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City of Prior Lake
Sump Pump and I/I Reduction
Inspection Form
Name: f~fre,~P~ ,,N~rtL~G~., ~~~~ 1,,~-, Date: ~/-1 /- 9 y Time: ~~~ a.m./p.m
First Inspection L'9~ Second 7
Address: ~.~ ~'~ /~u< ~or ~~ 1E Own: E~' Rent: ~ Age of Home:~
Residential: L~''~
Prior Lake, MN 55~ Phone: ~/L/ 7- 6~~/~ Non-Residential: ~
L o w rr G. .
A. BASEMENT I~ Yes l~ No 5UMP BASKET 0~ 1 ~ 2 ~ 3 ~
WATER IN BASKET I~ Yes d No SiJMP PUMP I~'0 ~ 1 ~ 2 ~ 3 ~
WATER IN BASEMENT (flow over floor) Q Yes ~'No CISTERN a Yes t3'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 d Sanitary sewer ~ Outside
at Inspection: a Floor drain ~ Other
Prior to Inspection:
When was system installed, or most recently modified? (Date) and why
~ Home came with system I~ Response to inspection program ~ Other
~ Water in basement Q Previous system failed
B. ROOF LEADERS: ~ Yes ~To DISCHARGE: Q Near ~ Away
C. YARD DRAINS Q Yes L~ No WINDOW WELLS ~ Yes ~'No
BEAVER SYSTEM ~ Yes ~No
D.
NOTES:
~ Spring ~ Winter
17 Back ~ Side
SUMP PUMP SYSTEM: ~'PASS ~ FAIL You have 30 days to bring your system inio compliance with currcnt
regulations. When you are ready for reinspection, ca[[ 651 /644-1469 for an appointment.
Is there another place where clear water enters the sanitary sewer system? O Yes C~No
Where is this location?
This area will need to be fixed so the clear water discharges to the storm sewer system.
Inspector: tit !' ~ ~.~.ofi Date: y-1 /- 99
Resident:
Q~
q~ Date: ~/• 1i- 99
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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.
PROPERTIES WITH 5UMP PUMPS
When does pump run? ~ Fall ~ Summer
(check all that apply) How often does pump run?
V~here does pump discharge to outside? ~ Front
White: Homeowner Yell~w: ; City Pink: HRG