Swppp Construction Inspection Report Form PDF Details

Essential for maintaining compliance with state regulations, the SWPPP Construction Inspection Report form is a comprehensive document provided by the State of Alaska Department of Transportation and Public Facilities. Designed to detail all necessary checks and inspections carried out at construction sites, this form plays a pivotal role in ensuring that projects adhere to stipulated environmental protection guidelines. It covers a broad spectrum of elements such as general information, weather conditions, site issues, discharge points, and site-specific BMPs (Best Management Practices). Additionally, it mandates detailed reporting on whether certain control measures are implemented, whether corrective actions are required, and the timelines for such actions. The structure of the form not only facilitates thorough onsite evaluations but also assists in the systematic documentation of the state of various environmental controls throughout the construction phase. Through the mandated entries ranging from weather conditions to the efficacy of sediment barriers and the handling of potential pollutants, it underscores the Alaska Construction Forms' commitment to minimizing environmental impacts during construction activities. This document is instrumental in promoting best practices on construction sites, aiming to keep Alaska's natural resources safeguarded amidst development activities.

QuestionAnswer
Form NameSwppp Construction Inspection Report Form
Form Length7 pages
Fillable?No
Fillable fields0
Avg. time to fill out1 min 45 sec
Other namespfs, alaska, 2016, stormwater

Form Preview Example

STATE OF ALASKA

DEPARTMENT OF TRANSPORTATION AND PUBLIC FACILITIES

SWPPP CONSTRUCTION SITE INSPECTION REPORT

Detailed instructions for completing this form can be found on the Alaska Construction Forms website:

http://dot.alaska.gov/stwddes/dcsconst/index.shtml

 

 

 

 

 

 

1.0 General Information

1.1

Project Name

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

1.2

Project Number

 

 

 

 

 

1.3 Location

 

 

 

 

 

 

 

 

 

 

 

 

1.4

NOI Tracking No.

Contractor’s:

 

 

DOT&PF’s:

 

 

 

 

 

 

 

 

1.5a Date of Inspection

 

 

 

 

 

1.5b Start/End Times:

 

 

 

 

 

 

 

 

 

1.6

Inspectors’ Names

Contractor:

 

 

DOT&PF:

 

 

 

 

 

 

 

 

1.7

Inspectors’ Titles

Contractor:

 

 

DOT&PF:

 

 

 

 

 

 

 

 

1.8

Inspectors’

Contractor:

 

 

DOT&PF:

Contact Information

 

 

 

 

 

 

 

 

1.9a AK-CESCL Cert. No.

Contractor:

 

 

 

DOT&PF:

 

 

 

 

 

 

1.9b AK-CESCL Exp. Date

Contractor:

 

 

 

DOT&PF:

 

 

 

 

 

 

 

 

 

 

 

1.10 Describe construction activities

1.11 Type of Inspection:

Regular

Post-storm Event

Reduced Inspection Frequency Period

2.0Weather Information

2.1Describe the weather since the last inspection, or start of construction activities if first Inspection.

Check all appropriate boxes.

 

 

 

 

 

 

Clear

Cloudy

Rain

Sleet

Fog

Snow

High Winds

Other:

2.2 Storm events. Complete storm event information if there were any storm events since the last inspection.

Storm event: a rainfall event that produces more than 0.5 inch of precipitation in 24 hours and that is separated from the previous storm event by at least 3 days of less than 0.1 inch of rain per day, CGP C16.

Estimated

Start Date:

Estimated

Duration (#days):

Approximate

Amount of

Precipitation (in):

2.3Weather at time of this inspection? Temperature:

Clear Cloudy Rain

Sleet Fog Snow

High Winds Other:

Form 25D-100 (6/2021)

Page 1 of 7

Project Number:

 

 

Inspection Date:

3.0 Overall Site Issues

For complete instructions, please see instructions on Constructions Forms web page, by separate form

Overall Site Issue -- These are general site issues that must be assessed during inspections.

Implemented? – If a BMP should be installed at the time of the inspection and you marked “No” in the “BMP Installed” column, then you must check “Yes” in the “BMP Action Required?” column. If there is good reason to mark “no” in the “BMP Installed” column (such as the BMP is no longer needed and was removed) then you can mark “no” in the “BMP Action Required?” column and explain in the “Comments” column.

Corrective Action Required? - When maintenance or some other corrective action is required, check “Yes” in this column.

Corrective Action Required, Complete by Date - When a corrective action 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 the “Complete by Date” blank.

If Corrective Action is required, describe Action and Location – Anytime you check “Yes” in the “Corrective Action Required?” column, you must fill in the “Describe Corrective Action and Location” column as well.

Corrective Action Log - When a Corrective Action is required as noted in this report, you must also enter all the information for this action in the Corrective Action Log and document on the Log the actual date of completed correction.

 

 

 

 

Corrective

If Corrective Action is

 

 

Overall Site Issue

Response

Action

required, describe

Comments

 

 

 

 

Required?

Action and Location

 

3.1

Have stabilization

 

 

Yes

No

 

 

 

measures been

 

 

 

 

 

 

 

 

 

 

 

 

initiated on slopes

Yes

No

Complete by

 

 

 

and disturbed areas

 

 

 

 

 

Date:

 

 

 

 

not actively being

 

 

 

 

 

 

 

 

 

 

 

 

 

worked?

 

 

 

 

 

 

3.2

Are natural resource

 

 

 

 

 

 

 

areas (e.g., streams,

 

 

 

 

 

 

 

wetlands, mature

 

 

Yes

No

 

 

 

trees, etc.) required

Yes

No

 

 

 

 

 

by the SWPPP to be

Complete by

 

 

 

delineated in the

 

 

Date:

 

 

 

 

field, identified with

 

 

 

 

 

 

 

barriers or markings?

 

 

 

 

 

 

 

 

 

 

 

 

 

 

3.3

Are perimeter

 

 

Yes

No

 

 

 

controls and sediment

 

 

 

 

 

 

 

 

 

 

 

 

barriers adequately

Yes

No

Complete by

 

 

 

installed (keyed into

 

 

 

 

 

Date:

 

 

 

 

substrate) and

 

 

 

 

 

 

 

 

 

 

 

 

 

maintained?

 

 

 

 

 

 

3.4

Are storm drain inlets

 

 

Yes

No

 

 

 

properly protected?

 

 

 

 

 

 

 

 

Yes

No

Complete by

 

 

 

 

 

 

Date:

 

 

 

 

 

 

 

 

 

 

 

3.5

Are the construction

 

 

Yes

No

 

 

 

exits preventing

 

 

 

 

 

 

 

 

 

 

 

 

sediment from being

Yes

No

Complete by

 

 

 

tracked into the

 

 

Date:

 

 

 

 

street?

 

 

 

 

 

 

 

 

 

 

 

 

3.6

Is trash/litter from

 

 

 

 

 

 

 

work areas collected

 

 

Yes

No

 

 

 

and disposed of

Yes

No

 

 

 

 

 

properly?

Complete by

 

 

 

 

 

 

Date:

 

 

 

 

 

 

 

 

 

 

 

Form 25D-100 (6/2021)

Page 2 of 7

Project Number:

 

 

Inspection Date:

 

 

 

 

Corrective

If Corrective Action is

 

 

Overall Site Issue

Response

Action

required, describe

Comments

 

 

 

 

Required?

Action and Location

 

3.7

Are washout facilities

 

 

Yes

No

 

 

 

(e.g., paint, concrete)

 

 

 

 

 

 

 

 

 

 

 

 

available, clearly

Yes

No

Complete by

 

 

 

marked, and

 

 

 

 

 

Date:

 

 

 

 

maintained?

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

3.8

Are vehicle and

 

 

 

 

 

 

 

equipment fueling,

 

 

Yes

No

 

 

 

cleaning, and

 

 

 

 

 

 

 

 

 

 

 

 

maintenance areas

Yes

No

Complete by

 

 

 

free of spills, leaks,

 

 

Date:

 

 

 

 

or any other potential

 

 

 

 

 

 

 

 

 

 

 

 

 

pollutants?

 

 

 

 

 

 

 

 

 

 

 

 

 

 

3.9

Are materials that are

 

 

 

 

 

 

 

potential stormwater

 

 

Yes

No

 

 

 

contaminants stored

Yes

No

 

 

 

 

 

inside or under

Complete by

 

 

 

cover?

 

 

Date:

 

 

 

 

 

 

 

 

 

 

 

3.10

Are non-stormwater

 

 

Yes

No

 

 

 

discharges (e.g., wash

 

 

 

 

 

 

 

 

 

 

 

 

water, dewatering)

Yes

No

Complete by

 

 

 

properly controlled?

 

 

Date:

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

3.11

Has Spill Response

 

 

Yes

No

 

 

 

kit been used since

 

 

 

 

 

 

 

 

 

 

 

 

the last inspection?

Yes

No

Complete by

 

 

 

 

 

 

Date:

 

 

 

 

 

 

 

 

 

 

 

3.12

Is the SWPPP Main

 

 

Yes

No

 

 

 

Entrance Signage

 

 

 

 

 

 

 

 

 

 

 

 

legible and does it

Yes

No

Complete by

 

 

 

contain the correct

 

 

Date:

 

 

 

 

information?

 

 

 

 

 

 

 

 

 

 

 

 

3.13

Are erodible

 

 

Yes

No

 

 

 

stockpiles properly

 

 

 

 

 

 

 

 

 

 

 

 

covered and have a

Yes

No

Complete by

 

 

 

perimeter control?

 

 

 

 

 

 

 

Date:

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

3.14

Are any additional

 

 

Yes

No

 

 

 

BMPs needed?

 

 

 

 

 

 

 

 

 

 

 

 

 

Yes

No

Complete by

 

 

 

 

 

 

Date:

 

 

 

 

 

 

 

 

 

 

 

3.15

(Other)

 

 

Yes

No

 

 

 

 

 

 

 

 

 

 

Yes

No

Complete by

 

 

 

 

 

 

Date:

 

 

 

 

 

 

 

 

 

 

 

Form 25D-100 (6/2021)

Page 3 of 7

Project Number:

 

 

Inspection Date:

4.0 Discharge Points

 

 

 

 

 

 

 

 

 

 

 

 

 

If Response is No,

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

Corrective

 

 

describe Location.

 

 

 

 

 

 

 

 

 

 

Overall Site Issue

 

 

 

 

 

 

 

If Corrective

 

 

 

 

 

 

 

 

 

 

 

 

Response

 

 

 

Action

 

 

 

 

 

Comments

 

 

 

 

 

 

 

 

 

 

 

 

Action is required,

 

 

 

 

 

 

 

 

 

 

 

 

 

Required?

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

describe Action

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

and Location

 

 

 

 

 

 

 

4.1

 

At the time of inspection, are the

 

Yes

 

Yes

 

 

 

 

 

 

 

 

 

 

 

 

discharge points and receiving waters

 

No

 

 

No

 

 

 

 

 

 

 

 

 

 

 

 

free of pollutant discharges (sediment

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

Complete by

 

 

 

 

 

 

 

 

 

 

 

 

deposits, sediment plume or oil sheen)?

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

Date:

 

 

 

 

 

 

 

 

 

 

 

 

(See Section 4.3 for list of discharge

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

points)

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

4.2

 

Since the last inspection, are the

 

Yes

 

Yes

 

 

 

 

 

 

 

 

 

 

 

 

discharge points and receiving waters

 

No

 

 

No

 

 

 

 

 

 

 

 

 

 

 

 

free of evidence that pollutants had left

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

Complete by

 

 

 

 

 

 

 

 

 

 

 

 

the project site (for example, sediment

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

Date:

 

 

 

 

 

 

 

 

 

 

 

 

deposits, oily residue)? (See Section

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

4.3 for list of discharge points)

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

4.3 Location of Discharge Points

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

List the project discharge point locations

 

 

 

 

 

Inspected?

 

 

 

 

 

 

 

 

 

 

Circle

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

Yes

No

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

Yes

No

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

Yes

No

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

Yes

No

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

Yes

No

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

Yes

No

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

Yes

No

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

Yes

No

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

Yes

No

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

Yes

No

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

Yes

No

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

Yes

No

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

Yes

No

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

Form 25D-100 (6/2021)

 

Page 4 of 7

 

 

 

 

 

Project Number:

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

Inspection Date:

 

 

 

List the project discharge point locations

5.0 Site-specific BMPs

Inspected?

Circle

BMP Identifier -- This column is a mandatory entry used to help correspond BMPs with the site map. Number the structural and non-structural BMPs identified in your SWPPP on your site map and list them below (add as many BMPs as necessary on the continuation sheets).

BMP and Location - Describe and give the location of the structural and non-structural BMPs identified in your SWPPP in the BMP column below (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 time of the inspection and you marked “No” in the “BMP Installed” column, then you must check “Yes” in the “BMP Action Required?” column. If there is good reason to mark “no” in the “BMP Installed” column (such as the BMP is no longer needed and was removed) then you can mark “no” in the “BMP Action Required?” column and explain in the “Comments” column.

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 certifying 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.

If BMP Action is required, describe Action and Location – Anytime you check “Yes” for “BMP Action Required,” then you must also fill in the “Describe BMP Action and Location” column.

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, and document on the Log the actual date of completing correction.

BMP Identifier

 

BMP & Location

 

 

 

 

 

 

 

 

 

 

 

 

Form 25D-100 (6/2021)

 

 

BMP

 

 

 

BMP Action

 

 

If BMP Action is required,

 

 

 

 

 

 

 

 

 

 

 

describe Action and

 

 

Comments

 

 

Installed?

 

 

 

Required?

 

 

 

 

 

 

 

 

 

 

 

Location

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

Yes

 

Yes

No

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

Complete by

 

 

 

 

 

 

 

 

 

 

 

No

 

 

 

 

 

 

 

 

 

 

 

 

 

Date:

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

Yes

 

Yes

No

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

Complete by Date:

 

 

 

 

 

 

 

 

 

 

 

No

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

Yes

 

Yes

No

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

Complete by Date:

 

 

 

 

 

 

 

 

 

 

 

No

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

Yes

 

Yes

No

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

Complete by Date:

 

 

 

 

 

 

 

 

 

 

 

No

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

Yes

 

Yes

No

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

Complete by Date:

 

 

 

 

 

 

 

 

 

 

 

No

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

Page 5 of 7

 

 

 

Project Number:

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

Inspection Date:

 

BMP

Identifier

 

 

 

 

 

 

 

BMP

 

 

 

BMP Action

 

 

If BMP Action is required,

 

 

 

 

 

 

 

BMP & Location

 

 

 

 

 

 

 

 

 

describe Action and

 

 

Comments

 

 

 

 

 

 

Installed?

 

 

 

Required?

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

Location

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

Yes

 

Yes

 

No

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

Complete by Date:

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

No

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

Yes

 

Yes

 

No

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

Complete by Date:

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

No

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

Yes

 

Yes

 

No

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

Complete by Date:

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

No

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

Yes

 

Yes

 

No

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

Complete by Date:

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

No

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

Yes

 

Yes

No

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

Complete by Date:

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

No

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

Yes

 

 

Yes

 

No

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

Complete by Date:

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

No

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

Yes

 

 

Yes

 

No

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

Complete by Date:

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

No

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

Yes

 

Yes

 

No

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

Complete by Date:

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

No

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

Yes

 

 

Yes

 

No

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

Complete by Date:

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

No

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

Yes

 

 

Yes

 

No

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

Complete by Date:

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

No

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

Yes

 

 

Yes

 

No

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

Complete by Date:

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

No

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

Yes

 

Yes

No

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

Complete by Date:

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

No

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

6.0 Inspection Certification

Form 25D-100 (6/2021)

Page 6 of 7

Project Number:

 

 

Inspection Date:

6.1 Areas of Inspection

Did you inspect all areas of the project that are required to be

Yes

If you did not inspect any required areas, list

 

inspected by the CGP including areas disturbed by construction

No

those locations here and explain why they

activity, areas used for storage of materials that are exposed to

weren’t inspected.

 

precipitation, areas where control measures are installed, areas

 

 

where sediment or other pollutants have accumulated or been

 

 

deposited and may have the potential for or are entering a

 

 

stormwater conveyance system, locations where vehicles enter

 

 

or exit the site, areas where storm water typically flows, points

 

 

of discharge from the site, and portions of the site where

 

 

temporary or permanent stabilization has been initiated?

 

 

 

 

 

6.2Project Compliance

If there are incidences of non-compliance identified in this inspection report then you must summarize below the incidence(s) of non-compliance.

If there is an Action Item described in the non-compliance box below that does not already have a “Complete by Date” assigned elsewhere in this report, then add a Complete by Date within the box.

Non-Compliance

Incidence(s) of Non-compliance:

Action Item(s) and Complete by Date(s):

Check the box below if there are no incidences of non-compliance with the CGP:

I certify that on the date of this inspection, this project was found to be in compliance with the terms of the applicable Construction General Permit.

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 significant penalties for submitting false information, including the possibility of fine and imprisonment for knowing violations.”

Contractor’s Duly Authorized Representative

DOT&PF’s Duly Authorized Representative

Print name:

 

 

Print Name:

 

 

Title: Superintendent

Title: Project Engineer

Signature

 

Signature

 

Date

 

 

Date

 

 

Form 25D-100 (6/2021)

Page 7 of 7

Project Number:

 

 

Inspection Date:

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cgp writing process outlined (stage 1)

2. After the previous part is finished, you'll want to add the necessary specifics in Clear Cloudy, Describe the weather since the, High Winds, Other, Rain, Sleet, Fog, Snow, Estimated Start Date, Estimated Duration days, Weather at time of this, Clear Cloudy Rain, Sleet, Fog, and Snow High Winds Other allowing you to progress to the 3rd part.

Clear Cloudy Rain, Fog, and Snow High Winds Other inside cgp

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cgp conclusion process clarified (part 3)

4. Now fill out this fourth portion! Here you will have these Required, Action and Location, Have stabilization, measures been initiated on slopes, Are natural resource areas eg, Are perimeter, controls and sediment barriers, Are storm drain inlets properly, Yes No, Yes No, Yes No, Yes No, Yes No, Complete by Date, and Yes No blank fields to fill out.

Yes No, Action and Location, and controls and sediment barriers in cgp

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Filling out section 5 in cgp

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