JUNE 2007 COMPLIANCE STATUS REPORT FOR THE
CONSTRUCTION STORM WATER GENERAL PERMIT
PROJECT NAME:
WDID #:
PART A: PERMITTEE INFORMATION
Owner Information (Note, if a change in ownership has occurred, the new owner must file a Notice Of Intent (NOI) and the old owner must file a Notice of Termination (NOT)):
Name:Street:
Contact:City: State:
Phone:Zip Code:
Developer or Agent Information:
Name: Street:
Contact:City: State:
Phone:Zip Code:
PART B: CONSTRUCTION SITE INFORMATION
(Please complete all of the following information. Failure to do so may be considered noncompliance.)
Project Name:
Site Latitude: Site Longitude:Site Post Mile Marker:
Site Address (Street and main cross-street):
SiteCity: Site Zip Code:
Site Phone: ext. #: Site Fax#:
Project Manager: Manager’s Cellular #:
Manager’s Pager#:
Size of Site (acres): # Acres Remaining to be Disturbed:
% of Site’s Area Disturbed :
% of Site’s Mass Grading: % Impervious Coverage Before Activity:
Projected % Impervious Coverage upon completion:
Expected Completion Date of Grading:
Expected Completion Date of Site Project:
PART C: CONTACT INFORMATION
Contact Person for Permit Compliance Concerns (Who should respond to requests from the Regional Board for technical reports? If same information as in ‘Owner Information’ section, then please leave blank.):
Name: Title: Phone #: ext. #:
Cellular Phone #: Pager #: Fax #:
Street:
City: State: Zip:
JUNE 2007 COMPLIANCE STATUS REPORT FOR THE
CONSTRUCTION STORM WATER GENERAL PERMIT
PART D: NARRATIVE DESCRIPTION OF WORK
On this sheet or on an attached sheet, you must include a narrative description of the following items:
- Current project status including, but not limited to grading, site disturbance, erosion and sediment control practices already in effect.
- Best Management Practices (BMPs – effective erosion and sediment control measures) that will be implemented prior to the next wet season (2003-2004), including a time schedule for implementation.
- Describe any major upcoming events such as project completion, land disturbances, selling of parcels, or transfer of ownership.
- Construction Time Schedule.
IF YOU HAVE A PERMIT AND HAVE NOT STARTED CONSTRUCTION ACTIVITY, PLEASE EXPLAIN BRIEFLY THE STATUS OF YOUR PROJECT AND PROVIDE CONSTRUCTION TIME SCHEDULE.
PART E: SECTION A of the GENERAL PERMIT,
STORM WATER POLLUTION PREVENTION PLAN (SWPPP)
Section A.1-4:
Are you implementing a SWPPP? Yes No
If yes, date SWPPP prepared: Date SWPPP last updated:
------
Comments:______
Section A.5-8:
Does your SWPPP include a description of potential pollutant sources, including storm water runoff containing sediment? Yes No
Note: If you have an active construction site, or you will have any soil disturbance activities during the
wet season, then you must include a map.
If yes, attach a copy of the color-coded site map with a legend included showing:
Areas of soil disturbance that have been stabilized.
Areas of active grading.
Areas to be graded along with a time schedule.
Areas of potential soil erosion where control practices will be implemented prior to October
15th. Also indicate the type of control practices and time schedule for implementation.
Locations of post-construction projects (i.e. ponds and detention basins).
Location of designated concrete wash-out pit and construction material storage area on site map.
Which of the following erosion and sedimentation control methods are included in your SWPPP?
Temporary Seeding Silt Fences Subsurface Drains
Permanent Seeding Detention Basins Pipe Slope Drains
Mulching Sediment Traps Storm Drain Inlet Protection
Sod Stabilization Sediment Basins Drainage Swales
Vegetative Buffer Strips Check Dams Rock Outlet Protection
Protection of Trees Fiber Rolls
Brush Barriers Other______
Section A.9:
Have all non-storm water discharges from the site been eliminated or otherwise permitted? Yes No
If yes, please attach a description of the measures taken to eliminate all non-storm water discharges.
If no, please indicate which of the following non-storm water discharges exist on your site:
Spills Landscape IrrigationWash Waters
Pipe Testing Storage Tanks Leaks Dust Control Runoff
Pipe Flushing Dewatering Other ______
Section A.10-13:
Your SWPPP must include control measures to reduce pollutants in storm water discharges after all construction phases are completed (Post-Construction), including an operations and maintenance schedule, short and long-term funding sources, and responsible parties.
Please indicate which of the following post-construction measures will be implemented in your project/site:
Clustered Development Wet Ponds Extended Detention Basins
Constructed Storm water Wetlands Grassy Swales Home Owner Education
Inlet Filters (e.g. ,“Fossil Filters”) Oil/Water Separators Vegetated Filter Strips
Infiltration Devices (e.g., infiltration trenches or basins) Porous Pavement
Media Filters (e.g., sand filters or compost storm water filters)
Site Design______(e.g., draining roof runoff to landscaped areas)
Other ______
Comments:______
______
JUNE 2007 COMPLIANCE STATUS REPORT FOR THE
CONSTRUCTION STORM WATER GENERAL PERMIT
PROJECT NAME:
PART F: SECTION B of the GENERAL PERMIT,
MONITORING PROGRAM AND REPORTING REQUIREMENTS
Section B.1-3:
Have you inspected your site prior to anticipated storms? Yes No
Frequency of inspections?______
Comments:______
Have you inspected your site following storm events? Yes No
Frequency of inspections?______
Comments:______
Have you kept records of all the wet and dry month inspections? Yes No
If yes, please attach examples of previously performed inspection reports.
Comments:______
Section B.4-6:
Do you certify, based on your site inspections, that your site is in compliance with the requirements of the NPDES General Permit for Discharges of Storm water Runoff Associated with Construction Activity?
Yes No
Comments:______
PART G: SECTION C of the GENERAL PERMIT,
STANDARD PROVISIONS FOR CONSTRUCTION ACTIVITY
Section C.10 and C.12:
“ 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 person or persons who manage the system or those persons directly responsible for gathering the information, the information submitted is 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 possibly of fine and imprisonment for knowing violations.”
Section C.9
Printed Name: ______
Signature: ______Date Signed: ______
(Please see Important Information handout of enclosed attachments concerning allowable signatures.)
Title: ______