Form Center

2. Location Information
4. Date and Time
   Date and Time

   Date and Time
5. Inspector
7. Outfall ID
8. Outfall Location
9. Receiving Waterbody
11. Photos Taken?

    1. Yes
    2. No
12. Photo ID
14. Weather

    Check all that apply:

    1. Sunny
    2. Partly Cloudy
    3. Cloudy
    4. Foggy
    5. Windy
15. Temperature
16. Precipitation in the past 3 days?

    1. Yes
    2. No
17. If "Yes", how many inches?
19. Standing Water

    1. Yes
    2. No
20. Constant Baseflow
    -- Select One --NoneTrickleSteady
21. Color (if flow present)
23. Inspection Information
25. Obvious Debris Pollution
    -- Select One --None 0Foam 3Floating Green Scum 8Oil/Film 9Vegetative Mat 9Sewage/Solids 10
26. Odor
    -- Select One --None/Natural 0Musty 5Sewage/Septic 10
27. Water Clarity
    -- Select One --Clear 0Cloudy 5Opaque 10
29. Grand Total Score (add scores from observations above)
31. Additional Information
33. Sediment Accumulation
    -- Select One --Depth less than 2 inchesDepth exceeds 2 inchesPlugged
34. Structure Condition
    -- Select One --ExcellentGoodFairPoor
35. Trash/Litter present?

    1. Yes
    2. No
36. Yard Waste observed?

    1. Yes
    2. No
38. Vegetation Coverage
    -- Select One --N/AGreater than 90%More than 10% sparse or bare soil
39. Vegetation Type
    -- Select One --Normal VegetationInvasive, Poisonous, or Noxious Weeds
40. Erosion or Scouring?

    1. Yes
    2. No
42. General Comments
43. Potential Sources/Actions Taken:
45. Follow-up required?

    1. Yes

    1. No
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47. 1. Receive an email copy of this form.
48. Email address

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