Receiving Inspection Report Template

					                                UPDES STORM WATER INSPECTION EVALUATION FORM
                                                                                                                                                   Insert City Logo
                                                    FOR                                                                                                  Here
                                             SWPPP COMPLIANCE

BACKGROUND INFORMATION
Site Name:                                                                                                            UPDES Permit #:

Site Address:

Local Jurisdiction or County:

Permit Effective Date:                                                               Permit Expiration Date:

Total Project Area:                                                                   Total Disturbed Area:
Project Type: (circle)                 Subdivision                   Commercial                 Industrial              Linear (Road/Pipe/Power)      Land Disturbance

OPERATOR CONTACT INFORMATION
                                               NAMES                                         PHONE NUMBERS                                         E-MAIL

Operator:

Onsite Facility Contact:

Important Contacts:

Important Contacts:
         SWPPP PRE-SITE REVIEW INFORMATION                                  YES    NO          SWPPP PRE-SITE REVIEW INFORMATION                               YES    NO
1. Has a pre-construction review of the SWPPP been conducted by the                     6. Does the SWPPP contain the site description, sequence of
applicable jurisdiction, if required?                                                   construction activities, and areas of the site to be disturbed?

2. Are the required post-construction elements included in the SWPPP?                   7. Does the SWPPP contain locations of storm drains, surface
(i.e. grass swales, detention basins, etc.)                                             drainage patterns, and locations of storm water discharges?

3. Are contact names and telephone numbers listed in the SWPPP?                         8. Does the SWPPP and/or site map address waste control &
                                                                                        disposal, off site tracking, sanitary concerns, exposure to
                                                                                        construction materials, lay down or storage areas, administrative
                                                                                        trailers, etc.?
4. Are the NOI and State permit in the SWPPP?                                           9. Does the SWPPP include the site map, sediment, and erosion
                                                                                        control design drawings, showing both structural and non structural
                                                                                        BMPs?
5. Did the “Operator” sign the SWPPP with authorization and certification
statements?

NOTICE OF TERMINATION (NOT) INSPECTION
Site Name:                                                                        Date of Evaluation:

Site Address:

Inspected By:                                                                     Title\Organization:
                                                                            YES    NO Comments:
1. Has the site been properly stabilized according to permit
requirements?

2. Have all temporary BMPs been removed?
3. Have post-construction (permanent storm water system) elements
been constructed and inspected in accordance with approved project
drawings?
4. Is the site acceptably clean?
Inspector: I certify that this document and all attachments were prepared under my direction. The information submitted is, to the best of my knowledge and belief, true,
accurate, and complete.


Inspector:

                           (Print Name)                           (Title)                               (Signature)                                (Date)


Operator:

                           (Print Name)                           (Title)                               (Signature)                                (Date)
                                (Attach additional sheets of narrative, pictures and checklists, as necessary)
                                                                                                                                                              Insert City Logo
                                               SWPPP COMPLIANCE INSPECTION FORM                                                                                     Here


Project Name:                                                      Address:                                                                                   Date:
Owner:                                                              Contractor: Gen/Sub                                                                       Start time:
Site Contact:                                                                                              Phone:                                             Stop time:
UPDES Permit #:                                     Expiration:                      Weather:         Sunny      Cloudy      Raining      Snowing      Other:
 Date of last rain event:                                          Duration:                    Approx. Rainfall (in):
   Inspected By (Print):                                                             Local Jurisdiction or County:
Reason for Inspection:            Scheduled              Complaint/Tip         Random            Receiving Waters:
                  BMP/HOUSEKEEPING INFORMATION                                 YES    NO                    BMP/HOUSEKEEPING INFORMATION                                    YES      NO
1. Are the SWPPP, NOI, and permit on site and accessible?                                      14. Are BMPs properly located, including inlet protection BMPs?
2. Are off-site flows entering the construction site?                                          15. Are wind erosion controls in place?
3. Are sediment & erosion control BMP's installed on the site as shown in                      16. Does repair/maintenance of existing sediment and erosion
the SWPPP, or on the site map if req'd?                                                        control BMPs need to occur?
(BMPs that are no longer necessary should be crossed out and dated,                            17. Are soil, construction material, landscaping items, or other
new BMPs drawn in and dated.)                                                                  debris evident on the street?
4. Does your site evaluation indicate a need to update and document the                        18. Have all on-site corrective action items from previous
SWPPP report and accompanying sediment and erosion control                                     inspections been addressed and documented within the time frame
drawings within the next seven (7) days?                                                       allotted by the inspector?
5. Are on-site inspection reports in the SWPPP? (Inspections are to be                         19. Are there locations where additional BMPS should be installed or
performed bi-weekly and within 24 hours after a measurable weather                             removed that are not identified in the SWPPP?
event, and/or as required by the SWPPP)                                                        20. Are all exits to public roads maintained to limit track-out?
6. Are updated BMP submittals in the SWPPP?                                                    21. Is there evidence of sediment discharge such as mud flows or
(specifications and engineering for BMPs, both structural and non-                             soil deposits from the construction site to downstream locations?
structural)
7. Is trash and debris cleanup being performed? (goodhousekeeping)                             22. Is there evidence of vehicles tracking sediment (mud-tracking)
                                                                                               off the construction site onto roads or property?
8. Are construction products, chemicals, and supplies properly managed                         23. Are soil, construction material, landscaping items, or other debris
and contained?                                                                                 evident on the street?
9. Is fuel storage properly located and maintained?                                            24. Are spill prevention controls in place?
10. Are proper (not dirt) curb ramps installed?                                                25. Do locations exist where BMPs could be removed?
11. Are port-a-potties properly located off impervious areas and anchored                      26. Should additional BMPs be installed that aren't in the SWPPP?
down
12. Are runoff controls properly located and maintained?                                       27. Is a concrete wash out area with sign properly located on the
(e.g. silt fences, straw bails, waddles, etc.)?                                                site?
13. Are there disturbed areas that have not had constrction activites for 14 to 21 days without stabilization? (except snow or frozen ground)?

                                         COMMENTS AND CORRECTIVE ACTIONS FOR SWPPP COMPLIANCE
Identify the problem and its location. If appropriate, describe (in general terms) what needs to be completed. However, only if qualified (e.g., you are a designer) should
you be mandating specific BMPs to install. Include the date when corrections are to be completed.




  Inspection         SW sampling                                      (S) State          Type Code
                                        Inspector Code (circle):                                                          1 - Municipal      2 - Industrial      4 - Federal
 Code (circle):    SW non-sampling                                    (L) Local           (circle):
Please list applicable Single Event Violation Codes:
Inspector: I certify that this document and all attachments were prepared under my direction. The information submitted is, to the best of my knowledge and belief, true,
accurate, and complete.

Inspector:
                            (Print Name)                                             (Title)                                               (Signature)                      (Date)


Operator:
                            (Print Name)                                             (Title)                                               (Signature)                      (Date)
                                         (Attach additional sheets of narrative, pictures and checklists, as necessary)
                ADDITIONAL COMMENTS AND CORRECTIVE ACTIONS FOR                                                                     Insert City Logo
                               SWPPP COMPLIANCE                                                                                          Here


Site Name:                                                          Date of Evaluation:                                     Page             of
Site Address:




EPA Form 3560-3 SEV Codes and Descriptions
                                       Available Single Event Violation Codes for WW Storm Water Construction
DOR11           Discharge without a permit                                    BR19B                Failure to properly operate and maintain BMP's
DOR18           Failure to apply for a Notice of Termination                  DOR12                Failure to submit required permit information
BOR12           Failure to conduct inspections                                EOR16                Failure to submit required report (non-DMR)
BOC17           Failure to develop any or adequate SWPPP/SWMP                 AOR22                Narrative effluent violation
BOC18           Failure to implement SWPPP/SWMP                               EOR14                Noncompliance with section 308 information request
BOR41           Failure to maintain records                                   AOR12                Numeric effluent violation
COR11           Failure to monitor                                            BOR42                Violation of a milestone in an order
BR19A           Failure to properly install/implement BMP's

				
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