HomeMy WebLinkAboutSump Pump Inspection~~ PRI~~ City of Prior Lake
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~ ~ Sump Pump and I/I Reduction
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fNNES°`` Inspection Form
ANNUAL CERTIFICATION RE-INSPECTION
Name: ~;~~;1~' Date: ~ f~ Time: ', (~ a~pm
Inspection: ^ First o Second 'X ~-flf~~
Address: y" ~ J`'f l,E~ I U rG~I b ~~{ .~' Own ; p Rent Age of Home:
Prior Lake, MN 55372 Phone: d-~ ~(~!~ Residential ~ Non-Residential
A. BASEMENT ~'Yes ^ No SUMP BASKET ^ 0'~(1 p 2 ^ 3 ^
WATER IN BASKET ^ Yes ^ No SUMP PUMP ^ 0 ~ 1 p 2 ^ 3 ^
WATER IN BASEME NT ^ Yes ~ No CISTEI~N ^ Yes ~No
(If no pump, place sticker across edge of sump cover and basement f3oor so any removal of cover will break seal. Skip to Part B.)
Discharge Point ^ Laundry tub ^ S~nitary~sewer ~ Outside
at Inspection: p Floor drain ^ Other
Prior to Inspection: ~
When was system installed, or most recently modified?,_ (Date) _
^ Home came with system p Response to inspection program
^ Water in basement ~ Previous system failed
B. ROOF LEADERS p Yes p No
C. YARD DRAINS ^ Yes ~j'No
BEAVER SYSTEM O Yes `~No
^ Other
and why?
DISCHARGE p Near p Away
WINDOW WELLS ^ Yes ^ 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 ^ Side
SUMP PUMP SYSTEM: ~PASS O FAIL Yon hure 30 d~ys ro hring yn~ir.~ya~ie~n i~un complim~ce wilh currenr
regrdulio~ar. When yot~ ure reudy firr re-insreclion. cn// 952/447-9833.j~,r ~,,, ~,~~~,~,n„~e„i.
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 cleaz water discharges to the storm sewer system.
Inspector: P Date: 1~ ~~ I 0 ~
Resident: Date: I ~II6~v I
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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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A. BASEMENT ~s ~ I~,o SiJMP BASKET ~ 0 IaiP"~ ~ 2 ~ 3 ~
WATER IN BA5KET ~s ~ No SUMP PUMP ~ 0 ir~'i""~~ 2~ 3 ~
WATER IN BASEMENT (flow over floor) ~ Yes I~'1~ CISTERN ~ Yes t~-P~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 ~ Laundry tub ~ Sanitary sewer 4"C~utside
at Inspection: ~ Floor drain ~ Other
Prior to Inspection:
When was systern installed, or most recently modified? (Date) ~~~ and why
~ Home came with system Q R~e ponse to inspection program ~ Other
~ Water in basement 9~'Frevious system failed
B. ROOF LEADERS: ~ Yes t7~ DISCHARGE: ~ Near t7 Away
C. YARD DRAINS ~ Yes E~''No WINDOW WELLS ~ Yes b7~
BEAVER SYSTEM ~ Yes ~J•~Qo
D. PROPERTIES WITH SUMP PUMPS
When does pump run? ~ Fall L9'~r~ummer I~~ing 17 Winter
(check all that apply) How often does pump run? ~~ ~,.~ ('~ t h ~
V~here does pump discharge to outside? ~ Front ~ck ~ Side
NOTES:
SUMP PUMP SYSTEM: Q.~'SS O FAIL You have 30 days to bring your system into compliance with current
regulations. When you are ready for reinspection, ca[! 651/644-1469 for an appointment.
Is there another place where clear water enters the sanitary sewer system? ~ Yes ~7•~~"~
Where is this location?
~This area will need~o be fixed sg the clear water discharges to the storm sewer system.
Inspector;
Date:
Date:
r`~
Disclaim~visual inspection is done with due diligence to find obvious clear water cross-connectrons I
and does not impl_y 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
Inst~ection Form
,1 ~
Name: ~ /`~"~ti ~~ ~~.~.~C .~ Date,z~'.~~ ~~ Time~J Da.m./p.m.
1/ , /, First Ins~pe 'on ~' Second ~
Address: `~~~'7' (..~. ~~-~~~ ~~) ~7 S~ Own:`~ Rent: ~_ Age of Home:~~
Residential: ~~ ~ f
Prior Lake, MN ` 55 3~~. Pl~one: ~e -7~~J ~ Non-Residential: ~
A. BASEMENT L~'Yes ~ No ~'' 5UMP BASKET ~ 0 19~1 Q 2 ~ 3 ~
WATER IN BASKET I~ Yes ~o SUMP -PiJM~'''~ 0 Q~~~ 2JQ ~3
WATER IN BASEMENT (flow over floor) ~ Yes ~O CISTERN ~ Yes Q~~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 ~ Laundry tub ~ Sanitary sewer L9"Outside
at Inspection: ~ Floor drain L~ Other
Prior to Inspection:
When was system installed, or most recently modified? (Date) A ~ and why
~~~~~ ~e came with system ~ Response to inspection program ~ Other
~ Water in basement ~ Previous sys failed
ROO RS• ~ Y ~" N : DISCHARGE: O Near ~ Awa
B. F L E A D E . e s o y
C. YARD DRAINS Q Yes L9'N/o WINDOW WELLS ~s ~ No
BEAVER SY5TEM 17 Yes [~fto
D. PROPERTIES WITH 5UMP PUMPS ~ ~ ,_,,.~'`~~~
When does pump run? D Fall l~ummer SCl pring ~ W' er
(check all that apply) How often does pump run? ~T~t~. Av ,~a 1~
V~here does pump discharge to outside? O Front ck Side
NOTES: ~ES ~~45 ~L~~ ~lds~ ~v OU7S1,D~ -•-•-•-•-•---•---•-----•-•-•-•-•-•-•-
SUMP PUMP SYSTEM: ~ PASS 6YFAIL You have 30 days to bri our system compliance with current
regu[ations. When you are ready for reinspecti call 651/6 1469 for an appointment.
Is there another place where clear water enters the sanitary sewer system? ~ L~"1'~0
Where is this location?
This area will need ~ fi~ so the cl~ v~ter discharges to the storm sewer system.
Inspector• ~'~Q~~~~,~`~ ~~ Date: Z- Z S-
Resident~.~ 9 ~_ Date: Z- Z 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