Middlefield, OH · Geauga County
Backwater Valve/Sanitary Check Valve Grant Program Reimbursement Form
Owner-occupants of eligible Middlefield homes use this application to request reimbursement for installing a backwater valve or sanitary check valve.
What this form is
This application requests reimbursement through the Village of Middlefield’s Backwater Valve/Sanitary Check Valve Grant Program after installation and inspection. The program is for owner-occupied single-family, duplex, and tri-plex homes; applicants must obtain a Village right-of-way permit before work starts and submit a paid contractor invoice, proof of payment, permit, and final inspection report. The Village reimburses 50% of installation cost, up to $1,000, subject to budgeted funds.
Who needs it
An owner of an eligible owner-occupied single-family, duplex, or tri-plex home who has installed and inspected a backwater or sanitary check valve may apply.
How to submit it
After installation and inspection, submit the completed application and relevant paperwork to the Village of Middlefield, 14860 N State Avenue, Middlefield, Ohio 44062. Include the contractor’s invoice, proof of payment, Village-issued right-of-way permit, and final inspection report.
About notarization
This application is signed and dated without a notary; the homeowner submits the listed installation and payment documents.
How to submit this form
- 1
Download The Application
Download the Backwater Valve/Sanitary Check Valve Grant Program Reimbursement Form.
- 2
Complete The Application
Enter the date, name, phone number, and property address, answer the eligibility question, and sign and date the form.
- 3
Gather Required Documents
Include the contractor’s invoice, proof of payment, Village-issued right-of-way permit, and final inspection report.
- 4
Submit To The Village
After installation and inspection, send the completed application and paperwork to the Village at 14860 N State Avenue, Middlefield, Ohio 44062.
Frequently asked questions
- Do I need a notary for the Backwater Valve Grant Reimbursement Form?
- No. The application is signed and dated without a notary. Submit the listed contractor invoice, proof of payment, right-of-way permit, and final inspection report.
- Who can apply for the valve grant?
- The program is for owner-occupied single-family, duplex, and tri-plex homes. The work must be done by a licensed professional.
- What documents must I include?
- Include the contractor’s invoice, proof of payment, the Village-issued right-of-way permit, and the contractor’s final inspection report.
- How do I submit the application?
- After installation work is completed and inspected, send the completed application and relevant paperwork to the Village of Middlefield, 14860 N State Avenue, Middlefield, Ohio 44062.
Need something notarized?
This Backwater Valve/Sanitary Check Valve Grant Program Reimbursement Form doesn’t need a notary — but if you have another Middlefield form that does, a commissioned online notary can help.