Npdes Permit Provision C

STAFF ONLY Date of Building Permit:______Permit #:______

NPDES PERMIT IMPERVIOUS SURFACE DATA COLLECTION WORKSHEET COMPLETE AND SUBMIT INFORMATION FROM FORM FOR MUNICIPAL STORMWATER NPDES PERMIT REPORTING FOR EACH NEW AND REDEVELOPMENT PROJECT WHERE 10,000 SQUARE FEET OR MORE OF IMPERVIOUS SURFACE WILL HAVE BEEN CREATED, ADDED AND/OR REPLACED THIS REPORTING PERIOD.

What Projects Apply? All project applicants proposing to create, add, and/or replace 10,000 sq. ft. or more of impervious surface on the project site must fill out this worksheet and submit it to the Building Division at the point of building permit issuance. Interior remodeling projects and routine maintenance or repair projects, such as re-roofing and re-paving, are NOT required to complete this worksheet.

What is an Impervious Surface? An impervious surface prevents the infiltration or passage of water into the soil. Impervious surfaces include building rooftops, paved patios, covered patios, driveways, parking lots, paved walkways, sidewalks and streets.

For More Information For more information regarding selection of Best Management Practices for stormwater pollution prevention or stormwater treatment contact:

Project Name: ______APN #______- __ __ - ______

Project Description: Applicant’s Name: Project Location: (address) 1. Project Type (Check all that apply):  Residential  Commercial  Industrial  Public

2. Project size:

a. Site size sq. ft. b. Existing impervious surface area (includes land covered by buildings, sheds, patios/covers, parking lots, streets, sidewalks, paved walkways and driveways on site) sq. ft. c. New impervious surface area to be created, added, and/or replaced sq. ft. d. Percent increase/replacement of impervious surface area______% c/b(100%) e. Estimated area of land disturbance during construction ______sq. ft. (including clearing, grading, or excavating).

D:\Docs\2017-12-12\02a3bc6c75bcfc2a0ea4c79038f1e0fc.doc Page 1 of 2version dated November 2007 3. Type of Pesticide Reduction Measures Used (Check all that apply): Description Code  Education PEDU  Condition of Approval PCOA  Doesn’t Apply DNA

4. Types of Stormwater Controls Used (check all that apply): Description Code  Stormwater Treatment Measure STM  Source Control Measure SCM  Site Design Measure SDM

Examples of Stormwater Control Measures:

Stormwater Treatment cleaning)  Other ______ Biofilter (veg. swale/strip) Source Controls Site Design  Detention basin (dry)  Detention pond (wet)  Wash area/racks, drain to  Minimize land disturbance  Underground detention sanitary sewer  Minimize impervious  Media filter (sand, organic  Roofed dumpster area, surfaces matter, bioretention) drain to sanitary sewer  Minimum-impact street or  Hydrodynamic device  Swimming pool drain to parking lot design (commercially available sanitary sewer  Cluster structures/pavement in-line treatment unit)  Beneficial landscaping  Disconnect downspouts  Infiltration trench (minimizes irrigation, runoff,  Alternative driveway design  Porous pavement pesticides and fertilizers;  Microdetention in landscape  Wetland basin promotes treatment)  Preserve open space  Wetland channel  Outdoor material storage  Protect riparian and wetland  Inlet filter protection areas, riparian buffers  Other ______ Covers, drains for loading  Minimize change in runoff docks, maintenance bays, hydrograph fueling areas  Other  Maintenance (street ______sweeping, catch basin

This section to be completed by Agency Staff Reviewed: Community Development Department Public Works Department Planning Division: ______Engineering:______Building Division: ______

Return form to: ______Data entry performed by: ______