Stormwater Construction Site Inspection Form - County of Napa, California

This California-specific "Stormwater Construction Site Inspection Form" is a document released by the California Department of Fish & Wildlife.

Download the fillable PDF by clicking the link below and use it according to the applicable legal guidelines.

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Stormwater Construction Site Inspection Form
Inspection ID: ________________________________
General Information
Inspector: ___________________________________ Date: _______________ Time: ____________ AM / PM
Project Name: _____________________________________________________
Proj. ID: _____________________________
Site Address: ______________________________________________________ APN: ___________________________
Type: ____ Non-Storm ____ Winterization ____ PreStorm ____ During Storm
____ Post-Storm ____ Complaint
Pre-announced: ___ Yes ___ No
Weather: ____ Sunny
_____ Cloudy
_____ Rain
Rain Amount: _______ inches
Site Rep: _______________________ Company: ________________________________ Phone: ________________
Pictures:
Best Management Practices (Site Review)
E = Effective, NM = Needs Maintenance, PI = Poor Installation, F = Failed/Not Appropriate,
NI = Not Implemented, 50 = <50% Implemented, 90 = <90% Implemented, NA = Not Applicable, NE = Not Evaluated
1. Run-on Management BMPs
a) Diversion of Run-On
b) Surface Roughening
Comments:
2. Erosion Control BMPs
a) Temporary Slope Stabilization
Blanket
Seed
Mulch
BFM
Landscaped
b) Temporary Flat Lot Stabilization
Blanket
Seed
Mulch
BFM
Landscaped
c) Permanent Slope Stabilization
Blanket
Seed
Mulch
BFM
Landscaped
d) Permanent Flat Lot Stabilization
Blanket
Seed
Mulch
BFM
Landscaped
Comments:
3. Sediment Control BMPs
a) Silt Fence
e) Stabilized CST Entrance
h) Sediment Basin
b) Fiber Roll
f) Check Dams
i) Dust Control
c) Perimeter Control
g) Sediment Trap
j)Storm Water Inlet Protection
d) Outlet Protection
Comments:
4. Post Construction BMPs
a) Post CST Implemented
Comments:
5. Material Management BMPs, and Non-Stormwater Mangement BMPs
a) Street Sweeping
i) Spill Kit On Site
e) Hazardous Materials Storage
b) Waste Collection/Litter
j) Portable Toilet
f) Stockpile Management
c) Concrete Wash-Out
g) Vehicle and Equipment Fueling
k) Dewatering Operations
d) Material Storage
h) Vehicle and Equipment Maintenance
Comments:
County of Napa
Department of Public Works
1195 Third Street, Room 201, Napa, CA 94559
Draft: 03-15-05
Page 1 of 2
707-253-4351
Stormwater Construction Site Inspection Form
Inspection ID: ________________________________
General Information
Inspector: ___________________________________ Date: _______________ Time: ____________ AM / PM
Project Name: _____________________________________________________
Proj. ID: _____________________________
Site Address: ______________________________________________________ APN: ___________________________
Type: ____ Non-Storm ____ Winterization ____ PreStorm ____ During Storm
____ Post-Storm ____ Complaint
Pre-announced: ___ Yes ___ No
Weather: ____ Sunny
_____ Cloudy
_____ Rain
Rain Amount: _______ inches
Site Rep: _______________________ Company: ________________________________ Phone: ________________
Pictures:
Best Management Practices (Site Review)
E = Effective, NM = Needs Maintenance, PI = Poor Installation, F = Failed/Not Appropriate,
NI = Not Implemented, 50 = <50% Implemented, 90 = <90% Implemented, NA = Not Applicable, NE = Not Evaluated
1. Run-on Management BMPs
a) Diversion of Run-On
b) Surface Roughening
Comments:
2. Erosion Control BMPs
a) Temporary Slope Stabilization
Blanket
Seed
Mulch
BFM
Landscaped
b) Temporary Flat Lot Stabilization
Blanket
Seed
Mulch
BFM
Landscaped
c) Permanent Slope Stabilization
Blanket
Seed
Mulch
BFM
Landscaped
d) Permanent Flat Lot Stabilization
Blanket
Seed
Mulch
BFM
Landscaped
Comments:
3. Sediment Control BMPs
a) Silt Fence
e) Stabilized CST Entrance
h) Sediment Basin
b) Fiber Roll
f) Check Dams
i) Dust Control
c) Perimeter Control
g) Sediment Trap
j)Storm Water Inlet Protection
d) Outlet Protection
Comments:
4. Post Construction BMPs
a) Post CST Implemented
Comments:
5. Material Management BMPs, and Non-Stormwater Mangement BMPs
a) Street Sweeping
i) Spill Kit On Site
e) Hazardous Materials Storage
b) Waste Collection/Litter
j) Portable Toilet
f) Stockpile Management
c) Concrete Wash-Out
g) Vehicle and Equipment Fueling
k) Dewatering Operations
d) Material Storage
h) Vehicle and Equipment Maintenance
Comments:
County of Napa
Department of Public Works
1195 Third Street, Room 201, Napa, CA 94559
Draft: 03-15-05
Page 1 of 2
707-253-4351
Stormwater Construction Site Inspection Form
Inspection ID: ________________________________
Turbidity (NTU): Outfall _____________
6. Illicit Discharge: ___ None ___ Potential ___ Observed
Comments:
Upstream ___________
Downstream _________
Corrective Actions Taken Since Last Inspection:
SWPPP Review/Recommendations:
Yes
No
Yes
No
Yes
No
SWPPP Onsite
Implementation Schedule
Inspection Documentation
Yes
No
Yes
No
Date Last Revised: _______________
Sub-Contractors List
Training Documentation
Comments:
Violations Noted and Corrective Action Required:
Item
Code
Corrective Action Required
Outreach Materials Provided:
______ NCSWMP - Stormwater Pollution Prevention for New Development and Redevelopment
______ NCSWMP - Guidance for Construction Site Runoff Control and Post- Construction Runoff Management
______ CA BMP Handbook Factsheet(s): __________________________________________________________________
______ Other: _________________________________________________________________________________________
Signatory Requirements
I have received a copy of this Stormwater Inspection Checklist which confirms compliance with stormwater regulations on the
____
date of the inspection.
I have received a copy of this Stormwater Inspection Checklist which constitutes an Order to Comply with the corrective actions
____
described above. The corrective actions identified above will be considered and acted upon by ________________________.
Inspector
Property Owner or Representative
___________________________________________________ ___________________________________________________
Print
Print
___________________________________________________ ____________________________________________________
Signature
Date
Signature
Date
County of Napa
Department of Public Works
1195 Third Street, Room 201, Napa, CA 94559
Draft: 03-15-05
Page 2 of 2
707-253-4351

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