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City of Prior Lake
Sump Pump and III Reduction
Inspection Form
Name: <' fJ A c t:= _
---- -
Date:~J-7q Time:
a.m./p.m.
Prior Lake, MN 55
Phone:
First Inspection S-
Own: ~ Rent: 0
Residential: .!St
Non-Residential: 0
Second 0
Age of Rome:
Address:/~tf1'-1 EA&I..E.. C.2UK f)v.c. 5 C
A. BASEMENT 0 Yes :<<l. No SUMP BASKET ~ 0 0 1 0 2 0 3 0
WATER IN BASKET 0 Yes 0 No SUMP PUMP '" 0 0 1 0 2 0 3 0
WATER IN BASEMENT (flow over floor) 0 Yes JO 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
o Home came with system 0 Response to inspection program 0 Other
o Water in basement 0 Previous system failed
B. ROOF LEADERS: 0 Yes ~ No DISCHARGE: 0 Near 0 Away
C. YARD DRAINS 0 Yes r!J No WINDOW WELLS 0 Yes 0 No
BEAVER SYSTEM 0 Y es~ 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?
Where does pump discharge to outside? 0 Front 0 Back 0 Side
-;O;ES:;::~q;O~!~~::.:~~~~~~~:::~-~~:3t.~;t~;~.~~_._+he
SUMP PUMP SYSTEM: J9... PASS 0 FAIL You have 30 days to bring your system into compliance with current
regulations. When you are ready for reinspection. call 6511644-1469 for an appointment.
Is there another place where clear water enters the sanitary sewer system?
Where is this location?
This area w~d toX fixed so th~ clear
Inspector~ -.A' f I '
Resident: ..
DYes
~No
r discharges to the storm sewer system.
Date: q...,;z / - e; 9
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
Yellow: City
Pink: HRG
City of Prior Lake
Sump Pump and III Reduction
Inspection Form
ANNUAL CERulflCATION RE-INSPECTION 2002
Name: KA-rHY ?RACE.
Address: MdY14- ~ ~ME.
Prior Lake, MN 55372
Phone: L-t4-1- 5'225
Date: 6 /q /62-
Time:
I: 10 lIMIpm
Inspection: D Second )( Third
~ Own D Rent
~ Residential
Age of Home: ?-J.,. Yes,
D Non-Residential
A.
BASEMENT ~ Yes 0 No SUMP BASKET 0 0 lzi 1 0 2 0 3 D
WATER IN BASKET DYes iJNo SUMP PUMP DO kJl D 2 030
WATERINBASEMENT DYes BlNo CISTERN DYes ~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.)
Discharge Point
at Inspection:
o LaundrY tub
o Floor drain
o Sanitary sewer
o Other
~Outside
Prior to Inspection:
When was system installed, or most recently modified? (Date) \ 2. - q <1 and why?
. 0 Home came with system D Response to inspection program 0 Water in basement
~ Previous system failed a Other
B.
ROOF LEADERS
o Yes "'No
,
DISCHARGE
o Near OAway
C.
YARD DRAINS
BEAVER SYSTEM
qYes
DYes
~No
!L'No
WINQOWWELLS DYes JIlNo
D.
PROPERTIES WITH SUMP PUMPS ~
When does pump run? 0 Fall 0 Summer - 0 Spring
(check all that apply) How often does pump run? ~ 01'1I ,I fa M~
Where does pump discharge to outside? D Front ~Back -
D Winter
1iil Side
.............................................................................................................................................................................................................................................................................................................................................................................................
NOTES:
SUMP PUMP SYSTEM:
}g PASS
o FAIL You have 30 days to bring your system into compliance with current
regulatio/l1J. Please call 9521447 -9833 for a re-inspection appointment.
Is there another place where clear water enters the sanitary sewer system? ;0 Yes Ji'l1 No
Where is this location?
This area will need to be fixed so the clear water discharges to the storm sewer system.
Inspector
Resident:
Date:
Date:
CS-qfD&
. I
~- ~
( .
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.
Re>i~t Uw M~
'I S(q/pz. ~
i
A.
B.
C.
D.
'rn,\
~
City of Prior Lake
Sump Pump and III Reduction
Inspection FOill! J AfP+ 1
Name:
Jtf(~5 / f;(/f/f'fl~V
r
") pC! (" ("
,
Date'. 12-- 21-7('0 TI'me', 1/ C~/p
f ~ .m.
Second )(
Age of Home: 1. \
Ita 01 f( FOr Ie 0~ ek 4v~ 5E
Prior Lake, MN 55/)11, Phone: '1l/7-5225""
First ~ection, 0
Own:)9.. ~~: 0
Residential~
Non-Residential: 0
Address:
BASEMENT 0 Yes ){ No
WATER IN BASKET !BYes oNo
WATER IN BASEMENT (flow over floor)
SUMP BASKET 0 0 "M. 1 0 2 0 3
SUMP PUMP oOxfl 0203
DYes <<No CISTERN 0 Yes ~ No
c:J"
'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
at Inspection:
o Laundry tub
o Floor drain
o Sanitary sewer )ci Outside
o Other
Prior to Inspection:
When was system installed, or most recently modified? (Date)
\1, qq
and why
o Home came with system
a Water in basement
~ Response to inspection program 0 Other
o Previous system failed
o Yes ~ No DISCHARGE: 0 Near 0 Away
o Yes ~No WINDOW WELLS 0 Yes)("No
o Yes~ No
ROOF LEADERS:
YARD DRAINS
BEAVER SYSTEM
PROPERTffiS WITH SUMP PUMPS '
When does pump run? 0 Fall 0 Summer )( Spring
(check aU that apply) How often does pump run?
Where does pump discharge to outside? 0 Front 0 Back
o Winter
/
~ Side
-----------------------.---------.-------------------------.-.-.---.-----.-.-.---------.-.-----.-.---.-.-.-------.---------------.-
NOTES:
SUMP PUMP SYSTEM:
)( PASS
o FAIL You have 30 days to bring your system into compliance with current
regulations. When you are ready for reinspection. call 6511644-1469 for an appointment.
:r( No
Is there another place where clear water enters the sanitary sewer system? 0 Yes
Where is this location? .lwate
This area will need ~,,' 'fft~, ofhe Cl.ea~r discharges to the storm sewer system,.", _
Inspector: I." \'- ,\' ~ Date: \ '- ./.f;). -l( \
Resident: ~ iL U, L.?~:"9--- Date: / l - t.. ~I .,! )'
I Disclaimer: This Visuat"inspe~ion is done with due diligence to find obvious clear water cross-connections
and does not imply the structure meets all City Codes.
-.c.t'
Y II . C. ~,
e ow. It}ti'
l:
Pink: HRG
White: Homeowner
i~ (
A.
City of Prior Lake
Sump Pump and III Reduction
Inspection Form NP/~//
Name: dpl9c..6, lJ ~HES Date0-/0.-9'0Ti~Oa.m./p.m.
/ Sf:
J/ ,Q / r _ /l L1 First I~sp~n ~nd 0
Addressf{pJO /^I.;C~~'-e C:e~EG HV Own: l!r"' R=-nt:j;L. Age of Home:Z J I..{f-.)
f -?,. j ;; ;; Residential: g-- J
Prior Lake, MN 550 ~ Phone:Y70 4"100 Non-Residential: 0
/ - I
IvC) We I~ /-- . ./" ~
BASEMENT ~s 0 ~ SUMP BASKET 0 0 ~ ~ 0 3 0
WATER IN BASKET ~s oNo SUMPPUMY 0 0 ~o 2 0 3~
WATER IN BASEMENT (flow over floor) 0 Yes ~ CISTERN 0 Yes o~
(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 ~dry tub 0 Sanitary sewer 0 Outside
at Inspection: 0 Floor drain 0 Other
B.
C.
Prior to Inspection:
When ~tem installed, or most recently modified? (Date)
~me came with system 0 Response to inspection program
o Water in basement 0 pre~ious s~iled
ROOF LEADERS: 0 Yes B1iV DISClIARGE: 0 Near 0 Away
YARD DRAINS 0 Yes~~ WlNDOWWELLS 0 Yes~
BEAVER SYSTEM 0 Yes!tY1<fO
and why
o Other
D.
PROPERTIES WITH SUMP PUMPS , ~
When does pump run? 0 Fall ~ummer
(check all that apply) How often does pump run?
Where does pump discharge to outside? 0 Front
Spring 0 Winter
;:J eDi.. iF I.{ C vi e t<.-
O Back ...., 0 Side
NOTES:
~-
;1../us{J/J,va C$.t: t:;.C !owJ
./
SUMP PUMP SYSTEM: 0 PASS D4AIL You hav~s~;t;g your system into compliance with current
regulations. When you are ready for reinspection. call 651/644-1469 for on ~ent.
Is there another place where clear water enters the sanitary sewer system? 0 Y es ~
Where is this location? _
This area will n.e eeedd t too b b~t, e~.. e.,clear ate~discharges to the storm sewer sy~tem.
Inspector: ~.f 0; ... Date: 3-10- 9CJ
Resident:",:!:l:J'~-{' Date: ..3-/ 0- ~9
r ,\ ..
) '"
Disclaimer: This. isual1DSpecfion is done with due diligence to fmd obvious clear water cross-connections .
and does not imply the structure meets all City Codes.
.'t
White: Homeowner
Yellow: City
Pink: HRG
J