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City of Prior Lake
Sump Pump and I/I Reduction
ction Form ,~,~,~,~
Name:~/.~,G .~,,~4?~, tC.-~~~~-G•~'~ Date: ~-~~ ~~ Time~~~~ m./p.m.
~ ~ ~ First Inspection 0" Second ~ /
Address:~,,~~~~ ~~'.E r•~}'~ ~~O ~ Own: F~ Rent: ~ Age of Home. tQ ~
/ Residential: ~ ~
Prior Lake, MN 55~/M~ Phone:~/'S~~ ;~a~~ Non-Residential: ~
A. BASEMENT ~ Yes LL~o~~~~ ~ SUMP BASKET L~ ~ 1 d 2 ~ 3 Q
WATER IN BASKET I~ Yes Q~No SUMP ~P~ 0~ 1 ~ 2 ~ 3 ~
WATER IN BASEMENT (flow over floor) ' Q Yes [iYfto CISTERN d Yes ~
(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 r---~7 Outside
at Inspection: ~ Floor drain O Other
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Prior to Inspection:
When was system installed, or most recently modified? (Date) and why
~ Home came with system ~ Response to inspection program ~ Other ""
Q Water in basement ~ Previous system failed
B. ROOF LEADERSc ~ Yes L~' No DISCHARGE: ~ Near ~ Away
C. YARD DRAINS Q Yes la'~ WINDOW WELLS ~ Yes ~~o
BEAVER SYSTEM 17 Yes L9' No
D. PROPERTIES WITH SUMP PUMPS
When does pump run? ~ Fall ~ Summer ~ S!„~,Wr' g ~ Winter
(check all that apply) How often does pump run?
V~here does pump discharge to outside? ~ Front D Back Q Side
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NOTES: ~---- ~~C ~9 ~3---•D ~~-•-• ~..~~ ta ~;,
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SUMP PUMP SYSTEM: ~'YASS ~ FAIL You have 30 days to bring your system into comp[iance with cunent
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 ~TN o
Where is this location?
This area will need to be d~e clear~ater~arges to the storm sewer system.
Inspector: J,.~-~' -
Date: .~ ~ -
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 Gity Codes.
White: Homeowner Yellow: City Pink: HRG