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 pe rson 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 th is 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 comp leted questionnaire to this address.

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



### Purpose of the Questionnaire

Stormwater discharges from developed la nd can negatively impact water quality through

increases in stormwater volume and increased pollutant loads to the receiving waters. To strengthen its stormwater regulations, EP A’s Office of Water (OW) is considering

revisions to the current National Pollutan t Discharge Elimination System (NPDES) regulations including the establishment of sta ndards for long term stormwater discharges from developed sites.

To collect data to inform to inform deci sions regarding how the nation’s stormwater regulations should be strengthened and to s upport the technical and financial feasibility associated with this rulemaking, EPA is sending the following questionnaire to owners/operators of regulated Municipal Se parate 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 sectio ns covering the following topic areas:

 Section A: Technical Information

 Section B: Financial Information

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



### General Information, continued

Authority

EPA has authority to administer this ques tionnaire under section 308 of the Clean Water Act (Federal Water Po llution 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 th e possibility of fines and imprisonment as explained in Section 308 of the Cl ean 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 da ys 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. Writ ten requests may be e-mailed to Mr. Brian

D’Amico at damico.brian@epa.gov

.

Certification Statement

A responsible MS4 official or authorized repr esentative 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 Certif ication statement, sign it, and return it to EPA at the following address:

U.S. Environmental Protection Agency Stormwater Management Including Di scharges 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 comple tion 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 assist ance by telephone should send an e-mail with “Please Call Me” in the subject line. Pl ease 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 47Survey 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 que stionnaire is not business confidential, EPA may make the information available to the public without further notice.

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



### Detailed Instructions for Co mpleting the Questionnaire

Complete the questionnaire consid ering the following instructions:

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

 Personnel most knowledgeable about the subj ect areas covered by a specific section should complete that secti on of the questionnaire.

 For all questions and sections, read all in structions and definitions carefully. Pay particular attention to the distincti on 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 app licable, 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 47Survey 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 Certificat ion 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 th e 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 request ed information, we have provided best engineering and/or financial estim ates or judgment. I am awar e that there are significant penalties for submitting false informati on, including the possibility of fines and imprisonment as explained in Section 308 of the Clean Wa ter Act (33 U.S.C., Section 1318).

_____________________________ _________________________ Signature of Certifying Official Date

_____________________________ (______)_________________ Printed Name of Certifying Of ficial Telephone Number

_____________________________ Title of Certifying Official

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



### Definitions

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

These definitions were written as broadl y as possible, relying on our regulations, guidance, fact sheets, etc. We acknowledge that there are likel y local or regional differences in the meanings of some of these terms. Where those di fferences will affect their answer to the quest ions, respondents should pr ovide 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 discha rges. Surface discharges are directed into shallow, landscape depressions, which are designed to incorporate many of the pollutant removal mechanisms that operate in forest ed or other natural (prairies, wetlands, etc) ecosystems. Includes rain gardens, sidewalk planters, curb extensions a nd other plant or soil systems designed to infiltrate or evapotranspirate stormwater.

Capacity Describes the hydraulic capacity th at the storm sewer system is designed for in terms of the vol ume 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 sum p, 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 ba sin, 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, fo r storing captured stormwater and can be integrated with more sophisticated pumping devices. For example, some cister ns collect stormwater that is subsequently used for non-potable plumbing, such as flushing of toilets, or irrigation applications.

MS4 Questionnaire Page 7 of 47Survey 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 wast ewater) through a single pipe system to a publicly owned treatment works.

Constructed Wetland A man-made basin that contains wa ter, a substrate (soil, gravel, rock, organic materials, etc. ), plants (vascular and nonvascular), and organisms sim ilar 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. Responsibilitiesunder 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 pe riod of time (hours to days) generally by controlling the si ze of the discharge volume and

flow rate. Also known as “wet/d ry 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 c onsidered a “bro wnfield site”.

Filter Strip / Vegetated

Buffer Vegetated surfaces used to reduc e 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 47Survey ID: ________________ OMB Control No. 20XX-XXXX Approval expires XX/XX/XX

Term Definition

Flood event Describes an overflow of stor mwater 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 memb rane, drainage, high inorganic growing media), and appropriate plant species. Green roofs reduce surface discharge from the rooftop by absorbing stormwater and slowing stormwat er flow rates, and provide ancillary benefits such as summer cooling, lowered urban heat island effect, and improved air quality.

Green Infrastructure Wet weather management approa ches and technologies that infiltrate, evapotranspire, captu re 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 construc ted facilities; areas that are covered with a low-permeability material such as asphalt or concrete; or areas such as gr avel 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 CF R 122.26(b)(14) or has been designated as causing a water qualit y standard exceedance or is a significant contributor of pollu tants 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 in filtrate 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 47Survey 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 st ructures, such as highways, bridges, or other transportation-re lated 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, in stitutional, or other land uses.

Municipal Separate Storm Sewer System (MS4) A conveyance or system of conveyances (including roads with drainage systems, municipal st reets, catch basins, curbs, gutters, ditches, man-made channe ls, or storm drains) that is owned by a state, city, town, v illage, or other public entity having jurisdiction over disposal of sewage, industrial wastes, stormwater, or other wastes, in cluding special districts under

state law such as a sewer dist rict, flood control district or drainage district, or similar enti ty, or an Indian tribe or an authorized Indian tribal orga nization, 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 ope n/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, monitori ng and enforcing permits under the authority of the Clean Water Act.

MS4 Questionnaire Page 10 of 47Survey 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 st ream 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 require d to obtain an EPA or State NPDES permit. Small MS4s incl ude 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 permeab le pavement material, which allows distributed infiltration into the underlying soil. There may also be an underlying stone reservoir that temporarily stores the surface discharge be fore 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 disc harges of stormwater from developed sites. Post-const ruction controls are those

stormwater controls that are installed and maintained to permanently manage stormwat er discharged from the developed sites.

Public Entity A public agency or body of a state, city, town, village or other municipal entity. Includes sp ecial 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 ex isting 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 47Survey ID: ________________ OMB Control No. 20XX-XXXX Approval expires XX/XX/XX

Term Definition

Retention Practices Stormwater techniques that mana ge stormwater on-site through infiltration, evapotranspira tion, or harvesting. Commonly referred to as Low Impact Development or Green Infrastructure practices.

Retrofit The installation or modificat ion of stormwater control measures on sites with existing development (including existing storm sewers) to enhan ce 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 wate r, 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 st ate’s border, that is the perimeter of the catchment basi n 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 st reets, 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 c ontrol or convey the volume of water being discharged during storm conditions.

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

Term Definition

Subsurface fluid distribution system An assemblage of perforated pipe s, drain tiles, or other similar

mechanisms intended to distribut e fluids below the surface of the ground. This could include a seepage pit, infiltration trench, or commercially manufact ured 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, tr ap particulates, and promote

infiltration. Grassed swales are of ten 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 ar e often referred to as bioswales, enhanced swales, or wa ter 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. Infilt ration 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 dr y swale, lacks an underdrain system. The wet swale is marsh like 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 storag e 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 mo re places — central place(s) — and the adjacent densely se ttled surrounding area — urban fringe — that together have a re sidential population of at least 50,000 and an overall population density of at least 1,000 people per square mile. A ny 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 47Survey 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, stor mwater control structure that incorporates wetland plants. Stor m discharge is directed into

the basin to control both wa ter 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 wa ter is displaced by discharge from a later storm (permanent pool).

MS4 Questionnaire Page 14 of 47Survey 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 47Survey 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 co mpleted 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 st ormwater 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 c onveyances such as ditches or gullies, ephemeral drainages)

□ Other, specify ____________________________________

□ None, only my MS4

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

Extent of Coverage

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

perm it. Under the Phase II stormwater regulat ions, 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 loca ted within an urbanized area. In addition, permitting authorities have extended coverage to other small MS4s outside of the urbanized area. The following questions are fo cused 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 th at 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 juri sdiction 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, dr ainage, 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 with in 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 47Survey ID: ________________ OMB Control No. 20XX-XXXX Approval expires XX/XX/XX

A-10 If your permitted MS4 area is less than the jurisd ictional 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 requ irements 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 discha rge to) the MS4 but discharg e 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 discha rge to) the MS4 but discharg e 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 47Survey ID: ________________ OMB Control No. 20XX-XXXX Approval expires XX/XX/XX

□ MS4 regulates these discharges thr ough local ordinance or other regulatory

m echanism

□ MS4 review site plans for these developments

□ MS4 review building permits for these developments

□ Other, describe________________

□ MS4 does not regula te 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 effectiv eness 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 De tection and Elimination __ Construction Site discharge control (i ncluding erosion/sediment control) __ Post Construction discharge control (including detention, retention and treatment) practices __ Pollution Prevention/Good Housekeep ing (including street sweeping) __ Industrial Inspections __ Wet weather outfall monitoring __ Monitoring to measure the performan ce of specific stormwater controls __ Instream monitoring __ Implementation of watershed management plans __ MS4 training programs __ Source control (limits on fe rtilizer or pesticides) __ Other, describe___________________________

A-14 What parts of your stormwater mana gement 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 47Survey 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 (conf erence 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 b een part of the illicit discharge component of your stormwater program from 20 05 - 2009? (Check a ll that apply.)  Paper tracking/inventory of outfalls  Database tracking/inventory of outfalls  Storm sewer system mapping  Field staff training (t o identify and eliminate illicit discharges)  Field/indicator sampling  Laboratory analyses  Priority area identif ication (i.e. prioritizing specif ic areas of your system where the probability of illicit di scharges may be higher)  Public reporting (i.e. hotline for reporting illicit discharges)

MS4 Questionnaire Page 20 of 47Survey 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 stormwat er 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 applicati on and management requirements  Fertilizer application a nd management requirements  Field staff training  Contractor training  Other, describe_____________

 None

A-20 Which of the following activ ities has been part of th e record keeping component of your stormwater program from 20 05 - 2009? (Check a ll 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 b een 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 a bout stormwater requirements and/or

controls  Site inspection of i ndustrial facilities  Site inspection of co mmercial facilities  Training of inspectors  Other, describe_____________  None - There is no industrial compone nt in the MS4 st ormwater program

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

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

sectors classified for NPDES cove rage under 40 CFR 122.26(b)(14)? How many of those facilities have you inspected in the last 5 years?

Inspection of Industria l 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 b een 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 construc tion sites for coverage under your state’s stormwater construction general permit? ___________ acres or sq feet How many construction sites (at the size th reshold 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 pr ogram from 2005 - 2009? Check all that apply.

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

 Review construction site plans for pos t construction storm w ater 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 pr oject that requires s ite plan review for stormwater quality and quantity control st ructures? Indicate th e 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 th at requires site plan revi ew for stormwater control

structures is identical for rede velopment and new development.

□ 5,000 sq ft

□ 1⁄2 acre

□ 1 acre

□ Other: _______________________________________________________

□ Unknown

□ Not Applicable

A-27 For long term (post cons truction) stormwater contro ls located on public property within your MS4 service area do you tr ack, inspect and/or maintain these

controls? Check all that apply.

□ MS4 tracks post construction controls on public property

□ MS4 inspects post co nstruction controls on public property

□ MS4 maintains post constructi on controls on public property

□ Other, describe __________________

A-28 For long term (post constr uction) stormwater controls located on private property within your MS4 service area do you tr ack, inspect and/or maintain these

controls? Check all that apply.

□ MS4 tracks post construction controls on private property

□ MS4 inspects post co nstruction controls on private property

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

□ MS4 m aintains post constructi on 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 ma intain stormwater control practices on privately-owned properties?

□ Yes, MS4 has authority to insp ect controls on private property

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

□ No, specify specific barriers or loca l 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 in spections of construction s ites)? Check all that apply.

□ Inspect controls only on public property

□ Inspect only specific t ypes 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 cons truction) stormwater contro ls that drain to your MS4 service area and are owned by private en tities (including homeowners or property owner associations, commercial and similar entities), what approximate percentage of the private land area in wh ich 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 47Survey ID: ________________ OMB Control No. 20XX-XXXX Approval expires XX/XX/XX

A-34 Do you have the authority to require pr ivate 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 readil y 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 readil y available? Provide your best estimate.

MS4 Questionnaire Page 25 of 47Survey 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 construc tion) 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 regard ing 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 threshol d 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 47Survey 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 re quirements or a c itation to the state law or a web page link to the design ma nual that contains the information).

Note: The options for standards that re quire detention or ex tended detention are those which hold stormwater temporar ily and discharge the stormwater over an extended period of time (hours to days ) generally by controll ing the size of the discharge volume and flow rate. The opti ons 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, st ormwater 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 percen tile storm event (such as the 80 th 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 47Survey 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 percen tile storm event (such as the 80 th percentile storm) ( Specify ) __________

□ Pollutant reduction requirement (for ex ample, stormwater control practices

must be installed to remove 80% of th e 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 area s within your jurisd iction, or only to

certain sites or waterbodies?

□ All areas

□ Only certain areas ( Specify : ____________)

□ Flood control requirements other than th e peak discharge rate control and onsite detention/retention re quirements specified above. Specify : ____________

□ Stream buffer requirements (for exampl e, a 50 foot vegetated buffer must be maintained/implemented adjacent to waters of the state) Specify : ____________

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

□ Lim its 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 threshol d 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 re quirements or a c itation to the state law or a web page link to the design ma nual 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 47Survey 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 percen tile storm event (such as the 80 th 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 percen tile storm event (such as the 80 th percentile storm) ( Specify ) __________

□ Pollutant reduction requirement (for ex ample, stormwater control practices

must be installed to remove 80% of th e 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 47Survey ID: ________________ OMB Control No. 20XX-XXXX Approval expires XX/XX/XX

□ Requirem ents for control of temperature Specify : ____________ Does this standard apply to all area s within your jurisd iction, or only to

certain sites or waterbodies?

□ All areas

□ Only certain areas ( Specify : ____________)

□ Flood control requirements other than th e peak discharge rate control and onsite detention/retention re quirements specified above. Specify : ____________

□ Stream buffer requirements (for exampl e, 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 standa rd or design criteria specified in Question A-42 or A-45, is the use of specific stor mwater 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 47Survey ID: ________________ OMB Control No. 20XX-XXXX Approval expires XX/XX/XX

□ Other, describe____________________

□ There is no post construction standard in m y MS4

A-49 Do you offer an alternative to complia nce 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 comp liance program offer by another level of government (state, county, etc), Specify: ______________________________

□ No, an alternative complia nce program does not exist

□ There are no post construction standards applied to my MS4

Retrofit of Stormwater M anagement Practices

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

is the installation or modification of struct ural 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 st ormwater retrofit program?

□ Yes

□ No (skip to A-57)

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

□ We require retrofits th rough regulation (local or dinance 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? Ch eck all that apply.

□ We pay for all re trofits on public and private property

□ We pay for retrofits only on public property

□ Private entities are required to pa y 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 47Survey ID: ________________ OMB Control No. 20XX-XXXX Approval expires XX/XX/XX

□ To addres s 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 pr ovided for stormwater retrofits?

□ Reduced stormwater utility fees. Specify : __________________________________________________________

□ Development Incentives: (e.g. zoning upgrades, expedited permitting, reduced stormwater requirements, increa ses in floor area ratios, etc): Specify : __________________________________________________________

□ Grants: Provide direct funding to prope rty owners and/or community groups for implementing a range of green infr astructure 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. pr ovide 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 proj ects could make the most effective difference in terms of restoring water quality in your area?

________________________________________________________________________

________________________________________________________________________

________________________________________________________________________

________________________________________

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



### SPECIFIC STORMWATER CONTROLS

In this section EPA is obtaining information a bout specific stormwater practices that exist in your MS4 including both dete ntion and retention practices.

Detention or extended detention practices ar e those which hold stormwater temporarily and discharge the stormwater over an extende d 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, dete ntion ponds, extended detention ponds.

Questions in this section also refer to the implementation of retention stormwater practices. These are practices that do not discha rge stormwater off-site or to surface water below a certain design capacity (design volume, stormwater size, etc.). The stormwater is infiltrated, evapotranspired, or harvested. Exam ples 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 pr actices. These practi ces 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 47Survey ID: ________________ OMB Control No. 20XX-XXXX Approval expires XX/XX/XX

Filte r 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 ha ve initiated (such as schools or libraries), have you completed a cost comparison be tween traditional stormwater practices (such as stormwater ponds) and stormwater retention practices (a s 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 sect ion) in your MS4 service area? Check all that apply.

□ Stormwater management requirement

□ CSO Long Term Control Plan requirement

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

□ Flood Control

□ TMDL or other water quality requirem ent

□ Other: _______________

□ Unknown

□ Not Applicable

A-60 In your MS4 service area, which of th e 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 ma y prevent the use of rain barrels, extended detention, or other practices.

□ Water rights issues

□ Restrictions rela ted to groundwater c ontamination potential

□ Restrictions related to so le source aquifer limitations

□ Restrictions on tree/we tland protection requirements

Site design/infrastructure practices

□ Curb and Gutter requirements which may re strict 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 se tbacks/frontages

□ Restrictions rela ted to plumbing codes (e.g., prohi bitions 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 alterna tives to conventional/impermeable paving

materials

□ Limited mixed use/compact development

□ Restrictions related to deeds

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

□ Other: _____________________________________________

MS4 Questionnaire Page 36 of 47Survey 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 ar eas 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 impervi ous 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 beginnin g 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, increa ses in floor area ratios, etc):

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

Specify : __________________________________________________________

□ Reduction in the volum e of stormwater required to be managed Specify : __________________________________________________________

□ Grants: Provide direct funding to prope rty owners and/or community groups for implementing a range of green infr astructure 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. pr ovide 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, increa ses in floor area ratios, etc): Specify : __________________________________________________________

□ Reduction in the volume of stormwater required to be managed Specify : __________________________________________________________

□ Grants: Provide direct funding to prope rty owners and/or community groups for implementing a range of green infr astructure 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. pr ovide 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 pro cess 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 47Survey ID: ________________ OMB Control No. 20XX-XXXX Approval expires XX/XX/XX

A-67 Is one of the purposes of this planni ng 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, brownfie ld development, or proximity to masstransit?

□ Reduced stormwater utility fees Specify : __________________________________________________________

□ Development Incentives (e.g., zoning upgrades, expedited permitting, reduced stormwater requirements, increa ses in floor area ratios, etc): Specify : __________________________________________________________

□ Reduction in the volume of stormwat er 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 prope rty owners and/or community groups for implementing a range of green infr astructure 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 fl ooding 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 infrastru cture, such as roads or utilities

□ Flooding that caused dam age to privat e 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 47Survey 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 organizati on, 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 geom orphology 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 Phas e 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 47Survey ID: ________________ OMB Control No. 20XX-XXXX Approval expires XX/XX/XX

A-77 Does your MS4, or a partner organizat ion, 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 ch emical, biological, and/or physical changes in the rece iving waters to which you discharge stormwater that you can attribute to y our 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 co mments for Section A in the space provided below.

_______________________________________________________________

_______________________________________________________________

_______________________________________________________________

_______________________________________________________________

_______________________________________________________________

_______________________________________________________________

_______________________________________________________________

_______________________________________________________________

_______________________________________________________________

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



### Section B: Financial Information

B-1 Indicate your jurisdiction’s total ope rating 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 w ith 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 cap ital improvement projects, such as capacity expansion, capital cons truction, stream restoration, land acquisition or retrofits (e.g., survey ing and document existing conditions, GIS development and operations, master planning) ___% Planning and engineering for other MS4 activities ___% Industrial component of MS4 progr am (inventory of facilities or inspections) ___% Monitoring ___% Public education and outreach ___% Public involvement and participation ___% Illicit discha rge detection and elimination ___% Construction site discha rge control program for cons truction activities that

disturb one or more acres (tracking, inspections, etc) ___% Post-construction discha rge control program for new and redeveloped areas (tracking, inspections, op eration and maintenance) ___% Pollution prevention/good housekeep ing for municipal operations (operation and maintenance, developi ng stormwater pollution prevent plan (SWPPP), training for municipal sta ff 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 47Survey ID: ________________ OMB Control No. 20XX-XXXX Approval expires XX/XX/XX

___% Inspection and enforcem ent (if not tracked in the activities above) ___% Incentives and rebates for privately initiated stormwater control measures ___% Other, describe______________________

The next two questions address staffi ng requirements for your program.

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

has devoted to stormwater related ac tivities over the past five years? _______________ # of full time equivalents

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

devoted to stormwater related activ ities over the past five years? ________________# of part time employees

Funding Questions

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

stormwater related activities. This informati on is requested for three different categories – operations and maintenance, capital impr ovements, 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 47Survey ID: ________________ OMB Control No. 20XX-XXXX Approval expires XX/XX/XX

□ Com bined 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 47Survey 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-ti me development fees (e.g., construction of additional infrastructure to service a new development)? ____ %

The following five questions pertain to recu rring stormwater fees charged to property

owners.

B-15 Do you charge recurring stormw ater 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 47Survey ID: ________________ OMB Control No. 20XX-XXXX Approval expires XX/XX/XX

□ Other:

______________________
□ None

B-19 Approximately what percent of the costs incurred by your orga nization associated with the operations and maintenance of long-term stormwater controls and

services do these recu rring fees cover? ____ %

Capital Improvement Project Questions

B-20 Did your jurisdiction initia te capacity expansion projec ts 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 percenta ge 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

D o l l a r s % of service

area

B-22 Did your jurisdiction initiate retrofit projects anytime in the period of FY 2005 through FY 2009? (Check the an swer that best applies.)

□ Yes

□ Yes, only on public property

□ No (skip to B-24)

B-23 What was the annual retrofit budget and nu mber of projects co mpleted? If not applicable, write NA. If unknown write UK.

Retrofit Projects a nd Budget, FY 2005-2009

Fiscal Year

2005 2006 2007 2008 2009

D o l l a r s Number of

projects

B-24 Did your jurisdiction initia te projects for stream re storation 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 47Survey 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 st ream 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

D o l l a r s
Stream

Miles

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

□ Erosion control to reduce sedime ntation of downstream reservoir

□ Stream bank stabilization to re duce scouring of infrastructure

□ Stream bank stabilization to re duce property loss due to erosion

□ Flood control

□ Habitat protection, fisheries concerns

□ Aesthetics

□ Other: ______________________

B-27 Indicate the type of stabil ization 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 co mments for Section B in the space provided below.

_______________________________________________________________

_______________________________________________________________

_______________________________________________________________

_______________________________________________________________

_______________________________________________________________

_______________________________________________________________

_______________________________________________________________

You have completed the questionnaire. Re fer to the instructions for mailing the questionnaire back to the United States Environmental Protection Agency. Thank you.