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City of Prior Lake
Sump Pump and III Reduction
Inspection FOl~ll
Name: (;...,e/ ~ p ~
Date: tj3./ ;-9'
Time: ,/ a.m~
Prior Lake, MN 55
Phone:
First I~pection CJ
Own:L\ Rent: 0
Residential :,Ar
N on-Residential: 0
Second 0
Age of Home:
Address:,j',<oS 8vff"t:,e/'lu-r e/i?...
A.
BASEMENT 0 Yes ~No
WATER IN BASKET dYe~' 0 No
WATER IN BASEMENT (flow over floor)
SUMP BASKET 10 0 0 1 0 2 0 3 0
SUMP PUMP l"" 0 0 1 0 2 0 3 0
o Yes ~No CISTERN 0 Yes)r{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
0 Home came with system 0
o Water in basement 0
B. ROOF LEADERS: 0
C. YARD DRAINS 0
BEAVER SYSTEM 0
Response to inspection program 0 Other
Previous system failed
Yesft(No DISCHARGE: 0 Near 0 Away
Yes ~. No WINDOW WELLS 0 Yes 0 No
Yes J(. No
D. PROPERll~S WITH SUMP PUMPS
When does pump run? 0 Fall 0 Summer 0 Spring 0 Winter
(check all that apply) How often does pump run?
_NOTES~~r*=-.d~C~~ge to~.~tsid~.~~*~._B~~k_._._._._~._S~d~_.___._._._._.__._._
SUMP PUMP SYSTEM:
)ri. 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.
~ No
DYes
Is there another place where clear water enters the sanitary sewer system?
Where is this 10 . n?
This area w' nee~;t ~e fri so the clear water 6~,,~arges to the storm sewer system.
Ins~ecto~ (.~.-.... ;:;:>L Date: <;-1- /y- ".~
ReSIdent: .., Date:
Disclaimer: This visual inspection is done with due diligence to fmd obvious clear water cross-connections
and does not imply the structure meets all City Codes.
White: Homeowner
YelIow: City
Pink: HRG
'. ~
City of Prior Lake
Sump Pump and III Reduction
Inspection Form Ai/tOf,
{ I
Name: C;(; e?p
A'(d("'~
Prior Lake, MN 55 '? 7-2
Phone: Lj'J 7- /'I.[l
Date: v2i)-r9 Time:/t'OOa.m.lp.m.
First Inspection ~ Second 0
Own: ~ Rent: 0 Age of Home: -;>
Residential: a--
Non-Residential: 0
Address: 3;)0 S- &ff~Y>1"1T- C!R 5 vJ
. /
vf" I ~.Q" T'
A. BASEMENT ~es 0 No SUMP BASKET d'O 0 1 0 2 0 3 0
WATER IN BASKET 0 Yes 0 No SUMP PUMP l3"'6 0 1 0 2 0 3 0
WATER IN BASEMENT (flow over floor) 0 Yes J3.,qQ CISTERN 0 Y es ~
(If no pump, place sticker across edge of sump cover and basement floor so any removal of cover will
bkak 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
o Home came with system 0 Response to inspection program 0 Other
o Water in basement 0 Previous system failed
ROOF LEADERS: f""'~es~o DISCHARGE: ~r 0
B.
C.
Away
YARD DRAINS
BEAVER SYSTEM
o Yes I31ifO
o Yes ~o
WINDOW WELLS 0 Yes l3-"1"fo
D.
PROPERll~S 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
o Winter
o Back
o 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 l3"'1'io
Where is this location?
This area will need to be fixed so the clear water discharges to the storm sewer system.
Inspector: ,.,. v4~1 IVv'{ ~ .
Resident~1AI1.u< /,)faLtf}~A 0/UALP
/ I , --r;l
Date:
Date:
S- -l 0 - 99
(" - 2 () - tf''l
Disclaimer: This visual inspection is done with due diligence to fmd obvious clear water cross-connections
and does not imply the structure meets all City Codes.
White: Homeowner
Yellow: City
Pink: HRG