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Name: ~~/.~~~ ~~;,,~ /~~.~~'~
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Address: t,~~~Q `t,.,J ~~~~~~~
Prior Lake, MN 55~ l,f~ Phone. .~i- /~~~
City of Prior Lake
Sump Pump and I/I Reduction
Insnection Form
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Dat~%"~" Time~%a.m./p.m.
First In~spe~c ~' L9'" Second ~
Own: I~'' Rent: ~ Age of Home:~ ~
Residential: ~
Non-Residential: ~
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A. BASEMENT es ~ No SiJMP BASKET ~ 0 ~ 2 ~ 3 ~
WATER IN BASKET 17 Yes o SUMP P O 1 ~ 2~~1~
WATER IN BASEMENT (flow over floor) C] Yes o CISTERN O Yes 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.)
Discharge Point ~ Laundry tub ~ Sanitary sewer ,._ Q Outside
at Inspection: ~ Floor drain ~ Other
......--~-
Prior to I ection:
When as system installed, or most recently modified? (Date) and why ._ .~
Home came with system L~ Response to inspection program Q Other
~ Water in basement l~ Prev' s system failed
B'Y N DISCHARGE: Q Near wa
B. ROOF LEADERS: es ~ o ~A y
C. YARD DRAINS ~ Yes J~' N~~ WINDOW WELLS ~ Yes ~~1Vo
BEAVER SYSTEM ~ Yes ~YNo
D. PROPERTIES WITH SUMP PUMPS
When does pump run? ~ Fall ~ Summer ~ Sp~ing a Winter
(check all that apply) How often does pump run? '--
V~here does pump discharge to outside? ~ Front ~ Back C7 Side
NOTES: ~~..~ /~~-~-~~~ti// "T's~-- f~~-•-•,{•~•~ ~"K~--~..,---._._._._.-•---•-•-
CJ
SUMP PUMP SYSTEM: A''PASS 17 FAIL You have 30 days ta bring your system into comp[iance with cur
regu[ations. When you are ready for reinspection, ca[[ 651 /644-1469 jor an ointment.
Is there another place where clear water enters the sanitary sewer system? ~ Yes No
Where is this location?
This area will need to be fi so lear wat~di~rges to the storm' sewer system. ~
Inspector:
Resident:
Date: -~ 'ti ~ "
Date: ~ c~ ' ,
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 `