HomeMy WebLinkAboutSump Pump Inspection~~ 4F PRIpfA
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Inspection Form j~1,~~Jr
Name: ~/~/~.~C~~ ~~=~.~/ ~~•~J~ ~ Date:,~ %~~"~/ TimeJ,~~i~-x m./p.m.
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r,., ~ ~ ~ First Inspec ' n ~nd ~
Address: f~p~~~ ~~~~ ~/~~= ~/ Own: R~e~nt: /~~~'ge of Home: ~~ ~
, /~/ ~- Residential:l~ ~
Prior Lake, MN 55 ~~~ Phone`7"'7~ ~~~~ Non-Residential: ~
A. BASEMENT ~ Yes ~l~o ~ SiJMP BASKET ~~A'~l ~ 2 ~ 3 ~
WATER IN BASKET ~ Yes o 5UMP~}'~ i~ l~~ ~ 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 ~ Sanitary sewe/ Q Outside
at Inspection: ~ Floor drain ~ Other
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~ Prior to Inspection: ""-"~
When was system installed, or most recently modified? (Date) and why
~ Home came with system ~ Response to inspection program ~ Other
a Water in basement ~ Prev' s system failed
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B. ROOF LEADERS: pP~~ es ~ No DISCHARGE: ~ Near 'A'"Away
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C. YARD DRAINS ~ Yes ~~ ~~ WINDOW WELLS ~ Yes~'No
BEAVER SYSTEM O Yes C~J' No
D. PROPERTIES WITH SUMP PUMPS
When does pump run? ~ Fall ~ Summer
(check all that apply) How often does pump run?
V~here does pump discharge to outside? l~ Front
NOTES:
City of Prior Lake
Sump Pump and I/I Reduction
~ Spring ~ Winter
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~ Back ~ Side
SUMP PUMP SYSTEM: ~ASS ~ FAIL You have 30 days to bring your system into compliance with curre
regu[ations. When you are ready for reinspection, cal[ 651 /644-1469 for an ent.
Is there another place where clear water enters the sanitary sewer system? Q Yes No
Where is this location?
This area will need to be ed~a-.~he clear~te i arges to the storm sewer system.
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Inspector: /~"' Date: ~
Resident: l..-~ ~ ~,~~ ~ r; ,~ ~> ,! r /~r'.,;~ F ~~%~ 1' ~ ~ 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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