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City of Prior Lake
Sump Pump and I/I Reduction
Ins~ection Form
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Name. Date:
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~ ~~ Time/ ~~~a.m.ip.m.
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,~/ ,/ First In~s~pe~cti ~' E~" Second ~ ~
Address: 7'Q~~'`~ ~~~~'~~~~~~ ~~ Own: L~-''"Rent: ~ ge of Home: ~ 2S
r~ ,~/ / Residential: ~
Prior La~ce, MN 55 ~/~~ Phone:7``~' ~'''~~2~ Non-Residential: Q
A. BASEMENT ~'Yes ~~ SUMP BASKET ~'I 0~ 2~ 3 O
WATER IN BASKET es ~ No SIJMP P ~ ~ 0 1~ 2 ~~~~
WATER IN BASEMENT (flow over floor) ~ Yes L~I~~'fo CISTERN ~ Yes Q'No
(If no pump, place sticker across edge of sump cover and basement floor so any removal of cove will
break seal. Skip to Part B of this form. )
Discharge Point ~ Laundry tub ~ Sanitary sewer side
at Inspection: a Floor drain O Other
Prior to Ins ion:
When system installed, or most recently modified? (Date) and why
Home came with system ~ Response to inspecti rogram ~ Other
~ Water in basement ~ Previous syste iled -
B. ROOF LEADERS:~ J~oN~ Yes o DISCHARGE: ~ Near ~ Away
C. YARD DRAINS ~ ~~ L, ~''Yes D~~_ No/ WINDOW WELLS ~ Yes C9~'Po
BEAVER SY5TE~• p~ A~ ~ Yes ~o"
~-1
D. PROPERTIES WITH SUMP PUMPS
When does pump run? ~ Fall ummer S rin Winter f
(check all that apply) How often does pump run? ~~,~ ~/ ~l,.J
Where does pump discharge to outside? Q Front ~ Back
NOTES:
SUMP PUMP SYSTEM: I~~ASS ~ FAIL You have 30 days to bring your system into compfiance with current ~,,,./
regulations. When you are ready jor reinspection, cal[ 651 /644-1469 for an a ' ra.
Is there another place where clear water enters the sanitary sewer system? ~ Yes ~ No
Where is this location?
This area will need to b~xe~e clear wa~ di~rges to the storm sewer system.
,
Inspector:
Date: -~
Date:
Disclaimer: This visual inspection is done with due diligence to find obvious clear water cross-connections
and does not imulv the structure meets all City Codes.
White: Homeowner Yellow: City Pink: HRG
A. BASEMENT ~ Yes ~No SUMP BASKET ~ 0 ~ 1 Q 2 ~ 3 ~
WATER IN BASKET ~ Yes ~ No SUMP PUMP .~ 0~ 1 ~ 2 ~ 3 ~
WATER IN BASEMENT (flow over floor) ~ Yes ~ No CISTERN D 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 Q Sanitary sewer ~ 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
~ Water in basement ~ Previous system failed
B. ROOF LEADERS: ~ Yes ~ No DISCHARGE: ~ Near ~ Away
C. YARD DRAINS ~ Yes ~ No WINDOW WELLS Q Yes ~ No
BEAVER SY5TEM ~ Yes y~ No
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D. PROPERTIES WITH SUMP PUMPS
When does pump run? ~ Fall ~ Summer ~ Spring ~ Winter
(check all that apply) How often does pump run?
Where does pump discharge to outside? ~ Front ~ Back Q Side
NOTES: -•-•-•-•-•--~ -• ~ •-•~ $_rt,~~ -•-•_' ~C~ •-rt"°:-----•---•-•-•-----•-•---------•-•-•---------•-•-•-•-•---------
SUMP PUMP SYSTEM: ~ PASS L~ FAIL You have 30 days to bring your system into complinnce with current
regulations. When you are ready for reinspection, ca[1651 /644-1469 jor an appointment.
Is there another place where clear water enters the sanitary sewer system? ~ Yes ~ No
Where is this location?
This area will ~d to l3e''~xed so the clear water dis~rges 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
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