SWM OM 15 North Edgewood Ave West Orange_2024 12 03

INSPECTION AND MAINTENANCE LOG Stormwater Management Drywell Facilities (This form to be submitted by April 1 every 3rd year) Name of Facility/Property Owner: __Property Owner of 15 North Edgewood Ave ______ Address: ____15 North Edgewood Ave ________ Block: ___158___ Lot: __3__ Date of Inspection/Maintenance: _____________ Weather: _____________________ Name of Inspector: ________________________ Phone: _______________________ Name of Contractor: _______________________ Phone: _______________________ 1. Debris and Sediment Condition (1, 2 or 3) Comments/ Special Instructions and Maintenance Performed a. Outlet Pipe b. Riprap Aprons c. Rodent Guards d. Inflow/ Interconnecting Pipe e. Drywells 2. Structural Components Condition (1, 2 or 3) Comments/ Special Instructions and Maintenance Performed a. Outlet Pipe b. Riprap Apron/Scour Hole c. Rodent Guard d. Inflow & Interconnecting Pipe e. Drywells f. Lid, Grate & Inspection Port (Attach additional sheets as necessary) 1 Item inspected and is in good condition, and the maintenance program is adequate. 2 Item inspected and requires attention, but does not present an immediate threat to the facility function or other facility components. 3 Item inspected requires immediate attention to keep the facility operational or to prevent damage to other facility components. Provide comments and details if conditions 2 or 3 exist. 3. Water Level Measurements Date Time Depth Comments a. Initial Measurement b. Subsequent Measurement c. Subsequent Measurement d. Subsequent Measurement e. Calculated Drain Time (Attach additional sheets as necessary) Signature of Inspector: _______________________ Date:_________________