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City of Prior Lake
Sump Pump and I/I Reduction
Insnection Form
Name: cay~~~ f~r~ ~Y ~ ~c
Address: ~ .S~a ~7 ~ ~G~~/ ~ a Ut ~`~ ~ /(/,L
Prior Lake, MN 55 ~~ 7~ Phone: ~/"/ `~- /~'~~
Date: ~'i - 2 G'- q~ Time: ~~ ~ a.m./p.m.
First Inspection Q'~^Second Q
Own: ~'""'Rent: ~ Age of Home: /; ,
Residential: C-~'"'"
Non-Residential: ~
w~l4v~ ~
A. BASEMENT ~~ No SUMP BASKET ~ 0 ~l ~ 2 ~ 3 C7
WATER IN BASKET ~ Yes I~To SUMP PUMP I~TI Q 1 ~ 2 ~ 3 ~
WATER IN BASEMENT (flow over floor) ~ Yes L'J'N`o CISTERN ~ Yes A-i~6
(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 I~ Laundry tub Q Sanitary sewer ~ Outside
at Inspection: ~ 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
~ Water in basement ~ Previous system failed
B. ROOF LEADERS: ~s ~ No DI5CHARGE: ~ Near A''~way
C. YARD DRAINS Q Yes L~'1Go . WINDOW WELi.S ~ Yes ~
BEAVER SYSTEM ~ Yes ~'No
D. PROPERTIES WITH SUMP PUMPS
When does pump run? ~ Fall Q Summer 17 Spring ~ Winter
(check all that apply) How often does pump run?
V~here does pump discharge to outside? ~ Front ~ Back ~ Side
NOTES:
SUMP PUMP SYSTEM: ~ASS L7 FAIL You have 30 days to bring your system into comp[iance with current
regulations. When you are ready for reinspection, ca11651/644-1469 for an appointment.
Is there another place where clear water enters the sanitary sewer system? Q Yes ~"°" ~"No
Where is this location?
This area will ~eec~to be fixed so the clear water discharges to the storm sewer system.
I Inspector: U ~%wlce~~~,.~-~-`" ~ Date: t./` -16' ~~ (
Resident: Date: '~- .7_ ` ~ 99
T7^~~
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