WATERSHED PROTECTION INSPECTION REPORT

[Local Government Name – Department Doing Inspection]

Inspection Date: ______

The [Local Government Name] Water Supply Watershed Protection Ordinance requires that runoff control structures be inspected annually to insure they are being maintained and are functioning as originally designed.

A.  General Information:

Project Name: / Owner/Contact Name:
Location: / Owner/Contact Address:
Identification No.:
Water Supply Watershed: / Receiving Stream:

B.  The following stormwater runoff controls are found at this project site:

Wet Detention Pond / Sand Filters / Extended Dry Detention / Infiltration Devices
Extended Detention Pond / Bioretention Area / Filter Strips / Stream Buffers: ______ft.
Grassed Swales / Pocket Wetlands / Other:______

C. The results of this year’s inspection are as follows:

Visual inspection found no apparent problems.

Complete the repair and/or maintenance items INDICATED BELOW within 90 days of this report:

D.  Repair and/or Maintenance Items to Completed Within 90 Days:

Ponds/Basins:

dam top & slopEs / faces / Principal & WQ Spillways
Remove trash & high bushes. / Clear obstructed water quality hole or riser.
Repair (applicable problems circled): holes, slides, / Repair riser/barrel (applicable problems circled): leaking, cracked,
depressions, cracks. / deteriorated, collapsed, damaged.
Evidence of (applicable problems circled): seepage, / Repair concrete spillway (applicable problems circled): leaking,
overtopping. / cracked, deteriorated, spalling, damaged.
Repair eroded areas. / Outlet end of barrel is eroded or blocked.
Seed bare areas. / Filter rock is clogged.
EMERGENCY SPILLWAY / IMPOUNDMENT
Remove trees and high bushes. / Repair eroded inlet channel and/or drains.
Repair eroded areas. / Repair eroded slopes.
Seed bare areas. / Clean sediment from forebay area.
Repair displaced rip-rap. / Permanent pool less than 3 feet. Perform pond volume check.
Remove obstructions from spillway. / Clean clogged filter surface.
Enlarge spillway to adequate capacity.
OTHER:______

Other Controls:

Restore sheet flow / Remove debris/trash / Restore vegetation / Other:______
Location:______

E. Additional Comments/Recommendations:

Please notify us when work is complete or if you have questions. Inspection by: ______

[Local government contact information: address and telephone number ]