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City of Prior Lake
Sump Pump and I/I Reduction
Inspection Form ,~;~P ~~-
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Name: ~GG ~r~~~ ~ /~,~~~~~ Date: ~~~'~./ Time;~~.~~a.mJp.m.
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/~,.r ~'' ~~ First Inspe 'on 4~ Second ~
Address: /~•.~ ~~~ ~~~/~'~~~ ~ ~ ~ Own: R~e~nt/: ~ Age of Home: ~~ --~
~y Residential: ~'" ~
Prior Lake, MN 55 ~~~' Phone:'~~~/ '~~~~~~on-Residential: ~
A. BASEMENT es~ ~,,~o SiJMP BASKET ~ 0 ~~~ 2~~~ 3 ~
WATER IN BA5KET L~Yes ~ No 5UMP P_~~ O 0 L~3'"1 ~ 2~ ~~~ ~
WATER IN BASEMENT (flow over floor) I~ Yes ISI~Qo CISTERN ~ Yes ~''No
(If no pump, place sticker across edge of sump{-eover and basement floor so any removal of cover will
break seal. Skip to Part B of this form.)
Discharge Point O Laundry tub ~ Sanitary sewer utside
at Inspection: ~ Floor drain ~ Other
Prior to Inspection: ~' ~ f ~
When was system installed, or most rece modified? (Date)~ and why
d Home came with system esponse to inspection program ~ Other
~ Water in basement ~ Previous syste failed
B. ROOF LEADERS: ~ Yes ~~ DI5CHARGE: (7 Near ~ Away
G YARD DRAINS Q Yes C~a~ WINDOW WELLS ~ Yes ~'J""No
BEAVER SYSTEM I~ Yes L9'No
D. PROPERTIES WITH SUMP PUMPS
When does um run? ~ Fall ummer rin Winter .
(check all that apply) How often does pump run? `~C ~/-~~
V~here does pump discharge to outside? Q Front ack O Side
NOTES:
SUMP PUMP SYSTEM: t~ASS 17 FAIL You have 30 days to bring your system into compliance with current
regu[ations. When you are ready for reinspection, cal[ 651 /644-1469 for an era.
Is there another place where clear water enters the sanitary sewer system? ~ Yes o
Where is this location?
This area will need to b ixed e clear w r d' c rges to thg storxn sewer system.
Inspector: • ~" `~ "" Date: '~ -'.3 -
Resident: ~;~1 ` ~fV t~',z~ _ ,, 1,,~ ' ~ Date: - / 3 -
Disclaimer: This visual inspection is done with due diligence to find obvious clear water cross-connections
and does not imulv the structure meets all Citv Codes.
White: Homeowner Yellow: City Pink:;;HRa