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City of Prior Lake
Sump Pump and III Reduction
Inspection Form
Name: f e Ie k... Date: 9-/~ J1-? Time:
/5363 ~.' - ~ f?~4 tb-ks k.J.SE
(; First ~ns"pection Ci Second 0
Address~.w ~ D I ~ 5' lr<r;~$ /<0..5 'Y~;"':' Own: BRent: 0 Age of Home:
(m""i1I'I'\~ ..7") Residential:~
Phone: Non-Residential: 0
a.m.lp.m.
Prior Lake, MN 55
A.
BASEMENT 0 Yes ~ No
WATER IN BASKET 0 Yes 0 No
WATER IN BASEMENT (flow over floor)
SUMP BASKET ~ 0 0 1 0 2 0 3 0
SUMP PUMP ~ 0 0 1 0 2 0 3 0
DYes ),(No CISTERN 0 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
at Inspection:
o Laundry tub
LJ Floor drain
o Sanitary sewer
o Other
o Outside
Prior to Inspection:
When was system installed, or most recently modified? (Date)
and why
o Home came with system
o Water in basement
o Response to inspection program 0 Other
o Previous system failed
DYes ~ No DISCHARGE: 0 Near 0 Away
OYes)q, No WINDOW WELLS 0 Yes 0 No
o Yes~ No
B.
ROOF LEADERS:
YARD DRAINS
BEAVER SYSTEM
C.
D. PROPERuJi.S WITH SUMP PUMPS
When does pump run? 0 Fall 0 Summer 0 Spring 0 Winter
(check all that apply) How often does pump run?
Where does pump discharge to outside? 0 Front 0 Back 0 Side
-NOTES~._._._=t)~-::.t'r~-'-'-'CO-:r'-'-'-'5"~-E--'-'p-'i'D'-iE-~'So~Da:5(J-'-'-'-
.- -
SUMP PUMP SYSTEM:
~ PASS
o FAIL You have 30 days to bring your system into compliance with current
regulations. When you are ready for reinspection, call 651/644-1469 for an appointment.
)if No
DYes
Is there another place where clear water enters the sanitary sewer system?
Where is this location?
This area will nee.dto be fixed so the clear water~' c. harges to the storm sewer system.
.~ '1 -----'
Inspector: \......L..J-(~,f,..{)., Date: C/_ LJ./ -7 <5
Resident: . - I Date:
Disclaimer: This visual inspection is done with due diligence to {'md obvious clear water cross-connections
and does not imply the structure meets all City Codes.
White: Homeowner
Yellow: City
Pink: HRG
,
City of Prior Lake
Sump Pump and III Reduction
Inspection FOill!
Name:
FeICK
Prior Lake, MN 55
Phone:
Date: 9-/- 9 7' Time:/t'~@p.m.
First InsQection)1 Second 0
Own:)(' ~: 0 Age of Home:
Residential:
Non-Resident al: 0
Address: 1!::J<.3 b 3
PGi.) {)~J5:S
A.
BASEMENT 0 Yes ~o SUMP BASKET :a 0 0 1 0 2 0 3 0
WATER IN BASKET 0 Yes 0 No SUMP PUMP ~ 0 0 1 0 2 0 3 0
WATER IN BASEMENT (flow over floor) 0 Yes ~o CISTERN 0 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
at Inspection:
o Laundry tub
0, Floor drain
o Sanitary sewer
o Other
o Outside
Prior to Inspection:
When was system installed, or most recently modified? (Date)
and why
B.
C.
ROOF LEADERS:
YARD DRAINS
BEAVER SYSTEM
o Response to inspection program 0 Other
o Previous system failed
o Yes~No DISCHARGE: 0 Near 0 Away
o Yes}f No WINDOW WELLS 0 Yes 0 No
o Yes RNo
o Home came with system
o Water in basement
D. PROPER.mS WITH SUMP PUMPS
When does pump run? 0 Fall 0 Summer 0 Spring 0 Winter
(check all that apply) How often does pump run?
-~C;iiiiS~~'.".~::;;~~~~-~.:,.~;".::;;_._~.~~-~._._._._~._Il~I<_._._._.-~'-~~~-'-'-'-'-'-'-'-'-'-'-.
SUMP PUMP SYSTEM:
ArASS
o FAIL You have 30 days to bring your system into compliance with current
regulations. When you are ready for reinspection, call 651/644-1469 for an appointment.
~NO
DYes
Is there another place where clear water enters the sanitary sewer system?
Where is this location?
This area w~ob~ed so the c~ear wateyttisfharges to the storm sewer system. .
Inspector~'( , \.. ; Date: c:; - / - 9 '7
Resident: Date:' ..
I Disclaimer: This visual inspection is done with due diligence to fmd obvious clear water cross-connections
and does not imply the structure meets all City Codes.
White: Homeowner
Yellow: City
Pink: HRG
../
/
City of Prior Lake
Sump Pump and III Reduction
Inspection FOilll
Name: {;:,'c k \ }c,VV"\('-'
Date: I" 'J. r"1 Time: /'//r a.m./p.m.
Address: /5.) f J ;:;. ,) c.. 4..1 1( j) (" E
First Inspection ~ Second 0
Own: LJ-""Rent: 0 Age of Home:.....? S-
Residential: 13-
Non-Residential: 0
Prior Lake, MN 55 ]7,). Phone: '-j'f 7 - II if)
A.
BASEMENT 0 Yes ~
WATER IN BASKET 0 Yes CJ'NO
WATER IN BASEMENT (flow over floor)
SUMP BASKET 13""0 0 1 0 2 0 3 0
SUMP PUMP I?"'"O 0 1 0 2 0 3 0
DYes r:J...M'O CISTERN 0 Yes I3"'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
at Inspection:
o Laundry tub
O' Floor drain
o Sanitary sewer
o Other
o Outside
Prior to Inspection:
When was system installed, or most recently modified? (Date)
and why
ROOF LEADERS:
YARD DRAINS
BEAVER SYSTEM
o Response to inspection program
o Previous system failed
re,J-f.. I
e--Yes 0 No
o Other
o Home came with system
o Water in basement
B.
C.
DISCHARGE: ~Near 0 Away
DYes tJ No
DYes r::J.-1q 0
WINDOW WELLS 0 Yes l3--1'fo
D.
PROPERTIES WITH SUMP PUMPS
When does pump run? 0 Fall 0 Summer
(check all that apply) How often does pump run?
Where does pump discharge to outside? 0 Front
o Spring
o Winter
o Back
o Side
---------------------------------------------------------------------.---------------.---------------.-----------------------------
NOTES:
g1> ASS 0 FAIL You have 30 days to bring your system into compliance with current
regulations. When you are ready for reinspection, call 651/644-1469 for an appointment.
Is there another place where clear water enters the sanitary sewer system? 0 Y es ~o
Where is this location?
This area will need to be fixed so the clear water discharges to the storm sewer system.
Inspector: . f)~llv'/\J.y~ Date: 6" 7- ?,
Resident: ----a.,"Lh,/,,-, ,,;:fl.{>.[ Date: ;: - 7- 9'9
SUMP PUMP SYSTEM:
Disclaimer: This visual inspection is done with due diligence to fmd obvious clear water cross-connections
and does not imply the structure meets all City Codes.
White: Homeowner
Yellow: City
Pink: HRG