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City of Prior Lake
Sump Pump and I/I Reduction
Insnection Form
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Name: ~ 1/~~ ~'~,~ /, ~/,~~,~ I)at~:~ r~ Time: /~~~. m. /p. m.
~j~ ~~~M~ ~~, ,r ,, `~~ ~,~ First In~s~p~e on Second ~ 2~
Address: ~/v ~ Y~•-~ Own: ~' Rent: - Age of Home:...N
~y /,f Residential: ~ ~
Prior L~,lce, MN 55 ~.."~ /~ Phone ~J"7' ~~~~~ Non-Residential: L7
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A. BASEMENT es ~ No~ SUMP BASKET ~O 1 Q 2 ~ 3 ~
WATER IN BASKET d Yes o SUMP P~ 0~ 1 a 2~ ~~ Q
W~iTER IN BASEMENT (flow over floor) Q Yes i9'No CISTEItN ~ Yes CYNo
(If no pump, ptace 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 D Laundry tub ~ Sanitary sewer Q Outside
at Inspection: Q Floor drain ~ Other 'r
Prior to Inspection:
When was system installed, or most recently modified? (Date) ~! and why
~ Home came with system ~ Response to inspection program ~ Other
Q Water in basement ~I Pre ' us system failed
B. ROOF LEADER5: Yes No DISCHARGE: ~ Near CYAway
~ ~, ,~~ ~--
C. YARD DRAINS ~,~v Yes ~~_ N~ WINDOW WELLS ~ Yes o
BEAVER SYSTEM ~~ O Yes I C V N o
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D. PROPERTIES WITH SUMP PUMPS
When does pump run? ~ Fall a Summer a Spring ~ Winter
(check all that apply) How often does pump run?
V~here does pump discharge to outside? ~ Front O Back O Side
NOTES:
SUMP PUMP SYSTEM: ~'ASS ^ FAIL You have 30 days to bring your system into compliance with current
regulations. When you are ready for reinspection, ca[l 651 /644-1468 for an ap ' ent.
Is there another place where clear water enters the sanitary sewer system? ~ Yes o
Where is this location?
This area will need to be ed~ s,~he clea~te~ischarges to the storm sewer system.
Inspector:
Resident:
Date: ~~
Date: ~
I Disclaimer: This vi~al inspection is done with due diligence to find obvious clear water cross-connections I
and does not imnlv the structure meets all Citv Codes.
White: Homeowner Yellow: City Pink:' HRG