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City of Prior Lake
Sump Pump and I/I Reduction
ection Form
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Name: ~~~~C ~9~, ~~C~/~~' ~ Date~~~~" y~ Time:~~0~~ a.m./p.m.
~ /9~ f/ ~~/~ ~~. First In~~s~p~ on ~cond Q
Address:1'Y 'Y ~P / ~?~~/,~ Own: l[~' Rent: Age of Home: ~~~( ,
>' Residential: ~ J
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Prior Lake, MN 55 ~J ~v" Phone: Non-Residential: ~
A. BASEMENT ~Yes Q No~/` SUMP BASKET ~ 1~ 2 ~ 3 ~
WATER IN BASKET ~ Yes LB'No SiJMP P 0 O 1 ~ 2 C] 3~
WATER IN BA5EMENT (flow over floor) L? Yes ~ 3~ o CISTERN ~7 Yes ~'1Qo
(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: f7 Floor drain Q Other
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Priar to Inspection:
B.
C.
When s system installed, or most recently modified? (Date) and why
C!~ Home came with s stem ~ Res onse to inspection rogram ~ Other
Y P P
Q Water in basement l~ Pr ous system failed
ROOF LEADERS: Yes ~ No DISCHARGE: ~ Near [9~Away
YARD DRAINS ~ Yes Q"1~T.o WINDOW WELLS Q Yes~ No
BEAVER SYSTEM ~
D. PROPERTIES WITH SUMP PUMPS
When does pump run? ~ Fall ~ Summer ~ Spr~ng ~ Winter
(check all that apply) How often does pump run?
V~here does pump discharge to outside? a Front ~ Back ~ Side
NOTES:
SUMP PUMP SYSTEM: CoJ PASS O FAIL You have 30 days to bring your systern into comp[iance with current
regulations. When you are ready for reinspection, call 651 /644-4469 for an tntment.
Is there another place where clear water enters the sanitary sewer system? ~ Yes No
Where is this location?
This area will need to e fi o the clear atey~ischarges to the storm sewer system.
Inspector: ~ Date: ~3 -~ ~- y ~
Residen~:.,~ ,,, ~rrs~a.~,r ~ ---~-rr: y.~..~„~ ~~,.~ Date: '/~-
Disclaimer: This visual inspection is done with due diligence to find obvious clear water cross-connections
and does not implv the structure meets all Citv Codes.
White: Homeowner Yellow: City Pink: HRG