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City of Prior Lake
Sump Pump and I/I Reduction
ection Form
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Name • ~ /~~~~r.~.~ C~ ~~ 7 ~'` ~
.(~~ ~, f~C.~'~~-~ Date:~„1~'7~~~ Time/~ a.mJp.m.
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LC~
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,~/~y First Inspec " n ~ Second ~
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Address:~..-~~"7 / /~~~~~ ~~~C',~1 S~°"~ Own: ~'° Re`nt~: Age of Home:~`~
f '~ ~ti Residential: Q'' J
Prior ake, MN 55 ~/~~ Phone'~~'7~ ~~~~ Non-Residential: ~
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A. BASEMENT es ~ No~ ~ SUMP BASKET K~ ~ 1~ 2 ~ 3 O
WA1'ER IN BASKET L7 Yes ~-iQo ' 5UMP ~P~ @~0 Q 1 ~ 2~ ~~--~~
WATER IN BASEMENT (flow over floor) ~ Yes D'No CISTERN ~ Yes LTNo
(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 sewerr. ~ Outside
at Inspection: ~ Floor drain O Other
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Prior to Inspection:
When l,~vas system installed, or most recently modified? (Date)
Ca Home came with system
O Water in basement
B. ROOF LEADERS:
C. YARD DRAINS
BEAVER SYSTEM
and why
~ Response to inspection program ~ Other
D Previous system failed
es ~ No . DISCHARGE: ~ Near ~'Away
~ Yes ~~~ WINDOW WELLS ~ Yes ~ No
~ Yes ~ No
D. PROPERTIES WITH SUMP PUMPS
When does pump run? O Fall ~ Summer
(check all that apply) How often does pump run?
V~here does pump discharge to outside? ~ Front
NOTES:
SUMP PUMP SYSTEM: C9'PASS I~ FAIL You have 30 days to bring your system into compliance with current
reguladons. When you are ready for reinspection, cal[ 651 /644-1469 for an ent.
Is there another place where clear water enters the sanitary sewer system? O Yes NL~X~~m
Where is this location?
This area will need to ixe e~`he clear~Va c~ischarges to the storm sewer system.
Inspector:
Resident: '
Date: _~~~
Date: c
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.
O Sgrixg- ~ Winter
a Back,~..- ~ Side
White: Homeowner Yellow: City Pink: HRG