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City of Prior Lake
Sump Pump and I/I Reduction
Inspection Form
Name: ~[ V1 P~. C.. r~t r~1
Address: ~.~~6~.~. !`~.1'~ ~o ~K7~ ~c D S~
Prior Lake, MN 55~~ Phone: ~/~/~ 793~"'
Date: ;r~%?- 99 Time: q oa.mJp.m.
First Inspection ~ Second 17
Own: ~'"Rent: Q Age of Home:~~
Residential: C-}~"'
Non-Residential: ~
~/a (kv~~
A. BASEMENT C~`es ~ No 5UMP BASKET ~'6~0 1~ 2 ~ 3 ~
WATER IN BASKET ~ Yes a-I'~f'`o ~ SiJMP PUMP L~~~ 1~ 2 Q 3 ~
WATER IN BASEMENT (flow over floor) ~ Yes ~ CISTERN ~ Yes ~-i'dv''"
(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 D Outside
at Inspection: ~ Floor drain C7 Other
Prior to Inspection:
When was system installed, ar most recently modi~ed? (Date) and why
~ Home came with system ~ Response to inspection program ~ Other
~ Water in basement ~ Previous system failed
B. ROOF LEADERS: ~ O No DISCHARGE: ~ Near C3'"Away
C. YARD DRAINS ~ Yes l3''1Q`o WINDOW WELLS a Yes C~"lVo
BEAVER SYSTEM 17 Yes f~'o
D. PROPERTIES WITH SUMP PUMPS
When does pump run? ~ Fall O Summer ~ Spring O Winter
(check all that apply) How often does putnp run?
V~here does pump discharge to outside? ~ Front ~ Back O Side
NOTES:~- -;D~ ~"c~ •--Be,Se ----•' Kc.orr~~-f-~ y---- ~; S~S ~'e S«I~nce u S /S3 ~ Y irff+-sd
SUMP PUMP SYSTEM: ~S ~ FAIL You have 30 days to bring your system into compliance with current
regutations. When you are ready for reinspection, caU 657 /644-1469 for an appointment.
Is there another place where clear water enters the sanitary sewer system? ~ Yes ~'6
Where is this location?
This area will need to be fixed so the clear water discharges to the storm sewer system.
Insp tor: - Date: ~ /~? - 9 ~
Resi nt: ~ Date: ~'= /.~ - ~ 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 SUMP BASKET ~ 0 ~ 1 ~ 2 ~ 3 Q
WATER IN BASKET ~ Yes ~ No SUMP PIJMP O 0 ~ 1 ~ 2 ~ 3 ~
WATER IN BASEMENT (flow over floor) Q Yes ~ No CISTERN O Yes ~ 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 ~ l7 Laundry tub ~ Sanitary sewer 17 Outside
at Inspection: ~ Floor d~ain ~ Other
Prior to Inspection:
When was system installed, or most recently modified? (Date) and why
D Home came with system ~ Response to inspection program Q Other
Q Water in basement ~ Previous system failed
B. ROOF LEADERS: ~ Yes ~ No DISCHARGE: ~ Near ~ Away
~. YARD DRAINS ~ Yes ~ No WINDOW WELLS O Yes ~ No
' BEAVER SYSTEM ~ Yes ~ No
D. PROPERTIES WITH 5UMP PUMPS
When does puxnp run? ~ Fall ~ Summer Q Spring ~ Winter
(check all that apply) How often does pump run?
V~here does pump discharge to outside? ~ Front ~ Back C7` Side
NOTES ~~~~~.~~' ~' ~ ~~ ~/ G - - - -•-•-•--- - -•-•-• k
.,. •---~~ -•---•- -•-•-•---•---•-'-
SUMP PUMP SYSTEM: ~ PASS ~ FAIL You have 30 days to bring your system into compliance with current
regulations. When you are ready for reinspection, ca11651/644-1469 for an appointment.
Is there another place where clear water enters the sanitary sewer system? ~ Yes ~ No
Where is this location?
This area will to be ed so the clear w 'scharges to the storm sewer system.
Inspect . Date: ~,,,~~ ~ ~_
~
Residen . Date:
Disclaimer: This visual inspection is done with due diligence to find obvious clear water cross-connections
and does not im 1 the structure meets all Cit Codes.
White: Homeowner Yellow: City Pink: HRG