Title Page

  • Conducted on

  • INSPECTED BY:

  • PROJECT NAME / ADDRESS:

  • SLC PERMIT / UTR PERMIT #:

  • OWNER / CONTRACTOR

  • SITE CONTACT / PHONE / EMAIL

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  • INSPECTION TYPE:

  • WEATHER:

EROSION, SEDIMENT and HOUSEKEEPING

  • 5. Have all the corrective actions from previous inspection been addressed and documented

  • 6. Are the storm water flows leaving or entering the site properly managed with appropriate perimeter controls

  • 7. Is there evidence of sediment discharge? (mud flows or soil deposits from construction downstream)

  • 8. Is there evidence of track out off of the construction site?

  • 9. Is there material (soil, landscaping items, other debris) on impervious surfaces that could be washed down with storm water?

  • 10. Is there a need to repair, maintain or improve sediment control BMPs? (Inlet protection, sediment basin,construction entrance, other)

  • 11. Is there a need to repair, maintain or improve erosion control BMPs? (Perimeter controls, site stabilization,dust control, other)

  • 12. Is there a need to repair, maintain or improve housekeeping? (Trash control, port-a-potty, storage and leakcontrols, concrete washout, other)

  • 14. Do BMPs need to be installed in certain areas, or removed?

COMMENTS and CORRECTIVE ACTIONS REQUIRED

  • FOLLOW UP DATE

PHOTOS

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ESCALATING ENFORCEMENT ACTIONS TAKEN (This document SHALL serve as a warning for permit noncompliance)

  • CORRECTIVE ACTION REQUIRED BY:

  • FOLLOW UP DATE:

  • I certify under penalty of law that this document and all attachments were prepared under my direction or supervision in accordance with a system designed to assure that qualified personnel properly gathered and evaluated the information submitted. Based on my inquiry of the person or persons who manage the system, or those persons directly responsible for gathering the information, the information submitted is, to the best of my knowledge and belief true, accurate, and complete. I am aware that there are significant penalties for submitting false information, including the possibility of fine and imprisonment for knowing violations.

  • INSPECTOR:

  • OPERATOR:

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