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City of Prior Lake
Sump Pump and IiI Reduction
Ins
Name :~l~~G'~.~~(./,~~'~CC ~ .~'
ection Form ,~~~~ 7-
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Date:~ ~~~~~Time~~~~.m./p.m.
--''r ~ ~~/ First In~sp~e °~n [~'' Second ~ ~/
Address:~sG~~ ~i4/.~'.~,.~'t~~t1 ~i~D~:`"S Own: l9" Rent: ~ Age of Home: /
, ~/~/ Residential: ~~ ~
Prior Lake, MN 55~ ~~ PhoneY''~` ~~~~~ Non-Residential: ~
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A. BASEMENT L~'i'"es ~~ATo SUMP BAS T~ 1 ~ 2 ~ 3 ~
WATER IN BASKET ~es ~ No SUMP P P 0(7 1~ 2~Q
WATER IN BASEMENT (flow over floor) 7 Yes No CISTERN ~ Yes o
(If no pump, place sticker across edge of sump cover and basement floor so any removal of cover will
br~ak seal. Skip to Part B of this form.)
Discharge Point ~ Laundry tub ~ Sanitary sewer 17 Outside
at Inspection: 17 Floor drain ~ Other ~
Prior to Ins ection:
When systern installed, or most recently modified? (Date) and why
Home came with system ~ Response to inspection program ~ Other
C] Water in basement ~ Previous system failed
B. ROOF LEADERS: ~ Yes C~iIQo DISCHARGE: ~ Near Q Away ~A
C. YARD DRAIN5 ~ Yes ~~' ~N9'~ WINDOW WELLS ~ Yes L~~No
BEAVER SYSTEM ~ Yes [!''No
D. PROPERTIES WITH SUMP PUMP5
When does pump run? ~ Fall ~ Summer
(check all that apply) How often does pump run?
V~here does pump discharge to outside? L~ Front
NOTES: .~
~ Spring O Winter
~ Back ~ Side
SU1vIP PUMP SYSTEM: CYPASS I~ FAIL You have 30 days to bring your system into compliance with curr nt
regularions. When you are ready for teinspecrion, call 651/644-1469 fo~ an oi»tment.
Is there another place where clear water enters the sanitary sewer system? Q Yes o
Where is this location?
This area will need to be xe~ the clea~a~iischarges to the storm sewer system.
Inspector:
Resident:
Date: .,.~ -/~ - ;
Date: -/.3 -
Disclaimer: This visual inspection is done with due diligence to find obvious clear water cross-connections
and does not imply the structure meets all Cit_y Codes.
White: Homeowner Yellow: City
Pink: HRG