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City of Prior Lake
Sump Pump and III Reduction
Inspection Form
ANNUAL CERTIFICATION RE-INSPECTION
Name: Dcth I ~ t(o,re h
Date:~. Time: 0'. t6 am/_
Inspection: 0 First 0 Second X TH f f!-D
Address: 5ll.o '2- 15:f' 3r.
Prior Lake, MN 55372 Phone:!:l4o -Lt?io 1
~ Own 0 Rent
j(J Resid~ntial
Age of Home:
o Non-Residential
A. BASEMENT ld Yes 0 No SUMP BASKET 0 O~ 1 02 0 3 0_
WATER IN BASKET DYes if No SUIYIPPUMP DO ~l 02030
WATER IN BASEMENT 0 Yes )rINo CISTERN 0 Yes )z1 No
(If no pump, place sticker across edge of sump ~over and basement floor so any removal of cover will break seal. Skip to Part B,)
, '
Discharge Point 0 Laundry tub 0 Sanitary sewer )d Outside
at Inspection: 0 Floor drain 0 Oth~r
Prior to Inspection: t
When was system installed, or most recently modified? '(Date) 2.. - C{~
o Home came with system 0 R~sponse to inspection program 0 Other
o Water in basement J{Previous system failed
and why?
B.
ROOF LEADERS
DYes )a.No
. :
, .
DISCHARGE
o Near oAway
c.
YARD DRAINS
BEAVER SYSTEM
DYes
DYes
~No
]iI No
WINDOW WELLS 0 Yes )(No
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
NGveR..
o Back
o Winter
o Side
NOTES:
SUMP PUMP SYSTEM:
~ PASS 0 FAIL YOiJhal'e30 days lohrillgyoursyslelll illlOCO/llp!iclIIce wilhcurrel/1
regu/aliclI/s, Whell you are readyfor re-illspeclioll, caI/952/447-9833,fi>r all appoil/1/11et1l,
Is there another place where clear water enters the sanitary sewer system? 0 Yes
Where is this location?
This area will need to be fixed so the clear water discharges to the storm sewer system.
)lfNo
Inspector:
Resident:
Date:
Date:
11/8/6{
f I
1//9/01
I I ,
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.
~S"i~ 41fy ~:I<Jl. 'It,
~
City 'of Prrdr Lake
Sump Pump and III Reduction
Inspection Form
Name:0;:;; H J...". /'1;q e. 71 AI
.'
Address:576:<J /-50 -& Si0E
Prior Lake, MN 5537~ Phone-sl'->t-A/-Zh7
/}ppJj
Date:3- 3 ~ 99 Timi'.o,.j~.m.lp.m.
First Inspe~ 0 Second ~
Own: iIV""Rent: 0 ......-Age of Home:_
Residential: ~
Non-Residential: 0
A. BASEMENT a Yes a No SUMP BASKET a 0 a 1 a 2 a 3 a
WATER IN BASKET aYes aNo SUMP PUMP a 0 a 1 a 2 a 3 a
WATER IN BASEMENT (flow over floor) a Yes a No CISTERN a Yes a 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:
a Laundry tub
a Floor drain
a Sanitary sewer
a Other
a Outside
Prior to Inspection: 2 a 9
When was system installed, or most rece ly modified? (Date) - /
and why
a Home came with system esponse to inspection program a Other
a Water in basement a Previous system failed
B. ROOF LEADERS: a Yes a No DISCHARGE: a Near a Away
C. YARD DRAINS a Yes a No WINDOW WELLS a Yes a No
BEAVER SYSTEM a Yes a No
D. PROPERTIES WITH SUMP PUMPS
When does pump run? a Fall a Summer a Spring a Winter
(check all that apply) How often does pump run?
Where does pump discharge to outside? 0 Front a Back a Side
-.-.-.-.-.-.-.-.-. 7:::S-'-'-:::Z::;JS'r;.:ii:Z'-'-N?'t::J-'-'-?ZLm'F'-'-:r-'-T~-~'-'-'-.-.-.-
IP€ 0 OU751t>~,
SUMP PUMP SYSTEM: SS a FAIL You have 30 days to bring your system into compliance with current
regulations. When you are ready for reinspection, cau651/644-1469 for an ~ent.
Is there another place where clear water enters the sanitary sewer system? 0 Y es ~
Where is this location?
This area will need to b ischarges to the storm sewer system.
Inspector:
Resident:
Date:
Date:
-3.9;
3-3-9
Disclaimer: This visual inspection is done with due diligence to rmd obvious clear water cross-connections
and does not im I the structure meets all Cit Codes.
White: Homeowner
Yellow: City
Pink: HRG
City of PribrLake
Sump Pump and III Reduction
Inspection Form pp);
Name:v!),lIr/..0., /'1fi:Je/JA.! Date:~'-9-9.5J TimeIOt?oa~.Ip,m.
~ /- I r-; 7i:I (P (';/ First Insp~ion ~d 0 "
Address: 0 76;:U /...:;;0 u 1'" u,A::" Own: g/ Re!1t:g...-Age of Home:20<..f 5
, / / L /'7/7' Residential: ~ :J
Prior Lake, MN 5537:0 Phone:,y.yO-'7~ Non-Residential: 0
A. BASEMENT es LJ ~
151 WATER IN BASKET ~s LJNo
VI,O WATER IN BASEMENT (flow over floor)
SUMP BASKET LJ 0 LJ 2 LJ 3 LJ
SUMP PUl\:IY' LJ 1 LJ 2 LJ ~
LJ Yes ~ CISTERN LJ Yes ~
(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 LJ Laundry tub ~nitary sewer 0 Outside
at Inspection: 0 Floor drain 0 Other
Prior to Insp' ion:
, When w system installed, or most recently modified? (Date)
,.--
and why
Home came with system
o Water in basement
B.
C.
ROOF LEADERS:
YARD DRAINS
BEAVER SYSTEM
o Response to inspection program 0 Other
o Previous system failed
LJYes~ '. DISCHARGE:Cl Near LJ Away
LJ Yes ~ WIND~W WELLS LJ Yes'~
LJ Yes ~o
D. PROPERTIES WITH SUMP PUMPS
When does pump run? LJ Fall LJ Summer LJ Spring LJ Winter
(check all that apply) How often does pump run?
Where does pump discharge to outside? LJ Front LJ Back LJ Side
-NOTES~'-'-S-;ia'A-;e'(i'-':l3A-sKE7-'-)::;A5-'-'?ipe'-'-70'-'-;c2oo';e'-'7)'ii~;~J'-'-'-
~47'" KOOi:::, tv?v C DI2AoJ A> o/A.J I
SUMP PUMP SYSTEM: 0 PASS AIL 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 ~ent,
Is there another place where clear water enters the sanitary sewer system? 0 Y es ~
Where is this location?
This area will need to be arges to the storm sewer system,
Inspector:
Resident:
Date:
Date:
Disclaimer: This visual inspection is done with due diligence to rmd obvious clear water cross-connections
and does not im I the structure meets all Cit Codes.
White: Homeowner
Yellow: City
Pink: HRG