Instructions for Form 650-040-03 "Stormwater Pollution Prevention Plan Construction Inspection Report" - Florida

This document contains official instructions for Form 650-040-03, Stormwater Pollution Prevention Plan Construction Inspection Report - a form released and collected by the Florida Department of Transportation. An up-to-date fillable Form 650-040-03 is available for download through this link.

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Instructions for Completing Form 650-040-03
(Stormwater Pollution Prevention Plan Construction Inspection Report)
In order to attain consistency and accuracy when completing for 650-040-03, the following
instructions should be followed. (The numbers on this instruction sheet corresponds to the
numbers on the sample inspection report.)
1. Enter the FM #.
2. Enter the contract number.
3. Enter the state road number.
4. Contractor enters his firm’s name.
5. Enter the date of the inspection.
6. Contractor enters FDEP permit number from contract.
7. Location on the project of control measure. For example, list as SR-500 or Race Track
Road.
8. Enter the stations for the installed control measure.
9. Enter the site location with regard to the centerline.
10. Contractor enters whether or not area where control measures are deployed is active or
idle.
11. Enter the date the soil was last disturbed in this particular location. The date may be the
date of the clearing and grubbing. Each time the area is worked (disturbed), that new date
should be entered.
12. Enter the date that permanent stabilization methods are used for final stabilization of the
project.
13. Enter the number of the “control measure code” (listed at the bottom of the inspection
report) used. Silt fence, inlet protection, etc.
14. Enter one of the letters or numbers listed in the “condition codes” that applies to the
current field conditions of the erosion control methods being used.
15. Use this section to enter comments when corrective action has been taken. Also
enter any comments that may be helpful in explaining certain situations. If the area on
the form in insufficient for necessary comments, additional documents, photographs,
emails, etc. can be added to the form. See PDF Portfolio Notes below.
16. The Contractor’s designated Responsible Authority signs the report; no initials accepted.
For contracts let after July 2016, this must be a Digital Signature and must be the last signature
executed. Once signed, the form will be LOCKED. (See Form Notes Part E for details on the
Responsible Authority).
17. Contractor dates form when signed. Unnecessary with digital signature.
18. Print inspector’s name on report.
19. Inspector signature. This signature may be either digitally signed or signed via stylus. It
must be signed prior to the Responsible Authority’s signature.
20. Contractor enters DEP Stormwater Management Inspection Certification #
21. Enter date certified by DEP.
FORM NOTES
A. Make sure that the location of control measure is consistently listed, once they are entered
on the report. A location can only be removed once the location is stabilized.
B. Copies of the report are no longer allowed due to the digital nature of the form. Each form
must be filled out, in its entirety, during the inspection.
C. Station-to-station distance identifiers may be large, 500’ or more. If the inspector notes
that maintenance or repair is needed, identify the specific area within the 500’. If the
specific area is not noted, then it is assumed that the whole 500’ is in need of maintenance
or repair. It is recommended that station-to-station distance identifiers be kept as small as
Instructions for Completing Form 650-040-03
(Stormwater Pollution Prevention Plan Construction Inspection Report)
In order to attain consistency and accuracy when completing for 650-040-03, the following
instructions should be followed. (The numbers on this instruction sheet corresponds to the
numbers on the sample inspection report.)
1. Enter the FM #.
2. Enter the contract number.
3. Enter the state road number.
4. Contractor enters his firm’s name.
5. Enter the date of the inspection.
6. Contractor enters FDEP permit number from contract.
7. Location on the project of control measure. For example, list as SR-500 or Race Track
Road.
8. Enter the stations for the installed control measure.
9. Enter the site location with regard to the centerline.
10. Contractor enters whether or not area where control measures are deployed is active or
idle.
11. Enter the date the soil was last disturbed in this particular location. The date may be the
date of the clearing and grubbing. Each time the area is worked (disturbed), that new date
should be entered.
12. Enter the date that permanent stabilization methods are used for final stabilization of the
project.
13. Enter the number of the “control measure code” (listed at the bottom of the inspection
report) used. Silt fence, inlet protection, etc.
14. Enter one of the letters or numbers listed in the “condition codes” that applies to the
current field conditions of the erosion control methods being used.
15. Use this section to enter comments when corrective action has been taken. Also
enter any comments that may be helpful in explaining certain situations. If the area on
the form in insufficient for necessary comments, additional documents, photographs,
emails, etc. can be added to the form. See PDF Portfolio Notes below.
16. The Contractor’s designated Responsible Authority signs the report; no initials accepted.
For contracts let after July 2016, this must be a Digital Signature and must be the last signature
executed. Once signed, the form will be LOCKED. (See Form Notes Part E for details on the
Responsible Authority).
17. Contractor dates form when signed. Unnecessary with digital signature.
18. Print inspector’s name on report.
19. Inspector signature. This signature may be either digitally signed or signed via stylus. It
must be signed prior to the Responsible Authority’s signature.
20. Contractor enters DEP Stormwater Management Inspection Certification #
21. Enter date certified by DEP.
FORM NOTES
A. Make sure that the location of control measure is consistently listed, once they are entered
on the report. A location can only be removed once the location is stabilized.
B. Copies of the report are no longer allowed due to the digital nature of the form. Each form
must be filled out, in its entirety, during the inspection.
C. Station-to-station distance identifiers may be large, 500’ or more. If the inspector notes
that maintenance or repair is needed, identify the specific area within the 500’. If the
specific area is not noted, then it is assumed that the whole 500’ is in need of maintenance
or repair. It is recommended that station-to-station distance identifiers be kept as small as
practical and at no time more than 1000’.
D. If there are multiple inspection reports for a weekly inspection, all copies must be
signed by the contractor.
E. Responsible Authority: Is defined per Rule 62-620.305 Florida Administrative Code.
The Responsible Authority is ultimately responsible for obtaining and complying with
the NPDES permit. The Responsible Authority must sign the inspection form unless a
Duly Authorized Representative has been designated, in writing to the FDEP Notices
Center, by the Responsible Authority. See NPDES Permit for further details.
PDF PORTFOLIO NOTES
(These steps must be performed BEFORE signatures are applied)
A. The form has added capacity to account for the larger projects:
1. Delete all unused pages before final document submission. You can only
delete a page if you have Adobe Pro, Nuance or BlueBeam.
B. To add documents to the form follow the steps below:
1. In Bluebeam: Left click the Thumbnail tab (looks like four small squares) in
the left margin. Right click within the margin where you would like the
document or photo to be added and chose Insert Pages. A pop-up will appear
to access your computer. Browse and chose the document or photo. Once the
document or photo is selected, a pop-up will appear asking for conformation.
Left click the Ok tab and the document or photo will appear in the document.
2. In Nuance: Left click the Pages Panel in the left margin (last tab). Right
click within the margin where you would like the document or photo to be
added and chose Insert. Browse and chose the document or photo. Once the
document or photo is selected, a pop-up will appear asking for conformation.
Left click the Ok tab and the document or photo will appear in the document.
3.
In Adobe Pro: Left click the Pages Thumbnail in the left margin. Hover
the cursor over a document page and right click. Select Insert Pages - From
File. Browse and select a file. Once the document or photo is selected, a
pop-up will appear asking for conformation.
C. To create a PDF Portfolio:
1. Follow the instructions on:
http://www.fdot.gov/construction/eConstruction/AsBuiltPlans.shtm
- PDF
Package/Portfolio
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