HomeMy WebLinkAboutSump Pump Inspection~F PRI~~
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City of Prior Lake
Sump Pump and I/I Reduction
Ins~ection Form
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Name: ;~~~~~L,~ ~v R,~~'. ~
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Date:~~-~~ Time~63~.m./p.m.
n,/~ ~ ~~First Inspe~tion B~'" Second ~
Address:~~~`/ 9.1-~~~N~ ~/~~~~~ Own: ~'"~Rent: ~ Age of Home:2~
//~/ -' Residential: ~~ ~
Prior Lake, MN 5~ ~~ Phone:'7`'~` ~''~~Z ~ Non-Residential: ~
/C_.,Uw ~ K 'c...'~_ ~
A. BASEMENT ~'Yes ~ No ,,,- SiJMP BA5KET ~ 0 ~~ 2 I~ 3 L~
WATER IN BASKET 17 Yes L~J'~1o SiJMP PLT~~ ~ D 1 ~ 2 ~_,,,3--t7
WATER IN BASEMENT (flow over floor) D Yes ~o CI5TERN ~ Yes ~7 No
(If no pump, place sticker across edge of sump ~over and basement floor so any removal of cover will
break seal. Skip to Part B of this form.)
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Discharge Point ~ Laundry tub ~ Sanitary sewer i--Q Outside
at Inspection: ~ Floor drain ~ Other
Prior to Inspection: '
When system installed, or most recently modified? (Date) and why
C'l Home came with s stem ~ Res onse to ins ection ro ram ~ Other
Y P P P g
~ Water in basement ~ Previous system failed
B. ROOF LEADERS: ~ Yes Q'~No DISCHARGE: O Near O Away
C. YARD DRAINS ~ Yes L'~'~'~N -'~ WINDOW WELLS Q Yes ~o
BEAVER 5YSTEM O Yes ~No
D. PROPERTIES WITH SUMP PUMPS
When does pump run? O Fall ~ Summer
(check all that apply) How often does pump run?
V~here does pump discharge to outside? ~ Front
NOTES:
~ Spring ~ Winter
--,..,
~ Back--- Q Side
SUMP PUMP SYSTEM: 19~PASS O FAIL You have 30 days to bring your system into compliance with cunent
regulations. When you are ready for reinspection, ca[1651 /644-1469 jor an appointment.
Is there another place where clear water enters the sanitary sewer system? ~ Yes C9'"No
Where is this location?
This area will need to fi o the cle w ischar s to the storm sewer system.
Inspector: Date: -
Resident: ~ Date: -
Disclaimer: is visual inspection is one with due diligence to f'md obvious clear water cross-connections
and does not imulv the structure meets all Citv Codes.
White: Homeowner Yellow: City Pi~k: HRG