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City of Prior Lake
Sump Pump and I/I Reduction
Insnection Form
Name: '~j~aG,.K~t~rj ~rtG~-°-~
Address: 3 ~ 7Q ~~~~~ ~~~ l ~ ~
Prior Lake, MN 55~~ Phone:
Date: 3'~' -99 Time: ~'~
First Inspection ~ Second ~
Own: A°"` Rent: Q Age of Home: /97 ~
Residential: ~°"p '
Non-Residential: ~
A. BASEMENT ~~ ~ No~ 5UMP BASKET ~~ 1 ~ 2 ~ 3 ~
WATER IN BAS T~ Yes o SiJMP PLT~P I~'tf Q 1 Q 2 ~ 3 ~
WATER IN BASEMENT (flow over floor) ~ Yes IF~To CISTERN 17 Yes QLPits'
(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 ~ Outside
at Inspection: ~ Floor drain ~ Other
Prior to Inspection:
When was systern installed, or most recently modi~ed? (Date) and why
~ Home came with system ~ Response to inspection program ~ Other
Q Water in basement ~ Previous system failed
B. ROOF LEADERS: ~ Yes ~' No DISCHARGE: ~ Near ~ Away
C. YARD DRAINS ~ Yes l~~'~N WINDOW WELLS ~ Yes ~No
BEAVER SYSTEM ~ Yes fi~'No
D. PROPERTIES WITH SiJMP PUMPS
When does pump run? ~ Fall ~ Summer ~ Spring [7 Winter
(check all that apply) How often does pump run?
V~here does pump discharge to outside? ~ Front ~ Back [] Side
NOTES:
SUMP PUMP SYSTEM: ~PASS ~ FAIL You have 30 days to bring your system into compliance with current
regulations. When you are ready for reinspection, ca[l 651 /644-1469 for an intment.
Is there another place where clear water enters the sanitary sewer system? Q Yes No
Where is this location?
This area will~ed to~~fixed so the clear water discharges to the storm sewer system.
Inspector:
Resident:
Date: 3 ' 2 -
Date:
Disclaimer: This visual inspection is done with due diligence to find obvious clear water cross-connections
and does not imnlv the structure meets all Citv Codes.
White: Homeowner Yellow: City Pink: HRG