HomeMy WebLinkAbout6.15.2021 Forest Terrace TESCPROPRIETARY COMPANY MATERIAL
NOTE 2016 Protocol: 6/15/2021
Maximum of one SSWR per
permit.
*PulteGroup
NATIONAL STORM WATER QUALITY PROGRAM
SITE INSPECTION REPORT (SIR)
For use on most PulteGroup Sites as of 01 /01/2016
Community Name: Forest Terrace, 2611 VZion Av_g NL- Banton. WA 98059 3MAR-3 10059
(Include Site Name, City, State, Zap Code and NPDES/Construction Storm Water PermitNumber)
Master Site List ID: 1419 Inspection performed by:
Andrew Glandon, WaterTechNW, CESCL #82522
(Print Name, Company, and Title / Qualifications )
Stages
of Construction: (checkall that apply)
N Land Development ❑ Inactive ❑ Vertical Construction ❑ Post -Construction
Type of Inspection: (checkall that apply)
❑ Routine Inspection N Storm -Event Related ❑ Final Site Inspection
❑ Other: Vault work, rough grading,
sweeper on site
I.
SWPPP —Respond to all Questions
Item
Yes NO If "No," then an
A.
Was the SWPPP accessible at the time of
the inspection?
Action Item
® ❑ is required.
B.
Is the SSWR correctly identified in the SWPPP?
® ❑
C.
Does the SWPPP reflect the current stage of development
g p
Describe allAction
Items onthe reverse
including a current BUT Site Map?
® ❑ side of this sheet.
D.
Have all SIR Action Items identified on
the preceding reports been resolved?
® ❑ (Section IV)
E.
Is NSQP Signage posted and in compliance with NSQP requirements?
® ❑
H.
Estimated date of most recent Storm Event that triggered an Inspection: 6/13/2021; 0.60"
Provide rainfall information as required by the Applicable Permit 0.10"
(Based on the storm -event related Inspection
M.
Site BMP Inspection
Not
Frequency required by the Applicable Permit)
Item
SWPPP Items
Applicable
Acceptable
A.._.-..
Erosion
Control
1
Protection of Disturbed Areas
❑
N
❑
2
Slope Protection
❑
N
❑
3
Vegetation/Revegetation
❑
N
❑
4
Velocity Reduction Devices/ Outlet
❑
N
❑
Protection
Sediment Control
5
Check Dams (rock, gravel, other)
N
❑
❑
6
Silt Fence
❑
N
❑
7
Berms, Dikes, Straw Wattles
❑
N
❑
8
Detention Basins/Sediment Traps
❑
N
❑
9
Stockpiles Protected / Stabilized
❑
N
❑
10
Storm Water Inlet Protection
❑
®
❑
Housekeeping/Trade Compliance
l 1
Waste and Trash Management
❑
N
❑
12
Spill and Leak Prevention
❑
N
❑
13
Sanitary Stations
❑
N
❑
14
Concrete and Construction Washouts
❑
®
❑
15
Material Use and Potential
10
❑
❑
Contaminate Storage
16
Equipment Storage and Maintenance
❑
N
❑
17
Construction Exits and Entrances
❑
N
❑
All capitalized terms are defined in the glossary of the NSQP Handbook.
Complete all Sections of this Report. Any information added after the signature date must be initialed and dated.
This report must he signed by the SSWR, dated and retained with the SWPPP.
0 PulteGroup, Inc. 2016 PROPRIETARY COMPANY MATERIAL Standard SIR 2016
Item
18
(19
Other
20
21
22
23
24
25
IV.
SWPPP Items (continued)
Dust Control
Street Sweeping�rsll
Not
Applicable Acceptable
El x
Action Item Assigned To
Non -storm water flow
❑
® ❑
Site's weathering of Storm Events
❑
® ❑
Site discharge points
❑
® ❑
BIVIP provider performance
❑
® ❑
No eonstructionstormwaterdischarge
❑
® ❑
❑
❑ ❑
Action Items
V. Responsive Action
Completion
Item Location and Responsive Action to be taken
Date
Noted
Date of
Completion
Initials
Attach additional sheet(s) of SIR addendum ifnecessary
SIR must be reviewed and sinned below by SSWR — Not Delezable: I certify under penalty of law that Sections I-V of this
document and all attachments were prepared by me or under my direction or supervision in accordance with a system designed to
assure that qualified personnel properly gathered and evaluated the in formation submitted. Based on my inquiry of the 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. Certification applies to the area under the supervision of
the SSWR signing this report.
�Kim lnual UV It! V 1V W VU 4UU a1r.11VU UC1V W UV oa VV .R ^ 1
Certified By. (SSWR — Must be a PulteGroup Employee)
Site Storm Water Representative —Print Name and Title
ite Storm Water Representative Signature (Use Ink) Date
CC rtiried By: (third Party Inspector if required by the Applicable Permit
Andrew Glandon CESCL 82522; 425 890 4858
Inspector — Print Name
Za Z/ 2 6115/2021
Inspector Signature (Use Ink) Date
VI. Justification for non -completion of Responsive Actions.
Describe why any Responsive Actions were not corrected within the permit required time period (if applicable).
Attach additionalsheet(s) ifnecessary
All capitalized terms are defined in the glossary of the NSQP Handbook.
Complete all Sections of this Report. Any information added after the signature date must be initialed and dated.
This report must be signed by the SSWR, dated and retained with the SWPPP.