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City of Prior Lake
Sump Pump and I/I Reduction
ction Form
Name: l`7~/t'~D~i~~N ~C` /,~ // ~Q
Address:1~9~~ ~~•~~i~i4~ ~i~ 53'~ ~ -
Prior Lake, MN 55 ~~ Phone. 'Y~-~~~
`w Gvc,~ L
A. BASEMENT es ~ No_ ~ SUMP BASKET I ~~ 1 ~ 2 ~ 3 ~
: WATER IN BASKET ~ Yes ~~'o SIJMP -PIUM~ ~ 0 ~ 1 a 21 Q~` `Q
WATER IN BASEMENT (flow over floor) ~ Yes ~d'o CISTERN t] Yes ~'ftO
(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 fornn.)
Discharge Point I~ Laundry tub O Sanitary sewer O Outside
at Inspection: ~ Floor drain ~ Other ~
Prior to Inspection: "
1 When was systern installed, or most recently modified? (Date) and why
~ Home came with system ~ Response to inspection program ~ Other
~ Water in basement ~ Previous syst `~ailed
B. ROOF LEADERS: a Yes I~~TTo DISCHARGE: ~ Near a Away
C. YARD DRAINS Q Yes l9-"~ WINDOW WELLS ~ Yes C~fifo
BEAVER SYSTEM ~ Yes [~'NO
D. PROPERTIES WITH SUMP PUMPS
When does pump run? ~ Fall ~ Summer ~ Spri~ ~ Winter
(check all that apply) How often does pump run?
V~here does pump discharge to outside? la Front ~ Back O Side
NOTES:
Date~i~=~.'"~ Time:~~~~a.m.Ip.m.
First Ins tion ~' econd ~
Own: ~~Rent: Age of Home: ~
Residential: ~
Non-Residential: ~
SUMP PUMP SYSTEM: I~~4SS Q FAIL You have 30 days to bring your system into comp[iance with current
regulations. When you are ready for reinspection, call 651 /644-1469 for an ap ent.
Is there another place where clear water enters the sanitary sewer system? ~ Yes L#''.No
Where is this location?
This area will need to be d~ clear wa~r di~rges to the storm sewer system.
Inspector:
Resident:
Date: ^~
Date: /~,
Disclaimer: This visual inspection is done with due diligence to find obvious clear water cross-connections
and does not unply the structure meets all City Codes.
'~~ 7"
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White: Homeowner Yellow: City Pink: HRG