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1 Detailed rebate form filled out. Completed Homeowner - invoice cost breakdown. Statement of rain garden function is signed and attached. All relevant receipts attached. Name of payee: Site Address: Everett, WA Zip: Mailing Address (if different than City: State: Zip: Amount to be paid: 2,500 or less) This section to be completed by city staff. Authorized Approval Date THESE FORMS SHOULD ONLY BE COMPLETED ONCE RAIN GARDEN IS INSTALLED. Let it Rain program rain garden rebates Rebate payment checklist ---PAGE BREAK--- 2 Name Site address Everett, WA Zip Mailing address (if City State Zip Email address Phone Type of installation: Rain Garden Contributing area: square feet How many downspouts are directed to garden? Size of rain garden: square feet Location of rain garden: Total cost to install facility By signing these forms, I certify that I am the owner of the installation site, that the information I have provided is complete and accurate, that I will maintain and keep the installed system in good working order and that I grant the city permission to conduct site inspections of my stormwater facility at times that are mutually acceptable to me and the city. Detailed rain garden form ---PAGE BREAK--- 3 STORE DESCRIPTION OF CATEGORY COST Materials: drainage pipe, connections, adhesives, plants, bioretention soil, mulch, gravel/rock Fees: disposal of soil, brush or delivery fees COST TOTALS MATERIALS TOTAL $ RENTALS Rentals: trailer, backhoe, tools (specify equipment) COST TOTALS RENTALS TOTAL $ CONTRACTOR PERMITS Contractor invoices *Labor costs can only be included if done by a contractor or someone with a business license. INVOICE TOTALS LABOR TOTAL $ TOTAL Total of all attached receipt. Attached receipts total and invoice breakdown total should match. $ Homeowner - invoice cost breakdown Only items directly related to the function of a rain garden should be included on this invoice breakdown. No art or non-essential expense can qualify for reimbursement. Always ask if not sure. Feel free to use additional sheets, as needed. Be sure to attach all receipts reflected below and include the tax in your totals. ---PAGE BREAK--- 4 Below are just some things to keep in mind while you or your hired contractor are installing your rain garden. 1. Call 811 before you dig. For some this may be the second or third time calling, but it can save you a lot of future issue if you ensure that there is consistency in the markings every time. 2. Install and maintain erosion control measures. This can mean, covering your excavated soil or mulch delivery so that it does not create sediment leaving your lot. This is a key measure to avoid sediment from clogging your local storm drain. 3. Keep city streets clean at all times. No dirt, mud, rocks, or debris to be tracked onto roadway. 4. Always keep your soil and mulch deliveries out of the rights-of-way so that there is no obstruction of the public’s ability to use public walkway. 5. Any damage done via your install that affects city improvements (sidewalk, curb, roadway, etc.) shall be replaced by property owner. 6. Don’t hose down use a broom to clean up spilled materials. 7. Dispose of all waste properly. Many construction materials, including broken asphalt and concrete, wood, and cleared vegetation can be recycled. 8. The City has approved your rain garden design location and specifications, so it is important to adhere to them. This helps ensure that stormwater runoff from any new/replaced impervious surfaces will be managed on-site in a manner that does not adversely affect neighboring properties, including the city's right-of-way and/or easements and the improvements located therein. Let it Rain program Be a good neighbor ---PAGE BREAK--- 5 Statement of rain garden function In order to reduce excess stormwater flows to the combined sewer system and Puget Sound, rain garden systems must be designed to meet or exceed the Let it Rain program standards and constructed so they cause no harm to you or your neighbors. While city staff are able to check for minimum standards of primary importance to the city (such as sizing and appropriate setbacks), only you, the homeowner, live with your new rain garden on a daily basis. You are in the best position to evaluate whether your system is functioning as designed. Your evaluation of system function via this document ensures that our rate payers are getting the value of service we are funding through the Let it Rain rebate program and also ensures you have a functioning system before you submit your final application to receive your rebate. Please follow the instructions below, sign and return this document with your application package. IT IS YOUR RESPONSIBILITY TO EVALUATE AND CONFIRM TO THE CITY OF EVERETT THAT YOUR RAIN GARDEN SYSTEM IS FUNCTIONING PROPERLY. IF YOUR RAIN GARDEN IS NOT FUNCTIONING PROPERLY, NOTIFY THE CITY OF EVERETT. CALL [PHONE REDACTED] OR EMAIL [EMAIL REDACTED] Rain Garden Systems The City of Everett will work with you to make sure your rain garden functions correctly. The City is not responsible for construction practices undertaken by a contractor that could cause the system to be nonfunctional. Examples would be the failure to test for soil infiltration, overly compacted soil or allowing silts or other fine materials to contaminate the bio-retention soils which could impede proper draining of a rain garden. Certification: I have observed my rain garden and its function and assert that it drains within a 24 -72 hour period and overflows to an approved discharge location. PRINT SIGNATURE Ponding duration Observe your rain garden during and after rain events. During summer or extended dry periods, use a hose to fill your rain garden to its ponding depth (up to the level of the overflow). Ponding is normal in a rain garden but in the absence of continuous rain the majority of your rain garden should drain over a 24-72 hour period after it stops raining. Overflow conveyance Observe your rain garden during large rain events or use a hose to simulate flows. Ensure that water leaving the rain garden discharges to the approved discharge location and not your neighbor’s property or your basement.