HomeMy WebLinkAboutStormwater Mng Facility & Oshkosh, Document 1708150 II I u
CITY OF OSHKOSH _ 8 2 8 9 2� 9 1
STORNIWATER MANAGEMENT FACILITY Tx,4209069
MAINTENANCE A.GREENIENT 1717176
Document Number Document Title
REGISTER'S OFFICE
/ WINNEBAGO COUNTY, WI
RECORDED ON
The City of Oshkosh,the Governing Body,and Bemis Healthcare Packaging,Inc,the 07/07/2016 9.19 AM
Property owner,along with their'successors and assigns,are the parties to this Agreement.
The purpose of this Agreement is to ensure adequate storm water draindge facilities for the CHRISTOPHER CARSON
Property described in this Agreement in connection with the surrounding public stone DEPUTY REGISTER OF DEEDS
water facilities. The consideration for this Agreement includes the City's approval of
proposed development on the Property. Additional consideration includes the Property RECORDING FEE 30.00
owner's clearer understanding of storm water drainage obligations for the Property,and PAGES' 14
the Governing Body's assurance that the storm water drainage issues relating to the '
property can be more easily achieved through this Agreement.
CURRENT PROPERTY OWNERS SUBJCCT TO THIS AGREEMENT: Recording Area
Bemis Healthcare Packaging, Inc. Name & Retum Address:
3500 North Main Street Oshkosh City Attorneys Office
PO Box 1130
Oshkosh, WI 54901 Oshkosh,WI 54903-1130
GOVERNING BODY: City of Oshkosh Tax Parcel Numbers:
PROPERTY SUBJECT TO THIS AGREEMCNT 91519603303, 9151960J.)
i
The Property subject to this Agreement is located in the City of Oshkosh,Winnebago
County,and is more particularly described as follows: V
Lots I and 2 of Certified Survey Map No.7060 recorded in the
Winnebago County Register of Deeds On March 3,2016
as Document 1703150
[Exhibit A,attached]
GRADING AND DRAINAGE PLAN
The Property must always comply with the grading and drainage plan approved by the City. The approved grading and drainage plan may
be amended or modified from time to time after consultation between the City and the Property owner. Compliance will be evaluated
according to the most current approved plan. A small scale version of the current grading and drainage plan is attached as Exhibit"B"far
identification and reference purposes. The full scale grading and drainage plan is on file for review with the City Department of Public
Works,and will be used to provide grading and drainage criteria and to govem compliance and any disputes.
PURPOSE
The three(3)primary purposes of this Agreement:
1)Notify the Property owner, as well as anyone interested in or connected to the Property that the Property is subject to this Agreement
and Chapter 14 of the Oshkosh Municipal Code,as amended, and that any owner of the Property assumes these obligations;and,
2)Identify specific storm water facilities that currently exist on the Property,or may be constructed or installed in the future,and,
3)Describe the minimum responsibilities for maintaining the Property's approved storm water management facilities and grading and-
drainage plan,
1
March 17,2016 (�
- t�
1
CITY OF OSHKOSH
.STOANIWATER MANAGEMENT FACILITY
MAINTENAkE AGREEMENT
Document Number Document Title
RESTRICTIONS
The Property must always conform to its most current grading and drainage plan approved by the City. The Property is also subject to all
aspects of the Municipal Code;including storm water management requirements,as may be amended,which are currently located in
Chapter 14 of the Municipal Code, The storm water management requirements of the Municipal Code change from time to time,with the
Property owner receiving public notice as required by law. Changes may be made to the grading"and drainage plan for the Property if
requested by the Property owner and after review of any changed circumstances on the Property, The approved grading and drainage plan
for the Property will be on file in the City of Oshkosh Department of Public Works and is fully incorporated by reference in this
Agreement.
RESPONSIBLE PARTIES
Each owner of the Property,jointly and severally,as well as their heirs,successors,and assigns, is responsible for maintaining the
Property,in the manner described in this Agreement, The Property owner's responsibilities include maintaining approved vegetation,
grading,drainage,and storm water facilities on the Property.
STORM WATER FACILITIES
The Property's storm water facilities consist of:
1. Storni Water basin;and
2. Storm Sewer;
3. Swales;and
4. Inlet and manhole covers.
INSPECTION AND MAINTENANCE
All storm water facilities and components of the storm water system shall be inspected at least semiannually,with one inspection occurring
in early spring and one inspection occurring in early autumn. The Property's storm water drainage system must also be inspected after
major storm events. The storm water facilities and grading and drainage scheme must be maintained as designed in order to achieve the
desired storm water drainage objectives. Therefore,maintenance and repairs must be performed expeditiously when system deficiencies
are identified, The existence of soil erosion,clogged or damaged inlets and/or pipes,sedimentation of the basin and/or biofilter,rilling of
side slopes,and other damaged features of the stormwater system are examples of items requiring maintenance or repair work, Material
removed fi-om the basin or biofiltermay require special handling dependent upon current Wisconsin Department of Natural Resources
disposal practices.
If biofilter is installed/constructed,then biofilter maintenance activities include:remove coarse and gravel sediment that has
accumulated;maintaining proper level of mulch; inspecting surface and repair eroded areas;inspect filter strip rip-rap and repair as
needed; inspect energy dissipator rock or grass inlet areas;inspect overflow structures; replace filter bad; inspect perforated pipe under
drain;remove litter and debris;water plants;replace dying plants;and replace vegetation when necessary. Biofilter inspection and
maintenance requirements applicable to the Property will change as the rules enforced by the Governing Body chane.
If a wet basin is installed/constructcd,then dredging operations are required to remove the excess sediment when the depth of water in the
wet detention basin diminishes below three feet causing the efficiency of the detention basin to decrease. The storm water detention
basin(s)must retain the safety shelf after dredging. Damage to the safety shelf or detention basin liner;rust be repaired to preserve the
safety and operation of the facilities.
If a dry basin and/or Swale is installed/constructed,then dry basin and swale maintenance includes removal of trash and debris,repairing
erosion,maintaining vegetation,and dredging when necessary.
The examples of maintenance activities that are identified above are not intended to be complete. The minimum information required to
be viewed as a guideline for potential maintenance or repair activities is identified in the Inspection and Maintenance Logs attached as
2
March 17,2016
CITY OF OSHKOSH
STORNIWATER MANAGEMENT FACILITY
MAINTENANCE AGREEMENT
Document Number J Document Title
.Exhibit C. The Property owner shall,upon request,make available for inspection all maintenance records to the City's Department of
Public Works,or any agent of the City,during the life of the system.
PROHIBITIONS
Mo+vin-in buffer areas,detention basin banks and drainage ways shall be minimized in order to maximize filtration of runoff. If
occasional mowing is necessary,the mowing height must not be less than six inches. Applications of fertilizers,herbicides,pesticide or
other chemical applications are prohibited in buffer areas,on detention basin banks and along drainage ways.
COMPLIANCE
The Property benefits from a properly maintained grading and drainage plan as well as properly maintained storm water-facilities. In the
event the Property owner fails to perforin any obligation related to this Agreement,the City of Oshkosh shall have the authority to enter
the private Property to inspect,maintain,repair,reconstruct,and/or modify any component of the approved grading and drainage plan or
storm water facility. The City has no duty to take such action but may do so at its discretion. The ability to enter the Property and take
such action is not an exclusive remedy, and the City may take any lawful action to enforce this Agreement and/or the Municipal Code.
The Property owner giants to the City of Oshkosh a limited, nonexclusive easement in perpetuity over the Property for the purpose of
addressing grading and drainage deficiencies,as well as providing reasonable and necessary access to any storm water facility that is
located on or within the Property. The City of Oshkosh shall use only that part of the Property reasonably necessary to allow the
inspection,'maintenance,and/or repair of the approved grading and drainage plan or any storm water facility. If the City elects to perform
maintenance or repairs on the Property,then all associated costs for performing this work and enforcing this Agreement and/or storm
water management requirements of Chapter 14 of the Municipal Code,as may be amended from time to time,are subject to
reimbursement from Property owners,jointly and severally,or through encumbrances on the Property itself. Reimbursement remedies
include placing an encumbrance against the Property as a Special Charge for Current Services pursuant to Sec.66.0627 Wisconsin
Statutes,as amended,or through other methods to collect directly from the Property owner as allowed by law at the City's discretion. Any
Special Charge for Current Services shall be a lien on the Property and shall be collected with the real estate taxes.The Property owner
affirmatively waives notice requirements for Special Charges,and this provision shall constitute the Property owner's;and any respective
lot/parcel owner(s)if applicable,waiver of notice of hearing otherwise required by Sections 66.0627 or 66.0703 of the Wisconsin Statutes.
The storm water management facilities shall be for the benefit of the City of Oshkosh and the Property as described in this Agreement.
This Agreement is not intended to benefit third parties and there shall be no third party beneficiaries.
RECORDING
This agreement shall be recorded with the land records of the Winnebago County,Wisconsin,Register of Deeds. Bemis Healthcare
Packaging, Inc.,shall bear the cost of recording this document,
AMENDMENTS
This Agreement may be amended in whole or in part at any time by the owner of the Property,provided: 1)the amendments)are
approved in writingby all of the owners of lots within the Property as recorded with the Register of Deeds, Winnebago County,
Wisconsin;and,2)the amendment(s)are approved in writing by the City of Oshkosh Board of Pub lie Works, This Agreement shall be a
permanent covenant that shall,'as provided by law,run with the land and any amendment to this Agreement shall be subject to the prior
approval by the City of Oshkosh.
This document was drafted by:
David J.Praska
Assistant City Attorney
Oshkosh,WI 54903-1130
3
March 17,2016
CITY OI,OSHKOSH
STORtN•IWATER MANAGEMENT FACILITY
MAINTENANCE AGREEMENT
Document Number Document Title
For the Owner/Developer:
Date: Apr', 1 �� , �r�O
Bemis He Itltcare Pa a , file.
By: G"
Jerry I{re a,Vice res
t&Treasurer
State of Wisconsin )
)ss'
Winnebago County } r
Personally came before me on this day of�?,''t 2016,the above named,Jerry S. Krems,to me
known to be the person whom executed the foregoiNotary
ument and ck�vleed same.
_ -
Public, State of Wisconsin
My commission ccpires:
City of Oshkosh:
Date:
By: '� By:-
Ma �Rohloff, ger Pamela R.Ubrig City Clerk
State of Wisconsin )
)ss.
Winnebago County )
Personally came before me on this_ day oft,, 1 ,2016 the above named,Mark A.Rohloffand Pamela
R. tJbrig,to me known to be the persons who executed the f retr Ing in trumLancknowledged the same.
NotaPu litate ofsinMycmmissionexpire
Approved as to form:
Date
L ALorenson, ttorney
4
March 17,2016
1708150
REGISTER'S OrFICE
WINNEBAGO COUNTY,WI
RECORDED ON
03/03/2016 8:33 AM
CERTIFIED SURVEY MAP N0. _7060_ ?*1. 1 Qg 7CW
ALL OF LOTS 1 AND 2 OF CERTIFIED SURVEY MAP NO.3685, CUTY REGISTER
E AR50N
DEPUTY I2EGI5"fER OF DEEDS
AND ALL OF LOTS 1 AND 2 OF CERTIFIED SURVEY MAP
NO.3586;LOCATED IN THE NORTHEAST 114 AND RECORDING FEE 30,00
'SOUTHEAST 1/4 OF THE NORTHWEST 114 OF SECTION 1, PAGVSr 3
TOWNSHIP 18 NORTH,RANGE 16 EAST,CITY OF OSHKOSH,
WINNEBAGO COUNTY,WISCONSIN.
110RTr UT CORNER
Sc 11 1
TI&N,R16E S 88'57'18'W
h..��.._.. -
---------------------------
.�.._..r.._.._.._,.--- .._.._.
YY .r• 1285.90' NORM 1/4 CORNER
SECTION 1
I BEARINGS ARE REFERENCED TO THE
' i18N, 816E WINAE&AGO COUMY COORDWATE SYSTEM
�w I UNPLA7?'Epl!+,N13S 1' ' �'
OVINER: ROtKO H. &
LOT 1 CS_M_IV0.�7?B .I 0 20 400
�,•1 JANE K• JOHNSON LLC SCALE N FEU
o OOCUTAENT NO, 994654
g (N 89'27'07' E) I tom oa 0SWOU
N 88°57'17'E i 614.00'
345.97' �niv 0r 0sKi0sR }
Fear
En O�,• } kOpun�: TTEoGf LANDS
HKO
SHL276SQ. T. DOCUiEW
NO, 540444
ce I q 3.863ACRES euaooQ 3'
I cv i `y zo'STORMS""
f r EASENEHf PER
S SB 35 fl— •. C.S.91 N0.3585
LEGEND
0 T'O.D.'IRON PIPE SET. 16"LORD,
IxnnuwusTA 1 _ Q� S;goo %VGFn'c 1.130 Las, PER L.N. Fr,
E'I I� I o _ fir•.' �. pOv�"r 0 SAW CUr'x'SET
1�r 111, ZO
CROSS
ESS 3/4"O.D. RELrAR FOUND
STCRMWATER O rtC B I � Y w Z O 7'IROY PIPE FOVNO
1+.II rn �SSE�P RAA TES SEPPRSTE NSIRUIENT! Z;zw�a ; GOVER yUNT CORNER
•6' 40,��.IriSTRU1dENC 20,I N ( ) REOO,46E0 ASV21 '
' -EXISr:N4 BULR`iC I A �. PELL`ffATED 6YETLA4DS '
ONR CONCURRENCE DATED
G8.3' 1 r SEPTEURER 12, 2014
I
20' STORM SEWLR
F-4 I EASEAIE._PER&R
I/
J3h�. DGc. ! s7230
s,us�sous
I i 1 20' STORM SEWER
EASEMENT PER
1 i Com•A � �N.110. 5586 1
x' I co e s LOT 2
�y "' ,
1 1 1 r v
a s' 691,676 SCI.F7. r ^w
UJ
0�I I 16,003ACRES r et ry JN
I I I 1]aSR+K o O �N'^30, sco1v,��U1�15t111y
a ! SU16H9 rL O C] .r S 'Ja -
S Q z GARYA
W ZAHRUiGER °k
o a, $249$ s
o �,JJJ`J�yOr VA ' X0
1 11s
�1 u�
4 1gn16%W IN"
I6I6 �1---�11__.-..__._, .�_-.._..-..._..._... _ y/_1 p�t,VJ ll•.
S 88955'29"W 614,00'
(S 69'25'19' w} UNPLATTE�LAhDS
OWNER; WISCONSIN POSUO SERVICE CORP. ,
DOCUMENT NO. 484033
Martenson & Eisele, Inc.
1377 MkKd ay Road PlaWng
Mecasha,VVI 54952 Erlvlronmenwi I
SAN STRE1"W.markenson�lsele.Com SDrySURVEY FOR: PROJECT N0. 1-0488-002
e 4,g
infoQmartanson•eiseiemrn Erlgneering J30D 1350 HEALTHCARE PACKAGth'C FILE 1-0488--002CSMAW9 SHEEP 1 OF 3 ,
920,73f.0381 1.800236.0381 Am ltecture N. ET
OSHxDSH. Vel 54901 TH3S p15TRUL+EN1 WAS ORAfTEO A. e for
S f _
CERTIFIED SURVEY MAP N0.
SURVEYOR°S CERTIFICATE,
I, GARY A. ZAHRINORR, PROVES51011AL 1,A_ND SURVEYOR, DO HEREBY CERTIFYt
THAT I HAVE SURVEYED, MAPPED, AND DIVIDED AT THE DIRECTION OF BEMIS HEALTHCARE PACKAGING, INC., -
ALL OF LOTS 1 AND 2, OF CERTIFIED SURVEY MAP M. 3585 AS RECORDED M THE OFFICE OF THE
REGISTER OF DEEDS FOR WINNEBA00 COUNTY, WISCONSIN ON THE 27TH DAY OF NOVEMBER, 1996 IN VOLUME
1 OF CERTIFIED SURVEY NAPS ON PAGE 3585 AS DOCUMENT NO. 955854] AND ALL OF LOTS 1 AND 2, OF
CERTIFIED SURVEY MAP 110. 3586 AS RECORDED IN THE OFFICE OF THE REGISTER OF DEEDS FOR WINNEBAGO
COUNTY, WISCONSIN ON THE 27TH DAY OF NOVERSER, 1996 IN VOLUMB 1 OF CERTIFIED SURVEY MAPS ON
PAGE 3586 AS DOCUMENT NO, 9558511 ALL BEING PART OF THE NORTHEAST 1/4 AND SOUTHEAST 1/4 OF THE
NORTHWHST 1/4 OF SECTION 1, TOWNSHIP 18 NORTH, •RANGE 16 EAST, CITY OF OSHKOSH, WINNE9AG0
COUNTY, WISCONSIN. CONTAINING 865,352 SQ.FT. [19.866 ACRES]. SUBJECT TO ALL EASEMENTS AND
RESTRICTIONS OF RECORD.
THAT I HAVE FULLY CCMPLIED WITH CHAPTER 236.34 OF THE WISCONSIN STATUTES AND WITH THE CITY
OF OSHKOSH BUODIVISION ORDINANCE IN SURVEYING, DIVIDING AND MAPPING THE SAME.
THAT PHIS MAP IS A CORRECT REPRESENTATION OF ALL THE EXTERIOR BOUNDARIES OF THE LAND
SURVEYED AND THE DIVISION THEREOF,
GIVEN UNDER MY HAND THIS 27TH DAY OF JANUARY, 2016.
GARY A. INCE , PRgFE55I0 WS LAND SURVEYOR 5-2098 ' U Ry
7 54 d'r
ZAHRINGER •.
_.STOCKeR E i
yll
sus�E;0
CITY OF OSHKOSH PLANNING COMKITTES CERTIFICATE-
THIS CERTIFIED SURVEY MAP OF BEING PART OF CITY OF OSHKOSH, WINNEBAGO COUNTY, WISCONSIN,
IS HEREBY APPROVED,
DATED THIS --f/ DAY OF I'P /`.l',f , 2016.
PMISSION SECRETARY
TREASURBR'S CERTIFICATE,
I HEREBY CERTIFY THAT THERE A" NO DELINQUENT TAXES OF ASSESSMENTS IN MY OFFICE FOR THE LAND
DESCRIBED IN THE FOREGOING CERTIFIED SURVEY MAP.
CITY TREASURER DATE O'. E E
THIS CERTIFIED SURVEY MAP IS CONFATHRD WHOLLY WITHIN THR PROPERTY DRSCRIBSD IN THE FOLLOWING
RECORDED INSTRUMENTS
OWNERS OF RECORD: RECORDING INFORMATION: PARCEL NUMBERS:
BEMIS HEALTHCARE PACKAGING, INC, DCCUKSK 140. 1670265 15-1960-3300 +
DOCUMENT NO. 1670264 15-1960-3302 '•
DOCUMENT NO. 1670266 15-1960-3301
'i
PRO.IECT NO. 1-0485--002 {
SHEET 2 OF 3 it
xhibit.Q Z��'
CERTIFIED SURVEY MAP N0. 7060
CORPORATE OWHERIS CERTXFXCAI&s
SR{AIS HEALTHCARE PACKAGING, INC., A DELAWARE CORPORATION, DULY ORGANIZED AND EXISTING UNDER
AND BY VIRTUE OF THE LAWS OF THE STATE OF DELAWARE, HEREBY CERTIFY THAT-WE CAUSED THE LAND
ABOVE DESCRIBED TO BE SURVEYED, MAPPED, DEDICATED AND DIVIDED AS SHOWN AND REPRESENTED ON
THIS MAP,
DATRO THIS DAY OF .F:�2Y1td�jJ 2Q1&.
S;ru7
SI�ATURE
PRINT NAMETIT& LE PRINT NAME & TITLE
STATE OF ((f✓+S�LIjr/� )
)9S
Z%/Ji ll Comm)
PERSONALLY CA14B BEFORE ME ON THE ?J-h DAY OF C LtYtl —' 2016, THE ABOVE OWNER(S) TO
M@ KNOWN TO BE THE PERSONS) WHO EXECUTED THE FOREGOING INSTRUMENT Aa`H,7 AClWOWLEDUR�THE SAME.
xKm!nu'+yr
Ehl
NOTARY p [2c. STATE ofC��CDlu/}7a Q,.•' ``•.'�i
myCOPLHISSI4DY�S PG RMANENT��fEXPIRES; ] t �qRY
'1-)7-
r +ee.U0f
ape+.ril'�i41
CONS
~= GAAYA. !. '161
�t Zr�FlflGi&E)i '�
STCCI(6R1C�C
U ��QQ'ti
fTi«114i1Rt ���� `4l.!�
� PROJECT H0. 1-0485-002
SHEET S OF 3
h-lbit-
x
- s��� ss�� s. 4/i ff� I `� — ��1 f -; :': '•�:,':. 1, i �a
U.
' \
VF
MEN
ME
I ; jg �` :': /�// /j �%�'i/�/ / :`ate^ `,9d•
. '
ri
:� •/ � +_ ' �� 111 /;
JOIN
eq
�
cif�.t
ell
ssa.za -
1 .,�_�r
,o r..rt
���'� 9 �� � 1 �f�� ��f��a c �5� .I—.�.7"�`-c}i:��-� ��r��� }��' �-{.-d s ,; •SEE;/ i
a+r. ..+•a.++a.aar•ei:Ar •. �E�
75 a3a�'n Ee$ -
Jii
'a T, p } •Cl//", 1 r�' _ '':4s';' 5•''')`'::•S)�:`�:ti:i:.•:::•:::: ::�A�::fir',.Yr• ",/��
Ii �� ='-Y'+:+ - 'i4Y Y•�� �:�;�;�:.i'lJ:!f'Y.;ti;y�'.1='t'•••:y _ .i•;'.":'.'.T�' ' ♦l.-.
C , 1 �ly r : _ ::: ::•54.19:.•:. —'3.F7_Si^6?N::.xl�, •: �.�'�• e
. � �.�' �r_ .%J%/��%//';��°%��%//��,�/%::>-i`/�.�//j%ref, E� •
ju )� '
BEMIS HEALTHCARE PACKAGING � RY �s9 Hoffman
3594 N PAIN STREET,OSMO5H,W SA941 m .o �1��«>..— -. �'••
a r..
o 8
C' m 01
Z7� Osseo
V j • _ ��n I
, ;5 �'e� j a � "� yid •
� v�owosle•er 3 '� e
. -.mss-.'__'�,o�'~-_�."..� "_�..�--c •
... �. ER4EIE '-•}aQ���� .IS�EIHI .. �IJ IFI��I �4 — -�1
� I� iso' �• �^- F �4 .,'--rs"_t _f e
_ _>. . � �' t��� :; r '��"'�`�` �• ._ � ,_._ _fir.�.-,. b
J �I, ZVY f f
AN
'd
J
M.—
�"fYsb'-
22 '
MEN
�6` tit''Y—_�.—. `'€+`•��`•'!%s.--�1 -_���j�V�� (•i�j._.
}I _ —'oma• _' � ��_3; .
�-
�� Wiz-- -=�:
` � �r�,! S.'P.•rf3�= uta-`---�:r. � ..
5�MIS
too
i F tl =�flr
S�' '�-- �.-- - — —i= �! : •,rr,cn-;v'ii�fe�-=�'ur�-'•.�•:'1=,�: _ .�t'.�g -"sC .
7' s D2AlNAGEf h f KOS FNkR 'c�coECT` 3Nil" 4
i
FLAN " EJCI PI l"41 S,KEr
"s L)
09t ASK rrrii:.-` c sJ.t�zs,,'•r�wc,ien.fa .
Inspection & Maintenance Log
Catch Basin I Proprietary Device
Inspection Year:
Name of Site: Address:
Inspector: Company:
Municipality Phone:
Contact:
* Facility owner responsible for inspecting, maintaining, and repairing facility components after major
storm events (greater than '/"), annually at a minimum. Check any deficiencies noted and comment
for maintenance actions taken, date of repair, and any alerts. Inspection items with no *should be
completed by a qualified professional every five years (or more frequently if concerns are noted).
Storm Storm Storm
Inspection ]tem Date Date Date Maintenance Action Date
Catch Basin 1 Proprietary Device
Inlet Protection * Remove after
Stabilization
Debris I Trash Accumulation * Clean up/kemove
Abnormal water levels k Contact Municipality
Sediment/Floatables Accumulation * Remoye(pump and .
dispose of at
wastewater treatment
plant)**
Depressions around facility Contact Municipality
Joint Separation Contact Municipality
Cracks in Concrete Contact Municipality
Deteriorated piping Contact Municipality
Displacement of Structure Contact Municipality
** Pumping Details (based on design guidelines):
Type of unit(s) Design Pumping Frequency
Dates Pumped
Pumper Disposal location
Page 1 of 1 Rev.02/22/2008
Eh bIt
Inspection & Maintenance Log
Detention Basin
Inspection Year:
Name of Site: Address:
Inspector: Company:
Municipality
Contact: Phone:
* Facility owner responsible for inspecting, maintaining, and repairing facility components after major
storm events(greater than %"), annually at a minimum. Check any deficiencies noted and comment
for maintenance actions taken, date of repair, and any alerts. Inspection items with no*should be
completed by a qualified professional every five years(or more frequently if concerns;are noted).
Storm Storm Storm
Inspection Item Date' Date Date Maintenance Action Date
Pond
Bank Erosion
Debris 1 Trash Accumulation
Visible pollution
Abnormal water levels
Sediment Accumulation
Depressions, Whirlpools, Sinkholes
Embankment
1. Upstream Slope- Moor Grass Cover*
Erosion or Slides
Trees/Brush Growing on Slopes*
Deficient Riprap Protection
Animal Burrows
Depressions or Bulges.
Settlement
Longitudinal Cracks
Transverse Cracks
Page 1 of 4 Rev.02/2212008
r habit. C 26��
Inspection & Maintenance Log
Detention Basin
Storm Storm Storm
Inspection Item Date Date Date Maintenance Action Date
2. Crest—Settlement
Misalignment
Cracking
3. Downstream Slope- moor Grass
Cover*
Erosion or Slides
Trees/Brush Growing on Slopes
Animal Burrows
Excessive or Cloudy Seepage
Longitudinal Cracks
Transverse Cracks
Depressions or Bulges
Settlement
Seeps, leaks, or boils.
Page 2 of 4 Rev.02122/2008
Exhibit C 3bf� a
Inspection & Maintenance Log
Detention Basin
Inspection Item Storm Storm Storm Maintenance Action Date
Gate Date Date
4, Emergency Spillway—Exposed
Fabric
Overgrown Vegetation
Erosion/Backcutting at berm or road*
Rutting or pot-holes
Obstructions or debris
Inadequate Riprap/Armor
Cracking
Slumping/Sloughing of Embankment
Settlement
Spillway
1. Eroding or Backcutting
Overgrown Vegetation
Obstructions with Debris
Excessive Siltation
Slumping/Sloughing
Control Structure
1. Inlet- Debris in Conveyance Area
Erosion or Undercutting
Stop-log deterioration I leaking
Joint Separation
Cracks in Concrete
Deteriorated piping
Displacement of Structure
Page 3 of 4 Rev.02/22/2008
r r i
• 1
.S
Inspection & [Maintenance Log
Detention Basin
2. Outlet-Erosion or Backcutting*
Debris in Culvert or Trash Rack*
UnderrttininglScour
Inoperable control valve
Inoperable flap gate
Joint Separation
Cracks.in Concrete
Downstream Area
1: Erosion
DONS/Obstructions'
2. Bridge/Culvert Problerns
Buildings Issues
Foundation Concerns
Page 4 or 4 Rev.02/22/2008
EehIbit C,bo