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City of Prior Lake
Sump Pump and I/I Reduction
ection Form
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~ Name: / ~G~~' ~Ol,~~t./ Date~.~~~ ~~ Time,r~~~a.mJp.m.
~"~ First I~n~s _e,~ n ~ond ~
Address: ~•~~~ ~~~~r ~~ C%~ ~'~Own: ~ Rent: ~ Age of Home:~~~
~ ~,, ,~/,/ / Residential: ~ ~
Prior Lake, MN 55 0~ Phone-:~`'~`~'~~~ Non-Residential: D
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A. BASEMENT es ~ No SUMP BASKET ~ 1 17 2~ 3 ~
WATER IN BA5KET ~ Yes o SiJMP~~P~'~~ 0~ 1 17 2~~
WATER IN BASEMENT (flow over floor) d Yes o CIS1'ERN ~ Yes ~.P~
(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 ~,,,_ I] Outside
at Inspection: ~ Floor drain ~ Other
Prior to Inspection: `~
When was system installed, or most recently modified? (Date) and why
O Home came with system ~ Response to inspection program ~ Other
Q Water in basement ~ Prev' us system failed
B. ROOF LEADERS: es ~ No DI5CHARGE: 17 Near way
C. YARD DRAINS ~ Yes t9' N~ WINDOW WELi.S O Yes ~
BEAVER SYS1'EM ~ Yes G~~1Vo
D. PROPERTIES WITH SUMP PUMPS
When does pump run? ~ Fall L7 Summer ~ Spring d Winter
(check all that apply) How often does pump run? ---
V~here does pump discharge to outside? ~ Front ~ Back ~ Side
-•-•-•-•- - -•-•-•-•-•-•-•-•---•-•-•-•-•-•-•-•-•-•-----•-•- -•-•-•-•-•-•-•-•-•-•-•-•-•r-•-•-•-•-•-•-•-•-•-•-•-•-•-•-•-•---._._._
NOTES':
SUMP PUMP SYSTEM: ASS C7~ FAIL You have 30 days to bring your system into compliance w&h curr
regulations. When you are ready for reinspection, ca11651/644-1469 jor an a tntment.
Is there another place whEre clear water enters the sanitary sewer system? Q Yes o
Where is this location?
This area will need to e the clea at ' charges to the storm sewer system.
Inspector: Date: -~,3 ~'
Resident: Date: - ~
Disclaimer: T~'s visual inspection is done with due diligence to find obvious clear water cross-connections
and does not imul_y the structure meets all City Codes.
White: Homeowner Yellow: City Pink: HRG