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City of Prior Lake
Sump Pump and I/I Reduction
Inspection Form ~,~,~ ~ ~-
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Name: ~~~~'~i~/, ~~i~'G~ i Dat~ti'7'" ~~ Tim~~,.3~ a.m./p.m.
~' ~ ~ First Insp~e 'on A-~Second ~
Aldress: ~c~~~~ 1.~,~,~ ,~•t,~,~ ~/~ ~wn: ~' R~nt: ~. Age of H~me:
~,/,, Residential: ~
Prior Iyake, MN 5~~~,~ Phone"~~~ ~~--~~G ~ Non-Residential: ~
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A. BASEMENT es ~ No~/`` SiJMP BASKET ~,~'' ~ 1 ~ 2 ~ 3 ~
WATER IN BASKET ~ Yes [~'No SiTMP P~~ Q' 0 Q 1 ~ 2~~ 3~
WATER IN BASEMENT (flow over floor) ~ Yes i~ T o CISTERN ~ 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 O Laundry tub
at Inspection: ~ Floor drain
Prior to Inspection:
When was system installed, or most recently modified? (Date)
~ Home came with system ~ Response to inspection program
O Water in basement ~ Previous system failed
~l Other
and why
B. ROOF LEADERS: @' Yes ~ No DISCHARGE: Q Near 7'Away
C. YARD DRAINS ~ Yes t9_'~ WINDOW WELi.S ~ Yes t~'No
BEAVER SYSTEM ~ Yes ~' No
D. PROPERTIES WITH SUMP PUMPS
When does pump run? ~ Fall O Summer ~ S~j;t1g ~ Winter
(check all that apply} How often does pump run?
V~here does pump discharge to outside? 17 Front d Back D Side
NOTES:
SUMP PUMP SYSTEM: Ly I~ASS ~ FAIL You have 30 days to bring your system uuo comp[iance with eurrent
regu[ations. When you are ready for reinspection, ca[1651 /644-1469 for an rntment.
Is there another place where clear water enters the sanitary sewer system? ~ Yes L~ No
Where is this location?
This area will need to b ixe~l..s~he cleary/ater,,~'scharges to the storm sewer system.
Inspector:
Resident:
Date: ~ ;.G"~'•
Date: ~
Disclaimers 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.
O Sanitary sewer O Outside
~ Other ~
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White: Homeowner Yellow: City Pink: HRG