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City of Prior Lake
Sump Pump and I/I Reduction
Inspection Form ,~~P~~-
Name: /~,+~~c./~t./,~"',,S', ~/C~~~"~~-- Date:~~~"~~ Time:~~~~.m./p.m.
~ ~ ~"`
'/ ~ ~ ~ First In~sp~ on ~ Second ~ ~
Address: ~~~'~`~ ~~- u~ DC>rE'.c/ ~i,e Own: C9' Rent: Age of Home:~
'/,/ Residential: ~
Prior Lake, MN 55 ~~iZ Phone:'Y'Y ~..~ %d~ Non-Residential: ~
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A. BASEMENT ~s a No SUMP BASKET ~ 1 C7 2~ 3 ~
WATER IN BASKET ~ Yes ~ 5iJMP P ~ 1 ~ 2 ~Q /3 ~
WATER IN BASEMENT (flow over flobr) '~ Yes '~CI5TERN Q Yes L~.P~S
(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 d Laundry tub
at Inspection: ~ Floor drain
Prior to Inspection:
When was system installed, or most recently modified? (Date).
~ Home came with system O Response to inspection program
Q Water in basement ~,,Previ s system failed
/
and why
~ Other
B. ROOF LEADERS: ~~'
PA ~ es ~ No DISCHARGE; ~ Near way
C. YARD DRAINS ,/
~ Yes l~
~''~
WINDOW WELLS ~ ~~/~"
Yes Q.d4"o
BEAVER SYSTEM ~
~ Yes [9'No
D. PROPERTIES WITH SUMP PUMPS
When does pump run? ~ Fall L7 Summer ~ Spr~ ~ Winter :
(check all that apply) How often does pump run?
V~here does pump discharge to outside? I~
•-•-•-•-•-•-------•-•-•-•---•-•-•-•---•-----. _. _._._.-•---•---•-•-• Front ~ Back U
-•-•-•-•-•-•-•-•--_===---•-•-•-•---- Side
-•---•---•-•-•-•-•-•--
NOTES:
5UMP PUMP SYSTEM: L~ASS ~ FAIL You have 30 days to bring your system into compliance witii current ,
regu[ations. When you are ready for reinspection, call 651/644-1469 Jor an appo' nt.
Is there another place where clear water enters the sanitary sewer system? ~ Yes ~ o
Where is this location?
This area will need to be f~d s~jte clear w~ter ~,charges to the storm sewer system.
Inspector:
Resident:
Date: __r~
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.
~ Sanitary sewer O Outside
~ Other '^
~._---
White: Homeowner ~ellow: City Pink: I~RG