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City of Prior Lake
Sump Pump and I/I Reduction
Ins~ection Form
Name: ~ ~ r' ~ ~ r c~ ~ .S ~ r' f ~~ ~ i
Address: ~ G~ ~U -•~~~ ~ ~ d/ ~~ac~C. ;~ ~. f"v/
Prior Lake, MN 55 ~ 7~ Phone: ~~ 7--~~/~I D
Date: ~~1- ~` `~ Time: L~ y~ a.m./p.m.
First Inspection 13'~Second ~
Own: ~''"Rent: Q Age of Home: /~ ~'
Residential: ~
Non-Residential: ~
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A. BASEMENT es ~ No SUMP BASKET ~~ 1 [7 2~ 3 a
WATER IN BASKET ~ Yes ~ No SiJMP PUMP ~~ 1 17 2~ 3 ~
WATER IN BASEMENT (flow over floor) ~ Yes l~~Qo CI5TERN ~ Yes L7.~Fo~
~.. -(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 a Laundry tub ~ Sanitary sewer ~ Outside
at Inspection: ~ Floor drain O Other
Prior to Inspection:
When was system installed, or most recently modified? (Date) and why
O Home came with system ~ Response to inspection program O Other
~ Water in basement 17 Previous system fail ed
B. ROOF LEADERS: es ~ No DISCHARGE: ~ Near L~''~~way
C. ~ARD DRAINS ~s ~ No WINDOW WELLS ~ Yes L~~'~Q'o
I BEAVER SYSTEM ~ Yes 1~-~3~do
~ Summer
en does pump run?
~ Front
NOTES. ~/~ ~~,. . -{v C~ c.v I ~ 5 l, ~" -•-•---•-•-•----------
D. PROPERTIES WITH SUMP PUMPS
When does pump run? ~ Fall
(check all that apply) How oft
V~here does pump discharge to outside?
,
~ Spring ~ Winter
~ Back ~ Side
SUMP PUMP SYSTEM: C~~ASS ~ FAIL You have 30 days to bring your system i»to compliance with current
regulations. When you are ready for reinspection, ca11651/644-1469 jor an appointment.
Is there another place where clear water enters the sanitary sewer system? Q Yes C-3'1~f o
Where is this location?
This area will ed to be fixed so the clear water discharges to the storm sewer system.
Inspector: - Date: ~- 2 - `~ 9
Resident: ~ate: ~'- ? - ~4
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Disclaimer: This visual inspection is done wit due diligence to find obvious clear water cross-connections
and does not imnlv the structure meets all Citv Codes.
White: Homeowner ~ Yellow: City
Pink: HRG