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City of Prior Lake
Sump Pump and I/I Reduction
Insuection Form
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Name: i~,,~pl.--~,~~//Cf/~~~G ~/`~~t,~'~,~.- Date: ~':.~~o -- `,~'~ Time: r a.m:~:m.
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~,. ~.- First Inspection ~ Second C7
Address: ~~j ~~ ~~t~ ''~ ~~ Own~ Re t: ~ Age of Home:~
~ Residential: ~
Prior Lake, MN 55 Phone~ ~~,,,3,~,~ Non-Residential: ~
A. BASEMENT ,~ Yes Q No SUMP BA5KET D 0~ 1 I~ 2~ 3 ~
~"`°~ WATER IN BASKE~~C~' Yes ~ No S P iJMP ~ 0~ 1~ 2 ~ 3 ~
- WATER IN BA5E E~N1~ (flow over floor) Q Yes No CISTERN ~ Yes No
(If no pump, place sticker across edge of sump cover and basement floor so any remova of cover will
break seal. Skip to Part B of this form.)
Discharge Point ~ Laundry tub ~ Sanitary sewer ~ Outside
at Inspection: ~ Floor drain ~ Other
B.
C.
D.
NOTES:
~ Spring ~ Winter
~ Back Side
SUMP PUMP SYSTEM: ~PASS ~ FAIL You have 30 days to bring your system into compliance with current
regulations. When you are ready jor reinspection, cal! 651 /644- 469 for an appointment,
Is there another place where clear water enters the sanitary sewer system? ~ Yes No
Where is this location?
This area ' ne to ixed so the~lear wa~ter discharges to the storm sewer system.
Date: f :
Date:
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.
Prior to Inspection: .
When was system installed, or most recently modified? (Date) and why
~ Home came with system ~ Response to inspection program a Other
~ Water in basement ~ Previous system failed
ROOF LEADER5: ~Yes ~ No DISCHARGE: ~ Near Away
YARD DRAINS ~ Ye No WINDOW WELLS ~ es ~ No
BEAVER SYSTEM ~ Yes No
PROPERTIES WITH SUMP PUMPS
When does pump run? ~ Fall ~ Summer
(check all that apply) How often does pump run?
V~here does pump discharge to outside? I~ Front
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White: Homeowner Yellow: City Pink: HRG