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City of Prior Lake
Sump Pump and I/I Reduction
Inspection Form ,~,o,o~~ ,
Name: o ~~ / (.~V l ~ ~-' ~ ~ N~ Date: ~.~~~Time;~~Da.m./p.m.
~~' ,~J ~~ ~~ First In~spfe ~'on L9' Second ~ Q
Address: ~~~ C~~~~~=~~ ~D (.,.>. (~/, Own: l~ Rent: Age of Home: /,~
~` '/ Residential: ~ ~
Prior Lake, MN 55 ~~N Phone: 'Y~~~ 870~ Non-Residential: ~
vv v ~-v c. K. - ~-
A. BASEMENT es O No~ SUMP BASKET Q 0 ~ 2 ~ 3 ~
WATER IN BASKET ~ Yes o SUMP PU1V~ 0 Q 1 ~ 2 ~~/C7
WATER IN BASEMENT (flow over floor) CI Yes [~~~ CISTERN ~ Yes L~•~
a
(If no pump, place sticker across edge of sump cover ar~d basement floor so any removal of cover will
break seal. 5kip to Part B of this form. )
Discharge Point ~ Laundry tub ~ Sanitary sewer Q
~ Outside
at Inspection: ~ Floor drain ~ Other '~
Prior to Inspection:
When was system installed, or most recently modified? (Date) ~'"''~ and why
~ Home came with system ~ Response to inspe i on program ~ Other -
Q Water in basement ~ Previous sys failed ~
B. ROOF LEADERS: L7 Yes DISCHARGE: ~ Near ~7 Away
C. YARD DRAINS
''~BEAVER SYSTEM ~
~ Yes f_~~~~' N~
Yes Ca/No WINDOW WELLS 17 Yes L'~fto
D. P~tOPERTIES WITH SUMP PUMP5
When does pump run? ~ Fall ~ Summer 17 Spring ~ Winter +~
(check all that apply) How often does pump run?+;
V~here does pump discharge to outside? ~ Front , Q Ba~k ~ Side
NOTES:
SUMP PUMP SYSTEM: ~ASS Q FAIL You have 30 days to bring your system into compliance with current '
regulations. When you are ready for reinspection, call 651 /644-1469 for an ap ointment.
Is there another place where clear water enters the sanitary sewer system? ~ Yes ' [~J'"No
Where is this location?
This area will need to be ed~ie clea~at~charges to the storm sewer system.
Inspector: • ~i~w Date: / ~ ~G'' ~ ~
Resident: ~ ~ ~ ~ _ Date:
Disclaimer: This visual inspection is done with ue diligence to find obvious clear water cross-connections
and does not imply the structure meets all City Codes.
White: Homeowner Yellow: City Pink: HRG