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City of Prior Lake
Sump Pump and III Reduction
Inspection Form
Name: XI{ y' u'\/E1 -J Q/,I/V Il J ~/\(4" E
Address:L6t/77::r~Al)()/VA ~cII
tIre. 5w
Prior Lake, MN 55
. ," ~}~"
Phone:
Date: 9--';/'0-9], Time:1/,,@.m.
First Inspection ~
Own: 'Ii( Rent: 0
Residential:.
Non-Residential: 0
Second 0 1~? :-
Age of Home: , :ot
A. BASEMENT 0 Yes )(NO SUMP BASKET ~ 0 0 1 0 2 0 3 0
WATER IN BASKET 0 Yes 0 No SUMP PUMP Roo 1 0 2 0 3 0
WATER IN BASEMENT (flow over floor) 0 Yes ')(NO CISTERN 0 Yes 0 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
at Inspection:
o Laundry tub
o Floor drain
o Sanitary sewer
o Other
o Outside
Prior to Inspection:
When was system installed, or most recently modified? (Date)
o Home came with system 0 Response to inspection program
o Water in basement 0 Previous system failed
o Yes)( No DISCHARGE: 0 Near 0 Away
o Yes ~ No WINDOW WELLS 0 Yes 0 No
o Yes)t1 No 57! / R()()>~J/#?r:.. 'STSW L/&'-M/VP
OW^f5 ell&/N 'Ii ~Ac.k Ltrr o~ ~
PROPERTIES WITH SUMP PUMPS 7?1~ 1< 110M&. '"
When does pump run? 0 Pall 0 Summer 0 Spring 0 Winter
(check all that apply) How often does pump run?
Where does pump discharge to outside? 0 Front 0 Back 0 Side
-NOTES~o-;$e~~h----1J-om~-o-C-LAfj,;:;-7--~t[/JKeo~o-o-ar;;~-~oDo--_0_0-
f:J.c>cr-+v I.~",,,,,.~ c /J: bl'J r...-:"el'1.-I- - It{ro SWlIs:kfJ i ~~I' Ct:I_~~
I '.....,( 'l)V'\ Oro~~r~
UMP PUMP SYSTEM: "" PASS 0 FAIL You have 30 days to bring ydur systt!m mto coTlpliSnce with current
regulations. When you are ready for reinspection. call 651/644-1469 for an appointment.
J:,(No
B.
ROOF LEADERS:
C.
YARD DRAINS
BEAVER SYSTEM
D.
and why
o Other
DYes
Is there another place where clear water enters the sanitary sewer system?
Where is this location?
This area wil~to nxed so the.. cle:r wate~charges to the storm sewer system.
Inspector: '::/;:JI. ~ ~.. Date: ~'-;il.O-97'
Resident: - (7 Date: r -
Disclaimer: This visual inspection is done with due diligence to fmd 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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City of Prior Lake
~ump Pump and I/I Reduction
Inst~ection Form
'~" ~
Name: ~ V/fi/~ ~,Jt~~,.~,`~' ~1/n,~v~.r'~--.
Address'..~ ~~,/r ~OSf_U~...~--7`_ ;;..~;~ ~;; t::~ .,1
Prior Lake, MN 55 Phone:
Date: 9-,~~-~~ Time: a.m./p.m.
First Inspection ~ Second ~
Own: ~ Rent: ~ Age of Home:~1~'~
Residential:~
Non-Residential: ~
A. BASEMENT ~es ~ No SiJMP BASKET 0 a 1 ~ 2 ~ 3 ~
WATER IN BASKET ~ Yes ~ No S PUMP 0~ 1 ~ 3~
WATER IN BASEMENT (flow over floor) ~ Yes o CI5TERN O Yes ~10
(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 Q Outside
at Inspection: Q Floor drain O Other
Prior to Inspection:
When was system installed, or most recently modified? (Date) and why
O Home came with system
C] Water in basement
B. ROOF LEADERS:
G YARD DRAIN5
BEAVER SYSTEM
NOTES: _
L/ 6~ '?""'
SUMP PUMP SYSTEM: ~ PASS ~1 FAIL You have 30 days to bring your system into compliance with cur~ent
regutations. When yau are ready for ~ein.spection, cau 651/644-1469 for an appoinrment.
Is there another place where clear water enters the sanitary sewer system? O Yes ~ No
Where is this location?
This area w'~'n 'e~e~to ixed so the clea~ter discharges to the storm sewer system.
---~r-_..,_ .
Resident: -
Date: ~~ n --
Date:
Disclaimer: This visual inspection is done with due diligence to find obvious clear water cross-conaections
and does not imply the structure meets all City Codes.
~ Response to inspection program ~ Other
~ Previous system failed
~ Yes~ No DISCHARGE: ~ Near ~ Away
~ Ye No WINDOW WELLS Q Yes~No
C7 Yes No
White: Homeowner Yellow: City Pink: HRG
D. PROPERTIES WITH SUMP PUMPS
When does pump run? O Fall Q Summer O Spring ~ Winter
(check all that apply) How often does pump run?
V~here does pump discharge to outside? Q Front ~ Back 17 Side