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City of Prior Lake
Sump Pump and I/I Reduction
Ins~ection Form
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i Name: r~'/''~~/~''~i~~ ~,~J~~-~C~ Date:s:,~~~" ~/ Time:~~.m./p.m.
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1~ ~-y f ) ---' First In~sp~e n~ Second ~
Address: ~~7 /~~~~~ ~~ ~~ ~~'U Own: I~' Rent: Age of Home: ~
,/ ~/ .y Residential: ~ ~
Prior I~ake, MN 55 ~~~/ Phone. '~'`~ ~'`'`~ / Non-Residential: ~
A. BASEMENT ~s~ ~,~o SiJMP BASKET Q 0 C~~,Y~~I~'~ 2~ 3 ~
WATER IN BASKET ~Yes ~ No SiJMP P~~ ~ 0 (9~I O 2~~_~ ~ ~3-~
WATER IN B~SEMENT (flow over floor) a Yes L~~~Qo CI5TERN ~ Yes L~Q"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 Outside
at Inspection: Q~ Floor drain ~ Other
Prior to Inspection:
When w stem installed, or most recently modified? (Date) and why
~"" Home came with system ~ Response t~ inspection program a Other
~ Water in basement ~ D Previ system failed
B. ROOF LEADE •~) U es No DISCHARGE: ~ Near way
(L ~/
C. YARD DRAINS ~i~~ ~'~' Yes ~ No " WINDOW WELL5 ~ Yes 9~No
BEAVER 5Y5TEM ~~ y Y ~ Yes O~
D. PROPERTIES WITH SUMP PUMPS
When does pump run? ~ Fall . Q Summer S ri ~! ~ Winter " '
(check all that apply) How often does pump run? F~~~-/~"/~= ~~ A/~ v
Where does pump discharge to outside? ~ Front ack ~
NOTES:
SUMP PUMP SYSTEM: ~ASS I~ FAIL You have 30 days to bring your system into comp[iance with curr
regulations. When you are ready for reinspection, ca[I 651 /644-1469 for an ntment.
Is there another place where clear water enters the sanitary sewer system? ~ Yes o
Where is this location?
This area will need to ixed,,sr~ihe clear/w is~ges to the storm sewer system.
Inspector: ~ ~~.,~`~" Date: ~ - G.~ -
Resident: ,~ -~ ~, , ,' % = ~-~ ~ ~ ~+~~ Date: ~
Disclaimer: This visual inspection is done with due diligence to find obvious clear water cross-connections
and does not impl the structure meets all City Codes.
White: Homeowner Yellow: City Pink: HRG