HomeMy WebLinkAboutSump Pump InspectionL
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~Q ~ City of Prior Lake
S Pu d I/I R d '
ump mp an e uction
Inspection Form
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.~ - ~ Time• m./p.m.
Name: Date: /- r O .~7~~
,~' First Inspe tion Q' Second ~ ~y
Address: ~~•~~~ /`"~/~S'~ ~f ~.D ~ ~ Own: ~Rent: ~ Age of Home: ~ /L
Residential: ~ J
Prior Lake, MN 55~7Z' Phone:'j~~~~~~Z~ Non-Residential: ~
A. BASEMENT Q'Yes la No~ SUMP BASKET ~ 1 ~ 2 ~ 3 ~
WATER IN BASKET ~ Yes o SiJMP~y~~ 0 Q 1 ~ 2 ~~/~
WATER IN BASEMENT (flow over floor) a Yes o CISTERN O 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.)
B.
C.
D.
NOTES:
Discharge Point
at Inspection:
Prior to Inspection:
When was system insta.lled, or most recently modified? (Date)
and why
Q Home came with system ~ Response to inspection program ~ Other
~ Water in basemen ~. Pr~' s system failed
'~I q ~~-- ~ ~/~
ROOF LEADERS: ~~' es ~ No DISCHARGE: ~ Near L~way
YARD DRAINS 17 Yes ~~ ~ WINDOW WELLS I~Yes ~ No
BEAVER SYSTEM L7 Yes @~1Vo
PROPERTIES WITH SUMP PUMPS
When does pump run? ~ Fall O Summer ~ Sprin~,,., D Winter
(check all that apply) How often does pump run?
V~here does pump discharge to outside? ~ Front ~ Back ~ Side
SUMP PUMP SYSTEM: CYPASS O FAIL You have 30 days to bring your system into compliance with current
regulations. When you are ready for reinspection, call 651/644-1469 for an ap ' era.
Is there another place where clear water enters the sanitary sewer system? Q Yes o
Where is this location?
This area will need to b~r ed~he clear~~harges to the storxn sewer system.
Inspector:
Date:
Date:
,_~,,_~.~
Disclaimer: This visual inspection is done with due diligence to find obvious clear water cross-connections
and does not imply the structure meets all Cit_y Codes.
~ Laundry tub L~ Sanitary sewer`. ~ Outside
O Floor drain ~ Other
White: Homeowner Yellow: City Pink: HRG
~.;; ~,> ('~a ~~4 ~~,~~5~~~ ~-~`
A. BASEMENT ~ Yes t~A1o SUMP BASKET ~ 0 ~ 1 ~ 2 ~ 3 CI
WATER IN BASKET O Yes I~ No SL1MP PUMP 1~ 0~ 1 a 2 ~ 3 O
WATER IN BASEMENT (flow over floor) ~ Yes ~ No CISTERN ~ 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 I~ Laundry tub ~ Sanitary sewer ~ Outside
at Inspection: ~ Floor drain ~ Other
Prior to Inspection:
When was system installed, or most recently modified? (Date) and why
D Home came with system
Q Water in basement
B. ROOF LEADERS:
C. YARD DRAINS
BEAVER SYSTEM
~ Response to inspection program ~ Other
~ Previous system failed
~ Yes ~ No DISCHARGE: ~ Near ~ Away
Q Yes 1~ No WINDOW WELi.S ~ Yes Q No
L7 Yes ~, No
D. PROPERTIES WITH SUMP PUMPS
When does pump run? ~ Fall ~ Summer ~ Spring ~ Winter
(check all that apply) How often does pump run?
V~here does ump discharge to outside? ~ Front ~ Back ~ Side
.---•-•-•-•-•-•- - - ---•-•-•- -•- -•- -•-•-•-•- -•- -;- - ,- ----- -•-----._.-----•-•-•---•-•-•-•-•-•-•-•-
NOTES: -r'
SUMP PUMP SYSTEM: ~ PASS 17 FAIL You have 30 days to bring your system into compliance with current
regu[adons. When you are ready for reinspection, call 651/644-1469,r'or an appointment.
Is there another place where clear water enters the sanitary sewer system? a Yes ~ No
Where is this location?
This area w' ne~ to be~xed so the clear wa~er~ischarges to the storm sewer system.
Resident:
Date: ~
Date:
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