HomeMy WebLinkAboutSump Pump Inspection0~ PRI~~f' City of Prior Lake
~ x
~ ~ Sump Pump and I/I Reduction
~-
jNNES~~ Inspection Form
ANNUAL CERTIFICATION RE-INSPECTION
Name: ~l~~fiY11C~ , V~1~"~C~.V'Vl ~ ~1,i,t-~C'~Date: ~ /~- dd Time: ~_ am/~
Inspection: ^ First ~ Second x~+~
-~ h
Address: ~~,~'~~ f~~` ~-~ • ~ Own p Rent Age of Home: ~5•
Prior Lake, MN 55372 Phone:~ '~ ~~ ~ Residential ~ Non-Residential
A. BASEMENT ~ Yes O No SUMP BASKET ^ 0 ~ 1 ^ 2 p 3 p
WATER IN BASKET ~C Yes C7 No SUMP PUMP ^ 0 ~ 1 ^ 2 ^ 3 p
WATER IN BASEMENT ^ Y~s jg( No CISTERN ^ Yes ,~' No
(If no pump, ptace sticker across edge of su{np cove~ and basement floor so any removal of cover will break seal. Skip to Part B.)
Discharge Point p Laundry'~tub ^ Sanitary sewer ~ Outside
at Inspection: p Floor drain ^ Other
Prior to Inspection: '
When was system installed, or most recently modified? (Date) _
p Home came with system p Response to inspection program
^ Water in basement Previous system failed
~
^ Other
B. ROOF LEADERS Yes p No DISCHARGE
and why? =
~Near p Away
C. YARD DRAINS ^.Yes '~ No WINDOW WELLS O 1'es p No
BEAVER SYSTEM p :Yes ~ No -
D. PROPERTIES WITH SUMP PUMPS
When does pump run? ^ Fall O Summer O Spring ^ Winter
(check all that apply) How often does pump run? ~,~p; heav~ v~i S
Where does pump discharge to outside? ~ Front ^ Back ' ~ Side ~~-
NOTES: .. .
SUMP PUMP SYSTEM: ~ PASS ^ FAIL Ynu hure 30 days in hrii~g yo~ir.+ys~em i~eio compliauce wi~h ci~rre~u
_Y(:R7fIGU01Lti. WI1G'II ~'Oll GYH 1'QGLIy fOY YC-%N.5~1LC//Oll, cn// 952/447-9833 f~,r u,~ unn~;~,~,~,~ru.
Is there another place where clear water enters the sanitary sewer system? ~ Yes ~~No
Where is this location?
This area will need to be fixed so the clear water discharges to the storm sewer system.
Inspector: Date: ~ l'~- ~/
Resident: ~.?L ~G Date: `'? 0
Disclaimer: This visual inspection is done with due diligence to tind obvious clear water cross-connections
and does not imply the structure meets all City Codes.
I'PS~~~rt~ ~~~'~i ~'u~c~~ ~~4~f
P
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(If no pump, place sticker across edge of sump cover and basement floar so any removal of cover will
break seal. Skip to Part B of this form.)
Discharge Point ~ Laundry tub d Sanitary sewer Q'Outside
at Inspection: ~ Floor drain ~ Other
Prior to Inspection:
When was system installed, or most recently modified? (Date)
L7 Home came with system ~ Response to inspection program ~ Other
~ Water in basement ~ Previous system failed
B. ROOF LEADERS: ~ Yes ~ No
C. Y DRAINS Q Yes ~ No
BEA R SYSTEM ~ Yes d No
D. PROPERTIES WITH SUMP PUMPS
When does pump run? ~ Fall
(check all that apply) How o~t
V~here does pump discharge to outside?'
NOTES: ~---~ ~ -~. //~ d -•-• N,. v/ --•---' ~
and why
DISCHARGE: Q Near 17 Away
WINDOW WELLS ~ Yes ~ No
~ Summer
does pump run?
17 Front
•G-•-•-•--~~-----
~ Spring a Winter
~ Back ~-~S~de
a~ ~s; ~/~ --•-•---•-•-•--
5U1VIP PUMP SYSTEM: ~' YASS I~ FAIL You have 30 days to bring your system i-tto compliance with current
regulations. When you are ready for reinspection, cal! 651 /644-1469 for an pointment. .
Is there another place where clear water enters the sanitary sewer system? ~ Yes ~No
Where is this location?
This area will need to be fixed so the clear water discharges to the storm sewer system.
Inspector: ~ f ~' ~ Date: .% - ~ ~ 9
Resident: /~ ,~,,~, ~ ~,,,.~~, Date: ( ~ ~ ~ y y'
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 - Yellow: City Pink: HRG
A. BASEMENT ~ Yes ~ No 5UMP BASKET Q 0 ~ 1 ~ 2 ~ 3 ~
WATER IN BASKET ~ Yes Q No SUMP PUMP ~ 0 ~ 1 ~ 2 ~ 3 O
WATER IN BASEMENT (flow over floor) ~ Yes ~ No CISTERN ~ Yes ~ No
~ ~.. - ,:~ ..
~
0
~~
~
(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 C-~'Laundry tub ~ Sanitary sewer ~ Outside
at Inspection: ~ Floor drain ~ Other
Prior to Inspection:
When was system installed, or most recently modified? (Date) and why
I~Home came with system ~ Response to inspection program ~ Other
~ Water in basement ~ Previous system failed
,wv~~u' ~
B. ROOF LEADERS: ~ L~''1'es ~ No DISCHARGE: ~ N
ear ~ ~
C3~Away
C. YARD DRAINS ~ Yes C.~' No . WINDOW WELLS I~Yes ~o
BEAVER SY5TEM ~ Yes 13~1Go
D. PROPERTIES WITH SUMP PUMPS
When does pump run? ~ Fall O Summer ~ Spring ~ Winter
(check all that apply) How often does pump run? 1~P~,~ ~~i~~ ~ ;~ ~~ ~
V~here does pump discharge to outside? ~ Front ~ Back 17 Side
NOTES: ~~ s ~ ,~~r ~ ba ~, ~-,G~+~ ~ ~~W. c ~„~----- ~'` L, /G /\/ ~-•-------
~, ,
~ •-•- •-•-•-----._._._._..
SUMP PUMP SYSTEM: Q PASS AIL You have 30 days to bring your system into comp[iance with current
regulations. When you are ready for reinspection, cal[ 651/644-1469 for an appointment.
Is there another place where clear water enters the sanitary sewer system? L7 Yes D' N o
Where is this location?
This area will need to be fixed so the clear water discharges to the storm sewer system.
Inspector: - Date: ~- ,~ ~ ' 9 9
Resident: ~ ,,,` Date: ~i 1 ~- y9
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 Yellow: City Pink: HRG
A. BASEMENT ~Yes ~ No SUMP BASKET ~ 0 Q 1 ~ 2 d 3 Q
WATER IN BASKET ~4'es ~ No SUMP PUMP ~ 0 ~1 ~ 2 ~ 3 ~
WATER IN BA5EMENT (flow over floor) ~ Yes D-No CISTERN ~ Yes A1Qo