HomeMy WebLinkAboutSump Pump Inspection/ ~F PRIp
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City of Prior Lake
Sump Pump and I/I Reduction
Inspection Form ,~'1,~,~~~-
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Name:_,~,~/~~.~i, ,~~~~/,~,~ Dater~'~~~~J Time~~a.m./ .m
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,/,, /~ '~~~ ~~~~ ~~ First In_~sp~,e, ~n~ Q Second ~
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Address:~~`~ ,,7J //'~ Own: C~'" Rent: ~ Age of Home: ~~ ~
~~Q, ~ Residential: ~
Prior Lake, MN 55 ~~~ phone: ~~~ Non-Residential: Q
A. BASEMENT ~~ No~ S~p'BASKE ~ 1~ 2 Q 3 ~
WATER IN BASKET a Yes o SiJMP P 0~ 1 Q 2` Q~ O
WATER IN BASEMENT (flow over floor) O Yes o CISTERN O Yes IJ'~To
(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 L~ Laundry tub ~7 Sanitary sewer Q Outside
at Inspection: ~ Floor drain d Other ^
Prior to Insp ion: -~""""
~When w ystem installed, or most recently modi~ed? (Date) and why
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ome came with system O Response to inspection program a Other
~ Water in basement 17 Previ us system failed
B. ROOF LEADERS: D~~'Yes ~ No DISCHARGE: ~
Near ~way
C. YARD DRAINS Q Yes WINDOW WELLS ~ Yes ~
BEAVER SYSTEM ~ Yes o
D. PROPERTIES WITH SUMP PUMPS
When does pump run? a Fall Q Summer ~ Spring d Winter
(check all that apply) How often does pump run? --"
V~here does pump discharge to outside? Q Front ~ Back Q Side
NOTES-•-•---•-•-•-•---•-•-•-•-•-----------•-•-•-•-•-•-•-•-•-•-•-•-•-•-•-•-•-•-•-•~..._._._._._._.-•-•-•---•-•-•-•-•-•---•-•-
SUMP PUMP SYSTEM: ~~ASS a FAIL You have 30 days to bring your system into compliance with ent
regulations. When you are ready for reinspection, ca[! 651 /644-1469 for an pointment,
Is there another place where clear water enters the sanitary sewer system? ~ Yes ~ o
Where is this location?
This area will need to be f s e clear w ter ' charges to the storm sewer system.
Inspector: ,• Date: `
Resident: • Date:
Disclaimer: This visual inspection is done wi due diligence to find obvious clear water :cross-connections
and does not imply the structure meets all Cit Codes
White: Homeowner Yellow: City Pink: HRG