Stormwater Pollution Prevention Plan (SWPPP)
INSERT PROJECT NAME
Construction SWPPP Template
Instructions
To help you develop your construction project Stormwater Pollution Prevention Plan (SWPPP), the
U.S Environmental Protection Agency (EPA) has created this SWPPP Template. The template is
designed to help you develop a SWPPP that is compliant with the minimum requirements of
ODEQ’s 2012 OKR10 Construction General Permit (“2012 OKR10”), and is customizable to your
specific project and site.
Using the SWPPP Template
Each section of the SWPPP Template includes “instructions” and space for your project and site
information. You should read the instructions for each section before you complete that section.
The SWPPP Template was developed as an editable document file so that you can easily add
tables and additional text, and delete unneeded or non-applicable fields. Note that some
sections may require only a brief description while others may require several pages of
explanation.
The following tips for using this template will help you ensure that the minimum permit
requirements are met:

Read the 2012 OKR10 thoroughly before you begin preparation of your SWPPP to ensure
that you have a working understanding of the permit’s underlying requirements. You will
also need to consult Part 9 of the permit to determine if your state or tribe has included
additional requirements that affect you.

Complete the SWPPP prior to submitting your Notice of Intent (NOI) for permit coverage.
This is required in Parts 1.4 and 7.1.1.

If you prepared a SWPPP for coverage under a previous version of ODEQ’s OKR10, you
must review and update your SWPPP to ensure that the 2012 OKR10 requirements are
addressed prior to submitting your NOI.

If there is more than one construction operator for your project, consider coordinating
development of your SWPPP with the other operators. However, while multiple operators
may share the same SWPPP, make sure that responsibilities and scope of work are clearly
described for each operator.

Once you have been provided coverage under the OKR10, include your NOI and
authorization email, as well as a copy of the OKR10, as attachments to the SWPPP. See
Appendices B and C of the SWPPP Template.
Every effort has been made to ensure the accuracy of all instructions and guidance contained
in the SWPPP Template, the actual obligations of regulated construction activities are
determined by the relevant provisions of the permit, not by the Template. In the event of a
conflict between the SWPPP Template and any corresponding provision of the 2012 OKR10, you
must abide by the requirements in the permit.
OKR10 SWPPP Template, Version 1.0
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Stormwater Pollution Prevention Plan (SWPPP)
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Stormwater Pollution Prevention Plan (SWPPP)
For Construction Activities At:
Insert Project/Site Name
Insert Project Site Location/Address
Insert City, State, Zip Code
Insert Project/Site Telephone Number
SWPPP Prepared For:
Insert Company or Organization Name
Insert Name
Insert Address
Insert City, State, Zip Code
Insert Telephone Number
Insert Fax/Email
SWPPP Prepared By:
Insert Company or Organization Name
Insert Name
Insert Address
Insert City, State, Zip Code
Insert Telephone Number
Insert Fax/Email
SWPPP Preparation Date:
__ __ / __ __ / __ __ __ __
Estimated Project Dates:
Project Start Date: __ __ / __ __ / __ __ __ __
Project Completion Date: __ __ / __ __ / __ __ __ __
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Contents
SECTION 1: CONTACT INFORMATION/RESPONSIBLE PARTIES ........................................ 1
1.1
1.2
Operator(s) / Subcontractor(s) .................................................................................................... 1
Stormwater Team .......................................................................................................................... 2
SECTION 2: SITE EVALUATION, ASSESSMENT, AND PLANNING....................................... 3
2.1
2.2
2.3
2.4
2.5
2.6
Project/Site Information ................................................................................................................ 3
Discharge Information .................................................................................................................. 4
Nature of the Construction Activity............................................................................................. 6
Sequence and Estimated Dates of Construction Activities ..................................................... 7
Allowable Non-Stormwater Discharges ...................................................................................... 8
Site Maps ........................................................................................................................................ 9
SECTION 3: DOCUMENTATION OF COMPLIANCE WITH OTHER FEDERAL
REQUIREMENTS ................................................................................................................ 10
3.1
3.2
Endangered Species Protection................................................................................................ 10
Historic Preservation .................................................................................................................... 10
SECTION 4: CONTROLS TO REDUCE POLLUTANTS.......................................................... 11
4.1
4.2
4.3
4.4
4.5
4.6
4.7
4.8
4.9
4.10
4.11
4.12
4.13
4.14
Natural Buffers or Equivalent Sediment Controls ..................................................................... 11
Perimeter Controls ....................................................................................................................... 13
Sediment Track-Out..................................................................................................................... 14
Stockpiled Sediment or Soil ........................................................................................................ 15
Minimize Dust................................................................................................................................ 15
Minimize the Disturbance of Steep Slopes ............................................................................... 16
Topsoil............................................................................................................................................ 17
Soil Compaction .......................................................................................................................... 17
Storm Drain Inlets ......................................................................................................................... 18
Constructed Stormwater Conveyance Channels .................................................................. 19
Sediment Basins ........................................................................................................................... 19
Dewatering Practices ................................................................................................................. 20
Other Stormwater Controls ......................................................................................................... 21
Site Stabilization ........................................................................................................................... 21
SECTION 5: POLLUTION PREVENTION STANDARDS........................................................ 23
5.1
5.2
5.3
5.4
5.5
5.6
5.7
5.8
Potential Sources of Pollution ..................................................................................................... 23
Spill Prevention and Response ................................................................................................... 24
Fueling and Maintenance of Equipment or Vehicles ............................................................. 24
Washing of Equipment and Vehicles ........................................................................................ 25
Storage, Handling, and Disposal of Construction Products, Materials, and Wastes ........... 26
Washing of Applicators and Containers used for Paint, Concrete or Other Materials ...... 28
Fertilizers ........................................................................................................................................ 29
Other Pollution Prevention Practices......................................................................................... 29
SECTION 6: INSPECTION AND CORRECTIVE ACTION ................................................... 31
6.1
6.2
6.3
Inspection Personnel and Procedures ...................................................................................... 31
Corrective Action ........................................................................................................................ 32
Delegation of Authority .............................................................................................................. 32
SECTION 7: TRAINING ..................................................................................................... 33
SECTION 8: CERTIFICATION AND NOTIFICATION .......................................................... 34
SWPPP APPENDICES ........................................................................................................ 35
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SECTION 1: CONTACT INFORMATION/RESPONSIBLE PARTIES
1.1
Operator(s) / Subcontractor(s)
Instructions (see definition of “operator” at OKR10 Part 9):
― Identify the operator(s) who will be engaged in construction activities at the site.
Indicate respective responsibilities, where appropriate. Also include the 24-hour
emergency contact.
― List subcontractors expected to work on-site. Notify subcontractors of stormwater
requirements applicable to their work.
― Consider using Subcontractor Agreements such as the type included as a sample in
Appendix G of the Template.
Operator(s):
Insert Company or Organization Name
Insert Name
Insert Address
Insert City, State, Zip Code
Insert Telephone Number
Insert Fax/Email
Insert area of control (if more than one operator at site)
[Repeat as necessary.]
Subcontractor(s):
Insert Company or Organization Name
Insert Name
Insert Address
Insert City, State, Zip Code
Insert Telephone Number
Insert Fax/Email
Insert area of control (if more than one operator at site)
[Repeat as necessary.]
Emergency 24-Hour Contact:
Insert Company or Organization Name
Insert Name
Insert Telephone Number
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1.2
Stormwater Team
Instructions (see OKR10 Part 4.5.1):
― Identify the staff members (by name or position) that comprise the project’s stormwater
team as well as their individual responsibilities. At a minimum the stormwater team is
comprised of individuals who are responsible for overseeing the development of the
SWPPP, any later modifications to it, and for compliance with the requirements in this
permit (i.e., installing and maintaining stormwater controls, conducting site inspections,
and taking corrective actions where required).
― Each member of the stormwater team must have ready access to either an electronic
or paper copy of applicable portions of the 2012 OKR10 and your SWPPP.
Development of SWP3
Position:
Name:
Telephone:
Email:
Modification of SWP3
Position:
Name:
Telephone:
Email:
Maintaining Stormwater Controls
Position:
Name:
Telephone:
Email:
Conducting Site Inspections and Corrective Actions
Position:
Name:
Telephone:
Email:
[Repeat as necessary.]
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SECTION 2: SITE EVALUATION, ASSESSMENT, AND PLANNING
2.1
Project/Site Information
Instructions (see “Project/Site Information” section of Appendix J – NOI form):
― In this section, you are asked to compile basic site information that will be helpful to you
when you file your NOI.
― Detailed information on determining your site’s latitude and longitude can be found at
http://www.deq.state.ok.us/mainlinks/gis/index.html
Project Name and Address
Project/Site Name: INSERT TEXT HERE
Project Street/Location: INSERT TEXT HERE
City: INSERT TEXT HERE
State: INSERT TEXT HERE
ZIP Code: INSERT TEXT HERE
County or Similar Subdivision: INSERT TEXT HERE
Project Latitude/Longitude
(Use one of three possible formats, and specify method)
Latitude:
Longitude:
1. _ _ º _ _ ' _ _'' N (degrees, minutes, seconds)
1. _ _ º _ _ ' _ _'' W (degrees, minutes,
seconds)
2. _ _ º _ _ . _ _' N (degrees, minutes, decimal)
2. _ _ º _ _ . _ _' W (degrees, minutes,
decimal)
3. _ _ . _ _ _ _ º N (decimal)
3. _ _ . _ _ _ _ º W (decimal)
Method for determining latitude/longitude:
USGS topographic map (specify scale:
Other (please specify):
Horizontal Reference Datum:
NAD 27
NAD 83 or WGS 84
)
EPA Web site
GPS
Unknown
If you used a U.S.G.S topographic map, what was the scale? ____________________________
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2.2
Discharge Information
Instructions (see “Discharge Information” section of Appendix J – NOI form):
― For Table 1, list the name of the first surface water that receives discharges from your
site. If your site has discharges to multiple surface waters, indicate the names of all such
waters.
― For Table 2, if any of the surface waters you listed out in Table 1 are listed as impaired by
ODEQ, provide specified information about pollutants causing the impairment and
whether or not a Total Maximum Daily Load (TMDL) has been completed for the surface
water. For more information on TMDLs and impaired waters, including a list of TMDL
contacts, visit http://www.deq.state.ok.us/wqdnew/tmdl/index.html.
Does your project/site discharge stormwater into a Municipal Separate Storm Sewer System
(MS4)?
Yes
No
Are there any surface waters that are located within 50 feet of your construction disturbances?
Yes
No
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Table 1 – Names of Receiving Waters
Name(s) of the first surface water that receives stormwater directly from your site and/or from the MS4
(note: multiple rows provided where your site has more than one point of discharge that flows to
different surface waters)
1.
2.
3.
4.
5.
6.
[Include additional rows as necessary.]
Table 2 – Impaired Waters / TMDLs (Answer the following for each surface water listed in Table 1 above)
Is this surface
water listed as
“impaired”?
1.
2.
3.
4.
5.
6.
YES
YES
YES
YES
YES
YES
What pollutant(s) are causing
the impairment?
NO
NO
NO
NO
NO
NO
If you answered yes, then answer the following:
Has a TMDL
been
Title of the TMDL document
completed?
YES
YES
YES
YES
YES
YES
Pollutant(s) for which
there is a TMDL
NO
NO
NO
NO
NO
NO
[Include additional rows as necessary.]
Describe the method(s) you used to determine whether or not your project/site discharges to an impaired water: INSERT TEXT HERE
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2.3
Nature of the Construction Activity
Instructions (see OKR10 Part 4.5.2):
― Provide a general description of the nature of the construction activities at your project.
― Describe the size of the property (in acres) and the total area expected to be disturbed
by the construction activities (in acres), construction support activities covered by this
permit, and the maximum area expected to be disturbed at any one time.
General Description of Project
Provide a general description of the construction project:
INSERT TEXT HERE
Size of Construction Project
What is the size of the property (in acres), the total area expected to be disturbed by the
construction activities (in acres), and the maximum area expected to be disturbed at any one
time?
Size of property: INSERT SIZE OF PROPERTY (in acres)
Total area of construction disturbance: INSERT TOTAL AREA OF CONSTRUCTION DISTURBANCES
(in acres)
Maximum area to be disturbed at any one time: INSERT MAXIMUM AREA TO BE DISTURBED AT
ANY ONE TIME (in acres)
[Repeat as necessary for individual project phases.]
Construction Support Activities (only provide if applicable)
Describe any construction support activities for the project (e.g., concrete or asphalt batch
plants, equipment staging yards, material storage areas, excavated material disposal areas,
borrow areas)
Description of construction support activity: INSERT DESCRIPTION OF CONSTRUCTION SUPPORT
ACTIVITY
Contact information for construction support activity: INSERT CONTACT INFORMATION FOR
CONSTRUCTION SUPPORT ACTIVITY (Name, Telephone No., Email Address)
Location information for construction support activity: INSERT LOCATION INFORMATION FOR
CONSTRUCTION SUPPORT ACTIVITY (Address and/or Latitude/Longitude)
[Repeat as necessary.]
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2.4
Sequence and Estimated Dates of Construction Activities
Instructions (see OKR10 Part 4.5.4):
― Describe the intended construction sequence and timing of major activities.
― For each phase of construction, include the following information:
 Installation of stormwater controls, and when they will be made operational;
 Commencement and duration of earth-disturbing activities, including clearing and
grubbing, mass grading, site preparation (i.e., excavating, cutting and filling), final
grading, and creation of soil and vegetation stockpiles requiring stabilization;
 Cessation, temporarily or permanently, of construction activities on the site, or in
designated portions of the site;
 Final or temporary stabilization of areas of exposed soil. The dates for stabilization
must reflect the applicable deadlines to which you are subject to in Part 3.3.2; and
 Removal of temporary stormwater conveyances/channels and other stormwater
control measures, removal of construction equipment and vehicles, and cessation
of any pollutant-generating activities.
― The construction sequence must reflect the following requirements:
 Part 3.3.1 (area of disturbance);
 Part 3.3.1.A (installation of stormwater controls); and
 Part 3.3.2 (stabilization deadlines).
― Also, see EPA’s Construction Sequencing BMP Fact Sheet at
http://water.epa.gov/polwaste/npdes/swbmp/Construction-Sequencing.cfm)
Phase I
INSERT GENERAL DESCRIPTION OF PHASE
 INSERT ESTIMATED START AND END DATES OF CONSTRUCTION DISTURBANCES ASSOCIATED WITH
THIS PHASE
 FOR EACH STORMWATER CONTROL, INSERT ESTIMATED DATE(s) OF INSTALLATION OF EACH
STORMWATER CONTROL
 FOR AREAS OF THE SITE REQUIRED TO BE STABILIZED, INSERT ESTIMATED DATE(s) OF APPLICATION
OF STABILIZATION MEASURES
 INSERT ESTIMATED DATE(s) WHEN STORMWATER CONTROLS WILL BE REMOVED
Phase II
INSERT GENERAL DESCRIPTION OF PHASE
 INSERT ESTIMATED START AND END DATES OF CONSTRUCTION DISTURBANCES ASSOCIATED WITH
THIS PHASE
 FOR EACH STORMWATER CONTROL, INSERT ESTIMATED DATE(s) OF INSTALLATION OF EACH
STORMWATER CONTROL
 FOR AREAS OF THE SITE REQUIRED TO BE STABILIZED, INSERT ESTIMATED DATE(s) OF APPLICATION
OF STABILIZATION MEASURES
 INSERT ESTIMATED DATE(s) WHEN STORMWATER CONTROLS WILL BE REMOVED
[Repeat as needed.]
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2.5
Allowable Non-Stormwater Discharges
Instructions (see OKR10 Parts 1.3.1.C and 4.5.16):
― Identify all allowable sources of non-stormwater discharges. The allowable nonstormwater discharges identified in Part 1.3.1.C of the 2012 OKR10 include:
 Discharges from emergency fire-fighting activities;
 Fire hydrant flushings;
 Landscape irrigation;
 Waters used to wash vehicles and equipment, provided that there is no discharge
of soaps, solvents, or detergents used for such purposes;
 Water used to control dust;
 Potable water including uncontaminated water line flushings;
 Routine external building wash down that does not use detergents;
 Pavement wash waters provided spills or leaks of toxic or hazardous materials have
not occurred (unless all spilled material has been removed) and detergents are not
used. You are prohibited from directing pavement was waters directly into any
surface water, storm drain inlet, or stormwater conveyance, unless the conveyance
is connected to a sediment basin, sediment trap, or similarly effective control;
 Uncontaminated air conditioning or compressor condensate;
 Uncontaminated, non-turbid discharges of ground water or spring water;
 Foundation or footing drains where flows are not contaminated with process
materials such as solvents or contaminated ground water; and
 Construction dewatering water that has been treated by an appropriate control.
List of Allowable Non-Stormwater Discharges Present at the Site
Type of Allowable Non-Stormwater Discharge
Discharges from emergency fire-fighting activities
Fire hydrant flushings
Landscape irrigation
Waters used to wash vehicles and equipment
Water used to control dust
Potable water including uncontaminated water line flushings
Routine external building wash down
Pavement wash waters
Uncontaminated air conditioning or compressor condensate
Uncontaminated, non-turbid discharges of ground water or spring water
Foundation or footing drains
Construction dewatering water
Likely to be Present at
Your Site?
YES
YES
YES
NO
NO
NO
YES
YES
YES
YES
YES
YES
NO
NO
NO
NO
NO
NO
YES
YES
YES
NO
NO
NO
(Note: You are reminded of the requirement to identify the likely locations of these allowable nonstormwater discharges on your site map. See Section 2.6, below, of the SWPPP Template.)
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2.6
Site Maps
Instructions (see OKR10 Part 4.5.5):
― Attach site maps in Appendix A of the Template. For most projects, a series of site maps
is necessary and recommended. The first should show the undeveloped site and its
current features. An additional map or maps should be created to show the
developed site or, for more complicated sites, show the major phases of development.
These maps must include the following features:
― Boundaries of the property and of the locations where construction will occur,
including:
 Locations where earth-disturbing activities will occur, noting any phasing of
construction activities;
 Approximate slopes before and after major grading activities. Note areas of steep
slopes(i.e. greater than 40%);
 Locations where sediment, soil, or other construction materials will be stockpiled;
 Locations of any crossings of surface waters;
 Designated points on the site where vehicles will exit onto paved roads;
 Locations of structures and other impervious surfaces upon completion of
construction; and
 Locations of construction support activity areas covered by this permit.
― Locations of all waters of the state within one mile of the site, including wetlands that
exist within or in the immediate vicinity of your site. Indicate which waterbodies are
listed as impaired for sediment, and which are identified by the state as Aquatic
Resources of Concern or Outstanding Resource Water.
― The boundary lines of any natural buffers (i.e., either the 100 foot or 50-foot buffer or
other buffer areas retained on site) consistent with Parts 1.3.2.E, 3.3.1.A.and 3.5.2.A.
― Topography of the site, existing vegetative cover (e.g., forest, pasture, pavement,
structures), and drainage pattern(s) of stormwater and allowable non-stormwater flow
onto, over, and from the site property before and after major grading activities.
― Stormwater and allowable non-stormwater discharge locations, including:
 Locations of any storm drain inlets on the site and in the immediate vicinity of the
site; and
 Locations where stormwater or allowable non-stormwater will be discharged to
surface waters (including wetlands).
― Locations of all potential pollutant-generating activities.
― Locations of stormwater control measures.
― If applicable, sampling locations if the project is subject to the Part 3.4.1 numeric
limitation (for asphalt batch plant). Also indicate the sampling location(s) and all
discharge points, and indicate which discharge points are considered “substantially
identical”
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SECTION 3: DOCUMENTATION OF COMPLIANCE WITH OTHER FEDERAL REQUIREMENTS
3.1
Endangered Species Protection
No storm water discharge-sensitive endangered or threatened species occur in Oklahoma
County.
3.2
Historic Preservation
Applicants and permittees must comply with the State Antiquities Act (Title 53, Chapter 20,
Section 361) where applicable and the Burial Desecration Law (Title 21, Chapter 47,
Section 1168.0-1168.6), as well as with any applicable local laws concerning the
identification and protection of historic properties.
Applicants and permittees who may receive Federal funding or other Federal assistance in
the completion of their projects must be aware that compliance with Section 106 of the
Act may apply. For information about the Section 106 review process in Oklahoma,
Oklahoma properties listed on or eligible for the National Register of Historic Places, and
related topics, contact:
State Historic Preservation Office
Oklahoma Historical Society
800 Nazih Zuhdi Drive
Oklahoma City, OK 73105
(405)521-6249
http://www.okhistory.org/shpo/shpom.htm
Oklahoma Archeological Survey
111 East Chesapeake
Norman, OK 73019
405/325-7211
http://www.ou.edu/cas/archsur
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SECTION 4: CONTROLS TO REDUCE POLLUTANTS
General Instructions (See OKR10 Parts 3.3.1 and 4.5.11):
― Describe the erosion and sediment controls that will be installed and maintained at your
site.
― For more information or ideas on BMPs, see EPA’s National Menu of BMPs
http://water.epa.gov/polwaste/npdes/swbmp/
4.1
Natural Buffers or Equivalent Sediment Controls
Instructions (see OKR10 Part 3.3.1.A, OKR10 ADDENDUM I and Appendix G):
This section only applies to you if a surface water is located within 50 feet your construction
activities. If this is the case, consult OKR10 Part 3.3.1.A and Appendix G for information on
how to comply with the buffer requirements.
― Describe the compliance alternative (OKR10 ADDENDUM I) that was chosen to meet
the buffer requirements, and include any required documentation supporting the
alternative selected. The compliance alternative selected must be maintained
throughout the duration of permit coverage. However, if you select a different
compliance alternative during your period of permit coverage, you must modify your
SWPPP to reflect this change.
― If you qualify for one of the exceptions in OKR10 Part ADDENDUM I, include
documentation related to your qualification for such exceptions.
Buffer Compliance Alternatives
Are there any surface waters within 50 feet of your project’s earth disturbances?
(Note: If no, no further documentation is required for this section.)
YES
NO
Check the compliance alternative that you have chosen:
I will provide and maintain a 50-foot undisturbed natural buffer.
(Note (1): You must show the 50-foot boundary line of the natural buffer on your site map.)
(Note (2): You must show on your site map how all discharges from your construction
disturbances through the natural buffer area will first be treated by the site’s erosion and
sediment controls. Also, show on the site map any velocity dissipation devices used to
prevent erosion within the natural buffer area.)
I will provide and maintain an undisturbed natural buffer that is less than 50 feet and is
supplemented by additional erosion and sediment controls, which in combination achieves the
sediment load reduction equivalent to a 50-foot undisturbed natural buffer.
(Note (1): You must show the boundary line of the natural buffer on your site map.)
(Note (2): You must show on your site map how all discharges from your construction
disturbances through the natural buffer area will first be treated by the site’s erosion and
sediment controls. Also, show on the site map any velocity dissipation devices used to
prevent erosion within the natural buffer area.)
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INSERT PROJECT NAME


INSERT WIDTH OF NATURAL BUFFER TO BE RETAINED
INSERT EITHER ONE OF THE FOLLOWING:
(1) THE ESTIMATED SEDIMENT REMOVAL FROM A 50-FOOT BUFFER USING APPLICABLE
TABLES IN APP. G, ATTACHMENT 1. INCLUDE INFORMATION ABOUT THE BUFFER
VEGETATION AND SOIL TYPE THAT PREDOMINATE AT YOUR SITE
OR


(2) IF YOU CONDUCTED A SITE-SPECIFIC CALCULATION FOR THE ESTIMATED SEDIMENT
REMOVAL OF A 50-FOOT BUFFER, PROVIDE THE SPECIFIC REMOVAL EFFICIENCY, AND
INFORMATION YOU RELIED UPON TO MAKE YOUR SITE-SPECIFIC CALCULATION.
INSERT DESCRIPTION OF ADDITIONAL EROSION AND SEDIMENT CONTROLS TO BE USED IN
COMBINATION WITH NATURAL BUFFER AREA
INSERT THE FOLLOWING INFORMATION:
- (1) SPECIFY THE MODEL OR OTHER TOOL USED TO ESTIMATE SEDIMENT LOAD
REDUCTIONS FROM THE COMBINATION OF THE BUFFER AREA AND ADDITIONAL
EROSION AND SEDIMENT CONTROLS INSTALLED AT YOUR SITE, AND
- (2) INCLUDE THE RESULTS OF CALCULATIONS SHOWING THAT THE COMBINATION OF
YOUR BUFFER AREA AND THE ADDITIONAL EROSION AND SEDIMENT CONTROLS
INSTALLED AT YOUR SITE WILL MEET OR EXCEED THE SEDIMENT REMOVAL EFFICIENCY
OF A 50-FOOT BUFFER
It is infeasible to provide and maintain an undisturbed natural buffer of any size, therefore I will
implement erosion and sediment controls that achieve the sediment load reduction equivalent
to a 50-foot undisturbed natural buffer.


INSERT RATIONALE FOR CONCLUDING THAT IT IS INFEASIBLE TO PROVIDE AND MAINTAIN A
NATURAL BUFFER OF ANY SIZE
INSERT EITHER ONE OF THE FOLLOWING:
(1) THE ESTIMATED SEDIMENT REMOVAL FROM A 50-FOOT BUFFER USING APPLICABLE
TABLES IN APP. G, ATTACHMENT 1. INCLUDE INFORMATION ABOUT THE BUFFER
VEGETATION AND SOIL TYPE THAT PREDOMINATE AT YOUR SITE
OR


(2) IF YOU CONDUCTED A SITE-SPECIFIC CALCULATION FOR THE ESTIMATED SEDIMENT
REMOVAL OF A 50-FOOT BUFFER, PROVIDE THE SPECIFIC REMOVAL EFFICIENCY, AND
INFORMATION YOU RELIED UPON TO MAKE YOUR SITE-SPECIFIC CALCULATION.
INSERT DESCRIPTION OF ADDITIONAL EROSION AND SEDIMENT CONTROLS TO BE USED IN
COMBINATION WITH NATURAL BUFFER AREA
INSERT THE FOLLOWING INFORMATION:
- (1) SPECIFY THE MODEL OR OTHER TOOL USED TO ESTIMATE SEDIMENT LOAD
REDUCTIONS FROM THE EROSION AND SEDIMENT CONTROLS INSTALLED AT YOUR SITE,
AND
- (2) INCLUDE THE RESULTS OF CALCULATIONS SHOWING THAT THE ADDITIONAL EROSION
AND SEDIMENT CONTROLS INSTALLED AT YOUR SITE WILL MEET OR EXCEED THE
SEDIMENT REMOVAL EFFICIENCY OF A 50-FOOT BUFFER
I qualify for one of the exceptions in OKR10 ADDENDUM I. (If you have checked this box, provide
information on the applicable buffer exception that applies, below.)
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INSERT PROJECT NAME
Buffer Exceptions
Which of the following exceptions to the buffer requirements applies to your site?
There is no discharge of stormwater to the surface water that is located 50 feet from my
construction disturbances.
(Note: If this exception applies, no further documentation is required for Section 4.1 of the
Template.)
No natural buffer exists due to preexisting development disturbances that occurred prior to the
initiation of planning for this project.
(Note (1): If this exception applies, no further documentation is required for Section 4.1 of the
Template.)
(Note (2): Where some natural buffer exists but portions of the area within 50 feet of the
surface water are occupied by preexisting development disturbances, you must still comply
with the one of the OKR10 ADDENDUM I compliance alternatives.)
4.2
Perimeter Controls
Instructions (see OKR10 Parts 3.3.1.B and 4.5.11):
― Describe sediment controls that will be used (e.g., silt fences, filter berms, temporary
diversion dikes, or fiber rolls) to meet the Part 3.3.1.B requirement to “install sediment
controls along those perimeter areas of your site that will receive stormwater from earthdisturbing activities.”
― For linear projects, where you have determined that the use of perimeter controls in
portions of the site is impracticable, document why you believe this is to be the case.
― Also see, EPA’s Silt Fence BMP Fact Sheet at
www.epa.gov/npdes/stormwater/menuofbmps/construction/silt_fences or Fiber Rolls
BMP Fact Sheet at http://water.epa.gov/polwaste/npdes/swbmp/Fiber-Rolls.cfm
General
 INSERT GENERAL DESCRIPTION OF HOW YOU WILL COMPLY WITH OKR10 Part 3.3.1.B.1
Specific Perimeter Controls
Perimeter Control # 1
Perimeter Control Description
 INSERT DESCRIPTION OF PERIMETER CONTROL TO BE INSTALLED. INDICATE SPECIFIC CONTROLS
THAT WILL BE INSTALLED AND MADE OPERATIONAL PRIOR TO EARTH DISTURBANCE
 INCLUDE COPIES OF DESIGN SPECIFICATIONS
Installation
 INSERT APPROXIMATE DATE OF INSTALLATION
Maintenance Requirements
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INSERT PROJECT NAME

INSERT MAINTENANCE REQUIREMENTS FOR THE PERIMETER CONTROL. AT A MINIMUM, OKR10 Part
3.3.1.B.2 REQUIRES REMOVAL OF SEDIMENT "before it has accumulated to one-half of the aboveground height of any perimeter control."
[Repeat as needed for individual perimeter controls.]
4.3
Sediment Track-Out
Instructions (see OKR10 Parts 3.3.1.C and 4.5.11):
― Describe stormwater controls that will be used to “minimize the track-out of sediment
onto off-site streets, other paved areas, and sidewalks from vehicles exiting your
construction site.”
― Describe location(s) of vehicle exit(s), procedures to remove accumulated sediment
off-site (e.g., vehicle tracking), and stabilization practices (e.g., stone pads or wash
racks or both) to minimize off-site vehicle tracking of sediment. Also include the design,
installation, and maintenance specifications for each control.
― Also, see EPA’s Construction Entrances BMP Fact Sheet at
http://water.epa.gov/polwaste/npdes/swbmp/Construction-Entrances.cfm
General
 INSERT GENERAL DESCRIPTION OF HOW YOU WILL COMPLY WITH OKR10 PART 3.3.1.C
Specific Track-Out Controls
Track-Out Control # 1
Track-Out Control Description
 INSERT DESCRIPTION OF TRACK-OUT CONTROL TO BE INSTALLED
 INCLUDE COPIES OF DESIGN SPECIFICATIONS HERE
Installation
 INSERT APPROXIMATE DATE OF INSTALLATION
Maintenance Requirements
 INSERT MAINTENANCE REQUIREMENTS FOR THE TRACK-OUT CONTROL.
(Note: At a minimum, you must provide for maintenance that meets the following
requirement in OKR10 Part 3.3.1.C.4: “Where sediment has been tracked-out from your site
onto the surface of off-site streets, other paved areas, and sidewalks, you must remove the
deposited sediment by the end of the same work day in which the track-out occurs or by
the end of the next work day if track-out occurs on a non-work day. You must remove the
track-out by sweeping, shoveling, or vacuuming these surfaces, or by using other similarly
effective means of sediment removal. You are prohibited from hosing or sweeping trackedout sediment into any stormwater conveyance (unless it is connected to a sediment basin,
sediment trap, or similarly effective control), storm drain inlet, or surface water.”)
[Repeat as needed for individual track-out controls.]
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4.4
Stockpiled Sediment or Soil
Instructions (see OKR10 Parts 3.3.1.D and 4.5.11):
― Describe stormwater controls and other measures you will take to minimize the
discharge of sediment or soil particles from stockpiled sediment or soil. Include a
description of structural practices (e.g., diversions, berms, ditches, storage basins),
including design, installation, and maintenance specifications, used to divert flows from
stockpiled sediment or soil, retain or detain flows, or otherwise limit exposure and the
discharge of pollutants from stockpiled sediment or soil.
― Also, describe any controls or procedures used to minimize exposure resulting from
adding to or removing materials from the pile.
General
 INSERT GENERAL DESCRIPTION OF HOW YOU WILL COMPLY WITH OKR10 PART 3.3.1.D
Specific Stockpile Controls
Stockpile Control # 1
Stockpiled Sediment/Soil Control Description
 INSERT DESCRIPTION OF STOCKPILE CONTROL TO BE INSTALLED
 INCLUDE COPIES OF DESIGN SPECIFICATIONS HERE
Installation
 INSERT APPROXIMATE DATE OF INSTALLATION
Maintenance Requirements
 INSERT MAINTENANCE REQUIREMENTS FOR THE STOCKPILE CONTROL.
(Note: At a minimum, you must comply with following requirement in OKR10 Part 3.3.1.D.4:
Do not hose down or sweep soil or sediment accumulated on pavement or other impervious
surfaces into any stormwater conveyance (unless connected to a sediment basin, sediment
trap, or similarly effective control), storm drain inlet, or surface water.)
[Repeat as needed for individual stockpile controls.]
4.5
Minimize Dust
Instructions (see OKR10 Parts 3.3.1.E and 4.5.11):
Describe controls and procedures you will use at your project/site to minimize the generation
of dust.
General
 INSERT GENERAL DESCRIPTION OF HOW YOU WILL COMPLY WITH OKR10 PART 3.3.1.E
Specific Dust Controls
Dust Control # 1
Dust Control Description
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INSERT PROJECT NAME


INSERT DESCRIPTION OF DUST CONTROL TO BE INSTALLED
INCLUDE COPIES OF DESIGN SPECIFICATIONS HERE
Installation
 INSERT APPROXIMATE DATE OF INSTALLATION
Maintenance Requirements
 INSERT MAINTENANCE REQUIREMENTS FOR THE DUST CONTROL
[Repeat as needed for individual dust controls.]
4.6
Minimize the Disturbance of Steep Slopes
Instructions (see OKR10 Parts 3.3.1.F and 4.5.11):
― Describe how you will minimize the disturbance to steep slopes (as defined by CGP
Appendix A).
― Describe controls (e.g., erosion control blankets, tackifiers), including design, installation
and maintenance specifications, that will be implemented to minimize sediment
discharges from slope disturbances.
― Also, see EPA’s Geotextiles BMP Fact Sheet at
http://water.epa.gov/polwaste/npdes/swbmp/Geotextiles.cfm
General
 INSERT GENERAL DESCRIPTION OF HOW YOU WILL COMPLY WITH OKR10 PART 3.3.1.F
Specific Steep Slope Controls
Steep Slope Control # 1
Steep Slope Control Description
 INSERT DESCRIPTION OF STEEP SLOPE CONTROL TO BE INSTALLED
 INCLUDE COPIES OF DESIGN SPECIFICATIONS HERE
Installation
 INSERT APPROXIMATE DATE OF INSTALLATION
Maintenance Requirements
 INSERT MAINTENANCE REQUIREMENTS FOR THE STEEP SLOPE CONTROL
[Repeat as needed for individual steep slope controls.]
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4.7
Topsoil
Instructions (see OKR10 Parts 3.3.1.G and 4.5.11):
― Describe how topsoil will be preserved and identify these areas and associated control
measures on your site map(s).
― If it is infeasible for you to preserve topsoil on your site, provide an explanation for why
this is the case.
General
 INSERT GENERAL DESCRIPTION OF HOW YOU WILL COMPLY WITH OKR10 PART 3.3.1.G. IF IT IS
INFEASIBLE FOR YOU TO COMPLY WITH THE REQUIREMENT, INCLUDE AN EXPLANATION OF WHY
THIS IS THE CASE.
Specific Topsoil Controls
Topsoil Control # 1
Topsoil Control Description
 INSERT DESCRIPTION OF TOPSOIL CONTROL TO BE INSTALLED
 INCLUDE COPIES OF DESIGN SPECIFICATIONS HERE
Installation
 INSERT APPROXIMATE DATE OF INSTALLATION
Maintenance Requirements
 INSERT MAINTENANCE REQUIREMENTS FOR THE TOPSOIL CONTROL
[Repeat as needed for individual topsoil controls.]
4.8
Soil Compaction
Instructions (see OKR10 Parts 3.3.1.H and 4.5.11):
― In areas where final vegetative stabilization will occur or where infiltration practices will
be installed, describe the controls, including design, installation, and maintenance
specifications that will be used to restrict vehicle or equipment access or condition the
soil for seeding or planting.
General
 INSERT GENERAL DESCRIPTION OF HOW YOU WILL COMPLY WITH OKR10 PART 3.3.1.H
Specific Soil Compaction Controls
Soil Compaction Control # 1
Soil Compaction Control Description
 INSERT DESCRIPTION OF SOIL COMPACTION CONTROL TO BE INSTALLED
 INCLUDE COPIES OF DESIGN SPECIFICATIONS HERE
Installation
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INSERT PROJECT NAME

INSERT APPROXIMATE DATE OF INSTALLATION
Maintenance Requirements
 INSERT MAINTENANCE REQUIREMENTS FOR THE SOIL COMPACTION CONTROL
[Repeat as needed for individual soil compaction controls.]
4.9
Storm Drain Inlets
Instructions (see OKR10 Parts 3.3.1.I and 4.5.11):
― Describe controls (e.g., inserts, rock-filled bags, or block and gravel) including design,
installation, and maintenance specifications that will be implemented to protect all
inlets that will receive stormwater from your construction activities, and that you have
authority to access.
― Also, see EPA’s Storm Drain Inlet Protection BMP Fact Sheet at
http://water.epa.gov/polwaste/npdes/swbmp/Storm-Drain-Inlet-Protection.cfm
General
 INSERT GENERAL DESCRIPTION OF HOW YOU WILL COMPLY WITH OKR10 PART 3.3.1.I
Specific Storm Drain Inlet Controls
Storm Drain Inlet Control # 1
Storm Drain Inlet Control Description
 INSERT DESCRIPTION OF STORM DRAIN INLET CONTROL TO BE INSTALLED
 INCLUDE COPIES OF DESIGN SPECIFICATIONS HERE
Installation
 INSERT APPROXIMATE DATE OF INSTALLATION
Maintenance Requirements
 INSERT MAINTENANCE REQUIREMENTS FOR THE STORM DRAIN INLET CONTROL
(Note: At a minimum, you must comply with following requirement in OKR10 Part 3.3.1.I.2:
“Clean, or remove and replace, the protection measures as sediment accumulates, the filter
becomes clogged, and/or performance is compromised. Where there is evidence of
sediment accumulation adjacent to the inlet protection measure, you must remove the
deposited sediment by the end of the same work day in which it is found or by the end of
the following work day if removal by the same work day is not feasible.”)
[Repeat as needed for individual storm drain inlet controls.]
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4.10
Constructed Stormwater Conveyance Channels
Instructions (see OKR10 Parts 3.3.1.J and 4.5.11):
If you will be installing a stormwater conveyance channel, describe control practices (e.g.,
velocity dissipation devices), including design specifications and details (volume, dimensions,
outlet structure), that will be implemented at the construction site.
General
 INSERT GENERAL DESCRIPTION OF HOW YOU WILL COMPLY WITH OKR10 PART 4.5.11
Specific Conveyance Channel Controls
Stormwater Conveyance Channel Control # 1
Stormwater Conveyance Channel Control Description
 INSERT DESCRIPTION OF STORMWATER CONVEYANCE CHANNEL CONTROL TO BE INSTALLED
 INCLUDE COPIES OF DESIGN SPECIFICATIONS HERE
Installation
 INSERT APPROXIMATE DATE OF INSTALLATION
Maintenance Requirements
 INSERT MAINTENANCE REQUIREMENTS FOR THE STORMWATER CONVEYANCE CHANNEL CONTROL
[Repeat as needed for individual stormwater conveyance channel controls.]
4.11
Sediment Basins
Instructions (see OKR10 Parts 3.3.1.K and 4.5.11.A.3):
If you will install a sediment basin, include design specifications and other details (volume,
dimensions, outlet structure) that will be implemented at in conformance with OKR10 Part
3.3.1.K.
― At a minimum, sediment ponds must provide storage for either (1) the calculated
volume of runoff from the 2-year, 24-hour storm, or (2) 3,600 cubic feet per acre drained
― Sediment ponds must also utilize outlet structures that withdraw water from the surface,
, unless infeasible
― Also, see EPA’s Sediment Basin BMP Fact Sheet at
http://water.epa.gov/polwaste/npdes/swbmp/Sediment-Basins-and-Rock-Dams.cfm
General
 INSERT GENERAL DESCRIPTION OF HOW YOU WILL COMPLY WITH OKR10 Part 3.3.1.K. IF YOU
HAVE DETERMINED THAT IT IS INFEASIBLE FOR YOU TO UTILIZE AN OUTLET STRUCTURE THAT
DISCHARGES FROM THE SURFACE, PROVIDE AN EXPLANATION FOR WHY THIS IS THE CASE.
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Specific Sediment Basin Controls
Sediment Basin Control # 1
Sediment Basin Control Description
 INSERT DESCRIPTION OF SEDIMENT BASIN CONTROL TO BE INSTALLED
 INCLUDE COPIES OF DESIGN SPECIFICATIONS HERE
Installation
 INSERT APPROXIMATE DATE OF INSTALLATION
Maintenance Requirements
 INSERT MAINTENANCE REQUIREMENTS FOR THE SEDIMENT BASIN CONTROL
(Note: At a minimum, you must comply with following requirement in OKR10 Part
4.5.11.A.1.d: “Sediment must be removed from sediment traps or sedimentation ponds when
design capacity has been reduced by 50%.”)
[Repeat as needed for individual sediment basin controls.]
4.12
Dewatering Practices
Instructions (see OKR10 Parts 3.3.1.L and 4.5.11):
If you will be discharging stormwater that is removed from excavations, trenches,
foundations, vaults, or other similar points of accumulation, include design specifications and
details of all dewatering practices that are installed and maintained to comply with OKR10
Part 3.3.1.L.
General
 INSERT GENERAL DESCRIPTION OF HOW YOU WILL COMPLY WITH OKR10 PART 3.3.1.L
Specific Dewatering Practices
Dewatering Practice # 1
Dewatering Practice Description
 INSERT DESCRIPTION OF DEWATERING PRACTICE TO BE INSTALLED
 INCLUDE COPIES OF DESIGN SPECIFICATIONS HERE
Installation
 INSERT APPROXIMATE DATE OF INSTALLATION
Maintenance Requirements
 INSERT MAINTENANCE REQUIREMENTS FOR THE DEWATERING PRACTICE
(Note: At a minimum, you must comply with following requirement in OKR10 Part 3.3.1.L.5-6:
“With backwash water, either haul it away for disposal or return it to the beginning of the
treatment process; and replace and clean the filter media used in dewatering devices when
the pressure differential equals or exceeds the manufacturer’s specifications.”)
[Repeat as needed for individual dewatering practices.]
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4.13
Other Stormwater Controls
Instructions:
― Describe any other stormwater controls that do not fit into the above categories.
General
 INSERT GENERAL DESCRIPTION OF THE PROBLEM THIS CONTROL IS DESIGNED TO ADDRESS
Specific Stormwater Control Practices
Stormwater Control Practice # 1
Description
 INSERT DESCRIPTION OF PRACTICE TO BE INSTALLED
 IF APPLICABLE INCLUDE COPIES OF DESIGN SPECIFICATIONS HERE
Installation
 INSERT APPROXIMATE DATE OF INSTALLATION
Maintenance Requirements
 INSERT MAINTENANCE REQUIREMENTS FOR THE STORMWATER CONTROL PRACTICE
[Repeat as needed.]
4.14
Site Stabilization
Instructions (see OKR10 Parts 3.3.2 and 4.5.11.A.2):
The OKR10 requires you to immediately initiate stabilization when work in an area of your site
has permanently or temporarily stopped, and to complete certain stabilization activities
within prescribed deadlines. See OKR10 Part 3.3.2.A. The OKR10 also requires that
stabilization measures meet certain minimum criteria. See OKR10 Part 2.2.2.B. For your
SWPPP, you must include the following:
― Describe the specific vegetative and/or non-vegetative practices that will be used to
stabilize exposed soils where construction activities have temporarily or permanently
ceased. Avoid using impervious surfaces for stabilization whenever possible.
― Also, see EPA’s Seeding BMP Fact Sheet at
http://water.epa.gov/polwaste/npdes/swbmp/Seeding.cfm
― Once you begin construction, consider using the Grading/Stabilization Activities log in
Appendix H of the Template to document your compliance with the stabilization
requirements in OKR10 Part 3.3.2
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Site Stabilization Practice (only use this if you are located in an arid, semi-arid, or drought-stricken area)
Vegetative
Non-Vegetative
Temporary
Permanent
Description of Practice
 INSERT DESCRIPTION OF STABILIZATION PRACTICE TO BE INSTALLED
 NOTE HOW DESIGN WILL MEET REQUIREMENTS OF PART 3.3.2.B
 INCLUDE COPIES OF DESIGN SPECIFICATIONS HERE
Installation
 FOR VEGETATIVE STABILIZATION IN ARID OR SEMI-ARID AREAS, INDICATE THE BEGINNING AND
ENDING DATES OF THE SEASONALLY DRY PERIOD AND DESCRIBE YOUR SITE CONDITIONS
 INSERT APPROXIMATE DATE OF INSTALLATION
 NOTE HOW DESIGN WILL MEET REQUIREMENTS OF PART 3.3.2.A
Maintenance Requirements
INSERT MAINTENANCE REQUIREMENTS FOR THE STABILIZATION PRACTICE
[Repeat as needed for additional stabilization practices.]
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SECTION 5: POLLUTION PREVENTION STANDARDS
5.1
Potential Sources of Pollution
Instructions (see OKR10 Part 4.5.6):
― Identify and describe all pollutant-generating activities at your site (e.g., paving
operations; concrete, paint, and stucco washout and waste disposal; solid waste
storage and disposal).
― For each pollutant-generating activity, include an inventory of pollutants or pollutant
constituents associated with that activity (e.g., sediment, fertilizers, and/or pesticides,
paints, solvents, fuels), which could be exposed to rainfall or snowmelt, and could be
discharged from your construction site. You must take into account where potential
spills and leaks could occur that contribute pollutants to stormwater discharges.
Construction Site Pollutants
INSERT TEXT OR USE TABLE BELOW
Pollutant-Generating Activity
Pollutants or Pollutant
Constituents
(that could be discharged if
exposed to stormwater)
Location on Site
(or reference SWPPP site map
where this is shown)
[Include additional rows as necessary.]
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5.2
Spill Prevention and Response
Instructions (see OKR10 Parts 3.3.3 and 4.5.11.B):
― Describe procedures you will use to prevent and respond to leaks, spills, and other
releases. You must implement the following at a minimum:
 Procedures for expeditiously stopping, containing, and cleaning up spills, leaks, and
other releases. Identify the name or title of the employee(s) responsible for
detection and response of spills or leaks; and
 Procedures for notification of appropriate facility personnel, emergency response
agencies, and regulatory agencies where a leak, spill, or other release containing a
hazardous substance or oil in an amount equal to or in excess of a reportable
quantity consistent with Part 3.3.3.C and established under either 40 CFR Part 110, 40
CFR Part 117, or 40 CFR Part 302, occurs during a 24-hour period. Contact
information must be in locations that are readily accessible and available.
― Some projects/site may be required to develop a Spill Prevention Control and
Countermeasure (SPCC) plan under a separate regulatory program (40 CFR 112). If
you are required to develop an SPCC plan, or you already have one, you should
include references to the relevant requirements from your plan.
INSERT SPILL PREVENTION AND RESPONSE PROCEDURES HERE
5.3
Fueling and Maintenance of Equipment or Vehicles
Instructions (see OKR10 Parts 3.3.3.B.3.c and 4.5.11.B):
― Describe equipment/vehicle fueling and maintenance practices that will be
implemented to eliminate the discharge of spilled or leaked chemicals (e.g., providing
secondary containment (examples: spill berms, decks, spill containment pallets) and
cover where appropriate, and/or having spill kits readily available.
― Also, see EPA’s Vehicle Maintenance and Washing Areas BMP Fact Sheet at
http://water.epa.gov/polwaste/npdes/swbmp/Vehicle-Maintenance-and-WashingAreas-at-Construction-Sites.cfm
General
 INSERT GENERAL DESCRIPTION OF HOW YOU WILL COMPLY WITH THE OKR10 PART 3.3.3.B.
REQUIREMENT TO "provide an effective means of eliminating the discharge of spilled or leaked
chemicals, including fuel, from the area where these activities will take place"
Specific Pollution Prevention Practices
Pollution Prevention Practice # 1
Description
 INSERT DESCRIPTION OF PRACTICE TO BE INSTALLED
 IF APPLICABLE INCLUDE COPIES OF DESIGN SPECIFICATIONS HERE
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Installation
 INSERT APPROXIMATE DATE OF INSTALLATION
Maintenance Requirements
 INSERT MAINTENANCE REQUIREMENTS FOR THE POLLUTION PREVENTION PRACTICE
[Repeat as needed.]
5.4
Washing of Equipment and Vehicles
Instructions (see OKR10 Parts 3.3.3.2.B.2 and 4.5.11.B):
― Describe equipment/vehicle washing practices that will be used to minimize the
discharge of pollutants from equipment and vehicle washing, wheel wash water, and
other types of washing (e.g., locating activities away from surface waters and
stormwater inlets or conveyances and directing wash waters to a sediment basin or
sediment trap, using filtration devices, such as filter bags or sand filters, or using other
similarly effective controls).
― Describe how you will prevent the discharge of soaps, detergents, or solvents by
providing either (1) cover (examples: plastic sheeting or temporary roofs) to prevent
these detergents from coming into contact with rainwater, or (2) a similarly effective
means designed to prevent the discharge of pollutants from these areas.
― Also, see EPA’s Vehicle Maintenance and Washing Areas BMP Fact Sheet at
http://water.epa.gov/polwaste/npdes/swbmp/Vehicle-Maintenance-and-WashingAreas-at-Construction-Sites.cfm
General
 INSERT GENERAL DESCRIPTION OF HOW YOU WILL COMPLY WITH OKR10 PART 3.3.3.B.2.
Specific Pollution Prevention Practices
Pollution Prevention Practice # 1
Description
 INSERT DESCRIPTION OF PRACTICE TO BE INSTALLED
 IF APPLICABLE INCLUDE COPIES OF DESIGN SPECIFICATIONS HERE
Installation
 INSERT APPROXIMATE DATE OF INSTALLATION
Maintenance Requirements
 INSERT MAINTENANCE REQUIREMENTS FOR THE POLLUTION PREVENTION PRACTICE
[Repeat as needed.]
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5.5
Storage, Handling, and Disposal of Construction Products, Materials, and Wastes
Instructions (see OKR10 Parts 3.3.3.B.3 and 4.5.11.B):
― For any of the types of construction products, materials, and wastes below in Sections
5.5.1-5.5.6 below that are expected to be used or stored at your site, provide the
information on how you will comply with the corresponding CGP provision and the
specific practices that will be employed.
― Also, see EPA’s General Construction Site Waste Management BMP Fact Sheet at
http://water.epa.gov/polwaste/npdes/swbmp/General-Construction-Site-WasteManagement.cfm
5.5.1 Building Products
(Note: Examples include asphalt sealants, copper flashing, roofing materials, adhesives, concrete
admixtures.)
General
 INSERT GENERAL DESCRIPTION OF HOW YOU WILL COMPLY WITH OKR10 PART 3.3.3.B.3.a
Specific Pollution Prevention Practices
Pollution Prevention Practice # 1
Description
 INSERT DESCRIPTION OF PRACTICE TO BE INSTALLED
 IF APPLICABLE INCLUDE COPIES OF DESIGN SPECIFICATIONS HERE
Installation
 INSERT APPROXIMATE DATE OF INSTALLATION
Maintenance Requirements
 INSERT MAINTENANCE REQUIREMENTS FOR THE POLLUTION PREVENTION PRACTICE
[Repeat as needed.]
5.5.2
Pesticides, Herbicides, Insecticides, Fertilizers, and Landscape Materials
General
 INSERT GENERAL DESCRIPTION OF HOW YOU WILL COMPLY WITH OKR10 PART 3.3.3.B.3.b
Specific Pollution Prevention Practices
Pollution Prevention Practice # 1
Description
 INSERT DESCRIPTION OF PRACTICE TO BE INSTALLED
 IF APPLICABLE INCLUDE COPIES OF DESIGN SPECIFICATIONS HERE
Installation
 INSERT APPROXIMATE DATE OF INSTALLATION
Maintenance Requirements
 INSERT MAINTENANCE REQUIREMENTS FOR THE POLLUTION PREVENTION PRACTICE
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[Repeat as needed.]
5.5.3
Diesel Fuel, Oil, Hydraulic Fluids, Other Petroleum Products, and Other Chemicals
General
 INSERT GENERAL DESCRIPTION OF HOW YOU WILL COMPLY WITH OKR10 PART 3.3.3.B.3.c
Specific Pollution Prevention Practices
Pollution Prevention Practice # 1
Description
 INSERT DESCRIPTION OF PRACTICE TO BE INSTALLED
 IF APPLICABLE INCLUDE COPIES OF DESIGN SPECIFICATIONS HERE
Installation
 INSERT APPROXIMATE DATE OF INSTALLATION
Maintenance Requirements
 INSERT MAINTENANCE REQUIREMENTS FOR THE POLLUTION PREVENTION PRACTICE
[Repeat as needed.]
5.5.4 Hazardous or Toxic Waste
(Note: Examples include paints, solvents, petroleum-based products, wood preservatives, additives,
curing compounds, acids.)
General
 INSERT GENERAL DESCRIPTION OF HOW YOU WILL COMPLY WITH OKR10 PART 3.3.3.B.3.d
Specific Pollution Prevention Practices
Pollution Prevention Practice # 1
Description
 INSERT DESCRIPTION OF PRACTICE TO BE INSTALLED
 IF APPLICABLE INCLUDE COPIES OF DESIGN SPECIFICATIONS HERE
Installation
 INSERT APPROXIMATE DATE OF INSTALLATION
Maintenance Requirements
 INSERT MAINTENANCE REQUIREMENTS FOR THE POLLUTION PREVENTION PRACTICE
[Repeat as needed.]
5.5.5 Construction and Domestic Waste
(Note: Examples include packaging materials, scrap construction materials, masonry products,
timber, pipe and electrical cuttings, plastics, styrofoam, concrete, and other trash or building
materials.)
General
 INSERT GENERAL DESCRIPTION OF HOW YOU WILL COMPLY WITH OKR10 PART 3.3.3.B.3.e
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Specific Pollution Prevention Practices
Pollution Prevention Practice # 1
Description
 INSERT DESCRIPTION OF PRACTICE TO BE INSTALLED
 IF APPLICABLE INCLUDE COPIES OF DESIGN SPECIFICATIONS HERE
Installation
 INSERT APPROXIMATE DATE OF INSTALLATION
Maintenance Requirements
 INSERT MAINTENANCE REQUIREMENTS FOR THE POLLUTION PREVENTION PRACTICE
[Repeat as needed.]
5.5.6
Sanitary Waste
General
 INSERT GENERAL DESCRIPTION OF HOW YOU WILL COMPLY WITH OKR10 PART 3.3.3.B.3.f
Specific Pollution Prevention Practices
Pollution Prevention Practice # 1
Description
 INSERT DESCRIPTION OF PRACTICE TO BE INSTALLED
 IF APPLICABLE INCLUDE COPIES OF DESIGN SPECIFICATIONS HERE
Installation
 INSERT APPROXIMATE DATE OF INSTALLATION
Maintenance Requirements
 INSERT MAINTENANCE REQUIREMENTS FOR THE POLLUTION PREVENTION PRACTICE
[Repeat as needed.]
5.6
Washing of Applicators and Containers used for Paint, Concrete or Other Materials
Instructions (see OKR10 Parts 3.3.3.B.4 and 4.5.11.B):
― Describe how you will comply with the OKR10 Part 3.3.3.B.4 requirement to “provide an
effective means of eliminating the discharge of water from the washout and cleanout
of stucco, paint, concrete, form release oils, curing compounds, and other construction
materials.”
― Also, see EPA’s Concrete Washout BMP Fact Sheet at
http://water.epa.gov/polwaste/npdes/swbmp/upload/concretewashout.pdf
General
 INSERT GENERAL DESCRIPTION OF HOW YOU WILL COMPLY WITH OKR10 PART 3.3.3.B.4
OKR10 SWPPP Template, Version 1.0
28
Stormwater Pollution Prevention Plan (SWPPP)
INSERT PROJECT NAME
Specific Pollution Prevention Practices
Pollution Prevention Practice # 1
Description
 INSERT DESCRIPTION OF PRACTICE TO BE INSTALLED
 IF APPLICABLE INCLUDE COPIES OF DESIGN SPECIFICATIONS HERE
Installation
 INSERT APPROXIMATE DATE OF INSTALLATION
Maintenance Requirements
 INSERT MAINTENANCE REQUIREMENTS FOR THE POLLUTION PREVENTION PRACTICE
[Repeat as needed.]
5.7
Fertilizers
Instructions (OKR10 Parts 3.3.3.D and 4.5.11.B):
Describe how you will comply with the OKR10 Part 3.3.3.D requirement to “minimize
discharges of fertilizers containing nitrogen or phosphorus”
General
 INSERT GENERAL DESCRIPTION OF HOW YOU WILL COMPLY WITH OKR10 PART 3.3.3.D
Specific Pollution Prevention Practices
Pollution Prevention Practice # 1
Description
 INSERT DESCRIPTION OF PRACTICE TO BE INSTALLED
 IF APPLICABLE INCLUDE COPIES OF DESIGN SPECIFICATIONS HERE
Installation
 INSERT APPROXIMATE DATE OF INSTALLATION
Maintenance Requirements
 INSERT MAINTENANCE REQUIREMENTS FOR THE POLLUTION PREVENTION PRACTICE
[Repeat as needed for individual fertilizer practices.]
5.8
Other Pollution Prevention Practices
Instructions:
Describe any additional pollution prevention practices that do not fit into the above
categories.
―
General
 INSERT GENERAL DESCRIPTION OF THE PROBLEM THIS CONTROL IS DESIGNED TO ADDRESS
OKR10 SWPPP Template, Version 1.0
29
Stormwater Pollution Prevention Plan (SWPPP)
INSERT PROJECT NAME
Specific Pollution Prevention Practices
Pollution Prevention Practice # 1
Description
 INSERT DESCRIPTION OF PRACTICE TO BE INSTALLED
 IF APPLICABLE INCLUDE COPIES OF DESIGN SPECIFICATIONS HERE
Installation
 INSERT APPROXIMATE DATE OF INSTALLATION
Maintenance Requirements
 INSERT MAINTENANCE REQUIREMENTS FOR THE POLLUTION PREVENTION PRACTICE
[Repeat as needed.]
OKR10 SWPPP Template, Version 1.0
30
Stormwater Pollution Prevention Plan (SWPPP)
INSERT PROJECT NAME
SECTION 6: INSPECTION AND CORRECTIVE ACTION
6.1
Inspection Personnel and Procedures
Instructions (see OKR10 Parts 4.5.11.C and 4.5.13):
Describe the procedures you will follow for conducting inspections in accordance with
OKR10 Parts 4.5.11.C and 4.5.13
Personnel Responsible for Inspections
INSERT NAMES OF PERSONNEL OR TYPES OF PERSONNEL WHO WILL BE CONDUCTING SITE
INSPECTIONS HERE
Note: All personnel conducting inspections must be considered a “qualified person.” OKR10
Part 4.5.13 clarifies that a “qualified person” is a person knowledgeable in the principles and
practices of erosion and sediment controls and pollution prevention, who possesses the skills
to assess conditions at the construction site that could impact stormwater quality, and the
skills to assess the effectiveness of any stormwater controls selected and installed to meet the
requirements of this permit.
Inspection Schedule
Specific Inspection Frequency
INSERT INSPECTION SCHEDULE BASED ON OKR10 PARTS 4.5.11.C and 4.5.13 , WHICHEVER APPLIES
Rain Gauge Location (if applicable)
SPECIFY LOCATION(S) OF RAIN GAUGE TO BE USED FOR DETERMINING WHETHER A RAIN EVENT OF
0.50 INCHES OR GREATER HAS OCCURRED (only applies to inspections conducted for Part
4.5.13.B)
Reductions in Inspection Frequency (if applicable)

For the reduction in inspections resulting from stabilization: SPECIFY (1) LOCATIONS
WHERE STABILIZATION STEPS HAVE BEEN COMPLETED AND (2) DATE THAT THEY WERE
COMPLETED
(Note: It is likely that you will not be able to include this in your initial SWPPP. If you
qualify for this reduction (see OKR10 Part 4.5.13.C), you will need to modify your
SWPPP to include this information.)

For the reduction in inspections in arid, semi-arid, or drought-stricken areas: INSERT
BEGINNING AND ENDING DATES OF THE SEASONALLY-DEFINED ARID PERIOD FOR YOUR
AREA OR THE VALID PERIOD OF DROUGHT

For reduction in inspections due to frozen conditions: INSERT BEGINNING AND ENDING
DATES OF FROZEN CONDITIONS ON YOUR SITE
Inspection Report Forms
INSERT COPY OF ANY INSPECTION REPORT FORMS YOU WILL USE HERE OR IN APPENDIX D
OKR10 SWPPP Template, Version 1.0
31
Stormwater Pollution Prevention Plan (SWPPP)
INSERT PROJECT NAME
6.2
Corrective Action
Instructions (OKR10 Parts 4.5.11.C and 4.5.15):
― Describe the procedures for taking corrective action in compliance with OKR10 Part
4.5.15.
Personnel Responsible for Corrective Actions
INSERT NAMES OF PERSONNEL OR TYPES OF PERSONNEL RESPONSIBLE FOR CORRECTIVE
ACTIONS
Corrective Action Forms
INSERT A COPY OF ANY CORRECTIVE ACTION FORMS YOU WILL USE HERE OR IN APPENDIX E
6.3
Delegation of Authority
Instructions:
― Identify the individual(s) or positions within the company who have been delegated
authority to sign inspection reports.
― See OKR10 Part 6.7.2.
Duly Authorized Representative(s) or Position(s):
Insert Company or Organization Name:
Insert Name:
Insert Position:
Insert Address:
Insert City, State, Zip Code:
Insert Telephone Number:
Insert Fax/Email:
OKR10 SWPPP Template, Version 1.0
32
Stormwater Pollution Prevention Plan (SWPPP)
INSERT PROJECT NAME
SECTION 7: TRAINING
Instructions (see OKR10 Part 4.5.14):
― Complete the table below to provide documentation that the personnel required to be
trained in OKR10 Part 4.5.14 completed the appropriate training
― The following personnel, at a minimum, must be receive training, and therefore should
be listed out individually in the table below:
 Personnel who are responsible for the design, installation, maintenance,
and/or repair of stormwater controls (including pollution prevention measures);
 Personnel responsible for the application and storage of treatment chemicals
(if applicable);
 Personnel who are responsible for conducting inspections as required in Part
4.5.13; and

Personnel who are responsible for taking corrective actions as required in Part
4.5.15.
― OKR10 Part 4.5.14 requires that the required personnel must be trained to understand
the following if related to the scope of their job duties:
 The location of all stormwater controls on the site required by this permit, and how
they are to be maintained;
 The proper procedures to follow with respect to the permit’s pollution prevention
requirements; and
 When and how to conduct inspections, record applicable findings, and take
corrective actions.
Table 7-1: Documentation for Completion of Training
Name
INSERT NAME OF PERSONNEL HERE
INSERT NAME OF PERSONNEL HERE
INSERT NAME OF PERSONNEL HERE
INSERT NAME OF PERSONNEL HERE
INSERT NAME OF PERSONNEL HERE
INSERT NAME OF PERSONNEL HERE
INSERT NAME OF PERSONNEL HERE
INSERT NAME OF PERSONNEL HERE
INSERT NAME OF PERSONNEL HERE
INSERT NAME OF PERSONNEL HERE
INSERT NAME OF PERSONNEL HERE
INSERT NAME OF PERSONNEL HERE
INSERT NAME OF PERSONNEL HERE
INSERT NAME OF PERSONNEL HERE
INSERT NAME OF PERSONNEL HERE
OKR10 SWPPP Template, Version 1.0
Date Training Completed
INSERT COMPLETION DATE HERE
INSERT COMPLETION DATE HERE
INSERT COMPLETION DATE HERE
INSERT COMPLETION DATE HERE
INSERT COMPLETION DATE HERE
INSERT COMPLETION DATE HERE
INSERT COMPLETION DATE HERE
INSERT COMPLETION DATE HERE
INSERT COMPLETION DATE HERE
INSERT COMPLETION DATE HERE
INSERT COMPLETION DATE HERE
INSERT COMPLETION DATE HERE
INSERT COMPLETION DATE HERE
INSERT COMPLETION DATE HERE
INSERT COMPLETION DATE HERE
33
Stormwater Pollution Prevention Plan (SWPPP)
INSERT PROJECT NAME
SECTION 8: CERTIFICATION AND NOTIFICATION
Instructions (OKR10 Part 6.7):
― The following certification statement must be signed and dated by a person who meets
the requirements of OKR10 Part 6.7
― This certification must be re-signed in the event of a SWPPP Modification.
I certify under penalty of law that this document and all attachments were prepared under my
direction or supervision in accordance with a system designed to assure that qualified personnel
properly gathered and evaluated the information submitted. Based on my inquiry of the person or
persons who manage the system, or those persons directly responsible for gathering the information, the
information submitted is, to the best of my knowledge and belief, true, accurate, and complete. I am
aware that there are significant penalties for submitting false information, including the possibility of fine
and imprisonment for knowing violations.
Name:
Title:
Signature:
Date:
[Repeat as needed for multiple construction operators at the site.]
OKR10 SWPPP Template, Version 1.0
34
Stormwater Pollution Prevention Plan (SWPPP)
INSERT PROJECT NAME
SWPPP APPENDICES
Attach the following documentation to the SWPPP:
Appendix A – Site Maps
Appendix B – Copy of 2012 OKR10
Appendix C – NOI
Appendix D – Inspection Form
Appendix E – Corrective Action Form
Appendix F – SWPPP Amendment Log
Appendix G – Subcontractor Certifications/Agreements
Appendix H – Grading and Stabilization Activities Log
Appendix I – Training Log
Appendix J – Delegation of Authority
Appendix K – Endangered Species Documentation
Appendix L – Historic Preservation Documentation
OKR10 SWPPP Template, Version 1.0
35
Stormwater Pollution Prevention Plan (SWPPP)
INSERT PROJECT NAME
Appendix A – Site Maps
INSERT SITE MAPS CONSISTENT WITH TEMPLATE SECTION 2.6
Stormwater Pollution Prevention Plan (SWPPP)
INSERT PROJECT NAME
Appendix B – Copy of 2012 OKR10
INSERT COPY OF 2012 OKR10
Stormwater Pollution Prevention Plan (SWPPP)
INSERT PROJECT NAME
Appendix C – Copy of NOI
INSERT COPY OF NOI
Stormwater Pollution Prevention Plan (SWPPP)
INSERT PROJECT NAME
Appendix D – Copy of Inspection Form
Inspection Report Template – Field Version
Purpose
This Inspection Report Template (or “template”) was designed to assist you in preparing inspection reports for
ODEQ’s 2012 OKR10. If you are covered under the 2012 OKR10, this template will enable you to create an
inspection report form that is customized to the specific circumstances of your project and that complies with
the minimum reporting requirements of Part 4.5.13 of the permit. Note that the use of this form is optional; you
may use your own inspection report form provided it includes the minimum information required in Part 4.5.13 of
the OKR10.
If you are covered under a state OKR10, this template may be helpful in developing a form that can be used
for that permit; however it will need to be modified to meet the specific requirements of that permit. If your
permitting authority requires you to use a specific inspection report form, you should not use this form.
Notes:
While every effort has been made to ensure the accuracy of all instructions and guidance contained in the
Inspection Report Template, the actual obligations of regulated construction activities are determined by the
relevant provisions of the permit, not by the template. In the event of a conflict between the Inspection Report
Template and any corresponding provision of the 2012 OKR10, you must abide by the requirements in the
permit.
Overview of Inspection Requirements
Construction operators covered under the 2012 OKR10 are subject to the following requirements in Part 4:
Inspection Frequency (see Part 4.5.13.B)
You are required to conduct inspections once every 14 calendar days and within 24 hours of a storm event of 0.50
inches or greater.
Your inspection frequency is increased if the site discharges to a sensitive water. See Part 4.1.3. Your inspection
frequency may be decreased to account for stabilized areas, or for arid, semi-arid, or drought-stricken conditions, or for
frozen conditions. See Part 4.1.4.
Areas That Need to Be Inspected (see Part 4.5.13.D.1)
During each inspection, you must inspect the following areas of your site:

Cleared, graded, or excavated areas of the site;

Stormwater controls (e.g., perimeter controls, sediment basins, inlets, exit points etc.) and pollution prevention
practices (e.g., pollution prevention practices for vehicle fueling/maintenance and washing, construction product
storage, handling, and disposal, etc.) at the site;

Material, waste, or borrow areas covered by the permit, and equipment storage and maintenance areas;

Areas where stormwater flows within the site;

Stormwater discharge points; and

Areas where stabilization has been implemented.
What to Check For During Your Inspection (see Part 4.5.13.D.2)
During your site inspection, you are required to check:

Whether stormwater controls or pollution prevention practices require maintenance or corrective action, or
whether new or modified controls are required;

For the presence of conditions that could lead to spills, leaks, or other pollutant accumulations and discharges;

Whether there are visible signs of erosion and sediment accumulation at points of discharge and to the channels
and streambanks that are in the immediate vicinity of the discharge;

If a stormwater discharge is occurring at the time of the inspection, whether there are obvious, visual signs of
pollutant discharges; and
Stormwater Pollution Prevention Plan (SWPPP)
INSERT PROJECT NAME

If any permit violations have occurred on the site.
Inspection Reports (see Part 4.5.13.E)
Within 24 hours of completing each inspection, you are required to complete an inspection report that includes:

Date of inspection;

Names and titles of persons conducting the inspection;

Summary of inspection findings;

Rain gauge or weather station readings if your inspection is triggered by the 0.50 inch storm threshold; and

If you determine that a portion of your site is unsafe to access for the inspection, documentation of what conditions
prevented the inspection and where these conditions occurred on the site
Instructions for Using This Template
This Field Version of the Inspection Report Template is intended to be used in the field and filled out by hand. If
you will be filling out the Inspection Report Template electronically (i.e., you will be typing in your findings),
please use the Electronic Version of the Inspection Report Template available at
http://water.epa.gov/polwaste/npdes/stormwater/Stormwater-Pollution-Prevention-Plans-for-ConstructionActivities.cfm. The Electronic Version includes text fields with instructions for what to enter.
Keep in mind that this document is a template and not an “off-the-shelf” inspection report that is ready to use
without some modification. You must first customize this form to include the specifics of your project in order for
it to be useable for your inspection reports. Once you have entered all of your site-specific information into
these fields, you may print out this form for use in the field to complete inspection reports.
The following tips for using this template will help you ensure that the minimum permit requirements are met:

Review the inspection requirements. Before you start developing your inspection report form, read the
OKR10’s Part 4 inspection requirements. This will ensure that you have a working understanding of the
permit’s underlying inspection requirements.

Complete all required text fields. Fill out all text fields. Only by filling out all fields will the template be
compliant with the requirements of the permit. (Note: Where you do not need the number of rows
provided in the template form for your inspection, you may leave those rows blank. Or, if you need
more space to document your findings, you may add an additional sheet.)

Use your site map to document inspection findings. In several places in the template, you are directed
to specify the location of certain features of your site, including where stormwater controls are installed
and where you will be stabilizing exposed soil. You are also asked to fill in location information for unsafe
conditions and the locations of any discharges occurring during your inspections. Where you are asked
for location information, You are encouraged to reference the point on your SWPPP site map that
corresponds to the requested location on the inspection form. Using the site map as a tool in this way
will help you conduct efficient inspections, will assist you in evaluating problems found, and will ensure
proper documentation.

Sign and certify each inspection report. Each inspection report must be signed and certified by the
permittee to be considered complete. Where your inspections are carried out by a contractor or
subcontractor, it is recommended that you also have the form signed and certified by the inspector, in
addition to the signature and certification required of the permitted operator. The template includes a
signature block for both parties.

Include the inspection form with your SWPPP. Once your form is complete, make sure to include a copy
of the inspection form in your SWPPP in accordance with Part 4.5.11.C of the OKR10.
Stormwater Pollution Prevention Plan (SWPPP)
INSERT PROJECT NAME

Retain copies of all inspection reports with your records. You must also retain in your records copies of all
inspection reports in accordance with the requirements in Part 4.5.13.E of the 2012 OKR10. These reports
must be retained for at least 3 years from the date your permit coverage expires or is terminated.
Section-by-Section Instructions
You will find specific instructions corresponding to each section of the report form on the reverse side of each
page. These instructions provide you with more details in terms of what is expected to be documented in these
reports.
Stormwater Pollution Prevention Plan (SWPPP)
INSERT PROJECT NAME
General Information
(see reverse for instructions)
1.
Name of
Project
3.
2.
Inspector Name, Title &
Contact Information
OKR10
Tracking No.
4.
5.
Inspection
Date
6.
7.
Present Phase of Construction
Inspection Location (if multiple
inspections are required,
specify location where this
inspection is being
conducted)
Inspection Frequency (Note: you may be subject to different inspection frequencies in different areas of the site. Check all that apply. )
Standard Frequency:
Every 14 days and within 24 hours of a 0.50” rain
Increased Frequency:
Every 7 days and within 24 hours of a 0.50” rain (for areas of sites discharging to sediment or nutrient-impaired waters or to waters
designated as ARC or OWR)
Reduced Frequency:
Once per month (for stabilized areas)
-
Once per month and within 24 hours of a 0.50” rain (for arid, semi-arid, or drought-stricken areas during seasonally dry periods or during drought)
-
Once per month (for frozen conditions where earth-disturbing activities are being conducted)
Was this inspection triggered by a 0.50” storm event?
Yes
No
If yes, how did you determined whether a 0.50” storm event has occurred?
Rain gauge on site
Weather station representative of site. Specify weather station source:
Total rainfall amount that triggered the inspection (in inches):
OKR10 SWPPP Template, Version 1.0
Stormwater Pollution Prevention Plan (SWPPP)
INSERT PROJECT NAME
Unsafe Conditions for Inspection
Did you determine that any portion of your site was unsafe for inspection per OKR10 Part 4.5.13?
Yes
If “yes”, complete the following:
Describe the conditions that prevented you from conducting the inspection in this location:
-
Location(s) where conditions were found:
OKR10 SWPPP Template, Version 1.0
No
Stormwater Pollution Prevention Plan (SWPPP)
INSERT PROJECT NAME
Instructions for Filling Out “General Information” Section
Name of Project
Enter the name for the project.
OKR10 Tracking No.
Enter the tracking number that was assigned to your NOI application for permit coverage.
Inspection Date
Enter the date you conducted the inspection.
Inspector Name, Title & Contact Information
Provide the name of the person(s) (either a member of your company’s staff or a contractor or subcontractor) that conducted this inspection.
Provide the inspector’s name, title, and contact information as directed in the form.
Present Phase of Construction
If this project is being completed in more than one phase, indicate which phase it is currently in.
Inspection Location
If your project has multiple locations where you conduct separate inspections, specify the location where this inspection is being conducted. If only
one inspection is conducted for your entire project, enter “Entire Site.” If necessary, complete additional inspection report forms for each separate
inspection location.
Inspection Frequency
Check the box that describes the inspection frequency that applies to you. Note that you may be subject to different inspection frequencies in
different areas of your site. If your project does not discharge to a “sensitive water” (i.e., a water impaired for sediment or nutrients, or listed as ARC or
OWR.) and you are not affected by any of the circumstances described in OKR10 Part 4.5.13.C, then your frequency is based on OKR10 Part 4.5.13.B
– every other week and within 24 hrs of a 0.50 in storm event. For any portion of your site that discharges to a sensitive water, your inspection
frequency for that area is fixed under OKR10 Part 3.5.1.B at weekly and within 24 hrs of a 0.50 inch storm event. If portions of your site are stabilized,
are located in arid, semi-arid, or drought-stricken areas, or are subject to frozen conditions, consult OKR10 Part 4.5.13.C for the applicable inspection
frequency. Check all the inspection frequencies that apply to your project.
Was This Inspection Triggered by a 0.50 Inch Storm Event?
If you were required to conduct this inspection because of a 0.50 inch (or greater) rain event, indicate whether you relied on an on-site rain gauge
or a nearby weather station (and where the weather station is located). Also, specify the total amount of rainfall for this specific storm event.
Unsafe Conditions for Inspection
Inspections are not required where a portion of the site or the entire site is subject to unsafe conditions. See OKR10 Part 4.5.13. These conditions
should not regularly occur, and should not be consistently present on a site. Generally, unsafe conditions are those that render the site (or a portion
of it) inaccessible or that would pose a significant probability of injury to applicable personnel. Examples could include severe storm or flood
conditions, high winds, and downed electrical wires.
OKR10 SWPPP Template, Version 1.0
Stormwater Pollution Prevention Plan (SWPPP)
INSERT PROJECT NAME
If your site, or a portion of it, is affected by unsafe conditions during the time of your inspection, provide a description of the conditions that
prevented you from conducting the inspection and what parts of the site were affected. If the entire site was considered unsafe, specify the location
as “Entire site”
OKR10 SWPPP Template, Version 1.0
Stormwater Pollution Prevention Plan (SWPPP)
INSERT PROJECT NAME
Condition and Effectiveness of Erosion and Sediment (E&S) Controls (OKR10 Part 3.3.1)
Type/Location of E&S Control
[Add an additional sheet if
necessary]
8.
Repairs or
Other
Maintenance
Needed?*
Corrective
Action
Required?*
Yes
No
Yes
No
Yes
No
Yes
No
Yes
No
Yes
No
Yes
No
Yes
No
Yes
No
Yes
No
Yes
No
Yes
No
Yes
No
Yes
No
Yes
No
Yes
No
Yes
No
Yes
No
Yes
No
Yes
No
9.
10.
11.
12.
13.
14.
OKR10 SWPPP Template, Version 1.0
(see reverse for instructions)
Date on Which
Notes
Maintenance or
Corrective Action First
Identified?
Stormwater Pollution Prevention Plan (SWPPP)
INSERT PROJECT NAME
15.
16.
17.
* Note: The permit differentiates between conditions requiring repairs and maintenance, and those requiring corrective action. The permit requires
maintenance in order to keep controls in effective operating condition and requires repairs if controls are not operating as intended. Corrective actions are
triggered only for specific, more serious conditions, which include: 1) A required stormwater control was never installed, was installed incorrectly, or not in
accordance with the requirements in Part 3; 2) You become aware that the stormwater controls you have installed and are maintaining are not effective
enough for the discharge to meet applicable water quality standards or applicable requirements in Part 3; 3) One of the prohibited discharges in Part 3.3.3.A
is occurring or has occurred; or 4) ODEQ or local MS4 operator requires corrective actions as a result of a permit violation found during an inspection carried
out under Part 6.15. If a condition on your site requires a corrective action, you must also fill out a corrective action form. See Part 4.5.15 of the permit for more
information.
OKR10 SWPPP Template, Version 1.0
Stormwater Pollution Prevention Plan (SWPPP)
INSERT PROJECT NAME
Instructions for Filling Out the “Erosion and Sediment Control” Table
Type and Location of E&S Controls
Provide a list of all erosion and sediment (E&S) controls that your SWPPP indicates will be installed and implemented at your site. This list must include
at a minimum all E&S controls required by OKR10 Part 3.3.1. Include also any natural buffers established under OKR10 Part 3.3.1.A. Buffer requirements
apply if your project’s earth-disturbing activities will occur within 50 feet of a surface water. You may group your E&S controls on your form if you have
several of the same type of controls (e.g., you may group “Inlet Protection Measures”, “Perimeter Controls”, and “Stockpile Controls” together on
one line), but if there are any problems with a specific control, you must separately identify the location of the control, whether repairs or
maintenance or corrective action are necessary, and in the notes section you must describe the specifics about the problem you observed.
Repairs or Other Maintenance Needed?
Answer “yes” if the E&S control requires a repair of any kind (due to normal wear and tear, or as a result of damage) or requires maintenance in
order for the control to continue operating effectively. At a minimum, maintenance is required in the following specific instances: (1) for perimeter
controls, whenever sediment has accumulated to ½ or more the above-ground height of the control (OKR10 Part 3.3.1.B); (2) where sediment has
been tracked-out onto the surface of off-site streets or other paved areas (OKR10 Part 3.3.1.C); (3) for inlet protection measures, when sediment
accumulates, the filter becomes clogged, and/or performance is compromised (OKR10 Part 3.3.1.I); and (4) for sediment basins, as necessary to
maintain at least ½ of the design capacity of the basin (OKR10 Part 3.3.1.K). Note: In many cases, “yes” answers are expected and indicate a
project with an active operation and maintenance program. You should also answer “yes” if work to fix the problem is still ongoing from the previous
inspection.
Corrective Action Needed?
Answer “yes” if during your inspection you found any of the following conditions to be present (OKR10, Part 4.5.15.B): (1) a required E&S control was
never installed, was installed incorrectly, or not in accordance with the corresponding OKR10 Part 3 requirement; (2) you become aware that the
inadequacy of the E&S control has led to an exceedance of an applicable water quality standard; or (3) ODEQ or local MS4 operator requires
corrective action for an E&S control as a result of a permit violation found during an inspection carried out under Part 6.15. If you answer “yes”, you
must take corrective action and complete a corrective action report, found at http://water.epa.gov/polwaste/npdes/stormwater/StormwaterPollution-Prevention-Plans-for-Construction-Activities.cfm. Note: You should answer “yes” if work to fix the problem from a previous inspection is still
ongoing.
Date on Which Maintenance or Corrective Action First Identified?
Provide the date on which the condition that triggered the need for maintenance or corrective action was first identified. If the condition was just
discovered during this inspection, enter the inspection date. If the condition is a carryover from a previous inspection, enter the original date of the
condition’s discovery.
Notes
For each E&S control and the area immediately surrounding it, note whether the control is properly installed and whether it appears to be working to
minimize sediment discharge. Describe any problem conditions you observed such as the following, and why you think they occurred as well as
actions (e.g., repairs, maintenance, or corrective action) you will take or have taken to fix the problem:
1. Failure to install or to properly install a required E&S control
2. Damage or destruction to an E&S control caused by vehicles, equipment, or personnel, a storm event, or other event
OKR10 SWPPP Template, Version 1.0
Stormwater Pollution Prevention Plan (SWPPP)
INSERT PROJECT NAME
3. Mud or sediment deposits found downslope from E&S controls
4. Sediment tracked out onto paved areas by vehicles leaving construction site
5. Noticeable erosion at discharge outlets or at adjacent streambanks or channels
6. Erosion of the site’s sloped areas (e.g., formation of rills or gullies)
7. E&S control is no longer working due to lack of maintenance
For buffer areas, make note of whether they are marked off as required, whether there are signs of construction disturbance within the buffer, which
is prohibited under the OKR10, and whether there are visible signs of erosion resulting from discharges through the area.
If repairs, maintenance, or corrective action is required, briefly note the reason. If repairs, maintenance, or corrective action have been completed,
make a note of the date it was completed and what was done. If corrective action is required, note that you will need to complete a separate
corrective action report describing the condition and your work to fix the problem.
OKR10 SWPPP Template, Version 1.0
Stormwater Pollution Prevention Plan (SWPPP)
INSERT PROJECT NAME
Condition and Effectiveness of Pollution Prevention (P2) Practices (OKR10 Part 3.3.3)
Type/Location of P2 Practices
[Add an additional sheet if
necessary]
1.
2.
Repairs or
Other
Maintenance
Needed?*
Corrective
Action
Required?*
Yes
No
Yes
No
Yes
No
Yes
No
Yes
No
Yes
No
Yes
No
Yes
No
Yes
No
Yes
No
Yes
No
Yes
No
Yes
No
Yes
No
Yes
No
Yes
No
Yes
No
Yes
No
Yes
No
Yes
No
3.
4.
5.
6.
7.
8.
OKR10 SWPPP Template, Version 1.0
(see reverse for instructions)
Date on Which
Notes
Maintenance or
Corrective Action
First Identified?
Stormwater Pollution Prevention Plan (SWPPP)
INSERT PROJECT NAME
9.
10.
* Note: The permit differentiates between conditions requiring repairs and maintenance, and those requiring corrective action. The permit requires
maintenance in order to keep controls in effective operating condition and requires repairs if controls are not operating as intended. Corrective
actions are triggered only for specific, more serious conditions, which include: 1) A required stormwater control was never installed, was installed
incorrectly, or not in accordance with the requirements in Part 2 and/or 3; 2) You become aware that the stormwater controls you have installed
and are maintaining are not effective enough for the discharge to meet applicable water quality standards or applicable requirements in Part 3.1;
3) One of the prohibited discharges in Part 2.3.1 is occurring or has occurred; or 4) EPA requires corrective actions as a result of a permit violation
found during an inspection carried out under Part 4.2. If a condition on your site requires a corrective action, you must also fill out a corrective action
form found at http://water.epa.gov/polwaste/npdes/stormwater/Stormwater-Pollution-Prevention-Plans-for-Construction-Activities.cfm. See Part 5 of
the permit for more information.
OKR10 SWPPP Template, Version 1.0
Stormwater Pollution Prevention Plan (SWPPP)
INSERT PROJECT NAME
Instructions for Filling Out the “Pollution Prevention (P2) Practice” Table
Type and Location of P2 Controls
Provide a list of all pollution prevention (P2) practices that are implemented at your site. This list must include all P2 practices required by Part 3.3.3,
and those that are described in your SWPPP.
Repairs or Other Maintenance Needed?
Answer “yes” if the P2 practice requires a repair of any kind (due to normal wear and tear, or as a result of damage) or requires maintenance in
order for the control to continue operating effectively. Note: In many cases, “yes” answers are expected and indicate a project with an active
operation and maintenance program.
Corrective Action Needed?
Answer “yes” if during your inspection you found any of the following conditions to be present (OKR10, Part 4.5.15): (1) a required P2 practice was
never installed, was installed incorrectly, or not in accordance with the corresponding OKR10 Part 3 requirement; (2) you become aware that the
inadequacy of the P2 practice has led to an exceedance of an applicable water quality standard; (3) one of the “prohibited discharges” listed in
OKR10 Part 3.3.3.A is occurring or has occurred, or (4) ODEQ or local MS4 operator requires corrective action for a P2 practice as a result of a permit
violation found during an inspection carried out under Part 6.15. If you answer “yes”, you must take corrective action and complete a corrective
action report (see http://water.epa.gov/polwaste/npdes/stormwater/Stormwater-Pollution-Prevention-Plans-for-Construction-Activities.cfm). Note:
You should answer “yes” if work to fix the problem from a previous inspection is still ongoing.
Date on Which Maintenance or Corrective Action First Identified?
Provide the date on which the condition that triggered the need for maintenance or corrective action was first identified. If the condition was just
discovered during this inspection, enter the inspection date. If the condition is a carryover from a previous inspection, enter the original date of the
condition’s discovery.
Notes
For each P2 control and the area immediately surrounding it, note whether the control is properly installed, whether it appears to be working to
minimize or eliminate pollutant discharges, and whether maintenance or corrective action is required. Describe problem conditions you observed
such as the following, and why you think they occurred, as well as actions you will take or have taken to fix the problem:
1. Failure to install or to properly install a required P2 control
2. Damage or destruction to a P2 control caused by vehicles, equipment, or personnel, or a storm event
3. Evidence of a spill, leak, or other type of pollutant discharge, or failure to have properly cleaned up a previous spill, leak, or other type of
pollutant discharge
4. Spill response supplies are absent, insufficient, or not where they are supposed to be located
5. Improper storage, handling, or disposal of chemicals, building materials or products, fuels, or wastes
6. P2 practice is no longer working due to lack of maintenance
OKR10 SWPPP Template, Version 1.0
Stormwater Pollution Prevention Plan (SWPPP)
INSERT PROJECT NAME
If repairs, maintenance, or corrective action is required, briefly note the reason. If repairs, maintenance, or corrective action have been completed,
make a note of the date it was completed and what was done. If corrective action is required, note that you will need to complete a separate
corrective action report describing the condition and your work to fix the problem.
OKR10 SWPPP Template, Version 1.0
Stormwater Pollution Prevention Plan (SWPPP)
INSERT PROJECT NAME
Stabilization of Exposed Soil (OKR10 Part 3.3.2)
Stabilization Area
[Add an additional sheet if
necessary]
Stabilization Method
1.
2.
3.
4.
(see reverse for instructions)
Have You Initiated
Stabilization?
YES
If yes, provide date:
NO
YES
If yes, provide date:
NO
YES
If yes, provide date:
NO
YES
If yes, provide date:
NO
YES
If yes, provide date:
NO
Notes
5.
Description of Discharges (OKR10 Part 4.5.13.D)
(see reverse for instructions)
Was a stormwater discharge or other discharge occurring from any part of your site at the time of the inspection?
If “yes”, provide the following information for each point of discharge:
Discharge Location
Observations
[Add an additional sheet if necessary]
1.
Describe the discharge:
Yes
No
At points of discharge and the channels and banks of surface waters in the immediate vicinity, are there any visible
signs of erosion and/or sediment accumulation that can be attributed to your discharge?
Yes
No
OKR10 SWPPP Template, Version 1.0
Stormwater Pollution Prevention Plan (SWPPP)
INSERT PROJECT NAME
If yes, describe what you see, specify the location(s) where these conditions were found, and indicate whether
modification, maintenance, or corrective action is needed to resolve the issue:
2.
Describe the discharge:
At points of discharge and the channels and banks of surface waters in the immediate vicinity, are there any visible
signs of erosion and/or sediment accumulation that can be attributed to your discharge?
Yes
No
If yes, describe what you see, specify the location(s) where these conditions were found, and indicate whether
modification, maintenance, or corrective action is needed to resolve the issue:
OKR10 SWPPP Template, Version 1.0
Stormwater Pollution Prevention Plan (SWPPP)
INSERT PROJECT NAME
Instructions for Filling Out the “Stabilization of Exposed Soil” Table
Stabilization Area
List all areas where soil stabilization is required to begin because construction work in that area has permanently stopped or temporarily stopped (i.e., work will
stop for 14 or more days), and all areas where stabilization has been implemented.
Stabilization Method
For each area, specify the method of stabilization (e.g., hydroseed, sod, planted vegetation, erosion control blanket, mulch, rock).
Have You Initiated Stabilization
For each area, indicate whether stabilization has been initiated.
Notes
For each area where stabilization has been initiated, describe the progress that has been made, and what additional actions are necessary to complete
stabilization. Note the effectiveness of stabilization in preventing erosion. If stabilization has been initiated but not completed, make a note of the date it is to
be completed. If stabilization has been completed, make a note of the date it was completed. If stabilization has not yet been initiated, make a note of the
date it is to be initiated, and the date it is to be completed.
Instructions for Filling Out the “Description of Discharges” Table
You are only required to complete this section if a discharge is occurring at the time of the inspection.
Was a Stormwater Discharge Occurring From Any Part of Your Site At The Time of the Inspection?
During your inspection, examine all points of discharge from your site, and determine whether a discharge is occurring. If there is a discharge, answer
“yes” and complete the questions below regarding the specific discharge. If there is not a discharge, answer “no” and skip to the next page.
Discharge Location (repeat as necessary if there are multiple points of discharge)
Location of discharge. Specify the location on your site where the discharge is occurring. The location may be an outlet from a stormwater control or
constructed stormwater channel, a discharge into a storm sewer inlet, or a specific point on the site. Be as specific as possible; it is recommended
that you refer to a precise point on your site map.
Describe the discharge. Include a specific description of any noteworthy characteristics of the discharge such as color; odor; floating, settled, or
suspended solids; foam; oil sheen; and other obvious pollution indicators.
Are there visible signs of erosion or sediment accumulation? At each point of discharge and the channel and streambank in the immediate vicinity,
visually assess whether there are any obvious signs of erosion and/or sediment accumulation that can be attributed to your discharge. If you answer
“yes”, include a description in the space provided of the erosion and sediment deposition that you have found, specify where on the site or in the
surface water it is found, and indicate whether modification, maintenance, or corrective action is needed to resolve the issue.
OKR10 SWPPP Template, Version 1.0
Stormwater Pollution Prevention Plan (SWPPP)
INSERT PROJECT NAME
Contractor or Subcontractor Certification and Signature
(see reverse for instructions)
“I certify under penalty of law that this document and all attachments were prepared under my direction or supervision in accordance with a
system designed to assure that qualified personnel properly gathered and evaluated the information submitted. Based on my inquiry of the
person or persons who manage the system, or those persons directly responsible for gathering the information, the information submitted is, to the
best of my knowledge and belief, true, accurate, and complete. I am aware that there are significant penalties for submitting false information,
including the possibility of fine and imprisonment for knowing violations.”
Signature of Contractor or Subcontractor:
Printed Name and Affiliation:
________________________________________________
Date:
________________________________________________
Certification and Signature by Permittee
(see reverse for instructions)
“I certify under penalty of law that this document and all attachments were prepared under my direction or supervision in accordance with a
system designed to assure that qualified personnel properly gathered and evaluated the information submitted. Based on my inquiry of the
person or persons who manage the system, or those persons directly responsible for gathering the information, the information submitted is, to the
best of my knowledge and belief, true, accurate, and complete. I am aware that there are significant penalties for submitting false information,
including the possibility of fine and imprisonment for knowing violations.”
Signature of Permittee or
“Duly Authorized Representative”:
Printed Name and Affiliation:
________________________________________________
________________________________________________
OKR10 SWPPP Template, Version 1.0
Date:
Stormwater Pollution Prevention Plan (SWPPP)
INSERT PROJECT NAME
Instructions for Signature/Certification
Each inspection report must be signed and certified to be considered complete.
Contractor or Subcontractor Signature and Certification
Where a contractor or subcontractor is relied on to carry out the inspection and complete the inspection report, you should require the inspector to
sign and certify each report. Note that this does not relieve the permitted operator of the requirement to sign and certify the inspection report as
well.
Signature and Certification by Permittee
At a minimum, the inspection report must be signed by either (1) the person who signed the NOI, or (2) a duly authorized representative of that
person. The following requirements apply to scenarios (1) and (2):
If the signatory will be the person who signed the NOI for permit coverage, as a reminder, that person must be one of the following types of
individuals:

For a corporation: A responsible corporate officer. For the purpose of this subsection, a responsible corporate officer means: (i) a president,
secretary, treasurer, or vice-president of the corporation in charge of a principal business function, or any other person who performs similar
policy- or decision-making functions for the corporation, or (ii) the manager of one or more manufacturing, production, or operating
facilities, provided, the manager is authorized to make management decisions which govern the operation of the regulated facility
including having the explicit or implicit duty of making major capital investment recommendations, and initiating and directing other
comprehensive measures to assure long term environmental compliance with environmental laws and regulations; the manager can ensure
that the necessary systems are established or actions taken to gather complete and accurate information for permit application
requirements; and where authority to sign documents has been assigned or delegated to the manager in accordance with corporate
procedures.

For a partnership or sole proprietorship: A general partner or the proprietor, respectively.

For a municipality, state, federal, or other public agency: Either a principal executive officer or ranking elected official. For purposes of this
subsection, a principal executive officer of a federal agency includes (i) the chief executive officer of the agency, or (ii) a senior executive
officer having responsibility for the overall operations of a principal geographic unit of the agency (e.g., Regional Administrator of EPA).
If the signatory will be a duly authorized representative, the following requirements must be met:

The authorization is made in writing by the person who signed the NOI (see above);

The authorization specifies either an individual or a position having responsibility for the overall operation of the regulated facility or activity
such as the position of plant manager, operator of a well or a well field, superintendent, position of equivalent responsibility, or an individual
or position having overall responsibility for environmental matters for the company. (A duly authorized representative may thus be either a
named individual or any individual occupying a named position); and
OKR10 SWPPP Template, Version 1.0
Stormwater Pollution Prevention Plan (SWPPP)
INSERT PROJECT NAME

The signed and dated written authorization is included in the SWPPP. A copy must be submitted to ODEQ or local MS4 operator, if requested.
OKR10 SWPPP Template, Version 1.0
Appendix E – Copy of Corrective Action Form
Corrective Action Report Form – Field Version
Purpose
This Corrective Action Report Form is designed to assist you in preparing corrective action reports for ODEQ’s
2012 Construction General Permit (OKR10). If you are covered under ODEQ’s 2012 OKR10, this form will enable
you to create a corrective action report that complies with the minimum reporting requirements of Part 4.5.15 of
the permit.
You are only required to fill out this form if one of the corrective action triggering conditions in Part 4.5.15.B.
Routine maintenance and repairs are generally not considered to be a corrective action triggering condition.
Corrective actions are triggered only for specific, more serious conditions that are identified below in the
“Overview of Corrective Action Requirements.”
Notes
While every effort has been made to ensure the accuracy of all instructions and guidance contained in the
Corrective Action Report Form, the actual obligations of regulated construction activities are determined by the
relevant provisions of the permit, not by the form. In the event of a conflict between the Corrective Action
Report Form and any corresponding provision of the 2012 OKR10, you must abide by the requirements in the
permit.
Overview of Corrective Action Requirements
Construction operators covered under the 2012 OKR10 are required to conduct corrective actions and report on
progress made in correcting the problem condition(s) in accordance with the following requirements:
Corrective Action Triggering Conditions (Parts 4.5.15.B)
Corrective action is required whenever any of the following conditions occur at your site:

A required stormwater control was never installed, was installed incorrectly, or not in accordance with the
requirements in Part 3;

The stormwater controls (e.g., erosion and sediment controls or pollution prevention controls) that have been
installed and maintained are not effective enough for the discharge to meet applicable water quality standards
or applicable requirements in Part 3.3.1 of the permit;

A Part 3.3.3.A prohibited discharge has occurred or is occurring; or

Any corrective actions required by ODEQ or local MS4 operator as a result of permit violations found during an
inspection carried out under Part 6.15.
Deadlines for Completing Corrective Actions (Part 5.2.1)
You must complete corrective action (e.g., installing and making operational any new or modified control, correcting
errors in installation, preventing, mitigating, or cleaning up spills or leaks making repairs) by no later than 7 calendar days
from the time of discovery of the condition. If infeasible to complete the installation or repair within 7 calendar days, you
must document why it is infeasible and document your schedule for completing the corrective action as soon as
practicable.
Deadlines for Documenting Corrective Actions in a Report (Part 4.5.15.C)
You are required to complete a corrective action report for each of corrective action you take in accordance with the
following deadlines.

Within 24 hours of discovering the occurrence of a corrective action triggering condition, you must document the
following:
The condition identified at your site;
The nature of the condition identified; and
The date and time of the condition identified and how it was identified

Within 7 calendar days of discovering a triggering condition, you must document the following:
-
Any follow-up actions taken to review the design, installation, and maintenance of stormwater controls,
including the dates such actions occurred;
A summary of stormwater controls modifications taken or to be taken, including a schedule of activities
necessary to implement changes, and the date the modifications are completed or expected to be
completed; and
Notice of whether SWPPP modifications are required as a result of the condition identified or corrective
action.
Instructions for Using This Report Form
This Field Version of the Corrective Action Report Form is intended to be used in the field and filled out by hand. If
you will be filling out the Corrective Action Report Form electronically (i.e., you will be typing in your findings),
please use the Electronic Version of the Corrective Action Report Form available at
http://water.epa.gov/polwaste/npdes/stormwater/Stormwater-Pollution-Prevention-Plans-for-ConstructionActivities.cfm. The Electronic Version includes text fields with instructions for what to enter.
The following tips for using this form will help you ensure that the minimum permit requirements are met:

Review the corrective action requirements. Before you fill out this corrective action report form, read the
OKR10’s Part 4 corrective action requirements. This will ensure that you have a working understanding of
the permit’s underlying corrective action requirements.

Complete a separate report for each condition that triggers corrective action. For each triggering
condition on your site, you will need to fill out a separate corrective action report form.

Complete all required text fields. Fill out all text fields. Only by filling out all fields will the form be compliant
with the requirements of the permit. (Note: Where you do not need the number of rows provided in the
corrective action report form, you leave those rows blank. Or, if you need more space to document your
findings, you may add an additional sheet.)

Sign and certify each corrective action report. Each corrective action report form must be signed and
certified by the permittee to be considered complete. Where your corrective actions are carried out by a
contractor or subcontractor, it is recommended that you also have the form signed and certified by the
inspector, in addition to the signature and certification required of the permitted operator. The form
includes a signature block for both parties.

Include the corrective action report form with your SWPPP. Once your form is complete, make sure to
include a copy of the corrective action report form in your SWPPP in accordance with Part 4.5.11.B of the
OKR10.

Retain copies of all corrective action reports with your records. You must retain copies of your corrective
action reports in your records in accordance with the requirements in Part 4.5.15.D of the 2012 OKR10.
These reports must be retained for at least 3 years from the date your permit coverage expires or is
terminated.
Section-by-Section Instructions
You will find specific instructions corresponding to each section of the report form on the reverse side of each
page. These instructions were written in order to provide you with more details in terms of what EPA expects to be
documented in these reports.
Section A – Initial Report (OKR10 Part 4.5.15.C.1)
(Complete this section within 24 hours of discovering the condition that triggered corrective action)
Name of Project
OKR10 Tracking
Today’s Date
No.
Date Problem First Discovered
Time Problem First Discovered
Name and Contact Information of
Individual Completing this Form
What site conditions triggered the requirement to conduct corrective action (check the box that applies):
A required stormwater control was never installed, was installed incorrectly, or not in accordance with the
requirements in Part 3
The stormwater controls that have been installed and maintained are not effective enough for the discharge to meet
applicable water quality standards or applicable requirements in Part 3.3.1 of the permit
A Part 3.3.3.A prohibited discharge has occurred or is occurring
EPA requires corrective action as a result of permit violations found during an ODEQ or local MS4 operator inspection
carried out under Part 6.15
Provide a description of the problem:
Deadline for completing corrective action (Enter date that is either: (1) no more than 7 calendar days after the date you
discovered the problem, or (2) if it is infeasible to complete work within the first 7 days, enter the date that is as soon as
practicable following the 7th day):
If your estimated date of completion falls after the 7-day deadline, explain (1) why you believe it is infeasible to complete
work within 7 days, and (2) why the date you have established for making the new or modified stormwater control
operational is the soonest practicable timeframe:
Section B – Corrective Action Progress (OKR10 Part 4.5.15.C.2)
(Complete this section no later than 7 calendar days after discovering the condition that triggered corrective action)
Section B.1 – Why the Problem Occurred
Cause(s) of Problem
(Add an additional sheet if necessary)
1.
How This Was Determined and the Date You Determined
the Cause
1.
2.
2.
Section B.2 – Stormwater Control Modifications to be Implemented to Correct the Problem
List of Stormwater Control Modification(s)
Needed to Correct Problem
(Add an additional sheet if necessary)
1.
2.
Date of
Completion
SWPPP Update
Necessary?
Yes
No
If yes, provide date
SWPPP modified:
Yes
No
If yes, provide date
SWPPP modified:
Notes
Instructions for Filling Out the Initial Report (Section A)
You must complete Section A of the report form within 24 hours of discovering the condition that triggered corrective
action
Name of Project
Enter the name for the project.
OKR10 Tracking No.
Enter the tracking number that was assigned to your NOI application for permit coverage.
Today’s Date
Enter the date you completed this form.
Date/Time Problem First Discovered
Specify the date on which the triggering condition was first discovered. Also specify the time of the discovery.
Name/Contact Information
Provide the individual’s name, title, and contact information as directed in the form.
Site Condition That Triggered Corrective Action
Under the OKR10, corrective action is required when one of 3 triggering conditions occurs at your site. See OKR10 Parts
5.2.1 and 5.3. Check the box that corresponds to the condition that triggered this corrective action.
Description of the Site Condition
Provide a summary description of the condition you found that triggered corrective action under OKR10 Part 4.5.15.B
and the specific location where it was found. Be as specific as possible about the location; it is recommended that you
refer to a precise point on your site map. If you have already provided this explanation in an inspection report, you can
refer to that report.
Deadline for Completing Corrective Action
This deadline is fixed in OKR10 Part 4.5.15.B. For all projects, the deadline is either: (1) no more than 7 calendar days after
the date you discovered the problem, or (2) if it is infeasible to complete work within the first 7 days, as soon as
practicable following the 7th day. If your estimated date of completion falls after the 7-day deadline consistent with (2),
above, explain (a) why you believe it is infeasible to complete work within 7 days, and (b) why the date you have
established for making the new or modified stormwater control operational is the soonest practicable timeframe:
Instructions for Filling Out the Corrective Action Progress Table (Section B)
You must complete Section B of the report form no later than 7 calendar days after discovering the condition that
triggered corrective action.
Section B.1 – Why the Problem Occurred
After you have had the opportunity to examine the problem more closely, provide details as to what you believe to be
the cause of the problem, and specify the follow-up actions you took (along with the dates of such actions) to diagnose
the problem. This is consistent with OKR10 Part 4.5.15.C.
Section B.2 – Stormwater Control Modifications to be Implemented
Provide a list of modifications you plan to make to your stormwater controls to correct the problem and the date you
completed such work. Keep in mind that your work must be completed within the timeline specified in Section A for the
completion of corrective action work.
Also, if a SWPPP modification is necessary consistent with Part 4.4. in order to reflect changes implemented at your site,
indicate the date you modified your SWPPP. Keep in mind that SWPPP changes must be made within 7 days of
discovering the problem that triggered this corrective action.
Space is provided for you to include additional notes or observations regarding the change that you implemented at
your site to correct the problem.
Section C – Certification and Signature (OKR10 Part 6.7)
Section C.1 – Certification and Signature by Contractor or Subcontractor
“I certify under penalty of law that this document and all attachments were prepared under my direction or supervision in
accordance with a system designed to assure that qualified personnel properly gathered and evaluated the information
submitted. Based on my inquiry of the person or persons who manage the system, or those persons directly responsible for
gathering the information, the information submitted is, to the best of my knowledge and belief, true, accurate, and
complete. I am aware that there are significant penalties for submitting false information, including the possibility of fine and
imprisonment for knowing violations.”
Signature of Contractor or Subcontractor:
Printed Name and Affiliation:
________________________________________________
Date:
________________________________________________
Section C.2 – Certification and Signature by Permittee
“I certify under penalty of law that this document and all attachments were prepared under my direction or supervision in
accordance with a system designed to assure that qualified personnel properly gathered and evaluated the information
submitted. Based on my inquiry of the person or persons who manage the system, or those persons directly responsible for
gathering the information, the information submitted is, to the best of my knowledge and belief, true, accurate, and
complete. I am aware that there are significant penalties for submitting false information, including the possibility of fine and
imprisonment for knowing violations.”
Signature of Permittee or
“Duly Authorized Representative”:
Printed Name and Affiliation:
________________________________________________
________________________________________________
Date:
Instructions for Signature and Certification (Section C)
Each corrective action report must be signed and certified to be considered complete.
Section C.1 – Contractor or Subcontractor Signature and Certification
Where a contractor or subcontractor is relied on to complete this report and the associated corrective
action, you should require the individual(s) to sign and certify each report. Note that this does not relieve
you of the requirement to sign and certify the report as well.
Section C.2 – Signature and Certification by Permittee
At a minimum, the corrective action report form must be signed by either (1) the person who signed the
NOI, or (2) a duly authorized representative of that person. The following requirements apply to
scenarios (1) and (2):
If the signatory will be the person who signed the NOI for permit coverage, as a reminder, that person
must be one of the following types of individuals:

F
or a corporation: A responsible corporate officer. For the purpose of this subsection, a responsible
corporate officer means: (i) a president, secretary, treasurer, or vice-president of the corporation in
charge of a principal business function, or any other person who performs similar policy- or
decision-making functions for the corporation, or (ii) the manager of one or more manufacturing,
production, or operating facilities, provided, the manager is authorized to make management
decisions which govern the operation of the regulated facility including having the explicit or
implicit duty of making major capital investment recommendations, and initiating and directing
other comprehensive measures to assure long term environmental compliance with environmental
laws and regulations; the manager can ensure that the necessary systems are established or
actions taken to gather complete and accurate information for permit application requirements;
and where authority to sign documents has been assigned or delegated to the manager in
accordance with corporate procedures.
F

or a partnership or sole proprietorship: A general partner or the proprietor, respectively.
F

or a municipality, state, federal, or other public agency: Either a principal executive officer or
ranking elected official. For purposes of this subsection, a principal executive officer of a federal
agency includes (i) the chief executive officer of the agency, or (ii) a senior executive officer
having responsibility for the overall operations of a principal geographic unit of the agency (e.g.,
Regional Administrator of EPA).
If the signatory will be a duly authorized representative, the following requirements must be met:

The authorization is made in writing by the person who signed the NOI (see above);

The authorization specifies either an individual or a position having responsibility for the
overall operation of the regulated facility or activity such as the position of plant manager,
operator of a well or a well field, superintendent, position of equivalent responsibility, or an
individual or position having overall responsibility for environmental matters for the company.
(A duly authorized representative may thus be either a named individual or any individual
occupying a named position); and

The signed and dated written authorization is included in the SWPPP. A copy must be
submitted to EPA, if requested.
Appendix F – Sample SWPPP Amendment Log
Instructions:
― Create a log here of changes and updates to the SWPPP. You may use the table
below to track these modifications.
― SWPPP modifications are required pursuant to OKR10 Part 4.4 in the following
circumstances:
 Whenever new operators become active in construction activities on your site, or
you make changes to your construction plans, stormwater control measures,
pollution prevention measures, or other activities at your site that are no longer
accurately reflected in your SWPPP;
 To reflect areas on your site map where operational control has been transferred
(and the date of transfer) since initiating permit coverage;
 If inspections or investigations determine that SWPPP modifications are necessary
for compliance with this permit;
 Where EPA determines it is necessary to impose additional requirements on your
discharge; and
 To reflect any revisions to applicable federal, state, tribal, or local requirements
that affect the stormwater control measures implemented at the site.
― If applicable, if a change in chemical treatment systems or chemically-enhanced
stormwater control is made, including use of a different treatment chemical, different
dosage rate, or different area of application.
No.
Description of the Amendment
Date of
Amendment
Amendment Prepared by
[Name(s) and Title]
Appendix G – Sample Subcontractor Certifications/Agreements
SUBCONTRACTOR CERTIFICATION
STORMWATER POLLUTION PREVENTION PLAN
Project Number:
Project Title:
Operator(s):
As a subcontractor, you are required to comply with the Stormwater Pollution Prevention Plan
(SWPPP) for any work that you perform on-site. Any person or group who violates any condition
of the SWPPP may be subject to substantial penalties or loss of contract. You are encouraged to
advise each of your employees working on this project of the requirements of the SWPPP. A
copy of the SWPPP is available for your review at the office trailer.
Each subcontractor engaged in activities at the construction site that could impact stormwater
must be identified and sign the following certification statement:
I certify under the penalty of law that I have read and understand the terms and conditions of
the SWPPP for the above designated project and agree to follow the practices described in the
SWPPP.
This certification is hereby signed in reference to the above named project:
Company:
Address:
Telephone Number:
Type of construction service to be provided:
Signature:
Title:
Date:
Appendix H – Sample Grading and Stabilization Activities Log
Date
Grading
Activity
Initiated
Description of Grading Activity
Description of Stabilization Measure
and Location
Date Grading
Activity Ceased
(Indicate
Temporary or
Permanent)
Date When
Stabilization
Measures
Initiated
Appendix I – Sample SWPPP Training Log
Stormwater Pollution Prevention Training Log
Project Name:
Project Location:
Instructor’s Name(s):
Instructor’s Title(s):
Course Location:
Date:
Course Length (hours):
Stormwater Training Topic: (check as appropriate)

Sediment and Erosion
Controls

Emergency Procedures

Stabilization Controls

Inspections/Corrective Actions

Pollution Prevention
Measures
Specific Training Objective:
Attendee Roster: (attach additional pages as necessary)
No.
1
2
3
4
5
6
7
8
Name of Attendee
Company
Appendix J – Sample Delegation of Authority Form
Delegation of Authority
I, _______________________ (name), hereby designate the person or specifically described position
below to be a duly authorized representative for the purpose of overseeing compliance with
environmental requirements, including the Construction General Permit, at the
____________________________________ construction site. The designee is authorized to sign any
reports, stormwater pollution prevention plans and all other documents required by the permit.
________________________________________ (name of person or position)
________________________________________ (company)
________________________________________ (address)
________________________________________ (city, state, zip)
________________________________________ (phone)
By signing this authorization, I confirm that I meet the requirements to make such a designation
as set forth in Part 6.7.1 of ODEQ’s Construction General Permit (OKR10), and that the designee
above meets the definition of a “duly authorized representative” as set forth in Part 6.7.2.
I certify under penalty of law that this document and all attachments were prepared under my
direction or supervision in accordance with a system designed to assure that qualified personnel
properly gathered and evaluated the information submitted. Based on my inquiry of the person
or persons who manage the system, or those persons directly responsible for gathering the
information, the information submitted is, to the best of my knowledge and belief, true,
accurate, and complete. I am aware that there are significant penalties for submitting false
information, including the possibility of fine and imprisonment for knowing violations.
Name:
Company:
Title:
Signature:
Date:
Appendix K – Endangered Species Documentation
INSERT DOCUMENTATION CONSISTENT WITH SWPPP TEMPLATE SECTION 3.1
Appendix L – Historic Properties Documentation
INSERT DOCUMENTATION CONSISTENT WITH SWPPP TEMPLATE SECTION 3.2