HomeMy WebLinkAboutSump Pump Inspection,~ ~,~~ ~F PRIO~P
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City of Prior Lake
Sump Pump and I/I Reduction
Inspection Form ,g~;~~ y
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Name: /U/~C/~/~/~~ ~ '~1 ~~.~~:.~7 Date~'~~"~7 Tim~l~~.m./p.m.
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/ ...•~~ First Inspe ' n ~econd ~
Address:~~~~ ~T~~/r7G'~" ~ Own: Rent: A e of Home: ~ ,
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~j//~ /~ Residential:
Prior ~,ake, MN 55~.~? ~~ Pl~on~'7` /"~/~~5~ Non-Residential: ~
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A. BASEMENT es I~ No SIJMP BASKET ~ 1 L7 2~ 3 ~
WATER IN BASKET ~ Yes o SUMP~~~ 0~ 1 ~ 2 ~ 3~'
WATER IN BASEMENT (flow over floor) ~ Yes o CISTERN ~ Yes L~--i~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.) v~
Discharge Point ~ Laundry tub ~ Sanitary sewer~..~-- l7 Outside
at Inspection: ~ Floor drain ~ Other
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Prior to Ins ection:
When system installed, or most recently modified? (Date) and why
, Home came with system ~ Response to inspection program Q Other
Q Water in basement ~ Pre~' s system failed
~ N
DISCHARGE
F LEADERS
N
RO
e L 9~ A
ear
:
s
o
O
:
B.
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~N ~ WINDOW WELLS Q
C. YARD DRAINS
pR ~~~ es ~ Yes ~~To
~
BEAVER SYSTEM ~~ T~ Yes l~~'No
D~yuf
D. PROPERTIES WITH SUMP PUMPS
When does pump run? ~ Fall ~ Summer ~ 5prin~ ~ Winter
(check all that apply) How often does pump run?
V~here does pump discharge to autside~ O Front ~ Back -- ~ Side
NOTES: - ~ ,
SUMP PUMP SYSTEM: C~''PASS ~ FAIL You have 30 days to bring your system into compliance with current
regulaaons. When you are ready for reinspection, call 6511644-1469 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 be f~'d so,~ie clear w~er ~harges to the storm sewer system.
Inspector:
Resident:
Date: ..3 - / O -
Date: ~ -/O -
Disclaimer: This visual inspection is done with due diligence to find obvious clear water cross-connections
and does not imnlv the structure meets all Citv Codes.
White: Homeowner Yellow: Gity Pink: HRG