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City of Prior Lake
Sump Pump and I/I Reduction
Inspection Form ,~..~ ~.~
Name:~o ~Pr ~. ,~/~ ~~ r°vuc ~~~--f
Address: ~~ ~'~ ~ ~ r ~~ ~..~h ...,~~; o rr,s ~~-~ S~
Prior Lake, MN 55 --~~ Phone: ~( 7-,~ 1/
Date: ~~~~~ ~% Time: //vl~ a.m./p.m.
--~
First Inspection ~
Own: t3'' Rent: Q
Residential: la--'~
Non-Residential: ~
Second ~-''~~
Age of Home: ~ /
~.,~,~a l -.µ
A. BASEMENT la''Yes d No SUMP BASKET ~ 0 ~ a 2 ~ 3 ~
WATER IN BASKET [~es ~ No SUMP PIJMP Q 0 ~~ 2 O 3 O
WATER IN BASEMENT (flow over floor) ~ Yes L=1'1~fo CISTERN C7 Yes ~#S"
(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 a Laundry tub ~ Sanitary sewer ~'O tside
at Inspection: ~ Floor drain ~ Other
Prior to Inspection:
When was system installed, or most recently modified? (Date) ~i~~ ,/ qq ~ and why
~ Home came with system C.~Kesponse to inspection program O Other
~ Water in basement a Previous system failed
B. ROOF LEADERS: a Yes L~ No DISCHARGE: I~ Near Q Away
C. YARD DRAINS ~ Yes t~' No WINDOW WELLS" ~~s Q No
BEA'VER SYSTEM ~ Yes L~io^~
D. PROPERTIES WITH SUMP PUMPS
When does pump run? O Fall ~''~~ummer L~"5~prin L~ Winter
(check all that apply) How often does pump run? ~-~'a..~ ~~r wy t'~ ~-~,.t
V~here does pump discharge to outside? ~ Front ~k Q Side
NOTES: ~~. r cJs,~-I- r'r.,,~.~ r~r~ aN•~a 9~~ ~r.~'e ~r ~~ n../ ~7,•~ ~~ ~.., m H 3j~`/.. ~, ~,`~,, ~y, ,~^T,L~o~,,, -•-•-
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~r~ ~~^tl 1°/, a-r~ ~ ~ ~'Y~°c4° Q -~--~ ~.. `.v ~ . ~ ['G ~~rG7 .~,.t.~: ~e ~~ l~,•„Tr~ T~C~`
5UMP PUMP SYSTEM: ~'PASS I~ FAIL You have 30 days to bring your system into compliance with current
regulatiorrs. When you are ready for reinspection, cal! 651 /644-1469 for an appointment.
Is there another place where clear water enters the sanita:ry sewer system7 Q Yes f~"o~
Where is this location?
This area will need to be fixed so the clear water discharges to the storm sewer system.
Inspector: ~.fl Date: G- F/- 9?
Resident: Date: /, . i 9- y? y
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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(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 Q Sanitary sewer O 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 inspection program ~ Other
O Water in basement I~ Previous system failed
B. ROOF LEADERS: ~ Y s o DISCHARG •~ Near ~ Away
Gvc,vE,e7' uNdE~ ~~U L"o~ w~ ORA/N T/ q L•v X£
C. YARD DRAIN5 Yes ~~ ~ WINDOW LLS es ~ No
BEAVER SYSTEM Yes ~'No
D. PROPERTIES WITH SUMP PUMP5
When does pump run? 17 Fall Q Summer D Spring ~ Winter
(check all that apply) How often does pump run?
Where does pump discharge to outside? ~ Front Q Back L7 Side
NOTES:
SUMP PUMP SYSTEM: -,J~, PASS O FAIL You have 30 days to bring your system into compliance with current
~~ ° regulations. When you are ready j'or reinspection, call 651 /644-1469 for an appointment.
Is there another place where clear water enters the sanitary sewer system? ~ Yes ~N o
Where is this location?
This area will need to~ ~xed so the clear water discharges to the storm sewer system.
~ ~
Inspector:
Resident:
Date: 3 - `/ -
Date:
Disclaimer: This visual inspection is done with due diligence to find obvious clear water cross-connections
and does not itnuly the structure meets all City Codes.
White: Homeowner Ye11ow: City Pink: HRG
A. BASEMENT ~s ~ No~ ~--~ SUMP BASKET Lzl 0 D 1 a 2 O 3 O
WATER IN BASKET Q Yes ~No SiJMP PUMP Ir~-~0'' O 1 ~ 2 ~ 3 Q
WATER IN BA5EMENT (flow over floor) ~ Yes ~ CISTERN I~ Yes ~-IQ'o'