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

 Approval expires XX/XX/XX

United States Environmental Protection Agency 

Stormwater Management 

Including Discharges from Developed Sites 

Non-Federally Regulated 

Municipal Separate Storm Sewer Systems (MS4s) 

Questionnaire 

Survey ID: ________________ 

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

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

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

average 1 hour per response. Send comments on the Agency's need for this information, the 

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

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

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

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

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

Owner/Developer Short Questionnaire Page 1 of 23
OMB Control No. 20XX-XXXX 

 Approval expires XX/XX/XX

Purpose of the Questionnaire 

Stormwater discharges from developed land can negatively impact water quality through 

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

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

the current National Pollutant Discharge Elimination System (NPDES) regulations including the 

establishment of standards for long term stormwater discharges from developed sites. 

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

strengthened, and to support the technical and financial feasibility associated with this 

rulemaking, EPA is sending the following questionnaire to MS4s that are not currently regulated 

by EPA’s municipal stormwater program. This questionnaire will provide EPA with information 

to: 

 Characterize the current scope and components of existing stormwater program at MS4s 

not subject to EPA’s municipal stormwater program; and 

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

on stormwater discharges. 

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

 Section A: Technical Information 

 Section B: Financial Information

Owner/Developer Long Questionnaire Page 2 of 23 
OMB Control No. 20XX-XXXX 

 Approval expires XX/XX/XX

General Information, continued 

Authority 

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

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

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

the completed questionnaire for your files. EPA may contact you with follow-up questions to 

clarify your answers. Late filing of the questionnaire, or failure to follow any related EPA 

instruction, may results in civil penalties, criminal fines, or other sanctions provided by law 

including the possibility of fines and imprisonment as explained in Section 308 of the Clean 

Water Act (33 U.S.C., Section 1318). 

When to Complete the Questionnaire 

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

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

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

date of this questionnaire. Written requests may be e-mailed to Mr. Brian D’Amico at 

damico.brian@epa.gov. 

Certification Statement 

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

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

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

the following address: 

 U.S. Environmental Protection Agency 

Stormwater Management Including Discharges from New Developed and Redeveloped 

Sites MS4 Questionnaire 

c/o Eastern Research Group, Inc. 

14555 Avion Parkway, Suite 200 

Chantilly, VA 20151 

Where to Get Help 

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

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

you are responding, the question number along with your questions. Respondents who desire 

assistance by telephone should send an e-mail with “Please Call Me” in the subject line. Please 

provide the call-back phone number, contact name, and desired day and time to call. The return 

phone call will be free of charge to the respondent. 

E-mail address for help line: _________________________________ 

Owner/Developer Long Questionnaire Page 3 of 23 
OMB Control No. 20XX-XXXX 

 Approval expires XX/XX/XX

Confidential Business Information 

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

make the information available to the public without further notice. 

Owner/Developer Long Questionnaire Page 4 of 23 
OMB Control No. 20XX-XXXX 

 Approval expires XX/XX/XX

Detailed Instructions for Completing the Questionnaire 

Complete the questionnaire considering the following instructions: 

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

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

complete that section of the questionnaire. 

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

attention to the distinction between establishments and firms. 

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

applicable, write “NA.” 

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

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

some respondents. 

 Use the units specified when responding to questions requesting measurement data (e.g., 

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

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

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

recommending that respondents collect new data to provide information for this survey. 

Owner/Developer Long Questionnaire Page 5 of 23 
OMB Control No. 20XX-XXXX 

 Approval expires XX/XX/XX

Certification Statement 

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

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

Statement below before returning both documents to the U.S. Environmental Protection Agency. 

The certifying official must be an MS4 official duly authorized representative. The Certification 

Statement must be printed, signed and submitted in accordance with the requirements contained 

in the Code of Federal Regulations at 40. CFR 122.22. 

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

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

properly gathered and evaluated the information submitted. The information submitted is, to the 

best of my knowledge and belief, accurate and complete. In those cases where we did not possess 

the requested information, we have provided best engineering and/or financial estimates or 

judgment. I am aware that there are significant penalties for submitting false information, 

including the possibility of fines and imprisonment as explained in Section 308 of the Clean 

Water Act (33 U.S.C., Section 1318). 

_____________________________ _________________________ 

Signature of Certifying Official Date 

_____________________________ _(______)_________________ 

Printed Name of Certifying Official Telephone Number 

_____________________________ 

Title of Certifying Official 

Owner/Developer Long Questionnaire Page 6 of 23 
OMB Control No. 20XX-XXXX 

 Approval expires XX/XX/XX

Definitions 

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

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

sheets, etc. We acknowledge that there are likely local or regional differences in the meanings of 

some of these terms. Where those differences will affect their answer to the questions, 

respondents should provide information on those differences in the survey blanks provided. 

Term Definition 

The period of time during which construction activity is 

occurring on a site and prior to the time that disturbed 

portions of the site are considered stabilized. 

Active construction 

Landscaping features adapted to provide on-site removal of 

pollutants from stormwater runoff. Surface runoff is 

directed into shallow, landscape depressions, which are 

designed to incorporate many of the pollutant removal 

mechanisms that operate in forested or other natural 

(prairies, wetlands, etc) ecosystems. Includes rain gardens, 

sidewalk planters, curb extensions and other plant or soil 

systems designed to infiltrate or evapotranspirate 

stormwater. 

Bioretention cells 

An inlet to the storm sewer system, which typically 

includes a grate or curb inlet, and a sump, to capture 

sediment, debris, and other pollutants. Also known as 

“storm drain inlets” or “curb inlets”. 

Catch Basin 

Retractable or non-retractable devices inserted into catch 

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

sediments from stormwater runoff, and to improve the 

efficiency of the catch basin. Inserts can either be dropped 

directly into the catch basin, or may require retrofit 

construction. Examples include filter fabrics and a system 

of trays with media filters. 

Catch Basin Insert 

Large storage devices that are often built below ground, at 

ground level, or on rooftops, for storing captured 

stormwater and can be integrated with more sophisticated 

pumping devices. For example, some cisterns collect 

stormwater that is subsequently used for non-potable 

plumbing, such as flushing of toilets, or irrigation 

applications. 

Cistern 

Combined Sewer 

System (CSS) 

A publicly owned conveyance system that discharges 

stormwater runoff combined with municipal sewage 

(domestic, commercial and industrial wastewater) through 

a single pipe system to a publicly owned treatment works. 

Owner/Developer Long Questionnaire Page 7 of 23 
OMB Control No. 20XX-XXXX 

 Approval expires XX/XX/XX

Term Definition 

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

gravel, rock, organic materials, etc.), plants (vascular and 

non-vascular), and organisms similar to those usually 

found in natural wetlands. The number of plants and the 

biodiversity of a constructed wetland are greater than that 

of wet retention pond. Constructed wetlands usually use a 

relatively impermeable subsurface layer to prevent water 

from seeping into the ground. 

Constructed 

Wetland 

Construction 

Activity 

Clearing, grading, excavation, and other earth-disturbing 

activities. 

A permitting arrangement under which two or more MS4s 

are covered under the same NPDES permit. 

Responsibilities under the permit may be divided among 

the different MS4 co-permittees in accordance with 

jurisdictional boundaries. 

Co-Permittee 

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 runoff 

to a storm sewer system. 

Curb and Gutter 

Practices which hold stormwater temporarily and discharge 

the stormwater over an extended period of time (hours to 

days) generally by controlling the size of the discharge 

volume and flow rate. Also known as “wet/dry ponds”, 

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

detention ponds.” 

Detention/ 

Extended Detention 

Practices 

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. 

Dry Well 

Vegetated surfaces used to reduce stormwater velocity 

from nearby less pervious surfaces, and to filter out 

pollutants from stormwater and allow infiltration into the 

underlying soil. Also referred to as “riparian buffer” if 

established around streams, lakes, and/or wetlands. 

Filter Strip / 

Vegetated Buffer 

Full Time 

Equivalent (FTE) 

The number of full-time employees that could have been 

employed if the reported number of hours worked by parttime 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. 

Owner/Developer Long Questionnaire Page 8 of 23 
OMB Control No. 20XX-XXXX 

 Approval expires XX/XX/XX

Term Definition 

A vegetative system installed on top of and in addition to 

the traditional roof system. A green roof includes 

engineered soil layers (e.g., a waterproof membrane, 

drainage, high inorganic growing media), and appropriate 

plant species. Green roofs reduce surface runoff from the 

rooftop by absorbing stormwater and slowing stormwater 

flow rates, and provide ancillary benefits such as summer 

cooling, lowered urban heat island effect, and improved air 

quality. 

Green Roof 

Wet weather management approaches and technologies 

that infiltrate, evapotranspire, capture and reuse stormwater 

to maintain or restore natural hydrology. 

Green Infrastructure 

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

buildings and associated constructed facilities; areas that 

are covered with a low-permeability material such as 

asphalt or concrete; or areas such as gravel roads and 

unpaved parking areas that are compacted through design 

or use to reduce their permeability. Common impervious 

areas include, but are not limited to, roads, rooftops, 

walkways, patios, driveways, parking lots or storage areas, 

concrete or asphalt paving, packed earthen materials, and 

macadam or other surfaces which similarly impede the 

natural infiltration of storm water. 

Impervious Area 

A facility engaged in any of the industrial activities 

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

designated as causing a water quality standard exceedance 

or is a significant contributor of pollutants to waters of the 

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

Industrial Facility 

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. 

Infill Development 

A shallow rock-filled trench or depression with no outlet 

intended to detain and then infiltrate stormwater into the 

underlying soil. Typically stormwater first passes through a 

swale or other stormwater control before reaching this 

device. 

Infiltration Basins 

and Trenches/Dry 

Well 

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 runoff close to its 

source. 

Low Impact 

Development (LID) 

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. 

Owner/Developer Long Questionnaire Page 9 of 23 
OMB Control No. 20XX-XXXX 

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Term Definition 

A conveyance or system of conveyances (including roads 

with drainage systems, municipal streets, catch basins, 

curbs, gutters, ditches, man-made channels, or storm 

drains) that is owned by a state, city, town, village, or other 

public entity having jurisdiction over disposal of sewage, 

industrial wastes, stormwater, or other wastes, including 

special districts under state law such as a sewer district, 

flood control district or drainage district, or similar entity, 

or an Indian tribe or an authorized Indian tribal 

organization, or a designated and approved management 

agency under section 208 of the CWA that discharges to 

waters of the U.S., which is not a combined sewer, and 

which is not part of a Publicly Owned Treatment Works 

(sewage treatment plant). 

Municipal Separate 

Storm Sewer 

System (MS4) 

Area over which an MS4 operator has jurisdiction to 

collect and dispose of stormwater. MS4 Service Area 

Development that occurs on an existing lot/parcel that has 

a land cover that is predominantly natural vegetation and 

generally includes no or minimal structures and other 

impervious surfaces, such as rooftops, parking lots, roads, 

and buildings. These sites are commonly referred to as 

“Greenfield sites.” 

New Development 

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

Elimination System” program for issuing, modifying, 

revoking and reissuing, terminating, monitoring and 

enforcing permits under the authority of the Clean Water 

Act. 

NPDES 

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

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

The term “outfall” does not include open conveyances 

connecting two MS4s, or pipes, tunnels or other 

conveyances which connect segments of the same stream 

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

of the U.S. 

Outfall 

Permeable 

Pavement 

Pavement composed of a permeable pavement material, 

which allows distributed infiltration into the underlying 

soil. There may also be an underlying stone reservoir that 

temporarily stores the surface runoff before it infiltrates 

into the underlying soil. Examples include pervious 

concrete, porous asphalt, permeable pavers. 

Owner/Developer Long Questionnaire Page 10 of 23 
OMB Control No. 20XX-XXXX 

 Approval expires XX/XX/XX

Term Definition 

Describes the phase of development immediately following 

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

developed sites. Post-construction controls are those 

stormwater controls that are installed and maintained to 

permanently manage stormwater discharged from the 

developed sites. 

Post Construction 

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

other municipal entity. Includes special districts under 

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

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

authorized Indian tribal organization, or a designated and 

approved management agency. 

Public Entity 

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

university. 

Redevelopment 

Development at a site with existing development, which 

will result in any alteration of the preexisting structures 

and/or other impervious surfaces. Redevelopment does not 

include alterations to the interior of an existing structure. 

Stormwater techniques that manage stormwater on-site 

through infiltration, evapotranspiration, or harvesting. 

Commonly referred to as Low Impact Development or 

Green Infrastructure practices. 

Retention Practices 

The installation or modification of stormwater control 

measures on sites with existing development (including 

existing storm sewers) to enhance the reduction of 

stormwater pollutants, or runoff volume or flow rates. 

Retrofit 

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.” 

Riparian Buffer 

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. 

Site plan review 

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). 

Soil Amendments 

Storm Sewer 

System 

A conveyance or system of conveyances, including roads 

with drainage systems, municipal streets, catch basins, 

curbs, gutters, ditches, manmade channels, or storm drains 

designed or used for collecting or conveying stormwater. 

Owner/Developer Long Questionnaire Page 11 of 23 
OMB Control No. 20XX-XXXX 

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Term Definition 

Stormwater Runoff, snowmelt runoff, and surface runoff and drainage. 

Practices that are installed and maintained to control 

stormwater discharges. Stormwater Control 

Stormwater Quality 

Control 

Stormwater control used to reduce or eliminate pollutants 

carried in stormwater discharges. 

Stormwater 

Quantity Control 

Stormwater control used to control or convey the volume 

of water being discharged during storm conditions. 

An assemblage of perforated pipes, drain tiles, or other 

similar mechanisms intended to distribute fluids below the 

surface of the ground. This could include a seepage pit, 

infiltration trench, or commercially manufactured 

stormwater infiltration device if it has a subsurface fluid 

distribution system. 

Subsurface fluid 

distribution system 

A broad, shallow channel used for conveying and 

management stormwater runoff. Grass on the side slopes 

and bottom acts to slow runoff velocity, trap particulates, 

and promote infiltration. Grassed swales are often referred 

to as bio-swales, enhanced swales, or water quality swales 

and can be classified as wet swales, dry swales, and 

grassed channels. See Swales: Other Vegetation. 

Swales: Grassed 

A broad, shallow channel used for conveying stormwater 

runoff. Vegetation on the side slopes and bottom acts to 

slow runoff velocity, trap particulates, and promote 

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

be classified as wet swales, dry swales, and grassed 

channels. 

A dry swale (bio-swale) incorporates additional elements 

with the vegetated swale design. Infiltration is aided by a 

soil bed (not necessarily natural soil) with an underdrain 

system composed of a perforated pipe surrounded by 

gravel. Check dams may be used to temporarily retain 

stormwater runoff. 

Swales: Other 

vegetation 

A wet swale is capable of temporarily retaining stormwater 

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

system. The wet swale is marshlike and relies on and 

supports wetland vegetation 

Tree Box 

Stormwater controls that direct stormwater discharges to a 

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

Some tree boxes may drain to a channel below, which 

conveys stormwater to the selected collection system. 

Underground 

Detention 

Underground vaults, storage cells, or water piping systems 

used for stormwater flow rate and volume control. This is 

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

Owner/Developer Long Questionnaire Page 12 of 23 
OMB Control No. 20XX-XXXX 

 Approval expires XX/XX/XX

Term Definition 

Describes land that has not been subject to prior 

development. See “new development.” Undeveloped 

A land area comprising one or more places — central 

place(s) — and the adjacent densely settled surrounding 

area — urban fringe — that together have a residential 

population of at least 50,000 and an overall population 

density of at least 1,000 people per square mile. Any MS4 

located within a 2000 Census-defined “urbanized area” is 

required to obtain an NPDES permit for discharges from its 

storm sewer system. 

Urbanized Area 

Similar to wet and dry ponds, stormwater control structure 

that incorporates wetland plants. Storm runoff is directed 

into the basin to control both water quality and quantity. 

Basin outlets are designed to detain and treat the 

stormwater runoff: 1) for a minimum duration (e.g., 24 

hours) for no permanent pool and 2) until the water is 

displaced by runoff from a later storm (permanent pool). 

Wetland Basin 

(Permanent Pool 

and No Permanent 

Pool) 

Owner/Developer Long Questionnaire Page 13 of 23 
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: ____________________________________________ 

 

Owner/Developer Long Questionnaire Page 14 of 23 
OMB Control No. 20XX-XXXX 

 Approval expires XX/XX/XX

A-4 What is the population, total area, and estimated percent impervious area of the entire 

jurisdiction as of 2009. Provide your best estimate. 

Entire Jurisdiction 

Population 

Population density 

Total Area 

Percent Impervious Area 

A-5 How is stormwater conveyed in your jurisdiction? Check all that apply. 

□ Separate storm sewer 

□ Combined sewer system 

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

to a stream, swales, natural conveyances such as ditches or gullies, ephemeral drainages) 

□ Other, specify ____________________________________ 

A-6 Are you the owner and operator of the separate storm sewer in your jurisdiction? 

□ Yes 

□ No 

 If no, who is the owner and operator of the separate storm sewer in your jurisdiction? 

Specify ____________________________________ 

A-7 Does your MS4 have an ordinance or other regulatory mechanism to address the 

following: 

□ Prohibit non-stormwater discharges into your storm sewer system 

□ Require erosion and sediment controls, including sanctions to ensure compliance, for 

 construction activity 

□ Address post-construction runoff from new development and redevelopment projects 

□ Other type of stormwater ordinance, Specify: 

 __________________________________________ 

□ No ordinances address stormwater quality. 

A-8 Does your MS4 do site plan review of proposed construction projects for stormwater 

 quality and quantity control structures? 

□ Yes 

□ No 

A-9 Do you currently have a stormwater management program (beyond just flood control)? 

 □ Yes 

 □ No [skip remaining questions] 

A-10 How many years has your stormwater management program been in place? 

 ________ # years 

Owner/Developer Long Questionnaire Page 15 of 23 
OMB Control No. 20XX-XXXX 

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A-11 If public education and outreach are components of your stormwater program, which of 

 the following activities have been part of your program? Check all that apply. 

 Brochures, fact sheets, guides, or similar documents 

 Radio features 

 Television advertisements 

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

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

 Staff training 

 Contractor training 

 Storm drain stenciling 

 Stormwater hotlines 

 Tributary signage 

 Website 

 Car washing public program 

  Other, describe_____________ 

 Public education is NOT part of our stormwater program 

A-12 If public involvement has been a component of your stormwater program, which of the 

following activities has been part of your program? 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_____________ 

 Public involvement is NOT part of our stormwater program 

A-13 If illicit discharge detection and elimination is a component of your stormwater program, 

which of the following activities has been part of your program? Check all that apply. 

 Paper tracking/inventory of outfalls 

 Database tracking/inventory of outfalls 

 Storm sewer system mapping 

 Field staff training (to identify and eliminate illicit discharges) 

 Field/indicator sampling 

 Laboratory analyses 

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

probability of illicit discharges may be higher) 

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

  Other, describe_____________ 

 Illicit discharge detection is NOT part of our stormwater program 

A- 14 If regulation of discharges from active construction sites is a component of your 

stormwater program, which of the following activities has been part of your program? 

Check all that apply. 

Owner/Developer Long Questionnaire Page 16 of 23 
OMB Control No. 20XX-XXXX 

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 Review site plans 

 Tracking/ inventory of sites

 Inspections 

 Field staff training

 Contractor training

 Other, describe_____________ 

 Regulation of active construction is NOT part of our stormwater program 

A-15 How many active construction starts have occurred in your MS4 in the last 5 years, 

 including both residential and non-residential starts? 

Number of active construction starts, FY 2005-2009

Fiscal year

2005 2006 2007 2008 2009 

Residential 

construction 

sites 

Nonresidential 

construction 

sites 

□ My MS4 does not track active construction starts 

A-16 If regulation of post construction discharges is a component of your stormwater program, 

which of the following activities have been part of your program? Check all that apply. 

 Review construction site plans for post construction stormwater water quality and/or 

water quantity requirements 

 Tracking/ inventory of sites

 Tracking/inventory of post-construction practices 

 Inspections of practices

 Maintenance of practices

 Field staff training

 Contractor training

 Other, describe_____________ 

 Regulation of post construction discharges is NOT part of our stormwater program 

A-17 If pollution prevention/good housekeeping are components of your stormwater program, 

which of the following activities have been part of your program? 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) 

Owner/Developer Long Questionnaire Page 17 of 23 
OMB Control No. 20XX-XXXX 

 Approval expires XX/XX/XX

 Street sweeping activities

 Pesticide/herbicide application and management requirements 

 Fertilizer application and management requirements 

 Field staff training

 Contractor training

  Other, describe_____________ 

 Pollution prevention/good housekeeping is NOT part of our stormwater program 

A-18 Which of the following additional program components are part of your stormwater 

 program? Check all that apply. 

__ Outfall monitoring 

__ Monitoring of specific stormwater controls 

__ Instream monitoring 

 __ Implementation of watershed management plans 

 __ MS4 training programs 

 __ Source control (limits on fertilizer or pesticides) 

__ Industrial Inspections 

 __ Other, describe___________________________ 

SPECIFIC STORMWATER CONTROLS 

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

your MS4 including both detention and retention practices. 

Detention or extended detention practices are those which hold stormwater temporarily and 

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

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

extended detention basins, detention ponds, extended detention ponds. 

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

These are practices that do not discharge stormwater off-site or to surface water below a certain 

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

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

planters, curb extensions and other plant or soil systems designed to infiltrate or evapotranspirate 

stormwater), porous pavement, green roofs, vegetated swales, cisterns and other practices. These 

practices are commonly referred to as Low Impact Development (LID) or Green Infrastructure 

(GI) practices. 

A-19 (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? 

Owner/Developer Long Questionnaire Page 18 of 23 
OMB Control No. 20XX-XXXX 

 Approval expires XX/XX/XX

(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 □ □ □ □

Filter Strip/Vegetated Buffer □ □ □ □

Wetland Basin/Channel □ □ □ □

Bioretention cells □ □ □ □

(includes raingardens, sidewalk 

planters, curb extensions and other 

plant or soil systems designed to 

infiltrate or evapotranspirate stormwater) 

Trees/Tree Box □ □ □ □

Media Filters □ □ □ □

Green Roof/ Ecoroof □ □ □ □

Riparian Buffers □ □ □ □

Extended Filtration □ □ □ □

(underdrained raingarden) 

Soil Amendment □ □ □ □

Permeable concrete/Permeable 

Asphalt/ Pavers □ □ □ □

Cistern □ □ □ □

Rain Barrel □ □ □ □

Downspout disconnection □ □ □ □

Native vegetation/landscaping 

planting requirements □ □ □ □

Xeriscaping or water 

efficient planting designs □ □ □ □

Conservation/protection 

of green open space □ □ □ □

Owner/Developer Long Questionnaire Page 19 of 23 
OMB Control No. 20XX-XXXX 

 Approval expires XX/XX/XX

Reduced Lot/Parcel Size□ □ □ □

Other Controls: _________________ □ □ □ □

Owner/Developer Long Questionnaire Page 20 of 23 
OMB Control No. 20XX-XXXX 

 Approval expires XX/XX/XX

Section B: Financial Information 

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

operating budget. 

 

Annual Budget ($) 

Fiscal Year 

2005 2006 2007 2008 2009 

Total 

Operating 

Budget 

Stormwater 

Related 

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

□ January □ July 

□ February □ August 

□ March □ September 

□ April □ October 

□ May □ November 

□ June □ December 

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) 

___% Reporting 

___% Developing stormwater management plan (SWMP) 

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

 expansion, capital construction, stream restoration, land acquisition or retrofits 

 (e.g., surveying and document existing conditions, GIS development and 

 operations, master planning) 

___% Planning and engineering for other MS4 activities 

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

___% Monitoring 

___% Public education and outreach 

___% Public involvement and participation 

___% Illicit discharge detection and elimination 

___% Construction site runoff control program for construction activities that 

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

Owner/Developer Long Questionnaire Page 21 of 23 
OMB Control No. 20XX-XXXX 

 Approval expires XX/XX/XX

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

 (tracking, inspections, operation and maintenance) 

___% Pollution prevention/good housekeeping for municipal operations (operation and 

 maintenance, developing stormwater pollution prevent plan (SWPPP), 

 training for municipal staff on pollution prevention measures and techniques, 

 regular street sweeping, reducing the use of pesticides or street salt, or 

 frequent catch-basin cleaning) 

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

___% Incentives and rebates for privately initiated stormwater control measures 

___% Other, describe______________________ 

Funding Questions 

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

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

maintenance, capital improvements, and capital debt financing. 

 

B-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___% 

□ 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___% 

□ 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 ___% 

Owner/Developer Long Questionnaire Page 22 of 23 
OMB Control No. 20XX-XXXX 

 Approval expires XX/XX/XX

Owner/Developer Long Questionnaire Page 23 of 23 

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

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