Lowery Street 2021 Sand Filter and Dry Detention Basin Inspection Reports

City of Winston-Salem Stormwater Division — Stormwater Post Construction Permit
Annual Compliance Report
Development Name: ,t-f..( i�_4ow�2 ST Permit No: N
Contact Person: Phone Number: 336 -1.41— d 4? b 1
Inspection Year %e.g. one 2019-May 2020): .L oa I
Development Address:2 1 ST —
Permit Information
Stormwater Management System Addresses (circle one): Water Quality Water Quantity Both
I" Cc>✓A-bo vW t IMF A `.yt�rp 'F t I.TcYL
Stormwater Control Me CM's) Inspected in the past year applicable to this site (insert number of each):
Infiltration Basins Infiltration Trenches Stormwater Wetland
i Dry Ponds Biore inc n Cells Permeable Pavement Sand filters (circle ) — Open/Closed
Mind Cistem/Piping Detention System Level Spreader/Filter Strip _Bay Filters Contech Filters
Other (specify type and number on site):
File Review -Notification of Chanaes etc.
1. 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
was not notified
2. In the case of a HOA 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?
4. Has the City of Winston-Salem Stormwater Division been notified of any owner changes and have the
appropriate procedures been followedfor such change in ownership per the 0&M Agreement
requirements?
Built Unon Area (BUA)
Yes No N/A
5.
Is the BUA still consistent with the permitted design or have other construction activities occurred
without the Stormwater Divisions knowled e?
6.
Is
the
BUA aspermitted) graded such that the runoff drains to the system?
7.
Is
the
drainage area still consistent with the ermit7 i.e, no un ermitted drainage to the SCMs
8.
Is
the
drainage area stabilized? (to reduce risk of sedimentation to the SCM's)
Stormwater SCM's -General
Yes No�F11A
9. Are the SCMs) still located er the ap roved lans?
C
10. Are the SCM s s ecifications still matchin ahe ermitted lans?
—�j
11. Have an un ermitted changes or modifications been made to the SCMs ?
✓
12. Are the Riparian buffers recorded during permittingif applicable) fiee of disturbance & built upon area?
11,40
Stormwater SCM s - Operation and Maintenance
Yes No N/A
13. Are the recorded Stormwater Access and Maintenance Easements, or general access to the site and [he
system in the case of a blanket easement, clear and well maintained?
14. Are the SCMs been operated and maintained per thepermit/recorded O&M Agreement requirements?
✓
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 SCMs) 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
/
V
along with photographic evidence of before and after repairs?
City of Winston-Salem Stormwater Division — Stormwater SCMs) Annaal Compliance Repot
Page 1 of 2
No)
vwlWtl'MT5

City of Winston-Salem Stormwater Division — Stormwater Post Construction Permit
Annual Compliance Report
SCM(s) Inspectors
Yes No NIA
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.
Ins ection Photo ra hs — **Re wired to be submitted with annual ins ectlon 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 photographs have date stam s7
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 necessary:
cIMS PrfLE t ^l Nivx� �
6jp, A rtLTl-"� MOk 1. IS NOT
t,Aftj �2 cN6nrtR.>� c� At,(. 'S ScrtS
uh M t v.ttrl'v/�+.1Gt
Pam. TFIF PtJ1v�1 lflvlooT
Ownership Information —Provide the latest owner andlor 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 StatemenAttached ❑ Yes ❑ No (If no explain why not and when this statement will be provided)
N1ON
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
-rNIS SoAkerKINot TWAT bC%(`A-Tt,AL`r T >lit pit V`VmM '2> Mv5T �Ect'fJE �Tflrn1 fZ�cJBlpr o�
lvtts IivsPE.CTtor.t Rr✓-Pdz.T K �a�
Inspector Name and
Inspector Qualifications:
(State NC License Number and attach seal tot is report or include a copy
City of Winston-Salem Stormwater Division—Stocmwa[er SCM(s) Annual Compliance Report
Page 2 of 2

5 �\LTCQ IVO - �?CTufll
�Cb N 49
P"n'N'^ vaa 9 n
SAND FILTERS, OPEN & CLOSED BASINS: O & M Inspection Checklist FZ�Q
NO'Tc`„ F\vftql� 'CS +SOT MWrtCK !DA�SLb^�i P�rwv} Ire —roc W,S ONC� L6130T
YES NO WA
1. The adjacent pavement is free of sediment: LJA� ❑ ❑
2. Inlet device (swale or pipe, if applicable) is free of damage, clogs or erosion: ❑ ❑ 2"
C✓ivT TELL OUE Fo *Ve9* CYV0(
3. Weir heights match approved plans: —des eN o FFxevz z,v ❑ LO� ❑
1k PeJ4FE
4. Level spreader Is still level and structurally sound: s � ❑ ©� ❑
PERIMETER
5. Perimeter is free of bare soil, erosion and gullies:
❑
❑
6. Vegetation at the perimeter Is maintained at 3 to 6 Inches:
❑
;�Z
❑
7. Vegetated side slopes are no steeper than 3:1:
❑
❑
MAIN TREATMENT
8. Sediment chamber is free of sediment accumulation of more than 6 inche$,•
ht O Ir OTS vE l`l�� PST RN Si�p�3af•'
9. Sediment chamber is free of erosion and trash:
10. Sediment chamber is free of weeds:
11. Sand Chamber surface is free of clogs and sediment:
12. Sand chamber surface is free of erosion and tr
13. Sand chamber surface is free of weeds:
14. Underdrains are functioning and are not clogged or damaged: 64r%,).AC 7- eLL�
15. Cleanouts (if provided in the design) arei`pllace and pare not damaged:
16. Underground chambers are structurally sound and not leaking:
❑ ❑
❑ El❑ t2w• El❑ J2� ❑
❑ zL�" El
El
17. MavGtreatment area iadrained and isfreefrom pondinq�2`4 hours after rain: ❑
18. Entire device has drawn down completely with no apparent outflow after 40 hours: ❑
F(50vt - o 1 ? -t o
19. Sand media has been replaced as needed and is a minimum of 18" deep: El20. Access easement is being maintained: v�T
tElfo�
❑ �
1� Eln� El El
❑ El
OUTLETS
21. Outflow spillway is free of shrubs or trees: ❑ L 1 ❑
22. Outflow pipe is free of damage or clogs: c.rvw'c Teq� 9�>r� DL—'"5E ❑ ❑/ ❑
23. Energy dissipaters are in place and functioning: , e'er. _ noT R� ❑ LfT ❑
Dtf5LJrJ 1. Aw'l eAi
24. Orifice size matches approved plans: D j. A,3 pe�0.06 ❑ 4�' ❑
25. Relative elevations match approved plans: �T g�J �vT PLxt 0e5ry„`j ❑ L ❑
Note: If there is more than 1 sand filter on the property then a separate inspection checklist must be completed for each
sand filter. The inspector should note on each checklist which sand filter the inspection form refers to and describe Its
location on the property

�L - OS - 0�
Date of Inspection
%-A o s pt\ i-o(xNz( \ 1
Name of Inspector (Please type)
Sig iature of Inspector
Qualification of Inspector (Please describe your credentials/qualifications to carry out this inspection below)
\\�, C , V EG ff:- 0 <-4-�9 16

Fti.Tee N(5+2
SAND FILTERS, OPEN & CLOSED BASINS: O & M Inspection Checklist
1. The adjacent pavement is free of sediment: tler ❑ ❑
2. Inlet device (swale or pipe, if applicable) is free of damage, clogs or erosion: t;� ❑ ❑
3. Weir heights match approved plans: 011' to -ram" D"e a PetQi®� ❑ ❑
O�r`�9Rwai� �liixN00 Lcum 1 C
4. Level spreader is still level and structurally sound: Be ,J20' ❑ ❑
PERIMETER
5. Perimeter is free of bare soil, erosion and gullies: 62r ❑ ❑
6. Vegetation at the perimeter is maintained at 3 to 6 Inches: ❑ ❑
7. Vegetated side slopes are no steeper than 3:1: ;1*� ❑ ❑
MAIN TREATMENT
8. Sediment cc amber is free of sediment accumulation of more than 6 inches: ❑ ❑
-f4%4. T2t•t- ove 'T.D fit- 7itowTrl- ASsQr+,nrt tt�OT
9. Sediment chamber is free of erosion and trash: LG?5 oP ; /ZASrt ❑ L�K ❑
10. Sediment chamber is free of weeds: Lo TA t.�j ort,,2q avwN ❑ AFer ❑
11. Sand Chamber surface is free of clogs and sediment: k- t tS6Ll 5eo,M%zwT ❑ Z?' ❑
e — cip�l r 5qa� SNr�o
12. Sand chamber surface is free of erosion and trash: �I/lAC.A P2e-sc^s 7 ❑ t� ❑
13. Sand chamber surface is free of weeds: �w ftc-t oveoLfv2c vN ❑ ❑
14. Underdrains are functioning and are not clogged or damaged: frpAeft2 i 0ec- LFzr ❑ ❑
15. Cleanouts (if provided in the design) are in place and caps are not damaged: ❑ ❑
16. Underground chambers are structurally sound and not leaking: ❑ ❑ c2o�
17. Main treeat[(1Mlr�t area has drained and is free from ppondinqq 24 hours after rain: ❑ � Elt
N u'j S,rYl.c—vt4-1 D#21 iDrNzloo WKeN loj SPI=r�TdD `A55vmel.zo
18. Entire device has drawn down completely with no apparent outflow after 40 hours: ❑ ❑
5%ae P1 ro4G— D.)6 to s%f6'0&.t3,t1T- tor SS,iM e" r�o
19. Sand media has been replaced as needed and is a minimum of 18" deep: ❑ t[ ❑
20. Access easement Is being maintained: ❑ ❑
of Hvt. a I rAr
UTLETSn ()GLZMwnstw( Pcx�Z PcYL nL31`i� C✓153
21. Outflow spillway is free of shrubs or trees: ❑ 1� ❑
22. Outflow pipe is free of damage or clogs: ❑ ❑
23. Energy dissipaters are in place and functioning: > ;4� ❑ ❑
24. Orifice size matches approved plans: f;XL Sv-( —ACcFW tL4' ❑ ❑
A, Ff,cuirT-Fc s t
25. Relative elevations match approved plans: ❑
Note: If there is more than 1 sand filter on the property then a separate inspection checklist must be completed for each
sand filter. The inspector should note on each checklist which sand filter the Inspection form refers to and describe Its
location on the property

\ - 08 -97 0r1 l
Date of Inspection
.6bznrtkk Pc(L
Name of Inspector (Please type)
Signature of Inspector
Qualification of Inspector (Please describe your credentials/qualifications to carry out this inspection below)
��- �� -FC)D`g1j6

Ir�l CC3^N60 \P%3'TV
3NJ� F�'t_xerz �0 2-
DRY EXTENDED DETENTION BASIN - O & M Inspection Report
YES NO WA
INLETS and FOREBAY
1. Inlet device (swale or pipe) Is free of damage, clogs or erosion: 1&V ^ ^ El El❑i
T Tce
2. Forebay is free of excessive sediment and weeds: =�> N/A ❑ ❑ Lla
3. Forebay is free of trash:
❑
❑
B
4. Forebay Is free of erosion or displaced rip -rap:
❑
❑
JD"
5. Energy dissipaters are in place at inlets and functioning: epn
❑
❑
�
Perimeter
6.
Perimeter is free of bare soil or erosive gullies:
❑-
❑
❑
7.
Side slopes are no steeper than 3:1
1,0
❑
❑
B.
Free of muskrat or beaver activity: G c T zr-L�- Doe
r cr%re 75(L� D. ,H
❑
❑
Ll
9.
Slopes and berms are free of woody vegetation:
❑
i[2�
❑
MAIN BAY
10.
Minimum of one foot of freeboard between the temporary pool and top
of berm/dam:
�E]
❑
❑
11.
Depth of the basin is < or = to 10 feet and built in accordance with the
plans:
LET
❑
❑
12.
Drain is provided and correctly installed:
4D""
❑
❑
13.
Basin is drained and it has been more than 5 days since last rain: MPe A(4S 5o
2.
❑
❑
14.
Stormwater flow through the basin is free of short circuiting:
, l�
❑
❑
15.
Main bay is free of excessive sediment:
❑
,2"
❑
16.
Main bay is free of trash and other debris:
❑
L20�
❑
17.
The vegetation in and around the basin is maintained at approximately
6" height:
❑
LP''
❑
18.
Grass cover is in good condition and not eroded:
❑
�
❑
19.
Basin is free of weeds or noxious vegetation:
❑
�
❑
20.
Access easement is being maintained:
LFfr
❑
❑
OUTLETS
21. Outlet device is free of damage or clogs: APP C7 n 5 s � ., "_��c vEr ❑ ❑
22. Riser (if applicable) is structurally sound and not leaking: cA�or Ac_�ess Fu u.-r ❑ ❑ te"
23. Trash racks are clean and In place: ❑ ❑ ADS'
24. Orifices/Weirs are free of damage or clogs ? wccc-5� ��'t c f El ElLD-
25. Outlet is free of erosion or other signs of damage:: Ll� ❑ ❑
26. Energy dissipater(s) at outlet pipe are built and function as designed (if applicable): ❑ ❑ aa'
27. Oriflce size matches approved plans: 4cC'Ess -r�U L-c-W-if ❑ ❑ ,�
28. Emergency spillways is in the correct location and in good condition -no erosion/damage: ❑ ❑ LSE
29. Spillway has correct ground cover as per approved plans (e.g. vegetated or rip -rap): ❑ ❑ L F::f
30. Relative elevations match approved plans: No 45- 3� «T5 i^j Hv" ❑ ❑ ❑
r vLWLIr-y

Note: If there is more than 1 dry extended detention basin on the property then a separate inspection checklist must be
completed for each basin. The inspector should note on each checklist which basin the Inspection form refers to and describe
its location on the property
1\ o$-' z.
Date of Inspection
Name of Inspector (Please type)
Sig ature of Inspector
Qualification of Inspector (Please describe your credentials/qualifications to carry out this inspection below)

)� �PkiI (�Ao .3
SAND FILTERS, OPEN & CLOSED BASINS: O & M Inspection Checklist
1. The adjacent pavement is free of sediment: tJ2 ❑ ❑
2. Inlet device (swale or pipe, if apArOkplicable) 's free of damage, clogs or erosion: . �? El ❑
3. Weir heights match approved plans: 3s AOOcVt2S cc� Fxll � ❑ ❑
ml?ortSo
4. Level spreader Is still level and structurally sound: tZ ❑ ❑
PERIMETER
5. Perimeter is free of bare soil, erosion and gullies: ❑ ❑
6. Vegetation at the perimeter is maintained at 3 to 6 inches: ❑ tFz' ❑
7. Vegetated side slopes are no steeper than 3:1: ,ET ❑ ❑
MAIN TREATMENT
8. Sediment chamber is free of sediment accumulation of more than 6 inches: ❑ LE? ❑
enyu'c f-vwt vxc&%Fi 9ve 20 DvaS� o N
'gSS..W.c Np
9. Sediment chamber is free of erosion and trash_ ❑ t[2' ❑
10. Sediment chamber is free of weeds: Ln Ts cK- v�� iroV Asjte F"4+J5 ❑ LEJOO� ❑
11. Sand Chamber surface is free of clogs and sediment: cA"' Af4zsi D" ❑ ❑
ovrv- aR prl
!Mort 5o
12. Sand chamber surface is free of erosion and trash: &+J , CR ❑ ❑
13. Sand chamber surface is free of weeds: ,�; ntt� d„c Lglztww ❑ >0 ❑
14. Underdrains are functioning and are not clogged or damaged: GiM✓t \fealFi ❑ ❑ Foo r
15. Cleanouts (if provided in the design) are in Rlacceeai Accap sue Tu Fa oV r/y ❑ ❑ '�
16. Underground chambers are structurally sound and not leaking: ❑ ❑ LO
17. Main treatment area has drained and is free from ponding 24 hours aafteer rain: El Elw Aa�.a #i55• Ae NO , vt`2ti osLi PM a wNt+'o
18. Entire device has drawn down completely with no apparent outflow a eferr 1 4 ou s: ❑ 10� ❑
+tiwcn ^55A/Me ^XD Vn� oR7 Pe(Z\a0 wn%Z� %N6 1CD J"
19. Sand media has been replaced as needed and is a minimum of 18" deep: ❑ J2 ❑
21. Outflow spillway is free of shrubs or trees: ❑ � ❑
22. Outflow pipe is free of damage or clogs: CV*Jrc vt�Lx" ❑ ❑ %LOT'
23. Energy dissipaters are in place and functioning: eWk J%e4Z.F1 ❑ ❑
24. Orifice size matches approved plans: (A+v t v j`kFy ❑ ❑
25. Relative elevations match approved plans: cFwt JuKtPI ❑ ❑ J2
Note: If there is more than 1 sand filter on the property then a separate inspection checklist must be completed far each
sand filter. The Inspector should note on each checklist which sand filter the inspection form refers to and describe its
location on the property

!1 � ©o?A z
Date of Inspection
• ,: ►
Name of Inspector (Please type)
c_
Signature of Inspector
qualification of Inspector (Please describe your credentials/qualifications to carry out this inspection below)
ry c Q�c 4fv m i 6