Fillable CITY OF DECATUR SANITARY SEWER BACKUP PREVENTION PROGRAM (City of Decatur Illinois)

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CITY OF DECATUR SANITARY SEWER BACKUP PREVENTION PROGRAM (City of Decatur Illinois)

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CITY OF DECATUR
SANITARY SEWER BACKUP PREVENTION PROGRAM
PROGRAM DIRECTIONS
1. Fill out the Preapproval Application
and the Settlement and Release Form and
send or submit to:
Sanitary Sewer Backup Prevention Program
Public Works Department
One Gary K Anderson Plaza
Decatur, IL 62523
217-424-2747
The Settlement and Release Form must be signed and dated in presence of a
Notary Public and sealed by a Notary Public. A Notary Public can be provided by
the Public Works Department at the address above or most banks will provide this
service for bank customers.
2. Applicant property owner must be the primary resident of the property to
qualify for the program.
3. Upon submittal of the Preapproval Application and the Settlement and Release
Form the property owner will be contacted by a representative of the Public
Works Department to arrange an inspection of the property for illegal connections
to the sanitary sewer system. Illegal connections may include sump pumps or
downspouts connected to the sanitary sewer system. All illegal connections must
be corrected by the property owner prior to approval for the program.
4. Upon inspection of the property for illegal connections by the inspector, the
property owner will receive an approved copy of the Preapproval Application.
The property owner shall contact a minimum of two (2) licensed plumbing
contractors. The plumbing contractor shall provide the property owner with a
detailed proposal and drawings for the installation of an overhead sewer device in
the residence. The proposed work must disconnect all fixtures lower than the
City’s upstream manhole rim elevation and connect the fixtures to the proposed
overhead sewer device. See Sanitary Sewer Backup Causes and Prevention on the
city's web site form more information on overhead sewer systems. If there are any
questions on the location of the City’s sewer, please contact the Public Works
Department for assistance. The property owner shall submit the Application for
Funding with two plumbing contractor’s proposals attached.
(PAGE 1 OF 2)
CITY OF DECATUR
SANITARY SEWER BACKUP PREVENTION PROGRAM
PROGRAM DIRECTIONS
5. Th
e property owner shall meet with the Public Works representative to review the
plumbing contractor’s proposals and determine the lowest cost proposal to
determine City’s cost share as shown on the Application for Funding. The
property owner shall not authorize the plumbing contractor to start work
until the property owner has received an approved copy of the Application for
Funding. The property owner may choose any of the plumbing contractor’s
proposals but City’s cost share will only provide funding for the lowest approved
proposal.
6. Upon approval of the Application for Funding, the property owner may direct the
plumber contractor to install the overhead sewer system. The plumber contractor
shall obtain all necessary permits from the City’s Building Inspection Department.
7. Any change orders or price adjustments shall be approved by the Public Works
representative prior to starting any extra work. The City will not reimburse
property owner for extra work performed without City approval (see Change
Order/Price Adjustment Form).
8. Prior to making any payments to the plumber, the property owner shall receive an
approved copy of the City of Decatur’s Field Inspection Report fro the City’s
Building Inspection Department.
9. The property owner shall pay the plumber for the completed work in full or pay
25% to the plumbing contractor and request a two party check from the City made
out to the property owner and plumbing contractor. The property owner shall
submit the payment receipt along with the Check Release Form to the City of
Decatur for reimbursement. The City will reimburse the property owner for 75%
of the approved cost for the overhead sewer up to a total reimbursement of
$5,625.
10. The property owner is responsible to provide maintenance to their overhead sewer
system as recommended by plumbing contractor and ejector pump manufacturer.
11. The City of Decatur does not own, maintain, or warranty the overhead sewer
system.
12. If there are any questions on the program please visit the Sanitary Sewer
Prevention program page on the city's web site or contact the Public Works
Department at 217-424-2747
(PAGE 2 OF 2)
CITY OF DECATUR
SANITARY SEWER BACKUP PREVENTION PROGRAM
PREAPPROVAL APPLICATION
Permit No. ____________
(
For Office Use)
Please print the following information:
Date:
I,
, am the property
(Name of property owner and co-owner if applicable)
owner(s) and primary resident(s) of the house located at _________________________________________
(Address of property)
____________________________ Decatur, Illinois ______________________.
(Zip Code)
My contact information - Home: Mobile/Daytime:
I experienced sanitary sewer backup(s) on the following date(s), please attached copies of
evidence:
Date of Backup Damage Caused Supporting Evidence
I understand that as part of this program, the City of Decatur assumes no liability for any defective work or
other damage, injury, or loss resulting from any act or omission of the plumbing contractor in the
performance of this work and agrees to abide by the Settlement and Release Form.
I understand that the installation of an overhead sewer is not a guarantee against future sanitary sewer
backups. I also understand that participation in this program will not entitle me to reimbursement for
damages caused by past and future sewer backups.
I authorize the City’s Public Works Department representative to inspect my property for any illegal
connections to sanitary sewer as per City Codes prior to approval of this application.
I understand that the City will not reimburse me for any Sanitary Sewer Backup Prevention Program work
that is preformed before approval of the Application for Funding.
I understand that I am responsible for all future maintenance and/or replacement costs and that I am the
owner of the overhead sewer system. I also understand that the City of Decatur does not own maintain or
warranty the overhead sewer system.
I have signed and submitted the Settlement and Release Form.
(Signature of property owner and co-owner if applicable)
(For Offi
ce Use Only)
Approval:
The property owner(s) meet all requirements of the program and are permitted to obtain proposal from
plumbers.
______________________ _____________
(Public Works Department Approval) (Title) (Date)
F Property has been inspected and is free of all illegal connections.
F Property owner has signed, notarized and submitted the Settlement and Release Form.
CITY OF DECATUR
SANITARY SEWER BACKUP PREVENTION PROGRAM
SETTLEMENT AND RELEASE FORM
(TO BE SUBMITTED WITH THE PREAPPROVAL APPLICATION)
THE UNDERSIGNED, for the sole consideration of 75% reimbursement of cost not to exceed $5,625 as
the City of Decatur’s share of the cost for the installation of a sanitary sewer backup prevention system for;
_____________________________________________________________________________
(Name of property owner and co-owner if applicable)
_____________________________________________________________________________
(Address, City, State Zip of residence)
does hereby release, acquit and forever discharge the City of Decatur, its officers, directors, agents,
attorneys, employees and affiliates, of and from all claims, causes of action, suits, fines, costs and demands
of whatever name or nature and any matter arising or growing out of or on account of a loss, expense,
injury, damages, or added expenses which occurred as a result of the sanitary sewer backup prevention
system.
THE UNDERSIGNED ACKNOWLEDGES that the consideration shown above will be full payment and
satisfaction of the City’s obligation for the installation of a sanitary sewer backup prevention system as
described above and that no other promise has been made by the City of Decatur or any of its officers,
directors, agents, attorneys or employees.
_____________________________ ____________________________
Property Owner Signature Co-owner Signature (if applicable)
_____________________________
Address
_____________________________
City, State, Zip
SIGNED this ___________ day of ______________________, 20___.
Seal __________________________________
NOTARY PUBLIC
CITY OF DECATUR
SANITARY SEWER BACKUP PREVENTION PROGRAM
APPLICATION FOR FUNDING
Permit No. ____________
(
For Office Use)
Please print t
he following information:
Date:
I,
, am the property
(Name of property owner and co-owner if applicable)
owner(s) and primary resident(s) of the house located at _________________________________________
(Address of property)
____________________________ Decatur, Illinois ______________________.
(Zip Code)
My contact information - Home: Mobile/Daytime:
List below a minimum of two (2) proposals received from licensed plumbing contractors. Attach all
detailed proposals to this document.
Name and Address of Plumbing Contractor
Proposal Price
I will not allow any work to be initiated prior to approval of the Application for Funding.
I understand that change orders, if necessary, must to be approved by the City prior to the start of any
additional work and I will not be reimbursed for more than the City’s maximum portion of $5,625.
(Signature of property owner and co-owner if applicable)
(For Office Use Only)
Approval:
Approved Proposal __________________________________________________
Approved Reimbursement: $_________________x 75%/100 = $_______________(Maximum $5,625)
______________________ _____________
(Public Works Department Approval) (Title) (Date)
CITY OF DECATUR
SANITARY SEWER BACKUP PREVENTION PROGRAM
CHECK RELEASE FORM
Permit No. ____________
(
For Office Use)
Please print the following information:
Date:
I,
, am the property
(Name of property owner and co-owner if applicable)
owner(s) and primary resident(s) of the house located at _________________________________________
(Address of property)
____________________________ Decatur, Illinois ______________________.
(Zip Code)
My contact information - Home: Mobile/Daytime:
I have:
F Submitted a receipt verifying that I have paid the plumbing contractor 25% of the approved cost
for the overhead sewer work and request a two party check to be written to the plumbing
contractor ______________________________________ and myself for the City’s 75% portion.
(
Plumbing contractor name)
OR
F Submitted a receipt verifying that I have paid the plumbing contractor 100% of the approved cost
for the overhead sewer work and request a check made out to myself as reimbursement for the
City’s 75% portion.
(Signature of property owner and co-owner if applicable)
(For Offi
ce Use Only)
Approval:
Plumbing Contractor __________________________________________________
F The overhead sewer system has been approved by Plumbing and Electrical Inspector.
Proposal Price: $_________________
Change Order / Price Adjustment to Proposal Price: $_________________ (If Applicable)
Reimbursement: $_________________x 75%/100 = $____________ (Maximum $5,625)
Check Payee(s) _______________________________________________________
______________________ _____________
(Public Works Department Approval) (Title) (Date)
CITY OF DECATUR
SANITARY SEWER BACKUP PREVENTION PROGRAM
CHANGE ORDER / PRICE ADJUSTMENT FORM NO. ______
Permit No. ____________
(
For Office Use)
Please print the following information:
Date:
I,
, am the property
(Name of property owner and co-owner if applicable)
owner(s) and primary resident(s) of the house located at _________________________________________
(Address of property)
____________________________ Decatur, Illinois ______________________.
(Zip Code)
My contact information - Home: Mobile/Daytime:
Reason for Change Order / Price Adjustment (Provide attachments as necessary):
Original Proposal: $____________________________
Net Increase or Decrease from Original Proposal: $___________________________
Revised Project Cost: $_____________________________
I will not allow any extra work to be started prior to approval of the Change Order / Price Adjustment Form
from the City of Decatur.
(Signature of property owner and co-owner if applicable)
(For Off
ice Use Only)
Approval:
Adjusted Project amount: $_________________
______________________ _____________
(Public Works Department Approval) (Title) (Date)
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Completed 15 February 2021

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