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Home My WebLink AboutForm_1_NCS000250_Combined Self Inspection Form_SPPPFORM30_fillable04/2019 SPPPFORM30 INSPECTION RECORD FOR ACTIVITIES UNDER STORMWATER GENERAL PERMIT NCGO10000 SELF -INSPECTION RECORD FOR LAND DISTURBING ACTIVITIES PER § 113A-54.1 RESPONSE FOR EROSION CONTROL FORM 1675 PROJECT LOCATION TIP/WBS# LEVEL II SUPERVISOR COUNTY CONTRACTOR All erosion and sedimentation control measures and stormwater discharge outfalls must be inspected once per seven calendar days AND within 24 hours of a rainfall of 1.0 inch or greater per 24-hour period. Permittee must keep a record of inspections. If using on site rain gage, complete daily rainfall measurement. If using Multi Precipitation Estimator (MPE), attach rainfall data for weekly period. Day Date Rain FAitnt in Notes 000 TT 00 W Th F Sat 00 Sun 00 Phase of Grading Place a check in the box of the current projectphase) Installation of perimeter erosion and sediment control measures Clearing and grubbing of existing ground cover Completion of any phase of grading of slopes or fills Installation of storm drainage facilities Completion of construction or development Establishment of permanent ground cover sufficient to restrain erosion Has all land disturbing activity been completed? (Y/N) Has the final permanent ground cover been completed and established? (Y/N) By this signature, I certify (in accordance with Part IV, Section B, 6(d) of the NCGO10000 permit) that this report is accurate and complete to the best of my knowledge: Cert. Level II Supervisor NCDOT Cert. Level II Representative Cert. # Cert. # Exceptions to standard monitoring requirements Idle projects: Idle projects must be inspected once every 14 calendar days and after 1.0" of rain in a 24-hour period. Idle projects are projects that have not been completed but where no construction activity occurs for 21 calendar days or more AND the entire project has been adequately stabilized with temporary vegetation pursuant to DEMLR guidelines. Completed projects: Completed projects are those projects where work has been completed and you're waiting for the permanent vegetation to establish (i.e. waiting for the grass to grow). Completed projects must be inspected once every 30 calendar days AND within 24 hours of a rain event 1.0 inch or greater in 24 hours. The reduced monitoring can begin once construction has been completed, and erodible slopes have been sufficiently stabilized to restrain erosion by application of permanent ground cover varieties and installation of temporary ground cover to include appropriate erosion control matting and/or other approved mulch materials. Form should not be signed until the week is complete and ALL corrective actions have been completed in the 24 hour and/or 5 day time periods. 04/2019 SPPPFORM30 Stormwater Discharge Outfalls (SDO) Visible Sedimentation and Stream (Required to list each SDO for each inspection) Turbidity Inspection Station Number Corrective Actions Needed Priority* Date other sediment stream Date Corrected Pollutants** Deposited*** Clarity**** * R=Routine, needs **Is there evidence of other pollutants discharging from ***Is there visible sediment deposited in a stream, ****Is there visible attention within 5 site such as oil sheen, discoloration, cement wastes, wetland, buffer or adjacent property? (Y/N) Contact decrease in stream clarity days; U=Urgent, sanitary waste, fertilizers, or fuel or chemical storage DWR within 24 hours if visible sediment greater than a 5 (increase turbidity -cloudy) needs attention leakage? (Y/N) **If Other Pollutants is marked Yes, gallon bucket is deposited in surface waters or wetlands, because of a discharge? within 24 hrs. describe extent of discharge and list the corrective actions and DEMLR if greater than 5 gallon bucket lost off site. (Y/N) taken. Report potential illicit discharges to NCDOT for NOTE: Any erosion control device that is damaged that has the potential to lose sediment and/or pollutants offsite and/or into surface waters should be treated as "URGENT". 04/2019 SPPPFORM30 Erosion & Sedimentation Control Devices (Required to list all devices that need maintenance) Inspection Station Number Corrective Actions Needed Priority* Date Date Corrected *R=Routine, needs attention within 5 days; U=Ur ent, needs attention within 24 hours. NOTE: Any erosion control device that is damaged that has the potential to lose sediment and/or pollutants offsite and/or into surface waters should be treated as "URGENT". 04/2019 SPPPFORM30 RESPONSE FOR EROSION CONTROL - INSPECTOR'S DAILY REPORT SUBSTITUE FORM 1675 Pay Item Standard/Metric Unit Quantity Comments Temporary Silt Fence LF M Special Sediment Control Fence TN/MTN LF/M Temporary Mulching AC HA Seed - Temporary Seeding LB KG Fertilizer - Temporary Seeding TN MTN Matting for Erosion Control SY M2 Coir Fiber Mat SY M2 Coir Fiber Baffles LF M Perm. Soil Reinforcement Mat SY M2 Seeding and Mulching AC HA Seed - Repair Seeding LB KG Fertilizer - Repair Seeding TN MTN Seed for Supplemental Seeding LB KG Fertilizer Topdressing TN MTN Response for Erosion Control EA EA Safety/Highly Visible Fencing LF M We agree that this is the work to be performed. We agree that this work was performed. NCDOT Representative: NCDOT Representative: Prime Representative: Prime Representative: Date Date