NCS000584_IDDE-MS4 Sched Inspection Form_20200720

SCHEDULED INSPECTION OF THE MS4
OBSERVATION FORM
PART 1 GENERAL INFORMATION
Address/Location:
Date: Time
Staff names:
How Long Since Last Rainfall? ❑ Raining now ❑ 0-2 Days ❑ 3 or more Days ❑ Unknown
PART 2 END -OF -PIPE INFORMATION & VISUAL OBSERVATIONS
End of Pipe Flows Into: ❑ Drainageway ❑ Pond ❑ Stilling Basin ❑Other Wetlands❑ Yes ❑ No
End of Pipe Submerged? ❑No ❑Yes If yes, how much? ❑25% or less ❑about 50%* ❑more than 50%*
End of Pipe Crushed? ❑ No ❑ Yes If yes, how much? ❑25% or less ❑about 50%* ❑almost closed*
Grate on End of Pipe? ❑No ❑Yes If yes, is grate plugged? ❑25% or less ❑about 50%* ❑more than 50%*
If discharge pt. is not a pipe, identify here Condition:
Water Flowing From End of Pipe? ❑ No ❑ Yes Comments:
If yes, what does water look like? ❑Clear El Colored, what color? ❑ Muddy ❑ Other
If yes, petroleum products present? ❑ No ❑ Yes If yes, ❑ Floating globs (visible product) ❑ Moving sheen
Sediment Accumulation in Pipe? ❑No ❑Yes Comments:
If yes, how much? ❑ 25% or less filled in ❑ About 50% filled in* ❑ More than 50% filled in*
Debris Accumulation in Pipe? ❑No ❑Yes Comments:
If yes, how much? ❑ 25% or less filled in ❑ About 50% filled in* ❑ More than 50% filled in*
Describe debris:
If End of Pipe Flows to a Stilling Basin or Pond is there (Near End of Pipe):
Sediment accumulation in stilling basin or pond? ❑ No ❑ Yes
If yes, how much? ❑ 25% or less filled in ❑ About 50% filled in* ❑ More than 50% filled in*
Debris accumulation in stilling basin or pond? ❑ No ❑ Yes
If yes, how much? ❑ 25% or less filled in ❑ About 50% filled in* ❑ More than 50% filled in*
Describe debris:
Is Erosion Occurring at the End of the Outfall Pipe? ❑ No ❑ Yes* Comments:
If yes, describe:
.................................................................................................................................................................................................................................................................................................
Evidence of previous illicit discharge(s)? ❑Yes ❑ No
PART 3 ADDITIONAL INFORMATION IF OBSERVING ACTIVE IDDE INCIDENT
DISCHARGER NAME/ADDRESS:
DISCHARGER LICENSE PLATE:
COMMENTS:
DISCHARGER VEHICLE:

INSTRUCTIONS FOR COMPLETION OF THE INSPECTION FORM
FIELD EQUIPMENT CHECKLIST- Make sure you have appropriate equipment before starting the inspection.
❑Appropriate protective work clothing and boots❑ Safety and communication equipment ❑ Outfall location maps
❑Clipboard ❑ Visual Inspection Forms ❑ Pencil or Waterproof permanent ink pen ❑ Mosquito protection if
appropriate
PART I GENERAL INFORMATION
Map to Location: Verify the map guiding you to the outfall location is accurate. Make location corrections to the map
and/or in the inspection form, if necessary. If the outfall cannot be found based on inspection crew experience or map
information, make a note and return the uncompleted form and map to crew leader. Note jurisdiction on form.
Date, Time and Field Crew Lead. When you arrive at an outfall to conduct the inspection, write the permanent
outfall identification number on the form. Record the date and time the inspection is made. Fill in the name of the
person conducting the inspection.
How Long Since Last Rainfall? Check the box that best represents when the last rainfall occurred. "Rainfall" is
defined as a rainstorm big enough to cause runoff from the streets to enter the local storm drains being inspected.
Indicate if you do not know the date of the last rainfall.
PART 2 END OF PIPE AND VISUAL OBSERVATIONS
The "end -of -pipe" is defined as the open-end of a pipe discharging stormwater from a piped stormwater conveyance
system into the environment.
Water Flowing from End -of -Pipe? Check the NO box if there is no water flowing out of the end -of -pipe. Note: If you
see standing water in the end -of -pipe or the end -of -pipe is partially submerged in water and you cannot determine if
the water is actually flowing out of the pipe, also check the NO box. Check the YES box only if water is flowing out of
the end -of -pipe. If you checked the YES box, you also need to answer the questions about the quality of the water
flowing out of the pipe. Check the appropriate boxes for the water quality questions.
If yes, what does water look like?
Clear (not colored): Imagine a glass of drinking water, you can see through the water and the water is not colored.
Is this what the water flowing from the end -of -pipe looks like?
Colored: Imagine a glass of tea, you can see through the water, but the water is colored. Is this what the water
looks like? Be careful not to let the color of subsurface objects fool you. For example, green algae under the water
can give water the appearance of being green. Color can range from light to dark. If the water seems very lightly
colored but you are in doubt, do not mark the "Colored" box.
Muddy: You cannot see through the water (it has a cloudy or muddy appearance).
If yes, petroleum products present in water? Imagine pouring new or used motor oil into water. Do you see this
effect in the water flowing from the end -of -pipe? Unless you see floating globs (visible product) or a moving sheen
of oil in the water, mark NO.
Sediment Accumulation in Pipe? If you can see sediment in the pipe, check the YES box. Then estimate how
much sediment is present in the pipe (less than full, about'/2 full, or more than full) and check the appropriate
box. Note: If you checked the "about'/2 full" or "more than full" box, also check the box at the bottom of the page to
flag the form for a supervisor's attention.
Debris Accumulation in Pipe? If you see any debris piled up in the pipe, check the YES box. Then estimate how
much debris is present in the pipe (less than full, about'/2 full, or more than full) and check the appropriate box.
Note: If you checked the "about'/2 full" or "more than full" box, also check the box at the bottom of the page to flag
the form for a crew leader's attention.
If the"End of Pipe" Flows into a rundown, stilling basin or pond, is there (near end of pipe) Sediment
Accumulation? If you can see sediment in the rundown, stilling basin, or pond, check the YES box. Then estimate
how much sediment is present (less than full, about''/2 full, or more than full) and check the appropriate box.
Note: If you checked the "about'/2 full" or "more than full" box, also check the box at the bottom of the page to flag
the form for a crew leader's attention.
Debris Accumulation? If you see any debris piled up in the rundown, stilling basin or pond, check the YES box.
Then estimate how much debris is present (less than full, about'/2 full, or more than full) and check the
appropriate box. Note: If you checked the "about'/2 full" or more than '/2 full" box, also check the box at the bottom of
the page to flag the form for a crew leader's attention.
PART 3 ADDITIONAL INFORMATION
As needed, record any observation information for an active IDDE incident you may be a witness to in the field.