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City of Prio~ ~.~,ake
Sump Pump and I%I Reduction
Insuection Form
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Address: ~~~~ C..c~~/+~4.c./S ~7~ ~~
Prior Lake, MN 55 ~~~ Phone~~~ ~~'S~
Date:
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~8`~/ Time%Oa.m./p.m.
First In~sp~e ~~ Second ~
Own: L~'' Rent: Age of Home: ~ -S
Residential: ~
Non-Residential: ~
A. BASEMENT es ~ No ~ SiJMP BASKET ~1 ~ 2 I~ 3~
WATER IN BASKET ~ Yes o SiJMP~I~~~ ~ 1 ~ 2 ~ 3
WATER IN BASEMENT (flow over floor) ~ Yes o CISTERN ~ Yes
(If no pump, place sticker across edge of sump cover and basement floor so any removal of cover witl
break seal. Skip to Part B of this form.)
Discharge Point
at Inspection:
~ Laundry tub ~ Sanitary sewer ~ Outside
~ Floor drain ~ Other --~''"~
Prior to Inspection:
When was system installed, or most recently modified? (Date)
~ Home came with system ~ Response to inspection program
~ Water in basement ~ Prev' system failed
B. ROOF LEADERS: es ~ No DISCHARGE:
~~,°
and why
~ Other
~ Near w
C. YARD DRAINS ~ Yes N WINDOW WELLS es ~ No
BEAVER 5YSTEM I~ Yes o
D. PROPERTIES WITH SUMP PUMPS
When does pump run? ~ Fall ~ Summer ~ Spring ~ Winter
(check all that apply) How often does pump run?
V~here does pump discharge to outside? O Front ~ Back O Side
NOTES:
SUMP PUMP SYSTEM: I~PASS L7 FAIL You have 30 days to bring your system into compliance with curr
regulations. When you are ready for reinspection, ca[1651 /644-1469 for an ointment.
Is there another place where clear water enters the sanitary sewer system? Q Yes No
Where is this location?
This area will need to b~'f,~xed s~the clear v~ater slischar~es to the storm sewer svstem.
Inspector:
Resident:
Date:~~~
Date: '` : .Z~ -
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.
White: Homeowner Yellow: City Pink: HRG
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