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City of Prior Lake
Sump Pump and I/I Reduction
Insuection Form
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~ Name: ~~~~s~~, ~C~~/~~ Date: ~"'~~" ~/ Time~~~'~ a.m./p.m.
~/,/~! ,~/ °~~First Insp~ec ' n ~econd ~
Address: ,~~ 7~'?` // /~ /7~w~-S /~~/ Own: I~ Rent: Age of Home:~~{
// ,/ ~,. Residential: ~ J
Prior Lake, MN 55 -~ ~~ Phone7`~Q-lo2'~`~ Non-Residential: ~
A. BASEMENT ~ Yes ~To ~ SIJMP BASKET ~~~b 1 O 2 ~ 3 ~
WATER IN BA5KET ~ Yes ~IQo SiJMP ~P~ @~0 Q 1 ~ 2~ ~~ O
WATER IN BASEMENT (flow over floor) ~ Yes C~No CISTERN ~ Yes LTNo
(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 I~ Laundry tub ~ Sanitary sewer ~.-- ~ Outside
at Inspection: ~ Floor drain ~ Other ~
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Prior to Inspection:
When was system installed, or most recently modified? (Date) and why
O Home came with system ~ Response to inspection program ~ Other
O Water in basement Q Previous syste failed
B. ROOF LEADERS: Q Yes L~~''No DISCHARGE: Q Near ~ Away
C. YARD DRAINS ~ Yes L,'~_~' WINDOW WELLS ~ Yes ~~1Vo
BEAVER SYSTEM ~ Yes ~'No
D. PROPERTIES WITH SUMP PUMPS
When does pump run? ~ Fall ~ Summer
(check all that apply) How often does pump run?
V~here does pump discharge to outside? ~ Front
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NOTES: --•-•-•---- ,~ ~} a- C~~~- ~~9 0 ~ -•-•-•-•-•--
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~ Spring ~ Winter
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Q Back ~ Side
SUMP PUMP SYSTEM: ~'ASS ~ FAIL You have 30 days to bring your system into compfiance with current
regutations. When you are ready for reinspection, call 6511644-1469 for an appointment.
Is there another place where clear water enters the sanitary sewer system? Cl Yes `E3"No
Where is this location?
This area will need to b ed~the clear~avater discharges to the storm sewer system.
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~ ~ Inspector: ~" ' /7~ ~ Date: 'S~-~~- ~ ~ ~~~ ~
Resident: K 4 ,s , ~r ,~,y-,. .,~~z.~- Date: -/p-
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