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City of Prior Lake
Sump Pump and I/I Reduction
Insnection Form
Name: ~~~~' ~~ ~o ! -~fi ~ ~ ; N ~ ~/ Date: ~ //- '~ Time: 2 Z d a.m.lp.m.
First Inspection ~Second O
Address: /~/ 7~ d ~'~ .;,~ wvo,s! ~~~ ~ Own: L~'''Ytent: ~ Age of Home:.~ r1,
Residential: l~-~'' ~
Prior Lake, MN 55~~ Phone: ~/ ~/~- C~.~-,~~, Non-Residential: [7
A. BASEMENT `~~~~ ~ No SUMP BASKET ~ 0 C~''~ ~ 2 ~ 3 ~
WATER IN BASKET ~ Yes A'1Q"'o SUMP PUMP t] 0~ O 2 ~ 3 O
WATER IN BASEMENT (flow over floor) ~ Yes .~s CISTERN I~ Yes C~~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 Q~Laundry tub ~ Sanitary sewer l~''~utside
at Inspection: ~ Floor drain ~ Other
Prior to Inspection:
When was system installed, or most recently modjfied? (Date) and why
0" Home came with system [7 Response to inspection program ~ Other
- a Water in basement [7 Previous system failed
B. ROOF LEADERS: l'~ Yes ~"J''~To~ DISCHARGE: ~ Near Q Away
C. YARD DRAINS O Yes t~"'l~o~ WINDOW WELLS ~ Yes L~PS`
BEAVER SYSTEM ~ Yes ~S'^
D. PROPERTIES WITH SUMP PUMP5
When does pump run? Q Fall a Summer a Spring./~ O Winter
(check all that apply) How often does pump run? /~P~rr-S t~,~, ,~ -~
V~here does pump discharge to outside? ~ Front O Back ~~1d'e
NOTES:
SUMP PUMP SYSTEM: @""YASS Q FAIL You have 30 days to bring your system into compliance with current
regu[ations. When youare ready for reinspection, ca11 6 5 7 /644-1 46 9 for an appointment.
Is there another place where clear water enters the sanitary sewer system? Q Yes ~o
Where is this location?
This area will need to be fixed so the clear water discharges to the storm sewer system.
Inspector: ~ Date: ~ = ~~` 9 9
Resident: ~ • Date: -!t ~' 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