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City of Prior Lake
Sump Pump and I/I Reduction
Inst~ection Form
Name: ~.G ~:~.~ ~`'` C7 ~.~
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Address:
Prior Lake, MN 55 ~//~ Phone": ~''`~` !'~"~ /
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Date:~`~~~~ Time:~~~~ m./p.m.
First Insp~e ~° n ~'" Second ~ /
Own: ~'' Rent: ~_ Age of Home: ~J ~
Residential: l4-''~' ~
Non-Residential: O
A. BASEMENT ~ Yes C]'No__~/ SUMP BASKET ~ 1 ~ 2 ~ 3 ~
WATER IN BASKET D Yes I~'No SUMP~P_~ 0~ 1 ~ 2_~ ~~'"~ O
WATER IN BASEMENT (flow over floor) ~ Yes LzYNo CISTERN ~ Yes ~'No
(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 ~ Sanitary sewer ..---t7 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 l7 Previous sys m failed
B. ROOF LEADERS: ~ Yes D~ N o DISCHARGE: O Near ~ Away
C. YARD DRAINS ~ Yes ~,~' WINDOW WELLS O Yes A''l~o '
BEAVER SYSTEM ~ Yes 17 No
D. PROPERTIES WITH SL~MP PUMPS
When does pump run? 17 Fall ~ Summer
(check all that apply) How often does pump run?
V~here does pump discharge to outside? ~ Front
~ Spring C~ Winter
~ ''Ba"ck ~ Side
NOTES: ~-----•-~~. A~~--a~-•~c~i~~C7~-•-•-----•-----•-•-
SUMP PUMP SYSTEM: SS ~ FAIL You have 30 days to bring your system into compliance with current
regu[ations. When you are ready for reinspection, ca116571644-1469 for an appointment.
Is there another place where clear water enters the sanitary sewer system? ~ Yes ~.D1~-'
Where is this location?
This area will need to ixe e clear w~r di,sC~'i ?ges to the storm sewer system.
Inspector:
Resident ~
Date: ~~ ~
Date: '~~~ ~
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