Survey ID: ________________ OMB Control No. 20XX-XXXX 

 Approval expires XX/XX/XX

United States Environmental Protection Agency 

Stormwater Management 

Including Discharges from Developed Sites 

Regulated Municipal Separate Storm Sewer Systems 

(MS4s) Questionnaire 

Survey ID: ________________ 

An Agency may not conduct or sponsor, and a person is not required to respond to, a collection 

of information, unless it displays a currently valid OMB control number. 

The public reporting and recordkeeping burden for this collection of information is estimated to 

average 23 hours per response. Send comments on the Agency's need for this information, the 

accuracy of the provided burden estimates, and any suggested methods for minimizing 

respondent burden, including through the use of automated collection techniques to the 

Director, Collection Strategies Division, U.S. Environmental Protection Agency (2822T), 1200 

Pennsylvania Ave., NW, Washington, D.C. 20460. Include the OMB control number in any 

correspondence. Do not send the completed questionnaire to this address. 

Owner/Developer Short Questionnaire Page 1 of 47
Survey ID: ________________ OMB Control No. 20XX-XXXX 

 Approval expires XX/XX/XX

Purpose of the Questionnaire 

Stormwater discharges from developed land can negatively impact water quality through 

increases in stormwater volume and increased pollutant loads to the receiving waters. To 

strengthen its stormwater regulations, EPA’s Office of Water (OW) is considering 

revisions to the current National Pollutant Discharge Elimination System (NPDES) 

regulations including the establishment of standards for long term stormwater discharges 

from developed sites. 

To collect data to inform to inform decisions regarding how the nation’s stormwater 

regulations should be strengthened and to support the technical and financial feasibility 

associated with this rulemaking, EPA is sending the following questionnaire to 

owners/operators of regulated Municipal Separate Storm Sewer Systems (MS4s). This 

questionnaire will provide EPA with information to: 

• Characterize the current scope, components, and implementation of existing local and 

state stormwater programs; ordinances and laws that may constrain the utilization of 

stormwater retention practices; and retrofit requirements for discharges from existing 

development; and 

• Estimate the burden and expenditures to comply with and enforce existing 

requirements on stormwater discharges. 

The survey is presented in two sections covering the following topic areas: 

 Section A: Technical Information 

 Section B: Financial Information

MS4 Questionnaire Page 2 of 47 
Survey ID: ________________ OMB Control No. 20XX-XXXX 

 Approval expires XX/XX/XX

General Information, continued 

Authority 

EPA has authority to administer this questionnaire under section 308 of the Clean Water 

Act (Federal Water Pollution Control Act, 22 U.S.C. Section 1318). Participation in this 

questionnaire is mandatory, and you are required to respond. You must retain a 

copy of the completed questionnaire for your files. EPA may contact you with followup questions to clarify your answers. Late filing of the questionnaire, or failure to 

follow any related EPA instruction, may results in civil penalties, criminal fines, or 

other sanctions provided by law including the possibility of fines and imprisonment 

as explained in Section 308 of the Clean Water Act (33 U.S.C., Section 1318). 

When to Complete the Questionnaire 

You must complete this questionnaire, then print, sign and return the certification 

statement to EPA no later than 60 calendar days after receiving the survey link. 

If you wish to request an extension, you must do so in writing no later than one week of 

the due date of this questionnaire. Written requests may be e-mailed to Mr. Brian 

D’Amico at damico.brian@epa.gov. 

Certification Statement 

A responsible MS4 official or authorized representative must verify the accuracy of the 

responses to the questionnaire by reading and signing the Certification Statement. After 

completing the survey, you must print the Certification statement, sign it, and return it to 

EPA at the following address: 

 U.S. Environmental Protection Agency 

Stormwater Management Including Discharges from New Developed and 

Redeveloped Sites MS4 Questionnaire 

c/o Eastern Research Group, Inc. 

14555 Avion Parkway, Suite 200 

Chantilly, VA 20151 

Where to Get Help 

If you have any questions regarding completion of this questionnaire you can request 

assistance using EPA’s e-mail helpline provided below. Please include the name of the 

survey to which you are responding, the question number along with your questions. 

Respondents who desire assistance by telephone should send an e-mail with “Please Call 

Me” in the subject line. Please provide the call-back phone number, contact name, and 

desired day and time to call. The return phone call will be free of charge to the 

respondent. 

MS4 Questionnaire Page 3 of 47 
Survey ID: ________________ OMB Control No. 20XX-XXXX 

 Approval expires XX/XX/XX

E-mail address for help line: _________________________________ 

Confidential Business Information 

Because the information requested in this questionnaire is not business confidential, EPA 

may make the information available to the public without further notice. 

MS4 Questionnaire Page 4 of 47 
Survey ID: ________________ OMB Control No. 20XX-XXXX 

 Approval expires XX/XX/XX

Detailed Instructions for Completing the Questionnaire 

Complete the questionnaire considering the following instructions: 

 This questionnaire is available at the following link: ____________________. 

 Personnel most knowledgeable about the subject areas covered by a specific section 

should complete that section of the questionnaire. 

 For all questions and sections, read all instructions and definitions carefully. Pay 

particular attention to the distinction between establishments and firms. 

 Do not leave any entry blank. If the answer is zero, write “0" or “zero”. If a question 

is not applicable, write “NA.” 

 Answer all of the questions in sequence unless you are directed to SKIP forward in 

the questionnaire. This is important since some questions and/or sections are only 

applicable to some respondents. 

 Use the units specified when responding to questions requesting measurement data 

(e.g., acres). If not specified and applicable, include units in your response. 

 The period of interest for the survey is your fiscal year (FY) 2009 unless indicated 

otherwise. 

 Provide the requested information based on data you currently have. EPA is not 

requesting or recommending that respondents collect new data to provide information 

for this survey. 

MS4 Questionnaire Page 5 of 47 
Survey ID: ________________ OMB Control No. 20XX-XXXX 

 Approval expires XX/XX/XX

Certification Statement 

The individual responsible for directing or supervising the preparation of the enclosed 

Stormwater Discharges from Developed Sites MS4 Survey must read and sign the 

Certification Statement below before returning both documents to the U.S. 

Environmental Protection Agency. The certifying official must be an MS4 official duly 

authorized representative. The Certification Statement must be printed, signed and 

submitted in accordance with the requirements contained in the Code of Federal 

Regulations at 40. CFR 122.22. 

 I certify under penalty of law that the attached questionnaire was prepared under 

my direction or supervision in accordance with a system designed to ensure that qualified 

personnel properly gathered and evaluated the information submitted. The information 

submitted is, to the best of my knowledge and belief, accurate and complete. In those 

cases where we did not possess the requested information, we have provided best 

engineering and/or financial estimates or judgment. I am aware that there are significant 

penalties for submitting false information, including the possibility of fines and 

imprisonment as explained in Section 308 of the Clean Water Act (33 U.S.C., Section 

1318). 

_____________________________ _________________________ 

Signature of Certifying Official Date 

_____________________________ (______)_________________

Printed Name of Certifying Official Telephone Number 

_____________________________ 

Title of Certifying Official 

MS4 Questionnaire Page 6 of 47 
Survey ID: ________________ OMB Control No. 20XX-XXXX 

 Approval expires XX/XX/XX

Definitions 

Note that the following terms are defined for the purposes of this questionnaire only. 

These definitions were written as broadly as possible, relying on our regulations, 

guidance, fact sheets, etc. We acknowledge that there are likely local or regional 

differences in the meanings of some of these terms. Where those differences will affect 

their answer to the questions, respondents should provide information on those 

differences in the survey blanks provided. 

Term Definition 

Construction 

The period of time during which construction activity 

(clearing, grading, and excavation) and other earth-disturbing 

activities are occurring on a site and prior to the time that 

disturbed portions of the site are considered stabilized. 

Bioretention cells 

Landscaping features adapted to provide on-site removal of 

pollutants from stormwater discharges. Surface discharges are 

directed into shallow, landscape depressions, which are 

designed to incorporate many of the pollutant removal 

mechanisms that operate in forested or other natural (prairies, 

wetlands, etc) ecosystems. Includes rain gardens, sidewalk 

planters, curb extensions and other plant or soil systems 

designed to infiltrate or evapotranspirate stormwater. 

Capacity 

Describes the hydraulic capacity that the storm sewer system is 

designed for in terms of the volume of stormwater that it can 

convey without flooding beyond design. 

Catch Basin 

An inlet to the storm sewer system, which typically includes a 

grate or curb inlet, and a sump, to capture sediment, debris, 

and other pollutants. Also known as “storm drain inlets” or 

“curb inlets”. 

Catch Basin Insert 

Retractable or non-retractable devices inserted into catch 

basins to provide removal of oil and grease, trash, and 

sediments from stormwater discharge, and to improve the 

efficiency of the catch basin. Inserts can either be dropped 

directly into the catch basin, or may require retrofit 

construction. Examples include filter fabrics and a system of 

trays with media filters. 

Cistern 

Large storage devices that are often built below ground, at 

ground level, or on rooftops, for storing captured stormwater 

and can be integrated with more sophisticated pumping 

devices. For example, some cisterns collect stormwater that is 

subsequently used for non-potable plumbing, such as flushing 

of toilets, or irrigation applications. 

MS4 Questionnaire Page 7 of 47 
Survey ID: ________________ OMB Control No. 20XX-XXXX 

 Approval expires XX/XX/XX

Term Definition 

Combined Sewer 

System (CSS) 

A publicly owned conveyance system that conveys stormwater 

discharges combined with municipal sewage (domestic, 

commercial and industrial wastewater) through a single pipe 

system to a publicly owned treatment works. 

Constructed Wetland 

A man-made basin that contains water, a substrate (soil, gravel, 

rock, organic materials, etc.), plants (vascular and nonvascular), and organisms similar to those usually found in 

natural wetlands. The number of plants and the biodiversity of 

a constructed wetland are greater than that of wet retention 

pond. Constructed wetlands usually use a relatively 

impermeable subsurface layer to prevent water from seeping 

into the ground. 

Co-Permittee 

A permitting arrangement under which two or more MS4s are 

covered under the same NPDES permit. Responsibilities 

under the permit may be divided among the different MS4 copermittees in accordance with jurisdictional boundaries. 

Curb and Gutter 

An engineering approach to convey stormwater through the 

use of a raised, concrete or stone border along a roadside 

(curb) and a channel (gutter) that directs stormwater discharge 

to a storm sewer system. 

Detention/ Extended 

Detention Practices 

Practices which hold stormwater temporarily and discharge the 

stormwater over an extended period of time (hours to days) 

generally by controlling the size of the discharge volume and 

flow rate. Also known as “wet/dry ponds”, “extended detention 

basins”, “detention ponds”, “extended detention ponds.” 

Dry Well 

A well, other than an improved sinkhole, or subsurface fluid 

distribution system, completed above the water table so that its 

bottom and sides are typically dry except when receiving 

fluids. 

Enterprise 

Communities / 

Empowerment Zones 

A program of the U.S. Department of Housing and Urban 

Development (HUD) and the U.S. Department of Agriculture 

(USDA) to bring together public and private partnerships to 

attract the investment necessary in distressed communities for 

sustainable and community development. 

Existing Development 

Describes an existing lot/parcel with a significant amount of 

impervious surfaces from prior development, or is significantly 

degraded and is covered with sand, gravel, stones, or other 

non-vegetative covering, or is considered a “brownfield site”. 

Filter Strip / Vegetated 

Buffer 

Vegetated surfaces used to reduce stormwater velocity from 

nearby less pervious surfaces, and to filter out pollutants from 

stormwater and allow infiltration into the underlying soil. Also 

referred to as “riparian buffer” if established around streams, 

lakes, and/or wetlands. 

MS4 Questionnaire Page 8 of 47 
Survey ID: ________________ OMB Control No. 20XX-XXXX 

 Approval expires XX/XX/XX

Term Definition 

Flood event 

Describes an overflow of stormwater from a storm sewer 

system during peak flow conditions as a result of a storm 

event. 

Full Time Equivalent 

(FTE) 

The number of full-time employees that could have been 

employed if the reported number of hours worked by part-time 

employees had been worked by full-time employees. This 

statistic is calculated separately for each function of a 

government by dividing the “part- time hours paid” by the 

standard number of hours for full-time employees in the 

particular government and then adding the resulting quotient to 

the number of full-time employees. 

Green Roof 

A vegetative system installed on top of and in addition to the 

traditional roof system. A green roof includes engineered soil 

layers (e.g., a waterproof membrane, drainage, high inorganic 

growing media), and appropriate plant species. Green roofs 

reduce surface discharge from the rooftop by absorbing 

stormwater and slowing stormwater flow rates, and provide 

ancillary benefits such as summer cooling, lowered urban heat 

island effect, and improved air quality. 

Green Infrastructure 

Wet weather management approaches and technologies that 

infiltrate, evapotranspire, capture and reuse stormwater to 

maintain or restore natural hydrology. 

Impervious Area 

The total area of a parcel or right-of-way that consists of 

buildings and associated constructed facilities; areas that are 

covered with a low-permeability material such as asphalt or 

concrete; or areas such as gravel roads and unpaved parking 

areas that are compacted through design or use to reduce their 

permeability. Common impervious areas include, but are not 

limited to, roads, rooftops, walkways, patios, driveways, 

parking lots or storage areas, concrete or asphalt paving, 

packed earthen materials, and macadam or other surfaces 

which similarly impede the natural infiltration of storm water. 

Industrial Facility 

A facility engaged in any of the industrial activities 

specifically listed in 40 CFR 122.26(b)(14) or has been 

designated as causing a water quality standard exceedance or is 

a significant contributor of pollutants to waters of the U.S. 

under 40 CFR 122.26(a)(1)(v). 

Infill Development 

Describes development activity that occurs on a generally 

undeveloped lot/parcel that is situated in an area in which most 

lots/parcels have already been developed. 

Infiltration Basins and 

Trenches/Dry Well 

A shallow rock-filled trench or depression with no outlet 

intended to detain and then infiltrate stormwater into the 

underlying soil. Typically stormwater first passes through a 

swale or other stormwater control before reaching this device. 

MS4 Questionnaire Page 9 of 47 
Survey ID: ________________ OMB Control No. 20XX-XXXX 

 Approval expires XX/XX/XX

Term Definition 

Linear Development 

Development that results from the installation, placement, or 

assembly of linear structures, such as highways, bridges, or 

other transportation-related structures; oil or gas pipelines; 

wastewater and stormwater sewers, pipes, or other 

conveyances; or similar structures. 

Long Term (Post 

Construction) 

Stormwater Controls 

See Post Construction 

Low Impact 

Development (LID) 

Development that is designed to be hydrologically functional 

by mimicking pre-development hydrology conditions. This is 

achieved by using design techniques that infiltrate, filter, 

evaporate, and store discharge close to its source. 

Media Filters 

Filters that stormwater passes through for removal of solids. 

Filters can be made out of sand, peat, foam, crushed glass, 

textile, or other suitable material. 

Mixed Use 

Development 

Development that includes a combination of residential, 

commercial, industrial, office, institutional, or other land uses. 

Municipal Separate 

Storm Sewer System 

(MS4) 

A conveyance or system of conveyances (including roads with 

drainage systems, municipal streets, catch basins, curbs, 

gutters, ditches, man-made channels, or storm drains) that is 

owned by a state, city, town, village, or other public entity 

having jurisdiction over disposal of sewage, industrial wastes, 

stormwater, or other wastes, including special districts under 

state law such as a sewer district, flood control district or 

drainage district, or similar entity, or an Indian tribe or an 

authorized Indian tribal organization, or a designated and 

approved management agency under section 208 of the CWA 

that discharges to waters of the U.S., which is not a combined 

sewer, and which is not part of a Publicly Owned Treatment 

Works (sewage treatment plant). 

MS4 Service Area Area over which an MS4 operator has jurisdiction to collect 

and dispose of stormwater. 

New Development 

Development that occurs on land where generally no or 

minimal structures and other impervious surfaces, such as 

buildings, parking lots, and roads exist and includes 

agricultural, forested and open/barren land. These sites are 

commonly referred to as greenfield sites. 

NPDES 

EPA’s or a State’s “National Pollutant Discharge Elimination 

System” program for issuing, modifying, revoking and 

reissuing, terminating, monitoring and enforcing permits under 

the authority of the Clean Water Act. 

MS4 Questionnaire Page 10 of 47 
Survey ID: ________________ OMB Control No. 20XX-XXXX 

 Approval expires XX/XX/XX

Term Definition 

Outfall 

Describes the place where a point source, as defined by 40 

CFR 122.2, discharges stormwater to waters of the U.S. The 

term “outfall” does not include open conveyances connecting 

two MS4s, or pipes, tunnels or other conveyances which 

connect segments of the same stream or other waters of the 

U.S. and are used to convey waters of the U.S. 

Phase I MS4 

A “large” (population of 250,000 or more) or “medium” 

(population of 100,000 or more) sized MS4, as defined in 40 

CFR 122.26(b)(4) and (7), required to obtain an EPA or State 

NPDES permit. 

Phase II MS4 

A “small” MS4, defined by 40 CFR 122.26(b)(16), not defined 

as “large” or “medium”, that is located in an urbanized area as 

determined by the latest Decennial Census by the Bureau of 

the Census, and therefore required to obtain an EPA or State 

NPDES permit. Small MS4s include non-traditional systems, 

for example: universities and systems maintained by 

transportation authorities such as a state’s department of 

transportation. 

Permeable Pavement 

Pavement composed of a permeable pavement material, which 

allows distributed infiltration into the underlying soil. There 

may also be an underlying stone reservoir that temporarily 

stores the surface discharge before it infiltrates into the 

underlying soil. Examples include pervious concrete, porous 

asphalt, permeable pavers. 

Post Construction 

Describes the phase of development immediately following the 

termination of construction activities on a site. “Postconstruction discharges” are discharges of stormwater from 

developed sites. Post-construction controls are those 

stormwater controls that are installed and maintained to 

permanently manage stormwater discharged from the 

developed sites. 

Public Entity 

A public agency or body of a state, city, town, village or other 

municipal entity. Includes special districts under state law 

such as a sewer district, flood control district or drainage 

district, or similar entity, or an Indian tribe or an authorized 

Indian tribal organization, or a designated and approved 

management agency. 

Private Entity A non-public body or institution, such as a private university. 

Redevelopment 

Development at a site with existing structures or impervious 

surfaces. Redevelopment does not include projects that are 

solely remodeling or alterations to the interior of a structure. 

MS4 Questionnaire Page 11 of 47 
Survey ID: ________________ OMB Control No. 20XX-XXXX 

 Approval expires XX/XX/XX

Term Definition 

Retention Practices 

Stormwater techniques that manage stormwater on-site through 

infiltration, evapotranspiration, or harvesting. Commonly 

referred to as Low Impact Development or Green 

Infrastructure practices. 

Retrofit 

The installation or modification of stormwater control 

measures on sites with existing development (including 

existing storm sewers) to enhance the reduction of stormwater 

pollutants, or discharge volume or flow rates. 

Riparian Buffer 

An area surrounding a shoreline, wetland, or stream within 

which development is restricted or prohibited. The primary 

function of aquatic buffers is to physically protect and separate 

a stream, lake, or wetland from future disturbance or 

encroachment. These areas are also called “resource 

protection areas.” 

Site plan review 

A procedure used by MS4s and other entities for conducting a 

review of development site plans for conformance with 

stormwater control requirements, such as sediment and erosion 

controls, and post-construction controls. 

Soil Amendments 

Material(s) added to the soil to enhance one or more of its 

attributes in order to improve the control of stormwater (e.g., 

drainage, water retention). 

State-defined source 

water protection area 

for public water 

supplies 

The area delineated by the state for a public water system or 

including numerous public water systems, whether the source 

is ground water or surface water or both, as part of the state 

Source Water Assessment Program approved by EPA under 

section 1453 of the Safe Drinking Water Act. For ground 

water sources of drinking water, this is the surface and 

subsurface area surrounding a well or well field, supplying a 

public water system, through which contaminants are 

reasonably likely to move toward and reach such water well or 

well field. For surface water sources of drinking water, it is the 

topographic boundary, up to the state’s border, that is the 

perimeter of the catchment basin that provides water to the 

intake structure of a public water system. 

Storm Sewer System 

A conveyance or system of conveyances, including roads with 

drainage systems, municipal streets, catch basins, curbs, 

gutters, ditches, manmade channels, or storm drains designed 

or used for collecting or conveying stormwater. 

Stormwater Runoff, snow melt runoff, and surface runoff and drainage. 

Stormwater Control Practices that are installed and maintained to control 

stormwater discharges. 

Stormwater Quality 

Control 

Stormwater control used to reduce or eliminate pollutants 

carried in stormwater discharges. 

Stormwater Quantity 

Control 

Stormwater control used to control or convey the volume of 

water being discharged during storm conditions. 

MS4 Questionnaire Page 12 of 47 
Survey ID: ________________ OMB Control No. 20XX-XXXX 

 Approval expires XX/XX/XX

Term Definition 

Subsurface fluid 

distribution system 

An assemblage of perforated pipes, drain tiles, or other similar 

mechanisms intended to distribute fluids below the surface of 

the ground. This could include a seepage pit, infiltration 

trench, or commercially manufactured stormwater infiltration 

device if it has a subsurface fluid distribution system. 

Swales: Grassed 

A broad, shallow channel used for conveying and management 

stormwater discharge. Grass on the side slopes and bottom acts 

to slow discharge velocity, trap particulates, and promote 

infiltration. Grassed swales are often referred to as bio-swales, 

enhanced swales, or water quality swales and can be classified 

as wet swales, dry swales, and grassed channels. See Swales: 

Other Vegetation. 

Swales: Other 

vegetation 

A broad, shallow channel used for conveying stormwater 

discharge. Vegetation on the side slopes and bottom acts to 

slow discharge velocity, trap particulates, and promote 

infiltration. Vegetated swales are often referred to as bioswales, enhanced swales, or water quality swales and can be 

classified as wet swales, dry swales, and grassed channels. 

A dry swale (bio-swale) incorporates additional elements with 

the vegetated swale design. Infiltration is aided by a soil bed 

(not necessarily natural soil) with an underdrain system 

composed of a perforated pipe surrounded by gravel. Check 

dams may be used to temporarily retain stormwater discharge. 

A wet swale is capable of temporarily retaining stormwater 

discharge, but, unlike the dry swale, lacks an underdrain 

system. The wet swale is marshlike and relies on and supports 

wetland vegetation 

Tree Box 

Stormwater controls that direct stormwater discharges to a 

treebox, where it can be filtered by the soil and vegetation. 

Some tree boxes may drain to a channel below, which conveys 

stormwater to the selected collection system. 

Underground Detention 

Underground vaults, storage cells, or water piping systems 

used for stormwater flow rate and volume control. This is an 

alternative to storage above ground (e.g., pond). 

Undeveloped Describes land that has not been subject to prior development. 

See “new development.” 

Urbanized Area 

A land area comprising one or more places — central place(s) 

— and the adjacent densely settled surrounding area — urban 

fringe — that together have a residential population of at least 

50,000 and an overall population density of at least 1,000 

people per square mile. Any MS4 located within a 2000 

Census-defined “urbanized area” is required to obtain an 

NPDES permit for discharges from its storm sewer system. 

Water of the U.S. / 

Water of the State Defined at 40 CFR 122.2. 

MS4 Questionnaire Page 13 of 47 
Survey ID: ________________ OMB Control No. 20XX-XXXX 

 Approval expires XX/XX/XX

Term Definition 

Wetland Basin 

(Permanent Pool and 

No Permanent Pool) 

Similar to wet and dry ponds, stormwater control structure that 

incorporates wetland plants. Storm discharge is directed into 

the basin to control both water quality and quantity. Basin 

outlets are designed to detain and treat the stormwater 

discharge: 1) for a minimum duration (e.g., 24 hours) for no 

permanent pool and 2) until the water is displaced by discharge 

from a later storm (permanent pool). 

MS4 Questionnaire Page 14 of 47 
Survey ID: ________________ OMB Control No. 20XX-XXXX 

 Approval expires XX/XX/XX

Section A: Technical Information 

A-1 Fill in the following identifying and contact information 

 ______________________________________________________ 

 Your Name and Title: 

 

 ______________________________________________________ 

 Address: 

 

 ______________________________________________________ 

 Phone Number: 

 ______________________________________________________ 

 Email Address: 

 

 ______________________________________________________ 

 Best Time to Contact: 

 

 ______________________________________________________ 

A-2 MS4 Owner and Operator Department/Agency 

 

 ______________________________________________________ 

 

A-3 Is the MS4 owner/operator: 

 □ City 

 □ Township 

 □ Town 

 □ Village 

 □ County 

 □ Borough 

 □ Municipal Utility District 

 □ Drainage district 

 □ Sewer district 

 □ Irrigation district 

 □ Flood control district 

 □ Watershed district 

 □ Other, Specify: ____________________________________________ 

 

MS4 Questionnaire Page 15 of 47 
Survey ID: ________________ OMB Control No. 20XX-XXXX 

 Approval expires XX/XX/XX

A-4 Which best describes your MS4 permit? 

Individual Permit:

□ Under a Large/Medium MS4 permit (Phase I) 

Specify any co-permittees: ____________________________________________ 

□ Under a Small MS4 permit (Phase II) 

Specify any co-permittees: ____________________________________________ 

General Permit:

□ Under a Large/Medium MS4 permit (Phase I) 

Specify any co-permittees if this permit is not statewide:____________________ 

□ Under a Small MS4 permit (Phase II) 

Specify any co-permittees if this permit is not statewide:____________________ 

A- 5 How many permits terms have you completed under the stormwater program 

(usually MS4 permits are issued every 5 years, however some permits may have 

continued after they expired) 

□ None, we have not yet completed our first permit term 

□ 1 permit term – we are currently covered under our second MS4 permit 

□ 2 permit terms– we are currently covered under our third MS4 permit 

□ 3 permit terms– we are currently covered under our forth MS4 permit 

□ 4 or more permit terms– we are currently covered under our fifth or more 

 permit 

A-6 In addition to your MS4, how else is stormwater conveyed in your jurisdiction? 

 Check all that apply. 

□ There is more than one permitted MS4 in my jurisdiction 

□ Separate storm sewer that is not permitted 

□ Combined sewer system 

□ De-centralized storm sewer system (i.e. unpiped/on-site practices, discharges 

directly to a stream, swales, natural conveyances such as ditches or gullies, 

ephemeral drainages) 

□ Other, specify ____________________________________ 

□ None, only my MS4 

MS4 Questionnaire Page 16 of 47 
Survey ID: ________________ OMB Control No. 20XX-XXXX 

 Approval expires XX/XX/XX

Extent of Coverage

EPA is obtaining information about the extent that your MS4 is covered by an NPDES 

permit. Under the Phase II stormwater regulations, small MS4s located within a Censusdefined urbanized area are required to be regulated. Some permitting authorities, 

however, have extended permit coverage beyond the urbanized area to cover the entire 

jurisdiction if only part of an MS4 was located within an urbanized area. In addition, 

permitting authorities have extended coverage to other small MS4s outside of the 

urbanized area. The following questions are focused on determining the extent to which 

your MS4 is regulated under an NPDES permit. The questions collect information about 

three areas: 

 1. MS4 permitted area – portion of your jurisdiction that drains to your MS4 (for 

 which you are the owner or operator) and is the area covered by Phase I/II MS4 

 permit (for example, this could be only the urbanized area portion of your 

 jurisdiction) 

 2. MS4 service area – portion of your jurisdiction that drains to your MS4 (for 

 which you are the owner or operator). This area may extend beyond the 

 permitted area. 

 3. Jurisdictional area – political boundaries of your jurisdiction 

A-7 Which of the following best describes the basis for how stormwater discharges 

from your MS4 are permitted? 

□ Based on the urbanized area boundary (as defined by the U.S. Census) 

□ Based on my jurisdictional boundary (city, town, county, etc) 

□ Based on sewer, irrigation, drainage, flood control district 

□ Based on watershed boundaries 

□ Based on watershed districts (or other watershed entity) 

□ Other, Specify: __________________________________________________ 

A-8 Does your stormwater permit cover discharges beyond the Census-defined 

 urbanized area? 

□ Yes 

□ No 

A-9 What are the population, total area, and estimated percent impervious area of both 

the permitted MS4 area and the entire jurisdiction as of 2009. Provide your best 

estimate. 

□ My jurisdictional boundary falls entirely within an urbanized area (in this case 

fill out only the “entire jurisdiction” column). 

Permitted MS4 Area Entire Jurisdiction 

Population 

Population density 

Total Area 

Estimated % Impervious 

Area 

MS4 Questionnaire Page 17 of 47 
Survey ID: ________________ OMB Control No. 20XX-XXXX 

 Approval expires XX/XX/XX

A-10 If your permitted MS4 area is less than the jurisdictional boundary, which of 

 these MS4 stormwater program activities apply to your entire jurisdiction? 

□ Public education and outreach 

□ Public involvement 

□ Illicit discharge and Elimination 

□ Pollution Prevention/Good Housekeeping (includes street sweeping) 

□ Record keeping 

□ Erosion and Sediment Controls for Construction Activities 

□ Post Construction stormwater requirements for new and redevelopment 

□ Industrial stormwater inspections 

□ Stormwater monitoring 

□ Other controls, Specify: ___________________________________ 

□ None 

□ Not Applicable 

A-11 In your MS4 service area, are there public and/or private entities that are not 

connected to (or do not discharge to) the MS4 but discharge to a private system or 

directly to a water of the U.S or water of the state? (Do not include discharges to 

combined sewer system) 

□ Yes 

□ No (skip to A-13) 

□ Unknown (skip to A-13) 

 

A-12 What is the estimated number of acres, number of parcels, or percentage of land 

area of your MS4 service area from which stormwater discharges are not 

connected to (or do not discharge to) the MS4 but discharge to a private system or 

directly to a water of the U.S or water of the state? What is the population density 

and the primary type(s) of development of estimated area that does not discharge 

to the MS4? 

 (Do not include discharges to combined sewer system) 

 __________ acres in MS4 service area 

 __________ parcels in MS4 service area 

□ 0-20% of total MS4 service area 

□ 21-40% of total MS4 service area 

□ 41-60% of total MS4 service area 

□ 61-80% of total MS4 service area 

□ 81-100% of total MS4 service area 

□ Unknown 

 __________ population density in MS4 service area 

 __________ type(s) of development 

 Which of the following activities apply to those discharges to a private system or 

 directly to a receiving waterbody with your MS4? 

MS4 Questionnaire Page 18 of 47 
Survey ID: ________________ OMB Control No. 20XX-XXXX 

 Approval expires XX/XX/XX

□ MS4 regulates these discharges through local ordinance or other regulatory 

 mechanism 

□ MS4 review site plans for these developments 

□ MS4 review building permits for these developments 

□ Other, describe________________ 

□ MS4 does not regulate these entities 

Specific Stormwater Program Components 

The following section collects information on the activities that you are currently doing 

as part of your stormwater program. 

A-13 Do you have data or other information to show the effectiveness of any of the 

 following components of your stormwater program to protect waterbodies from 

 stormwater impacts? Check all that apply. 

__ Public Education and Outreach 

__ Public Participation/Involvement 

__ Illicit Discharge Detection and Elimination 

__ Construction Site discharge control (including erosion/sediment control) 

__ Post Construction discharge control (including detention, retention and 

 treatment) practices 

__ Pollution Prevention/Good Housekeeping (including street sweeping) 

__ Industrial Inspections 

__ Wet weather outfall monitoring 

__ Monitoring to measure the performance of specific stormwater controls 

__ Instream monitoring 

 __ Implementation of watershed management plans 

 __ MS4 training programs 

 __ Source control (limits on fertilizer or pesticides) 

 __ Other, describe___________________________ 

A-14 What parts of your stormwater management program are carried out by other 

 departments or other governmental agencies (for example a county may 

 implement a public education program for a city)? 

  Public education and outreach 

  Public involvement 

  Illicit discharge detection and elimination 

  Pollution prevention/good housekeeping 

  Construction stormwater program 

  Post construction stormwater program 

  Record keeping/ annual reporting 

  Other, describe_____________ 

  None (skip to A-16) 

A- 15 Does your agency have oversight over those departments or governmental 

 agency’s stormwater management activities? 

MS4 Questionnaire Page 19 of 47 
Survey ID: ________________ OMB Control No. 20XX-XXXX 

 Approval expires XX/XX/XX

  Yes 

  No 

  Not all activities 

  Not applicable 

A-16 Which of the following activities have been part of the public education and 

 outreach component of your stormwater program from 2005 - 2009? (Check all 

 that apply.) 

 Brochures, fact sheets, guides, or similar documents 

 Radio features 

 Television advertisements 

 Educational programs (for the general public, school children, teachers, etc.) 

 Event participation (conference participation, earth day events, fairs, etc.) 

 Staff training 

 Contractor training 

 Storm drain stenciling 

 Stormwater hotlines 

 Tributary signage 

 Website 

 Car washing public program 

  Other, describe_____________ 

 None 

A-17 Which of the following activities have been part of the public involvement 

component of your stormwater program from 2005 - 2009? (Check all that apply.) 

  Public meetings/citizen panels 

 Volunteer water quality monitoring 

 Volunteer educators/speakers 

 Storm drain stenciling 

 Community clean-ups 

 Citizen watch groups 

 “Adopt A Storm Drain” programs 

  Other, describe_____________ 

 None 

A-18 Which of the following activities have been part of the illicit discharge component 

of your stormwater program from 2005 - 2009? (Check all that apply.) 

 Paper tracking/inventory of outfalls 

 Database tracking/inventory of outfalls 

 Storm sewer system mapping 

 Field staff training (to identify and eliminate illicit discharges) 

 Field/indicator sampling 

 Laboratory analyses 

 Priority area identification (i.e. prioritizing specific areas of your system where 

the probability of illicit discharges may be higher) 

  Public reporting (i.e. hotline for reporting illicit discharges) 

MS4 Questionnaire Page 20 of 47 
Survey ID: ________________ OMB Control No. 20XX-XXXX 

 Approval expires XX/XX/XX

 Other, describe_____________ 

 None 

A-19 Which of the following activities have been part of the pollution prevention/good 

housekeeping component of your stormwater program from 2005 - 2009? (Check 

all that apply.) 

 Inventory of your facilities 

 Facility assessment (to determine the facility’s potential to discharge 

pollutants) 

 Vehicle washing requirements 

 Fueling operations requirements 

 Vehicle maintenance requirements

 De-icing/Anti-icing material storage 

 Facility inspections 

 Storm sewer system maintenance activities (includes inspections and cleaning) 

 Street sweeping activities

 Pesticide/herbicide application and management requirements 

 Fertilizer application and management requirements 

 Field staff training

 Contractor training

  Other, describe_____________ 

 None 

A-20 Which of the following activities has been part of the record keeping component 

of your stormwater program from 2005 - 2009? (Check all that apply.) 

 Spill response 

 Construction inspection 

 Industrial inspection 

 Illicit discharge detection and elimination 

 Annual reporting 

  Other, describe_____________ 

 None 

INDUSTRIAL 

A-21 Which of the following activities have been part of the industrial component of 

your MS4 stormwater program from 2005 - 2009? (Check all that apply.) 

 Inventory of industrial facilities 

 Education of industrial operators about stormwater requirements and/or 

controls 

 Site inspection of industrial facilities 

 Site inspection of commercial facilities 

 Training of inspectors 

  Other, describe_____________ 

 None - There is no industrial component in the MS4 stormwater program 

MS4 Questionnaire Page 21 of 47 
Survey ID: ________________ OMB Control No. 20XX-XXXX 

 Approval expires XX/XX/XX

A-22 What is the number of the industrial facilities in your MS4 that are included in the 

sectors classified for NPDES coverage under 40 CFR 122.26(b)(14)? How many 

of those facilities have you inspected in the last 5 years? 

Inspection of Industrial Facilities, FY 2005-2009

Fiscal year

2005 2006 2007 2008 2009 

Number of 

Industrial 

Sites 

Number of 

Inspections 

□ My MS4 does not track industrial facilities. 

□ My MS4 does not perform industrial site inspections 

CONSTRUCTION PROGRAM 

A- 23 Which of the following activities have been part of the construction component of 

your MS4 stormwater program from 2005 - 2009? Check all that apply. 

 Review site plans 

 Tracking/ inventory of sites

 Inspections 

 Field staff training

 Contractor training

 Other, describe_____________ 

 None 

A-24 What is the size threshold for construction sites for coverage under your state’s 

 stormwater construction general permit? 

 ___________ acres or sq feet 

 How many construction sites (at the size threshold for coverage) have occurred in 

your MS4 in the last 5 years? 

Number of construction sites, FY 2005-2009

Fiscal year

2005 2006 2007 2008 2009 

Number of 

construction 

sites 

□ My MS4 does not track construction sites 

POST CONSTRUCTION 

A-25 Which of the following activities have been part of the post construction 

component of your MS4 stormwater program from 2005 - 2009? Check all that 

apply. 

MS4 Questionnaire Page 22 of 47 
Survey ID: ________________ OMB Control No. 20XX-XXXX 

 Approval expires XX/XX/XX

 Review construction site plans for post construction stormwater water quality 

and/or water quantity requirements 

 Tracking/ inventory of sites

 Tracking/inventory of post-construction practices 

 Inspections of practices

 Maintenance of practices

 Field staff training

 Contractor training

 Other, describe_____________ 

 None 

A-26 For your MS4, what is the minimum size project that requires site plan review for 

stormwater quality and quantity control structures? Indicate the size criteria for 

both new development and redevelopment projects. 

 For new development projects: 

□ 5,000 sq ft 

□ 1⁄2 acre 

□ 1 acre 

□ Other: _______________________________________________________ 

□ Unknown 

□ Not Applicable 

For redevelopment: 

□ The minimum size project that requires site plan review for stormwater control 

structures is identical for redevelopment and new development. 

□ 5,000 sq ft 

□ 1⁄2 acre 

□ 1 acre 

□ Other: _______________________________________________________ 

□ Unknown 

□ Not Applicable 

A-27 For long term (post construction) stormwater controls located on public property 

within your MS4 service area do you track, inspect and/or maintain these 

controls? Check all that apply. 

□ MS4 tracks post construction controls on public property 

□ MS4 inspects post construction controls on public property 

□ MS4 maintains post construction controls on public property

□ Other, describe __________________ 

A-28 For long term (post construction) stormwater controls located on private property 

within your MS4 service area do you track, inspect and/or maintain these 

controls? Check all that apply. 

□ MS4 tracks post construction controls on private property 

□ MS4 inspects post construction controls on private property 

MS4 Questionnaire Page 23 of 47 
Survey ID: ________________ OMB Control No. 20XX-XXXX 

 Approval expires XX/XX/XX

□ MS4 maintains post construction controls on private property

□ Other, describe __________________ 

□ No 

A-29 Does your MS4 have an ordinance or other regulatory mechanism that give you 

authority to inspect and operate and maintain stormwater control practices on 

privately-owned properties? 

□ Yes, MS4 has authority to inspect controls on private property 

□ Yes, MS4 has authority to operate and maintain controls on private property 

□ No, specify specific barriers or local issues prevent you from having such 

authority? ____________________________________________ 

□ Not applicable, Specify: __________________________________________ 

 

A-30 What is your criteria for inspection of long term (post controls) stormwater 

controls (not including inspections of construction sites)? Check all that apply. 

□ Inspect controls only on public property 

□ Inspect only specific types of controls, specify__________________ 

□ Inspect controls on residential property (may include those owned by a 

homeowner association) 

□ Inspect controls on commercial property 

□ Other, describe __________________ 

□ Not applicable 

A-31 For long term (post construction) stormwater controls that drain to your MS4 

service area and are owned by private entities (including homeowners or property 

owner associations, commercial and similar entities), what approximate 

percentage of the private land area in which the controls are maintained by the 

MS4? Provide your best estimate. 

 _____% privately owned, but maintained my MS4 

□ Unknown 

A-32 Do you require private property owners to maintain stormwater controls on their 

 property? 

□ Yes 

□ No, Specify why not: ____________________________________________ 

□ Not applicable, Specify: __________________________________________ 

A-33 What type of private property owners must maintain stormwater controls on their 

 property? Check all that apply. 

□ Private Homeowners 

□ Homeowner Associations 

□ Homebuilders 

□ Commercial entities 

□ Private Institutions 

□ Other, specify: ____________________________________________ 

□ Not applicable 

MS4 Questionnaire Page 24 of 47 
Survey ID: ________________ OMB Control No. 20XX-XXXX 

 Approval expires XX/XX/XX

A-34 Do you have the authority to require private property owners (for example, home 

owner associations) to include stormwater maintenance obligations or rights of 

inspection in recorded covenants, deeds, conditions and restrictions or equivalent 

documents that is binding on privately owned properties? 

□ Yes, describe________________________________ 

□ No 

□ Not applicable, Specify: __________________________________________ 

 

NEW DEVELOPMENT AND REDEVELOPMENT 

A-35 Do you consider the following part of new development or redevelopment? 

Infill projects on existing undeveloped parcels □ New □ Redevelopment □ Neither 

Projects involving the conversion from one □ New □ Redevelopment □ Neither 

land use type to another (e.g. a commercial 

property is converted into townhouses) 

Development extensions that add □ New □ Redevelopment □ Neither 

imperviousness onto previously undeveloped 

land, but are part of the same plot/parcel 

(e.g. a commercial parking lot is extended 

into an adjoining forested area) 

Road widening projects (e.g. adding a lane) □ New □ Redevelopment □ Neither 

Replacement of impervious surfaces (road □ New □ Redevelopment □ Neither 

resurfacing, sidewalk replacement, etc) 

Other, specify ________________________ □ New □ Redevelopment □ Neither 

A-36 How many acres of new development have occurred in the last 5 years in your 

jurisdiction, if readily available? Provide your best estimate. 

Acres of New Development 

Fiscal year 

2005 2006 2007 2008 2009 

Acres of 

new 

development 

A-37 How many acres of redevelopment have occurred in the last 5 years in your 

jurisdiction, if readily available? Provide your best estimate. 

MS4 Questionnaire Page 25 of 47 
Survey ID: ________________ OMB Control No. 20XX-XXXX 

 Approval expires XX/XX/XX

Acres of Redevelopment 

Fiscal year 

2005 2006 2007 2008 2009 

Acres of 

new 

development 

Stormwater Performance Standard or Design Criteria for 

Development 

A-38 Are new development or redevelopment activities in your MS4 subject to a long 

term (post construction) standard that includes either numeric or specific 

stormwater performance standards or design criteria for stormwater control? 

□ Yes 

□ No (skip to A-50) 

A-39 Who determined your MS4’s stormwater performance standard or design criteria 

for long term (post construction) controls for new or redevelopment activities? 

Check all that apply. 

□ The State enacted these requirements that are implemented through the MS4 

 permit 

□ The State enacted these requirements that are implemented through the state 

 construction stormwater permit 

□ The County enacted these regulations that the MS4 is required to implement 

□ It is imposed by our local government 

□ Other, describe__________________________________________ 

A-40 Is your long term (post construction) standard for redevelopment projects 

different than for new development projects? 

□ Yes (Answer questions A-41 – A-43 regarding your standard for new 

 development, answer questions A-44 – A-46 regarding your standard for 

 redevelopment) 

□ No (Answer question A-41 – A43 regarding your standard for development, 

 skip A44- A46) 

Stormwater Performance Standard or Design Criteria for (New) 

Development Projects 

A-41 For new development projects, what is the threshold to which the long term (post 

construction) stormwater performance standards or design criteria apply? 

 

 Size of site 

□ 1⁄2 acre 

□ 1 acre 

MS4 Questionnaire Page 26 of 47 
Survey ID: ________________ OMB Control No. 20XX-XXXX 

 Approval expires XX/XX/XX

□ 5,000 sq ft 

□ Other: ____________________ 

 Other threshold 

□ ____quality of impervious surface 

□ Other: ____________________ 

A-42 Indicate which specific or numeric stormwater performance standards or design 

criteria requirements apply to new development projects. Provide your standard 

in the “specify” blank. Check all that apply. 

 Attach copies and/or citations for the relevant standards and criteria (such as a 

copy of your municipal stormwater design requirements or a citation to the state 

law or a web page link to the design manual that contains the information). 

 Note: The options for standards that require detention or extended detention are 

 those which hold stormwater temporarily and discharge the stormwater over 

 an extended period of time (hours to days) generally by controlling the size of the 

 discharge volume and flow rate. The options for standards that require retention 

 are those that do not discharge stormwater off-site or to surface water below a 

 certain design capacity (design volume, stormwater size, etc.). The stormwater is 

 infiltrated, evapotranspired, or harvested. 

□ Post-development peak runoff/discharge rate must match pre-development peak 

runoff/discharge rate for a specified storm return interval or intervals 

□ 1 year storm □ 25 year storm 

□ 2 year storm □ 100 year storm 

□ 5 year storm □ Other (Specify) __________ 

□ 10 year storm 

□ Detention of a specified storm depth or volume (such as 0.5 inch per acre or 1 

inch per impervious acre) 

 (Specify) __________ 

□ Detention of a specified storm volume (such as 1,800 cubic feet per acre or 

3,600 cubic feet per impervious acre) 

 (Specify) __________ 

□ Detention of a specified percentile storm event (such as the 80th percentile 

storm) 

 (Specify) __________ 

□ Retention of a specified storm depth or volume (such as 0.5 inch per acre or 1 

inch per impervious acre) 

 (Specify) __________ 

MS4 Questionnaire Page 27 of 47 
Survey ID: ________________ OMB Control No. 20XX-XXXX 

 Approval expires XX/XX/XX

□ Retention of a specified storm volume (such as 1,800 cubic feet per acre or 

3,600 cubic feet per impervious acre) 

 (Specify) __________ 

□ Retention of a specified percentile storm event (such as the 80th percentile 

storm) 

 (Specify) __________ 

□ Pollutant reduction requirement (for example, stormwater control practices 

must be installed to remove 80% of the post-construction TSS loading and 40% of 

the post-construction nitrogen loading) 

Specify: ____________ 

□ Channel protection measures (such as a maximum allowable discharge velocity 

or other metric) 

Specify: ____________ 

□ Infiltration/groundwater recharge requirement (for example, maintain 

predevelopment groundwater recharge levels or infiltrate the first 0.5 inch of 

runoff) 

Specify: ____________ 

□ Limits for effluent concentrations of specific pollutants measured at the 

 stormwater control 

Specify: ____________ 

□ Limits for effluent concentrations of specific pollutants in receiving waters 

Specify: ____________ 

□ Requirements for control of temperature 

Specify: ____________ 

Does this standard apply to all areas within your jurisdiction, or only to 

certain sites or waterbodies? 

□ All areas 

□ Only certain areas (Specify: ____________) 

 

□ Flood control requirements other than the peak discharge rate control and onsite detention/retention requirements specified above. 

Specify: ____________ 

□ Stream buffer requirements (for example, a 50 foot vegetated buffer must be 

maintained/implemented adjacent to waters of the state) 

Specify: ____________ 

 

MS4 Questionnaire Page 28 of 47 
Survey ID: ________________ OMB Control No. 20XX-XXXX 

 Approval expires XX/XX/XX

□ Limits on the maximum percent imperviousness for the site, or maximum 

 directly connected impervious surface or other limits on impervious surfaces. 

Specify: ____________ 

□ Other Standards Not Identified Above, Specify: ___________________ 

A-43 Which type of new development do your stormwater performance or design 

standards (as described in Question A-55) apply? Check all that apply. 

□ Requirements are the same for all types of new development 

□ Residential 

□ Commercial 

□ Industrial 

□ Institutional 

□ Mixed use 

□ Other, Specify: __________ 

Stormwater Performance Standards or Design Criteria for 

Redevelopment Projects 

A-44 For redevelopment projects, what is the threshold to which the long term (post 

construction) stormwater performance standards or design criteria apply? 

 

 Size of site 

□ 1⁄2 acre 

□ 1 acre 

□ 5,000 sq ft 

□ Other: ____________________ 

 Other threshold 

□ ____quality of impervious surface 

□ Other: ____________________ 

A-45 Indicate which specific or numeric stormwater performance standards or design 

criteria requirements apply to redevelopment projects. Provide your standard in 

the “specify” blank. Check all that apply. 

 Attach copies and/or citations for the relevant standards and criteria (such as a 

copy of your municipal stormwater design requirements or a citation to the state 

law or a web page link to the design manual that contains the information). 

□ Post-development peak runoff/discharge rate must match pre-development peak 

runoff/discharge rate for a specified storm return interval or intervals 

□ 1 year storm □ 25 year storm 

□ 2 year storm □ 100 year storm 

□ 5 year storm □ Other (Specify) __________ 

□ 10 year storm 

MS4 Questionnaire Page 29 of 47 
Survey ID: ________________ OMB Control No. 20XX-XXXX 

 Approval expires XX/XX/XX

□ Detention of a specified storm depth or volume (such as 0.5 inch per acre or 1 

inch per impervious acre) 

 (Specify) __________ 

□ Detention of a specified storm volume (such as 1,800 cubic feet per acre or 

3,600 cubic feet per impervious acre) 

 (Specify) __________ 

□ Detention of a specified percentile storm event (such as the 80th percentile 

storm) 

 (Specify) __________ 

□ Retention of a specified storm depth or volume (such as 0.5 inch per acre or 1 

inch per impervious acre) 

 (Specify) __________ 

□ Retention of a specified storm volume (such as 1,800 cubic feet per acre or 

3,600 cubic feet per impervious acre) 

 (Specify) __________ 

□ Retention of a specified percentile storm event (such as the 80th percentile 

storm) 

 (Specify) __________ 

□ Pollutant reduction requirement (for example, stormwater control practices 

must be installed to remove 80% of the post-construction TSS loading and 40% of 

the post-construction nitrogen loading) 

Specify: ____________ 

□ Channel protection measures (such as a maximum allowable discharge velocity 

or other metric) 

Specify: ____________ 

□ Infiltration/groundwater recharge requirement (for example, maintain 

predevelopment groundwater recharge levels or infiltrate the first 0.5 inch of 

runoff) 

Specify: ____________ 

□ Limits for effluent concentrations of specific pollutants measured at the 

 stormwater control 

Specify: ____________ 

□ Limits for effluent concentrations of specific pollutants in receiving waters 

Specify: ____________ 

MS4 Questionnaire Page 30 of 47 
Survey ID: ________________ OMB Control No. 20XX-XXXX 

 Approval expires XX/XX/XX

□ Requirements for control of temperature 

Specify: ____________ 

Does this standard apply to all areas within your jurisdiction, or only to 

certain sites or waterbodies? 

□ All areas 

□ Only certain areas (Specify: ____________) 

 

□ Flood control requirements other than the peak discharge rate control and onsite detention/retention requirements specified above. 

Specify: ____________ 

□ Stream buffer requirements (for example, a 50 foot vegetated buffer must be 

maintained/implemented adjacent to waters of the state) 

Specify: ____________ 

 

□ Limits on the maximum percent imperviousness for the site, or maximum 

 directly connected impervious surface or other limits on impervious surfaces. 

Specify: ____________ 

□ Other Standards Not Identified Above, Specify: ___________________ 

A-46 To which type of redevelopment does your stormwater performance and/or design 

standards (described in Question A-45) apply? 

□ Requirements are the same for all types of redevelopment 

□ Residential 

□ Commercial 

□ Industrial 

□ Institutional 

□ Mixed use 

□ Other, describe __________ 

Follow-up questions for post construction standard for new or redevelopment. 

A-47 To comply with the performance standard or design criteria specified in Question 

A-42 or A-45, is the use of specific stormwater controls measures, or choosing 

from a menu of such controls, a requirement? 

□ Yes, specific controls are specified to meet the standard 

□ Yes, choosing specific controls from a menu is specified to meet the standard 

□ No, there are no specific controls required to meet the standard 

□ There is no post construction standard in my MS4 

A-48 What is the enforcement mechanism to assure that post construction program 

requirements are met? 

□ Site inspection 

□ Site plan review/approval acceptance 

□ Review self-reporting/ self-certification database 

MS4 Questionnaire Page 31 of 47 
Survey ID: ________________ OMB Control No. 20XX-XXXX 

 Approval expires XX/XX/XX

□ Other, describe____________________ 

□ There is no post construction standard in my MS4 

A-49 Do you offer an alternative to compliance with your performance standard or 

design standard for new or redevelopment? 

□ Yes, it is a stormwater mitigation program, describe __________ 

□ Yes, it is a payment in lieu program 

□ Yes, there is another type of alternative compliance program

 describe___________ 

□ No, but there is an alternative compliance program offer by another level of 

government (state, county, etc), Specify: ______________________________ 

□ No, an alternative compliance program does not exist

□ There are no post construction standards applied to my MS4

Retrofit of Stormwater Management Practices 

The following questions collect information about retrofit practices in your MS4. Retrofit 

is the installation or modification of structural control measures on sites with existing 

development (including existing storm sewers) to enhance the reduction of stormwater 

pollutants, or runoff volume or flow rates. 

A-50 Does your MS4 have a stormwater retrofit program? 

□ Yes 

□ No (skip to A-57) 

A-51 What are the components of your retrofit program? Check all that apply. 

□ We require retrofits through regulation (local ordinance or other legal 

 mechanism) 

□ We provide incentives for retrofits 

□ We initiate retrofits on public property 

□ We initiate retrofits on private property 

□ Stream restoration is part of our retrofit plan 

□ Other, describe _______________ 

A-52 Who is responsible for paying for the retrofit projects? Check all that apply. 

□ We pay for all retrofits on public and private property 

□ We pay for retrofits only on public property 

□ Private entities are required to pay for retrofits on their property 

□ Other, describe _______________ 

□ Not applicable 

A-53 What is the purpose of the stormwater retrofit program in your MS4? Check all 

that apply. 

□ To comply with stormwater permit requirements 

□ To comply with CSO long term control plan 

□ To address flood control 

MS4 Questionnaire Page 32 of 47 
Survey ID: ________________ OMB Control No. 20XX-XXXX 

 Approval expires XX/XX/XX

□ To address wetlands mitigation 

□ To comply with Total maximum daily load (TMDL) or other water quality 

 requirement(s) 

□ Other requirements, such as state requirements, describe_______ 

□ Not to meet a requirement listed above, but to address watershed plan or 

 local water quality, habitat or stream stability or geomorphology concerns 

□ Other: ________________________________________ 

□ Not applicable 

 A-54 What, if any, incentives are provided for stormwater retrofits? 

□ Reduced stormwater utility fees. 

Specify: __________________________________________________________ 

□ Development Incentives: (e.g. zoning upgrades, expedited permitting, reduced 

 stormwater requirements, increases in floor area ratios, etc): 

Specify: __________________________________________________________ 

□ Grants: Provide direct funding to property owners and/or community groups for 

 implementing a range of green infrastructure projects and practices. 

Specify: __________________________________________________________ 

□ Rebates & Installation Financing: (e.g. provide funding, tax credits or 

 reimbursements to property owners who install specific practices) 

Specify: __________________________________________________________ 

□ Awards & Recognition Programs (e.g. provide marketing opportunities and 

 public outreach for exemplary projects) 

Specify: __________________________________________________________ 

□ Other: ______________________________________________________ 

□ None 

□ Not Applicable 

A-55 Provide a description of your retrofit program.

__________________________________________________________________

__________________________________________________________________

__________________________________________________________________

__________________________________________________________________ 

A-56 What kind of retrofit projects could make the most effective difference in terms of 

restoring water quality in your area?

 ________________________________________________________________________

 ________________________________________________________________________

 ________________________________________________________________________

 ________________________________________

MS4 Questionnaire Page 33 of 47 
Survey ID: ________________ OMB Control No. 20XX-XXXX 

 Approval expires XX/XX/XX

SPECIFIC STORMWATER CONTROLS 

In this section EPA is obtaining information about specific stormwater practices that exist 

in your MS4 including both detention and retention practices. 

Detention or extended detention practices are those which hold stormwater temporarily 

and discharge the stormwater over an extended period of time (hours to days) generally 

by controlling the size of the discharge volume and flow rate. Also known as wet/dry 

ponds, extended detention basins, detention ponds, extended detention ponds. 

Questions in this section also refer to the implementation of retention stormwater 

practices. These are practices that do not discharge stormwater off-site or to surface water 

below a certain design capacity (design volume, stormwater size, etc.). The stormwater is 

infiltrated, evapotranspired, or harvested. Examples are bioretention cells (includes rain 

gardens, sidewalk planters, curb extensions and other plant or soil systems designed to 

infiltrate or evapotranspirate stormwater), porous pavement, green roofs, vegetated 

swales, cisterns and other practices. These practices are commonly referred to as Low 

Impact Development (LID) or Green Infrastructure (GI) practices. 

A-57 (a) Which of the following stormwater controls are installed within your MS4 

(includes those controls located on both public and private property)? 

 (b) Which stormwater controls in the MS4 responsible for maintaining (at any 

level of service)? 

 (c) For which practices do you have available cost information, including both 

capital cost and operation and maintenance cost? 

 (d) For which stormwater controls do you have performance data? 

(Note: An EPA representative may contact you at a later date in order to get more 

detailed information about this cost and performance data.) 

 (a) (b) (c) (d) 

 Available Performance 

 Installed/ Maintain Cost Data 

 applied Information 

Extended Detention Basin (wet or dry) □ □ □ □

Curb and Gutter/Storm Sewer □ □ □ □

Catch Basins □ □ □ □ 

Catch Basin Insert □ □ □ □

Underground Detention □ □ □ □

Underground Infiltration □ □ □ □

Infiltration Trench □ □ □ □

Dry well □ □ □ □

Sand filters □ □ □ □

Oil/water separators □ □ □ □

Vegetated Swale □ □ □ □ 

Constructed Wetland □ □ □ □

MS4 Questionnaire Page 34 of 47 
Survey ID: ________________ OMB Control No. 20XX-XXXX 

 Approval expires XX/XX/XX

Filter Strip/Vegetated Buffer □ □ □ □

Wetland Basin/Channel □ □ □ □

Bioretention cells □ □ □ □

(includes raingardens, sidewalk 

planters, curb extensions and other 

plant or soil systems designed to 

infiltrate or evapotranspirate stormwater) 

Trees/Tree Box □ □ □ □

Media Filters □ □ □ □

Green Roof/Ecoroof □ □ □ □

Riparian Buffers □ □ □ □

Extended Filtration □ □ □ □

(underdrained raingarden) 

Soil Amendment □ □ □ □

Permeable concrete/Permeable 

Asphalt/ Pavers □ □ □ □

Cistern □ □ □ □

Rain Barrel □ □ □ □

Downspout disconnection □ □ □ □

Native vegetation/landscaping 

planting requirements □ □ □ □

Xeriscaping or water 

efficient planting designs □ □ □ □

Conservation/protection 

of green open space □ □ □ □

Reduced Lot/Parcel Size□ □ □ □

Other Controls: _________________ □ □ □ □

A-58 For any construction projects that you have initiated (such as schools or libraries), 

have you completed a cost comparison between traditional stormwater practices 

(such as stormwater ponds) and stormwater retention practices (as described at the 

beginning of this section)? 

  Yes 

  No 

 If so, is the cost data available? 

  Yes 

  No 

A-59 What is the driver for implementation of the stormwater retention practices (as 

described at the beginning of this section) in your MS4 service area? Check all 

that apply. 

□ Stormwater management requirement 

□ CSO Long Term Control Plan requirement 

MS4 Questionnaire Page 35 of 47 
Survey ID: ________________ OMB Control No. 20XX-XXXX 

 Approval expires XX/XX/XX

□ Flood Control 

□ TMDL or other water quality requirement 

□ Other: _______________ 

□ Unknown 

□ Not Applicable 

A-60 In your MS4 service area, which of the following ordinances or other types of 

regulations may prevent stormwater retention practices (as described at the 

beginning of this section) from being implemented? 

 Check all that apply. This question should be answered regardless of the level of 

government that imposes the requirement. 

Specific Water Requirements

□ Standing water restrictions which may prevent the use of rain barrels, 

 extended detention, or other practices. 

□ Water rights issues 

□ Restrictions related to groundwater contamination potential 

□ Restrictions related to sole source aquifer limitations 

□ Restrictions on tree/wetland protection requirements 

Site design/infrastructure practices

□ Curb and Gutter requirements which may restrict roadside infiltrations practices 

□ Maximum/Minimum parking lot size requirements 

□ Maximum/Minimum roadway widths 

□ Requirements setting minimum/maximum cul-de-sac radius 

□ Restrictions on the width of rights of way 

□ Conflicts in obtaining private land (e.g., for use as a public right of way) 

Building/Structure Requirements

□ Restrictions on setbacks/frontages 

□ Restrictions related to plumbing codes (e.g., prohibitions on stormwater reuse 

for toilet flushing) 

Vegetation Requirements

□ Restriction on height of vegetation (e.g. wetland vegetation or grasses) 

□ Restriction related to tree placement (e.g., restricting the places where trees may 

be planted, such as near sidewalks, utility poles, along certain stretches of roads) 

□ Aesthetic requirements for plantings 

Other Requirements

□ Requirements that may restrict the use of pervious concrete, porous asphalt, 

modular block pavers, or other alternatives to conventional/impermeable paving 

materials 

□ Limited mixed use/compact development 

□ Restrictions related to deeds 

□ Restrictions on stormwater reuse for irrigation (e.g., health code restrictions) 

□ Other: _____________________________________________ 

MS4 Questionnaire Page 36 of 47 
Survey ID: ________________ OMB Control No. 20XX-XXXX 

 Approval expires XX/XX/XX

 

A-61 Does you have any maintenance concerns that may prevent stormwater retention 

practices (as described at the beginning of this section) from being implemented 

in your MS4? 

 Describe____________________________________________ 

A-62 In your MS4, are there categories or areas excluded from stormwater infiltration 

 due to concerns for groundwater contamination? 

□ Yes, describe____________________ 

□ No 

□ Not applicable, specify: ____________________________________________ 

A-63 Are there stormwater discharges from your MS4 to a state-defined source water 

 protection area for public water supplies? 

□ Yes 

□ No 

□ Not applicable, specify: ____________________________________________ 

A-64 Are any of the following implemented in your MS4 service area? Check all that 

apply. 

□ Open Space requirements 

□ Urban growth boundaries 

□ Natural area protection 

□ Stream restoration/remediation program 

□ Incentives for infill/redevelopment 

□ Incentives for Brownfield development 

□ Incentives for mixed use 

□ Enterprise Communities or Empowerment Zones 

□ Buffer/riparian corridor requirements 

□ Incentives for green infrastructure/low impact development practices 

□ Restrictions on the amount of impervious surfaces (e.g., caps on the amount of 

impervious surfaces) 

□ Other, describe:_____________________ 

□ None 

□ Not Applicable 

A-65 What, if any, incentives are provided to use stormwater retention practices (as 

described at the beginning of this section) in new development and 

redevelopment projects (commercial, residential, mixed use, and/or institutional) 

in your MS4 service area? Check all that apply. 

 

New Development

□ Reduced stormwater utility fees 

Specify: __________________________________________________________ 

□ Development Incentives: (e.g. zoning upgrades, expedited permitting, reduced 

 stormwater requirements, increases in floor area ratios, etc): 

MS4 Questionnaire Page 37 of 47 
Survey ID: ________________ OMB Control No. 20XX-XXXX 

 Approval expires XX/XX/XX

Specify: __________________________________________________________ 

□ Reduction in the volume of stormwater required to be managed 

Specify: __________________________________________________________ 

□ Grants: Provide direct funding to property owners and/or community groups for 

 implementing a range of green infrastructure projects and practices. 

Specify: _________________________________________________________ 

□ Rebates & Installation Financing: (e.g. provide funding, tax credits or 

 reimbursements to property owners who install specific practices) 

Specify: __________________________________________________________ 

□ Awards & Recognition Programs (e.g. provide marketing opportunities and 

 public outreach for exemplary projects) 

Specify: __________________________________________________________ 

□ Other: ______________________________________________________ 

□ None 

□ Unknown 

□ Not Applicable 

Redevelopment

□ Reduced stormwater utility fees 

Specify: __________________________________________________________ 

□ Development Incentives: (e.g. zoning upgrades, expedited permitting, reduced 

 stormwater requirements, increases in floor area ratios, etc): 

Specify: __________________________________________________________ 

□ Reduction in the volume of stormwater required to be managed 

Specify: __________________________________________________________ 

□ Grants: Provide direct funding to property owners and/or community groups for 

 implementing a range of green infrastructure projects and practices. 

Specify: __________________________________________________________ 

□ Rebates & Installation Financing: (e.g. provide funding, tax credits or 

 reimbursements to property owners who install specific practices) 

Specify: __________________________________________________________ 

□ Awards & Recognition Programs (e.g. provide marketing opportunities and 

 public outreach for exemplary projects) 

Specify: __________________________________________________________ 

□ Other: ______________________________________________________ 

□ None 

□ Unknown 

□ Not Applicable 

A-66 Do your MS4 have a master plan or other planning process that projects 

development over a certain time period (may be done by other departments or 

agency in your jurisdiction)? 

□ Yes 

□ No (skip) 

MS4 Questionnaire Page 38 of 47 
Survey ID: ________________ OMB Control No. 20XX-XXXX 

 Approval expires XX/XX/XX

A-67 Is one of the purposes of this planning process to direct development towards 

specific area, such as infill areas, high density or compact development, 

brownfield development, or proximity to mass-transit? 

□ Yes 

□ No 

A-68 What, if any, incentives are provided in your MS4 service area for infill, high 

density or compact development, brownfield development, or proximity to masstransit? 

□ Reduced stormwater utility fees 

Specify: __________________________________________________________ 

□ Development Incentives (e.g., zoning upgrades, expedited permitting, reduced 

 stormwater requirements, increases in floor area ratios, etc): 

Specify: __________________________________________________________ 

□ Reduction in the volume of stormwater required to be managed (e.g., 

development projects must manage the first 1⁄2” of rainfall on-site while 

redevelopment projects much manage less rainfall) 

Specify: __________________________________________________________ 

□ Grants: Provide direct funding to property owners and/or community groups for 

 implementing a range of green infrastructure projects and practices. 

Specify: __________________________________________________________ 

□ Rebates & Installation Financing (e.g., provide funding, tax credits or 

 reimbursements to property owners who install specific practices) 

Specify: __________________________________________________________ 

□ Awards & Recognition Programs (e.g., provide marketing opportunities and 

 public outreach for exemplary projects) 

Specify: __________________________________________________________ 

□ Other: ______________________________________________________ 

□ None 

□ Unknown 

□ Not Applicable 

A-69 In the past five years, has flooding occurred within your jurisdiction due to 

insufficient capacity of your MS4? 

□ Yes 

□ No (skip to A-72) 

□ Don’t know (skip to A-72) 

A-70 Indicate the type of flooding that has occurred within your jurisdiction in the past 

five years due to insufficient capacity of your MS4 (check all that apply). 

□ Nuisance flooding, such as flooding of roads that did not cause damage to 

 infrastructure or public or private property 

□ Flooding that caused damage to infrastructure, such as roads or utilities 

□ Flooding that caused damage to private property, such as flooding of homes 

□ Flooding that caused damage to public property, such as flooding of schools or 

 libraries 

□ Other, Specify: ____________________ 

MS4 Questionnaire Page 39 of 47 
Survey ID: ________________ OMB Control No. 20XX-XXXX 

 Approval expires XX/XX/XX

A-71 In general, how frequently do flooding events occur within your jurisdiction due 

to insufficient capacity of your MS4? 

□ Rarely, or less than once per year 

□ Occasionally, or once or twice every year 

□ Often, or five or more times per year 

 

A-72 Do you have a program or plan for future capital improvements to address lack of 

capacity in your MS4? 

□ Yes 

□ No 

□ Not applicable, Specify: ____________________________________________ 

MONITORING 

A-73 Does your MS4, or a partner organization, perform any of the following types of 

monitoring as part of your MS4 stormwater program? (Check all that apply.) 

□ Stormwater outfall monitoring 

□ Stormwater monitoring of specific stormwater controls 

□ In-stream monitoring for water quality parameters 

□ In-stream monitoring for biological parameters 

□ In-stream monitoring for geomorphology or physical habitat 

A-74 Are you required to perform any type of monitoring of any outfalls as part of your 

 stormwater MS4 permit? 

 Yes 

  No 

A-75 What is the total number of outfalls (pipes greater than 12 inch diameter) in your 

 MS4 that is subject to either a Phase I or Phase II MS4 stormwater permit? 

 _______ # of outfalls 

□ Unknown 

A-76 How many outfalls did you, or a partner organization monitor in the last 5 years? 

Outfall Monitoring, FY 2005-2009

Fiscal year

2005 2006 2007 2008 2009 

Number of 

outfalls 

monitored 

MS4 Questionnaire Page 40 of 47 
Survey ID: ________________ OMB Control No. 20XX-XXXX 

 Approval expires XX/XX/XX

A-77 Does your MS4, or a partner organization, conduct monitoring of outfalls for 

pollutant levels (e.g., pH, metals, nutrients, suspended solids, etc.) or flow-related 

parameters (e.g., flow rate, volume, etc.)? 

□ Pollutant levels 

□ Flow-related parameters 

□ Both 

□ No 

A-78 Do you, or a partner organization, have data indicating any chemical, biological, 

and/or physical changes in the receiving waters to which you discharge 

stormwater that you can attribute to your stormwater program (e.g., we saw a 

reduction in total nitrogen and an increase in sensitive stream 

microinvertebrates)? 

□ Yes, describe__________________________________________________ 

□ No 

□ Unknown 

□ Not Applicable 

A-79 Provide any additional comments for Section A in the space provided below. 

 _______________________________________________________________ 

 _______________________________________________________________ 

 _______________________________________________________________ 

 _______________________________________________________________ 

 _______________________________________________________________ 

 _______________________________________________________________ 

 _______________________________________________________________ 

 _______________________________________________________________ 

 _______________________________________________________________ 

MS4 Questionnaire Page 41 of 47 
Survey ID: ________________ OMB Control No. 20XX-XXXX 

 Approval expires XX/XX/XX

Section B: Financial Information 

B-1 Indicate your jurisdiction’s total operating budget and stormwater related annual 

operating budget. 

 

Annual Budget ($) 

Fiscal Year 

2005 2006 2007 2008 2009 

Total 

Operating 

Budget 

Stormwater 

Related 

B-2 Select the month that begins your fiscal year? 

[Provide pull down menu with start of months?] 

B-3 For the five year period from 2005 to 2009, on average, what percent of the 

stormwater budget did you approximately spend on the following activities? 

Provide your best estimate. Total must equal 100%. 

___% Program administration (e.g., clerical activities, financial management) 

___% Developing annual report 

___% Developing stormwater management plan (SWMP) 

___% Planning and engineering for capital improvement projects, such as 

 capacity expansion, capital construction, stream restoration, land 

 acquisition or retrofits (e.g., surveying and document existing conditions, 

 GIS development and operations, master planning) 

___% Planning and engineering for other MS4 activities 

___% Industrial component of MS4 program (inventory of facilities or 

 inspections) 

___% Monitoring 

___% Public education and outreach 

___% Public involvement and participation 

___% Illicit discharge detection and elimination 

___% Construction site discharge control program for construction activities that 

disturb one or more acres (tracking, inspections, etc) 

___% Post-construction discharge control program for new and redeveloped areas 

 (tracking, inspections, operation and maintenance) 

___% Pollution prevention/good housekeeping for municipal operations 

 (operation and maintenance, developing stormwater pollution prevent plan 

 (SWPPP), training for municipal staff on pollution prevention measures 

 and techniques, regular street sweeping, reducing the use of 

 pesticides or street salt, or frequent catch-basin cleaning) 

MS4 Questionnaire Page 42 of 47 
Survey ID: ________________ OMB Control No. 20XX-XXXX 

 Approval expires XX/XX/XX

___% Inspection and enforcement (if not tracked in the activities above) 

___% Incentives and rebates for privately initiated stormwater control measures 

___% Other, describe______________________ 

The next two questions address staffing requirements for your program. 

B-4 What is the average number of full time equivalents (FTEs) that your organization 

has devoted to stormwater related activities over the past five years? 

 _______________ # of full time equivalents 

B-5 What is the average number of part time employees that your organization has 

devoted to stormwater related activities over the past five years? 

________________# of part time employees 

Funding Questions 

The following three questions request information on the sources of revenue for your 

stormwater related activities. This information is requested for three different categories – 

operations and maintenance, capital improvements, and capital debt financing. 

 

B-6 What percentage of your stormwater operations and maintenance funding comes 

from the following sources. (Total must equal 100%) 

□ Stormwater User Fee ___% 

□ Ad valorem taxes ____% 

□ Permitting and other fees___% 

□ Sales Taxes___% 

□ Special Tax districts___% 

□ New development impact fees___% 

□ Other ___% 

B-7 What percentage of your stormwater capital improvement funding comes from the 

following sources. (Total must equal 100%) 

□ Stormwater User Fee ___% 

□ Ad valorem taxes ____% 

□ Permitting and other fees___% 

□ Sales Taxes___% 

□ Special Tax districts___% 

□ New development impact fees___% 

□ Other ___% 

B-8 What percentage of your stormwater capital debt financing comes from the 

following sources. (Total must equal 100%) 

□ General obligation (tax) bonds ___% 

□ Stormwater revenue bonds ____% 

□ Sales tax bonds___% 

MS4 Questionnaire Page 43 of 47 
Survey ID: ________________ OMB Control No. 20XX-XXXX 

 Approval expires XX/XX/XX

□ Combined stormwater/other bonds___% 

□ Benefit district bonds___% 

□ Other ___% 

Stormwater Fee Questions 

B-9 Does your jurisdiction have the authority to charge and/or increase stormwater 

 fees? 

□ Yes 

□ No 

The following five questions pertain to one time, development impact fees charged for 

property development. These fees are also known as system development charges. 

B-10 Do you charge a one-time development fee for new stormwater permit 

applications? 

□ Yes 

□ No (Skip to B-15) 

B-11 What is the basis for this one-time development fee for new, single-family 

residential stormwater permit applications? 

□ Flat fee: $ 

□ $ ____ per $1000 of project value 

□ $ ____ per acre of gross area 

□ $ ____ per square foot of impervious area 

□ $ ____ per square foot of total floor area 

□ Other: ______________________ 

□ None 

B-12 What is the basis for this one-time development fee for new, multi- family 

residential stormwater permit applications? 

□ Flat fee: $ 

□ $ ____ per $1000 of project value 

□ $ ____ per acre of gross area 

□ $ ____ per square foot of impervious area 

□ $ ____ per square foot of total floor area 

□ Other: ______________________ 

□ None 

B-13 What is the basis for this one-time development fee for new, non-residential

stormwater permit applications? 

□ Flat fee: $ 

□ $ ____ per $1000 of project value 

□ $ ____ per acre of gross area 

□ $ ____ per square foot of impervious area 

□ $ ____ per square foot of total floor area 

MS4 Questionnaire Page 44 of 47 
Survey ID: ________________ OMB Control No. 20XX-XXXX 

 Approval expires XX/XX/XX

□ Other: ______________________ 

□ None 

B-14 Approximately what percent of your costs that are associated with new 

development are covered by these one-time development fees (e.g., construction 

of additional infrastructure to service a new development)? 

 ____ % 

 

The following five questions pertain to recurring stormwater fees charged to property 

owners. 

 

B-15 Do you charge recurring stormwater fees to property owners? 

□ Yes 

□ No (Skip to B-20) 

B-16 What is the basis for the recurring stormwater fees for single-family residential

properties? 

□ Flat fee: $ 

□ $ ____ per $1000 of property value 

□ $ ____ per acre of gross area 

□ $ _____per acre of gross area with runoff factor 

□ $ ____ per square foot of impervious area 

□ $ ____ per square foot of total floor area 

□ Other: ______________________ 

□ None 

B-17 What is the basis for the recurring stormwater fees for multi-family residential

properties? 

□ Flat fee: $ 

□ $ ____ per $1000 of property value 

□ $ ____ per acre of gross area 

□ $ _____per acre of gross area with runoff factor 

□ $ ____ per square foot of impervious area 

□ $ ____ per square foot of total floor area 

□ Other: ______________________ 

□ None 

B-18 What is the basis for the recurring stormwater fees for non-residential

properties? 

□ Flat fee: $ 

□ $ ____ per $1000 of property value 

□ $ ____ per acre of gross area 

□ $ _____per acre of gross area with runoff factor 

□ $ ____ per square foot of impervious area 

□ $ ____ per square foot of total floor area 

MS4 Questionnaire Page 45 of 47 
Survey ID: ________________ OMB Control No. 20XX-XXXX 

 Approval expires XX/XX/XX

□ Other: ______________________ 

□ None 

B-19 Approximately what percent of the costs incurred by your organization associated 

with the operations and maintenance of long-term stormwater controls and 

services do these recurring fees cover? 

 ____ % 

Capital Improvement Project Questions 

 

B-20 Did your jurisdiction initiate capacity expansion projects to address inadequate 

stormwater system capacity anytime in the period of FY 2005 through FY 2009? 

□ Yes 

□ No (skip to B-22) 

B-21 What was the annual budget and percentage of your total stormwater system 

addressed by the capacity expansion? If not applicable, write NA. If unknown 

write UK. 

Capacity Expansion Activity and Budget, FY 2005-2009 

Fiscal Year 

2005 2006 2007 2008 2009 

Dollars

% of service 

area 

B-22 Did your jurisdiction initiate retrofit projects anytime in the period of FY 2005 

through FY 2009? (Check the answer that best applies.) 

□ Yes 

□ Yes, only on public property 

□ No (skip to B-24) 

B-23 What was the annual retrofit budget and number of projects completed? If not 

applicable, write NA. If unknown write UK. 

Retrofit Projects and Budget, FY 2005-2009 

Fiscal Year 

2005 2006 2007 2008 2009 

Dollars

Number of 

projects 

B-24 Did your jurisdiction initiate projects for stream restoration associated with 

correcting or mitigating impairment from urban runoff anytime in the period of 

FY 2005 through FY 2009? 

□ Yes 

□ No (skip to B-28) 

MS4 Questionnaire Page 46 of 47 
Survey ID: ________________ OMB Control No. 20XX-XXXX 

 Approval expires /XX/XX

MS4 Questionnaire Page 47 of 47 

XX

B-25 What was the annual budget and miles of stream restored that was associated with 

urban runoff? If not applicable, write NA. If unknown write UK. 

Stream Restoration and Budget, FY 2005-2009 

Fiscal Year 

2005 2006 2007 2008 2009 

Dollars

Stream 

Miles 

B-26 What was the purpose or goal of stream restoration? (Check all the answers that 

apply.) 

□ Erosion control to reduce sedimentation of downstream reservoir 

□ Stream bank stabilization to reduce scouring of infrastructure 

□ Stream bank stabilization to reduce property loss due to erosion 

□ Flood control 

□ Habitat protection, fisheries concerns 

□ Aesthetics 

□ Other: ______________________ 

 

B-27 Indicate the type of stabilization measures that were done? 

□ Vegetative stabilization 

□ Non-vegetative stabilization such as concreting, installing riprap, etc 

□ Combination of vegetative and non-vegetative measures 

B-28 Provide any additional comments for Section B in the space provided below. 

 _______________________________________________________________ 

 _______________________________________________________________ 

 _______________________________________________________________ 

 _______________________________________________________________ 

 _______________________________________________________________ 

 _______________________________________________________________ 

 _______________________________________________________________ 

You have completed the questionnaire. Refer to the instructions for mailing the 

questionnaire back to the United States Environmental Protection Agency. Thank you.