HomeMy WebLinkAboutSump Pump Inpsection«
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~~ PRI~~ City of Prior Lake
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~ ~ Sump Pump and I/I Reduction
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INNES°`` Inspection Form
ANNUAL CERTIFICATION RE-INSPECTION
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Name: ~ p~~ ; Date: 3 b Time: ~~~J~ ~'pm
Inspection: ^ First ^ Second x T~fi~2,p
Address: '~~YI~-~ ~C~• ~Own ^ Rent Age of Home:
Prior Lake, MN 55372 Phone: ~~~ Residential o Non-Residential
1 p 2 ^ 3
es O No SUMP BASKET ^ 0
A. BASEMENT ^
~
~
WATER IN BASKET Yes. ^ No SUMP PUMP p 0 1 p 2 ^ 3 p
WATER IN BASEMENT O Yes ~ No CISTERN O Yes ~No :
(If no pump, place st~cker across edge of sump cover and basement floor so any removal of cover will break seal. Skip to Part B.) ;
Discharge Point p Laundry tub p Sanitary sewer ~Outside ,
at Inspection: p Floor drai:n ^ Other
Prior to Inspection: ~
When was syster~- installed, or most "recently modified? (Date) and why?
p Home came {with system ^ Response to inspection program p Other
p Water in basement ~Previous system failed _
B. ROOF LEADERS ^: ~Ces p No DISCHARGE ^ Near p Away ;
C. YARD DRAINS p Yes No ~ WINDOW WELLS p Yes p No
BEAVER SYSTEM O 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 to outside? ~ Front O Back ^ Side
NOTES:
SUMP PUMP SYSTEM: ~ PASS O FAIL You hure 30 dByS ~o briiig ynursy.~•len~ imn cno~pliunce wi~h currem
regnla~ia~.x. When yoa are reudy jor re-i~~snrc~inn, cull 952/447-9833 jor m~ nppoinlnienl.
Is there another place where clear water enters the sanitary sewer system? ~ Yes ~No
Where is this location?
This azea will need to be fixed so the clear water disch'arges to the storm sewer system.
Inspect • Date: ~ ~ ~
Resident: Date: ~~ ~~
Disctaimer: 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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(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 I~ Laundry tub ~ Sanitary sewer C3~utside
at Inspection: O 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 O Previous system failed
B. ROOF LEADERS: a Yes ~ No DISCHARGE: ~ Near C~ Away
C. YARD DRAIN5 a Yes (~ No WINDOW WELLS ~ Yes ~ No
BEAVER 5YSTEM I~ Yes ~ No
D. PROPERTIES WITH 5UMP PUMPS
When does pump run? ~ Fall ~ Summer ~ Spring ~ Winter
(check all that apply) How often does pump run?
V~here does pump discharge to outside? ~ront ~ Back ~ Side
NOTES:
SUMP FUMP SYSTEM: ~ASS ~ FAIL You have 30 days to bring your system into compliance with current
regulations. When you are ready for reinspection, cal! 651 /644-1469 for an appointment.
Is there another place where clea~~:~vater enters the sanitary sewer system? ~ Yes Q No
Where is this location?
This area will need to be fixed so the clear water discharges to the storm sewer system.
Inspector: '`-(~, . ~,. .; .~,.~ Date: [/_ .-,1 y 9 9
Residen • „ ,06.,: ;, Date: ~/ .,19 9 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: Hpmeowner Yellow: City Pink: HRG
A. BASEMENT ~ Yes ~ No 5UMP BASKET ~ 0 ~ O 2 ~ 3 ~
WATER IN BA5KET ~ Yes ~1 No SiJMP PUMP l~ 0 C~1 ~ 2 ~ 3 O
WATER IN BASEMENT (flow over floor) Q Yes ~ No CISTERN ~ Yes ~ No
. ~
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(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 aundry tub [~ Sanitary sewer ~ Outside
at Inspection: O Floor drain a Other
Prior to Inspection:
When was system installed, or most recently modified? (Date) and-why
~' Home came with system ~ Response to inspection program Q Other
~ Water in basement ~ Previous syst ailed
B. ROOF LEADERS: ~ Yes o DISCHARGE: ~ Near Q Away
C. YARD DRAINS Q Yes ~~ ~N ~ WINDOW WELLS C~J~Yes Q No
BEAVER SYSTEM ~ Yes a"'No
D. PROPERTIES WITH SUMP PUMPS
When does pump run? O Fall ummer Spring ~ W' ter
(check all that apply) How often does pump run? ~42(Y, ~~~ ~~~
V~here does pump discharge to outside? ~ Front ~ Back ~ Side
NOTES:
SUMP PUMP SYSTEM: ~ PASS AIL You have 30 days to bring your system into compliance with current
regu[ations. When you are ready for reinspection, cafl 651 /644-1469 for an appoi t.
Is there another place where clear water enters the sanitary sewer system? ~ Yes o
Where is this location?
This area will need to b ed he clear ate ' charges to the storm sewer system.
Inspector: ~ Date: - 4~
Resident: _ ._ .~.~ ~ .,....~ Date: ' o -
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 ~-~it'~s__ ~~~" SUMP BA5KET ~ 0 /~~ 2~ 3 ~
WATER IN BASKET ~es Q No 5iJMP P~~ ~ 0 L~'I ~ 2 ~ 3 ~
WATER IN BASEMENT (flow over floor) ~ Yes I~L~Qo CISTERN O Yes Q No