RainReady Program Certification of Work Performed

Size: px

Start display at page:

Download "RainReady Program Certification of Work Performed"

Nathan Cross
5 years ago
Views:

1 RainReady Program Certification of Work Performed The Village of Oak Park GENERAL INFORMATION Owner Name Application Building Address WORK COMPLETED work was completed Permit # Name of contractor performing work Scope of work performed: (check all that apply) Installed rain garden or bioswale Removed impermeable pavement, and installed vegetation or permeable pavement Installed cistern or dry well Disconnected downspouts Other, please describe OWNER CERTIFICATION I,, certify that I am the owner and occupant of the property listed above and I certify that all the information contained in this application is true and correct to the best of my knowledge. Owner Signature CONTRACTOR CERTIFICATION I, of certify that all work described above has been completed and has been performed in accordance with all applicable Village Code. Contractor Signature Submit completed application to: Village of Oak Park 06/17

2 RainReady Program Request for Reimbursement The Village of Oak Park GENERAL INFORMATION Owner Name Application Building Address Daytime Phone Number Address SCOPE OF WORK work was completed Permit # Name of contractor performing work Total cost of eligible expenses (attach paid receipt) Total amount of grant requested (50 percent of eligible expenses, not to exceed $1,300) OWNER CERTIFICATION I,, certify that I am the owner and occupant of the property listed above and I certify that all the information contained in this application is true and correct to the best of my knowledge. I also agree to maintain the completed property improvements and respond to periodic surveys and other communications from CNT or the Village of Oak Park for the purposes of program evaluation. Owner Signature Submit this form to: The Village of Oak Park,, 123 Madison Street, For Village Use Only approved for permits: by: of final inspection approval: by: 06/17

3 RainReady Program Downspout Disconnection Waiver The Village of Oak Park GENERAL INFORMATION Owner Name Application Building Address Daytime Phone Number Address DOWNSPOUT LOCATION(S) Please identify individually all locations where you believe that disconnecting downspouts from the Village s combined sewer system and directing rain water on to your property would negatively impact neighboring property or create a hazardous condition. I hereby grant permission for property inspectors from the Village of Oak Park to enter my property for the purpose of verifying conditions for downspout discharge. Owner Signature OFFICE USE ONLY The above referenced property currently has one or more downspouts connected to the Village of Oak Park combined sewer system which cannot be disconnected from the Village sewer system to have the runoff re-directed on to the owner s property without directing the runoff onto a neighbor s property or on to a paved area where ice would pose a hazard to pedestrians. The Village of Oak Park will waive the requirement to disconnect downspouts from the Village combined sewer system at the following locations: Property Maintenance Inspector Signature 06/17

4 RainReady Oak Park Eligible Landscaping Costs Please submit this form with the RainReady Oak Park grant reimbursement form. Your landscaping installer can help complete this form. Please return all forms to and Complete the workseet for the type(s) of landscaping installed at your home. Rain Garden, Bioswale or Dry Well Cistern Downspout Disconnection Total Eligible Costs $ - Total Eligible Costs $ - Total Eligible Costs $ - Area of rain garden / dry well (sq. ft.) Total number of cisterns Total number of downspouts disconnected for the grant Area of surface (roof, sidewalk, driveway) draining to rain garden / dry well (sq. ft.) Area of roof draining to cistern (sq. ft.) Area of roof draining to downspout(s) (sq. ft.) Ponding height (inches) Depth of prepared soil and/or gravel (in.) Percolation test results for rain garden / dry well (in./hr.) Size of each cistern (gallons) Maximum emptying rate (gallons/day) Complete the workseet for the type(s) of landscaping installed at your home. Depaving Permeable Pavement Total Eligible Costs $ - Total Eligible Costs $ - Net amount of conventional concrete/asphalt removed (sq. ft.) (Do not include area of newly installed concrete or asphalt) Permeable Pavement Area (sq. ft.) Pavement Thickness (in.) Gravel Layer Thickness (in.) 1

5 Plant Selection Checklist Native Plants for Rain Gardens on Loamy and Clay Soils Full Sun or Half-Sun Gardens Checkbox Scientific Name Common Name Allium cernuum Nodding Pink Onion Amsonia tabernaemontana Common Bluestar Camassia scilloides Wild Hyacinth Chelone glabra White Turtlehead Dodecatheon meadia Shootingstar Gentiana andrewsii Bottle Gentian Iris shrevei Wild Iris Iris versicolor Blue Flag Iris Lobelia siphilitica Great Blue Lobelia Mimulus ringens Monkeyflower Penstemon digitalis Smooth Penstemon Phlox glaberrima Marsh Phlox Solidago ohioensis Ohio Goldenrod Solidago rigida Stiff Goldenrod Zizia aurea Golden Alexanders Asclepias incarnata Red Milkweed Aster novae-angliae New England Aster Baptisia lactea White False Indigo Cassia hebecarpa Wild Senna Eupatorium maculatum Joe Pye Weed Eupatorium perfoliatum Boneset Filipendula rubra Queen of the Prairie Helenium autumnale Dogtooth Daisy Hibiscus palustris Rose Mallow Liatris pycnostachya Prairie Blazingstar Liatris spicata Dense Blazingstar Lobelia cardinalis Cardinal Flower Rudbeckia subtomentosa Sweet Black Eyed Susan Thalictrum dasycarpum Tall Meadowrue Verbena hastata Blue Vervain Vernonia fasciculata Ironweed Veronicastrum virginicum Culver s Root Eupatorium fistulosum Tall Joe Pye Weed Rudbeckia laciniata Silphium Vernonia terebinthinaceum altissima Green Headed Coneflower Prairie Tall Ironweed Dock Elymus canadensis Canada Wild Rye Elymus virginicus Virginia Wild Rye Hierochloe odorata Vanilla Sweet Grass Carex comosa Bottlebrush Sedge Carex hystericina Porcupine Sedge Carex muskingumensis Palm Sedge Carex stipata Awl Fruited Sedge Carex vulpinoidea Fox Sedge

6 Shady Gardens Checkbox Scientific Name Common Name Lobelia cardinalis Cardinal flower Aquilegia canadensis Columbine Iris cristata Crested iris Zizia aurea Golden Alexanders Aster macrophyllus Big-leaved Aster Carex grayii Gray s sedge Carex radiate Star sedge Adantium pedatum Maidenhair fern Asarum Canadensis Wild ginger Carex rosea Curly-styled Wood Sedge

Plants to Enhance and Stabilize Your

Ecological Consulting Native Plant Nursery Restoration Services Cultural Resource Management Plants to Enhance and Stabilize Your Shoreline Brian Majka Brian Majka Senior Restoration Ecologist Today we