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City of Prior Lake
Sump Pump and I/I Reduction
Ins~ection Form
Name: /~-dP~..~on ~`a~ ~- y Date: ~ Time: 9~~a.m./p.m.
First Inspection 13~ Second ~
Address: ~`~ ~7~ /V~ r~f"~, „~.,~, ~l ~'c p N~ Own: ~ Rent: ~ Age of Home:~S.
Residential: I~-
Prior Lake, MN 55 ?`7~ Phone: ~JO- P9 y Non-Residential: ~
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A. BASEMENT ~~ No SUMP BA5KET D 0 A'7~ ~ 2 ~ 3 ~
WATER IN BASKET [a'ires O No SUMP PUMP a'1~~ ~ 1 ~ 2 ~ 3 ~
WATER IN BASEMENT (flow over floor) ~ Yes ~o CISTERN Q Yes L3~a
(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 CI Outside
at Inspection: ~ Floor drain ~ Other
Prior to Inspection:
When was system installed, or most recently modified? (Date) and why
O Home came with system ~ Response to inspection program ~ Other
[7 Water in basement O Previous system failed
.-f ~ ~ ~
B. ROOF LEADERS: ~~ Q No DISCHARGE: ~ Near ~y
C. YARD DRAINS ~ Yes C-~"R'o WINDOW WELLS ~ Yes L3'1Q"o
BEAVER 5YSTEM ~ Yes ~'Ro
D. PROPERTIE5 WITH 5UMP PUMPS
When does pump run? ~ Fall ~ Summer Q Spring 17 Winter
(check all that apply) How often does pump run?
V~here does pump discharge to outside? a Front ~ Back O Side
NOTES: ~~i~U~~.r~ ~k~ori«f/~ ~~'rf.r Gf~Jr.rf qs /~~~7 -•-•-•---•-•-•-•-•--
SUMP PUMP SYSTEM: C~'"~ASS 17 FAIL You have 30 days to bring your system into compliance with current
regulations. When you are ready for reinspection, cal[ 651/644-1469 for an appointment.
Is there another place where clear water enters the sanitary sewer system? ~ Yes ~"N~o
Where is this location?
This area will need to be fixed so the clear water discharges to the storm sewer system.
Inspector: Date: ~ / ~' ~
Resident: Date: fl'-- /~ -- 9 ~
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
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