Form - Village of Mundelein

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SEWER BACKUP
PREVENTION PROGRAM
________________________________________________________________________________________ 300 Plaza Circle ▪ Mundelein, Illinois 60060 ▪ (847) 949‐3283 ▪ Fax (847) 949‐4278 ▪ building@mundelein.org PROGRAM DESCRIPTION
The Village will provide partial funding for a Village approved overhead sewer, backflow prevention
device and/or related equipment to single-family and multi-family residential property owners who
have experienced or may experience sanitary sewer backups or basement flooding during periods of
heavy rainfall. Funding shall be provided on a reimbursement basis once the project is complete and
receives final inspection by the Village Building Department.
PROCEDURE AND REQUIREMENTS
1. Reimbursement Amount. The Village will reimburse an owner 50% of the approved cost
up to $4,000 for the installation of a Village approved overhead sewer, backflow prevention
device and/or related equipment. The program is limited to the actual costs of the labor and
materials to install the overhead sewer, backflow prevention device and/or related
equipment, subject to the funding limitations contained herein. The Village shall not
reimburse for other costs such as landscape restoration, interior finish restoration, painting,
tile, carpeting, etc.
2. Eligibility. Eligibility to participate in the program is subject to the following:
a. Only single-family and multi-family properties connected to the Village of Mundelein
sanitary sewer system are eligible. In order to apply for the reimbursement, you must
provide evidence of ownership of the subject property satisfactory to the Village.
b. The reimbursement applies to the installation of an overhead sewer, backflow
prevention device and/or related equipment made after August 1, 2013. There shall
be no retroactive reimbursements for work performed prior to August 1, 2013.
c. All work subject to reimbursement must be completed within six (6) months of the
date that the building permit is issued. Any work not completed within that
timeframe shall not be eligible for reimbursement. Also, if the property owner fails
to comply with all of the requirements of the Sewer Backup Prevention Program, the
Village shall have no obligations to reimburse him or her for any of the costs thereof.
d. No owner shall be eligible for reimbursement if there is an outstanding balance with
respect to payment of any fees and charges due to the Village.
e. An owner may be eligible for participation more than once for the same property;
however, in no case shall the total reimbursement from the Village for any one
property exceed the limits prescribed in paragraph 1 above.
f. The Village shall have the sole authority to determine eligibility for participation,
prioritization of requests, funding of Program and compliance with all Village Codes
and Ordinances.
________________________________________________________________________________________ 300 Plaza Circle ▪ Mundelein, Illinois 60060 ▪ (847) 949‐3283 ▪ Fax (847) 949‐4278 ▪ building@mundelein.org 3. Types of Sewer Backup Prevention Systems.
There are different types of sewer backup prevention methods and devices, almost all of which
are eligible. The following is a list of several different types of sewer backup prevention systems:
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‒
‒
‒
‒
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Rerouting of the under floor sewer to an overhead sewer. (See attached diagram)
Installation of an interior flood control device (check valve) in your sanitary line.
Installation of a battery back-up for the storm water sump pump.
Installation of an exterior flood control valve.
Installation of an injector pit as part of an overhead sewer installation.
Connection of sump pump discharge into a Village storm sewer system.
4. Application Process. Prospective applicants must complete and submit a building permit
application and drawings of the proposed work. (See Application/Project Checklist) In
addition applicants must provide (a) an Affidavit of Evidence of Ownership satisfactory to
the Village, i.e. a copy of a recorded deed or a title insurance policy, (b) Property Owner's
Agreement/Waiver of Liability and (c) proposals for the work from two licensed
contractors. (A list of contractors that have performed this type of work in the Village is
attached.)
5. Reimbursement Process. Reimbursement of eligible items at approved amounts shall be
made after all work is completed, inspected and approved by the Village Building
Department. A completed and signed Sewer Backup Prevention Reimbursement Form
must be completed and submitted with other documentation including a detailed invoice,
waiver of lien and notarized statement from the contractor of record.
(Also,
Application/Project Checklist)
6. Waiver Required. Owner(s) of the property where the overhead sewer, backflow
prevention device and/or related equipment is installed must execute an Agreement which
includes a provision wherein the owner(s) waive, release and indemnify the Village and its
officials, employees and agents from liability as provided therein. (See Application/Project
Checklist)
7. Program Duration. Financial participation of the Village is limited to funds budgeted for
the program in the fiscal year ending April 30, 2014. The program will be evaluated annually
as part of the Village's annual budget process, and the Village may change or eliminate the
program at that time. Funding levels may be changed or eliminated based on the Village's
periodic review of the program.
8. Other Sewer Backup Prevention System Requirements. The Sewer Backup Prevention
System shall comply with the following requirements:
________________________________________________________________________________________ 300 Plaza Circle ▪ Mundelein, Illinois 60060 ▪ (847) 949‐3283 ▪ Fax (847) 949‐4278 ▪ building@mundelein.org a.
The installation of an overhead sewer, backflow prevention device and/or
related equipment shall meet current Village Codes and Ordinances and be
approved by the Village Building Department. Ends of all abandoned pipes
must be properly capped and sealed as directed by the Village Building
Department.
b.
No plumbing or electrical work shall commence until Village approval is
obtained and a permit is issued. The Village Building Department shall be
notified to inspect the plumbing and electrical work as required under any
permit.
c.
The perimeter drain tile and other sources of storm water, including but not
limited to all footing drains and storm water tiles, must be disconnected from
the sanitary sewer service. Installation of a sump pit and sump pump may be
required, if it does not already exist. The sump pump discharge must be
connected to a Village storm sewer. If a Village storm sewer is not available,
the sump pump must discharge in the rear yard in a location that will not
cause an impact to neighboring properties. The property owner(s) shall be
responsible for regular and periodic maintenance of all pump systems.
d.
Proper functioning of foundation drains is necessary to prevent seepage of
ground water through the walls below grade. The Village will not be
responsible for testing existing foundation drains for proper function. The
property owner(s) have the responsibility for all inspections, testing and
corrective work regarding foundation drains that may be or may become
necessary.
e.
The Sewer Backup Prevention Program is designed to substantially reduce
the risk of basement backups. However, there is always some risk of
basement backup as a result of unexpected sewer collapse, obstruction,
power failure, extreme environmental conditions or other unforeseen factors.
f.
It is recommended that the property owner install a battery backup system to
provide protection in the event of a power failure. The cost of a battery
backup system, if installed shall be eligible for funding subject to the funding
limitations contained herein.
APPLICATION PROCESS
________________________________________________________________________________________ 300 Plaza Circle ▪ Mundelein, Illinois 60060 ▪ (847) 949‐3283 ▪ Fax (847) 949‐4278 ▪ building@mundelein.org Contact the Building Department at 847-949-3283 to inquire about the
program and
obtain the application forms. The forms are also
available on the Village's website,
www.mundelein.org.
Owner submits application for a building permit and all associated
documentation, including a drawing of proposed work and proposals from
two licensed contractors; Affidavit and Evidence of Ownership; and
Property Owner's Agreement/Waiver of Liability.
The drawings will be reviewed and will either be approved as noted or
returned for revisions. When drawings receive approval, the permit
will be issued and the contractor can start the work.
Owner schedules inspections as needed and completes the work. Once
work is complete, a final inspection must be scheduled.
After work receives final approval, the property owner must pay the full
amount to the contractor and then submit the Sewer Backup Prevention
Reimbursement Form with verification that the work is paid in full
(accompanied by a detailed invoice, waiver of lien, and notarized statement
from contractor of record.)
The Village will process the reimbursement request and remit payment
to the applicant within approximately four weeks of receiving all of
the final closeout documentation.
APPLICATION/PROJECT CHECKLIST
□
Building Permit Application (and all associated documentation)
□
Affidavit and Evidence of Ownership (see attached form)
________________________________________________________________________________________ 300 Plaza Circle ▪ Mundelein, Illinois 60060 ▪ (847) 949‐3283 ▪ Fax (847) 949‐4278 ▪ building@mundelein.org □
Property Owner's Agreement/Waiver of Liability (see attached form)
□
Sewer Backup Prevention Reimbursement Form to be submitted upon completion of the
project (see attached form)
□
Documentation that the work is paid in full (accompanied by a detailed invoice, waiver of
lien, and notarized statement from contractor of record)
STATE OF ILLINOIS
)
) SS.
COUNTY OF ___________ )
________________________________________________________________________________________ 300 Plaza Circle ▪ Mundelein, Illinois 60060 ▪ (847) 949‐3283 ▪ Fax (847) 949‐4278 ▪ building@mundelein.org AFFIDAVIT AND EVIDENCE OF OWNERSHIP
The undersigned ____________________________________, under oath, states as follows:
1.
Street address of Subject Property: ___________________________________________
2.
Name(s) of Owner(s) of Record (Please Print):
________________________________________________________________________
________________________________________________________________________
________________________________________________________________________
________________________________________________________________________
3.
Evidence of Ownership Submitted (check applicable box):
□
Copy of recorded deed
□
Copy of title insurance policy
Signature of Owner: ____________________________________
Signature of Co-Owner (if applicable): ___________________________________
Subscribed and Sworn to before me
this _____ day of _________________, 20_____.
_________________________________________
Notary Public
________________________________________________________________________________________ 300 Plaza Circle ▪ Mundelein, Illinois 60060 ▪ (847) 949‐3283 ▪ Fax (847) 949‐4278 ▪ building@mundelein.org SEWER BACKUP PREVENTION PROGRAM
PROPERTY OWNER'S AGREEMENT/WAIVER OF LIABILITY
1.
The undersigned states that the Subject Property is a single-family or multi-family residential
property located in the Village of Mundelein and has experienced or may experience sanitary
sewer backups or basement flooding during periods of heavy rainfall. As such the Subject
Property is eligible for participation in the Village of Mundelein Sewer Backup Prevention
Program.
2.
The undersigned has applied to the Village of Mundelein for partial reimbursement, i.e. 50%
of the approved cost up to a maximum of $4,000.00, for the installation of a Village
approved overhead sewer, backflow prevention device and/or related equipment on the
Subject Property.
3.
The undersigned is the owner(s) of the Subject Property and has read, fully understands and
agrees to the terms and conditions of the Village's Sewer Backup Prevention Program as set
forth in the Program Description distributed by the Village, a copy of which is attached to
this Agreement/Waiver of Liability.
4.
The undersigned agrees to waive and release the Village of Mundelein and its officials,
employees, and agents from any and all liability resulting from (a) prior and subsequent
sewer backups, flooding and other wastewater and stormwater damage to the Subject
Property; (b) any and all determinations by the Village as to eligibility for participation,
prioritization of requests, funding of the Program and compliance with all Village Codes and
Ordinances and (c) installation, maintenance and operation of the overhead sewer, backflow
prevention device and/or related equipment installed on the Subject Property and the
performance of the contractor installing same. Further, the undersigned agrees to indemnify
and hold harmless the Village of Mundelein, its officials, employees, and agents from any
and all liability arising from claims by third parties for injury or damages related in any way
to the installation, operation and maintenance of the overhead sewer, backflow prevention
device and/or related equipment installed on the Subject Property.
Street Address of Subject Property: _______________________________, Mundelein, Illinois.
Names and Addresses of Owner(s) of Record of Subject Property
(Please Print)
______________________________________
______________________________________
Signatures of Owner(s) or Authorized Person(s) executing this document:
______________________________________
Date: ________________________
______________________________________
Date: ________________________
________________________________________________________________________________________ 300 Plaza Circle ▪ Mundelein, Illinois 60060 ▪ (847) 949‐3283 ▪ Fax (847) 949‐4278 ▪ building@mundelein.org SEWER BACKUP PREVENTION
REIMBURSEMENT FORM
NAME OF OWNER(S)
STREET ADDRESS OF
SUBJECT PROPERTY
PHONE (WORK)
(HOME/MOBILE)
CONTRACTOR NAME
CONTRACTOR ADDRESS
CONTRACTOR PHONE
COST OF ELIGIBLE
EXPENSES
REIMBURSEMENT
REQUESTED*
*(50% of eligible expenses not to exceed $4,000)
Owner(s) Certification
The undersigned, ______________________________, owner(s) of the Subject Property certify
that all of the information contained on this Request for Reimbursement Form is true and correct to
the best of my/our knowledge.
___________________________________________
________________
Signature of Owner
Date
___________________________________________
________________
Signature of Co-Owner (if applicable)
Date
Contractor's Certification
The undersigned, ______________________________ of ______________________________
certify that all work completed under this program has been performed in accordance with the
Village of Mundelein Sewer Backup Prevention Program and all applicable Village Codes and
Ordinances.
___________________________________________
________________
Signature of Owner or Authorized Officer
Date
**************************************OFFICE USE ONLY********************************
PERMIT # DATE
FINAL
FINAL
REIMB.
REIMB.
ISSUED
INSPECTION APPROVAL APPROVED SENT
DATE
BY
________________________________________________________________________________________ 300 Plaza Circle ▪ Mundelein, Illinois 60060 ▪ (847) 949‐3283 ▪ Fax (847) 949‐4278 ▪ building@mundelein.org ________________________________________________________________________________________ 300 Plaza Circle ▪ Mundelein, Illinois 60060 ▪ (847) 949‐3283 ▪ Fax (847) 949‐4278 ▪ building@mundelein.org ________________________________________________________________________________________ 300 Plaza Circle ▪ Mundelein, Illinois 60060 ▪ (847) 949‐3283 ▪ Fax (847) 949‐4278 ▪ building@mundelein.org 
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