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City of Prior Lake
Sump Pump and I/I Reduction
Inst~ection Form
Name: ~~U°~'r~a: .~~,~ ,,~l~t~`r~~.. ~
Address: ~l~`?4~ f'~~t~l;~,~:~' G..lf. l~~
Prior Lake, MN 55 :~~Z. Phone: ~/~{Cl ~~, .'.~f,~'C
Date: ~'~~ ~ ~ ~~`3 Time:~, - ~S a.m~~
First Inspection ~ Second Q
Own: ~3'''~ Rent: ~ Age of Home:3~
Residential: L~`
Non-Residential: L~
A. BASEMENT ~s ~ No SIJMP BASKET ~''~~ d 1 Q 2 O 3 ~
WATER IN BASKET ~ Yes ~1~ SLTMP ~PU~"M/P, C~6 ~ 1 ~1 2~ 3 ~
WATER IN BASEMENT (flow over floor) ~ Yes ~r~ CI5TERN O Yes ~-~Yo
(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 ~ Laundry tub ~ Sanitary sewer ~ Outside
at Inspection: ~ Floor drain ~ Other
Prior to Inspection:
When was system installed, or most recently modified? (Date)
~ Home came with system
~ Water in basement
B. ROOF LEADER5:
G YARD DRAINS
BEAVER SYSTEM
~ Respo e to inspection program a Other
L7 Pr 'ous system failed
and why
Yes a No DISCHARGE: ~ Near I~Away
~ Yes ~~~/io WINDOW WELLS ~ Yes ~No
~ Yes LL~""1~No
D. PROPERTIES WITH SUMP PUMPS
When does pump run? t7 Fall ~ Summer ~ Spring ~ Winter
(check all that apply) How often does pump run?
Where does pump discharge to outside? ~ Front ~ Back ~ Side
NOTES:
SUMP PUMP SYSTEM: ~~ASS ~ FAIL You have 30 days to bring your system into compliance with current
regulationr. When you are ready jor reinspection, cal[ 651 /644-1469 for an htment.
Is there another place where clear water enters the sanitary sewer system? Q Yes ~ No
Where is this location?
This area will need to be fixed so the clear water dischar~es to the storm sewer system. ~
Inspector: Date: .,~ /~ `
Resident: Date: ~g q
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. ~'k-
White: Homeowner Yellow: City Pink: HRG