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City of Prior Lake
Sump Pump and I/I Reduction
Inspection Form ~~,~'~
Name: /rC~~s 7~~'ON(~ /~,~ ~ .C; Date:o.~ ~-7'' ~ Time~9~~a.m./p.m.
~~~~~~~ /7 First In~s~pfe ~ion CtY' Second ~
Address: ~~~ L~ ~~ ~~ Own: L~J' Rent: L~ Age of Home:~~ ,
Residential: ~ ~
Prior Lake, MN 55 ~~~' Phone~~~'~ln`~....3 Non-Residential: ~
A. BASEMENT L~°~'es ~ No_ ~ SiJMP BASK~T ~~~''~ ~ 1 Q 2 ~ 3 I~
WATER IN BASKET Q Yes ~'No 5IJMP P~ Q Q ~ 1 Q 2 ~~ ~
WATER IN BASEMENT (flow over floor) ~ Yes C1'No 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 L7 Outside
at Inspection: ~ Ploor drain O Other '~
Prior to Inspection:
When was system installed, or most recently modified? (Date)
and why
~ Home came with system Q Response to inspection program ~ Other
O Water in basement a Prev' s system failed
B. ROOF LEADERS: fl ~No DISCHARGE: ~ Near ~
~o~,,us~ Y
C. YARD DRAINS p M~~~t'u ~ Yes Q_ N/o '' WINDOW WELLS
BEAVER SY5TEM L~~ a~ ~ Yes ~i1Qo
pP`~
D. PROPERTIES WITH 5UMP PUMPS
When does pump run? ~ Fall ~ Summer ~ Spring
(check all that apply) How often does pump run? ''
V~here does pump discharge to outside? O Front ~~ack
NOTES:
O Side
SUMP PUMP SYSTEM: ~ASS O FAIL You have 30 days to bring your system into compliance with current
regutations. When you are ready for reinspection, ca11 651 /644-1 469,t'or an ap ent.
Is there another place where clear water enters the sanitary sewer system? ~ Yes ~3~^.~
Where is this location?
This area will need to ed~the clear grater~i~"charges to the storm sewer system.
Inspector:
Resident: ~
~ Yes ~
Q Winter
Date: ~-'
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 City Codes.
White: Homeowner Yellow: City Pink: HRG