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ATTACHMENT B: SWPPP INSPECTION FORM .� Minnesota Pollution Control Agency 520 La fayrar Rood Nuo tr i St. Paul, MN 55155-4194 moi. , ! x v ite n R O U P ATTACHMENT B: Construction stormwater Inspection Checklist Construction Stormwater Program .r]rr. 7yr�: Fl.fm;ffpn. [:n=r-v.s' Note: This inspection report does not address all aspects of the National Pollutant Discharge Elimination System/St ate Disposal System (NP1)ESIS DS) Construction Stormwat.er permit {Permit} issued on August 1, 2013. The completion of this checklist does not guarantee that all permit requirements are in compliance; it is the responsibility of the Permittee(s) to read and understand the permit requirements. Facility Information Site name: Facility address: Permit number: City: State: Zip code: Inspection Information Inspector name: Phone number.- Date umber:Date (mmlddlyyyy): Time: ❑ am ❑ pm Is the inspector certified in sediment and erosion control and it is documented in the Starmwater Pollution Prevention Plan (SWPPP)? ❑ Yes ❑ No Is this inspection routine or in response to a storm event: Rain Fall amount (if applicable) Is site within one aerial mile of special or impaired water? ❑ Yes ❑ No Ifyes, Follow Appendix A and other applicable permit requirements. Note: If NA is selected at anytime, specify why in the comment area for that section. Erasion Control Requi rement (Part IV.B) www,pca.srate.mn.us • 651-296.6300 • 800.657-3864 TTY 651.282.5332 or 800657.3864 • Avatable in altemattve formats M-stun2-36 • 314114 Page i of 4 I f ite G R b U P 6. Do pipe outlets have energy dissipation? ❑ I ❑ ❑ Comments: Sediment Control Requirement (Part IV.C.) Yes Yes No NA 1. Soil stabilization vahere no construction activity for 14 days? r7 da s wereapplicable) El 2. Perimeter control trenched in where appropriate? ❑ 2. Has the need to disturb steep slopes been minimized? 3. 50 Foot -natural buffer maintained around all surface waters? 13 ❑ 3, All ditches stabilized 200' back from p oint of disch arg a within 24 hours? Not mulch) ❑ ❑ ❑ 4. Are there erosion BMP's for onsite stock iIas? ❑ ❑ ❑ 5. Are appro PHate BM P's installed protectin g inIAsloutlets? ❑ 7. Are all infiltration systems staked and marked to avoid com action? ❑ www,pca.srate.mn.us • 651-296.6300 • 800.657-3864 TTY 651.282.5332 or 800657.3864 • Avatable in altemattve formats M-stun2-36 • 314114 Page i of 4 I f ite G R b U P 6. Do pipe outlets have energy dissipation? ❑ I ❑ ❑ Comments: Sediment Control Requirement (Part IV.C.) Comments: Maintenance -Erosion and Sediment Control BM Ps (Part IV. E.) Yes No I NA 1. Perimeter control installed on all down gradient perimeter s? Ll F1 El 2. Perimeter control trenched in where appropriate? ❑ 2. Any ditch erosion observed? 3. 50 Foot -natural buffer maintained around all surface waters? ❑ ❑ ❑ IF No, have redundant sediment controls been installed? ❑ ❑ ❑ 4. Inlet proteetion on all catch basins and culvert inlets? Are inlet p rot ection devices maintained and functionin q properl ? Ll 71 5. Vehicle tracking Best Management Practices (BMPs) at all site exits? 6. All tracked sediment removed within 24 hours? ❑ ❑ ❑ 7. Are all infiltration systems staked and marked to avoid com action? ❑ ❑ ❑ 8. Are all infiltration areas protected with a pretreatment device? ❑ ❑ ❑ 9. Do all stockpiles have perimeter control? ❑ ❑ ❑ Comments: Maintenance -Erosion and Sediment Control BM Ps (Part IV. E.) Comments: Other Yes No NA 1. Are all materials that can leach pollutants under cover? ❑ ❑ ❑ www.pca.state.mn.us 651-296.6300 800.657-3864 TTY 651.282.5332 or 800657.3864 Avatable in altemattve formats M-stun2.36 • 3141!4 Page 2 of 4 CivilSite G R tl tf P 2. Has access been restricted to onsite hazardous materials? Yes No I NA 1. Are all previously stabilized areas maintaining 90% ground cover? ❑ ❑ ❑ 2. Any ditch erosion observed? ❑ ❑ ❑ 3. Perimeter Control -Has sediment reached one half the height orthe device? ❑ ❑ ❑ 4. Are inlet p rot ection devices maintained and functionin q properl ? Ll F1 El Comments: Other Yes No NA 1. Are all materials that can leach pollutants under cover? ❑ ❑ ❑ www.pca.state.mn.us 651-296.6300 800.657-3864 TTY 651.282.5332 or 800657.3864 Avatable in altemattve formats M-stun2.36 • 3141!4 Page 2 of 4 CivilSite G R tl tf P 2. Has access been restricted to onsite hazardous materials? ❑ ❑ ❑ 3. Does on-site fueling only occur in a contained areal L1 n L1 4. Are all solid rrestes being properly disposed of? ❑ ❑ ❑ 6. Is the concrete washout area completely contained? ❑ ❑ ❑ 6. Is the concrete washout area marked with a sign? Fl I F1 debris, inflow pipes and overfloxv spillways are clear, Inlet areas are clean, Comments: 7. Were any discharges seers during this inspection, sediment, water, or otherwise? ❑ Yes ❑ No If yes, state the exact location of all points of discharge. Photograph the discharge and describe the discharge (color, odor, foam, oil sheen, etc). How will it be removed? How did the discharge happen? How much was discharged? Ho,r! will it be stopped, and hrnri long mill it take to stop? Is the discharge going into an adjacent site? Was the discharge a secimen t delta? If yes, will the delta be recovered within 7 days? 8. WII a permanent storrrmater management system be udIized in this project as required and in accordance with Part IIID of the permit? Describe: 9. Is any dewatering occurring on site? ❑ Yes ❑ No If yes, where? What BMP is being used? Hrnrr much water is being deveatered? Is the water clear? Where is the water being discharged to? 10. Is a copy of the SWPPP located on the construction site? ❑ Yes ❑ No 11. Has the SVVPPP been followed and implemented on site? ❑ Yes ❑ No 12. Is a sedimentation basin required for this project as specified in the permit? ❑ Yes ❑ No Ifyes, are they maintained as specified in the permit? ❑ Yes ❑ No 13. Is the topsoil on this project being preserved? ❑ Yes ❑ No Ifyes, explain haw the topsail is being preserved. If not, explain why it was infeasible. 14. Are all infiltration systems marked to avoid compaction? ❑ Yes ❑ No Do all infiltration areas have pretreatment devices? ❑ Yes ❑ No www.pca.srate.mn.us • 651-296.6300 • 800.657-3864 TTY 651.282.5332 or 800657.3864 • Avatable in altemattve formats M-stun2-36 • 314114 Page 3 of 4 1'"' le G R b tf P 15. Description or areas of non-compliance noted during the inspection, required corrective actions, and recommended date of completion ofcorrective actions 16. Proposed amendments to the SWPPP 17. Potential areas of Future concern. 18. Additional comments, Disclosures: • After ciscovery, the permit requires many of the deficiencies that may be found in this checklist be corrected within a specified period of time. See permit for more details. • This inspection checklist is an option for small construction sites. Large construction sites and linear projects require more exten siv efma re location specific inspection requirements. • The Permittee(s) islare responsible for the inspection and maintenance oftorn porery and permanent water quality management BM P's as well as erosion prevention and sediment control B M P s until another Permittee has obtained coverage under this Permit according to Part II.B.5., or the project has undergone Final Stabilization and a Notice of Termination has been submitted to the M PCA. www.pca.srate.mn.us • 651-296.6300 • 800.657-3864 TTY 651.282.5332 or 800657.3864 • Avatable in altemattve formats M-stun2-36 • 314114 Page 4 of 4 ATTACHMENT C: MAINTENANCE PLAN FOR PERMANENT STORM WATER TREATMENT SYSTEM �_.i Va Site G R n U P ATTACHMENT C (C R017 0 Ro�e c� 00 o ao 00 4931 W. 35TH ST. SUITE 200 ST. LOUIS PARK, MN 55416 CivilSiteGroup.com Matt Pavek 763-213-3944 Pat Sarver 952-250-2003 STORMWATER MANAGEMENT FACILITY MAINTENANCE SCHEDULE LAKE W�EST I . All stormlNater retenTion, detention and treatment ha -.ins muse he. inspetLed dl least once a year Lo determine Lhal krasin relenlion and lreaLrnerrl DEVELOPMENT, LLC characteristics are adequate. A storage treatment basin will be considered Inadequate If sediment has decreased the wet storage volume by 50 percent or dry storage volume by 25 percent of its original design volume. Based on this inspection, if a stormwater basin requires sediment cleanout, the basin will be restored to its original design contours and vegetated state within one Vear of the inspersion daTe. 2. All grit Chdrrlbers, sump calch bdsiris, Surrlu manholes, oulleL structures, culverts, outfall structures and other storinwater facilities for which maintenance requirements are not otherwise specified herein must be inspected in the spring, summer and fall of each year. 1V'ithin 30 days ofthe inspection date, all accumulated sediment.and debris must be removed such that each stormwater facility operates as designed and permitted. Contributing drainage ureas must he. kept clear of IiTter and t ege.ratia r debris, inflow pipes and overflew spillways kept clear, inlet areas kept clean, and undesirable vegetation removed. Erosion irrlpairing the function or integrity crl Lhe lacilities, if ally, will be corrected, and any structural damage Impairing or threatening to Impair the function of the facilities must be repaired. 3. Volume control facilities and contributing drainage areas must be inspected every three months during the operational period (between spring snn><vmclt and first srlhstantial snowfall) and monitored afrer rainfall eax�nTs of 1 J LO inch or rnpre Lo ensure Thal Ale con LrIbulirig di dindge area is tledr Ul tiller and (y) debris, inflow pipes and overfloxv spillways are clear, Inlet areas are clean, undesirable vegetation is removed and there is no erosion impairing or ^ z threatening to impair the function of a facility. If sediment has accumulated in a infiltration feature, within 30 days of inspection deposited sediments must be Z Y removed, the infiltration capacity of the underlying soils must be restored, and co W Z any surfarc disttrrhanrc must he stahili7(A. InspOrtion must ensure that LO scdimcnt traps and forehays.arra t mothan 50 e tpping sediment and thareLU z 0- O UJ V o 0 z z I o J J 0� W a O > N Lu C) W Lu i- write /a LL r^ VJ percent of the storage volume remains, the contributing drainage area is stable > ti (i.e., no erosion is observed), and inlets and outlet ioverflow. spillways are in OQ L qood conditions with no erosion. (Maintenance techniques used must protect CSO the infiltration capacity of the practice by limiting soil compaction to the M >_ greatest OXTent passible (e.g., by using low impart earth moving equipmenT). (D W 2 'L Urldeigromid Slordge Lharribers rrlust be inspecLed at least once a LID year to ensure that adequate storage capacity remains. Capacity will he Q N LID considered inadequate if sediment has decreased the storage volume by 50 J percent of its aridinal design volume. Accumulated debris and sediment will be w removed, and inlet and outlet structures will be cleared of any flow O impediments, a 2 I HEREBY CERTIFY THAT THIS PLAN, SPECIFICATION, OR REPORT WAS PREPARED BY ME OR UNDER MY DIRECT SUPERVISION AND THAT I AM A DULY LICENSED PROFESSIONAL ENGINEER UNDER THE LAWS OF THE STATE OF MINNESOTA. - MaTthew R. Pavek DATE 10/18/17 LICENSE No. 44263 ISSUE/SUBMITTAL SUMMARY REVISION SUMMARY PROJECT NO.: 17059 PRELIMINARY SWPPP - ATTACHMENTS SW1 05 @COPYRIGHT 2017 CIVIL SITE GROUP INC.'