NCS000584_COL IDDE Inv_insp Form fillable_20200720

ILLICIT DISCHARGE REPORTING FORM
Inspector Information
Name:
Contact Phone Number: Date and Time Discharge Discovered:
(1) Owner Name/Address:
Nearest Intersection/Landmark:
GPS location, if known: Lat: Long:
How Long since Last Rainfall:
Nature of Discharge or Flow:
❑ Solid (Continuous) ❑ Intermittent (Occasional)
❑ Raining Now ❑ 0-2 Days ❑ 3 or more Days
❑ Pulsing (Fluctuating) El Transitory (Prior Spill)
If possible, identify the source of the discharge'
Potential for Discharge to enter into:
❑ Pipe Outfall ❑ Gutter
❑ Stream/Water Body
❑ Sanitary Wastewater ❑ Ditch
❑ Septic System ❑ Spill
❑ Wetland
❑ Storm Sewer ❑ Other:
❑ Storm Drain
" Add descriptions of discharge/source to Field Photograph Log Sheet
❑ Other:
Was water flow observed? ❑ Yes ❑ No
Was a photo taken? ❑Yes ❑ No If yes, attach photos.
Direct Connection to pipe/inlet? ❑ Yes ❑ No
(2) Describe Odor:
❑ None ❑ Musty
❑ Rotten Eggs (Sulphur) ❑ Rancid/Sour Milk
❑ Sewage ❑ Gas/Petroleum
❑ Cooking Oil ❑ Other:
(2) Describe Clarity:
❑ Clear ❑ Cloudy ❑ Opaque ❑ Sheen ❑ Gray
(2) Describe Color:
❑ Red ❑ Yellow ❑ Brown ❑ Green
❑ Gray ❑ White ❑ Other:
(2) Solids/Floatables:
❑ Garbage ❑ Sewage ❑ Tissue ❑ Oil Sheen ❑ Suds ❑ Scum ❑ Iron Sheen ❑ Unknown
Additional Information to assist in the Investigation (Vegetation
Impacts?):
Describe Upstream/Source Origin/Land Use: ❑ Forest ❑ Ag
❑ Res ❑ Farmstd ❑ Com ❑ Ind ❑ Vac ❑ Inst ❑ Muni ❑ Mng

INSTRUCTIONS TO COMPLETE ILLICIT DISCHARGE (PID) REPORTING FORM
WHAT IS AN ILLICIT DISCHARGE:
An illicit discharge is any discharge into the
storm sewer system that is not composed entirely of
stormwater. Examples:
• Dry weather discharges of wastewater into the
storm sewer system from illegal dumping; spills
and other non-stormwater pollution sources
• Discharges of pollutants, contaminants or illicit
materials into storm drainage/sewer systems (oil,
grease, solvents, metals, nutrients, toxics, viruses,
bacteria)
• Improper antifreeze, oil disposal from vehicle
maintenance, service stations
• Vehicle washing wastewaters
• Autobody/repair facility waste waters
• Plating shop waste water
• Manufacturers waste water
• Private service agencies waste water
• Wholesale/retail est. waste water
• Sanitary wastewater/connections
• Mobile rug cleaning waste dumping
• Laundry waste waters
• Disposal of auto/household toxics
WHAT IS NOT AN ILLICIT DISCHARGE:
The following non-stormwater discharges are not illicit
discharges:
• Discharges from firefighting activities
• Potable water sources including dechlorinated
waterline and fire hydrant flushings
• Irrigation drainage
• Lawn watering
• Water from individual residential car washing
• Dechlorinated swimming pool discharges
• Water from crawl space pumps
• Uncontaminated water from foundation or footing
drains
• Routine external building wash down which does
not use detergents or other compounds
• Pavement wash waters where spills or leaks of
toxic or hazardous materials have not occurred
(unless spilled material has been removed) and
where detergents are not use
• Air conditioning condensate
• Springs
• Uncontaminated groundwater
(1.) Property Owner Information:
Determine property owners name, if available, and street address of the discharge source in the event that follow-up
action or elimination is required. If unable to determine owner, write in "undetermined".
(2.) Description of Discharge for source identification/verification.
a. Odor: Determine which odors apply.
b. Clarity: How clear is the discharge?
c. Color: Discharge color and colors in swale, pipe, ditch, etc.(Document if red/green deficient)
d. Solids/Floatables: Identify indicators of source.
Description of Solids/Floatables: • Iron vs. Oil Sheens:
Iron leaches from soils forming a breakable sheen on stagnant water surfaces when poked with a stick. Oil sheens
will conform around and coat the surface of the stick.