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City of Prior Lake
Sump Pump and I/I Reduction
Insnection Form
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Name: /~~ ~~~~ ~
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Address:~ ~~/ ~ie~/.(/Gc%OQ ~/,~
Prior Lake, MN 55 a~/~~ Phone'7?" /~~g~
Dat~~~~~~ Time,~~.~~m./p.m.
First In~s~ ion !~ Second ~ ~-
Own: PJ Rent: Age of Home: 2 j
Residential: ~ ~
Non-Residential: ~
~ S/ v wv •.~+ ~.+ ~- .
A. BASEMENT es ~ No SUMP BASKE 1 d 2 ~ 3 ~
WATER IN BASKET 17 Yes o 5LJMP P 0~ 1 a 2~ Q
WATER IN BA5EMENT (flow over floor) ~ Yes o CISTERN ~ Yes o
(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 L7 Sanitary sewer~ D Outside
at Inspection: ~ Floor drain ~ Other
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Prior to Inspection: --''
When was system installed, or most recently modified? (Date) and why
- D Home came with system ~ Response to inspection program ~ Other
~ Water in basement a Previous syste ailed
B. ROOF LEADERS: ~ Yes o DISCHARGE: O Near Q Away
G YARD DRAINS ~ Yes WINDOW WELLS ~ Yes ~~1'~0
BEAVER SYSTEM O Yes o
D. 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 r ~ Side
NOTES:
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SUMP PUMP SYSTEM: L~PASS O FAIL You have 30 days to bring your system into compliance with current
regulations. When you are ready for reinspection, cal[ 651 /644-1469 for an appointment.
Is there another plac~, where clear water enters the sanitary sewer system? ~ Yes L~'N o
Where is this location`~~,
This area will need to b"; ed,86'the clear w~fer sli,scharges to the storm sewer system.
Inspector: ,,~--''`-..,J~i~`~~"~"."~`.---~-'" Date: .~CU- ;
Resident: ~` . -, Date: ~ ~ ~-'
Disclaimer: This~visual inspeation is done with due diligence to find obvious clear water cross-connections
and does not imply the structure meets all City Codes.
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White: Homeowner Yellow: City Pink: HRG