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City of Prior Lake
Sump Pump and I/I Reduction
ection Form
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Name: cni ~~ ti~ ~ ~• Date• --~ ~ Tim m./p.m.
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~y , y~ ~' ~'First Inspe~ieii ~" Second O
Address: ~~ / ~~~~•~'~~0~' /~.G Own: L9''~ Rent: Age of Home: l gY
,~y ,~,~ Residential: ~ ~J
Prior I~ake, MN 55 ~/%~ Phone:iZ~~v ~JB.~/ Non-Residential: ~
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A. BASEMENT es ~ Si7MP BA5KET 0 ~/"' 2~ 3 ~
WATER IN BASKET es Q No 5UMP P ~ 0~~ ~ 2 ~ 3~
WATER IN BASEMENT (flow over floor) ~ Yes o CISTERN O Yes ~p7~
(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.)
Dischar e Point ~ Laund tub ~ Sanita sewer utside
g rY rY
at Inspection: ~ Floor drain ~ Other
Prior to Inspection:
~r When was tem installed, or most recently modified? (Date) and why
ome came with system ~ Response to inspecti n program 17 Other
~ Water in basement ~ Previous syste i ed
B. ROOF LEADERS: ~ Yes o DISCHARGE: ~ Near ~ Away
G YARD DRAINS L7 Yes No WINDOW WELI,S ~ Yes
BEAVER SYSTEM ~ Yes o
D. PROPERTIES WITH SUMP PUMPS
When does pump run? ~ Fall ummer pring ~ Winter
(check all that apply) How often does pump run? J~' ~./O /f'ItLT
V~here does pump discharge to outside? ~ Front ~ Back ~ Side
NOTES:
SUMP PUMP SYSTEM: L~/~ASS ~ FAIL You have 30 days to bring your system into compliance with current
regulations. When you are ready for reinspection, call 657/644-1469 fnr an appo' .
Is there another place where clear water enters the sanitary sewer system? ~ Yes o
Where is this location?
This area will need to be d~se~the clear~a~scharges to the storm sewer system.
Inspector: ~'~~~/. '~~l --' Date: ,~ "~~ " ~ y' - I
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Resident: ,i~ ~„ Date: -
I Disclaimer: Thi~ visual inspection is done with due diligence to find obvious clear water cross-connections I
and does not imply the structure meets all City Codes.
White: Homeowner Yellow: City Pinkc HRG
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