SWPPP Inspection Form Century Companies, Inc

• Permit Authorization Number: MTR105530 Century Sidney Facilty Primary SWPPP Administrator: Tim Barth Secondary SWPPP Administrator: Garrett Workman

• Permit Authorization Number: ND Theodore Roosevelt National Park Primary SWPPP Administrator: Tim Barth Secondary SWPPP Administrator: David Drga

• Conducted on

  Date

• Prepared by

• Additional personnel on audit:

General Information

• Type of inspection?

  Biweekly Routine

  Post-Storm Event

  Monthly for Inactive Site

  Completed Construction

• Date of previous inspection

  Date

• Weather Conditions

• Temperature

• Sky Conditions

  Select Clear Partly Cloudy Overcast Windy Raining Thunderstorm Snowing

  • Clear
  • Partly Cloudy
  • Overcast
  • Windy
  • Raining
  • Thunderstorm
  • Snowing

• Ground Conditions

  Select Dry Wet Saturated Frozen Snow Cover

  • Dry
  • Wet
  • Saturated
  • Frozen
  • Snow Cover

• Has it Rained since the last inspection?

  Yes

  No

  N/A

• Date of Storm Event:

  Date

• Amount of Precipitation:

• Storm water runoff occurring?

  Yes

  No

  N/A

• Location(s) and description- of discharges of sediment or other potential pollutants from the site:

Site Assessment

Inspection Areas

• Section/Map/Sheet No.

• Have BMP's been installed

  Yes

  No

  N/A

• Installed correctly

  Yes

  No

  N/A

• What needs to be corrected

• Do they follow the SWPPP

  Yes

  No

  N/A

• Has the SWPPP been changed to show changes

  Yes

  No

  N/A

• Changes made

  Media

• Construction status

  Disturbed

  Undisturbed

• Are there any discharges that have occurred since the last inspection?

  Yes

  No

  N/A

• Was discharge in compliance?

  Yes

  No

  N/A

• Describe the non-compliant discharge

• Description of corrective action taken for items identified, date for the corrective action(s) taken for each, measures taken to prevent future recurrences.

  Yes

  No

  N/A

• Has the non-compliant been reported?

  Yes

  No

  N/A

• Have changes to the SWPPP been made to reflect the measures taken?

  Yes

  No

  N/A

• Site perimeter contained?

  Yes

  No

  N/A

• Disturbed areas contained?

  Yes

  No

  N/A

• Estimated disturbed area at time of inspection (acres):

• Are dust control measures being used as needed?

  Yes

  No

  N/A

• Material storage areas contained?

  Yes

  No

  N/A

• Material stockpiles contained?

  Yes

  No

  N/A

• Is a spill containment kit on site?

  Yes

  No

  N/A

• Vehicle/equipment areas contained?

  Yes

  No

  N/A

• Is there evidence of equipment leaks

  Yes

  No

  N/A

• Has the leaked been repaired

  Yes

  No

  N/A

• Debris containers available

  Yes

  No

  N/A

• Offsite tracking minimized?

  Yes

  No

  N/A

• Identify potential pollutants present

  Select Petroleum products Sanitation chemicals Concrete washout Form oil/curing compound Saw-cutting Trash/waste debris

  • Petroleum products
  • Sanitation chemicals
  • Concrete washout
  • Form oil/curing compound
  • Saw-cutting
  • Trash/waste debris

BMPs inspection

• Are there BMPs that need to be maintained:

  Yes

  No

  N/A

• Location(s) and description:

• Description of corrective action taken for items identified, date for the corrective action(s) taken for each, measures taken to prevent future recurrences.

• Are there BMPs that failed to operate as designed or proved inadequate for a specific location

  Yes

  No

  N/A

• Location(s) and description:

• Description of corrective action taken for items identified, date for the corrective action(s) taken for each, measures taken to prevent future recurrences.

• Are there additional BMPs are needed that were not in place at the time of inspection

  Yes

  No

  N/A

• Location(s) and descriptions:

• Description of corrective action taken for items identified, date for the corrective action(s) taken for each, measures taken to prevent future recurrences.

Site Stabilization

• Have all disturbed areas been stabilized with temporary or permanent measures within 7 days of the end of active disturbance?

  Yes

  No

  N/A

• Are stabilization measures effective?

  Yes

  No

  N/A

Inlet Protection

• Are all inlets that are or will be functional during construction protected?

  Yes

  No

  N/A

• Is the inlet protection being maintained?

  Yes

  No

  N/A

Site Debris

• Are all construction materials kept within the project limits?

  Yes

  No

  N/A

Concrete Wash Outs

• Are there concrete activities present

  Yes

  No

  N/A

• Are washouts adequate for the amount of material being discharged?

  Yes

  No

  N/A

• Are liners free from rips and tares?

  Yes

  No

  N/A

• Are washouts located in a location that will not effect water inlets?

  Yes

  No

  N/A

• 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 gather and evaluate the information submitted. Based on my inquiry of the 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

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• SWPPP Administrator

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