HomeMy WebLinkAboutSump Pump Inspection~ ~--~ dF PRI p
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City of Prior Lake
Sump Pump and I/I Reduction
Inspection Form ,~~ f-~
Name:~~~~~~/~~;~/~1f~; ~~~~~5 Date~ %2 ~,~ Timel~'`~~.m./p.m.
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~~~~ ~~~ ! l~ ~~,,~ First Inspe ' n ~cond ~ , /~
Address: ~, /q~ /~ Own: Rent: ~ ge of Home:'~f ~
r~ ,~ /~/ ,~ Residential: ~
Prior Lake, MN 55~ /~ Phone:I""~`~i~~!y-~ Non-Residential: d
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A. BASEMENT es ~ No ~ SUMP BASKET ~ 1 ~ 2 ~ 3 ~
WATER IN BASKET ~ Yes o SUMP P~ 0~ 1 ~ 2 ~
WATER IN BA5EMENT (flow over floor) ~ Yes L~1'No CI5TERN ~ 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 C'~ Sanitary sewer ~ Outside
at Inspection: a Floor drain ~ Other """~
Prior to Inspection:
When was system installed, or most recently modified? (Date) and why
~ Home came with system ~ Response to inspection program ~ Other
~ Water in basement ~ Previ ystem failed
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B. ROOF LEADERS: e~~ ~ es Q o DISCHARGE: ~ Near way
C. YARD DRAINS ~~G ~ es ~~ N/o ~ WINDOW WELLS ~ Yes o
BEAVER SYSTEM ~ y ~ ~ Yes ~~o
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D. PROPERTIES WITH SUMP PUMPS
When does pump run? O Fall O Summer ~ Spring ~ Winter
(check all that apply) How often does pump run? ----
V~here does pump discharge to outside? I~ Front ~ Back O Side
NOTES: T ~
SUMP PUMP SYSTEM: L~"PASS ~ FAIL You have 30 days to bring your system iruo compliance wuh current
regulations. When you are ready for reinspection, ca[1651/644-1469 for an ra.
Is there another place where clear water enters the sanitary sewer system? O Yes o
Where is this location?
This area will need to b xe the clea wat ischarges to the storm sewer system.
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Inspector:
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
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