SWPPP WA FS ERFO 2015(1)-20(1).pdf

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FEDERAL filGHW.AY .ADMINISTRATION ' WES'I1QlN FEDftAL LANDS

BIGHWAYDMSION

SWPPP CONSl'RUCTION SITE INSPECTION REPO:Q,T

Project Name:

Date oflnspectio~: Start/End Times:

Project Name:

Inspector's Names:

Inspector's Com{Jany:

Inspector's Contact Information:

Inspector's QuaJi:{ications (CESCL or other certification number): Inspector's Qualifications expiratton date:

Descdbe present p.hase of construction

Type ofinspection:

0Regular D Post-storm.event D Reduced inspection frequency period

Has there been a stor~ event since the lasfinspection? D Yes No If yes, provide:

Estimated Storm Start Date & Time:_. _______ _ Estimated Sto~ Duratio:µ (hrs):

Approximate Amount of Precipitation (in):------

Weather at time of this inspection?

D Clear 0Cloudy D Rain 0 Sleet 0Fog D Snowing D High Win.ds 0 Other:

Temperature: ______ _

WFLHD 157-2 (5/201i)

5.

Site-specific BMPs

• BMP - Describe and give the location of the structural and non-structural BMPs identified in your SWPPP in the BMP column below (add as many BMPs as necessary on the continuation sheets. Include areas that are required to be inspected by the CGP, such as material storage areas that are exposed to precipitation.

• BMP Installed:... If a BMP should be installed at the current phase of the project and you marked "No " in the "BMP Installed" column, then you must check "Yes" in the "BMP Action Required?" colu.mn

• BMP Action Required? - .If a BMP needs repair, modification, replacement, maintenance or a new BMP is needed or a SWPPP amendment is needed, then a BMP Action is required.

• BMP Action Required, Complete by Date - Before certi.fYing the report, fill in the date when the BMP Action can reasonably be expected to be completed. When a BMP Action is NOT required, leave the "Complete by Date" blank. · ·

• DescribeBMP Action, ifNeeded-Anytimeyou check "Yes"for "BMPAction Required", then you must also fill in the "Describe BMP Action" column.

• Delay(!d Action Item Report - When a lJMP Action is required and the Complete by Date is not met, you must then fill out. the Delayed Action Item Report to explain why the date was not met. Keep the Delayed A~tion Item Report in the SWPPP. . .

• Corrective Action Log - When a BMP Action is required as noted in this report, you must also enter all the

· information for this action in the Corrective Action Log.

BMP & Location BMP BMPAction Describe BMP Action, if Needed Insb11led? Required?

0Yes LJNo 0Yes UNo

Complete by Date:

0Yes 0No UYes 0No

Complete by Date:

0Yes 0No UYes 0No

Complete by Date:

0Yes 0No 0Yes 0No

Complete by Date:

UYes 0No 0Yes UNo

Complete by Date:

UYes 0No LJYes UNo

Complete by Date:

0Yes 0No 0Yes UNo

Complete by Date:

0Yes 0No UYes 0No

Complete by Date:

Page2 Project Name:

Inspection Date:

BMP & Location BMP BMPActj.on Describe BMP Action, if Needed Installed? Required?

9 0Yes 0No 0Yes LJNo

Complete by Date:

-10 0Yes .c;JNo 0Yes LJNo

Complete by Date:

11 0Yes L]No L]Yes LJNo

Complete by Date.:

12 0Yes LJNo LJYes·LJNo

Complete by "

Date:

13 [JYes L]No 0Ye8 L]No

Complete by Date:

14 LJYes 0No LJYes LJNo

Complete by· Date:

15 LJYes 0No UYes LJNo

Complete by Date:

16 L]Yes 0No 0Yes L]No

Complete by Date:

17 L]Yes 0No 0Yes 0No

P>mpleteby Date:

18 L]Yes 0No L]Yes L]No

Complete by Date:

19 L]Yes 0No 0Yes 0No

Complete by Date:

20 L]Yes 0No L]Yes L]No

Complete by Date:

21 L]Yes LJNo 0Yes 0No

Complete by Date:

• Please use continuation sheets if there are additional B.MPs to list.

Pag~ 3 Project Name:

Overall Site Issues

• BMP or Activity · -- These are some general ~ite issues that must be assessed during inspectioTis.

• Implemented? - If a BMP or activity should be implemented at the current phase· of the project and you check "No", then you must mark "Yes" in the "Corrective Action Required?" column.

• . Corrective Action Required? - When maintenance or some other corrective action is required, ~heck

"Yes" in this column.

• Corrective Action Required, Complete by Date - When a corrective acti~n. is required, before certifying the report, fill in the date when the corrective action can.reasonably be expected to be completed. When a corrective action is NOT required, leave th(! "Complete by Date" blank. .

• Describe Corrective Action, if Needed -Anytime you check "Yes" in the "Corrective Action Required?"

column, you must fill in the "Describe Corrective Action " column as well.

• Delayed Action Item Report - When a Corrective Action is required and the Complete by Date is not met, you must then fill out the Delayed Action Item Report to explain why the date was not met. Keep the Delayed Action Item Report in the SWPPP.

• Corrective Action Log - When a Corrective Action is required as noted in this report, you must also enter aU the information for this action in the C01:ective Action Log.

BMP or Activity Implemented? Corrective Describe Corrective Action and Location, if Needed Action Required?

Have stabilization lJYes LJNo LJYes 0No measures been initiated on slopes and disturbed Complete ·by areas not actively being Date:

worked?

Are natural resource 0Yes 0No 0Yes 0No areas (e.g., streams, wetlands, mature trees, Complete by etc.) required by the Date:

SWPPP to be delineated in the field, identified with barriers or markings?

Are perimeter controls lJYes 0No lJYes 0No and sediment barriers

. adequately installed Complete by (keyed into substrate) .Date:

and maintained?

Are ~toi;ro drain inlets 0Yes 0No lJYes 0No pr9perly protected? Complete by

Date:

Are the construction LJYes LJNo UY~ lJNo exits preventing sediment from being Complete by tracked. into the street? Date:

ls trash/litter from work LJYes LJNo UYes UNo areas collected and placed in covered Complete by dumosters? Date:

Are washout faciliti~s LJYes LJNo LJYes 0No (e.g., paint, concrete) available, clearly Complete by marked, and maintained? Date:

Page4 Project Name:

BMP or Activity Implemented? Corrective Describe Corrective Action and Location, if Needed Action Required?

8 Arn vehicle and 0Yes 0No 0Yes 0No equipment fueling, cleaning, and Complete by maintenance areas free Date:

of spills, leaks, or any other deleterious material?

9 Are materials that are 0Yes 0No UYes O·No potential stormwater Complete by contaminants stored Date:

inside or under cover?

10 Are non-stormwater LJYes 0No 0Yes 0No discharges (e.g., wash Complete by water, dewatering) Date:

properly controlled?

Overall Site Issue Answer to Corrective Question Action Describe Corrective Action and Location, if Needed

Reauired?

I . At the time of LJYes LJNo 0Yes LJNo inspection, are the Complete by discharge points and Date:

receiving waters free of pollutant discharges (sediment deposits, sediment plume or oil sheen)? (See continuation page for list of discharge ooints)

2 Since the last inspection; UYes 0No LJYes UNo are the discharge points · Complete by and receiving waters free Date:

of evidence that pollutants had left the project site (for example, sediment deposits, oily residue)?· (See continuation page for list . of discharge points)

0.Yes 0No 3 Has Spill Response kit LJYes 0No been used since the last Complete by inspection? If yes, has Date:

stock been maintained?

4 . Ai.e any additional 0Yes 0No 0Yes 0No BMPs needed? Complete by

Date:

5 (Other) LJYes LJNo LJYes 0No

0 Complete by Date:

Pages Project Name:

Scope oflnspection

Did you inspect all areas of the project that are LJYes LJNo If you did not inspect any required.areas, list thase required to be inspected by th~ CGP (areas locations here and explain why they weren't inspected.

disturbed by construction activity, areas used for storage of materials that are exposed to precipitation, discharge locations and locations .where vehides enter or exit the site)?

• Check the box below if the project is in compliance with the CGP and the SWPPP:

0 I certify that on the date of this inspection, this project was found to be in compliance with the terms of its Storm Water ·Pollution Prevention Plan and the current Construction General Permit.

• If there are incidences of non-compliance, then do not check the box above.

• When you don't check the box above, then you must describe each incident of non-c0mpliance and the· actions that are·needed to bring the project into compliance.

• If there is an Action Item described in the non-compliance box' that does not already have a "Complete by

Date" assigned elsewhere in this report, then add a completion date Within the box.

Non-Compliance

Incidence of Non-compliance:

Action Item and Complete by Date:

CERTIFICATION STATEMENT

"I certify under penalty of law that this document and all attachments were prepared under my direction or supervision in accordance with a system designed to assure that qualified personnel properly gathered and evaluated 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 signifieant penalties for submitting false information, including the possibility of fine and imprisonment for knowing violations."

Contractor's Duly Authorized Representative FHW A's Duly Authoriied Representative

Print name: Print Name:·

Title: Superintendent Title: Proj~t Engineer

Signature: Signature:

Page6 Project Name: