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City of Prior Lake
Sump Pump and I/I Reduction
Inspection Form ~,oT ~£~~~. ~.QQ
Name: /~i/f i I'~' ~~ j ~'~~'`c~p'~~
Address: /5~9a F~~ sl~ P~ ~
Prior Lake, MN 553~Z Phone:yS/7- Z205"
Date: 3/5=-~ Time:~~ ~O a. p.m.
First Inspection LLJ'~ Second O
Own: ~ Rent: ~ Age of Home:
Residential: I~''
Non-Residential: ~
A. BASEMENT ~s ~ No SUMP BASKET L~ /0~ 1 C? 2~ 3 ~
WATER IN BASKET ~ Yes ~ No SiTMP PiJ1Y~P L~7'Q Q 1 ~ 2 ~ 3 ~
WATER IN BASEMENT (flow over floor) I~ Yes ~4o CISTERN Q Yes ~To
(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.)
B.
C.
D.
Discharge Point
at Inspection:
~ Laundry tub
~ Floor drain
CI Sanitary sewer ~ Outside
~ Other
NOTES:
SUMP PUMP SYSTEM: ~ASS ~ FAIL You have 30 days to bring your system into comp[iance with current
regulations. When you are ready for reinspection, call 651 /644-1469 for an appointment.
Is there another place where clear water enters the sanitary sewer system? ~ Yes G~o
Where is this location?
This area will need to be fixed so the clear water discharges to the storm sewer system.
I Inspector: ~ ,~;rp',~-:~y~~ _ Date: 3-/9-9~? I
Resident: ~ ~~ , , , Date:
Disclaimer: This visual inspection is done with due diligence to fmd obvious clear water cross-connections
and does not imply the structure meets all City Codes.
Prior to Inspection:
When was system installed, or most recently modified? (Date) and why
~ Home came with system ~ Response to inspection program ~ Qther
~ Water in basement Q Previous sys m failed
ROOF LEADERS: D Yes o DISCHARGE: ~ Near ~ Away
YARD DRAINS O Yes ,(~Na WINDOW WELLS ~ Yes ~No
BEAVER SYSTEM L7 Yes ~To
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? ~ Front ~ Back ~ Side
White: Homeowner Yellow: City Pink: HRG