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City of Prior Lake
Sump Pump and I/I Reduction
Ins~ection Form
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Name: ~~~'~V C~~% i(~~ '~'~-/1~'~.~Lt/ Date: ~ f g~
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Time;/~~4~m. /p. m.
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~~~ O~ ~,, V, First In~sp~e ' ~[Y Second i~ /Z
Address: ~~~ 9~ /~ ~ Own: @'" Rent: ~ ge of Home.
// ~3, Residential: ~ ~
Prior Lake, MN 55~~~ Ph,9n~`~'~~'~~~/ Non-Residential: ~
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A. BASEMENT es ~ SUMP BASKET O 0 O 2 ~ 3 ~
WATER IN BASI~ET es ~ No SLTMP~~~ ~ 1 ~ 2 O 3
WATER IN BASEMENT (flow over floor) ~ Yes o CI5TERN ~ Yes
(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 t7 Laundry tub
at Inspection: I~ Floor drain
Prior to pection:
Whe as system installed, or most recently modified?
~ Sanitary sewer ~ Outside
~ Other "'~
(Date) and why
Home came with system ~ Response to inspection program
~ Water in basement 17 Previous sys failed
~ Other
B. ROOF LEADERS: Ca Yes o DISCHARGE: ~ Near ~ Away
C. YARD DRAINS ~ Yes ~,_~ WINDOW WELLS ~ Yes ~'"No
BEAVER SYSTEM ~ Yes ~'No
D. PROPERTIES WITH SUMP PUMPS
When does pump run? C~ Fall O Summer ~ Sprin~ ~ Winter
(check all that apply) How often does pump run?
V~here does pump discharge to outside? ~ Front D Back ~ Side
NOTES:
SUMP PUMP SYSTEM: t~J'PASS ~ FAIL You have 30 days to bring your system into compliance with cur nt
regu[ations. When you are ready for reinspection, ca[1651/644-1469 for pointment.
Is there another place where clear water enters the sanitary sewer system? ~ Yes No
Where is this location?
This area will need to be ed~,se~he clear ~er sc arges to the storm sewer system.
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Inspector: / `~ ` ~'"'-~' Date: "~' " ~ ' y y
Resident: , ,~~_ ~~ ~ 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 Cit_y Codes.
White: Homeowner Yellow: City Pink: HRG