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City of Prior Lake
Sump Pump and I/I Reduction
Inspection Form ~,~,~ ~ 7-
Name: ' ' ' `~``~~~~/ ""' '~~'~'Q~~'~'~ Date:~~~~ ~~ Timel~~a.~n ,/p.m.
/~'~~ ~~~ ~~~.T. ~~' First In,s~P '' n L°1" Second ~ ~
Address: ~~ Own: L7 Rent: Age of Home~~~`'
~`~ ~ , ~ Residential: ~ `~
Pri9r Lake, MN ~55 Phone:~`3 ~'~~ Non-Residential: ~
A. BASEMENT ~Yes ~ No~~ 5UMP BASKET ~~~~ 1~ 2 ~ 3 ~
WATER IN BASKET 17 Yes Q No SUMP~~ Q 0 Q 1 O 2~ d~~ O
WATER IN BASEMENT (flow over floor) O Yes Q No CISTERN ~ 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 O Laundry tub O Sanitary sew,~ Q Outside
~ at Inspection: ~ Floor drain O Other
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Prior to Inspection:
When was systern installed, or most recently modified? (Date) and why
~ Home came with system 17 Response to inspection program ~ Other
Q Water in basement L~ P ous system failed
B. ROOF LEADERS: Yes ~ DISCHARGE: O Near Away
C. YARD D1tAINS ~ Yes~~ o ~ WINDOW WELLS ~ Ye~-~' No ~
BEAVER 5YSTEM 17 Yes"Q No
D. PROPERTIES WITH ~UMP PU1bII'S
When does pump run? ~ Fall ~ Summer 17 S~ring Q Winter
(check all that apply) How often does pump run?
V~here does pump discharge to outside? I~ Front O Ba`~kk ~ Side
NOTES:
SUMP PUMP SYSTEM: ~ PASS ~] FAIL You have 30 days to bring your system into compliance with curre
regulations. When you are ready for reinspection, ca[l 651l644-1469 for an ent.
Is there another place where clear water enters the sanitaty sewer system? ~ Yes No
Where is this location?
This area will need t e fi ~ so the c r~r discharges to the storm sewer system.
...,~Y.,.,~.,..
Resident~
Date: y ~' ' ` 7 7
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