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Inspection Form ,~,~,~~,-
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Name: ~~~7'~~~~ .~;~i(/~C/,C~,E~I Date~~~'~~ Time/~oQ~a.m./p.m.
.~2 ,/ ,~1/'~' First In_~s~pe~c ' ~L~-^'"S~e ond ~ 2~
Address: ~~i~U ~ fi~/~if'~~~/,~.~ ~Y Own: C~ Re~nt: ~~/ Age of Home. J
,/,/ ,` Residential: LzY' ~
Prior Lake, MN 55 ~~~ Phone:'7"~` ~' ~~'7`'~ Non-Residential: ~
A. BASEMENT ~~"s ~7 No__ / SUMP BA5KET ~~~6
" 1~ 2 ~ 3 ~
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WATER IN BASKET ~ Yes ~iQo P~ L7
SiJMP
0 Q 1 17 ~~' ~
2
WATER IN BASEMENT (flow over floor} ~
~ Yes ~ftO CISTERN ~ 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 ~ Sanitary sewer Q Outside
~ at Inspection: ~ Floor drain a Other ~
Prior to Inspection: r
When was system installed, or most recently modified? (Date) and why
~ Home came with system ~ Response to inspection program ~ Other
~ Water in basement ~ Previ s system failed
B. ROOF LEADER5:~ ~~ /~ ~ es No DISCHARGE: ~ Near wa
~p.A
C. YARD DRAINS ~~' ~.N es ~~ N/o WINDOW WELL5 es ~ No
BEAVER SY51'EM pA ~ I~ Yes l~~o
D. PROPERTIES WITH SUMP PUMPS
When does pump run? ~ Fall ~ Summer
(check all that apply) How often does pump run?
W7here does pump discharge to outside? ~ Front
NOTES:
~ Spring ~ Winter
~ k O Side
SUMP PUMP SYSTEM: ~ S CI FAIL You have 30 days to bring your system into compliance with current
regulations. When you are ready}'or reinspection, ca11651/644-1469 for an ent.
Is there another place where clear water enters the sanitary sewer system? ~ Yes No
Where is this location?
This area will need to be f ~ clear w~er d~arges to the storm sewer system.
Inspector:
Resident:
Date: iG '~~o " ~
Date: -/
Disclaimer: This visual inspection is done with due diligence to find obvious clear water cross-connections
and does not impl_y the structure meets all Cit_y Codes.
City of Prior Lake
Sump Pump and I/I Reduction
White: Homeowner Yellow: City Pink:;~HRG