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City of Prior Lake
Sump Pump and I/I Reduction
Inspection Form
Name: s~°~~ .~~ U~~ Date: 3-Z-`~'~ Time:/.'v0 a.m.~
/,y' /.~ 4 ~,Qr 7~ h 59~1 ~~ f~~ ~'~irst Insp~e ion L~ Second ~
Address: Own: C~ Re~n~t%: ~ Age of Home:
ResidentiaL• CFl
Prior Lake, MN 55 37Z Phone: ~L~7-~2I Q Non-Residential: C~
A. BASEMENT ~~ No SLJMP BASKET ~ 0 ~~ ~ 2~ 3 O
WATER IN BASKET ~~ No SUMP PUMP ~ 0 G'T ~ 2- ~ /3 [a
WATER IN BASEMENT (flow over floor) Q Yes A'1Qo CISTERN I~ Yes ~NO
(If no pump, place sticker across edge of sump cover and basement floor so any rem~al of cover will
break seal. Skip to Part B of this form.)
Discharge Point ~ Laundry tub ~ Sanitary sewer t~J"Outside
at Inspection: ~ Floor drain ~ Other
Prior to Inspection:
',~,^„ When was system installed, or most recently modified? (Date) NI ~ w~ q$~ and why
f
Q Ho e came with system ~ Response to inspection program ~ Other
ater in basement ~ Previous system failed
C1
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B. ROOF LEADERS: Near
es ~ No D
SCHARGE: Away
'
C. YARD DRAINS ~ Yes QYN WINDOW WELLS A ~
i'es ~ No
BEAVER SYSTEM ~ Yes ~
D. PROPERTIES WITH SUMP PUMFS
When does pump run? d Fall a Summer L'a pring ~ Winter
(check all that apply) How often does pump run? ~ T~+ ~ h .,
V~here does pump discharge to outside? O Front Back ide
NOTES:
SUMP PUMP SYSTEM: ~ASS ~ FAIL You have 30 days to bring your system into compliance with current
regulations. When you are ready far reinspection, caU 651 /644-1469 for an appointmera.
Is there another place where clear water enters the sanitary sewer system? Q Yes ~'No
Where is this location?
This area will need to be fixed s the clear water discharges 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
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