HomeMy WebLinkAboutSump Pump Inspection/ l~ 4F PRtp
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Name : ~~ ~' ~i~ ~ /~GG .S.S.~.G ~.
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Address: ~~ 9~ ~~~~~ ~ ~f~ ~~~
Prior Lake, MN 55~~~ Phone~~~~ ~~ %~
City of Prior Lake
Sump Pump and I/I Reduction
ction Form
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Date;~".~~ "~.~ Tim~~~~a. m. /p. m.
First In_sp~e 'on ~''~ Second ~
Own: F~ Re`n~t: Age of Home: ~Z ,
Residential: L~ ~
Non-Residential: ~
A. BASEMENT ~'Yes d No~ SUMP BASKET ~ 1 a 2 ~ 3 ~
WATER IN BASKET D Yes o SUMP Pi~ 0 Q 1 ~ 2 ~,,3'' ~
WATER IN BASEMENT (flow over floor) ~ Yes [~No CISTERN ~ Yes ~10
(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 O Sanitary sewer ~ I~ Outside
at Inspection: O Floor drain ~ Other
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Prior to Inspection:
When system installed, or most recently modified? (Date) and why
Home carne with system ~ Response to inspection program ~ Other
Q Water in basement ~ Pre ious system failed
B. ROOF LEADERS: ~Yes CJ No DISCHARGE: Q Near L9~A
G YARD DRAINS ~ Yes ~~ ~ WINDOW WELLS es a No
BEAVER SYSTEM I~ Yes CYNo
D. PROPERTIE5 WITH SUMP PUMPS
When does pump run? ~ Fall ~ 5ummer 17 S~g ~ Winter
(check all that apply) How often does pump run?
V~here does pump discharge to outside? d Front 17 Back Q Side
NOTES:
SUMP PUMP SYSTEM: ~D~`PASS ~ FAIL You have 30 days to bring your system into compliance with current
regu[ations. When you are ready for reinspection, ca[[ 651/644-1469;t'or an ent.
Is there another place where clear water enters the sanitary sewer system? ~ Yes o
Where is this location?
This area will need to be ed e clear~ate ~scharges to the storm sewer system.
Inspector:
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