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City of Prior Lake
Sump Pump and I/I Reduction
ction Form ,q ~~' ~
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Name: ~~ J~~~"~~~ ~ ~~~~' Date~~" ~/ Time;~~~'~ m./p.m.
~ ` ~,~-~
~ ~~ First Inspe~res' n~Y" Second ~
Address:~~~~o ~~'~~~~~ ~~ ~9CN /~ Own: f~ Rent: Age of Home:~~
~y ,~/,/ Residential: ~ ~
Prior Lake, MN 55~ /.~ Phone:'Y'Y ~~~~~ Non-Residential: D
A. BASEMENT ID~4'es a No / SLJMP BASKET 1~0~7 1~ 2 ~ 3 ~
WATER IN BASKET D Yes ~0 5UMP_ ~P~~~ Li?'~0 ~ 1 ~ 2_ ~~' - O
WATER IN BASEMENT (flow over floor) ~ Yes L~No CI5TERN ~ Yes Q'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 ~ Laundry tub ~ Sanitary sewer ~,Q 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 C] Other
~ Water in basement Q Previous syste failed
B. ROOF LEADERS: ~ Yes L~~''No DISCHARGE: ~ Near ~ Away
C. YARD DRAINS ~ Yes l~___' N~` WINDOW WELL5 ID~Yes Q No
BEAVER 5YSTEM Q Yes ~~1Vo
D. PROPERTIES WITH SUMP PUMPS
When does pump run? ~ Fall ~ Summer ~ Spring- ~ Winter
(check all that apply) How often does pump run? .,,.--
V~here does pump discharge to outside? I~ Front ~ acB k ~ Side
NOTE3:
SUMP PUMP SYSTEM: C~/~~ASS ~ FAIL You have 30 days to bring your system into compliance with current
regulations. When you are ready}'or reinspection, ca[I 651/644-1469 for an appointment.
Is there another place where clear water enters the sanitary sewer system? O Yes L9''1Vo
Where is this location?
This area will need to be e~he clear ~r di~irges to the storm sewer system.
Inspector:
Resident: ,, ,~e
Date: ~ ~.G -
Date: ~
Disclaimer: This visual inspection is done with due diligence to find obvious clear water cross-connections
and does not impl_y the structure meets all City Codes.
White: Homeowner Yellow: City Pink: HRG