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Name:
City of Prior Lake
Sump Pump and I/I Reduction
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Inspection Form ~ ~a~~
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j~~='~-5 Date: '~~ /~ Time~~a~a.m./p.m.
/ ~~ ~ ~ ~ ~G~First In~spfe ~'on ~Y Second ~
Address: ~~/~~~ /V~>~'/~~~ ~ Own: [~' Re-n~t: '" Age of Home:
~y , Residential: (~
Prior I~ake, MN 55 ~/~ Phone~~~ ~~~ Non-Residential: ~
A. BASEMENT C~es Q No ~ SLTMP BA5KET ~~ 2 O 3 ~
WATER IN BASKET d Yes o SUMP~ P~ 0 Q 1 ~ 2 ~~ ~3-~
WATER IN BASEMENT (flow over floor) a Yes L~lTio CISTERN ~ Yes I~-ICo
(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 17 Outside
at Inspection: ~ Floor drain ~ Other ----
Prior to Inspection: -''~
When was system installed, or most recently modified? (Date) and why
a Home came with system ~ Respon to inspection program 17 Other
a Water in basement \ 17 Pre ' us system failed
B. ROOF LEADER • ~~~ es No DISCHARGE: ~ Near way `
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C. YARD DRAINS ~~ es ~ No . WINDOW WELLS ~ Yes Q~-#15'~~
BEAVER SYS M~ u~ Yes ~~
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D. PROPERTIES WITI~ SUMP PUMPS
When does pump run? a Fall ~ Summer Q Spring ~ Winter
(check all that apply) How often does pump run? "~
Where does pump discharge to outside? ~ Front O Back ~] Side
NOTES:
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SUMP PUMP SYSTEM: b'PASS 17 FAIL You have 30 days to bring your sysdem intn cnmpliance with ctu'rent
regulations. When you are ready for reinspection, cal! 651/644-1469 for an tntment.
Is there another place where clear water enters the sanitary sewer system? ~ Yes No
Where is this location?
This area will n to ixed e clear wate 'scharges to the storm sewer system.
Inspector: • ~ Date: " ~ '
Resident: Date: - ~ 3 -
Disclaimer: 'sual inspection is one with due diligence to find obvious clear water cross-connections
and does not imnlv the structure meets all City Codes.
White: Homeowner Yellow: City Pink: HRG