HomeMy WebLinkAboutSump Pump Inspection/„ (~ 4~ PRIp~
l~ t~J ~~ ~
U ~
City of Prior Lake
Sump Pump and I/I Reduction
Inspection Form ,q~,~~ ~
Name: ~Cj~~~~ ~~~~i~ ~ Date~ ~ ~~ Time/y~m./p.m.
~J' ` -~ ~~ First In~sp~e ' n l9~" Second ~ ~y
Address: ~ov"Y ~~,~~~ ~~7~ ~/~' Own: L9'~ Rent: Age of Home: ~/
L9' ,
~y ~/ .y~ Residential: ~
Prior Lake, MN 55 ~/~ Phone!y~/"~0~~ Non-Residential: ~
/W w c /c.'~
A. BASEMENT es ~ No SiJMP BAS T~ 0 1~ 2 ~ 3 ~
WATER IN BASKET ~ Yes o SiJMP P 0 Q 1 ~ 2~ ~
WATER IN BASEMENT (flow over floor) ~ 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 O Sanitary sewe~ ~ Outside
at Inspection: I~ F1oor drain ~ Other
Prior to I pection: ~"~~
When s systern installed, or most recently modified? (Date) and why
Home came with system ~ Respo to inspection program ~ Other
~ Water in basement ~ Pre ' us system failed
B. ROOF LEADERS: Yes O No DISCHARGE: Q Near L~Away
C. YARD DRAINS ~ Yes LzJ'~N ~ WINDOW WELLS Q Yes No
BEAVER SYSTEM ~ Yes dYT1o
D. PROPERTIES WITH SUMP PUMPS
When does pump run? ~ Fall ~ Summer ~,.S,pring L7 Winter
(check all that apply) How often does pump run?
V~here does pump discharge to outside? ~ Front I~-~°ack ~ Side
NOTES:
SUMP PUMP SYSTEM: L~PASS ~ FAIL You have 30 days~to bring your system into compliance with current
regulation.s. When you are ready for reinspection, ca[l 651 /644-1469 for an app ' ent.
Is there another place where clear water enters the sanitary sewer system? ~ Yes o
Where is this location?
This area will need to b xe the clea~e~charges to the storm sewer system.
Inspector: ~ ./"~-`~"`" ~"'-'~'"~" Date: ...~ `~ -
Resident: ,z. ~ .-~.~ ~,~,- ~ Date: ~ - Z -
Disclaimer: This visual inspection is done with due diligence to fmd obvious clear water cross-connections
and does not imply the structure meets all City Codes.
White: Homeowner Yellow: City Pink: HRG