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City of Prior Lake
Sump Pump and I/I Reduction
ection Form
Name: ~_ ~cY a~ ~cfv~ r r ~~- ,~d «n
Address: 1~~~~ y~~h ,' fa H t"~r ~ ~t/~
Prior Lake, MN 55 3 7.Z Phone: ~/ ~-~ ~f3
Date: ;l'- ?~- yy Time: /~ a.m./p.m.
First Inspection Q'` Second ~
Own: C~'"~ Rent: ~ Age of Home: ~ ~
Residential: 0''
Non-Residential: ~
/c^ (k o~-r
A. BASEMENT ~es ~ No SUMP BASKET ~~ 1 ~ 2 ~ 3 ~
WATER IN BASKET ~ Yes ~ No SUMP PUMP ~ ta 1 O 2 ~ 3 ~
WATER IN BASEMENT (flow over floor) ~ Yes L~"No CISTERN ~ Yes C~'A~o
(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 D Sanitary sewer D Outside
at Inspection: D Floor drain d Other
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 Q Previous system failed
B. ROOF LEADERS: C~'Yes L~ No DISCHARGE: ~ear ~ Away
C. YARD DRAINS ^ Yes L~'"~1o WINDOW WELLS ~ Yes L~"'1Go
BEAVER SY5TEM ~ Yes l~To
D. PROPERTIES WITH SUMP PUMPS
When does pump run? ~ Fall ~ Summer d Spring ~ Winter
(check all that apply) How often does pump run?
V~here does pump discharge to outside? ~ Front ~ Back ~ Side
NOTES:
SUMP PUMP SYSTEM: C~'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 jor an appointment.
Is there another place where clear water enters the sanitary sewer system? O Yes ~'l~o
Where is this location?
This area will need to be fixed so the clear water discharges to the storm sewer system.
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Inspector: (~~~ ~-'~~,~, 11 Date: S- 211 - 9 9
Resident: ~C~,~~ , Date: S- ~.2 ~ 9 ~j
I Disclaimer~ T~is visual inspection is done with due diligence to find obvious clear water cross-connections I
and does no~unnlv the structure meets all Citv Codes.
White: Homeowner Yellow: City Pink: HRG