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City of Prior Lake
Sump Pump and I/I Reduction
Ins~ection Form
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Name: /,L ~,C~ /~ . Date:~~'J "'~9 Time~i~a.m./p.m.
/ ,/ i ~'~' ~~ First Inspect' Se ond ~
Address:1~~~°`~`` ~~~ ~% ~~~~~k~~wn: Rent: ~ Age of Home~~u
~~~ ~,/ ~ ~~~ J Residential: ~ '~
Prior Lake, MN 55 Phone ~'7`~ Non-Residential: ~ ~'
A. BASEMENT l~s ~ No ~ SUMP BASKET ~ 0~ 2 ~ 3 ~
WATER IN B~T ~ Yes o SUMP~~~ Q 0 ~ 2~
WATER IN BASEMENT (flow over floor) ~ Yes o CISTERN ~ Yes o
(If no pump, place sticker across edge of sump cover a~d basement floor so any removal of cover will
break seal. Skip to Part B of this form.)
Discharge Point a Laundry tub Q Sanitary sewer Outside
at Inspection: ~ Floor drain ~ Other
Prior to Ins ion:
When system installed, or most recently modified? (Date)
.~
Home came with system ~ Response t' spection program
~ Water in basement ~ Previ s stem failed
~ Other
and why
Y
B. ROOF LEADERS: es ~ DISCHARGE: Q Near ~ way
S ~ Yes ~ WINDOW WELi.S O Yes ~~1Vo
C. YARD DRAIN
BEAVER SYSTEM ~ Yes No
D. PROPERTIES WITH SUMP PUMPS
When does pumg run? ~ Fall ~ Summer ,,,P rinP, O Winter . /
(check all t~at apply) How often does pump run? ~~/ G ~C- ~~ L~ v ~/~./
V~here does pump discharge to outside? f7 Front Q Back
NOTES:
SUMP PUMP SYSTEM: L~-~ASS C] FAIL You have 30 days to bring your system into compliance with current
regutations. When you are ready for reinspection, cQ[! 651 /644-1469 for an appoi .
Is there another place where clear water enters the sanitary sewer system? (~ Yes o
Where is this location?
This area will need to b xec e clea~ter~charges to the storm sewer system.
Inspectar: • /~" ""~-- Date: ~ -J -
Resident: ~ ~c,,,~n . ;~~cp~ Date: ~.,,~ ~ -
Disclaimer: This visual inspection is done with due diligence to find obvious clear water cross-connections
and does not impl_y the structure meets all City Codes.
White: Homeowner Yellow: City Pink: HRG