CHESTERFIELD COUNTY
DEPARTMENT OF ENVIRONMENTAL ENGINEERING
OPERATION AND MAINTENANCE INSPECTION RECORD
1. A licensed professional engineer or certified inspector must conduct all inspections utilizing the approved
construction plans.
2. As a minimum, all items must be inspected, and note any discrepancies or necessary repairs needed. Include
estimated cost of necessary repairs or actions.
3. Upon completion of the inspection, indicating estimated completion date and cost of noted discrepancies and
repairs, it is to be forwarded by the inspection firm to: Chesterfield County, Department of Environmental
Engineering, Attn: BMP Section, P.O. Box 40 Chesterfield, VA 23832. The original form must be forwarded to
the owner of the facility for signature by the organization's representative.
4. The facility owner's representative must indicate on his/her photocopy the actual completion date and actual cost
of acquired repairs and return the form to: Chesterfield County, Department of Environmental Engineering Attn:
BMP Section, P.O. Box 40 Chesterfield, VA 23832
Project Name:
Facility ID:
Facility Address:
Inspection Date:
Facility Owner:
Facility Type:
Inspection Item
YES NO N/A If YES Describe Required Repairs
Estimated Cost
Of Repairs
DAMS AND EMBANKMENTS
Are there any trees, bushes, fallen
trees, or unwanted growth present?
Are bare spots, cracks, depressions or
erosion present?
Evidence of rodent or wildlife,
vehicle, or pedestrian damage?
Is there any evidence of seepage/sinkholes?
Bridges that are present, in need of
repair or replacement?
PRINCIPAL, OVERFLOW, OR EMERGENCY SPILLWAY/ INLET/OUTLET STRUCTURES
Are there any obstructions present?
(Debris or Trash)
Is there any separation of joints, cracks,
breaks, or deterioration of concrete?
Is there signs of differential settlement,
undermining, or seepage?
Is there sediment buildup?
Is there scouring/ blockage, separation,
undermining, rock missing, wildlife
damage at the inlet or outlet?
Outfall- Plunge pool/rock reworking,
debris, overgrowth present?
For Internal Use Only
Page 1 of 4
OPERATION AND MAINTENANCE INSPECTION RECORD
Page 2 of 4
Project Name:
Inspection Item
YES
NO
N/A
If YES Describe Required Repairs
Estimated Cost
Of Repairs
RISER AND TRASH RACK
Is the riser or trash rack less than vertical?
Is the riser, trash rack, or anti vortex
separated or in need of repair?
Is the stone cone, energy dissipater, or riser
grate less than fully functional/ in need of
repair?
Are low flow perforations clogged or
damaged?
Is there any accumulated debris around or in
the trash rack or riser?
GATES OR VALVES
Are gates or valves less than fully functional?
Is there rust damage?
Is there any evidence of leaking?
RESERVOIR AREA
Is there sediment build up or debris in the
basin?
Are there any trees, bushes or any unwanted
growth present?
Does growth in or around the basin block
any inlet or outlet pipe or channel?
Does wet design volume appear to be
reduced by excess vegetation?
FACILITY SPECIFIC REQUIREMENTS
Underdrains - blockage, standing water,
broken, observation wells proper, debris or
overgrowth at outlet or rocks displaced?
Cover (75-90% with vegetation and mulch)
Functionality - debris, sediment buildup,
trash, undermining, erosion, pretreatment
area not functioning?
Low Flow Channels - blockage, undermining,
sediment buildup?
Infiltration, Media - clogged, contaminated,
erosion?
Infiltration, Mulch - contaminated, proper
thickness, needs replacing, needs reworking
to be level
Aquatic Bench (plants healthy, biodiversity,
not blocking inlets/spillways, wetland
grasses health)
Form # CEE 008
OPERATION AND MAINTENANCE INSPECTION RECORD
Page 3 of 4
Project Name:
Inspection Item
YES
NO
N/A
If YES Describe Required Repairs
Estimated Cost Of
Repairs
VEGETATION
Any health concerns? (Need
replacement, bare spots, dying)
Missing (not present according to
plans)
Other (support structures for veg.
failing, more than 10% invasive)
FENCES
Are post/fencing in need of repair or
replacement?
Is there accumulated debris around
the fence?
Is the access gate or its hardware in
need of repair or replacement?
Have vegetative barriers been
removed or died?
OTHER
Gravel Diaphragm (foot/vehicular
traffic compromising it, sediment)
Level Spreader (concentrated flows
downstream, clogged with debris)
Signage - missing, leaning, fallen
Accessibility - overgrown,
missing/broken grates/manhole
covers
Other structures (bridges, walking
paths, etc.) (if applicable)
Other (woody vegetation, pond
level unusually high/low, excessive
algae/duckweed/water meal, other
pollutants)
Note any other discrepancies observed/necessary repairs here or on separate page:
OPERATION AND MAINTENANCE INSPECTION RECORD
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Project Name:
Was maintenance completed? Y/N
Estimated repair
c
completion date:
Total estimated
c
cost of repairs:
PROFESSIONAL ENGINEER'S INFORMATION
Inspection conducted by:
Email:
P.E.
A
ddress (Street, City, St., Zip)
Phone:
Firm:
Signature of P.E
In Inspection conducted by:_________________________________________________________________________________________________________________
E
mail: _________________________________________________________________________________________
Ad
dress (Street, City, St., Zip): __________________________________________________________________________________________________________________
_________________________________________________________________________________
Phone:
Co
mpany Name: ________________________________________________________________________________
Signature of SWIN:
FACILITY OWNER /OWNER'S REPRESENTATIVE INFORMATION
In
Owner/Representative Name::_________________________________________________________________________________________________________________
T
itle: _________________________________________________________________________________________
Mailing Address: __________________________________________________________________________________________________________________
_________________________________________________________________________________
Phone:
Email: _______________________________________________________________________________
Owner/Representative 's Signature
STORMWATER INSPECTOR INFORMATION
Place professional stamp here and date
SWIN#:
____________________________
Date all repairs were
completed
Total cost of all repairs
I hereby confirm all information on this form is accurate. Having consulted the plans and completed maintenance, the facility addressed
will function as designed
.
Owner/Representative 's Signature: _______________________________________________________________________________
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