HomeMy WebLinkAboutSump Pump InspectionCity of Prior Lake
Sump Pump and I/I Reduction
Ins~ection Form
Name: C~. ~ .~, ~,~Gc~~k-' ~
Address: ~'Y~,~ ~~~~ ~`~~7~ ~•~
Prior Lake, MN 55 .,~ ~i~/ Phone:'~'i~~ ~.2'~'S~
Yellow: City
A. BASEMENT l~es~ ~~° SiJMP BA5KET ~ 0 ~ 2 Ca 3~
WATER IN BASKET Cd~es ~ No SiJMP P ~ 1 ~ 2 C1 3 O
WATER IN BA5EMENT (flow over floor) ~ Yes I~~ CISTERN ~ Yes C7.pF6~
(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 O Laundry tub ~ Sanitary sewer ~ Outside
at Inspection: ~ Floor drain ~ Other `~
Prior to Ins tion: ~r
When w system installed, or most recently modified? (Date) and why
ome came with system ~ Response to inspection program ~1 Other
~ Water in basement 17 Previous sys failed
B. ROOF LEADERS: ~ Yes No DISCHARGE: ~ Near ~ Away
C. YARD DRAINS ~ Yes ~~ WINDOW WELLS ~ Yes ~'1Go
BEAVER SYSTEM a Yes L~~'"No
D. PROPERTIES WITH SUMP PUMPS
When does pump run? ~ Fall ~ Summer ~ Spring C7 Winter
(check all that apply) How often does pump run?
V~here does pump discharge to outside? ~ Front D Back ~ Side
~ NOTES: ~ ~
SUMP PUMP SYSTEM: ASS O FAIL You have 30 days to bring your system into compliance with currens
regulations. When you are ready for reinspection, ca[[ 651 /644-1469 for an appoi era.
Is there another place where clear water enters the sanitary sewer system? ~ Yes ~
Where is this location?
This area will need to be ed e clear ater ' charges to the storm sewer system.
Inspector: - ./f~ Date: - 9 - ~ ~
Resident: . ,~- / ~a-a.. Date: ~2 - `~ - ~ 9
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
~p~'~
Date:~G ~ ~ ~.~ Time:/,,~OOa.m./p.m.
First Insp~e ~n E~" Second D ~
~ ~
Own: [~'' Rent: ~ Age of Home: ~
Residential: ~ ~
Non-Residential: ~
Pink: HRG