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City of Prior Lake
Sump Pump and I/I Reduction
Inspection Form ~,~~ r,-
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Name:
1- ~~
Address: ~~Z~ ~~~7~~ ~~ C~.~,~
Prior I~ake, MN 55~/~ Phone:Y"~' /'"7'~~~~o
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Dat~;~-~-~~ Tim ~~~a.mJp.m.
First Inspe ° "n ~econd ~
Own: Rent: ~ Age of Home:
Residential: L~"'~~
Non-Residential: ~
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A. BASEMENT ~~ No~~,/~ SUMP BASKET ~ /~ 1 U 2 O 3 ~
WATER IN BA5KET ~ Yes LZ3'No SiJMP ~P~ L~0 ~ 1 ~ 2~ O~- ~
WATER IN BASEMENT (flow over floor) ~ Yes I~ No CI5TERN ~ Yes t~'Qo
(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 L7 Laundry tub
at Inspection: Q Floor drain
Prior to Inspection:
When was system installed, or most recently modified? (Date)
Q Home came with system
~ Water in basement
B. ROOF LEADERS:
C. YARD DRAINS
BEAVER SYSTEM
and why
~ Response to inspection program ~ Other
17 Previ system failed
es ~ No DISCHARGE: Q Near way
~ Yes ~~~~ WINDOW WELI~S Q Yes Q No
~ Yes l3'No
D. PROPERTIES WITH SUMP PUMPS
When does pump run? ~ Fall ~ Summer
(check all that apply) How often does pump run?
Where does pump discharge to outside? a Front
NOTES:
~ Spring L7 Winter
....-
~ Back
~ Side
SUMP PUMP SYSTEM: L~' PASS ~ FAIL You have 30 days to bring your system into comp[iance with current
regu[ations. When you are ready for reinspection, ca[[ 651 /644-1469 for an ~ntment.
Is there another place where clear water enters the sanitary sewer system? ~ Yes L~ No
Where is this location?
This area will need to b ixe~he clear~r d~rges to the storm sewer system.
Inspector:
Date: ...~--G.S -
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.
~ Sanitary sewer~ Outside
~ Other
~--'
White: Homeowner Yellow: City Pink: HRG