HomeMy WebLinkAboutSump Pump Inspection~~~~~~ ~ ~~~
City of Prior Lake
Sump Pump and I/I Reduction
Insnection Form
Name: ~ ~~ ~~--
.~.~ ~..3 ~.urz~.% ~
Address: ~~~'t~ --`j~G'~-'i~'''''F- ~i~
Prior Lake, MN 55 Phone:
Date: j ~~r~~ Time: a.m./p.m.
First Inspection ~ Second ~
Own: I~ Rent: Q Age of Home:
Residential: ~
Non-Residential: ~
A. BASEMENT ~ Yes Q No SUMP BA5KET ~ 0 Q 1 ~ 2 ~ 3 L~
WATER IN BASKET ~ Yes ~ No 5UMP PUMP O 0 ~ 1 ~ 2 O 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 ~ Laundry tub ~ Sanitary sewer t7 Outside
at Inspection: Q Floor drain ~ Other
Prior to Inspection:
When was system installed, or most recently modi~ed? (Date} and why
~ Home came with system ~ Response to inspection program ~ Other
~ Water in basement D Previous system failed
B. ROOF LEADERS: Q Yes ~ No DISCHARGE: ~ Near L~ Away '
C. YARD DRAINS ~ Yes Q No WINDOW WELLS O Yes ~ No
BEAVER SYSTEM ~ Yes ~ No
D. PROPERTIES WITH SUMP PUMPS
When does pump run? 17 Fall ~ Summer ~ Spring D Winter
(check all that apply) How often does pump run?
V~here does pump discharge to outside? Q Front ~ Back ~ Side
NOTES: "/ !.E'~~~1 •---~s'''~-s~i'1~'i~~- -~----~~• ~ :-•--- p~ f ---~7` ~/
(l~at. '7~'e r O r- ,.~ ~' c,...a ~.° /'
SUMP PUMP SYSTEM: PASS d 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 appointment.
Is there another place where clear water enters the sanitary sewer system? ~ Yes ~No
Where is this location?
This area will n~'S'~be ~X~tjed so the clear water disc~ges to the storm sewer system.
I Inspector: Date: ~`c.~,_;1' ` 7' ~ I
Resident: 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
~~3~~~~:~~~~~
A. BASEMENT ~ Yes ~No SUMP BASKET 0~ 1 ~ 2 ~ 3 ~
WATER IN BA5KET CI Yes ~ No S UMP 0~ 1 ~ 2 ~ 3 ~
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 ~ Laundry tub ~ Sanitary sewer ~ Outside
at Inspection: ~ Floor drain a Other
Prior to Inspection:
When was systern installed, or most recently modified? (Date) and why
a Home came with system ~ Response to inspection program 17 Other
Q Water in basement ~ Previous system failed
B. ROOF LEADER5: ~ Ye~ No DISCHARGE: O Near Q Away
C. YARD DRAINS ~ Yes No WINDOW WELi.S Q Yes ~ No
BEAVER SYSTEM ~ Yes No
D. PROPERTIES WITH SUMP PUMP5
When does pump run? ~ Fall ~ Summer O Spring ~ Winter •
(check all that apply) How often does pump run?
Where does pump discharge to outside? O Front ~ Back 17 Side
NOTES: -•-•- -•'~~ ._...G.., ~ L-,!~ /~~-•-----•-------•-~-•-•-•-•-•---•-------------._.-•-•-•-•-------•-•-•-
SUMP PUMP SYSTEM: ~ PASS O FAIL You have 30 days to bring your system into compliance with current
regulations. When you are ready for reinspection, ca11 651 /644-1 469 for an appointment.
Is there another place where clear water enters the sanitary sewer system? Q Yes ~1 No
Where is this location?
This area wil eed~ be ~ so the clear ~water sc rges 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