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City of Prior Lake
Sump Pump and I/I Reduction
Insuection Form
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Name: G~~~~ /" 1~.~~ Date~:7'''"~~ ~~ Time:~JOc~.m./p.m.
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~ %~ N~ ~~ First In,~s ~on Second ~ ~ -r-
Address: ~~~ ~~~)~' ~ c'~/ Own: ~ Rent: Age of Home: ~ `~ S`
~ ,~f11 Residential: ~ ~...J
Priar Lake, MN 55 ~~i'~ Phone~'"~ ~~~~~ Non-Residential: ~
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A. BASEMENT es ~ No~ / SIJMP BASKET ~ 1 ~ 2 ~ 3 ~
WATER IN BASKET O Yes L~J'No SUMP P~ 0~ 1 ~ 2 ~ 3 ~
WATER IN BASEMENT (flow over floor) ~ Yes ~YNo CISTERN Q Yes ~
(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 L~ Laundry tub I~ Sanitary sewe~ Outside
at Inspection: ~ Floor drain ~ Other
Prior to Inspection: -'''~~
When was systern installed, or most recently modified? (Date) and why
• O Home came with system ~ Response to inspection program ~ Other
~ Water in basement Q Previ s system failed
B. ROOF LEADERS: es ~ No DISCHARGE: ~ Near B' Awa
Y
C. YARD DRAINS O Yes ~' WINDOW WELLS ['~ Yes ~
~"~'" `' BEAVER 5YSTEM O Yes ~
D. PROPERTIES WITH SUMP PUMPS
When does pump run? ~ Fall ~ Summer ~ S~iug~-- ~ 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: ['~/~ASS l~ FAIL You have 30 days to bring your system into compliance with current
regulatiorrs. When you are ready for reinspection, call 651 /644-1469 for an app '" ent.
Is there another place where clear water enters the sanitary sewer system? ~ Yes ~]~iVo
Where is this location?
This area will need to b ixe o e clear ter~arges to the storm sewer system.
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Inspector: /''~-~J • .~i'/~`'``" Date: ~ "
Resident:~ G`~ T ~ ' , _ .,~. ~.----- 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