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City of Prior Lake
Sump Pump and I/I Reduction
Ins~ection Form
Name:~U (P K , ~,~a~~ ~ Sr~c~ ~~
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Address: ~.~.,~ / l /~r c ~~ l l ~, / ~ . '; ~
Prior Lake, MN 55 ;' 702 Phone: ~ ~ C~ -/@? ~/G
Date: ~-/6- 9y Time:O,Ta a a.m./p.m.
First Inspection ~
Own: I~'` Rent: ~
Residential: ~
Non-Residential: ~
Second Q
Age of Home: ~~
r~t~1 J ~i-. /
A. BASE NT ~" Yes ~ No SiJMP BASKET 13' 0 O 1 C~ 2~ 3 ~
WATER IN BASKET Q Yes ~ No SiJMP PUMP ~" 0~ 1 O 2 ~ 3 ~
WATER IN BASEMENT (flow over floor) d Yes I~No CI5TERN ~ Yes C~To
(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:
~ Laundry tub O Sanitary sewer ~ Outside
Q Floor drain ~ Other
Prior to Inspection:
When was system installed, or most recently modified? (Date)
and why
~ Home came with system ~ Response to inspection program ~ Other
O Water in basement l7 Previous system failed
B. ROOF LEADERS: I~Yes ~ No DISCHARGE: ~ Near C~3"Away
C. YARD DRAINS ~ Yes C~No WINDOVi~ WELL5 ~ Yes A~No
BEAVER SYSTEM ~ Yes 13' No
D. PROPERTIES WITH SUMP PUMPS
When does pump run? I~ Fall ~ Summer O Spring ~ Winter
(check all that apply) How often does pump run?
V~here does pump discharge to outside? ~ Front ~ Back 17 Side
NOTES:
SUMP PUMP SYSTEM: PASS I~ FAIL You have 30 days to bring your system into compliance with current
regulations. When you are ready for reinspection, ca[l 651 /644-1469 for an appointment.
Is there another place where clear water enters the sanitary sewer system? Q Yes L~`No
Where is this location?
This area will need to be fixed so the clear water discharges to the storm sewer system.
Inspector: f1i'~ ~^' Date: ~j! /G - ~/ q
Resident: /Lc,..,,, , ~~, a . ~ Date: y • /~ - q 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