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City of Prior Lake
Sump Pump and I/I Reduction
Insnection Form
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Address:~~ 6 90 l~J; l ~o ~ L~. J~
Prior Lake, MN 55 ~ 7~. Phone: `1 Y 7- //~' /
Date: ~-z:- %9 Time:~a.m./p.m.
First Inspection L3''~Second ~
Own: ~`"Rent: ~ Age of Home:~~
Residential: ~''
Non-Residential: ~
A. BASEMENT ~C-~'Yes~N a No 5iJMP BASKET Q 0 ~~ 2 O 3 ~
WATER IN BASKET ~ Yes L~-iG~o ~ SUMP PUMP ~~ 1 ~ 2 ~ 3 ~
WATER IN BA5EMENT (flow over floor) ~ Yes C~o~ CIS1'ERN ~ Yes C~-~d'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 ~ Laundty tub ~ Sanitary sewer ~ Outside
at Inspection: ~ Floor drain ~ Other
Prior to Inspection:
When was system installed, or most recently modified? (Date) and why
17 Home came with system ~ Response to inspection program ~ Other
~ Water in basement ~ Previous system failed
B. ROOF LEADERS: ~,,. 1' , w 1
~ I~Yes ~ No
DISCHARGE: .A~l~Tear
Q Away
C. YARD DRAINS ~ Yes L~'14'~o WINDOW WELLS ~ Yes I~~
BEAVER SY5TEM'` ~ Yes L~o
D. PROPERTIE5 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? O Front ~ Back ~ Side
NOTES:
SUMP PUMP SY5TEM: ~ ~ FAIL You have 30 days to bring your system into compliance with current
regulations. When you are ready for reinapection, call 651/644-1468 for an appointment.
Is there another place where clear water enters the sanitary sewer system? ~ Yes C"1"'l~0
Where is this location?
This area will need to be fixed so the clear water discharges to the storm sewer system.
Inspector: ..~,rf ~ Date: ~ = Z 3 - ~ ~
Resident• (~ ~ n 1 '"~~~ ~ Date: 8'- 1~ - 9 j
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