Stormwater Maintenance Plan and Field Manual 01282026 4932 5213 7869 v2

PART V - Inspection Checklist / Maintenance Actions Checklist (circle one): Quarterly / Annual / Monthly / Special Event Inspection Checklist No. ______________ Inspection Date: _______________ Preventative Maintenance Date of most recent rain event: __________ Frequency Circle One Quarterly Annual Rain Event Rain Condition (circle one): Drizzle / Shower / Downpour / Other _____________ Ground Condition (circle one): Dry / Moist / Ponding / Submerged / Snow accumulation For Inspector For Maintenance Crew Component No. Component Name Inspection Item and Inspection Item No. Inspected Preventative / Corrective Maintenance Actions Comments Storm Sewer Collection system 1 Structures broken or in disrepair, sediment, water present after 72 hours. Y__ N__ 2 Sediment and standing water observed after 72 hours. Y__ N__ 3 Excessive sediment or debris present in the inspection port Y__ N__ . 4 Little or no flow into the system Y__ N__

For Inspector For Maintenance Crew Component No. Component Name Inspection Item and Inspection Item No. Inspected Preventative / Corrective Maintenance Actions Comments Storm Sewer Collection system Site conditions 5 Downspout or Overflow pipe is clogged Y__ N__ 6 Odor present Y__ N__ 7 Overflow from the top of the casting Y__ N__ 8 Storm Collection System Y__ N__ 9 Vegetation Y__ N__ 10 Embankment erosion control Y__ N__ The inspection report shall include copies of photographs depicting the conditions of the BMPs. ________________________ __________________ ________________ Inspector Name Signature Date File this Corrective Maintenance Record in the Maintenance Log after performing maintenance.