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Home My WebLink AboutBlum Park Wetland Completed Inspection Forms 2021City of Winston-Salem Stormwater Division — Stormwater Post Construction Permit Annual Compliance Report Development Name: Contact Person:. Inspection Year (e.g. June 2019-May 20201: Development Address: WL 5 ez> % Permit No: Phone Number: '336. 14't.646 Permit Information Stormwater Management System Addresses (circle one): Water Quality Water Quantity Both Stormwater Control Measures.(SCM's) Inspected in the past year applicable to this site (insert nu Wet Ponds Infiltration Basins Infiltration Trenches Swales ' Storritwater Wetlan Dry Ponds Bioretention Cells Permeable Pavement Sand filters'(circ e one — pen ose Underground Cistern/Piping Detention System Level Spreader/Filter Strip _Bay Filters Contech Filters Other (specify type and number on site): Files Ravines . AI fifirnfinn of nhnnnac off; V,. L1.. AI/A I: Is the development still consistent with the approved set of as -built records? (Have additions been made. to the site which have increased the impervious area for example but for which the City Stormwater Division v o was not notified 2. In the case of a BOA has the contact person for the HOA changed since the time of the recorded O&M Agreement? If so please provide the new contact for the HOA in a later section of this report ✓ 3. Has the ownership of the system changed since the O&M Agreement was recorded? f 4. Has the City of Winston-Salem Stormwater Division been notified of any owner changes and have the appropriate procedures been followed for such change in ownership per the O&M Agreement requirements? Built Unon Area /6UAl Vac Aln wA 5. Is the BUA still consistent with the permitted design or have other construction activities occurred without the Stormwater Divisions knowled e? / V 6. Is the BUA aspermitted) graded such that the runoff drains to the system? 7. Is the draina a area still consistent with thepermit? i.e. no un ermitted drainage to the SCMs 8. Is the drainage area stabilized? to reduce risk of sedimentation to the SCM's Stnrmwatar SC:M'c _ r�anaral Vnc I.In AI/A 9. Are the SCM s) still located er the a proved plans? 10. Are the SCM s s ecifications still matching the ermitted Tans? f 11. Have any un errritted changes or modifications been made to the SCM(s)? 12. Are the Riparian buffers recorded during permitting if applicable) free of disturbance & built upon area? Stnrmwatar SCMtcI - nnerafinn and Maintenances Vcc Aln AI/A 13. Are the recorded Stormwater Access and Maintenance Easements, or general access to the site and the system in the case of a blanket easement, clear and well maintained? 1// 14. Are the SCM(s) been operated and maintained per thepermit/recorded O&M Agreement requirements? L/ 15. Have all of the SCM(s) inspections carried out in the past year been carried out per the required frequency as stated in the O&M Agreement and copies of those inspections provided here with this annual report? ✓ 16. If the inspections necessitated any maintenance of the SCM(s) has all such documentation of maintenance been provided here as in what the issue was, who carried out the maintenance/repairs, when was it done along with photographic evidence of before and after repairs? City of Winston-Salem Stormwater Division-Stormwater SCM(s) Annual Compliance Repon Page 1 af2 City of Winston-Salem Stormwater Division — Stormwater Post Construction Permit Annual Compliance Report SQVIlsi Insi3ectors 17. Have all of the past years inspections of the SCM(s) been carried out by a suitable qualified professional such as a Registered Engineer or Landscape Architect in the State of North Carolina, or an individual who has attained certification to inspect SCM(s) through North Carolina State University's SCM Inspection course? Documentation of such credentials must be included with the annual inspection records submitted ✓ with this report and should include the name, their contact address and phone number and proof of their qualifications to carry out such inspections such as seals attached to the inspections or photocopies of their NC State certification. tns ectron t'noto ra hs —'•Re uired to be submitted with annual ins ection re orts** Yes No N/A 18. Are all relevant photographs taken during the individual inspections and if applicable, maintenance ✓ activities, included here in with this report submittal and do all these nhoweranhs have date stamns7 Comments -Please list or include below any other comments that you may see as relevant to this submittal of records Please add and attach additional sheets to the back of this report if more room is necessarv: wEOWIw.sz rvec'.DS cvtC2trlWr.)t... \Nvg31vF Q�,wn,zs �t.l �}2w,.nt7 t�R.twl,t�t�l� p�Sp.Te No Rae%nSOrt pcv� \�WAiz , +S q't EVnnclLgNeVrocy Ali6oq6 wlA tvv c QZ% F i c C IS F4�l.ow t w9? GW,�NOT Mk4v s 4>Q 11�n/f ..A .�n �� 1 .. ♦G n N._ e -r o.�_ .at-,...e_ n _ —^' - -n .... - --- --- - .. __ t��l^iJ 1<^�TYYbLtSM I W'1 t Tn.M1sK tLc W1rn/1p / f�•t2c tNV iRSt VE C{ V2ranr�K i2.twtc�p ; iLe-t�')rig ttSN— `aNC dF NcXiwlt Ps�v� �tV+ATtorJ ETG.,, Ownership Information — rovi etl the la es owner and/or HOA contact person name, address and phone number below. Please note that if changes to ownership were made without the City Stormwater Division been made aware of it, then the original owner and the new owner must immediately address and comply with the O&M Agreement item that details transfer of ownership and request that the Stormwater Division reissue the permit to the new owner. Please state if this is the case also below and when the Stormwater Division can expect to be notified. Financial Statement of Escrowed Funds — If a HOA is involved in the ownership of this Stormwater management system then this means there was an escrow account established at the time of permitting. The HOA is obliged to add funds to this account per the Post Construction Stormwater Management ordinance and O&M Agreement/Escrow Agreement requirements and to maintain such funds in this account. A most recent financial statement of escrowed funds should be attached here to this report Financial Statement Attached p4'V%,.❑ Yes ❑ No (If no explain why not and when this statement will be provided) Compliance'Status ❑ Compliant � Non -Compliant If non -compliant with any aspect of the permit and its O&M Agreement please provide additional documentation, plan of action etc, of how and when the non -compliant issues will be addressed. -il wt" GCE AY � AD V 110 of Xj tL9NLT VAeN T 1Nt W�Af1$atit tali iC W KO wt l l AOY I$� A PLAN ce ptcrT I A4 cay�Sucant sic cywv ,s Inspector Name and Signature:-T�ept'. Ciaa(4�n2, a l �, : Inspector Qualifications: b (State NC License Number and attach seal to this r ort or include a copy of NC State City of Winston-Salem Stormwater Division — Stormwater SCM(s) Ammal Compliance Report Page 2 of 2 STORMWATER WETLANDS: O & M Inspection Checklist 1. Inlets are located per the approved lans: c.wt�o r s=I 'Nw Vt CuvaE5 10*410 iWW w 4m, KC � O�Ta DzwSE 2. Inlet device (swale or pipe) is free�or ro'sX) ag or clogs� � �N�` � G c�T 'tt'L(. Fv(L e+K -3� �vE 5� 5w'( 7t5 I�UtSS� 3. Forebay berm is in place and without eroqsion: El WN'C ice,(,-li p�.svrS�+Jli KOTVt5,�t� 4. Energy dissipaters such as rip -rap aprons and plunge pools are in place and functioning: ❑ 6 %.rT mreL - 5. Forebay is free of excessive sediment: a p,4,r -rou, ❑ 6. Forebay is free of trash: ❑ 7. Vegetated side slopes are no steeper than 3:1: ❑ ❑ 8. Banks are stable and free of erosion or bare soil: (7 ❑ ❑ 9. Slopes or berms are free of woody vegetation: ❑ tPA ❑ 10. Free of muskrat or beaver activity: «ao-r Thar'C I C40Jub 5k 9 /Ml LL, ❑ JI-7/ El11. Plants are healthy and being maintained: ElP�o ❑ MAIN TREATMENT AREA 12. Shallow land is free of flooding at 5 days after rain event should drayv down in 2-5 days): ❑ ❑ po+�» 15 31 DOW40 . (vv'N wc.2 �+T*, M o 13. Main treatment area is free of excess sediment accumulation: WK"" �' ` ❑ Lk ❑ 14. Main treatment area is free of trash and other debris: ❑ LJ;? ❑ 15. Algal growth covers less than 25% of the basin surface area: J�� ❑ ❑ 16. Cattails, phragmites or other invasive plants cover less than 25% of the basin surface area: ❑ 20#� ❑ 17. Access easement is being maintained: ,2� ❑ ❑ 18. Swale or emergency outlet bypass (spillway) is in the correct place and in good condition: �" ❑ ❑ 19. Spillway has correct ground cover as per approved device (e.g. vegetated or rip -rap): ❑ ❑ 20. Deep pool near outlet is free of vegetation: vim]' .❑ El�" 9�c't1MS 'tb VZ 21, Drawdown device is correctly sized free of damage or cloggin ruLu "'" t tivt Ia+Y El El, ----_in IS r� Pews 3' p2 22. Drawdown valve (if applicable) is closed and not leaking: �.I RW N,` ',J`4e,'Y IN Wovatd2� ❑ ❑ 23. Orifice size matches the approved plans and is not clogged: C MA*1?q 4r q4y ❑ El24. Outlet riser (if applicable) is structurally sound and not leaking: �,,� F�L tL? ❑ ❑ 15 , ovi Flci 25. Weir size matches the approved plans and is not clogged or damaged: 41ps l L;ko ❑ ❑ 26. Area at outlet is free of erosion, clogs or other signs of damage: LE2" ❑ ❑ 27. Energy dissipater at outlet is in place and functioning: ❑ ❑ 1.O 28. Trash rack is provided: K ❑ ❑ 29. The vegetated filter and level spreader is in place (if applicable): ❑ ❑ tLg�o 30. Vegetated filter strip and level spreader inspection form completed (If applicable): ❑ ❑ t�J' 31. Relative elevations match the approved plans: . L? ❑ ❑ Note: If there is more than 1 wetland on the property then a separate inspection checklist must be completed for each wetland. The inspector should note on each checklist which wetland the inspection form referstdand describe its location on the property Date of Inspection �oac�JN �-H1LT`i Name of Inspector (Please type) gn re of Inspector Qualification of Inspector (Please describe your credentials/qualifications to carry out this inspection below)