Inspection Schedule Request - Village of Algonquin

Sump Pump Discharge Inspection Request

The Village of Algonquin is evaluating potential sources of Inflow and Infiltration into the sanitary sewer system. This evaluation includes a brief interview and inspection of your sump pump discharge locations and associated piping. We will be performing inspections Monday – Friday between the hours of 7:30AM – 2:00PM. The Village is requesting your cooperation with this process.

Please complete and submit the form below in order to request your sump pump inspection.

You will receive a confirmation of the inspection via your desired contact method (phone or e-mail).

Contact Name*

First NameLast Name

Address*

Street Address

Street Address Line 2

Phone Number*

E-mail*

E-mailCall

Preferred days and time for your inspection

Inspections are performed Mon-Fri between 7:30AM - 2:00 PM

YesNo

Click here to see the Remote Virtual Inspection Guide for Sump Pump.

Name of Remote Virtual Inspection Participant

First NameLast Name

Smart Phone Number (must be capable of receiving SMS/TXT messages. Mobile messaging rates may apply.

Email address.

example@example.com

By signing this Waiver of Liability form, I provide consent to the followings.

I consent to the use of the Remote Virtual Inspections (RVI) using the Zoom platform.
I am responsible for my own safety during the Remote Virtual Inspections.
I allow the complete use of the videos and photos of the Remote Virtual Inspections by the Village.
I certify that I am making available the site and inspection items truthfully and to the best of my ability.
I acknowledge that participation in the Remote Virtual Inspections program is voluntary.
I acknowledge that the decision to perform a Remote Virtual Inspections is at the sole discretion of the Village.
Required inspection records, including, but not limited to, correction notices, electronic media, recordings or photo documentation, shall be maintained in accordance with the Village’s policy, laws, regulations, and applicable codes, and may be subject to disclosure.

Zoom mobile App:

Allow Zoom permission to access the camera and microphone on your device.

Electronic Signature

Please type your First and Last Name

Current Date

Date

Current Time

:HourMinutesAM/PM Option