HomeMy WebLinkAboutSump Pump Inspection(~ QF PR.~p
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City of Prior Lake
Sump Pump and I/I Reduction
Name:~~~~~~~
Inspection Form ,Q~,~ J 7'
U ~~f•~ ~ Dat~~~'~/ Time~~~Da.m./p.m.
,.~~ ~ /~~~~Q~~ ~T ~~,,, First Inspec n econd ~
Address: ~~ ~•~ Own: Re~nt: ~/ Age of Home:~~ ~S
~ ~~ ~ /3 Residential: I~~
Prior Lake, MN 55 ~.~ ~i~ Phone. ~ ~~D Non-Residential: ~
A. BASEMENT ~s ~ No /' SUMP BASKET ~''l'~~.~Q' 1~ 2 ~ 3 Q
WATER IN BASKET ~ Yes ~]~l~0 5iJMP PIJM A~0 l7 1 O 2~
WATER IN BASEMENT (flow over floor) O Yes o CISTERN ~ 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 ~ Laundry tub ~ Sanitary sewer ~ Outside
at Inspection; L'~ 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
~ Water in basement ~ Previ system failed
V''
B. ROOF LEADERS: ~~i~~ ~ es Q No DISCHARGE: ~ Near ~ Away
C. YARD DRAINS ~ Yes Q~'N~~ WINDOW WELLS ~ Yes Q~'No
BEAVER SYSTEM Q Yes GYNo
D. PROPERTIES WITH SUMP PUMPS
When does pump run? ~ Fall ~ Summer ~ S~.-~ ~ Winter
(check all that apply) How often does pump run?
Wthere does pump discharge to outside? L~ Front ~ Back ~ Side
NOTES: ~.
SUMP PUMP SYSTEM: ~~ASS ~ FAIL You have 30 days to bring your system into compliance wuh current
regutations. When you are ready for reinspection, caU 651 /644-1469 for an appo~.
Is there another place where clear water enters the sanitary sewer system? O Yes ~'No
Where is this location?
This area will need to ixe~-s~the clear/vv ate~charges to the stortn sewer system.
I Inspector: ~ '/G~`~ ''`~---~'' Date: ti%GU' ~7 I
Resident: n . ~~t ~ Date: 4--~
Disclaimer: This visual inspection is done with due diligence to find obvious clear water cross-connections
and does not imulv the structure meets all City Codes.
White: Homeowner Yellow: City Pink: HRG