"Inflow and Infiltration Reduction Annual Report Form" - Oregon

Inflow and Infiltration Reduction Annual Report Form is a legal document that was released by the Oregon Department of Environmental Quality - a government authority operating within Oregon.

Form Details:

  • The latest edition currently provided by the Oregon Department of Environmental Quality;
  • Ready to use and print;
  • Easy to customize;
  • Compatible with most PDF-viewing applications;
  • Fill out the form in our online filing application.

Download a printable version of the form by clicking the link below or browse more documents and templates provided by the Oregon Department of Environmental Quality.

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Download "Inflow and Infiltration Reduction Annual Report Form" - Oregon

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Inflow and Infiltration Reduction Annual Report
Year:
(Submit a separate form for each satellite collection system)
Facility Name:
DEQ File #:
Facility Location:
Permit #:
Miles of Common Sewer:
EPA ID#:
Number of Pump Stations:
Date of most recent I and I Study:
Number of storm caused SSOs last year:
Flow
Design Values
Observed Last Year
Average Dry Weather Flow
Average Wet Weather Flow
Maximum Month Wet Weather Flow
Peak Day Flow
Inspection, Maintenance, and Construction Activities
Enter activities completed in prior 5 years, completed last year, planned for upcoming year
Activity
Last 5 Years
Last Year
Planned
Smoke Testing* (miles & percent of total)
Cleaning & TV inspection* (miles & percent of total)
Cleaning w/o TV inspection* (miles & percent of total)
Main line repaired ( miles & percent of total)
Main line replaced ( miles & percent of total)
Manholes repaired (number & percent of total)
Manholes replaced (number & percent of total)
Cross-connections** (number discovered & eliminated)
* - Do not double report activities done in the same section during the same time period.
** - Include storm drains, area drains, and roof drains.
ATTACHMENTS: Please attach additional information regarding collection system repair and
replacement work done last year and planned for the current year.
Signature Requirement
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, 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 fines and imprisonment for knowing violations.
Signature of Responsible Official:
Name and Title (Please Print):
Date of Signature:
Telephone:
Inflow and Infiltration Reduction Annual Report
Year:
(Submit a separate form for each satellite collection system)
Facility Name:
DEQ File #:
Facility Location:
Permit #:
Miles of Common Sewer:
EPA ID#:
Number of Pump Stations:
Date of most recent I and I Study:
Number of storm caused SSOs last year:
Flow
Design Values
Observed Last Year
Average Dry Weather Flow
Average Wet Weather Flow
Maximum Month Wet Weather Flow
Peak Day Flow
Inspection, Maintenance, and Construction Activities
Enter activities completed in prior 5 years, completed last year, planned for upcoming year
Activity
Last 5 Years
Last Year
Planned
Smoke Testing* (miles & percent of total)
Cleaning & TV inspection* (miles & percent of total)
Cleaning w/o TV inspection* (miles & percent of total)
Main line repaired ( miles & percent of total)
Main line replaced ( miles & percent of total)
Manholes repaired (number & percent of total)
Manholes replaced (number & percent of total)
Cross-connections** (number discovered & eliminated)
* - Do not double report activities done in the same section during the same time period.
** - Include storm drains, area drains, and roof drains.
ATTACHMENTS: Please attach additional information regarding collection system repair and
replacement work done last year and planned for the current year.
Signature Requirement
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, 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 fines and imprisonment for knowing violations.
Signature of Responsible Official:
Name and Title (Please Print):
Date of Signature:
Telephone: