20050732 Ver 01_Worksheets_20070916

FIELD COPY
Form A June 2005
Site Inspection form- Construction Stormwater Permit NPDES NCG010000
Site Name: ~ '
DWQ RO:
Inspector: L ~.Z--~ 1. DWQ Inspection date: (A1)
Location:
2. County: (A2) C
3. Basin: (A3) C
4. Location description
7. Land disturbance due to construction/ development?
8. On-site represents
Name(s)
Title(s)
Employer(s)
(Topographical vicinity map of site is attached for case file]
(A7) Yes ~ No
9. Erosion and Sedimentation Control Plan (Part I. Section A: No. 2.)
Is a copy of the approved plan on site and available for review? (A9) ~ Yes r- No #- Not
1 n sp a ct®d -'
10. Rain Gauge (Part I. Section B. No. 1.1
Is a rain gauge present on the site at the time of inspection? (A10)~YOS 1- No r-- root
lnspactad""
11. Rain Gauge Data (Part I. Section B. No. 1.1
Is rain gauge data measured and recorded? (A11) r YeS Not
_. _-_-.... ~ No ~ Inspected'
Data from past 14 da s:
Week 1 Date: ~~-~ (,,~~~
Amount: ~°
Week 2 Date:
Amount:
12. Minimum Monitoring & Record Keeping (Part I. Section B. No. 3.)
Are inspection records of erosion & sedimentation control facilities complete & a'
(A12)
Dates of documented ins ections Burin the ast 14
Week 1:
Week 2:
ailab e o uest? ~~~~ ~ ~ ~" "
Ye 1- No ~ Not //)~ ~//
Inspact8 l -j'VVV
13. Sedimentation impacts to waters: 14. Approximate Linear ft of stream im acts: 9~~3 ~~) ~N
Typical range of sediment depth: (A13a) to~inches (A14) ^
Maximum depth of sediment: (A13b) inches
15. Photo Documentation: Were photos taken. ~®. S ll (A15) ~ YeS r-- No
Photos (1. impacted water, 2. sedimentation depths, 3. sediment control measures, and 4. un-impacted upstream waters)
and sketch/map of where photos were taken are attached /or case hle
• Project personnel not available during D WQ site inspection
16. Notes: