CCB0016_CrowellConstruction_INSP_20191205

STRUCTUAL FILL
COAL ASH INSPECTION
Page 1 of 5 Revised 2019 supplemental SF site inspection
Site Name / Notification No.
County:
Date of Inspection / Site Visit:
Inspection Performed by (Inspector / Division):
Physical Address / Crossroads of Location / GPS Location:
Size of Structural Fill:
<10,000 cubic yards (CY)
Between 10,000 and 100,000 CY
>100,000 CY
Landowner verified:
Current use of site? Has use changed from last inspection? Are there any areas of exposed ash?
Design concerns (if applicable)
What is the proximity of the structural fill to receptors and amount of receptors?
Private Dwellings
Community Centers
Surface Water Features 50’ (Lakes, Ponds, Wetlands, Streams)
Water Supply Wells 100’/500’ (Public and Private)
Desktop Receptor Check
Seasonal high groundwater table
100 year / 500 year floodplain
Are there any known utilities in close proximity to, within and/or beneath the fill area?
STRUCTUAL FILL
COAL ASH INSPECTION
Page 2 of 5 Revised 2019 supplemental SF site inspection
Past Noted Violations: (What were they and were the violations resolved?)
Additional Comments:
_______________________________
Inspector Name and Division/Section Phone Number
STRUCTUAL FILL
COAL ASH INSPECTION
Page 3 of 5 Revised 2019 supplemental SF site inspection
Pictures
pg. 4
pg. 5
pg. 6
pg. 7