HomeMy WebLinkAboutSump Pump Inspection/V~
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City of Prior Lake
Sump Pump and I/I Reduction
Ins~ection Form
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~~..~i~ /~~~i~,~; ~ Date~ c~- g ~
Time~d~~a.m./p.m.
Name:
/ ~~ ~,,. First In~spe~c ° n B' Second ~
Address:/~~~~t~' ,~p ~/,D.~~ ~/~ Own: ~' Rent: Age of Home:~~'
~ , '/` ~,~/ Residential: ~ -
Prior Lake, MN 55 ~~~ Phon~`~'"~/ ',~~3 Non-Residential: 17
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A. BASEMENT es ~~~ o SiJMP BASKET Q a 2 ~ 3 ~
WATER IN BASKET L~'Yes ~ No SiJMP~ P~~ 0~ 1 ~ 2 Q 3 ~
WATER IN BASEMENT (flow over floor) ~ Yes Q-~Qo CISTERN d Yes ~
(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.)
B.
C.
D.
NOTES:
SUMP PUMP SYSTEM: @` PASS ~J FAIL You have 30 days to bring your system into compliance with current
regulations. When you are ready for reinspection, ca[[ 651 /644-1469 for an ent.
Is there another place where clear water enters the sanitary sewer system? ~ Yes No
Where is this location?
This area will need to ixecJ,sO'~he clear w er ~harges to the storm sewer syste~n.
Inspector: ' `/ ~`'`'"" "`"'""" Date: "~' ` ~ " ~ %
Resident: ~^ ~ ~,f~ ,~'~"~~, , ~ Date: - -
Discharge Point ~ Laundry tub ~ Sanitary sewer ~ Outside
at Inspection: O Floor drain ~ Other -''"~~
Prior to Inspection:
When s system installed, or most recently modified? (Date)
~' Home came with s stem 17 Res onse to ins ection ro ram
Y P P P S
~ Water in basement i~ Previous syst failed
r
_ and why
~ Other
ROOF LEADER5: ~ Yes C~"No DI5CHARGE: t~ Near ~ Awa
Y
YARD DRAINS ~ Yes C_~'~N WINDOW WELLS ~ Yes L"'#"'1~o i
BEAVER SYSTEM ~ Yes C!'NO
Disclairner: 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.
PR4PERTIES WITH SUMP PUMPS
When does pump run? l7 Fall Q Summer ~ Spring a Winter
(check all that apply) How often does pump run? "
V~here does pump discharge to outside? ~ Front ~] ~ack O Side
White: Homeowner Yellow: City Pink: HRG