1. Outfall Location:_________________________________________________
1a. Structure Description:___________________________________________
1b. Address:______________________________________________
2. Inspector:___________ 3. Inspection Date:____ 4. Last Rain Date:____
5. Outfall Data:
[ ] RCP [ ] CMP [ ] VCP [ ] Other:______ Pipe size:___inches
Condition:________________________________________________________
Structure Data:
Condition:_________________ Invert(s):___________ Invert dia. (s):________
6. Visible Flow? [ ] Yes [ ] No
6a. Flow Depth:_____inches 6b. Est. Flow:_____cfs
6c. Flow Direction (toward or away from outfall location):_______________
If yes, check all that apply - go to #12. If no, check as needed - skip #7.
[ ] Colored water (describe)______________________________ [ ] Oily Sheen
[ ] Odor*(describe)__________________________________ [ ] Sludge Present
[ ] Murky [ ] Clear Water
[ ] Floating objects (describe)_________________________________________
[ ] Stains on conveyance pad
[ ] Absence of plant life at point of discharge
[ ] Notable difference in plant life at point of discharge
[ ] Scum [ ] Suds [ ] Other:___________________________________
*e.g. rotten eggs, oil, gasoline, chemical, chlorine, earthy, sewage, etc.
7. Was there any unusual piping, ditches, overland flow directed to the storm water infrastructure?
[ ] Yes [ ] No
If yes, explain:
______________________________________________________________________________________________
8. Was there evidence of sanitary sewer overflows in area? [ ] Yes [ ] No
If yes, give locations:
______________________________________________________________________________________________
9. General Comments:
______________________________________________________________________________________________ ________________________
10. Photographs Taken: [ ] Yes [ ] No
Describe:_________________________________________________________
11. Smoke Test: [ ] Yes [ ] No
12. Was Hamilton County General Health District (HCGHD) or Greater Cincinnati Metropolitan Sewer District (MSD) contacted for assistance in obtaining samples to test for water quality?
[ ] Yes [ ] No
If yes, then which: [ ] HCGHD [ ] MSD Date Contacted:_____________
Inspector's Signature:_____________________________________________
Database Record Date:_____________________________By:_____________