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HomeMy WebLinkAboutSump Pump Inspection City of Prior Lake Sump Pump and III Reduction Inspection Form Name:-ble. -rt Ie. . /YJ e . I Prior Lake, MN 55 Phone: Date:f ,,1~ime: q,ljla.~ First!ection ld' Second 0 Own' inra Age of Home: Resident 1: Non-Residen ial: 0 ~~Address: ~()6? S~..e/N'f. LI< Rp '-""" "~ A. BASEMENT 0 Yes ~o SUMP BASKET )( 0 0 1 0 2 0 3 0 WATER IN BASKET o Yes ONo SUMPPUMP go 0 1 0 2 0 3 0 WATER IN BASEMENT (flow over floor) 0 Yes ~NO CIStERN 0 Yes 0 No (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 at Inspection: o Laundry tub o Floor drain o Sanitary sewer o Other o Outside Prior to Inspection: When was system installed, or most recently modified? (Date) and why B. C. o Home came with system 0 Response to inspection program 0 Other o Water in basement 0 Previous system failed ROOF LEADERS: 0 Yes ~No DISCHARGE: 0 Near 0 Away YARD DRAINS 0 Yes1x'No WINDOW WELLS 0 Yes 0 No BEAVER SYSTEM 0 Yes ~NO PROPERTIES WITH SUMP PUMPS When does pump run? 0 Fall 0 Summer 0 Spring 0 Winter (check all that apply) How often does pump run? Where does pump discharge to outside? 0 Front 0 Back 0 Side D. -----'-'-'_._----.~- ._.-;r.::--------_._-----~-------_._----------'-------------.-.-.-----------.-------------------.-.-------.-.- NOTES: ",( ~TC.- .... SUMP PUMP SYSTEM: ').:J PASS 0 FAIL You have 30 days to bring your system into compliance with current 1":.. regulations. When you are ready for reinspection. call 651/644-1469 for an appointment. Is there another place where clear water enters the sanitary sewer system? 0 Yes (..A No Where is this location? /\.. L...I' This area w' to yPxed so the c~r wa~scharges to the storm sewer system. Inspecto . . '". Date: .x~ -7'7' Resident: V Date: Disclaimer: This visual inspection is done with due diligence to rmd obvious clear water cross-connections and does not imply the structure meets all City Codes. White: Homeowner Yellow: City Pink: HRG 00 i b,!Q ~ City of Prior Lake Sump Pump and III Reduction Inspection Form ,.47;0,0/7 Name:0~e~~ J1/Ci-ijC),cL Date~6-99 Time)63Q.m./p.m. - ~tJ ....s . {I / // First Insp~on ~cond 0 / I ~ Address:~Ob3 vpe/,,(/~ A...-;:;;U::E~.o Own: g/' Rent: D. Age ofHome:YN''f~~5 -?/ " J /, L J L. Residential: ~ -J Prior Lake, MN 55 v m Phone':7'''iV.Af950 Non-Residential: 0 ..- A. BASEMENT ~ 0 No /' SUMP BASKET ~ 1 0 2 0 3 0 WATER IN BASKET o Yes 000 SUMPP~ ~O 1 0 2 03- 0 WATER IN BASEMENT (flow over floor) 0 Y es ~o CISTERN 0 Yes 8'1'fo (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 at Inspection: o Laundry tub o Floor drain o Sanitary sewer 0 Outside o Other ,..-- Prior to Inspection: When was system installed, or most recently modified? (Date) ,.,..- and why o Home came with system o Water in basement o Response to inspection program 0 Other o P~ous system failed 8"Yes 0 Ny~ DISCHARGE: ~r 0 Away o Yes ~Jjd WINDOW WELLS 0 Yes Q-NO- o Yes ~No B. C. ROOF LEADERS: YARD DRAINS BEAVER SYSTEM D. PROPERTIES WITH SUMP PUMPS When does pump run? 0 Fall 0 Summer (check all that apply) How often does pump run? Where does pump discharge to outside? 0 Front o Spring 0 Winter ---- o Back 0 Side -.--------------------------------------------------------------------------------------------------------------------------------- NOTES: / SUMP PUMP SYSTEM: ~SS 0 FAIL You have 30 days to bring your system into compliance with current regulations. When you are ready for reinspection, call 651/644-1469 for ~intment. Is there another place where clear water enters the sanitary sewer system? 0 Yes B"No Where is this locationc This area will need t~ fi~ the cle~a~ischarges to the storm sewer systeJI. . Inspector: -e5J . ~-:/'1Ci...c.~'/ Date: ~_-h -7::7 Resident.......} .-- /?--/,.....~____ ______ Date: ~-~ - ~ ~ Disclaimer: This visual inspection is done with due diligence to rmd obvious clear water cross-connections and does not imply the structure meets all City Codes. White: Homeowner Yellow: City Pink: HRG