NCS000434_Archdale Self Audit_Miller_20201026

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MUNK�PAL SEPARATE STORM SEWER SYSTEM QMS4D
PROGRAM AUDIT REPORT
N PDES PERNT V10o NCSOo CO©XXX
CITY, NORTH CAROLINA
Address
Audit Date: DATE
Report Date: DATE
North Carolina Department of Environmental Quality
Division of Energy, Mineral & Land Resources Stormwater Program
512 N. Salisbury Street, 9th floor
1612 Mail Service Center
Raleigh, SIC 27699-1612

MS4 Permit Audit Report
City, NC: NPDES Permit No. NCSOOOXXX
(This page intentionally left blank)
Audit Date: XXX

MS4 Permit Audit Report
Citv, NC: NPDES Permit No. NCSOOOXXX
TABLE OF CONTENTS
Audit Details..........................................................1
........................................................................................
PermitteeInformation..................................................................................................................................2
SupportingDocuments..................................................................................................................................3
Program Implementation, Documentation & Assessment...........................................................................4
PublicEducation and Outreach.....................................................................................................................8
Public Involvement and Participation.........................................................................................................11
Illicit Discharge Detection and Elimination IDDE.......................................................................13
ConstructionSite Runoff Controls...............................................................................................................16
Post -Construction Site Runoff Controls ............................................... ............•.......•••••.••••••.••••..."'............19
Pollution Prevention and Good Housekeeping for Municipal Operations.................................................25
TotalMaximum Daily Loads TMDLs.........................................................................................28
Site Visit Evaluation: Municipal Facility No. 1.............................................................................................30
Site Visit Evaluation: Municipal Facility No. 2.............................................................................................32
Site Visit Evaluation: MS4 Outfall No. 1......................................................................................................34
Site Visit Evaluation: MS4 Outfall No. 2.................................................... ..................................................36
Site Visit Evaluation: Construction Site No. 1..............................................................................................38
Site Visit Evaluation: Construction Site No. 2..............................................................................................40
Site Visit Evaluation: Post -Construction Stormwater Control Measure No. 1
............................................42
Site Visit Evaluation: Post -Construction Stormwater Control Measure No. 2
............................................44
Appendix A: Supporting Documents
Appendix B: Photograph Log
DISCLAIMER
This audit consists of an evaluation of program compliance with the issued permit and implementation of
the approved Stormwater Management Plan. This audit report does not include a review of all program
components, and program deficiencies in addition to those noted may be present. The permittee is
required to assess program progress and permit compliance, and to implement the approved Stormwater
Management Plan in accordance with the issued permit.
Audit Date: XXX

MS4 Permit Audit Report
City, NC: NPDES Permit No. NCSOOOXXX
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Audit Date: XXX

MS4 Permit Audit Report
City NC NPDES Permit No. NCSOOOXXX
Audit Details
Audit ID Number:
Audit Date(s):
NCS000XXX_City M54 Audit_2019MODAY
Minimum Control Measures Evaluated:
❑ Program Implementation, Documentation & Assessment
❑ Public Education & Outreach
❑ Public Involvement & Participation
❑ Illicit Discharge Detection & Elimination
❑ Construction Site Runoff Controls — No delegated Sediment and Erosion Control Program
❑ Construction Site Runoff Controls — Delegated Sediment and Erosion Control Program
❑ Post -Construction Site Runoff Controls
❑ Pollution Prevention and Good Housekeeping for Municipal Operations
❑ Total Maximum Daily Loads (TMDLs)
Field Site Visits:
❑ Municipal Facilities. Number visited:
❑ MS4Outfalls. Number visited: • :: : �,- _.:: i s ;;:•
❑ Construction Sites. Number visited:
❑ Post -Construction Stormwater Runoff Controls. Number visited::
❑ Other: Number visited:
❑ Other: . Number visited: ,. ,nose .: ic�r::.
Inspector(s) Conducting Audit
Name, Title
Organization
0� 0 0,1 OC, V),Af Ofii B" f
Audit Report Author:
Signature � � �
g
Date:
l 9
Audit Report Author: G
Date
Signature
Audit Date(s): DATE Page 1 of 47

MS4 Permit Audit Report
City, NC: NPDES Permit No. NCSOOOXXX
Permittee Information
MS4 Permittee Name:
C " A-
Permit Effective Date:
2/ZV 1�
Permi Expiration Date:
z 1 :22-
City, State, ZIP: /
4f C� ��>? J � Z ��
Date of Last MS4 Inspection/Audit:
Co-permittee(s), if applicable:
Permit Owner of Record:
Primary MS4 Representatives Participating in Audit
Name, Title
Organization
MS4 Receiving Waters
Waterbody
Classification
Impairments
M.44
Audit Date(s): DATE Page 2 of 47

MS4 Permit Audit Report
Citv. NO NPDES Permit No. NCSOOOXXX
Supporting Documents
When Provided
Item
Document Title (Prior to/During/After)
Number
Audit Date(s): DATE Page 3 of 47

MS4 Permit Audit Report
City, NC: NPDES Permit No. NCSOOOXXX
Program Implementation, Documentation & Assessment
Staff Interviewed:
(Name, Title, Role)
Permit Citation
Program Requirement
Status
Supporting
Doc No.
Staffing and
The permittee maintained adequate funding and staffing to implement and manage
the the Stormwater Plan
"`
S;:
t �- 2
Funding
provisions of and meet all requirements of the permit.
;,C
The Stormwater Plan identifies a specific position(s) responsible for the overall
_se
coordination, implementation, and revision to the Plan.
pc
Responsibilities for all components of the Stormwater Plan are documented and
2
position(s) assignments provided.
!J1
The permittee is current on payment of invoiced administering and compliance
monitoring fees (see stormwatere-payments on DEMLR MS4 web page).
Comments (Briefly describe funding mechanism, number of staff, etc.)
II.A.2 Stormwater
Plan
The permittee evaluated the performance and effectiveness of the program
ee_e
)tc 2
Implementation
components at least annually.
nf- -,s.
and Evaluation
If yes, the permittee used the results of the evaluation to modify the program
Jic0Se
components as necessary to accomplish the intent of the Stormwater Program.
Did the permitted MS4 discharges cause or contribute to non -attainment of an
11 CO
SCE 2�
applicable water quality standard?
�2;•�
If yes, did the permittee expand or better tailor its BMPs accordingly to address
:cos,
the non -attainment?
Comments
I
Audit Date(s): DATE Page 4 of 47

MS4 Permit Audit Report
City, NC: NPDES Permit No. NCSOOOXXX
Irogram Implementation, Documentation & Assessment
Keeping the The permittee kept the Stormwater Plan up to date.?
Stormwater Plan
Up to Date
The permittee notified DEMLR of any updates to the Stormwater Plan.
Comments (Indicate the date of latest Stormwater plan and describe the nature of any updates, if applicable).
II.A.4 Availability The permittee kept an up-to-date version of its Stormwater Plan available to the i� Jcc Z
of the Stormwater Division and the public online. `—' �'C-i '
Plan pa�
The online materials included ordinances, or other regulatory mechanisms, or a list
identifying the ordinances, or other regulatory mechanisms, providing the legal
authority necessary to implement and enforce the requirements of the permit.
Comments (Note what materials are available on line)
II.A.3 & II.A.S
Stormwater Plan Did DEMLR require a modification to the Stormwater Plan?
Modifications
If yes, did the permittee complete the modifications in accordance with the ;
established deadline?
Comments (Note date of DEMLR notification, modifications required, and date modifications were completed, as applicable)
II.A.6 Sharing ScC 2,�
Responsibility Are any control measures implemented by an entity other than the permittee?
✓T -;, .
If yes, is there a written agreement in place?
Comments (List the specific control measures implemented by others that do not have adequate written agreements, if
applicable)
I.A.7 r o �. 2 4
The permittee maintained written procedures for implementing the six minimum
Written control measures.
Procedures
Written procedures identified specific action steps, schedules, resources and
responsibilities for implementing the six minimum measures.
Comments (List the specific minimum measures that do not have adequate written procedures, if applicable)
Audit Date(s): DATE Page 5 of 47

MS4 Permit Audit Report
City, NC: NPDES Permit No. NCSOOOXXX
Program Implementation, Documentation & Assessment
III. A
The permittee maintained documentation of all program components including, but
Program
not limited to, inspections, maintenance activities, educational programs,
J ^_
Documentation
implementation of BMPs, enforcement actions etc., on file for a period of five years.
Comments (List the specific program components that do not have adequate documentation on file and why, if applicable)
III_B
The permittee submitted annual reports to the Department within twelve months
Annual Report
from the effective date of the permit (See Section III.B. for the annual reporting
Submittal
period specific to this MS4).
The permittee submitted subsequent annual reports every twelve months from the
scheduled date of the first annual report submittal.;
The Annual Reports included appropriate information to accurately describe the progress, status, and results
of the permittee's Stormwater Plan, including, but not limited the following:
I. A detailed description of the status of implementation of the Stormwater Plan
as a whole. This will include information on development and implementation
of each major component of the Stormwater Plan for the past year and
schedules and plans for the year following each report.
2. An adequate description and justification of any proposed changes to the
` /
Stormwater Plan. This will include descriptions and supporting information for
I
the proposed changes and how these changes will impact the Stormwater
i::e:-; '.
Plan (results, effectiveness, implementation schedule, etc.).
3. Documentation of any necessary changes to programs or practices for
"
assessment of management measures implemented through the Stormwater
Plan.:
4. A summary of data accumulated as part of the Stormwater Plan throughout
the year along with an assessment of what the data indicates in light of the
Stormwater Plan.
5. An assessment of compliance with the permit, information on the
establishment of appropriate legal authorities, inspections, and enforcement
Y
actions.''"
Comments (Note dates
that annual reports cover under current permit and generally describe report deficiencies, if any)
111.13
Annual Reporting
The Annual Reports document the following:
I. A summary of past year activities, including where applicable, specific
quantities achieved and summaries of enforcement actions.
ai
2. A description of the effectiveness of each program component.
3. Planned activities and changes for the next reporting period, for each
program component or activity.
c �2
Vie;
Audit Date(s): DATE Page 6 of 47

M54 Permit Audit Report
rity NC- NPDES Permit No. NCSOOOXXX
-Grogram implementaticn, Documentation & Assessment
4. Fiscal analysis.
Comments (Note dates that annual reports cover under current permit and generally describe report deficiencies, if any)
Page 7 of 47
Audit Date(s): DATE

MS4 Permit Audit Report
City, NC: NPDES Permit No. NCSOOOXXX
Public Education and Outreach
Staff Interviewed:
(Name, Title, Role)
Permit Citation
Program Requirement Status Supporting
Doc No.
11.B.2.a
Goals and
The permittee defined goals and objectives of the Local Public Education and Scc
Outreach Program based on community wide issues..;.
Objectives
Comments (Generally describe process for establishing goals/objectives)
II.B.2.b
Target Pollutants
The permittee maintained a description of the target pollutants and/or stressors and
likely sources.
JAG
Comments (List (List target pollutants, note any that are missing or not appropriate)
11.B.2.c
The perrriittee identified, assessed annually and updated the description of the target
`'
Target Audiences
audiences likely to have significant storm water impacts and why they were selected.,,
Comments (Describe any changes made, if applicable) w n, r�
/" N S G w lc ofCei
�^� �'l l oft r (JI r� F'r• w�. I S WG S ('xx1 rt cG�
Audit Date(s): DATE Page 8 of 47

MS4 Permit Audit Report
ri+., fair. KIPr1FS Permit Kin nlc•,;nnnxxx
®iihiir rrllierntinn and Outreach
II.B.2.d Residential
and Industrial/
The permittee described issues, such as pollutants, the likely sources of those
pollutants, potential impacts, and the physical attributes of stormwater runoff in
_
Y.t
Commercial Issues
their education/outreach program.
Comments (Generally describe the residential/industrial/commercial issues addressed)
l n/
J)Y)W,k S ) ff,44 Aj I; 2ve,.4S
4V- � 0 ne
11.B.2.e
Informationalr'.,
The permittee promoted and maintained an internet web site designed to convey the
r-1
Web Site
program's message.
..
Comments (list web page address andgeneralcontents, or attach/ screen shot of landing page)
�u✓w •GdCN��'L —Al[r . 0✓�Q�Cindu�L/.s•I-�'/w+w�—�'+oHr��^�' .
5 ,/
n
C a ✓t ,11 icy o,pi
1/4r/'PA
II.B.2.f
The permittee distributed stormwater educational material to appropriate target
Public Education
groups.
Materials
Comments (List distributed materials and quantity, message, distribution mechanism, target audience for each if not included in
program documentation/annual reporting) /�)` IC D_ 6J
G,J UcJs ? I� 1`( "
II.B.2.
The permittee promoted and maintained a stormwater hotline/helpline for the
Hotline/Help Line
purpose of public education and outreach. -'
Comments (Note h time contact information and method(s) for advertising it)
vN wcJ� Nam- r r� �( -
•M P --
11.B.2.h
The permittee's outreach program, including those elements implemented locally or
through a cooperative agreement, included a combination of approaches designed to
CA
J
reach the target audiences.
Audit Date(s): DATE Page 9 of 47

MS4 Permit Audit Report
City, NC: NPDES Permit No. NCSOOOXXX
flc EducaUen and Ooutreaach
F
Education
utreach
For each media, event or activity, including those elements implemented locally or
Program
through a cooperative agreement the permittee estimated and recorded the extent
of exposure.
Comments (Generally describe approaches, extent of exposure. Note any cooperating entities, agr ements and scope of services,
or reference comments in Section B.A.6. above.) �'
r I V
V idc $
Additional
Comments:
Audit Date(s): DATE Page 10 of 47

MS4 Permit Audit Report
r ;i-%, Kir- NIPr1FC Permit Kin nircnnnxxx
Public Involvement and Participation
Staff Interviewed:
(Name, Title, Role)
Permit Citation
Program Requirement
Status Supporting
No.
II.C.2.a Volunteer
Community
('Doc
The permittee included and promoted volunteer opportunities designed to promote
Involvement
ongoing citizen participation.
Program
Comments (Note opportunities promoted and date(s)II of volunteer events) )
Pe rs Uo� fin l
d f "W1 J i�orl p.�� Ivl
V
I� I
I I.C.2.b
Mechanism for
The permittee provided and promoted a mechanism for public involvement that
r e
J11
Public
provides for input on stormwater issues and the stormwater program.
Involvement
Comments (Note mechanism(s) for input and how promoted)
II.C.2.c
The permittee promoted and maintained a hotline/helpline for the purpose of public
Se
� 2
Hotline/Help Line
involvement and participation.
Comments (Note hotline contact information and how it is promoted)
� 1 ''� GS'1 'CS 1 I "4-'j "G'
Audit Date(s): DATE
Page 11 of 47

M54 Permit Audit Report
City, NC: NPDES Permit No. NCSOOOXXX
PubUc �nvo�vernent and Participation
Additional
Comments:
Audit Date(s): DATE Page 12 of 47

MS4 Permit Audit Report
City, NC: NPDES Permit No. NCSOOOXXX
illicit Discharge Detection and Elimination (IDDE)
Staff Interviewed:
(Name, Title,
Role)
Status Supporting
Permit Citation Program Requirement (nDoc No.
II.D.2.a JCGq
IDDE Program The permittee maintained a written IDDE Program.
S
If yes, the written program includes provisions for program assessment and
evaluation and integrating program.
Comments (Note any deficiencies)
I I. D.2. b
Legal Authorities
Comments
The permittee maintained an IDDE ordinance or other regulatory mechanism(s) that q
provides the legal authority to prohibit illicit connections and discharges to the MS4.
If yes, the ordinance applies throughout the corporate limits of the permittee. -
[Permit Part I.D]
II.D.2.c
The permittee maintained a current map showing major outfalls and receiving
Storm Sewer
streams.
System Map
Comments hn c,•+r3 c, Ap �6 r Gars i vP
erg( 0( '- 4.5 ock- �.F ftl') .. - . , �f-
II.D.2.d The permittee maintained a program for conducting dry weather flow field = SLTq
Dry Weather Flow observations in accordance with written procedures.
Program
Comments (Generally summarize program, including frequency of observations and # or % of outfalls screened)
Audit Date(s): DATE Page 13 of 47

MS4 Permit Audit Report
City, NC: NPDES Permit No. NCSOOOXXX
Illicit Discharge Detection and Elimination (IDDE)
II.D.2.e
Investigation
The permittee maintained written procedures for conducting investigations of
identified illicit discharges.
,
S'eR q
r
Procedures
Comments A(Generally describe what procedures a documented)
"I&,69L, �`� �� ks C Ccv�.�n�S ��a SC,( �t
y
1)D
II.D.2.f
Track and
For each case of an illicit discharge or potential illicit discharge, the permittee documented and tracked the
following:
Document
Investigations
1. The date(s) the illicit discharge was observed
2. The results of the investigation
3. Any follow-up of the investigation
77'J`
4. The date the investigation was closed
Comments (Note whether a standard inspection form is utilized to capture consistent information and a tracking mechanism is
used) f rr_ �D /\l .jr
i��0� ; , hcl-1CS Q_WO t �l t •I l.V 1.'U k
II.D.2.s Employee
Training
The permittee implemented and documented a training program for appropriate
municipal staff who, as part of their normal job responsibilities, may come into
contact with or otherwise observe an illicit discharge or illicit connection. .
Comments (Generally describe t e staff training program, including frequenT and which staff are trai ed)
.h Public
Public Education
The permittee informed public employees of hazards associated with illegal
discharges and improper disposal of waste.
•. J�: is
r
The permittee informed businesses of hazards associated with illegal discharges and
improper disposal of waste.
, o.
The permittee informed the general public of hazards associated with illegal
L463SP
discharges and improper disposal of waste.
Comments (Note how each sector was informed, if applicable) p
e- i L
w. c , .S (_J
A &VAt
x''`e,
UM
Audit Date(s): DATE Page 14 of 47

IVIS4 Permit Audit Report
City NC- NPDES Permit No. NCSOOOXXX
illicit Discharge Detection and Elimination (IDDE)
II.D.2.i
The permittee promoted, publicized, and facilitated a reporting mechanism for the
Public Reporting
public to report illicit discharges.
Mechanism
The permittee promoted, publicized, and facilitated a reporting mechanism for staff
to report illicit discharges.
The permittee established and implemented response procedures for citizen
requests/reports.
Comments (Generally describe reporting mechanisms and how promoted/publicized/facilitated/established)
,,
/A 4-4 ;A Itop
(n -ed ICA-5 6r�d
II— The permittee implemented a mechanism to track the issuance of notices of violation
Enforcement and enforcement actions administered by the permittee. Q
If yes, the mechanism includes the ability to identify chronic violators for
'
initiation of actions to reduce noncompliance.
`= '
Comments (Generally describe the established tracking mechanism, if applicable)
GK.�t �� K/_/v� ice 5 V, 0 u,' I
1 u S try
0,3 J dt S et -► 1 O1 C Lt, , Q '6
Audit Date(s): DATE Page 15 of 47

MS4 Permit Audit Report
City, NC: NPDES Permit No. NCSOOOXXX
Construction Site Runoff Controls
Staff Interviewed:
(Name, Title, Role)
am Delegation Status:
7Th
e permittee has a deleg
ated gated Sediment and Erosion Control Program and implements the North Carolina
Sedimentation Pollution Control Act (SPCA) of 1973 components of this minimum measure (complete the permit
citation and SPCA citation sections).
❑ The permittee does not have a delegated Sediment and Erosion Control Program and relies on DEMLR to comply
with the North Carolina Sedimentation Pollution Control Act (SPCA) of 1973 components of this minimum measure
(complete only the permit citation section).
Permit Citation Program Requirement Status
Supporting
Doc No.
II.E.3 Construction
Site Runoff Controls The permittee provides and promotes a means for the public to notify the
're
(NPDES Permit No. appropriate authorities of observed erosion and sedimentation problems (e.g.,
NCS0004351 promoting the existence of the DEQ DEMLR "Stop Mud" hotline).
Comments (Describe how provided and promoted) I
0�c� ,-i6 )� �e s �'S d) c S J'a r^-
- cA- . c�
P f �' c rtr�
�rr
t aJ- -rFcA4 o�f-c4C
SPCA Citation
Delegated Program Requirement
Status
Supporting
Doc No.
113A-60 Local
erosion and
The permittee has adopted an ordinance or other regulatory mechanism to enforce
the
..0-; 2(1�D
sedimentation
erosion and sedimentation control program.I
J
control programs (a)
If yes, the ordinance meets or exceeds the minimum requirements of the
-' ems:
SPCA.
If yes, the ordinance applies throughout the corporate limits of the permittee.
n; e
�
(Permit Part I. DI
Comments (Provide regulatory mechanism reference or Supporting Documentation number)
§ 113A-60 Local
erosion and
The permittee collects a fee paid by each person who submits an erosion and
sedimentation
sedimentation control plan.
control programs (d)
Audit Date(s): DATE Page 16 of 47

MS4 Permit Audit Report
r•ct%, Kir'• f\IPnFG Permit Nn nlcsnnnxxx
Construction Site Runoff Controls
Comments (indicate the pee amount, it appucamel
§ 113A-60 Local
Has any person initiated a land -disturbing activity (within the permittee's
erosion and
jurisdiction) for which an erosion and sedimentation control plan is required in the
sedimentation
absence of an approved plan?
control programs (e)
If yes, the permittee has notified the North Carolina Sedimentation Control
=
Commission of all such cases.
Has the permittee determined that a person engaged in a land -disturbing activity
I'
has failed to comply with an approved erosion and sedimentation control plan?:_,
.
If yes, has the permittee referred any such matters to the North Carolina
=
Sedimentation Control Commission for inspection and enforcement?
Comments
�(1C,,2 0,JA160�
)A�-
ecac,Qa^
P
113A-61 Local
The permittee reviews each erosion and sedimentation control plan submitted to
approval of erosion
them and notifies the person submitting the plan that it has been approved,
and sedimentation
approved with modification, or disapproved within 30 days of receipt.
control plans
The permittee only approves an erosion and sedimentation control plan upon
determining that it complies with all applicable State and local regulations.
=.:.
The permittee has disapproved of an erosion and sedimentation control plan in
l
order to protect riparian buffers along surface waters.
If yes, the permittee notified the Director of the Division of Energy,
Mineral, and Land Resources within 10 days of the disapproval.
Comments
§ 113A-61.1
Inspection of land-
The certificate of approval of each erosion and sedimentation control plan
disturbing activity;
approved by the permittee includes a notice of the right to inspect.
notice of violation
(a)
The permittee provides for inspection of land -disturbing activities to ensure
5(c.compliance
with the SPCA and to determine whether the measures required in an
erosion and sedimentation control plan are effective.
Comments
Audit Date(s): DATE Page 17 or 4i

MS4 Permit Audit Report
City, NC: NPDES Permit No. NCSOOOXXX
Construction Site Runoff Controls
§ 113A-61.1
When the permittee determines that a person engaged in land -disturbing activity
Inspection of land-
has failed to comply with the SPCA, the Permittee immediately issues a notice of
A! -
disturbing activity;
violation upon that person.
notice of violation
(c)
Each notice of violation issued by the permittee specifies the date by which the
person must comply.
Each notice of violation issued by the permittee informs the person of the actions
K
that need to be taken to comply.
Comments
113A-64 Penalties
Does the permittee issue civil penalties as part of the erosion and sedimentation
program?
.,.
Comments (indicate when/why a civil penalty is issued, and the amount, if applicable)
Ptq4 jl,03/���
, 4" e i l�l
Audit Date(s): DATE Page 18 of 47

MS4 Permit Audit Report
i :.. mr. ^IDr11:4Z Dnrmit Kin nircnnrncxx
Post -Construction Site Runoff Controls
Staff Interviewed:
(Name, Title, Role)
Audit Date(s): DATE Page 19 of 47

MS4 Permit Audit Report
City, NC: NPDES Permit No. NCSOOOXXX
Post -Construction Site Runoff Controls
Implementation (check all that apply):
❑ The permittee implements the components of this minimum measure.
❑ The permittee relies upon another entity to implement the components of this minimum measure: name of entity
The permittee implements the following deemed -compliant program(s), which meet NPDES MS4 post -construction
requirements for the areas where implemented and in compliance with the specific program requirements as provided in 15A
NCAC and noted below (Complete Session Low2006-246 section below):
❑ Water Supply Watershed I (WS-1) — 15A NCAC 213.0212
❑ Water Supply Watershed II (WS-II) —15A NCAC 2B .0214
❑ Water Supply Watershed III (WS-III) —15A NCAC 2B .0215
❑ Water Supply Watershed IV (WS-IV) —15A NCAC 26 .0216
❑ Freshwater High Quality Waters (HQW) —15A NCAC 2H .1006
❑ Freshwater Outstanding Resource Waters (ORW) —15A NCAC 2H .1007
❑ Neuse River Basin Nutrient Sensitive (NSW) Management Strategy —15A NCAC 2B .0235
❑ Tar -Pamlico River Basin Nutrient Sensitive (NSW) Management Strategy —15A NCAC 2B .0258
❑ Randleman Lake Water Supply Watershed Nutrient Management Strategy-15A NCAC 2B .0251
❑ Universal Stormwater Management Program —15A NCAC 2H .1020
Ordinance(s) (check all that apply):
The permittee utilizes the following ordinances and/or regulatory authority to fulfill post construction minimum measure program
requirements throughout the MS4 permitted area (check all that apply):
` ❑ DEQ model ordinance
( IMS4 designed post -construction practices that meet or exceed 15A NCAC 02H .1000.
F)bEQ approved comprehensive watershed plan
❑ DEQ approved ordinance for a deemed -compliant Program (see list above)
Instructions:
For MS4s not implementing a S.L. 2006-246 deemed -compliant program, complete only the Permit Citation section below.
For MS4s implementing a S.L. 2006-246 deemed -compliant program, complete the Session Law 2006-246 section below. If the MS4
does not implement a deemed -compliant program throughout the entire MS4 permitted area, then complete the Permit Citation
section below for the permitted area(s) not covered under the S.L. 2006-246 deemed -compliant program.
Session Law 2006- hD.c:No.
prting
246 Program Requirement Status
Audit Date(s): DATE Page 20 of 47

MS4 Permit Audit Report
City, NC: NPDES Permit No. NCSOOOXXX
Post -Construction Site Runoff Controls
Deemed -Compliant The permittee implements deemed -compliant Program requirements in
Program(s) accordance with the applicable 15A NCAC rules. 'ole _.; .I. J
The permittee implements deemed -compliant Program requirements throughout
the entire MS4 area (If not, also complete the Permit Citation section below.)
Jf 1".1.
The permittee applies deemed -compliant Program requirements to all federal,
state and local government projects within the permitted MS4 area who do not
�S
have their own NPDES stormwater permit.
The permittee included deemed -compliant Program reporting in their MS4 Annual
Reports.
The permittee included deemed -compliant Program implementation in their
P.
Stormwater Management Plan.
Comments
Permit Citation
Status Supporting
Program Requirement Doc No.
II.F.2.a
The permittee maintained an ordinance or other regulatory mechanism designed e �� t
Legal Authority
to meet the objectives of the Post -Construction Site Runoff Controls Stormwater �n
Management Program.
If yes, the ordinance applies throughout the corporate limits of the permittee
(Verify permit coverage area listed in Part I.D of permit and modify.
accordingly).
The permittee has the authority to review designs and proposals for new
development and redevelopment to determine whether adequate stormwater
control measures will be installed, implemented, and maintained.
The permittee has the authority to request information such as stormwater plans,
inspection reports, monitoring results, and other information deemed necessary tom=
evaluate compliance with the Post -Construction Stormwater Management
Program.
The permittee has the authority to enter private property for the purpose of
inspecting at reasonable times any facilities, equipment, practices, or operationsi°
related to stormwater discharges.
Comments (if the permittee relies upon another entity, specifically note the legal authority that allows that entity to implement
the program within the MS4 area)
II.F.2.b
Stormwater Control The permittee utilizes strategies which include SCMs appropriate for the MS4.
Measures (SCMs)
SCMs comply with 15A NCAC 02H .1000.
Audit Date(s): DATE
Page 21 of 47

MS4 Permit Audit Report
City, NC: NPDES Permit No. NCSOOOXXX
Post -Construction Site Runoff Controls
Lommenn
II.F.2.c
The permittee conducted site plan reviews of all new development and
S`
Plan Reviews
redeveloped sites that disturb greater than or equal to one acre (including sites
2
I
that disturb less than one acre that are part of a larger common plan of
P
development or sale).
If yes, the site plan reviews addressed how the project applicant meets the:•:
performance standards.
, ;:.•.:a
If yes, the site plan reviews addressed how the project will ensure long-term
maintenance.:
Comments
II.F.2.d
The permittee maintained an inventory of projects with post -construction
Inventory of Projects
structural stormwater control measures installed and implemented at new
development
and redeveloped sites.
The inventory included both public and private sector sites located within the
permittee's corporate limits that are covered by its post -construction ordinance
�^
requirements.
-
Comments
I I. F.2.e
Deed Restrictions
The permittee provided mechanisms such as recorded deed restrictions and
and Protective
protective covenants that ensure development activities will maintain the project
y `
Covenants
consistent with approved plans.
='
Comments
II.F.2.f
Mechanism to
The permittee implemented or required an operation and maintenance plan for
the long-term operation the SCMs by
Require Long-term
of required the program.,
Operation and
Maintenance
The operation and maintenance plan required the owner of each SCM to perform
`�.
f
and maintain a record of annual inspections of each SCM.
Annual inspection of permitted structural SCIVIs are required to be performed by a
qualified professional�"
ye
4&-,
Comments
Audit Date(s): DATE Page 22 of 47

MS4 Permit Audit Report
City, NC: NPDES Permit No. NCSOOOXXX
Post -Construction Site Runoff Controls
II.F.2.g
The permittee conducted and documented inspections of each project site covered
_
Inspections of
under performance standards, at least one time during the permit term (Verify this
Structural
is a permit condition in Part II.F.2.g of permit and modify accordingly).
Stormwater Control
Before issuing a certificate of occupancy or temporary certificate of occupancy, the
Measures
permittee conducted a post -construction inspection to verify that the permittee's
performance standards have been met or a bond is in place to guarantee
completion(Verify this is a permit condition in Part II.F.2.g of permit and modify
accordingly.
The permittee developed and implemented a written inspection program for SCMs
installed pursuant to the post -construction program(Verify this is a permit
e
condition in Part II.F.2.g of permit and modify accordingly.
The permittee documented and maintained records of inspections.
The permittee documented and maintained records of enforcement actions.
Comments `�o�A��`n V'� I l�
3tzr- YO LA.Fd1t;
II.F.2.h
The permittee made available through paper or electronic means, ordinances,
Educational
post -construction requirements, design standards checklists, and other materials
Materials and
Training for
appropriate for developers.
Note: New materials may be developed by the permittee, or the permittee may use
=...
Developers
materials adopted from other programs and adapted to the permittee's new
development and redevelopment program.
Comments (If the permittee has adopted materials from other programs, indicate here which materials they are using)
L - )t'\�uv', , J') � I v (Ard S ,
II.F.2.i Enforcement
The permittee tracked the issuance of notices of violation and enforcement
actions.`''
If yes, the tracking mechanism included the ability to identify chronic violators
for initiation of actions to reduce noncompliance./
Comments r01 1 /_
II.F.3.b
New Development
Comments
The permittee fully complies with post construction program requirements on its
own publicly funded construction projects.
Audit Date(s): DATE Page z3 of 47

MS4 Permit Audit Report
City, NC: NPDES Permit No. NCSOOOXXX
Post -Construction Site Runoff Controls
I1.F.3.c
Does the MS4 have areas draining to Nutrient Sensitive Waters (NSW) pursuant to
Nutrient Sensitive
15A NCAC 02H .0150?
Waters
If yes, does the permittee use SCMs that reduce nutrient loading in order to
_
meet local program requirements.
_.
If yes, does the permittee also still incorporate the stormwater controls
=
required for the project's density level.
If yes, does the permittee also require documentation where it is not feasible to
use SCMs that reduce nutrient loading.
Comments (Provide reference for local requirements)
II.F.3.d
The permittee ensured that the design volumes of SCMs take into account the
-
Design Volume
runoff at build out from all surfaces draining to the system.
Where "streets" convey stormwater, the permittee designed SCMs to be sized to
treat and control stormwater runoff from all surfaces draining to the SCM including
streets, driveways, and other impervious surfaces.
Comments
Audit Date(s): DATE Page 24 of 47

MS4 Permit Audit Report
r'tty hl(-- KIPr)FC Permit Nn nicsnnnxxx
Pollution Prevention and Good Housekeeping for Municipal Operations
Staff Interviewed:
(Name, Title, Role)
Permit Citation
Status Supporting
Program Requirement Doc No.
II.G.2.a
The permittee maintained a current inventory of facilities and operations owned 94iZ
Facility Inventory
and operated by the permittee with the potential for generating polluted cc
stormwater runoff.
Comments (Note number of facilities, typical inventory data andl any facilities that are not inventoried that should be)
7Gc r�-�ilS(Yv�u�ic� � — Ue�,�c��S. p ���e%le�`e� ,.�C
II.G.2.b
The permittee maintained and implemented an O&M program for municipally
c" ..
S12
Operation and
owned and operated facilities with the potential for generating polluted�_'.,
Maintenance (O&M)
stormwater runoff.
for Facilities
If yes, the 0&M program specifies the frequency of inspections.
..,
If yes, the 0&M program specifies the frequency of routine maintenance
7C)_
«
requirements.
If yes, the permittee evaluated the O&M program annually and updated it as
rc
necessary.
Comments
II.G.2.c
Spill Response
The permittee had written spill response procedures for municipal operations.
Procedures
Comments
II.G.2.d Streets,
The permittee evaluated existing and new BMPs that reduce polluted stormwater
lots within its
Sep �1
Roads, and Public
runoff from municipally -owned streets, roads, and public parking
corporate limits annually.
Audit Date(s): DATE Page z5 of 41

MS4 Permit Audit Report
City, NC: NPDES Permit No. NCSOOOXXX
Pollution Prevention and Good Housekeeping for Municipal Operations
Parking lots
Maintenance
If yes, the permittee evaluated the effectiveness of existing and new BIVIPs
SzG
based on cost and the estimated quantity of pollutants removed.
Comments
II.G.2.f
O&M for Catch
The permittee maintained and implemented an 0&M program for the stormwater
l�
Basins and
sewer system including catch basins and conveyance systems that it owns and
`
Conveyance Systems
maintains.
Comments (Briefly describe O&M program)
II•G•2•g
The permittee maintained a current inventory of municipally -owned or operated
Structural
structural stormwater controls installed for compliance with the permittee's post-
Stormwater Controls
construction ordinance.
Comments (Describe inventory informati nand number of controls in inventory) r
II.G.2.h
The permittee maintained and implemented an 0&M program for mu icipally-
O&M for Structural
owned or maintained structural stormwater controls installed for compliance with
to
Stormwater Controls
the permittee's post -construction ordinance. If yes, then:
The 0&M program specified the frequency of inspections and routine
maintenance requirements.;L
•. -.
The permittee documented inspections of all municipally -owned or maintained
" 0 ,sc
structural stormwater controls.
The permittee inspected all municipally -owned or maintained structural�
stormwater controls in accordance with the schedule developed by permittee.
The permittee maintained all municipally -owned or maintained structural
stormwater controls in accordance the developed by
^^
with schedule permittee.
an- 'L *{;
The permittee documented maintenance of all municipally -owned or
S2
maintained structural stormwater controls.
Commentb /M I%,7�f a-e of G._A� . ti 6C alk
II.G.2.J
The permittee ensured municipal employees are properly trained in pesticide,
-
,irn.
herbicide and fertilizer application management.
Audit Date(s): DATE Page 26 of 47

IVIS4 Permit Audit Report
Citv. NC: NPDES Permit No. NCSOOOXXX
PnIluti®n Prevention and Good Housekeeping for Municipal Operations
Pesticide, Herbicide
The permittee ensured contractors are properly trained in pesticide, herbicide and
and Fertilizer
Application
fertilizer application management.'
Management
The permittee ensured all permits, certifications, and other measures for
e'
applicators are followed.
Comments
44
4
l
)� G�,
II.G.2.j
The permittee implemented an employee training program for employees involved
., ..
Staff Training
in implementing pollution prevention and good housekeeping practices.
Comments G�'.,' _ ..% ry I M �d�VQS "S1 1� �CI�{ I )(IB^('cl�
II.G.2.k
The permittee described and implemented measures that prevent or minimize
from for vehicle and equipment
Vehicle and
contamination of stormwater runoff all areas used
Equipment Cleaning
cleaning.
Comments
Audit Date(s): DATE Page 27 of 47

MS4 Permit Audit Report
City, NC: NPDES Permit No. NCSOOOXXX
Total Maximum Daily Loads (TMDLs)
Staff Interviewed:
(Name, Title, Role)
Program Status:
❑ The permittee is not subject to an approved TMDL (skip the rest of this section).
❑ The permittee is subject to an approved TMDL for: name of parameter(s) and date(s) approved
There ❑ is ❑ is not a Waste Load Allocation (WLA) in the approved TMDL (If there is a WLA, then complete items II.H.1-5
below. If there is not a WLA, skip to item I/.H.6 below)
Permit Citation Program Requirement
Status
Supporting
Doc No.
II.H.3 TMDLs Within 12 months of final TMDL approval, the permittee's annual reports included
a description of existing programs, controls, partnerships, projects and strategies to
-
address impaired waters.
Within 12 months of final TMDL approval, the permittee's annual reports provided
a brief explanation as to how the programs, controls, partnerships, projects and
strategies address impaired waters.
n is M.
II.H.4 TMDLs Within 24 months of final TMDL approval, the permittee's annual reports included
an assessment of whether additional structural and/or non-structural BMPs are
necessary to address impaired waters.
Within 24 months of final TMDL approval, the permittee's annual reports included
a brief explanation as to how the programs, controls, partnerships, projects and
strategies address impaired waters.
Comments
II.H.5 TMDLs Within 36 months of final TMDL approval, the permittee's annual reports included
a description of activities expected to occur and when activities are expected to
occur.
an.
Audit Date(s): DATE Page 28 of 47

MS4 Permit Audit Report
City, NC: NPDES Permit No. NCSOOOXXX
Total Maximum Daily Loads (TMDLs)
Comments
II.H.6 TMDLs If there is no Waste Load Allocation in the approved TMDL, the permittee
evaluated strategies and tailored and/or expanded BMPs within the scope of the
six minimum measures to enhance water quality recovery strategies in the rr:.
watershed(s) to which the TM DL applies.
The permittee described strategies and tailored and/or expanded BMPs in their =
Stormwater Management Plan and annual reports
Comments
Audit Date(s): DATE Page 29 of 47

MS4 Permit Audit Report
City, NC: NPDES Permit No. NCSOOOXXX
Site Visit Evaluation: Municipal Facility No. 1
Facility Name:
Date and Time of Site Visit:
Facility Address:
Facility Type (Vehicle Maintenance, Landscaping, etc.):
Name of MS4 inspector(s) evaluated:
Most Recent MS4 Inspection (List date and name of inspector):
Name(s) and Title(s) of Facility Representative(s) Present During the Site Visit:
Name
Title
Observations
Facility Documentation/Training
Does the facility have a Stormwater Pollution Prevention Plan (SWPPP) or similar document? Is it facility -specific?
What type of stormwater training do facility employees receive? How often?
Inspector Training/Knowledge
What type of stormwater training does the MS4 inspector receive? How often?
Did the MS4 inspector appear knowledgeable about Permit requirements for pollution prevention and good housekeeping?
Did the MS4 inspector appear knowledgeable about stormwater pollution prevention and good housekeeping?
Inspection Procedures
Does the MS4 inspector's process include the use of a checklist or other standardized form?
Does the MS4 inspector's process include taking photos?
Does the MS4 inspector's process include reviewing the facility's SWPPP (or similar document)?
Audit Date(s): DATE Page 30 of 47

MS4 Permit Audit Report
City, NC: NPDES Permit No. NCSOOOXXX
Site Visit Evaluation: Municipal Facility No. 1
Does the MS4 inspector's process include walking the entire facility and inspecting all points of discharge?
Did the MS4 inspector miss any obvious areas of concern? If so, explain:
Does the MS4 inspector's process include presenting the inspection findings to the facility contact?
Inspection Results
Did the facility inspection result in any corrective actions to be implemented? If so, for what issue(s)?
If compliance corrective actions were identified, what timeline for correction/follow-up was provided?
Notes/Comments/Recommendations
Audit Date(s): DATE rage 51 or 41

MS4 Permit Audit Report
City, NC: NPDES Permit No. NCSOOOXXX
Site Visit Evaluation: Municipal Facility No. 2
Facility Name:
Date and Time of Site Visit:
Facility Address:
Facility Type (Vehicle Maintenance, Landscaping, etc.):
Name of MS4 inspector(s) evaluated:
Most Recent MS4 Inspection (Date and Entity):
Name(s) and Title(s) of Facility Representative(s) Present During the Site Visit:
Name
Title
Observations
Facility Documentation/Training
Does the facility have a Stormwater Pollution Prevention Plan (SWPPP) or similar document? Is it facility -specific?
What type of stormwater training do facility employees receive? How often?
Inspector Training/Knowledge
What type of stormwater training does the MS4 inspector receive? How often?
Did the M54 inspector appear knowledgeable about Permit requirements for pollution prevention and good housekeeping?
Did the MS4 inspector appear knowledgeable about stormwater pollution prevention and good housekeeping?
Inspection Procedures
Does the MS4 inspector's process include the use of a checklist or other standardized form?
Does the MS4 inspector's process include taking photos?
Does the MS4 inspector's process include reviewing the facility's SWPPP (or similar document)?
Audit Date(s): DATE Page 32 of 47

MS4 Permit Audit Report
City, NC: NPDES Permit No. NCSOOOXXX
Site Visit Evaluation: Municipal Facility No. 2
Does the MS4 inspector's process include walking the entire facility and inspecting all points of discharge?
Did the MS4 inspector miss any obvious areas of concern? If so, explain:
Does the MS4 inspector's process include presenting the inspection findings to the facility contact?
Inspection Results
Did the facility inspection result in any corrective actions to be implemented? If so, for what issue(s)?
If compliance corrective actions were identified, what timeline for correction/follow-up was provided?
Notes/Comments/Recommendations
Audit Date(s): DATE rage :5s or 4i

MS4 Permit Audit Report
City, NC: NPDES Permit No. NCSOOOXXX
Site Visit Evaluation: MS4 Outfall No. I
Outfall ID Number:
Date and Time of Site Visit:
Outfall Location:
Outfall Description (Pipe Material/Diameter, Culvert, etc.):
Receiving Water:
Is Flow Present? If So, Describe (Color, Approximate Flow Rate,
Sheen, Odor, Floatables/Debris, etc.):
Most Recent Outfall Inspection/Screening (Date):
Days Since Last Rainfall:
Inches:
Name of MS4 Inspector(s) evaluated:
Observations
Inspector Training/Knowledge
What type of stormwater training does the MS4 inspector receive? How often?
Did the MS4 inspector appear knowledgeable about illicit discharge indicators and investigations?
Inspection Procedures
Does the inspector's process include the use of a checklist or other standardized form?
Does the inspector's process include taking photos?
Did the MS4 inspector miss any obvious potential illicit discharge indicators or maintenance issues? If so, what were they?
Audit Date(s): DATE Page 34 of 47

M54 Permit Audit Report
rt+„ mr. KIPhFC Permit Mn i\wrnnnxxx
Site Visit Evan uaUon- NAS4 Outfaf0 No. I
inspection Results
Did the outfall inspection result in any work orders or maintenance requests? If so, for what issue(s)?
Will a follow-up outfall inspection be conducted? If so, for what reason?
Notes/Comments/Recommendations
Audit Date(s): DATE rage 55 or 141

MS4 Permit Audit Report
City, NC: NPDES Permit No. NCSOOOXXX
Site Visit Evaluation. MS4 Outfall IV®, 2
Outfall ID Number:
Date and Time of Site Visit:
Outfall Location:
Outfall Description (Pipe Material/Diameter, Culvert, etc.):
Receiving Water:
Is Flow Present? If So, Describe (Color, Approximate Flow Rate,
Sheen, Odor, Floatables/Debris, etc.):
Most Recent Outfall Inspection/Screening (Date):
Days Since Last Rainfall:
Inches:
Name of MS4 Inspector(s):
Observations
Inspector Training/Knowledge
What type of stormwater training does the MS4 inspector receive? How often?
Did the MS4 inspector appear knowledgeable about illicit discharge indicators and investigations?
Inspection Procedures
Does the inspector's process include the use of a checklist or other standardized form? Obtain copy.
Does the inspector's process include taking photos?
Did the MS4 inspector miss any obvious potential illicit discharge indicators or maintenance issues? If so, what were they?
Audit Date(s): DATE Page 36 of47

MS4 Permit Audit Report
City, NC: NPDES Permit No. NCSOOOXXX
Site Visit Evaluation: MS4 Outfall No. 2
Inspection Results
Did the outfall inspection result in any work orders or maintenance requests? If so, for what issue(s)?
Will a follow-up outfall inspection be conducted? If so, for what reason?
Notes/Comments/Recommendations
Audit Date(s): DATE Page 37 of 47

MS4 Permit Audit Report
City, NC: NPDES Permit No. NCSOOOXXX
7SIte'Visit Evaluation: Construction Site No. I
Site/Project Name:
Date and Time of Site Visit: q
Site/Project Address:
Operator:
Project Type (Commercial, Industrial, Residential, CIP, Roadway,
etc.):
NCG Permit ID Number:
Disturbed Acreage:
Recent Enforcement Actions (Include Date):
Name of MS4 Inspector(s) evaluated:
Name(s) and Title(s) of Site Representative(s) Present During the
Site Visit:
Name
Title
Observations
Site Documentation/Training
Does the site have a Stormwater Pollution Prevention Plan (SWPPP) or similar document? Is it site -specific?
Does the site have approved erosion and sedimentation control plans onsite? Are they representative of current site conditions?
What type of stormwater training do site employees receive? How often?
Inspector Training/Knowledge
What type of stormwater training does the MS4 inspector receive? How often?
Did the M54 inspector appear knowledgeable about MS4 and NCG010000 requirements for construction sites?
Did the MS4 inspector appear knowledgeable about erosion and sedimentation control/stormwater pollution prevention BMPs?
Audit Date(s): DATE Page 38 of 47

MS4 Permit Audit Report
City, NC: NPDES Permit No. NCSOOOXXX
Site Visit (Evaluation: Construction Site No. I
Inspection Procedures
Does the MS4 inspector's process include the use of a checklist?
Does the MS4 inspector's process include taking photos?
Does the MS4 inspector's process include reviewing approved plans (erosion and sedimentation control and/or SWPPP)?
Does the MS4 inspector's process include walking the entire site and inspecting all points of discharge?
Did the MS4 inspector miss any obvious violations? If so, explain:
Does the MS4 inspector's process include presenting the inspection findings to the site contact in writing?
Does the MS4 inspector's process include providing construction stormwater educational materials to the site contact?
Compliance/Enforcement
What, if any, enforcement actions (verbal warnings, NOV, etc.) did the inspection result in?
If compliance issues were identified, what timeline for correction/follow-up was provided?
Notes/Comments/Recommendations
Audit Date(s): DATE rake 3V vi 1+1

MS4 Permit Audit Report
City, NC: NPDES Permit No. NCSOOOXXX
Site Visit Evaluation: Construction Site No. a
Site/Project Name:
Date and Time of Site Visit:
Site/Project Address:
Operator:
Project Type (Commercial, Industrial, Residential, CIP, Roadway,
etc.):
NCG Permit ID Number:
Disturbed Acreage:
Recent Enforcement Actions (Include Date):
Name of MS4 Inspector(s) evaluated:
Name(s) and Title(s) of Site Representative(s) Present During the Site Visit:
Name
Title
Observations
Site Documentation/Training
Does the site have a Stormwater Pollution Prevention Plan (SWPPP) or similar document? Is it site -specific?
Does the site have approved erosion and sedimentation control plans onsite? Are they representative of current site conditions?
What type of stormwater training do site employees receive? How often?
Inspector Training/Knowledge
What type of stormwater training does the MS4 inspector receive? How often?
Did the MS4 inspector appear knowledgeable about MS4 and NCG010000 requirements for construction sites?
Did the MS4 inspector appear knowledgeable about erosion and sedimentation control/stormwater pollution prevention BMPs?
Audit Date(s): DATE Page 40 of 47

MS4 Permit Audit Report
City, NO NPDES Permit No. NCSOOOXXX
Site Visit Evaluation: Construction Site No. 2
Inspection Procedures
Does the MS4 inspector's process include the use of a checklist? Obtain copy.
Does the MS4 inspector's process include taking photos?
Does the MS4 inspector's process include reviewing approved plans (erosion and sedimentation control and/or SWPPP)?
Does the MS4 inspector's process include walking the entire site and inspecting all points of discharge?
Did the MS4 inspector miss any obvious violations? If so, explain:
Does the MS4 inspector's process include presenting the inspection findings to the site contact in writing?
Does the MS4 inspector's process include providing construction stormwater educational materials to the site contact?
Compliance/Enforcement
What, if any, enforcement actions (verbal warnings, NOV, etc.) did the inspection result in?
If compliance issues were identified, what timeline for correction/follow-up was provided?
Notes/Comments/Recommendations
Audit Date(s): DATE Page 41 of 47

M54 Permit Audit Report
City, NC: NPDES Permit No. NCSOOOXXX
Site Visit Evaluation: Post -Construction Stormwater Control measure No. 1
Site Name:
Date and Time of Site Visit:
Site Address:
SCM Type:
Most Recent MS4 Inspection (Include Date and Entity):
Name of MS4 Inspector(s) evaluated:
Most Recent M54 Enforcement Activity (Include Date):
Name(s) and Title(s) of Site Representative(s) Present During the Site Visit:
Name
Title
Observations
Site Documentation
Does the site have an operation and maintenance plan?
Does the site have records of annual inspections? Are they performed by a qualified individual?
Inspector Training/Knowledge
What type of stormwater training does the MS4 inspector receive? How often?
Did the MS4 inspector appear knowledgeable about MS4 requirements for post -construction site runoff controls?
Did the MS4 inspector appear knowledgeable about post -construction BMPs (general purpose/function, components, O&M
requirements, etc.)?
Inspection Procedures
Does the MS4 inspector's process include the use of a checklist or other standardized form? What format?
Does the MS4 inspector's process include taking photos?
Does the MS4 inspector's process include reviewing the site's operation and maintenance plan and records of annual inspections?
Audit Date(s): DATE Page 42 of 47

MS4 Permit Audit Report
City. NC NPDES Permit No. NCS000XXX
Site Visit Evaluation: Post -Construction Stormwater Control Measure No. 1
Does the MS4 inspector's process include walking the entire site and inspecting all points of discharge?
Did the MS4 inspector miss any obvious operation and maintenance deficiencies? If so, explain:
Does the MS4 inspector's process include presenting the inspection findings to the site contact in writing?
Compliance/Enforcement
What, if any, enforcement actions (verbal warnings, NOV, etc.) did the inspection result in?
If compliance issues were identified, what timeline for correction/follow-up was provided?
Notes/Comments/Recommendations
Audit Date(s): DATE Page 43 of 47

MS4 Permit Audit Report
City, NC: NPDES Permit No. NCSOOOXXX
Site Visit Evaluation: Post -Construction Storrnwaater Control Measure No. 2
Site Name:
Date and Time of Site Visit:
Site Address:
SCM Type:
Most Recent MS4 Inspection (Include Date and Entity):
Name of MS4 Inspector(s) evaluated:
Most Recent MS4 Enforcement Activity (Include Date):
Name(s) and Title(s) of Site Representative(s) Present During the Site Visit:
Name
Title
Observations
Site Documentation
Does the site have an operation and maintenance plan?
Does the site have records of annual inspections? Are they performed by a qualified individual?
Inspector Training/Knowledge
What type of stormwater training does the MS4 inspector receive? How often?
Did the MS4 inspector appear knowledgeable about MS4 requirements for post -construction site runoff controls?
Did the MS4 inspector appear knowledgeable about post -construction BMPs (general purpose/function, components, 0&M
requirements, etc.)?
Inspection Procedures
Does the MS4 inspector's process include the use of a checklist or other standardized form? What format?
Does the MS4 inspector's process include taking photos?
Does the MS4 inspector's process include reviewing the site's operation and maintenance plan and records of annual inspections?
Audit Date(s): DATE Page 44 of 47

MS4 Permit Audit Report
City, NC: NPDES Permit No. NCSOOOXXX
site Visit Evaluation: Post -Construction Stormwoater Control Measure No. 2
Does the MS4 inspector's process include walking the entire site and inspecting all points of discharge?
Did the MS4 inspector miss any obvious operation and maintenance deficiencies? If so, explain:
Does the MS4 inspector's process include presenting the inspection findings to the site contact in writing?
Compliance/Enforcement
What, if any, enforcement actions (verbal warnings, NOV, etc.) did the inspection result in?
If compliance issues were identified, what timeline for correction/follow-up was provided?
Notes/Comments/Recommendations
Audit Date(s): DATE Page 45 of 47

MS4 Permit Audit Report
City, NC: NPDES Permit No. NCSOOOXX)(
APPENDM A. SUPPORT�NG DOCUMENTS
Audit Date(s): DATE Page 46 of 47

MS4 Permit Audit Report
City, NC: NPDES Permit No. NCSOOOXXX
APPENDIX Bo PHOTOGRAPH LOG
Audit Date(s): DATE Page 47 of 47