MS4 Respondents

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

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 23 hours 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.

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 questionnaire is presented in two sections covering the following topic areas:

• Section A: Technical Information

• Section B: Financial Information

General Information

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 prior to the due date of this questionnaire. Written requests may be e-mailed to Ms. Jan Matuszko at matuszko.jan@epa,gov. Submittal of an extension request does not alter the due date of your questionnaire unless and until EPA agrees to the extension and establishes a new date.

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 with your completed questionnaire to EPA at the following address:

U.S. Environmental Protection Agency

Stormwater Management Non-Federally Regulated 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 EPA prefers you request assistance using EPA’s e-mail helpline provided below.

E-mail address for help line: _________________________________

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. For pressing questions that require a more immediate response, please call _________________.

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.

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.

• 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 questionnaire 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 questionnaire.

Certification Statement

The individual responsible for directing or supervising the preparation of the enclosed Stormwater Management Including Discharges from Developed Sites Non-Federally Regulated MS4 Questionnaire 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 judgments where possible. 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

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
Construction		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.
Bioretention		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.
Catch Basin		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 Insert		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.
Cistern		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.
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.
Constructed Wetland		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.
Construction Activity		Clearing, grading, excavation, and other earth-disturbing activities.
Co-Permittee		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.
Curb and Gutter		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.
Detention/ Extended Detention Practices		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.”
Dry Well		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.
Filter Strip / Vegetated Buffer		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.
Full Time Equivalent (FTE)		The number of full-time employees that could have been employed if the reported number of hours worked by part-time 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.
Green Roof		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 Infrastructure		Wet weather management approaches and technologies that infiltrate, evapotranspire, capture and reuse stormwater to maintain or restore natural hydrology.
Impervious Area		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.
Industrial Facility		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).
Infill Development		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.
Infiltration Basins and Trenches/Dry Well		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.
Low Impact Development (LID)		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.
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.
Municipal Separate Storm Sewer System (MS4)		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).
MS4 Service Area		Area over which an MS4 operator has jurisdiction to collect and dispose of stormwater.
New Development		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.”
Directly Connected Impervious Area		Any impervious surface which drains into a storm drain, catch basin, area drain, or other conveyance structure without first flowing across permeable land area.
	NPDES	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.
	Outfall	Outfall means a point source as defined by 40 CFR 122.2 at the point where a municipal separate storm sewer discharges to waters of the United States and does not include open conveyances connecting two municipal separate storm sewers, or pipes, tunnels or other conveyances which connect segments of the same stream or other waters of the United States and are used to convey waters of the United States.
	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.
	Post Construction	Describes the phase of development immediately following the termination of construction activities on a site. “Post-construction 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.
	Public Entity	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.
	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.
	Retention Practices	Stormwater techniques that manage stormwater on-site through infiltration, evapotranspiration, or harvesting. Commonly referred to as Low Impact Development or Green Infrastructure practices.
	Retrofit	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.
	Riparian Buffer	An area surrounding a shoreline, wetland, or stream within which development is restricted or prohibited. The primary function of aquatic buffers may to physically protect and separate a stream, lake, or wetland from future disturbance or encroachment.  These areas are also called “resource protection areas.”
	Site plan review	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.
	Soil Amendments	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).
	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.
	Stormwater	Runoff, snow melt runoff, and surface runoff and drainage.
	Stormwater Control	Practices that are installed and maintained to control stormwater discharges.
	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.
	Subsurface fluid distribution system	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.
	Swales: Grassed	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: Other vegetation	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 bio-swales, 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. 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).
	Undeveloped	Describes land that has not been subject to prior development. See “new development.”
	Urbanized Area	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. Currently, any MS4 located within a 2000 Census-defined “urbanized area” is required to obtain an NPDES permit for discharges from its storm sewer system.
	Wetland Basin (Permanent Pool and No Permanent Pool)	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).

Section A: Technical Information

A-1 Fill in the following identifying and contact information

______________________________________________________

Your Name and Title:

______________________________________________________

Agency/ Department:

______________________________________________________

Address:

______________________________________________________

Phone Number:

______________________________________________________

Email Address:

______________________________________________________

Best Time to Contact:

______________________________________________________

A-2 Municipal Separate Storm Sewer Owner and Operator Department/Agency (if applicable)

______________________________________________________

A-3 Is the MS4 owner/operator:

□ Tribe

□ City

□ Township

□ Town

□ Village

□ County

□ Borough

□ Municipal Utility District

□ Drainage district

□ Sewer district

□ Irrigation district

□ Flood control district

□ Watershed district

□ Other, Specify: ____________________________________________

A-4 What is the population, total area, and estimated percent directly connected impervious area of the entire jurisdiction as of 2009. Provide your best estimate.

	Entire Jurisdiction
Population
Total Area
Percent directly connected impervious area □ Unknown

If applicable, describe how was the percent directly connected impervious cover in your jurisdiction was estimated?

_________________________________

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

□ Separate storm sewer

□ Combined (storm and sanitary) sewer system

□ Privately-owned and operated storm sewer system (e.g., industrial park, subdivision/homeowners association)

□ Individual direct stormwater discharges (e.g., private home, business or industry directly to a waterbody)

□ Other, describe ____________

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 ____________________________________

□ Not applicable (no separate storm sewer in the jurisdiction)

A-7 Does your jurisdiction 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 jurisdiction 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 to Question A-20]

A-10 Is your stormwater program a requirement under State regulations?

□ Yes

□ No

A-11 How many years has your stormwater management program been in place?

________ # years

A-12 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-13 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-14 If illicit (non- stormwater) 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- 15 If regulation of discharges from construction sites is a component of your stormwater program, which of the following activities has been part of your program? Check all that apply.

 Review site plans for erosion and sediment controls

 Tracking/ inventory of sites

 Inspections

 Field staff training

 Contractor training

 Other, describe_____________

 Regulation of construction is NOT part of our stormwater program

A-16 How many construction starts have occurred in your jurisdiction in the last 5 years, including both residential and non-residential starts?

Number of construction starts, FY 2005-2009
	Fiscal year
	2005	2006	2007	2008	2009
Residential construction sites
Non-residential construction sites

□ My jurisdiction does not track construction starts

A-17 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 requirements

 Review construction site plans for post construction stormwater 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-18 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)

 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-19 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 jurisdiction 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 are those in which stormwater is infiltrated, evapotranspired, or harvested. Examples include bioretention (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-20 (a) Which of the following stormwater controls are installed/applied within your jurisdiction (includes those controls located on both public and private property)?

(b)Which stormwater controls is the MS4 operator responsible for maintaining (at any level of service)?

(c) For which practices do you have available cost information, including either capital cost or operation and maintenance cost or both?

(d) For which stormwater controls do you have monitoring data showing the performance of the control?

(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 in Information

jurisdiction public private

Extended Detention Basin (wet or dry) □ □ □ □ □

Retention Basin □ □ □ □ □

Curb and Gutter/Storm Sewer □ □ □ □ □

Catch Basins □ □ □ □ □

Catch Basin Insert □ □ □ □ □

Underground Detention □ □ □ □ □

Underground Infiltration □ □ □ □ □

Infiltration Trench □ □ □ □ □

Dry well □ □ □ □ □

Sand filters □ □ □ □ □

Other Media Filters □ □ □ □ □

Oil/water separators □ □ □ □ □

Vegetated Swale □ □ □ □ □

Constructed Wetland □ □ □ □ □

Filter Strip/Vegetated Buffer □ □ □ □ □

Wetland Basin/Channel □ □ □ □ □

Bioretention □ □ □ □ □

(includes raingardens, sidewalk

planters, curb extensions and other

plant or soil systems designed to

infiltrate or evapotranspirate stormwater)

Trees/Tree Box □ □ □ □ □

Green Roof/ Ecoroof □ □ □ □ □

Riparian Buffers □ □ □ □ □

Soil Amendment □ □ □ □ □

Permeable concrete/Permeable

Asphalt/ Pavers □ □ □ □ □

Cistern □ □ □ □ □

Rain Barrel □ □ □ □ □

Downspout disconnection □ □ □ □ □

Native vegetation/landscaping

planting □ □ □ □ □

Manufactured devices □ □ □ □ □

describe ____________

Other Controls: _________________ □ □ □ □ □

Section B: Financial Information

B-1 Select the month that begins your fiscal year?

□ January	□ July
□ February	□ August
□ March	□ September
□ April	□ October
□ May	□ November
□ June	□ December

B-2 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 Budget

B-3 Describe the activities included in your FY 2009 budget and percent (or actual dollar amount if available) of the total stormwater budget that you approximately spend on the activities. Provide your best estimate.

% Actual Amount Activity

___ ________ _______________________________________________

___ ________ _______________________________________________

___ ________ _______________________________________________

___ ________ _______________________________________________

___ ________ _______________________________________________

___ ________ _______________________________________________

___ ________ _______________________________________________

___ ________ _______________________________________________

___ ________ _______________________________________________

___ ________ _______________________________________________

___ ________ _______________________________________________

___ ________ _______________________________________________

___ ________ _______________________________________________

___ ________ _______________________________________________

___ ________ _______________________________________________

These activities may include:

• Program administration (e.g., clerical activities, financial management)

• Developing annual report

• Developing stormwater management plan (SWMP)

• Capital expenses for new stormwater sewers, capital for facility replacement, maintenance cost for cleaning sewers, maintenance cost for repairing sewers

• 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 discharge control program for construction activities that disturb one or more acres (tracking, inspections, etc)

• Post-construction discharge control program for new and redeveloped areas (tracking, inspections, operation and maintenance)

• Street sweeping

• Other 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, 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

The next two questions address staffing requirements for your program.

B-4 What is the estimated number of full time equivalents (FTEs) that your organization has devoted to stormwater related activities over the past five years (corresponds to the budget in Question B-2)? In the first row, enter hours worked by staff who work directly for the stormwater management program. If there are municipal staff whose primary responsibility is to non-stormwater programs, yet still contribute to the work of the stormwater program, please estimate the hours in FTEs they contribute in the second row. EPA recognizes that this second category may not be routinely tracked, and is only asking for a best estimate.

Full Time Equivalents (FTEs)
	Fiscal Year
	2005	2006	2007	2008	2009
Stormwater Staff (FTE)
Non-stormwater Staff (FTE)

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-5 What percentage of your stormwater operations and maintenance funding comes from the following sources. (Total must equal 100%)

□ Stormwater Utility/ 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 improvement funding comes from the following sources. (Total must equal 100%)

□ Stormwater Utility/ User Fee ___%

□ Ad valorem taxes ­­­­____%

□ Permitting and other fees___%

□ Sales Taxes___%

□ Special Tax districts___%

□ New development impact fees___%

□ Revenue from the sale of bonds ___%

□ Other ___%

B-7 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 ___%

You have completed the questionnaire. Refer to the instructions for mailing the questionnaire back to the United States Environmental Protection Agency. Thank you.

Non-Regulated MS4 Questionnaire - FINAL Page 1 of 31