DEMLR Monitoring

Project Information

Project Name

Project/Permit #

Land Quality / Local Program (Approving Authority)

Date of Plan Approval

Expiration Date (if applicable)

NCG010000 Certificate of Coverage #

Date of COC Issuance

Coverage under the NCG010000 permit must be renewed annually, if issued after April 1, 2019 until Notice of Termination is filed and approved.

Part 1A — Rainfall Data (inches)

Mon

Tue

Wed

Thu

Fri

Sat (Optional)

Sun (Optional)

Part 1B — Phase(s) of the Plan

Initial installation of erosion and sediment control measures Clearing & grubbing of existing ground cover Completion of any grading that requires ground cover Completion of all land-disturbing activity, construction or development Permanent ground cover sufficient to restrain erosion has been established

Any site or project conditions that limit completion of inspection? If yes, explain areas that were inaccessible.

Part 2 — Stormwater Plans & Controls

For each item, select Y / N / N/A. All "No" items should be referenced and corrected in Part 3A.

Part 2A: Storm Water Plans and Related Documents

Ref	Question	Yes	No	N/A
A	Is the approval letter or certificate, COC and a copy of the NPDES CGP on site? (Electronic CGP acceptable)
B	Is the approved plan on site and current?

Part 2B: Stormwater Pollutant Controls

Ref	Question	Yes	No	N/A
C	Are erosion and sediment controls shown on the approved plan installed and operating properly with no repairs needed?
D	Are stormwater controls shown on the approved plan installed and operating properly with no repairs needed?
E	Vehicle Tracking: Are construction entrances operating properly with no repairs needed?
F	Soil Stabilization: Are areas where construction activities have ceased properly stabilized within required timeframes?
G	Are earthen stockpiles stabilized or otherwise protected, and located at least 50 ft away or downhill from drain inlets and surface waters?

Report oil spills and releases of hazardous substances to the appropriate DEQ Regional Office within 24 hours of discovery.

Part 2C: Non-Storm Water Pollutant Controls

Ref	Question	Yes	No	N/A
H	Concrete, stucco, paint, etc. washouts: Installed, properly located, posted and operating with no repairs needed?
I	Solid & hazardous wastes: Are trash, debris, and hazardous materials properly managed?
J	Sanitary waste: Are portable toilets properly located and operating with no visible repairs needed?
K	Equipment and stored fluids: Are fuels, lubricants, hydraulic fluids, etc. contained so as not to enter surface and ground waters?

Report visible sedimentation into streams or wetlands to the appropriate DEQ Regional Office within 24 hours of discovery.

Part 2D: Sedimentation

Ref	Question	Yes	No	N/A
L	Are sediment or other pollutants noted beyond the approved/permitted limits of disturbance?
M	Are BMPs detected as releasing sediment or other pollutants into receiving waters?

Part 3A — Erosion & Sedimentation Control Measures

Inspect at least once per 7 calendar days and within 24 hours of ≥ 1.0" rainfall in 24 hours.

Measure ID / Location and Description	Reference(s)	Operating Properly? (Y/N)	Inspection Date	Describe Actions Needed	Date Previous Action(s) Observed as Corrected	—

Report unanticipated bypasses or non-compliance conditions that may endanger health or the environment to the appropriate DEQ Regional Office within 24 hours of discovery.

Part 3B — Stormwater Discharge Outfalls (SDOs)

Inspect at least once per 7 calendar days and within 24 hours of ≥ 1.0" rainfall in 24 hours.

Stormwater Discharge Outfall ID / Location	Any Visible Sedimentation in Streams/Wetlands/Outside Site Limits? (Y/N)	Any Increase in Stream Turbidity from Discharge? (Y/N)	Any Visible Erosion below SDO? (Y/N)	Any visible oil sheen / floating or suspended solids / discoloration? (Y/N)	Inspection Date	Describe Actions Needed	Date Previous Action(s) Observed as Corrected	—

Part 3C — Ground Stabilization

Must be recorded, at a minimum, after each phase. Add rows as needed.

Site area description and location where activities have temporarily or permanently ceased	Time Limit for Ground Cover	Have stabilization measures been installed? (Y/N)	Temporary or Permanent (T/P)	Is Ground Cover sufficient to restrain erosion? (Y/N)	Original Inspection Date	Describe Actions Needed	Date Previous Action(s) Observed as Corrected	—

Part 3D — New or Revised Measures

Document measures omitted/installed/altered/relocated/removed since last inspection. Add rows as needed. Corrective actions should be included in Part 3A.

Measure ID or Location and Description	Proposed Dimensions (ft.)	Actual Dimensions (ft.)	Significant Deviation from Plan? (Y/N)	Date measure observed as installed / altered / relocated / removed	Installed (I) / Altered (A) / Relocated (R) / Removed (X)	—

*Significant deviation means any omission, alteration or relocation of a measure that prevents it from performing as intended.

Part 4 — Signature of Inspector

Inspector Name

Employer

Inspector Type

Address

County

Phone Number

Email Address

Date & Time of Inspection

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