HomeMy WebLinkAboutSump Pump Inspection.~
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(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 ~ Outside
at Inspection: I~ Floor drain ~ Other
Prior to Inspection: ~ ~
When was system installed, or most recently modified? (Date) and why
~ Home came with system ~ Response to inspection program ~ Other
~ Water in basement ~ Previous system failed
B. ROOF LEADERS: ~ Yes ~ No DISCHARGE: ~ Near ~ Away
C. YARD DRAINS ~ Yes No WINDOW WELLS ~ Yes~ No
BEAVER SYSTEM ~ Yes~ No
D. PROPERTIES WITH SUMP PUMPS
When does pump run? ~ Fall I~ Summer ~ Sprin D Winter
(check all that apply) How often does pump run?
V~here does pump discharge to outside? ~ Front Q Back ~ Side
NOTES:
SUMP PUMP SYSTEM: ~ PASS I~ FAIL You have 30 days to bring your system into compliance with catrrent
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? ~ Yes ~No
Where is this location?
This area will~eed to L}~ fixed so the clear water discharges to the storm sewer system.
Resident:
Date:
Date:
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 ~~ G
,.
A. BASEMENT ~ Yes ~ No SUMP BASKET ~ 0 1~ 2 ~ 3 17
WATER IN BASKET ~ Yes 1~No SUMP PUMP ~ 0~ 1 ~ 2 O 3 ~
WATER IN BASEMENT (flow over floor) ~ Yes ~No CISTERN ~ Yes `~ No
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(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 ~ Outside
at Inspection: ~ Floor drain ~ Other
Prior to Inspection:
When was system installed, or most recently modified? (Date)
and why
~ Home came with system ~ Response to inspection program ~ Other
~ Water in basement ~ Previous system failed
ROOF LEADERS: ~ Yes ~ No
YARD DRAINS a Yes ~ No
BEAVER SYSTEM a Yes ~ No
DISCHARGE: ~ Near ~ Away
WINDOW WELLS I~ Yes ~ No
PROPERTIES WITH SUMP PUMPS
When does pump run? ~ Fall ~ Summer ~ Spring
(check all that apply) How often does pump run?
Where does pump discharge to outside? O Front D Back ~ Side
NOTES:
SUMP PUMP SYSTEM: l~, PASS O 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 an appointment.
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: G- Z- 4~
Resident: Date:
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.
~ Winter
White: Homeowner Yellow: City Pink: HRG :
A. BASEMENT ~ Yes ~ No SUMP BASKET ~ 0~ 1 ~ 2 ~ 3 ~
WATER IN BASKET ~ Yes ~ No SiJMP PiJMP ~ 0~ 1 ~ 2 ~ 3 ~
WATER IN BASEMENT (flow over floor) ~ Yes ~ No CISTERN ~ Yes ~ No
'""~` x: M•;
City of Prior Lake
Sump Pump and I/I Reduction
Inst~ection Form
/~ (~ ~~T /~~n
Name : ~/ ~~ ~ `~'~~.~. ~ .~, ~~,•~%-' `7 D ~ °~r ~ ~ ~ Time/~~`-~ `-~. m. /p. m.
~ ~ ,/~ First Insp~ec.~'~ ~'" Second O
Address: ~~ ~~ /. 7' ~~'~ ~ ~`'~ ~ Own: (~` Rent: ~ Age of Home:
,/ Residential: t~-''r
Prior Lake, MN 55~ 7~ PhonefOl~ uy~ Non-Residential: ~
/ ~,_._ / ~ .
A. ~BASEMENT ~es ~ N~'`~ SiJMP BA5KET ~ 0 L~~/1 ~~ 2~ 3 ~
WATER IN BASKET ~l:~s ~ No SiJMP PLJM ~ 0 @''1 ~ 2~ ~~' ~
WATER IN BASEMENT (flow over floor) ~ Yes ~CISTERN ~ Yes e7-IQo
(If no pump, place sticker across edge of s cover and basement floor so any removal of cover will
break seal. Skip to Part B of this form.
Discharge Point aundry tub ~ Sanitary sewer ~ Outside
at Inspection: ~ Floor drain a Other
Prior to Ins tion:
When w system installed, or most recently modified? (Date) and why
ome came with system ~ Response to inspe ' program ~ Other
~ Water in basement ~ Previous sys failed
B. ROOF LEADERS: ~ Yes No DI5CHARGE: ~ Near Q Away
C. YARD DRAINS ~ Yes ~ WINDOW WELLS O Yes o
BEAVER SYSTEM ~ Yes ~
D. PROPERTIES WITH 5UMP PUMPS
When does pump run? ~ Fall mmer r Winter
(check all that apply) How often does pump run? ~~~ ~,~ ~l/ ,~ /~~ r
Where does pyx~p discharge to outside? ~ Front d Back ~ Side
NOTES:
. .~~~,~ . ~1,~~~. . ~iU ~ a _'---~---------------------
L.~ u~~oe ~i ~u
SUMP PUMP SYSTEM: ~ PASS ~ ~IL You have 30 days to bring your system into compliance wuh current
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? Q Yes ~-~ ~
Where is this location?
This area will need to b ix so the clear w~d~harges to the storm sewer system.
Inspector:.,,'_~
Resident: ~ ,~~., ~
Date: '`~ /-
Date: ~
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 .