floor) ~ Yes L~-I'~b CISTERN ~ Yes la#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 ~undry tub ~ Sanitary sewer Q Outside
at Inspection: ~ Floor drain ~ Other
~
Prior to Inspection:
When was system installed, or most recently modified? (Date) and why
C~' Home came with system ~ Response to inspection program ~ Other
~ Water in basement ~ Previous system failed
B. ROOF LEADERS: C~Yes ~ No DI5CHARGE: ~ Near way
C. YARD DRAINS - WINDOW WELLS O'
~ Yes l~
'
iQo Yes ~
BEAVER SYSTEM ~
~
-
~ Yes C~"No
D. PROPERTIES WITH SUMP PUMPS ~ ~-~
'
When does pump run? ~ummer ~ring
~ Fall C~3 ~ Winter
(check all that apply) How often does pump run? /~-~»- ,~ u ~c' ~ y
V~here does pump discharg e to outside? ~ Front Q Back ~ Side
NOTES:
SUMP PUMP SYSTEM: ~ PASS AIL You have 30 days to bring your sy ' ce with current
regulations. When you are ready for reinspection, c[ 651 /644-1469 f an appoinhnent.
Is there another place where clear water enters the sanitary sewer system? O Yes ~3'1~0
Where is this location?
This area will~eed„~ be fixed so the clear water discharges to the storm sewer system.
I Inspector: _U..~I /l-v~J,,,14•-,-s _ Date: ~'= /~- 5 9 I
Resident: ,.f', Date; ~- /..T ~ y'S
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