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City of Prior Lake
Sump Pump and I/I Reduction
Ins~ection Form
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Name: c~ ~ t~~,.~ , ~~~.~ ~ L,'r ~,~
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Address: C ~ 7 ~ -~ ~r.:' ~ ~~ ~d', ~ 1~
Prior Lake, MN 55 ~ 7~,2. Phone: 4/ ~~~~'~ 0
Date: ~- /- ~/ 9 Time: .3~ a.m./p.m.
First Inspection O~Second fl
Own: ~Rent: ~ Age of Home:~J.
Residential: C~''
Non-Residential: ~
l„~w /`I • •,
A. BASEMENT es ~ No SiJMP BASKET O 0 1 a 2 ~ 3 I~
WATER IN BASKET ~ Yes 0'~To SUMP PiJMP ~ Q 1 ~ 2 ~ 3 ~
WATER IN BA5EMENT (flow over floor) ~ Yes I~fiTo CISTERN ~ Yes ~1'Qo
(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"a Sanitary sewer ~ Outside
~ Floor drain ~ Other
Prior to Inspection:
When was system installed, or most recently modified? (Date)
and why
Q Home came with system L~ Response to inspection program Q Other
O Water in basement ~ Previous system failed
B. ROOF LEADERS: L~Yes a No DISCHARGE: C~ Near 0''~Away
C. YARD DRAINS ~ Yes ~'No WINDOW WELLS ~ Yes ~'''~10
BEAVER SYSTEM ~ Yes L~''1G^o
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
NOTES:
Q Spring ~ Winter
~ Back ~ Side
SUMP PUMP SYSTEM: ~PASS ~ 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 place where clear water enters the sanitary sewer system? O Yes ~o
Where is this location?
This area will need to be fixed so the clear water discharges to the storm sewer system.
Inspector: • _ Date: ~- / - ~ 9
Resident: c.. ~ Date: -~- /- y f
Disclaimer: This visual inspection is done with due diligence to find obvious clear water cross-connections I
and does not implv the structure meets all Citv Codes. I
White: Homeowner Yellow: City Pink: HRG