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City of Prior Lake
Sump Pump and I/I Reduction
Inspection Form ,~~,~~,~
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~ Name: L~V/.G~D~/~ i~/C~~9~'O Date~:~i~g ~~ Time1~~~ a.m./p.m.
~~~ ~ , ~~~ irst In~sp~e Second ~
Address: ~ ~'v~~~ ~/2 ~/l~Own: L~' Rent: ~ ge of Home: ~~
~y //,/// /Residential: ~ J
Prior Lake, MN 55 ~/~ Phone:7 I" ~' 7~3l~' Non-Residential: ~
A. BASEMENT L~es Q No SiJMP BASKET ~ 0 1 D 2 O 3 ~
WATER IN BASKET ~ Yes ~ SUMP P~~ 0~ 1 C] 2~ I~~ /3 ~
WATER IN BASEMENT (flow over floor) ~ Yes L~~'No CISTERN a Yes d7~vo
(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 ~ Sanita.ry sew~ C7 Outside
at Inspection: O Floor drain L~ Other
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Prior to Ins tion:
When system installed, or most recently modified? (Date) and why
Home came with system ~ Response to inspection program ~ Other
a Water in basement ~ Previous syste iled
B. ROOF LEADERS: Q Yes o DISCHARGE: ~ Near O Away
C. YARD DRAINS ~ Yes L~~F'_'N,9~'~~ WINDOW WELLS es ~ No
BEAVER 5Y5TEM ~ Yes ~~"No
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:
~ S,pring Q Winter
~ B~k ~ Side
SUMP PUMP SYSTEM: L~/~ASS ~ FAIL You have 30 days to bring your system iruo compliance with current
regulations. When you are ready for reinspection, ca[l 651/644-7469 for an ap o' nt.
Is there another place where clear water enters the sanitary sewer system? ~ Yes o
Where is this location?
This area will need to b xe~e clear~ater~~discharges to the storm sewer system.
I Inspector:
Resident:
,~~zs.._. ,
Date: .S - L y-
Date: 3 Z S -
Disclaimer: This visual inspection is done with due diligence to find obvious clear water cross-connections
and does not imply the structure meets all City Codes.
";~ ~ , } ,~
White: Homeowner Yellow: Ciry Pink: HRG
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A. BASEMENT I~ Yes ~No SUMP BASKET ~ 0 ~ 1 I~ 2 Q 3 O
WATER IN BASKET ~ Yes ~ No SiJMP PUMP ~" 0~ 1 17 a 3 ~
WATER IN BASEMENT (flow over floor) ~ Yes l'Ro 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 t7 Laundry tub ~ Sanitary sewer a Outside
at Inspection: Q Floor drain ~ Other
Prior to Inspection:
When was system installed, or most recently modified? (Date) and why
~ Home came with system ~ Response to inspection program Q Other
~ Water in basement (7 Previous system failed
B. ROOF LEADERS: Q Yes~ No DISCHARGE: ~ Near C7 Away
C. YARD DRAINS l7 Yes~ No WINDOW WELLS ~ Yes ~ No
BEAVER SYSTEM 17 Yes l~' No
regutations. When you are ready Jor remspect[on, ca[l da~io~w-~~~ Jor an appoinnnent.
Is there another place where clear water enters the sanitary sewer system? ~ Yes ,~No
Where is this location?
This area will~"ed,'EQ be ~d so the clear water d~charges to the storm sewer system.
Inspector: Date:
Resident: Date:
Disclaimer: This visual inspection is done with due diligence to find obvious clear water cross-connections
and does not imply the structure meets all City Codes.
White: Homeowner Yellow: City Pink: HRG
D. PROPERTIES WITH SUMP PUMP5
When does pump run? ~ Fall ~ 5ummer ~ Spring ~ Winter
(check all that apply) How often does pump run?
Where does pump discharge to outside? ~ Front ~ Back a Side