Annual Storm Drain Structure Maintenance Report

Annually, all privately owned storm drain structures must be inspected and a report submitted to Water Environment Services. In addition, if any cleaning or maintenance/repair is performed, this must be included in the report.

Site Location and Contact Information

Site/Facility Name:  
Site/Facility Street Address:  
City:  
Zip:   97045 / 97045-1234
Contact Name:  
Phone: ###-###-####
Email:   name@example.com
Billing address if different than above:  
City:  
Zip:   97045 / 97045-1234
Inspected by (name or company):  
Date Inspected:   mm/dd/yyyy / /

Type and Number of Structures Inspected, Cleaned, or Repaired
(Complete all that apply)

Stormdrains
Total # on property
# inspected
# repaired
# cleaned

Manholes/Flow Control Manholes
Total # on property
# inspected
# repaired
# cleaned

Hydrodynamic Separators (CDS, Contech, Stormceptor, Vortech, etc.)
Total # on property
# inspected
# repaired
# cleaned

Oil-Water Separators
Total # on property
# inspected
# repaired
# cleaned

Cartridge Vault and Filters
Total # on property
# inspected
# repaired
# cleaned

Detention Tanks/Detention Pipes
Total # on property
# inspected
# repaired
# cleaned

Water Quality Swales/Planters
Total # on property
# inspected
# repaired
# cleaned

Inlet/outlet pipes unobstructed by plants/debris?
Yes
No
N/A

Vegetation dense and in good condition?
Yes
No
N/A

Invasive vegetation at less than 10%?
Yes
No
N/A

Sediment accumulation is < 50% of sump?
(In pond structures and pond bottom)
Yes
No
N/A

Water Quality/Detention Ponds
Total # on property
# inspected
# repaired
# cleaned

Inlet/outlet pipes unobstructed by plants/debris?
Yes
No
N/A

Vegetation dense and in good condition?
Yes
No
N/A

Invasive vegetation at less than 10%?
Yes
No
N/A

Sediment accumulation is < 50% of sump?
(In pond structures and pond bottom)
Yes
No
N/A

Other Structures (Use the comment field to provide more detail)
Total # on property
# inspected
# repaired
# cleaned

Debris Removed
 Total estimated amount of debris removed:
Unit of Measurement:  
Date cleaned:   mm/dd/yyyy / /
Cleaned by (name or company):  
Comments: