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City of Prior Lake
Sump Pump and I/I Reduction
ection Form
Name:~~~-r~/~~-i~ ~, ~~ ~~~y~l Date: -/- Time: f/~(5'a.mJp.m.
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First Inspection l3'rSecond D
Address: ~a ~~ ~ c~i~ ~.~ C ~ ~~~ Own: ~Rent: ~ Age of Home:~~J
Residential: ~''"
Prior Lake, MN 55~~ Phone: G/ `T 7-S `(7,~ Non-Residential: C7
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A. BASEMENT ~s l7 No SUMP BASKET lJ 0 Q 1 ~ 2 ~ 3 ~
WATER IN BASKET ~ Yes ~ No SUMP PUMP I~0 Q 1 ~ 2 O 3 Q
WATER IN BASEMENT (flow over floor) ~ Yes @'~o CISTERN ~ Yes ~o
(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 sewer Q Outside
at Inspection: ~ Floor drain ~ Other
Prior to Inspection:
When was system installed, or most recently modified? (Date) and why
~ Home came with system U Response to inspection program ~ Other
~ Water in basement ~ Previous system failed
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B. ROOF LEADERS: ~~es ~ No DISCHARGE: ~ Near ~
C. YARD DRAINS ~ Yes C~1'1~To WINDOW WELLS ~ Yes l~-~`S
BEAVER SYSTEM ~ Yes ~'o
D. PROPERTIES WITH 5UMP PUMPS
When does pump run? ~ Fall ~ Summer ~ 5pring ~ Winter
(check all that apply) How often does pump run?
V~here does pump discharge to outside? ~ Front ~ Baek Q Side
NOTES:
SUMP PUMP SYSTEM: ASS ~ FAIL You have 30 days to bring your system into comp[iance with current
regu[ations. When you are ready for reinspection, ca[l 651 /644-1469 for an appointment.
Is there another place where clear water enters the sanitary sewer system? Q Yes I~iv o
Where is this location?
This area will need to be fixed so the clear water discharges to the storm sewer system.
I Inspector: ''' ~'~1~~ - Date: "7' /` ~~ I
Resident: ....- Date: ~ / -
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Disclaimer: This vis~ai' inspection is done with due diligence to find obvious clear water cross-connections
and does not imply the structure meets all City Codes. _
White: Homeowner Yellow: City Pink: HRG
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