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HomeMy WebLinkAboutCCB0017_CrowellConstruction_INSP_20191205STRUCTUAL 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