HomeMy WebLinkAboutSump Pump Inspectionh I 4~ PRIp~P
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City of Prior Lake
Sump Pump and I/I Reduction
ection Form
Name: O~G ~,~ ~~~/`
..e, %'e' S - ~' •
Address: ~~'`'~~~v ~'~/~,G,~c.J ~ c.S~i~10,r'.E.~'
Prior Lake, MN 554~ ~'~' Phone~~`~~-~'~'a
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Date: '~~'°~~ TimeQ~'~~ a.m./p.m.
._.-__..
First In~s~pfe ~ion ~econd ~ ' /
Own: I~ Rent: Q~.~ Age of Home: ~'7`~
Residential: ~' ~-1
Nc~n-R~sidential: ~
F ~,.C.~t.,v C; ~.. ~- .
A. BASEMENT es ~ No /'~ SiJMP BAS ~ 0 2~ 3 ~
WATER IN BASKET 17 Yes ~"'~io SUMP P ~ 0 1~ 2~L7
WATER IN BASEMENT (flow over floor) ~ Yes No 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 t~Outside
at Inspection: ~ Floor drain O Other
Prior to Inspection: r/
When was s stem installed, or most recentl modified? (Date) f'~~ and why
Y Y
Q me came with system Q Response o inspection program
Water in basement Q Prev' system failed
B. ROOF LEADERS:
C. YARD DRAINS
BEAVER SYSTEM
~ Other
Yes Q N DISCHAR~E: ~
~ Yes ~~"N WINDOW WELLS
~ Yes o
D. PROPERTIE5 WITH SUMP PUMPS
When does pump run? ~ Fall Q Summer
(check all that apply) How often does pump run?
Wrhere does pump discharge to outside? ~ Front
Near way
Q Yes Q No
S n ,,.~ Q Wint r,
~?~7L,~ ~.a~~.f ~>~cio -MEc.T
ack ~ Side
NOTES:
SUMP PUMP SYSTEM: I~ASS I~ FAIL You have 30 days to bring your system into compliance wuh current
regu[ations. When you are ready fo~ reinspection, caU 651 /644-1468 fnr an appo' .
Is there another place where clear water enters the sanitary sewer system? ~ Yes o
Where is this location?
This area will need to ixe s the clear,~atg~j- discharges to the storm sewer system.
Inspector: ~ """~ Date: ~
Resident: . Date: O -
Disclaimer: This ~i~dal insiiection is done with due diligence to find obvious clear water cross-connections
and does not impl_y the structure meets all City Codes.
White: Homeowner Yellow: City Pink: HRG