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



## United States Environmental Protection Agency

Stormwater Management Including Discharges from Developed Sites

Transportation-Related 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 55 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 45Survey 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 a nd increased pollutant loads to the receiving waters. . To strengthen its stormwater regulations, EPA’s Offi ce of Water (OW) is considering revisions to the current National Pollutant Discharge Elimin ation System (NPDES) re gulations including the establishment of standards for long term stormw ater discharges from developed sites.

To collect data to inform deci sions and support analysis of the technical and econom ic feasibility associated with this rulemaking, EPA is sending the following ques tionnaire to owners/operators of transportation-related facili ties like state and county depart ments of transportation that own/operate roadway systems. This questionnaire will provide EPA with information to:

 Characterize scope, components, and implementation of existing transportation-related stormwater programs; and ordinances and laws that may constrain long term stormwater best management practices; and

 Estimate the burden and expenditures to comply with and enforce existing requirements.

The survey is presented in three secti ons covering the following topic areas:

 Section A: Technical Information

 Section B: Financial Information

 Section C: Contact Information

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### General Information, continued

Authority

EPA has authority to administer this questi onnaire 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 follow-up questions to clarify your answers. Late filing of the questionnaire, or failure to follow any related EPA instruction, may results in civi l 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 questionn aire, then print, sign and return the certification statement to EPA no later than 60 calendar days af ter 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 request s 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 Certifica tion statement, sign it, and return it to EPA at the following address:

U.S. Environmental Protection Agency Stormwater Management Including Discharg es 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. Pl ease include the name of the survey to which you are responding, the question number along w ith 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 a nd time to call. The return phone call will be free of charge to the respondent.

E-mail address for help line: _________________________________

Transportation MS4 Questionnaire Page 3 of 45Survey ID: ________________ OMB Control No. 20XX-XXXX Approval expires XX/XX/XX

Confidential Business Information

Because the inform ation requested in this ques tionnaire is not business confidential, EPA may

make the information available to the public without further notice.

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### 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 subject areas covered by a specific section should complete that section of the questionnaire.

 For all questions and sections, r ead all instructions and defini tions carefully. Pay particular

attention to the distinction betw een 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 unle ss you are directed to SKIP forward in the questionnaire. This is important since some ques tions 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 specifie d and applicable, include units in your response.

 The period of interest for the survey is your fis cal year (FY) 2009 unless indicated otherwise.

 Provide the requested information based on data you currently have. EPA is not requesting or recommending that respondents co llect new data to provide information for this survey.

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### 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 acco rdance 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 co mplete. In those cases where we did not possess the requested information, we have provided be st engineering and/or financial estimates or judgment. I am aware that there are significa nt penalties for submitting false information, including the possibility of fines and imprisonmen t as explained in Se ction 308 of the Clean Water Act (33 U.S.C., Section 1318).

_____________________________ _________________________ Signature of Certifying Official Date

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

_____________________________ Title of Certifying Official

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### Definitions

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

These definitions were written as broadly as pos sible, 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 informa tion 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.

Transportation MS4 Questionnaire Page 7 of 45Survey 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.

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.

Flood event Describes an overflow of stor mwater from a storm sewer system during peak flow conditions as a result of a storm

event.

Transportation MS4 Questionnaire Page 8 of 45Survey ID: ________________ OMB Control No. 20XX-XXXX Approval expires XX/XX/XX

Term Definition

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 constructed 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 situ ated 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.

Transportation MS4 Questionnaire Page 9 of 45Survey 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.

Transportation MS4 Questionnaire Page 10 of 45Survey 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.

Transportation MS4 Questionnaire Page 11 of 45Survey 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.

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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 si de 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 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. 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.

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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).

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### 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:

□ State Department of Transportation

□ County Department of Transportation

□ Local Department of Transportation

□ Other, Specify: ____________________________________________

A-4 Which example best describes your agency’s hierarchy?

□ The agency has one overarching office with regional offices underneath that deal with various aspects of the stormwater program.

□ The agency has one overarching office with watershed offices underneath that deal with various aspects of the stormwater program.

□ The agency has one overarching office, regi onal offices underneath, and districts that deal with various aspects of the stormwater program.

□ The agency has one overarching office that deals with the various aspects of the

stormwater program.

□ Other, Specify: ___________________________________________________

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A-5 Which best describes your MS4 permit?

Individual P ermit:

□ Large/Medium MS4 permit (Phase I) Specify any co-permittees: ____________________________________________

□ Small MS4 permit (Phase II) Specify any co-permittees: ____________________________________________

General Permit:

□ Large/Medium MS4 permit (Phase I) Specify any co-permittees if this permit is not statewide:____________________

□ Small MS4 permit (Phase II) Specify any co-permittees if this permit is not statewide:____________________

A- 6 How many permits terms have you complete d under the stormwater program (usually MS4 permits are issued every 5 years, howev er 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-7 In addition to your MS4, how else is stormwater conveyed in the area under your control? Check all that apply.

□ Separate storm sewer that is not permitted

□ Combined sewer system

□ De-centralized storm sewer system (i.e. unp iped/on-site practices, discharges directly to a stream, swales, natural conveyances such as ditches or gullies, ephemeral drainages)

□ Other, specify ____________________________________

□ None, only MS4

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Extent of Coverage

EPA is obtaining information about the extent of that your MS4 is covered by an NPDES per mit. Under the Phase II stormwater regulations, sm all MS4s located within a Census-defined urbanized area are required to be regulated. So me permitting authorities, however, have extended permit coverage beyond the urbanized area to cove r the entire area under your control if only part of an MS4 was located within an urbani zed 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 info rmation about three areas: 1. MS4 permitted area – area covered by Phase I/II MS4 permit

2. MS4 service area – area over which an MS4 is the owner and operato r of the municipal separate storm sewer system and has the auth ority to collect and discharge stormwater, may extend beyond the permitted area. 3. Area under your control – boundaries of the area which you control/operate

A-8 Which of the following best describes the ba sis for how stormwater discharges from your MS4 are permitted?

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

□ Based on the entire area under my contro l (state roads, county roads, 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-9 Does your stormwater permit cover discharges beyond the Census-defined

urbanized area?

□ Yes

□ No

A-10 Do you have a GIS map showi ng the area covered by your permit?

□ Yes - Provide the location c itation of the GIS information. Provide the URL if the GIS information is posted on the web: _______________________________

□ No

A-11 What are the total area, and estimated percent impervious area of both the permitted MS4 portion of the area under your control (as described in A-7) and the entire area under your

control.

□ My boundary falls entirely within an urbani zed area (in this case please fill out only the “entire area under your control” column).

Permitted MS4 Area Entire Area Under Your

Control

Total Area Estimated % Impervious Area (if available)

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A-12 If your stormwater permit does not cover th e entire area under your control (for example the entire roadway), which of these MS4 st ormwater program activ ities apply to the entire area under your control?

□ 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

A-13 Do you allow other entities to construct in your right of way/ar ea under your control where you apply the components of the stormwater program?

□ Yes

□ No

□ Unknown

Specific Stormwater Program Components

The following section collects information on the activ ities that you are curren tly doing as part of

your stormwater program.

A-14 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 (incl uding detention, reten tion and treatment) practices __ Pollution Prevention/Good Housekeep ing (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 fe rtilizer or pesticides) __ Other, please describe___________________________

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A-15 What parts of your stormwater management program are carried out by other departments or other governmental agencies (for exampl e some departments of transportation may combine their efforts for public education with 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, please describe_____________  None (skip to A-16)

A- 16 Does your agency have oversight over those departments or governmental agency’s stormwater management activities?

 Yes

 No

 Not all activities  Not applicable

A-17 Which of the following activities have been part of the public education and outreach component of your stormwater pr ogram from 2005 - 2009? (Check all that apply.)  Brochures, fact sheets, guides, or si milar documents for the general public  Brochures, fact sheets, guides, or sim ilar documents for your agency’s staff

 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  Municipality training  Storm drain stenciling

 Stormwater hotlines  Tributary signage

 Website  Car washing public program  Other, please describe_____________

 None

A-18 Which of the following activit ies have been part of the public involvement component of your stormwater program from 2005 - 2009? (Check all that apply.)  Public meetings/citizen panels

 Public notification and review of stormwater program elements  Informational briefings for public officials (politicians, managers, etc.)  Volunteer water quality monitoring

Transportation MS4 Questionnaire Page 19 of 45Survey ID: ________________ OMB Control No. 20XX-XXXX Approval expires XX/XX/XX

 Volunteer educators/speakers

 Storm drain stenciling  Public reporting of litter/po llution (telephone hotline or website)  Community clean-ups  Citizen watch groups  Coordination with highway patrol (or sim ilar entity) regarding stormwater complaints  “Adopt A Highway” programs  Other, please describe_____________

 None

A-19 Which of the following activit ies 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

 Outfalls that drain to sensitive waters heds are tracked separately/differently  Storm sewer system mapping  Field staff training (t o identify and eliminate illicit discharges)  Field/indicator sampling  Laboratory analyses  Priority area id entification (i.e. prioritizing specif ic areas of your system where the probability of illicit discharges may be higher)  Public reporting (i.e. hotline for reporting illicit discharges)  Adoption of ordinances/codes es tablished by local jurisdictions  Other, please describe_____________

 None

A-20 Which of the following activities have been part of the pollution prevention/good housekeeping component of your stormwater pr ogram from 2005 - 2009? (Check all that apply.)  Inventory of your facilities  Facility assessment (to determine the facil ity’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, please describe_____________

 None

Transportation MS4 Questionnaire Page 20 of 45Survey ID: ________________ OMB Control No. 20XX-XXXX Approval expires XX/XX/XX

A-21 Which of the following activit ies has been part of the reco rd keeping component of your

storm water program from 2005 - 2009? (Check all that apply.)  Spill response  Construction inspection  Industrial inspection  Illicit discharge detection and elimination  Annual reporting  Other, please describe_____________

 None

A-22 Do you use other departments, governmental ag encies, or contractors to complete any of the following parts of your stormwater program? (Check all that apply.)

□ Designing stormwater controls

□ Constructing stormwater controls

□ Maintaining stormwater controls

□ Inspecting construction stormwater controls

□ Inspecting post-construction stormwater controls

□ Other, Specify: ___________________________________________________

□ None (skip to Question A-24)

A-23 For those parts of your stormwater program that are performed by other departments, governmental agencies, or contractors, do you include any stormwater requirements in your contracts or other binding agreements for the following ac tivities? (Check all that apply.)

Yes No Not applicable Designing stormwater controls □ □ □ Constructing stormwater controls □ □ □ Maintaining stormwater controls □ □ □ Inspecting construction st ormwater controls □ □ □ Inspecting post-constructi on stormwater controls □ □ □ Other, Specify: ________________________ □ □ □

Justification:

A-24 What mechanisms other than ordinan ces do you use to implement your stormwater program? (Check all that apply.)

□ Internal policies

□ Cooperative agreements

□ Third party construction contracts contain stormwater requirements

□ Third party contracts related to operati ng and/or maintaining stormwater control measures contain stormwater requirements

□ Other, Specify: ___________________________________________________

Transportation MS4 Questionnaire Page 21 of 45Survey ID: ________________ OMB Control No. 20XX-XXXX Approval expires XX/XX/XX

A-25 When planning, developing, and designing tran sportation projects, when is storm water management first considered?

□ During the transportation planning proce ss (considering the stormwater management needs of the transportatio n system), Specify: ___________________

□ During the project development (NEPA) process or preliminary design stage for individual projects, Specify: __________________________________________

□ During final design, Specify: ________________________________________

□ Other, Specify: ___________________________________________________

A-26 Which of the following activ ities have been part of th e industrial component of your 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 i ndustrial facilities  Site inspection of co mmercial facilities  Training of inspectors  Other, Specify: ___________________________________________________  None - There is no industrial compone nt in your stormwater program

A- 28 Which of the following activ ities have been part of the construction component of your stormwater program from 2005 - 2009? (Check all that apply.)  Review site plans  Tracking/ inventory of sites  Inspections  Approved construction control manual  Field staff training  Contractor training  Other, please describe_____________

 None - There is no construction co mponent in your stormwater program

A-30 Are there major roadway proj ects that are either under cons truction or in the process of being funded, which have the potential to open rural portions of your state to suburban or urban development over the next three decades?

 Yes

 No  Not applicable

If you answered yes to this question please supply the requested information in the following table for each project that has this pote ntial. If available pl ease attach a map of the project.

Transportation MS4 Questionnaire Page 22 of 45Survey ID: ________________ OMB Control No. 20XX-XXXX Approval expires XX/XX/XX

Project Name Type of project (check one) Anticipated Project Completion

Date Web Address for Additional Project Information (if available)

 New roadway

 Expansion of an existing roadway

 Both an addition of a new road and expansion of an existing roadway

 New roadway

 Expansion of an existing roadway

 Both an addition of a new road and expansion of an existing roadway

 New roadway

 Expansion of an existing roadway

 Both an addition of a new road and expansion of an existing roadway

 New roadway

 Expansion of an existing roadway

 Both an addition of a new road and expansion of an existing roadway

 New roadway

 Expansion of an existing roadway

 Both an addition of a new road and expansion of an existing roadway

Transportation MS4 Questionnaire Page 23 of 45Survey ID: ________________ OMB Control No. 20XX-XXXX Approval expires XX/XX/XX

POST CONSTRUCTION

A-31 Which of the following activit ies have been part of the post construction component of your stormwater program from 2005 - 2009? (Check all that apply.)  Review construction site pl ans for post construction stormw ater water quality and/or water quantity requirements  Tracking/inventory of sites  Tracking/inventory of post-construction practices  Inspections  Field staff training  Contractor training  Inspection and main tenance of practices  Other, please describe_____________

 None

A-32 Who reviews your site plans for stormwater control structures? (Includes reviews for both water quality and quantity concer ns. Check all that apply)

 State  County  Municipality

 EPA

 Self-review  Third party contractor/entity  Other, Specify: __________________________________________________

A-33 For long term (post construc tion) stormwater controls lo cated 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 co nstruction controls on public property

□ MS4 maintains post constructi on controls on public property

□ Other, describe __________________

□ No

A-34 Do you have stormwater controls located on privately-owned properties?

□ Yes

□ No, we do not allow our stormwater cont rols to be located on privately-owned properties

□ Not applicable, Specify: __________________________________________

Transportation MS4 Questionnaire Page 24 of 45Survey ID: ________________ OMB Control No. 20XX-XXXX Approval expires XX/XX/XX



### 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

Bridge repair □ New □ Redevelopment □ Neither

Development extensions that add □ New □ Redevelopment □ Neither imperviousness onto previously undeveloped land, but are part of the same plot/parcel (e.g. a rest stop parking lot is extended into an adjoining forested area)

Reconstruction/ Road widening projects □ New □ Redevelopment □ Neither (e.g. adding a lane or modifying an older roadway to improve safety)

Replacement of impervious surfaces (road □ New □ Redevelopment □ Neither resurfacing, sidewalk replacement, etc)

Pavement structural and joint repair □ New □ Redevelopment □ Neither

Removal or protection of roadside obstacles □ New □ Redevelopment □ Neither

Other, specify ________________________ □ New □ Redevelopment □ Neither

A-36 How many linear square feet have you developed in the last 5 years, if readily available? Provide your best estimate.

Linear Square Feet of New Development Fiscal year

2005 2006 2007 2008 2009 Linear square feet of development



### Stormwater Management: Specific or Numeric Performance Standard and/or Design Criteria for Long ter m (post construction) controls

A-37 Are new development or redevelopment activ ities in your MS4 service area subject to performance and/or design standards for st ormwater retention, volume control, or discharge rate?

□ Yes

□ No (skip to A-48)

Transportation MS4 Questionnaire Page 25 of 45Survey ID: ________________ OMB Control No. 20XX-XXXX Approval expires XX/XX/XX

A-38 What is the enforcement mechanism to assu re that post construction standards or design

criteria are m et?

□ Site inspection

□ Site plan review/approval acceptance

□ Review self-reporting/ self-certification database

□ None, there are no post constructio n standards applied to my MS4

A-39 Do you participate in an alternative pr ogram to compliance with your performance standard or design standard?

□ Yes, it is a stormwater off-site mitigation program; Specify: _______________

□ Yes, it is a payment in lieu program

□ Yes, it is a stormwater crediting program; Specify: _________________

□ Yes, it is a mitigation banking system; Specify: ____________________

□ Yes, there is another type of a lternative compliance program, please 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

A-40 Who determined your MS4’s stormwater pe rformance standards and/or design criteria requirements for long term (post constructio n) 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-41 Is your long term (post cons truction) standard for redevel opment projects different than for new development projects?

□ Yes (Answer questions A-42 – A-44 regarding your standard for new development, answer questions A-45 – A-47 regarding your standard for redevelopment)

□ No (Answer question A-42 – A44 regarding your standard for development, skip questions A45- A47)



### Stormwater Performance Standard a nd/or Design Criteria for (New) Development Projects

A-42 For new development projects, what is the threshol d to which the long term (post construction) stormwater performance sta ndards and/or design criteria apply?

Size of site

□ 1⁄2 acre

□ 1 acre

□ 5,000 sq ft

□ Other: ____________________

Transportation MS4 Questionnaire Page 26 of 45Survey ID: ________________ OMB Control No. 20XX-XXXX Approval expires XX/XX/XX

Other threshold

□ ____quality of im pervious surface

□ Other: ____________________

A-43 Indicate which specific or numeric stor mwater performance standards and/or design criteria requirements apply to new development projects. Please 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 design requirements for stormwater

controls or a citation to th e state law or a web page li nk to the design manual that contains the information).

Note: Standards that require detention or extended detention are those which hold stormwater temporarily and discharge the st ormwater over an extended period of time (hours to days) generally by controlling the si ze of the discharge volume and flow rate. 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, evapotrans pired, 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 vol ume (such as 0.5 inch per acre or 1 inch per impervious acre) ( Specify ) __________

□ Detention of a specified storm volume (suc h as 1,800 cubic feet pe r 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 vol ume (such as 0.5 inch per acre or 1 inch per impervious acre) ( Specify ) __________

□ Retention of a specified storm volume (suc h as 1,800 cubic feet pe r acre or 3,600 cubic feet per impervious acre) ( Specify ) __________

Transportation MS4 Questionnaire Page 27 of 45Survey ID: ________________ OMB Control No. 20XX-XXXX Approval expires XX/XX/XX

□ Retention of a specified percen tile storm event (such as the 80 th percentile storm) ( Specify ) __________

□ Pollutant reduction requirement (for exampl e, stormwater control practices must be installed to remove 80% of the post-cons truction TSS loading and 40% of the postconstruction nitrogen loading) Specify : ____________

□ Channel protection measures (such as a maximum allowable discharge velocity or other metric) Specify : ____________

□ Infiltration/groundwater recharge requireme nt (for example, maintain predevelopment groundwater recharge levels or infilt rate the first 0.5 inch of runoff) Specify : ____________

□ Limits for effluent concentrations of speci fic 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 unde r your control or only to certain sites or

waterbodies?

□ All areas

□ Only certain areas ( Specify : ____________)

□ Flood control requirements other than the peak discharge rate control and on-site detention/retention requirements 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: ___________________

Transportation MS4 Questionnaire Page 28 of 45Survey ID: ________________ OMB Control No. 20XX-XXXX Approval expires XX/XX/XX

A-44 Which type of new development do your storm water perfor mance and/or design

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

□ Requirements are the same for all new development

□ Bridge deck replacement

□ Roadway resurfacing

□ Roadway widening

□ Maintenance yard creation

□ Creation of a roadway bypass or a new roadway

□ Road reconstruction projects

□ Parking lot expansion

□ Pavement structural and joint repair

□ Removal or protection of roadside obstacles

□ Other, Specify: __________



### Stormwater Performance Standards and/or Design Criteria for Redevelopment Projects

A-45 For redevelopment projects in your MS4, what is the thre shold to which long term (post construction) stormwater performance sta ndards and/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-46 Indicate which specific or numeric stor mwater performance standards and/or design criteria requirements apply to redevelopment projects. Please 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 design requirements for stormwater

controls or a citation to th e state law or a web page li nk 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

Transportation MS4 Questionnaire Page 29 of 45Survey ID: ________________ OMB Control No. 20XX-XXXX Approval expires XX/XX/XX

□ Detention of a specified storm depth or vol ume (such as 0.5 inch per acre or 1 inch per impervious acre) ( Specify ) __________

□ Detention of a specified storm volume (suc h as 1,800 cubic feet pe r 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 vol ume (such as 0.5 inch per acre or 1 inch per impervious acre) ( Specify ) __________

□ Retention of a specified storm volume (suc h as 1,800 cubic feet pe r 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 exampl e, stormwater control practices must be installed to remove 80% of the post-cons truction TSS loading and 40% of the postconstruction nitrogen loading) Specify : ____________

□ Channel protection measures (such as a maximum allowable discharge velocity or other metric) Specify : ____________

□ Infiltration/groundwater recharge requireme nt (for example, maintain predevelopment groundwater recharge levels or infilt rate the first 0.5 inch of runoff) Specify : ____________

□ Limits for effluent concentrations of speci fic 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 unde r your control or only to certain sites or

waterbodies?

Transportation MS4 Questionnaire Page 30 of 45Survey ID: ________________ OMB Control No. 20XX-XXXX Approval expires XX/XX/XX

□ All areas

□ Only cer tain areas ( Specify : ____________)

□ Flood control requirements other than the peak discharge rate control and on-site detention/retention requirements 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-47 To which type of redevelopment does your stormwater performance and/or design standards apply (describ ed in Question A-38)?

□ Requirements are the same for all new development

□ Bridge deck replacement

□ Roadway resurfacing

□ Roadway widening

□ Maintenance yard creation

□ Creation of a roadway bypass or a new roadway

□ Road reconstruction projects

□ Parking lot expansion

□ Pavement structural and joint repair

□ Removal or protection of roadside obstacles

□ Other, Specify: __________



### Retrofit of Stormwater Management Practices

The following questions collect information about retrofit practices in you r 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 stor mwater pollutants, or runoff

volume or flow rates.

A-48 Does your MS4 have a st ormwater retrofit program?

□ Yes

□ No (skip)

A-49 What are the components of your retr ofit program? (Check all that apply.)

□ We are required to retrofit

□ We receive incentives for retrofits

Transportation MS4 Questionnaire Page 31 of 45Survey ID: ________________ OMB Control No. 20XX-XXXX Approval expires XX/XX/XX

□ W e initiate retrofits on public property

□ We initiate retrofits on private property

□ Stream restoration is part of our retrofit plan

A-50 Who is responsible for paying for the re trofit projects? (Che ck 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

□ None

A-51 What is the purpose of your stormwater retrofit program? (Check all that apply.)

□ To comply with stormwater permit requirements

□ To address flood control

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

□ Other requirements, such as st ate requirements, please describe

□ Not to meet a requirement listed above, but to address watershed plan or local water quality, habitat or stream st ability or geomorphology concerns

□ Other: ________________________________________

□ Not applicable

A-52 Provide any additional deta ils of your retrofit program.

________________________________________________________________________

________________________________________________________________________

________________________________________________________________________

________________________________________________

A-53 What kind of retrofit proj ects could make the most effective difference in terms of restoring water quality in your area?

________________________________________________________________________

________________________________________________________________________

________________________________________________________________________

________________________________________

Transportation MS4 Questionnaire Page 32 of 45Survey 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 detenti on and retention practices.

Detention or extended detention practices are those which hold stormwater temporarily and discharge the stormwater over an extended pe riod of time (hours to days) generally by controlling the size of the disc harge volume and flow rate. Also known as wet/dry ponds, extended detention basins, deten tion ponds, extended detention ponds.

Questions in this section also refer to the im plementation of retention stormwater practices. These are practices that do not discharge stormwater off-site or to surfa ce water below a certain design capacity (design volume, stormwater size, etc.). The stormwater is infiltrated, evapotranspired, or harvested. Examples are bioret ention cells (includes rain gardens, sidewalk planters, curb extensions and othe r plant or soil systems designed to infiltrate or evapotranspirate stormwater), porous pavement, green roofs, vegeta ted swales, cisterns a nd other practices. These practices are commonly referred to as Low Impact Development (LID) or Green Infrastructure (GI) practices.

A-54 What process do you have for determining whic h stormwater controls are selected for use on your projects? (Check all that apply.)

□ We have a stormwater control testing program.

□ We consult with the permitting authority for an approved list of stormwater controls.

□ The state has a testing program that we reference.

□ We have a process that is part of our retrofit program.

□ We do not have a formal process for approvi ng particular stormwat er controls for use on our projects.

□ We have specific design standa rds that we created and follow.

A-55 (a) Which of the following stormwater cont rols 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 availabl e 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 □ □ □ □

Transportation MS4 Questionnaire Page 33 of 45Survey ID: ________________ OMB Control No. 20XX-XXXX Approval expires XX/XX/XX

Catch Basin Insert □ □ □ □ Underground Detention □ □ □ □ Underground Infiltration □ □ □ □ Infiltration Trench □ □ □ □ Dry well □ □ □ □ Sand filters □ □ □ □ Oil/water separators □ □ □ □

Vegetated Swale □ □ □ □ Constructed Wetland □ □ □ □ Filter Strip/Vegetated Buffer □ □ □ □ Wetland Basin/Channel □ □ □ □ Bioretention cells □ □ □ □ (includes raingardens, sidewalk planters, curb extensions and other plant or soil system s 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 □ □ □ □ Open Graded Friction Course □ □ □ □ Other Controls: _________________ □ □ □ □

A-56 For any construction projects that you have initiated have you completed a cost comparison within the past 5 years between traditional stormwater practices (such as stormwater ponds) and stormwater retention pr actices (as described at the beginning of this section)?

 Yes

 No

Transportation MS4 Questionnaire Page 34 of 45Survey ID: ________________ OMB Control No. 20XX-XXXX Approval expires XX/XX/XX

If so, is the cost data available?

 Yes

 No

A-57 What is the driver for impl ementation of the stormwater re tention practices (as described at the beginning of this section) in your MS4 service area? (Check all that apply.)

□ Stormwater management requirement

□ Flood Control

□ TMDL or other water quality requirement

□ Other: _______________

□ Unknown

□ Not Applicable

A-58 In your MS4 service area, which of the follo wing ordinances or othe r types of regulations

may prevent stormwater retention practices (as descri bed 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 prev ent 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 setbacks/fr ontages (e.g. for metro stati ons or rest stop buildings)

□ 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 st retches of roads)

□ Aesthetic requirements for plantings

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Other Requirements

□ Requirements that may restrict the use of pervious concrete, porous asphalt, modular block pavers, or other alternatives to conventional/impermeable paving materials

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

□ Other: _____________________________________________

A-59 Do 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?

□ Yes

□ No Describe____________________________________________

A-60 In your MS4, are there cate gories or areas excluded from st ormwater infiltration due to concerns for groundwater contamination?

□ Yes

□ No

□ Not applicable, specify: ____________________________________________

A-61 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-62 Are any of the following implemented in your MS4 service area? Check all that apply.

□ Requirements limiting the amount of land that can be disturbed at any given time (e.g. only 20 percent of the land can be distur bed for any project at any given time)

□ Natural area protection

□ Stream restoration/remediation program

□ 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-63 Do you have a master plan or other planning process that projects development over a certain time period (may be done by other de partments or agency in your jurisdiction)?

□ Yes

□ No (skip)

A-64 In the past five years, has flooding occurred within your jurisdiction due to insufficient capacity of your MS4?

□ Yes

□ No (skip to A-67)

□ Don’t know (skip to A-67)

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A-65 Indicate the type of floodi ng that has occurred within your jurisdiction in the past five years due to insufficient capacity of your stor m water conveyance system. (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 damage to privat e property, such as flooding of homes

□ Flooding that caused damage to public prope rty, such as flooding of rest stops or transportation buildings

□ Other, Specify: ____________________

A-66 In general, how frequently do flooding ev ents occur within your jurisdiction due to insufficient capacity of your st ormwater conveyance system?

□ Rarely, or less than once per year

□ Occasionally, or once or twice every year

□ Often, or five or more times per year

A-67 Do you have a program or plan for future capital improvements to address lack of capacity in your stormwater conveyance system?

□ Yes

□ No

□ Not applicable, Specify: ____________________________________________

MONITORING

A-68 Have you performed any of the following type s of monitoring? (Ch eck 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-69 Are you required to perform any type of monitoring of any outfalls as part of your stormwater MS4 permit?

 Yes

 No

A-70 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

□ Not Applicable

A-71 How many outfalls did you mon itor in the last 5 years?

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Outfall Monitoring, FY 2005-2009 Fiscal year

2005 2006 2007 2008 2009

Number of

outfalls

monitored

A-72 Do you conduct monitoring of outfalls for pol lutant 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

A-73 Do you have data indicating any chemical , biological, and/or phys ical changes in the receiving waters to which you discharge st ormwater that you can attribute to your stormwater program (e.g., we saw a reducti on in total nitrogen and an increase in sensitive stream microinvertebrates)?

□ Yes, describe__________________________________________________

□ No

□ Unknown

□ Not Applicable

A-74 Provide any additional co mments for Section A in the space provided below.

_______________________________________________________________

_______________________________________________________________

_______________________________________________________________

_______________________________________________________________

_______________________________________________________________

_______________________________________________________________

_______________________________________________________________

Transportation MS4 Questionnaire Page 38 of 45Survey 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 follo wing activities? (Total must equal 100%) ___% Program administration ( e.g., clerical activities, financial management, NPDES compliance and reporting) ___% Planning and engineering (e.g., surveying and document existing conditions, GIS development and operations, master planning) ___% Capital improvements (e.g., capacity expansion, capital construction, stream restoration, land acquisition, retrofits) ___% Pollution prevention/good housekeeping fo r municipal operations (training for municipal staff on pollution preventi on measures and techniques, regular street sweeping, reducing the us e of pesticides or street salt, or frequent catchbasin cleaning) ___% Other operations and maintenance (e .g., remedial maintenance, emergency response operations) ___% Illicit discha rge detection and elimination ___% Other inspection and enforcement ___% Incentives and rebates for privately initiated stormwater control measures ___% Public education and outreach ___% Public involvement and participation ___% Construction site runoff control progr am for construction activities that

disturb one or more acres ___% Post-construction runoff control pr ogram for new and redeveloped areas ___% Other

Transportation MS4 Questionnaire Page 39 of 45Survey ID: ________________ OMB Control No. 20XX-XXXX Approval expires XX/XX/XX

Funding Questions

The following three questions request inform ation 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-4 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___%

□ Federal Highway Administration Tran sportation Enhancement Activity ____%

□ State Transportation Improve ment Program (STIP) _______%

□ Transportation Improvement Program (TIP) _______%

□ State General Fund

□ Grants (EPA 319 Funds, etc.)

□ Other ___%

B-5 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___%

□ Federal Highway Administration Tran sportation Enhancement Activity ____%

□ State Transportation Improve ment Program (STIP) _______%

□ Transportation Improvement Program (TIP) _______%

□ State General Fund

□ Grants (EPA 319 Funds, etc.)

□ Other ___%

B-6 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___%

□ Combined stormwater/other bonds___%

□ Benefit district bonds___%

□ Other ___%

The next two questions are about the funding of environmental mitigation projects.

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B-7 Do you have an off-site mitigation program that requires dev elopers or property owners to mitigate the impacts of changes to site hydrology?

□ Yes

□ No

B-8 Do you allow for payment-in-lieu of mitigation?

□ Yes

□ No

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

B-9 What is the average number of full time em ployees that your organization has devoted to

stormwater related activities over the past five years? _______________ # of full time employees

B-10 What is the average number of pa rt time employees that your organization has

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

Stormwater Fee Questions

B-9 Does your jurisdiction have the authority to charge and/or in crease stormwater
fees?

□ Yes

□ No

The following five questions pertain to one time , development impact fees charged for property development. These fees are also kno wn as system development charges.

B-10 Do you charge a one-time development f ee 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

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

□ 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 recurrin g stormwater fees char ged 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

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□ $ ____ 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

□ 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 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 answer that best applies.)

□ Yes

□ Yes, only on public property

□ No (skip to B-24)

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B-23 What was the annual retrofit budget and nu m ber 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 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)

B-25 What was the annual budget and miles of str eam 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 rest oration? (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

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Transportation MS4 Questionnaire Page 45 of 45 XX

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

_______________________________________________________________

_______________________________________________________________

_______________________________________________________________

_______________________________________________________________

_______________________________________________________________

_______________________________________________________________

_______________________________________________________________

_______________________________________________________________

_______________________________________________________________

_______________________________________________________________



### Section C: Contact Information

C-1 Provide the contact information for the pe rson who would be able to answer questions regarding this information that was requested in this questionnaire.

Name

_____________________________________________ Title

_____________________________________________ Phone/Fax Number

_____________________________________________ Email

_____________________________________________ Best Time to Contact

_____________________________________________

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

back to the United States Envir onmental Protection Agency. Thank you.