HomeMy WebLinkAboutNCS000247_Winston-Salem MS4 Self Audit Template Transmittal_20220405From:Powell, Jeanette
To:keithh1@cityofws.org
Cc:Clark, Paul
Subject:NCS000247: Winston-Salem MS4 Self-Audit Template Transmittal
Date:Tuesday, April 5, 2022 2:03:00 PM
Attachments:NCS000247_Winston-Salem MS4 Self Audit Template_20220405.docx
As explained in the March 15, 2022 email to the Phase I MS4s, please see the attached self-audit
template for the City of Winston-Salem MS4 permit number NCS000247. The city should complete
the self-audit and submit the results to NCDEQ on or before close of business on Friday, May 6,
2022. If you have any questions, please contact either myself or your MS4 Auditor, Paul Clark, who
is cc’d on this email.
Regards,
J
Jeanette Powell
MS4 Program Coordinator
919-707-3620
Jeanette.Powell@ncdenr.gov
North Carolina Department of Environmental Quality
Division of Energy, Mineral & Land Resources Stormwater Program
512 N. Salisbury Street, 6th Floor
1612 Mail Service Center
Raleigh, NC 27699-1612
Email correspondence to and from this address is subject to the North Carolina Public Records Law and may be
disclosed to third parties.
https://deq.nc.gov/sw
MUNICIPAL SEPARATE STORM SEWER SYSTEM (MS4)
PHASE I PROGRAM SELF-AUDIT REPORT
NPDES PERMIT NO. NCS000247
CITY OF WINSTON-SALEM, NORTH CAROLINA
Address
Self-Audit Date: DATE
Report Date: DATE
insert City logo here
NCS000247_Winston-Salem 2022 MS4 Self-Audit ii
* A Duly Authorized Representative can be the Mayor, City Manager, or an authorized person or position.
To be authorized, a Delegation of Signature Authority Form signed by the Mayor or City Manager must
be on file with the Department.
Self-Audit Certification
By my signature below, I certify, under penalty of law, that I am a Duly Authorized Representative* and this
document and all attachments were prepared under my direction or supervision in accordance with a system
designed to assure that qualified personnel properly gather and evaluate the information submitted. Based
on my inquiry of the person or persons who manage the system, or those persons directly responsible for
gathering the information, the information submitted is, to the best of my knowledge and belief, true,
accurate, and complete. I am aware that there are significant penalties for submitting false information,
including the possibility of fines and imprisonment for knowing violations.
Name:
Title:
Signature:
Date:
NCS000247_Winston-Salem 2022 MS4 Self-Audit iii
TABLE OF CONTENTS
Self-Audit Details ..................................................................................................................................... 1
Permittee Information ............................................................................................................................. 2
List of Supporting Documents .................................................................................................................. 3
Program Implementation, Documentation & Assessment ........................................................................ 4
Public Education and Outreach ................................................................................................................ 7
Public Involvement and Participation....................................................................................................... 9
Illicit Discharge Detection and Elimination (IDDE) .................................................................................. 11
Construction Site Runoff Controls .......................................................................................................... 13
Post-Construction Site Runoff Controls .................................................................................................. 14
Pollution Prevention and Good Housekeeping for Municipal Operations ............................................... 18
Program to Monitor and Evaluate Stormwater Discharges to Municipal Systems ................................... 21
Water Quality Assessment and Monitoring............................................................................................ 23
Site Visit Evaluation: Municipal Facility No. 1 ......................................................................................... 24
Site Visit Evaluation: Municipal Facility No. 2 ......................................................................................... 26
Site Visit Evaluation: MS4 Outfall No. 1 .................................................................................................. 28
Site Visit Evaluation: MS4 Outfall No. 2 .................................................................................................. 30
Site Visit Evaluation: Construction Site No. 1 ......................................................................................... 32
Site Visit Evaluation: Construction Site No. 2 ......................................................................................... 34
Site Visit Evaluation: Post-Construction Stormwater Control Measure No. 1 .......................................... 36
Site Visit Evaluation: Post-Construction Stormwater Control Measure No. 2 .......................................... 38
Appendix A: Supporting Documents
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.
NCS000247_Winston-Salem 2022 MS4 Self-Audit Page 1 of 40
Self-Audit Details
Audit ID Number:
NCS000247_Winston -Salem 2022 MS4 Self-Audit
Self-Audit Date(s):
Minimum Control Measures Evaluated:
☒ Program Implementation, Documentation & Assessment
☒ Public Education & Outreach
☒ Public Involvement & Participation
☒ Illicit Discharge Detection & Elimination
☒ Construction Site Runoff Controls
☒ Post-Construction Site Runoff Controls
☒ Pollution Prevention and Good Housekeeping for Municipal Operations
☒ Program to Monitor and Control Pollutants
☒ Water Quality Assessment & Monitoring
Field Site Visits:
☐ Municipal Facilities. Number visited: Choose an item.
☐ MS4 Outfalls. Number visited: Choose an item.
☐ Construction Sites. Number visited: Choose an item.
☐ Post-Construction Stormwater Runoff Controls. Number visited: Choose an item.
☐ Other: ________________________________. Number visited: Choose an item.
☐ Other: ________________________________. Number visited: Choose an item.
Auditors
Name Title
Audit Report Author
___________________________________ __ ___
Name
_____________________________________ _____
Title
___________________________________ _____
Date
___________________________________ _____
Signature
Audit Report Author
___________________________________ __ ___
Name
_____________________________________ _____
Title
___________________________________ _____
Date
___________________________________ _____
Signature
NCS000247_Winston-Salem 2022 MS4 Self-Audit Page 2 of 40
Audit Report Author
___________________________________ __ ___
Name
_____________________________________ _____
Title
___________________________________ _____
Date
___________________________________ _____
Signature
Audit Report Author
___________________________________ __ ___
Name
_____________________________________ _____
Title
___________________________________ _____
Date
___________________________________ _____
Signature
Permittee Information
MS4 Permittee Name:
Permit Effective Date:
Permit Expiration Date:
Mailing Address:
Date of Last MS4 Inspection/Audit:
Permit Owner of Record:
Primary MS4 Representatives Participating in Audit
Name Title
NCS000247_Winston-Salem 2022 MS4 Self-Audit Page 3 of 40
List of Supporting Documents
Item
Number Document Title Document Format
(web link, e- file, etc.)
NCS000247_Winston-Salem 2022 MS4 Self-Audit Page 4 of 40
Program Implementation, Documentation & Assessment
Staff Interviewed:
(Name, Title, Role)
Permit Citation Program Requirement Status Supporting
Doc No.
II.A.
Program
Implementation
The permittee maintained adequate legal mechanisms, such as regulations,
ordinances, policies and procedures to implement all provisions of the Stormwater
Management Plan (SWMP).
Choose
an item. ---
The permittee implemented provisions of the Stormwater Management Plan and
evaluated the performance and effectiveness of the program components annually.
Choose
an item. ---
The permittee maintained written procedures for implementing the six minimum
control measures, which identify specific action steps, schedules, resources and
responsibilities.
Choose
an item. ---
The permittee is current on payment of invoiced administering and compliance
monitoring fees (see stormwater e-payments on https://deq.nc.gov/sw).
Choose
an item. ---
Comments
III.
Program
Documentation
The permittee maintained documentation of all program components including, but
not limited to, inspections, maintenance activities, educational programs, monitoring
and sampling, implementation of BMPs, enforcement actions and other stormwater
activities.
Choose
an item. ---
Documentation is kept on-file by the permittee for a period of five (5) years. Choose
an item. ---
The permittee’s Stormwater Management Plan is reviewed and updated as
necessary, but at least on an annual basis.
Choose
an item. ---
Comments
IV.B.
Annual Reporting
The permittee submitted annual reports to the Department by October 31st of each
calendar year for the previous fiscal year's activities (from July 1st to June 30th).
Choose
an item. ---
The Annual Reports included appropriate information to accurately describe the progress, status, and results
of the permittee’s Stormwater Management Plan, including, but not limited the following:
NCS000247_Winston-Salem 2022 MS4 Self-Audit Page 5 of 40
Program Implementation, Documentation & Assessment
a. A detailed description of the status of implementation of the Stormwater
Management Plan. This includes information on development and
implementation of each major component of the Stormwater Management Plan
for the past year and schedules and plans for the year following each report.
Choose
an item. ---
b. A description and justification of any proposed changes to the Stormwater
Management Plan. This includes descriptions and supporting information for the
proposed changes and how these changes will impact the Stormwater
Management Plan (results, effectivene ss, implementation schedule, etc.).
Choose
an item. ---
c. Documentation of any necessary changes to programs or practices for
assessment of management measures implemented through the Stormwater
Management Plan.
Choose
an item. ---
d. A summary of data accumulated as part of the Stormwater Management Plan
throughout the year along with an assessment of what the data indicates.
Choose
an item. ---
e. An assessment of compliance with the permit, information on the establishment
of appropriate legal authorities, inspections, and enforcement actions.
Choose
an item. ---
f. Discussion of program funding. Choose
an item. ---
Comments
IV.D.
Other Information The Permittee maintained a record of any illicit discharge that reaches waters of the
state and may cause or contribute to a violation of the water quality standards or
constitute an imminent threat to health or the environment.
Choose
an item. ---
The record includes dates, identification of possible responsible parties, causes, and
any action taken by the permittee or the responsible party.
Choose
an item. ---
Discharges that constitute an imminent threat to health or the environment were
reported within 24 hours by phone or e-mail to the Division Regional Office during
business hours, or to the NC Division of Emergency Management State Operations
Center hotline outside of business hours.
Choose
an item. ---
Comments
NCS000247_Winston-Salem 2022 MS4 Self-Audit Page 6 of 40
Program Implementation, Documentation & Assessment
Additional
Comments:
NCS000247_Winston-Salem 2022 MS4 Self-Audit Page 7 of 40
Public Education and Outreach
Staff Interviewed:
(Name, Title, Role)
Permit Citation Program Requirement Status Supporting
Doc No.
II.B.2.a.
Target Pollutants
& Sources
The permittee described the target pollutants and target pollutant sources that the
public education program is designed to address and why they are an issue.
Choose
an item. ---
Comments
II.B.2.b.
Target Audiences
The permittee described the target audiences likely to have significant stormwater
impacts and why they were selected.
Choose
an item. ---
Comments
II.B.2.c.
Informational
Web Site
The permittee promoted and maintained an internet web site designed to convey the
program’s message.
Choose
an item. ---
Comments
II.B.2.d.
Public Education
Materials
The permittee distributed general stormwater educational material to appropriate
target groups as likely to have a significant stormwater impact.
Choose
an item. ---
Comments
II.B.2.e.
Stormwater
Hotline
The permittee promoted and maintained a stormwater hotline(s) or helpline(s) for
the public to request information about stormwater, public involvement &
participation, and to report illicit connections & discharges, etc.
Choose
an item. ---
Comments
II.B.2.f.
Public Education
& Outreach
The permittee’s outreach program, including those elements implemented locally or
through a cooperative agreement, include a combination of approaches designed to
reach the target audiences.
Choose
an item. ---
NCS000247_Winston-Salem 2022 MS4 Self-Audit Page 8 of 40
Public Education and Outreach
Program
Implementation For each media, event or activity, including those elements implemented locally or
through a cooperative agreement, the permittee estimated and recorded the extent
of exposure.
Choose
an item. ---
Comments
Additional
Comments:
NCS000247_Winston-Salem 2022 MS4 Self-Audit Page 9 of 40
Public Involvement and Participation
Staff Interviewed:
(Name, Title, Role)
Permit Citation Program Requirement Status Supporting
Doc No.
II.C.2.a.
Volunteer
Community
Involvement
Program
The permittee include d and promoted volunteer opportunities designed to promote
ongoing citizen participation.
Choose
an item. ---
Comments
II.C.2.b.
Mechanism for
Public
Involvement
The permittee provided and promoted a mechanism for public involvement that
provides for input on stormwater issues and the stormwater program.
Choose
an item. ---
Comments
II.C.2.c.
Hotline/Help Line
The permittee promoted and maintained a hotline/helpline for the public to request
information about stormwater, public involvement & participation, and to report
illicit connections & discharges, etc.
Choose
an item. ---
Comments
II.C.2.d.
Public Comment
The permittee made the most recent Stormwater Management Plan available for
public review and comment.
Choose
an item. ---
Comments
II.C.2.e.
Public Notice
The permittee complied with State, Tribal and local public notice requirements when
implementing the public involvement / participation program.
Choose
an item. ---
Comments
NCS000247_Winston-Salem 2022 MS4 Self-Audit Page 10 of 40
Public Involvement and Participation
Additional
Comments:
NCS000247_Winston-Salem 2022 MS4 Self-Audit Page 11 of 40
Illicit Discharge Detection and Elimination (IDDE)
Staff Interviewed:
(Name, Title,
Role)
Permit Citation Program Requirement Status Supporting
Doc No.
II.D.2.a.
Legal Authorities The permittee maintained adequate ordinances or other legal authorities to prohibit
illicit connections and discharges and enforce the approved IDDE Program.
Choose
an item. ---
Comments
II.D.2.b.
MS4 Mapping The permittee maintained a current map showing major outfalls and receiving
streams.
Choose
an item. ---
Comments
II.D.2.c.
Dry Weather Flow
Program
The permittee maintained written procedures and/or Standard Operating Procedures
(SOPs) for detecting and tracing the sources of illicit discharges.
Choose
an item. ---
The permittee maintained written procedures and/or Standard Operating Procedures
(SOPs) for removing the sources or reporting the sources to the State to be properly
permitted.
Choose
an item. ---
The permittee maintained written procedures and/or SOPs that specify a timeframe
for monitoring and how many outfalls and the areas that are to be targeted for
inspections.
Choose
an item. ---
Comments
*Major outfalls are discharges from > 36” diameter pipes or drainage areas of > 50 acres. In areas zoned for industrial activity, major outfalls
are > 12” or drainage area > 2 acres.
II.D.2.d.
Employee Training The permittee conducted training for appropriate municipal staff on detecting and
reporting illicit connections and discharges.
Choose
an item. ---
Comments
II.D.2.e.
Public Reporting
The permittee maintained and publicized reporting mechanism(s) for the public to
report illicit connections and discharges.
Choose
an item. ---
NCS000247_Winston-Salem 2022 MS4 Self-Audit Page 12 of 40
Illicit Discharge Detection and Elimination (IDDE)
Comments
II.D.2.f.
Documentation The permittee documented the date of investigations, any enforcement action(s) or
remediation that occurred.
Choose
an item. ---
Comments
Additional
Comments:
NCS000247_Winston-Salem 2022 MS4 Self-Audit Page 13 of 40
Construction Site Runoff Controls
Staff Interviewed:
(Name, Title, Role)
Program Delegation Status:
The permittee has a delegated Sediment and Erosion Control Program to implement the North Carolina Sedimentation Pollution
Control Act (SPCA) of 1973 and Chapter 4 of Title 15A of the North Carolina Administrative Code.
The delegated or authorized Sediment and Erosion Control Program effectively meets the NPDES MS4 MEP standard
for Construction Site Runoff Controls by permitting and controlling development activities disturbing one or more acres
of land surface and those activities less than one acre that are part of a larger common plan of development as authorized
under the Sediment Pollution Control Act of 1973 and Chapter 4 of Title 15A of the North Carolina Administrative Code.
Permit Citation Program Requirement Status Supporting
Doc No.
II.E.2.a.
Delegated SPCA
Program
The permittee implements a delegated program in compliance with the
Sediment Pollution Control Act of 1973 and Chapter 4 of Title 15A of the
North Carolina Administrative Code within the city’s jurisdictional area.
Choose
an item. ---
Comments (Note date of last SPCA delegated program review by NCDEQ-DEMLR staff and result)
II.E.2.c.
Reporting
Mechanism
The permittee provided and promoted a means for the public to notify the
appropriate authorities of observed erosion and sedimentation problems.
Choose
an item. ---
Comments
II.E.2.d.
Coordination with
DEMLR
The permittee coordinated the approval of the construction site runoff control with
DEMLR for new development and redevelopment projects to be built within the
permittee’s planning jurisdiction by entities with eminent domain authority.
Choose
an item. ---
Comments
Additional
Comments:
NCS000247_Winston-Salem 2022 MS4 Self-Audit Page 14 of 40
Post-Construction Site Runoff Controls
Staff Interviewed:
(Name, Title, Role)
Program 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: list name of entity
☐ The permittee implements the following Qualifying Alternative Program(s), which meet NPDES MS4 post-construction
requirements in the areas where they are implemented and in compliance with the specific program requirements as provided in
15A NCAC and noted below:
☐ Water Supply Watershed I (WS-I) – 15A NCAC 2B .0212 (Eff. March 1, 2019 15A NCAC 02B .0620 - .0624)
☐ Water Supply Watershed II (WS-II) – 15A NCAC 2B .0214 (Eff. March 1, 2019 15A NCAC 02B .0620 - .0624)
☐ Water Supply Watershed III (WS-III) – 15A NCAC 2B .0215 (Eff. March 1, 2019 15A NCAC 02B .0620 - .0624)
☐ Water Supply Watershed IV (WS-IV) – 15A NCAC 2B .0216 (Eff. March 1, 2019 15A NCAC 02B .0620 - .0624)
☐ 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
Regulatory Authority:
The permittee utilizes the following ordinances and/or regulatory authority to fulfill post construction minimum measure program
requirements (check all that apply):
☐ DEQ model ordinance
☐ MS4 designed post-construction practices that meet or exceed 15A NCAC 02H .1000
☐ DEQ approved comprehensive watershed plan
☐ DEQ approved Qualifying Alternative Program listed above
Program Requirement Status Supporting
Doc No.
The permittee implements the Qualifying Alternative Program requirements
checked above in accordance with the applicable 15A NCAC rules.
Choose
an item. ---
NCS000247_Winston-Salem 2022 MS4 Self-Audit Page 15 of 40
Post-Construction Site Runoff Controls
02H .1017
Qualifying
Alternative
Program(s)
The permittee cumulatively implements the Qualifying Alternative Program
requirements checked above throughout the entire MS4 permitted area.
Choose
an item. ---
If response is no or partial, the permittee implements MS4 post-
construction requirements in accordance with 15A NCAC 02H .1017(3) –
(14) throughout the balance of the MS4 permitted area.
Choose
an item. ---
Comments
Permit Citation Program Requirement Status Supporting
Doc No.
II.F.2.a.
Legal Authority
The permittee maintained an ordinance or similar regulatory mechanism that
authorizes a program to address stormwater runoff from new development and
redevelopment to the extent allowable under State law.
Choose
an item. ---
Comments
II.F.2.b.
Stormwater Control
Measures (SCMs)
The permittee maintains strategies that include a combination of structural and/or
non-structural SCMs in concurrence with the legal authorities above (II.F.2.a.).
Choose
an item. ---
The permittee provides a mechanism to require long-term operation and
maintenance of structural SCMs.
Choose
an item. ---
The permittee requires annual inspection reports of permitted structural SCMs
performed by a qualified professional.
Choose
an item. ---
The permittee implements SCM requirements that are at least as stringent as the
minimum requirements in 15A NCAC 02H .1000.
Choose
an item. ---
Comments
II.F.2.c.
Deed Restrictions
and Protective
Covenants
The permittee provides mechanisms such as recorded deed restrictions, plats,
and/or protective covenants so that development activities maintain the project
consistent with approved plans.
Choose
an item. ---
Comments
NCS000247_Winston-Salem 2022 MS4 Self-Audit Page 16 of 40
Post-Construction Site Runoff Controls
II.F.2.d.
Operation and
Maintenance Plans
The developer provides the permittee with an operation and maintenance plan for
the stormwater system, indicating the operation and maintenance actions that
shall be taken, specific quantitative criteria used for determining when those
actions shall be taken, and who is responsible for those actions.
Choose
an item. ---
The plans clearly indicate the steps that shall be taken and who shall be responsible
for restoring a stormwater system to design specifications if a failure occurs.
Choose
an item. ---
The plans include a legally enforceable acknowledgment by the responsible party. Choose
an item. ---
Development is maintained consistent with the requirements in the approved
plans.
Choose
an item. ---
Modifications to those plans must be / are approved by the Permittee. Choose
an item. ---
Comments
II.F.2.e.
Educational
Materials and
Training
The permittee provided educational materials and training for developers. Choose
an item. ---
Comments
II.F.4.
Sensitive Receiving
Waters
The permittee applies additional requirements to projects draining to SA waters by
requiring SCMs that result in the highest degree of fecal coliform die-off and
controls sources of fecal coliform to the maximum extent practicable in accordance
with 15A NCAC 02H .1017(9)
Not
Applicable ---
The permittee applies additional requirements to projects draining to Trout waters
by requiring SCMs that avoid a sustained increase in receiving water temperature
in accordance with 15A NCAC 02H .1017(9)
Not
Applicable ---
The permittee implements an approved locally implemented Nutrient
Management Strategy that addresses post-construction runoff and the provisions
of that Strategy fulfill the MS4 post-construction requirement.
Choose
an item. ---
Comments
II.F.5.
Permittee Projects
The permittee meets the requirements of the post-construction program for
construction projects that are performed by, or under contract for, the permittee.
Choose
an item. ---
NCS000247_Winston-Salem 2022 MS4 Self-Audit Page 17 of 40
Post-Construction Site Runoff Controls
Comments
II.F.6.
SCM Design Volume
The permittee requires that the water quality design volume of SCMs account for
the runoff at build out from all surfaces draining to the system.
Choose
an item. ---
Comments
II.F.7.
Linear
Transportation
Projects
The permittee fulfills the post-construction minimum control measure
requirements for non-NCDOT linear transportation projects if they are designed,
constructed, and conveyed as set forth in 15A NCAC 02H .1001(1)(c):
(i) Constructed to NCDOT standards and in accordance with the NCDOT BMP
Toolbox;
(ii) Conveyed to NCDOT or other public entity and regulated in accordance with
that entity’s NPDES MS4 Permit; and
(iii) The project is not part of a common plan of development.
Choose
an item. ---
Comments
Additional
Comments:
NCS000247_Winston-Salem 2022 MS4 Self-Audit Page 18 of 40
Pollution Prevention and Good Housekeeping for Municipal Operations
Staff Interviewed:
(Name, Title, Role)
Permit Citation Program Requirement Status Supporting
Doc No.
II.G.2.a.
Municipal Facility
Inventory
The permittee maintained an inventory of municipal facilities and operations
owned and operated by the permittee that have been determined by the
permittee to have significant potential or generating polluted stormwater runoff.
Choose
an item. ---
The permittee maintained an inventory of municipally-owned structural SCMs. Choose
an item. ---
Comments
II.G.2.b.
Inspection and
Maintenance for
Municipal Facilities
The permittee implemented an inspection and maintenance program for facilities
and operations owned and operated by the permittee for potential sources of
polluted runoff, including stormwater controls and conveyance systems.
Choose
an item. ---
The inspection program evaluates pollutant sources, documents deficiencies, plans
corrective actions, implements appropriate controls, and documents the
accomplishment of corrective actions.
Choose
an item. ---
The maintenance program includes maintenance activities and procedures aimed
at preventing or reducing pollutants generated from municipal facilities and
operations.
Choose
an item. ---
Comments
II.G.2.c.
Site Pollution
Prevention Plans for
Municipal Facilities
The permittee maintained and implemented Site Pollution Prevention Plans for
municipal facilities owned and operated by the permittee that have been
determined by the permittee to have significant potential for generating polluted
stormwater runoff that has the goal of preventing or reducing pollutant runoff.
Choose
an item. ---
Comments
NCS000247_Winston-Salem 2022 MS4 Self-Audit Page 19 of 40
Pollution Prevention and Good Housekeeping for Municipal Operations
II.G.2.d.
Spill Response
Procedures for
Municipal Facilities
The permittee maintained spill response procedures for municipal facilities and
operations owned and operated by the permittee that have been determined by
the permittee to have significant potential for generating polluted stormwater
runoff.
Choose
an item. ---
Comments
II.G.2.e.
Vehicle and
Equipment Cleaning
Areas
The permittee described measures that prevent or minimize contamination of the
stormwater runoff from all areas used for vehicle and equipment cleaning,
including fire stations that have more than three fire trucks and ambulances.
Choose
an item. ---
The permittee performs all cleaning operations indoors, covers the cleaning
operations, ensures wash water drains to the sanitary sewer system, collects wash
water and stormwater run-on from the cleaning areas and provide s treatment or
recycling, or other equivalent measures
Choose
an item. ---
The permittee, if sanitary sewer is not available to the facility and cleaning
operations take place outdoors, ensures wash water drains to an SCM for
treatment, or else the cleaning operations take place on or drain directly to grassed
or graveled areas to prevent point source discharges of wash water into the storm
drains or surface waters.
Choose
an item. ---
The permittee, where cleaning operations cannot be performed as described above
and when operations are performed in the vicinity of a storm drainage collection
system, covers the drain(s) with a portable drain cover during cleaning activities,
and any excess standing water is removed and properly handled prior to removing
the drain cover.
Choose
an item. ---
The permittee facilities that have three or fewer fire trucks and ambulances
attempt to comply with the above requirements; however, those that cannot
comply with these requirements due to existing limitations incorporate structural
measures during facility renovation to the extent practicable.
Choose
an item. ---
Comments
II.G.2.f.
Streets, Roads and
Public Parking Lot
Maintenance
The permittee implements BMPs to reduce polluted stormwater runoff from
municipally-owned streets, roads, and public parking lots within the corporate
limits.
Choose
an item. ---
Comments
NCS000247_Winston-Salem 2022 MS4 Self-Audit Page 20 of 40
Pollution Prevention and Good Housekeeping for Municipal Operations
II.G.2.g.
Inspection and
Maintenance for
Municipal SCMs and
MS4
The permittee maintained and implemented an inspection and maintenance
program for structural stormwater control measures (SCMs) owned and operated
by the municipality.
Choose
an item. ---
The permittee maintained and implemented an inspection and maintenance
program for the municipal storm sewer system (including catch basins, the
conveyance system and SCMs).
Choose
an item. ---
Comments
II.G.2.h.
Staff Training The permittee maintained a training plan that indicates when, how often, and who
is required to be trained and what they are to be trained on.
Choose
an item. ---
The permittee implemented a training plan that indicates when, how often, and
who is required to be trained and what they are to be trained on.
Choose
an item. ---
Comments
Additional
Comments:
NCS000247_Winston-Salem 2022 MS4 Self-Audit Page 21 of 40
Program to Monitor and Evaluate Stormwater Discharges to Municipal Systems
Staff Interviewed:
(Name, Title, Role)
Permit Citation Program Requirement Status Supporting
Doc No.
II.H.2.a.
Industrial Facility
Inventory
The permittee maintained an inventory of permitted hazardous waste treatment,
disposal, and recovery facilities, industrial facilities that are subject to Section 313
of Title III of the Superfund Amendments and Reauthorization Act of 1986 (SARA).
Choose
an item. ---
The permittee maintained an inventory of industrial facilities identified with an
industrial activity (as defined in 40 CFR 122.26) permitted to discharge storm water
to the permittee’s MS4.
Choose
an item. ---
Comments
II.H.2.b.
Inspection Program
The permittee identified priorities and inspection procedures. At a minimum,
priority facilities include those identified above (subsection II.H.2.a).
Choose
an item. ---
Comments
II.H.2.c.
Industrial Facility
Evaluation
The permittee evaluated control measures implemented at permitted hazardous
waste treatment, disposal, and recovery facilities, industrial facilities that are
subject to Section 313 of Title III of the Superfund Amendments and
Reauthorization Act of 1986 (SARA).
For the purpose of this permit, the Permittee is authorized to inspect the permitted
hazardous waste treatment, disposal, and recovery facilities as an authorized representative
of the Director.
Choose
an item. ---
The permittee evaluated control measures implemented at industrial facilities
identified with an industrial activity permitted to discharge storm water to the
permittee’s MS4.
For the purposes of this permit, industrial activities shall mean all permitted industrial
activities as defined in 40 CFR 122.26.
Choose
an item. ---
For permitted industrial facilities, the permittee established procedures for
reporting deficiencies and non-compliance to the permitting agency.
Choose
an item. ---
NCS000247_Winston-Salem 2022 MS4 Self-Audit Page 22 of 40
Program to Monitor and Evaluate Stormwater Discharges to Municipal Systems
Where compliance with an existing industrial stormwater permit does not result
in adequate control of pollutants to the MS4, the permittee recommends and
documents the need for permit modifications or additions to the permit issuing
authority.
Choose
an item. ---
The permittee evaluated control measures implemented at industrial facilities
identified as an illicit discharge under the IDDE Program.
Choose
an item. ---
Comments
Additional
Comments:
NCS000247_Winston-Salem 2022 MS4 Self-Audit Page 23 of 40
Water Quality Assessment and Monitoring
Staff Interviewed:
(Name, Title, Role)
Permit Citation Program Requirement Status Supporting
Doc No.
II.I.2.a.
Water Quality
Assessment and
Monitoring Plan
The permittee maintained a Water Quality Assessment and Monitoring Plan. Choose
an item. ---
The Water Quality Assessment and Monitoring Plan includes a schedule for
implementing the proposed assessment and monitoring activities.
Choose
an item. ---
Comments
II.I.2.b.
Water Quality
Monitoring
The permittee maintained and implemented the Water Quality Assessment and
Monitoring Plan submitted to DEMLR.
Choose
an item. ---
The Division waived the requirement to maintain a Water Quality Assessment and
Monitoring Plan.
Choose
an item. ---
Comments
Additional
Comments:
NCS000247_Winston-Salem 2022 MS4 Self-Audit Page 24 of 40
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)?
NCS000247_Winston-Salem 2022 MS4 Self-Audit Page 25 of 40
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
NCS000247_Winston-Salem 2022 MS4 Self-Audit Page 26 of 40
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 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)?
NCS000247_Winston-Salem 2022 MS4 Self-Audit Page 27 of 40
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
NCS000247_Winston-Salem 2022 MS4 Self-Audit Page 28 of 40
Site Visit Evaluation: MS4 Outfall No. 1
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?
NCS000247_Winston-Salem 2022 MS4 Self-Audit Page 29 of 40
Site Visit Evaluation: MS4 Outfall No. 1
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
NCS000247_Winston-Salem 2022 MS4 Self-Audit Page 30 of 40
Site Visit Evaluation: MS4 Outfall No. 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) 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?
NCS000247_Winston-Salem 2022 MS4 Self-Audit Page 31 of 40
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
NCS000247_Winston-Salem 2022 MS4 Self-Audit Page 32 of 40
Site Visit Evaluation: Construction Site No. 1
Site/Project Name:
Date and Time of Site Visit:
Site/Project Address:
Operator:
Project Type
(Commercial, Industrial, Residential, CIP, Road, 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?
NCS000247_Winston-Salem 2022 MS4 Self-Audit Page 33 of 40
Site Visit Evaluation: Construction Site No. 1
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
NCS000247_Winston-Salem 2022 MS4 Self-Audit Page 34 of 40
Site Visit Evaluation: Construction Site No. 2
Site/Project Name:
Date and Time of Site Visit:
Site/Project Address:
Operator:
Project Type
(Commercial, Industrial, Residential, CIP, Road, 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?
NCS000247_Winston-Salem 2022 MS4 Self-Audit Page 35 of 40
Site Visit Evaluation: Construction Site No. 2
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
NCS000247_Winston-Salem 2022 MS4 Self-Audit Page 36 of 40
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 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, 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?
NCS000247_Winston-Salem 2022 MS4 Self-Audit Page 37 of 40
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
NCS000247_Winston-Salem 2022 MS4 Self-Audit Page 38 of 40
Site Visit Evaluation: Post-Construction Stormwater 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, 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?
NCS000247_Winston-Salem 2022 MS4 Self-Audit Page 39 of 40
Site Visit Evaluation: Post-Construction Stormwater 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
NCS000247_Winston-Salem 2022 MS4 Self-Audit Page 40 of 40
APPENDIX A: SUPPORTING DOCUMENTS