EPA Stormwater Inspection Report

• Project Name:

  Select

• Project Number

• NPDES ID Number

• Prepared by

Inspector Information

• Inspector Name:

• Title:

• Company Name:

• Email:

• Address:

• Phone Number:

Inspection Details

• Inspection Date:

  Date

• Inspection Location:

• Inspection Start Time:

  Date

• Inspection End Time:

  Date

• Current Phase of Construction:

• Weather Conditions During Inspection:

  Select Cold Snowing Sunny Cloudy Raining Windy

  • Cold
  • Snowing
  • Sunny
  • Cloudy
  • Raining
  • Windy

• Temperature

• Did you determine that any portion of your site was unsafe for inspection per CGP Part 4.5?

  Yes

  No

• If "Yes" provide the following information

• Location of unsafe conditions:

• The conditions that prevented you inspecting the location:

Indicate the required inspection frequency

• Standard Frequency (CGP Part 4.2):

• At least once every 7 calendar days; or

• Once every 14 calendar days and within 24 hours of the occurrence of either:

• A storm event that produces 0.25 inches or more of rain within a 24-hour period, or

• A snowmelt discharge from a storm event that produces 3.25 inches or more of snow within a 24-hour period

• Increased Frequency (CGP Part 4.3.1) (If site discharges to sediment or nutrient-impaired waters or to waters designated as Tier 2, Tier 2.5, or Tier 3):

• Once every 7 calendar days and within 24 hours of the occurrence of either:

• A storm event that produces 0.25 inches or more of rain within a 24-hour period, or

• A snowmelt discharge from a storm event that produces 3.25 inches or more of snow within a 24-hour period

• Was this inspection triggered by a storm event producing 0.25 inches or more of rain within a 24-hour period?

  Yes

  No

• If "Yes" how did you determine whether the storm produced 0.25 inches or more of rain?

  Select Onsite rain gauge Weather station representative of the site

  • Onsite rain gauge
  • Weather station representative of the site

• Total rainfall amount that triggered the inspection (inches)

• Was this inspection triggered by snowmelt discharge from a storm event producing 3.25 inches or more of snow within a 24-hour period?

  Yes

  No

• If "Yes" how did you determine whether the storm event producing 3.25 inches or more of snow within a 24-hour period?

  Select Onsite rain gauge Weather station representative of the site

  • Onsite rain gauge
  • Weather station representative of the site

• Total snowfall amount that triggered the inspection (inches)

Inspections for the following Environmental Controls / BMP's were performed

• Construction Fence

• Silt Fence

• Hay Bales

• Waddles

• Aggregate Bags (Rock Socks)

• Road Sweeping

• Inlet/Outlet Protection

• Vehicle Tracking Control (VTC)

• FOD Tracking Control

• Surface Roughening

• Erosion Control Blankets

• Check Dams

• Compacted Earth Berms

• Temporary Slope Drains

• Sediment Pond

• Sediment Trap

• Solid Waste Management

• Portable Toilets

• Concrete Washout(s)

• Petroleum Product Containment

• Dust Control Measures

Section C - Observations Made (Erosion and Sediment Controls)

• Are there any of the above BMP's that require repairs or new BMP's installed

  Yes

  No

• Type and location of practices and controls

• Conditions requiring routine maintenance

  Yes

  No

• If "Yes" how many times (including this occurrence) has this condition been identified

• Conditions requiring corrective action?

  Yes

  No

• Date on which conditions first observed (if applicable)

  Date

• Description of conditions observed

• Photos

  Media

• Date issue corrected and/or completed

• If the same routine maintenance was found to be necessary three or more times for the same control at the same location (including this occurrence), follow the corrective action requirements and record the required information in your corrective action log, or describe here why you believe the specific condition should still be addressed as routine maintenance:

Section D - Observations Made (Pollution Prevention)

• Are there any of the above BMP's that require repairs or new BMP's installed

  Yes

  No

• Type and location of practices and controls

• Conditions requiring routine maintenance

  Yes

  No

• If "Yes" how many times (including this occurrence) has this condition been identified

• Conditions requiring corrective action?

  Yes

  No

• Date on which conditions first observed (if applicable)

  Date

• Description of conditions observed

• Photos

  Media

• Date issue corrected and/or completed

• If the same routine maintenance was found to be necessary three or more times for the same control at the same location (including this occurrence), follow the corrective action requirements and record the required information in your corrective action log, or describe here why you believe the specific condition should still be addressed as routine maintenance:

Section E - Observations Made (Stabilization of Exposed Soils)

• Are there any of the above BMP's that require repairs or new BMP's installed

  Yes

  No

• Specific location that has or will be stabilized

• Stabilization method and applicable deadline

• Stabilization Initiated?

  Yes

  No

• If "Yes" date initiated

  Date

• Final Stabilization Criteria met?

  Yes

  No

• If "Yes" date criteria met

  Date

• Photos

  Media

• Notes:

Section F - Observations Made (Discharges)

• Was a discharge (not including dewatering) occurring from any part of your site at the time of the inspection?

  Yes

  No

• If “Yes,” for each point of discharge, document the following:
  • The visual quality of the discharge.
  • The characteristics of the discharge, including color; odor; floating, settled, or suspended solids; foam; oil sheen; and other indicators of stormwater pollutants.
  • Signs of the above pollutant characteristics that are visible from your site and attributable to your discharge in receiving waters or in other constructed or natural site drainage features.

• Discharge Location

• Observations

• “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 contained therein. Based on my inquiry of the person or persons who manage the system, or those persons directly responsible for gathering the information, the information contained is, to the best of my knowledge and belief, true, accurate, and complete. I have no personal knowledge that the information submitted is other than 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.”

Mandatory: Signature of Operator or "Duly Authorized Representative:"

• Signature:

  Sign

• Affiliation:

• Date

  Date

Optional: Signature of Contractor or Subcontractor

• Signature:

  Sign

• Affiliation:

• Date

  Date