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City of Prior Lake
Sump Pump and I/I Reduction
Inspection Form
Name: ~~ r~ a-~ Pc~ y, ~c°~ ~-~'-
Address: ~'/,,2// , ~~~;,-~r,/r,d~ ~/P'. /VE
Prior Lake, MN 55 37~ Phone: ~lLl~7 ~~3~ 9
Date: j''- ,.~- 9~ Time: 3o a.m./p.m.
First Inspection L~'' Second ~
Own: C-1'"" Rent: ~ Age of Home: ~ 3
Residential: !~-
Non-Residential: ~
~~ /COc„'1f'
A. BASEMENT ~s ~ No SUMP BASKET ~~ 1 ~ 2 ~ 3 ~
WATER IN BASKET ~ Yes ~ No SiJMP PUMP I~''6 ~ 1 ~ 2 ~ 3 O
WATER IN BASEMENT (flow over floor) ~ Yes l~-Pdtf CISTERN ~ Yes L~~
(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
at Inspection:
~ Laundry tub L~ Sanitary sewer 17 Outside
~ 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
Q Water in basement 17 Previous system failed
B. ROOF LEADERS: ~ Yes l~"'No DISCHARGE: ~ Near O Away
C. YARD DRAINS ~ Yes I~1o WINDOW WELLS ~ Yes ~~o
BEAVER SYSTEM ~ Yes I~-~
D. PROPERTIES WITH SUMP PUMPS
When does pump run? ~ Fall Q Summer
(check all that apply) How often does pump run?
Where does pump discharge to outside? ~ Front
NOTES:
~ Spring Q Winter
~ Back ~ Side
SUMP PUMP SYSTEM: ASS ~ FAIL You have 30 d8ys to bring your system into compliance with current
regulations. When you are ready for reinspection, ca11651 /644-1469 for an appointment.
Is there another place where clear water enters the sanitary sewer system? ~ Yes C-~'1Qo
Where is this location?
This area will ne to be fixed~o the clear water discharges to the storm sewer system.
Inspector: J/~ ~(¢~l BJ~"~-v-~'""~ Date: ~
Resident: A,~.O Date: -7'- ~ ~
Disclaimer: This visual inspection is done with due diligence to find obvious clear water cross-connections
and does not impl_y the structure meets all City Codes.
White: Homeawner: ' Yellow: City
Pink: HRG