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City of Prior Lake
Sump Pump and I/I Reduction
Inspection Form ,q~~J-r~
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Name: V ~~~~~~ ~`- Date:~"~'~~ Tim~~Ja.m./p.m.
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~;~ ~ ~ First Insp~ ion econd ~
Address: ~~•~ 9i~ ~iQ~' ~/~Q ~~~/,~ Own: L~' Rent: Age of Home: ~
./ Residential: ~ ~
Prior Lake, MN 55~~~ Phone:~Y~'~'~~'~Non-Residential: ~
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A. BASEMENT tW~'es C7 No 5iJMP BASKET ~
~~ 1~ 2 ~ 3 ~
WATER IN BASKET ~ Yes o SiJMP
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e' 0~ 1 ~ 2 D 3 Q
WATER IN BASEMENT (flow over floor) _
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Q Yes ~No 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 O Laundry tub O Sanitary sewer ,id Outside
at Inspection: Q Floor dtain ~ Other
Prior to Inspection: ~-
When was systern installed, or mo st recently modified? (Date) and why
17 Home came with system ~ Response to inspecti on program ~ Other
Q Water in basement Q Previous syst ailed
B. ROOF LEADERS: ~ Yes o DISCHARGE: O Near ~ Away
C. YARD DRAINS Q Yes ~No
~ WINDOW WELLS ~ Yes D~Po
BEAVER SYSTEM ~ Yes
D. PROPERTIES WITH SUMP PUMPS
When does pump run? ~ Fall ~ Summer ~ Spring ~ Winter
(check all that apply) How often does pump run? --
V~here does pump discharge to outside? ~ Front a Back ~ Side
NOTES:
SUMP PUMP SYSTEM: L~jIrASS ~ FAIL You have 30 days to bring your system into compliance with current
regulations. When you are ready for reinspection, ca[[ 651 /644-1469 for an appo nt.
Is there another place where clear water enters the sanitary sewer system? ~ Yes ~L'No
Where is this location?
This area will need to be~'ixed~,.s~o the clear water ~j,scharges to the storm sewer system.
Inspector:
Resident:
Date:
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Disclaimer: T visual inspection is done with due diligence to find obvious clear water cross-connections
and does not imply the structure meets all City Codes.
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White: Homeowner Yellow: City Pink: HRG