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Insnection Form
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Name:~ i ~~ r= ~~~ , y~~t ~- f~~',~ ~i ~ e
Address: f ! ~ ~ ~ ,~~' y ~ ' 1` ~'D ~;.~
.~ ~~ y P~ 7 c~ ~,~
Prior Lake, MN 55 ~~.~ Phone: ~~/7-.3~~ 3
Date: ~- .-1~~ 9y Time: Q 9y.~ a.m./p.m.
First Inspection ~ Second ~
Own: ~''~Rent: ~ Age of Home: ~ O
Residential: ~'`
Non-Residential: ~
~. p w~-r c .
A. BASEMENT L~es ~ No SiJMP BASKET ~ 0 ~~ 2 ~ 3 Q
WATER IN BASKET C3'Yes ~ No SUMP PUMP ~ 0 I~1 ~ 2 O 3 ~
WATER IN BASEMENT (flow over floor) I~ Yes C~'1~fo CI5TERN ~ Yes A'~'~To
(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 A' Outside
at Inspection: ~ Floor drain ~ Other
Prior to Inspection:
When was system installed, or most recently modified? (Date) L?~ 7'~ I 9 9~' and why
~ Home came with system
~ Water in basement
B. ROOF LEADERS:
C. YARD DRAINS
BEAVER SYSTEM
Q'`Response to inspection program ~ Other
~ Previous system failed
~ Yes L3' No DISCHARGE: ~ Near ~ Away
17 Yes CT No WINDOW WELLS O Yes C'J''~o
~ Yes I~~1o
D. PROPERTIES WITH SUMP PUMPS
When does pump run? ~ Fall Q'~ummer L~'"S^pring I~ Winter
(check all that apply) How often does pump run? .L~~ r<^3 w* f P~' ~' ~ ~~ ~
V~here does pump discharge to outside? ~ Front 'I~S"'ack Q Side
NOTES:
SUMP PUMP SYSTEM: ~ASS ~ FAIL You have 30 days to bring your system into compliance with current
regulations. When you are ready for reinspection, ca[! 651/644-1469 for an appointment.
Is there another place where clear water enters the sanitary sewer system? ~ Yes ~ No
Where is this location?
This area will need to be fixed so the clear water discharges to the storm sewer system.
Inspector: Date: ,,~r- ..?.2 - 9 7
Resident: Date: ~,""- .?.1- 99
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.
City of Prior Lake
Sump Pump and I/I Reduction
White: Homeowner Yellow: City Pink: HRG