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City of Prior Lake
Sump Pump and I/I Reduction
Inst~ection Form
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Name:// /l~Cc~ '~~=~ ~1.~ µ.~~)~' i~ ~/%,E~a~,l.~/~._ Date: ~~'.._/~' .~~`~ Time: a.m./p.m.
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r. ~ First Inspection ~ Second ~ ~
Address:~`,7~~ cf~ ~~{-L-~ ~~('~~/~ y~-~,~Own:;~ Rcnt: ~ Age of Home:~
Prior Lake, MN 55 Phone:
Residential.
Non-Resident'al: ~
A. BASEMENT ~Yes ~ No SUMP BASKET Q 0 ~ 1 2~ 3 ~
WATER IN BASKET 17 Yes ~No SiJMP PiJMP ~ 0 Q 1 2~ 3 O
WATER IN BASEMENT (flow over floor) ~ Yes~ No CISTERN ~ Yes ~No
(If no pump, place sticker across edge of sump cover and basement floor o any removal of cover will
break seal. Skip to Part B of this form.) ~~~s~~' ~~/1 ~t~+~~Y'
Dischar e Point ~ Laund tub Sanitar sewer Outside
b rY ~ Y ~
at Inspection: ~ Floor drain Other
Prior to Inspection:
When was system installed, or most recently modified? (Date) and why
~ Home came with system Q Response to inspection program ~ Other
Q Water in basement l7 Previous system failed
B. ROOF LEADERS: l7 Yes No DISCHARGE: Q Near ~ Away
C. YARD DRAINS ~ Yes No WINDOW WELLS ~ Yes ~ No
BEAVER 5YSTEM ~ Yes D No
D. PROPERTIES WITH 5UMP PUMPS
When does pump run? ~ Fall ~ Summer
(check all that apply) How often does pump run?
V~here does pump discharge to outside? ~ Front
~.rnm~c. ~~c~ .., ~i.~r'f c----_'7 /J n L-,. L., .- i, ,..
~ Spring Q Winter
~ Back ~ Side
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ur ~'i~'~EY~ .p~/~'crr fi~oar~F'_~~
SUMP PUMP SYSTEM: PASS FAIL You have 30 days to bring your system tnto compliance with current
~~~~ ~`~~ ~m ~,~ re ulatt . When you are ready for reinspection, ca[[ 651/644-1469 for an appointment.
s there ano e~r p ace where clear water enters the sanitary sewer system? ~ Yes ~ No
Where is this location?
This area will need to,b~ fixed so the rlear w~r ~ischarges to the storm sewer system.
Resident:
Date: r~ -~
Date:
Disclaimer: This visual inspection is done with due diligence to fumd obvious clear water cross-connections
and does not imply the structure meets all City Codes. _
White: Homeowner Yellow: City Pink: HRG