HomeMy WebLinkAboutSump Pump Inspection~F PRIQ~
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City of Prior Lake
Sump Pump and I/I Reduction
Inspection Form ~~~
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Name: ~~~~~~~ ~ C~.J~--'~~ Datei~~~~Time:~/~~mJp.m.
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,~/ ` ~~~~ /~.~ 7.. ~ First Inls-pfe ~on ~''"Second ~ 2t~
Address: ~~ 7~ ~ ~ Own: ~'' Rent: Age of Home. /
~y, 1` Residential:~ ~
Prior Lake, MN 55~/"~ Phone:Y~~ ~~~p Non-Residential: ~
A. BASEMENT ~es ~ No SUMP BAS T ~ 1~ 2 ~ 3 ~
WATER IN BASKET ~ Yes o SUMP P Q' Q~ 1 ~ 2~ ~~ La
WATER IN BASEMENT (flow over floor) ~ Yes No CISTERN ~ Yes ~iQo
(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~_ I~ Outside
" at Inspection: ~ Floor drain ~ Other
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Prior to Inspection:
When was systern installed, or most recently modified? (Date) and why
Q Home came with system ~ Respo e to inspection program Q Other
Q Water in basement a Pr ous system failed
B. ROOF LEADERS: Yes ~ N DISCHARGE: ~ Near y
C. YARD DRAINS ~ Yes WINDOW WELLS Yes ~ No
BEAVER SYSTEM ~ Yes No
D. PROPERTIES WITH SUMP PUMPS
When does pump run? U Fall ~ Summer ~ Sp,~i~g ~ Winter
(check all that apply) How often does pump run?
V~here does pump discharge to outside? ~ Front f~ Back ~~ Side
NOTES: r
SUMP PUMP SYSTEM: ASS ~ FAIL You have 30 days to bring your system into compliance with urrent
regulations. When you are ready for reinspection, call 651/644-1469,r'or appointment.
Is there another place where clear water enters the sanitary sewer system? ~ Yes No
Where is this location?
This area will need to b xed clear wat di a es to the storm sewer system.
Inspector: Date: '..~0-
Resident: Date: .,.. -.3G -
Disclaimer: This visual inspection is done with dne diligence to find obvious clear water cross-connecHons
and does not im 1 the structure meets a1T Cit Codes.
White: Homeowner Yellow: City Pink: HRG