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Annual Stormwater Control Measure Inspection Form Submittal
Property Address:
*
Date of Inspection:
*
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Owner Name (First & Last):
*
Inspector Name (First & Last):
*
Inspector Email Address:
*
Inspector Phone Number:
*
Date of Last Rain Event:
*
Amount of Last Rain Event:
*
Type of SCM
*
Bio Retention
Crystal Stream Filter
Dry Detention
Grassed Swale
Infiltration Basin
Level Spreader
Permeable Pavement
Permeable Pavers
Sand Filter
Underground Detention
Wet Detention
Wetland
Trash/Debris Present:
*
Yes
No
Perimeter of SCM:
*
Yes
No
N/A
Bare soil/Erosive gullies
Yes
No
N/A
Vegetation is too short/too long
Yes
No
N/A
Inlet Device:
*
Yes
No
N/A
Pipe is clogged
Yes
No
N/A
Pipe is damaged
Yes
No
N/A
Erosion occurring in swale
Yes
No
N/A
Stone verge clogged or covered in sediment
Yes
No
N/A
Vegetation
*
Yes
No
N/A
Pruning Needed for Optimal Plant Health
Yes
No
N/A
Plants are Dead, Diseased, or Dying
Yes
No
N/A
Invasive Vegetation
Yes
No
N/A
Tree Stakes/Wires are present 6 months after planting
Yes
No
N/A
Forebay or Pretreatment Area:
*
Yes
No
N/A
Sediment Accumulation
Yes
No
N/A
Erosion/Gullies Present
Yes
No
N/A
Invasive Vegetation
Yes
No
N/A
Flow is Bypassing Pretreatment
Yes
No
N/A
Weeds are present
Yes
No
N/A
Filter Bed & Underground Collection Drain System
*
Ponding water more than 24 hours after storm event
Yes
No
N/A
Soils and Mulch:
*
Yes
No
N/A
Mulch is breaking down or floated away
Yes
No
N/A
Soils/Mulch covered with sediment
Yes
No
N/A
Low soil pH/Heavy metals accumulation (soil test)
Yes
No
N/A
Permeable Pavement & Pavers SCM ONLY: Surface of Permeable Pavement or Pavers
*
Yes
No
N/A
Rutting/uneven settlement
Yes
No
N/A
Trash/Debris is present
Yes
No
N/A
Weed growth present
Yes
No
N/A
Sediment is present on the surface
Yes
No
N/A
Pavement is deteriorating or damaged
Yes
No
N/A
Pavement does not drain properly between storms
Yes
No
N/A
Underground Detention SCM ONLY: Underground Vaults/Pipes
*
Yes
No
N/A
Sediment accumulation
Yes
No
N/A
Seepage or settlement accompanied by cracking
Yes
No
N/A
Joint alignment, elongation, or cracks
Yes
No
N/A
Surface wear or loss of protective coating or corrosion
Yes
No
N/A
Blockage of pipe or vault
Yes
No
N/A
Main Treatment Area:
*
Yes
No
N/A
Sediment Accumulation
Yes
No
N/A
Algal growth over 50% of water surface area
Yes
No
N/A
Invasive vegetation covers 50% of water surface area
Yes
No
N/A
Embankment:
*
Yes
No
N/A
Shrubs/trees present
Yes
No
N/A
Evidence of muskrat or beaver activity
Yes
No
N/A
Needs repair
Yes
No
N/A
Receiving Water:
*
Yes
No
N/A
Erosion/ Other signs of damage
Yes
No
N/A
Outlet Device:
*
Yes
No
N/A
Clogging has occurred
Yes
No
N/A
Device is damaged
Yes
No
N/A
Debris on trash rack
Yes
No
N/A
Miscellaneous:
*
Yes
No
N/A
Access
Yes
No
N/A
Vandalism
Yes
No
N/A
Signage
Yes
No
N/A
Gated/Fenced in
Yes
No
N/A
The following repairs/maintenance are needed at this time (if no repairs or maintenance are needed at this time, insert N/A):
*
Signature of engineer, surveyor or landscape architect who completed the inspection:
*
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Photo(s) of SCM/BMP:
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