HomeMy WebLinkAbout2024 Private Storm Water Inspection Form
2024 Stormwater Facility Maintenance Form
Date: Address:
Site Occupant: Site Phone No.:
Contact: Phone No.:
Email:
Mailing Address: Same as Site Address
Street/P.O. Box: City: Zip Code:
Contractor(s) Information: Note: you may need more than one contractor, depending on services needed on your site.
Name: Phone No.:
Email:
Street/P.O. Box: City: Zip Code:
Name: Phone No.:
Email:
Street/P.O. Box: City: Zip Code:
(remember to include checklists, invoices, and any photos) and return to:
City of Medina, Public Works
Attn: Rob Kilmer
Email: rkilmer@medina-wa.gov
(425) 233-6413
2024 Stormwater Facility Maintenance Table
Fill out sections applicable to your system
Catch Basins, Manholes and Control Structures
Inspection Date: ________________
Number Inspected: __________ Control structures: ________
Control structure type(s):______________________________
Okay
Needs Work
Date Maintenance Completed
Access to structure
Structure sound
Standing water below pipe level after a 24-48 hour dry period
Clear of contamination, pollution or debris
Inlets/outlets free of obstructions
Clear of sediment (not to exceed 1/3 of the sump depth)
Control Structure only:
Overflow clear of obstruction
Orifice/Gate functioning
Other:
Other:
Comments: (briefly describe issues and how addressed)
Underground Vaults, Tanks and Galleries
Inspection Date: ________________
Number Inspected: __________ Type(s): _________________
Okay
Needs Work
Date Maintenance Completed
Access to cleanouts/ structure
Structure sound
Clear of contamination, pollution or debris
Inlets/outlets free of obstructions
Ventilation clear of blockage
Baffle structure sound
Detention only:
Less than 4 inches of sediment
Standing water below pipe level after a 24-48 hour dry period
Infiltration Only:
No sediment/perforations clear
Drains after 24-48 hour dry period
Other:
Other:
Comments: (briefly describe issues and how addressed)
2024 Stormwater Facility Maintenance Table
Fill out sections applicable to your system
Ponds
Inspection Date: ________________
Number Inspected: __________ Type(s): ________
Okay
Needs Work
Date Maintenance Completed
Maintain overgrown vegetation, removing noxious and invasive plants
Free of trees growing in bottom and slopes of pond
Inlet/outlet pipes clear of excess sediment/vegetation/trash
Sediment level less than 10% of design depth
Energy dissipaters free of erosion & sediment
Clear of trash/yard waste
Access/signage/fence/security
Debris barriers secure, free of obstructions
Free of animal/insect damage
Wet Pond only:
No exposed liners, holes or bubbles
Less than 25% cattails
Infiltration or Dry Pond only:
Drains in a 24-48 hour dry period
Other:
Other:
Comments: (briefly describe issues and how addressed)
Swales, Ditches, Conveyance__________________
Inspection Date: ________________
Number Inspected: __________
Okay
Needs Work
Date Maintenance Completed
Inlet/outlet pipes clear of excess sediment/vegetation/trash
Maintained vegetation, removed noxious and invasive plants
Energy dissipation free of erosion, sediment buildup less than 10%
No ponding during dry periods
Dispersion free flowing, dispersing correctly
Free flowing, dispersing correctly
Debris barriers secure, structurally sound, free of debris/obstruction
Other:
Other:
Comments: (briefly describe issues and how addressed)
2024 Stormwater Facility Maintenance Table
Fill out sections applicable to your system
Bioretention
Inspection Date: ________________
Number Inspected: __________ Type(s): ________
Okay
Needs Work
Date Maintenance Completed
Access to underdrain (if applicable)
Free of animal/insect damage
No ponding during dry periods
Health of plants/irrigation
Energy dissipation – no sediment buildup, erosion or scouring
Free of weeds, invasives and noxious plants
Inlets/outlets clear of blockage/vegetation/trash
Media functioning, not compacted/maintain mulch cover
Flow control/check dams/weirs functioning (if applicable)
Other:
Other:
Comments: (briefly describe issues and how addressed)
Treatment Vaults
Inspection Date: ________________
Number Inspected: __________ Type:_____________________
Okay
Needs Work
Date Maintenance Completed
Baffle structure sound
Inlets & outlets clear of trash and debris
Sediment in vaults must be les than 4 inches
High sediment water line in vault at or above filter height
Standing water in vaults should drain in a 24-48 hour dry period
Access to structure
Structure sound
Filters only:
Sediment on filters must be less than ¼ inch
Filter media clean
Other:
Other:
Comments: (briefly describe issues and how addressed)
2024 Stormwater Facility Maintenance Table
Fill out sections applicable to your system
Other:___________________________________
Inspection Date: ________________
Number Inspected: __________ Type(s): ________
Okay
Needs Work
Date Maintenance Completed
Other:
Other:
Other:
Comments: (briefly describe issues and how addressed)
Other:___________________________________
Inspection Date: ________________
Number Inspected: __________ Type(s): ________
Okay
Needs Work
Date Maintenance Completed
Other:
Other:
Other:
Comments: (briefly describe issues and how addressed)
Other:___________________________________
Inspection Date: ________________
Number Inspected: __________ Type(s): ________
Okay
Needs Work
Date Maintenance Completed
Other:
Other:
Other:
Comments: (briefly describe issues and how addressed)