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City of Prior Lake
Sump Pump and III Reduction
Inspection Form
Name: P kc./t 1;.),- (( \ L; """:/('11 /tOt12"f'v IV...; t Date: j-I) -71 Time:O?Jja.m./p.m.
First Inspection ~ Second 0
Own: l3"""" Rent: 0 Age of Home: :)-0 +--
Residential: g.-
Non-Residential: 0
Address: 16 I> S-Y I tV G ~ A i) A) 11 RAt t. CI r<
Prior Lake, MN 55 '] '7 -l Phone:
"A. BASEMENT ~s 0 No SUMP BASKET 13"'0 0 1 0 2 0 3 0
WATER IN BASKET 0 Yes 0 No SUMP PUMP era 0 1 0 2 0 3 0
WATER IN BASEMENT (flow over floor) 0 Yes ~ CISTERN 0 Yes Q..N-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.)
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Discharge Point
at Inspection:
o Laundry tub
o Floor drain
o Sanitary sewer
o Other
o Outside
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Prior to Inspection:
When was system installed, or most recently modified? (Date)
and why
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o Home came with system
o Water in basement
o Response to inspection program 0 Other
o Previous system failed
~s 0 No DISCHARGE: ~ar 0
Away
PROPERI1ES WITH SUMP PUMPS
When does pump run? 0 Fall 0 Summer 0 Spring
(check all that apply) How often does pump run?
Where does pump discharge to outside? 0 Front
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NOTES: IVt, bQr (J.../ h(;J~l'\.f~,.. \. .k-/- i-\-r /'" +0 A~ ;",-~~~,t/o""-. ~<)I.,"'c!
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~SS
B.
C.
ROOF LEADERS:
YARD DRAINS
BEAVER SYSTEM
D.
SUMP PUMP SYSTEM:
o Yes ~
o Yes Q..-No
WINDOW WELLS 0 Yes ~
o Winter
o Back
o Side
o FAIL You have 30 days to bring your system into compliance with current
regulations. When you are ready for reinspection. cal/651/644-1469 for an appointment.
Is there another place where clear water enters the sanitary sewer system? 0 Yes B1'fo
Where is this location?
This area will need to be fixed so the clear water discharges to the storm sewer system.
Inspector: --;) J 4-1. ~ / / Date: (: /' J.J - i tj
Resident: ~?7 cc>L-'[A..-- Date: {-, I 7 - .7,
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
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