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City of Prior Lake
Sump Pump and I/I Reduction
Inspection Form ,~~~J~'
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Name: ~ O.(/,~,G ~ G Date: :~ ~~,9 Time!~~ni a.m./p.m.
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~/ "'~ ~ First Inspe tion ~ Second ~ /
Address:~~~~~ /~~,~ ,,~li~l~.s J~ ,0 Own: ~Rent: Age of Home: Z~P~
,.~ Residential: ~ ~
Prior Lake, MN 55 ~~/(/ Phone~~9~ ~ Non-Residential: ~
..-, _.
A. BA5EMENT ~es ~ No ~ SUMP BASKE 0 L~YI ~'d 2~ 3 Q
WATER IN BASKET Q Yes o SUMP P O 0 QY1~~ C~.~ ~ 3 ~
WATER IN BASEMENT (flow over floor) ~ Yes o CISTERN (~es ~ 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 ~ Laundry tub Q Sanitary sewer Outside
at Inspection: ~ Floor drain ~ Other
Prior to I ection:
When as system installed, or most recently modified? (Date)
B.
C.
D.
NOTES:
SUMP PUMP SYSTEM: ASS d FAIL You have 30 days to bring your system into compliance with current
regulations. ~Vhen you are ready for reinspection, ca[I 651 /644-1469 for an appo' ent.
Is there another place where ear water enters the sanitary sewer system? C] Yes o
Where is this location? .
This area will need to be ed clear wa di ges to the storm sewer syste
Inspector: - - ~' ~ Date: - ~ -
Resident: _, i~ ~~ ~, ~!' . Date: ~ ~ r _ _
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.
and why
Home came with system ~ Response to inspection program O Other
~ Water in basement ~~ Previous syst failed
ROOF LEADER ~1 ~ G ~ Ye o DI5CHARGE: O Near ~ Away
'~ "~~~ Yes ~ No WINDOW WELL5 ~ Yes o
YARD DRAINS ~ 0 „~
BEAVER SY TEM ~~ ~~ ~ Yes o
PROPERTIE ~`H SUMP PUMPS
When does pump run? ~ Fall ummer ,~SPrin l/ Q Winter
(check all that apply) How often does pump run? /c /G ./`7'~A~ ~/~
Where does pump discharge to outside? ~ Front ack Q Si
White: Homeowner Yellow: City Pink: HRG