HomeMy WebLinkAboutSump Pump Inspection~~ a~ PRro~
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City of Prior Lake
Sump Pump and I/I Reduction
ion Form
Name: ~ ~~ ~~~ ~ ~~ ~ Date~ ~a "gJTime~~,~Qa.m./p.m.
~~ ~
~~, ~ ~ / First In.sp~ 'on ~-''Second ~ O
Address:~~~~~j".~~ ~~/~ ~ Own: ~ Re`n~t: Age of Home. ~
~y~ ~/~/r~ ~y,~f /I~esidential: Q' ~
Prior Lake, MN 5~ /~ Phone: ~` "T /'~/ ~ 7~ Non-Residential: ~
~.vl.v,~;•c., /`.~- '
A. BASEMENT ~'Yes~ Q ~o SUMP BASKET ~ 0 ~ 2 ~ 3 ~
WATER IN BASKET LZYYes ~ No SUMP~P~~ ~ 0 1~ 2~ ~~'' Q
WATER IN BASEMENT (flow over floor) ~ Yes ~No CISTERN O Yes I~IQo
(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.)
Di Point ~ Laund tu O Sanita sewer OC9'' utside
scharge ry b ry
at Inspection: Q Floor drain t7 Other
Prior to Inspection:
When system installed, or most recently modified? (Date)
Home came with system ~ Response to inspec 'on program
~ Water in basement Q Previous sys ailed
~ Other
and why
B. ROOF LEADERS: ~ Yes N DISCHARGE: ~ Near 17 Away
C. YARD DRAINS ~ Yes WINDOW WELLS ~ Yes No
BEAVER SYSTEM ~ Yes No
D. PROPERTIES WITH SU MP P
When does um run?
P P Fall ummer rin
P g
2~ ~'- ~~ inter
8~i»
D~
ES/AA
y
7
(check all that apply) How often does pump run? ~q F~~ p ~~ --
~
Where does pump discharge to outside? ~ Front ~ Back Sid
NOTES:
SUMP PUMP SYSTEM: I~''PASS C1 FAIL You have 30 days to bring your system into compliance with curre
regu[ations. When you are ready}'or reinspection, call 6511644-1469 for an ntmera.
Is there another place where clear water enters the sanitary sewer system? Ca Yes o
Where is this location?
This area will need to be f d s clear wate isc ges to the storm sewer system.
Inspector: Date: " ~ `
Resident: Date: " ~ '
Disclaimer: This visual inspection ~s done th due diligence to f'md obvious clear water cross-connections
and does not imul_y the structure meet City Codes.
White: Aomeowner Yellow: City Pink: HRG