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City of Prior Lake
Sump Pump and I/I Reduction
Insuection Form
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Name: /~~~s~ C~ ~~ Date:~~~° ~~/ Time!~~~a.m./p.m.
,/~~ ~First Inspe~c ' n dY''Second ~
Address:~~~"~'"~ ~`~'~'~~'`~~~~ ~~ ~ Own: ~ Rent: Age of Home: ~ Q
~/ ,, Residential: ~ ~
Prior Lalce. MN 55 ~~/~ Phone":~'~~ ~~ ~~ Non-Residential: a
A. BASEMENT ~ Q o 5iJMP BASKET ~C~iQ/1Yl ~ 2 17 3~
WATER IN BASKET es ~ No SUMP PiT 0~ 1 ~ 2~ a
WATER IN BASEMENT (flow over floor) ~ Yes o CISTERN ~ Yes 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 ~ Sanitary sewer ~ Outside
at Inspection: ~ Floor drain ~ Other "''
Prior to I ection: --~
When s system installed, or most recently modified? (Date) and why
Home came with system ~ Response to inspection program ~ Other ~
~ Water in basement ~ Prev' system failed
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B. ROOF LEADERS: es ~ No DI5CHARGE: ~ Near way
C. YARD DRAINS ~ Yes L~J WINDOW WELLS Q Yes E-i~1Qo
BEAVER 5YSTEM L7 Yes L~1'~
D.
NOTES:
PROPERTIES WITH SUMP PUMPS
When does pump run? a Fall ~ Summer
(check all that apply) How often does pump run?
V~here does pump discharge to outside? 7 Front
D Spring ~ Winter
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~ Back Q Side
SUMP PUMP SYSTEM: C1~'~'ASS ~ FAIL You have 30 days to bring your system into compliance with curre
regutations. When you are ready,jor reinspection, call 651/644-1469 for an ent.
Is there another place where clear water enters the sanitary sewer system? ~ Yes o
Where is this location?
This area will need to be ed e clea~ate i arges to the storm sewer system.
Inspector: ~
Resident: ti i~ yi
Date:
Date:
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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.
White: Homeowner Yellow: City Pink: HRG