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 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 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 comp leted questionnaire to this address.

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



### Purpose of the Questionnaire

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

increases in stormwater volume and increased pollutant loads to the receiving waters. To strengthen its stormwater regulations, 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 regarding how the nation’s st ormwater regulations should be strengthened, and to support the technical and financial feasibility associated with this rulemaking, EPA is sending the following questionnair e 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 municipa l stormwater program; and

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

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

 Section A: Technical Information

 Section B: Financial Information

Owner/Developer Long Qu estionnaire Page 2 of 23OMB Control No. 20XX-XXXX Approval expires XX/XX/XX



### General Information, continued

Authority

E PA 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: _________________________________

Owner/Developer Long Qu estionnaire Page 3 of 23OMB Control No. 20XX-XXXX Approval expires XX/XX/XX

Confidential Business Information

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

make the information available to the public without further notice.

Owner/Developer Long Qu estionnaire Page 4 of 23OMB Control No. 20XX-XXXX Approval expires XX/XX/XX



### Detailed Instructions for Co mpleting the Questionnaire

Complete the questionnaire consid ering the following instructions:

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

 Personnel most knowledgeable about the 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.

Owner/Developer Long Qu estionnaire Page 5 of 23OMB Control No. 20XX-XXXX Approval expires XX/XX/XX



### C ertification Statement

T he 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

Owner/Developer Long Qu estionnaire Page 6 of 23OMB Control No. 20XX-XXXX Approval expires XX/XX/XX



### Definitions

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

These definitions were written as 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 The period of tim e during which construction activity is occurring on a site and prio r 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) ecosys tems. Includes rain gardens, sidewalk planters, curb extens ions 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 inle t, 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 rem oval 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 ba sin, or may require retrofit construction. Examples include filter fabrics and a system of trays with media filters. Catch Basin Insert

Large sto rage 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 subseq uently 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 i ndustrial wastewater) through a single pipe system to a publicly owned treatment works.

Owner/Developer Long Qu estionnaire Page 7 of 23OMB 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 we tland are greater than that of wet retention pond. Construc ted 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 perm itting arrangement under which two or more MS4s

are covered under the sa me 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 storm water through the use of a raised, concrete or stone border along a roadside (curb) and a channel (gutter) th at directs stormwater runoff

to a storm sewer system. Curb and Gutter

Practices which hold stormwater temporarily and discharge

the storm water 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 sink hole, or subsurface fluid distribution system, completed above the water table

so that its bottom and sides ar e typically dry except when receiving fluids. Dry Well

Vegetated s urfaces 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 numb er of hours worked by parttime employees had been worked by full-time employees.

This statistic is calculated se parately 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 Qu estionnaire Page 8 of 23OMB 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 grow ing 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 is land effect, and improved air quality. Green Roof

Wet weather m anagement appr oaches 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 constr uc ted 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, p acked earthen materials, and macadam or other surfaces which similarly impede the

natural infiltration of storm water. Impervious Area

A facility en gaged in any of the industrial activities specifically listed in 40 CF R 122.26(b)(14) or has been designated as causing a wate r 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 d evelopment activity that occurs on a generally undeveloped lot/parcel that is s ituated in an area in which most lots/parcels have already been developed. Infill Development

A shallow r ock-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. Infiltration Basins and Trenches/Dry

Well

Developm ent that is designed to be hydrologically functional by mimicking pre-development hydrology

conditions. This is achiev ed 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 Qu estionnaire Page 9 of 23OMB Control No. 20XX-XXXX Approval expires XX/XX/XX

Term Definition A conveyance or system of conveyances (including roads with drainage system s, muni cipal streets, catch basins, curbs, gutters, ditches, man-made channels, or storm drains) that is owned by a state, city, town, vill age, or other public entity having jurisdicti on over disposal of sewage, industrial wastes, stormwater , or other wastes, including special districts under state la w 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 w hich an MS4 opera tor has jurisdiction to collect and dispose of stormwater. MS4 Service Area

Developm ent that occurs on an existing lot/parcel that has a land cover that is predomin antly natural vegetation and generally includes no or mini mal 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 “Nati onal Pollutant Discharge

Elim ination System” program for issuing, modifying, revoking and reissuing, term inating, monitoring and enforcing permits under the authority of the Clean Water

Act. NPDES

Describes th e 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 pi pes, 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 unde rlying 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 23OMB Control No. 20XX-XXXX Approval expires XX/XX/XX

Term Definition Describes the phase of developm ent immediately following

the termination of constructi on 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. Post Construction

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

other m unicipal entity. In cludes 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. 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 interi or of an existing structure.

Storm water techniques that manage stormwater on-site through infiltration, evapotra nspiration, or harvesting. Commonly referred to as Lo w Impact Development or Green Infrastructure practices. Retention Practices

The installation or m odificat ion of stormwater control measures on sites with existing development (including existing storm sewers) to enhance the reduction of stormwater pollutants, or r unoff volume or flow rates. Retrofit

An area surrounding a shoreline, wetland, or stream within which developm ent 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 developm ent site plans for conformance with stormwater control requirements, such

as sediment and erosion c ontrols, and post-construction

controls. Site plan review

Mater ial(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, muni cipal streets, catch basins, curbs, gutters, ditches, manmade channels, or storm drains designed or used for collecti ng or conveying stormwater.

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

Term Definition

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

Practices that are installed and m aintained 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 assem blage 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 co mmercially manufactured

stormwater infiltration device if it has a subsurface fluid distribution system. Subsurface fluid distribution system

A broad, shallow channel used for conveying and

m anagement stormwater runoff. Grass on the side slopes

and bottom acts to slow runoff velocity, trap particulates, and promote infiltration. Grasse d 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. Vege tation on the side slopes and bottom acts to slow runoff 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. Infiltration is aided by a soil bed (not necessarily natu ral soil) with an underdrain system composed of a perforated pipe surrounded by gravel. Check dams may be us ed 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 collec tion 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).

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

Term Definition

Describes land that has no t been sub ject to prior development. See “new development.” Undeveloped

A land area com prising one or more places — central place(s) — and the adjacent densely settled surrounding area — urban fringe — that t ogether 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-d efined “urbanized area” is required to obtain an NPDES permit for discharges from its

storm sewer system. Urbanized Area

Sim ilar to wet and dry ponds, stormwater control structure that incorporates wetland plan ts. Storm runoff is directed

into the basin to control bot h 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 23OMB 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 23OMB Control No. 20XX-XXXX Approval expires XX/XX/XX

A-4 What is the population, total area, and estim ated percent impervious area of the entire jurisdiction as of 2009. Provi de 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. unp iped/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 opera tor 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 ot her regulatory mechanism to address the following:

□ Prohibit non-stormwater discharg es into your storm sewer system

□ Require erosion and sediment controls, incl uding 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 construc tion projects for stormwater quality and quantity control structures?

□ Yes

□ No

A-9 Do you currently have a stormwater mana gement 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 23OMB Control No. 20XX-XXXX Approval expires XX/XX/XX

A-11 If public education and outr each are components of your st ormwater 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 (conf erence participation, earth day events, fairs, etc.)  Staff training  Contractor training  Storm drain stenciling

 Stormwater hotlines  Tributary signage

 Website  Car washing public program  Other, describe_____________  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 pa rt of our stormwater program

A-13 If illicit discharge detecti on and elimination is a component of your stormwater program, which of the following activities has been pa rt of your program? Check all that apply.  Paper tracking/inventory of outfalls  Database tracking/inventory of outfalls  Storm sewer system mapping  Field staff training (t o identify and eliminate illicit discharges)  Field/indicator sampling  Laboratory analyses  Priority area 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)  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 ac tivities has been part of your program? Check all that apply.

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

 Review site plans  Tracking/ inventory of sites  Inspections  Field staff training  Contractor training  Other, describe_____________  Regulation of active cons truction 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 residentia l and non-residential starts?

Number of active constr uction 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 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 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 ar e 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 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)

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

 Street sweeping activities  Pesticide/herbicide applicati on and management requirements  Fertilizer application a nd 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 fe rtilizer 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 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-19 (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?

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

Reduced Lot/Parcel Size □ □ □ □

Other Controls: _________________ □ □ □ □

Owner/Developer Long Questionnaire Page 20 of 23OMB 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 2008 2007 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 im provement 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 (i nventory of facilities or inspections) ___% Monitoring ___% Public education and outreach ___% Public involvement and participation ___% Illicit discha rge detection and elimination ___% Construction site runoff control progr am for construction activities that

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

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___% Post-construction runoff control pr ogram for new and redeveloped areas (tracking, inspections, op eration and maintenance) ___% Pollution prevention/good housekeeping fo r municipal operations (operation and maintenance, developing stormwater pollution prevent plan (SWPPP), training for municipal staff on polluti on prevention measures and techniques, regular street sweeping, reducing the us e 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 23OMB 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 Envir onmental Protection Agency. Thank you.