United States Environmental Protection Agency

Stormwater Management Including Discharges for Newly Developed and
Redeveloped Sites 

Industry Questionnaire

Survey ID: ________________

General Information 

Purpose of the Questionnaire

Stormwater discharges from newly developed and redeveloped land can
negatively impact water quality through increases in stormwater volume
and increased pollutant loads to the receiving waters.  This Information
Collection Request (ICR) will collect data to inform decisions regarding
how the nation’s stormwater regulations should be strengthened,
including additional provisions for stormwater discharges from newly
developed and redeveloped sites. 

EPA is issuing the following questionnaire to owners, developers, and
contractors of new and redeveloped sites to provide EPA with information
to: 

Determine current usage, availability, design, and cost of post
construction stormwater controls, BMPs, and retention practices;

Assess the compliance costs and pollutant and flow reductions associated
with various regulatory options to control post construction stormwater
from newly and redeveloped sites; and

Characterize the economic status of the construction industry that could
be subject to revised regulations and estimate the impact of compliance
costs.

	

The survey is presented in four sections covering the following topic
areas:

Section A:	General Information

Section B:	Firm Financial Information

Section C:	Project Level Information for Owners/General Contractors

Section D:	Project Level Information for Non-Owners/General 			
Contractors

Section E:  	Certification

General Information, Continued

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

The response to this questionnaire must be received by EPA no more than
60 calendar days after receiving it.  

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 requests
may be e-mailed to Mr. Brian D’Amico at damico.brian@epa.gov.

Where to Return the Questionnaire

After completing the questionnaire and certifying the information that
it contains, use the enclosed mailing label to mail the completed
questionnaire to:

	U.S. Environmental Protection Agency

Stormwater Management Including Discharges from Newly Developed and
Redeveloped Sites Industry Questionnaire 

c/o Eastern Research Group, Inc.

14555 Avion Parkway, Suite 200

Chantilly, VA 20151

Certification Statement

The individual responsible for directing or supervising the preparation
of the questionnaire must read and sign the Certification Statement
listed below.  The certifying official must be a responsible corporate
official or his/her authorized representative.

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. 
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.

E-mail address for help line: _________________________________

Confidential Business Information 

Regulations governing the confidentiality of business information are
contained in the Code of Federal Regulations (CFR) at Title 40 Part 2,
Subpart B.  You may assert a business confidentiality claim covering
part or all of the information you submit, other than effluent data and
information or data that is otherwise publicly available, as described
in 40 CFR 2.203(b):

“(b) Method and time of asserting business confidentiality claim.  A
business which is submitting information to EPA may assert a business
confidentiality claim covering the information by placing on (or
attaching to) the information, at the time it is submitted to EPA, a
cover sheet, stamped or typed legend, or other suitable form of notice
complying language such as ‘trade secret,’ ‘proprietary,’ or
‘company confidential.’  Allegedly confidential portions of
otherwise nonconfidential documents should be clearly identified by the
business, and may be submitted separately to facilitate identification
and handling by EPA.  If the business desires confidential treatment
only until a certain date or until the occurrence of a certain event,
the notice should so state.”

If no business confidentiality claim accompanies the information when it
is received by EPA, EPA may make the information available to the public
without further notice.

You may claim as confidential all information included in the response
to a question by checking the Confidential Business Information (CBI)
box next to the question number.  Note that you may be asked to justify
any claim of confidentiality at a later time, for example if someone
requests access to your data.  Note also that airport effluent data are
not eligible for confidential treatment, pursuant to Section 308(b) of
the Clean Water Act.  In addition, information that is publicly
available should not be claimed confidential.  Note also that
information claimed confidential cannot be accessed or used by the
industry to evaluate data and analyses supporting the national effluent
guidelines regulations. 

Information covered by a claim of confidentiality will be disclosed by
EPA only to the extent of, and by means of, the procedures set forth in
40 CFR Part 2, Subpart B.  In general, submitted information protected
by a business confidentiality claim may be disclosed to other employees,
officers, or authorized representatives of the United States concerned
with implementing the Clean Water Act.  The authorized representatives
include employees of other executive branch agencies, who may review CBI
during the course of reviewing draft regulations.

Information covered by a claim of confidentiality will be made available
to EPA contractors to enable the contractors to perform the work
required by their contracts with EPA.  All EPA contracts provide that
contractor employees use the information only for the purpose of
performing the work required by their contracts and will not disclose
any CBI to anyone other than EPA without prior written approval from
each affected business or from EPA's legal office.

Detailed Instructions for Completing the Questionnaire

Complete the questionnaire considering the following instructions:

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. Pay particular attention to the distinction between
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 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 survey is fiscal year (FY) 2005-2009
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 survey. 

When requested financial information is available in your balance
sheets, you may attach them as opposed to filling out the associated
questions.  Be sure to identify, in the appropriate comment section,
which questions responses are fulfilled with the balance sheets.

Definitions

These definitions are for the purpose of this questionnaire only.

Term	Definition

Bioretention	A system for controlling runoff using soils and plants.
Surface runoff is directed into shallow, landscaped depressions. These
depressions are designed to incorporate many of the pollutant removal
mechanisms that operate in forested ecosystems. In some cases, filtered
runoff is collected in a perforated underdrain and returned to the storm
drain system or is discharged into another stormwater management device.


Catch Basin	A chamber or sump, typically at curb level, through which
stormwater runoff enters a conveyance system. Sediment may be retained
in a low area beneath the outlet to the conveyance system. 

Commercial/Institutional	Designed for use by retail, wholesale, office,
hotel, or service users

Contract Builder	A person who or business who has entered into a
contract with someone to build or construct a structure for them

Constructed Wetland	A constructed wetland is 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. 

Curb and Gutter	A roadside curb with a gutter that provides an improved
drainage, typically along roadways. 

Detention Basin (Dry Pond)	A stormwater control structure into which
storm runoff is directed to control both water quality and quantity. The
outlets to the basin are designed to detain and treat stormwater runoff
through settling over a period of time. The storm runoff storage also
decreases peak flow. Dry ponds are not designed to permanently contain
water. 

Developer	Owner’s agent who is responsible for handling the
construction and development 

Establishment	A single physical location where business is conducted, or
where services are performed

Firm	A business organization or entity consisting of one or more
domestic establishment locations under common ownership or control

General/Lead Contractor	A person who or business that performs or
supervises the construction or development of a property pursuant to the
terms of a primary contract with the property owner. The general
contractor may use its own employees to perform the work and/or the
services of other contractors called subcontractors

Green Roofs	Green roofs are vegetated and reduce runoff from the rooftop
by absorbing some stormwater and slowing stormwater flow.

Industrial	Designed for industrial purposes such as factories

Infiltration Basins and Trenches/Dry Well	A rock-filled trench with no
outlet. Typically stormwater first passes through a swale or other
stormwater management application before reaching the trench. The
stormwater filters through the soil. 

Linear Projects	A construction project including, roads and pipelines
that are substantially longer than they are wide.

Linear - Transportation	Includes uses such as highways and bridges

Linear  - Utility	Includes uses such as water and gas pipelines and
powerlines

Manufactured Devices	A manufactured device which is designed to
intercept stormwater runoff and prevent the transfer of pollutants
downstream.

Mixed Use	Designed/used for more than one land use category

Multifamily Residential 	Housing where multiple separate housing units
for residential (ie non-commercial) inhabitants are contained within one
building; also known as multi-dwelling unit 

Municipal Separate Storm Sewer System (MS4)	A conveyance or system of
conveyances that is owned by a state, city, town, village, or other
public entity that discharges to waters of the United States. The system
is designed or used to collect or convey stormwater (including storm
drains, pipes, ditches, etc.) but is not part of a Publicly Owned
Treatment Works (sewage treatment plant).

Newly Developed/New Construction	Construction that occurs on previously
undeveloped lots including infill which is new development within
existing developed areas

Owner	The firm, individual, or institutions for whom the project is
being built

Permeable Pavement	Pavement composed of a permeable pavement surface,
which allows infiltration into the subsoil. There may also be an
underlying stone reservoir that temporarily stores the surface runoff
before it infiltrates into the subsoil.

Redeveloped	A developed site that has been previously developed and is
typically covered or partially covered with impervious or compacted
surface.  Redeveloped areas do not include alterations to the interior
of an existing structure.

Retention Basin (Wet Pond)	A stormwater control structure with a
permanent pool of water into which storm runoff is directed to control
both water quality and quantity. Runoff from each storm is retained and
treated, and sediment particles and associated pollutants settle out,
until the water is displaced by runoff from a later storm. 

Retention Practices	Stormwater techniques which infiltrate,
evapotranspirate and reuse rainfall in order to reduce off-site surface
runoff.

Single-Family Residential 	Housing unit designed and maintained for
occupancy by only one family.

Stormwater Control System	The management of stormwater on or off site,
including detention, retention and infiltration.

Subcontractor	A person or company under contract to perform work for a
developer or a general contractor

Swales: Grassed	A broad, shallow channel used for conveying 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. Water treatment 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 	Tree boxes are usually located in urban areas. Runoff is
directed to the 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.

Section A: General Information 

A-1	Provide contact information for your establishment.

		Establishment’s Full Legal Name

		_________________________________________________

		Address

		_________________________________________________

		Phone/Fax Number

		_________________________________________________

		Website

		_________________________________________________			

A-2	Provide contact information for the person responsible for
completing this section.

		Name

		_________________________________________________		

		Title

		_________________________________________________

		Phone/Fax Number

		_________________________________________________

		Email

		_________________________________________________

		Best Time to Contact

		_________________________________________________

A-3	Indicate the state(s) where your establishment has completed
projects in Fiscal Year (FY) 2005 through FY 2009.

		□ AL	□ FL	□ LA	□ NE	□ OK	□ VT

		□ AK	□ GA	□ ME	□ NV	□ OR	□ VA

		□ AZ	□ HI	□ MD	□ NH	□ PA	□ WA

		□ AR	□ ID	□ MA	□ NJ	□ RI	□ WV

		□ CA	□ IL	□ MI	□ NM	□ SC	□ WI

		□ CO	□ IN	□ MN	□ NY	□ SD	□ WY

		□ CT	□ IA	□ MS	□ NC	□ TN		

		□ DE	□ KS	□ MO	□ ND	□ TX		

		□ DC	□ KY	□ MT	□ OH	□ UT		

A-4 	Did your establishment complete at least one project  from FY 2005
through FY 2009 that meets both of the following criteria?

	1. Your establishment was the owner, developer, general or lead
contractor, or 	contract builder; and

	2. The project was NOT a pipeline or other utility related activity
where the 	original land cover was replaced at the end of the project.

	

 Yes (Skip to Section B)

 No (You have completed the survey.  Sign the certification statement
in Section E and return to address indicated on page 3)

	

Section B:  Firm Financial

B-1	Is this establishment independently owned and operated (e.g. the
establishment is the business entity)?

			

		□ Yes (skip to Question B-3) 

		□ No (continue to the next question)

B-2	Provide contact information for the Firm.

		Firm’s Full Legal Name

		_____________________________________________

		Address

		_____________________________________________

		Phone/Fax Number

		_____________________________________________

		E-mail

		_____________________________________________

		

B-3	Indicate the firm’s type of business organization.

	□ Sole proprietorship

	□ Partnership

	□ Corporation (standard, “C” corporation)

	□ Subchapter S Corporation

	□ Limited Liability Corporation

	□ Other: _______________________________________	

B-4	In what state is your firm organized as a legal entity?	

	__________________________________________

B-5	When was the start of the firm’s current fiscal year?

		__________	___________		

		Month (MM)	Year (YYYY)

	

B-6	Indicate the number of months in each year listed below for which
you have financial information for your firm. In some
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□ CBI	B-7	Complete the following table with information from your
firm’s balance sheet. 	Provide values to the nearest dollar and
fill-in all values, indicating not 	applicable categories with a
“0”.

Firm Balance Sheet Data ($)

Item	Fiscal Year

	2005	2006	2007	2008	2009

Assets

Cash, cash equivalents, and accounts receivable





	Inventories





	Completed construction projects





	Construction projects in progress





	Land for current or future development





	Other





	Other Current Assets





	Net Fixed Assets





	Completed construction projects held for the firm’s own accounts
(e.g., commercial investment property)





	Other net fixed assets





	Goodwill and Other Intangibles





	Other Non-Current Assets





	Total Assets (Sum of the above)





	Liabilities and Net Worth

Total Current Liabilities





	Long-Term Debt





	Deferred Taxes





	All Other Non-Current Liabilities





	Total Liabilities (Sum of the above)





	Net Worth





	

□ CBI	B-8	Complete the following table with information from your
firm’s income 	statement. Provide values to the nearest dollar and
fill-in all values, indicating not 	applicable categories with a
“0”.

		

Firm Income Statement Data ($)

Item	Fiscal Year

	2005	2006	2007	2008	2009

Revenue





	Sale of constructed projects





	Sale of land or other uncompleted construction projects





	Construction (e.g., as contract builder) and related services (e.g.,
design, construction management) 





	Other revenue; 

Please specify

 __________________





	Cost of Revenue





	Gross Margin





	Operating Expenses





	Operating Income





	All Other Expenses





	Income Before Interest and Tax





	Interest Expense





	Profit Before Tax





	Tax





	Net Income After Tax





		

□ CBI	B-9	Complete the following table with information on your
firm’s cash flow 	statement. Provide values to the nearest dollar and
fill-in all values, indicating not 	applicable categories with a
“0”.

					

Firm Cash Flow Statement Data ($)

Item	Fiscal Year

	2005	2006	2007	2008	2009

Cash Flows from Operating Activities





	Income from Operations





	Depreciation/Non-Cash Charges





	Net Change in Accounts Receivable/Accounts Payable





	Change in Inventories





	Net Change in Other Current Assets/Current Liabilities





	Net Cash Provided by Operating Activities





	Cash Flows from Investing Activities





	Capital Expenditures





	Investments





	Other Cash Flows from Investing Activities





	Cash Flows from Financing Activities





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□ CBI 	B-10	How much of your firm’s revenue was generated by
performing each of the 	following roles during the period FY 2005
through FY 2009? Provide values to 	the nearest dollar and fill-in all
values, indicating not applicable categories with a 	“0”.

	

Revenue ($)

Role	Fiscal Year

	2005	2006	2007	2008	2009



Owner/ Developer & Builder





	Owner/ Developer





	General or Lead Contractor or Contract Builder





	Other Contractor/ Subcontractor Role





	Other; Please specify





	

□ CBI 	B-11	How much of your firm’s revenue came from the following
categories of 	construction activities during the period from FY 2005
through FY 2009? Provide 	values to the nearest dollar and fill-in all
values, indicating not applicable 	categories with a “0”.

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□ CBI 	B-12	How much of your firm’s revenue came from the following
categories of 	activities during the period from FY 2005 through FY
2009? Provide values to the 	nearest dollar and fill-in all values,
indicating not applicable categories with a “0”.

Revenue ($)

Category	Fiscal Year

	2005	2006	2007	2008	2009

Single-Family Residential





	Multifamily Residential





	Commercial/Institutional 





	Industrial





	Linear Transportation





	Linear Utility





	Mixed Use





	Other; specify





	

□ CBI 	B-13	In the table below, indicate how many full-time equivalent
employees your firm employed at the end of each fiscal year requested. 
Include all full-time and part-time employees. Do not include contract
labor.

	Total Number of Firm Employees (Full-Time Equivalent)

Fiscal Year

2005	2006	2007	2008	2009









B-14	Provide contact information for the person responsible for
completing this section.

		

Name

		_________________________________________________		

		Title

		_________________________________________________

		Phone/Fax Number

		_________________________________________________

		Email

		_________________________________________________

		Best Time to Contact

		_________________________________________________

Section C Project Level Information

C-1 	How many projects was your establishment engaged in on the last day
of FY 2009?

	__________________________________________________

C-2	How many projects did your establishment complete during the period
of FY 2005 through FY 2009?

Number of Projects

Category	Project Size (acres)

	<1	1- <3	3- <5	5- <7.5	7.5-<10	10- <15	15- <20	20- <30	30- <40	40- <60
60- <80	80- <100	>100

Single-Family Residential













	Multifamily Residential













	Commercial/Institutional 













	Industrial













	Linear – Transportation













	Linear – Utility













	Mixed Use













	Other













	Total













	

C-3	Was your establishment the owner/general contractor for any 

	project completed during FY 2009?

□ Yes (Complete the remainder of this section) 

		□ No (Skip to Section D)

		□ No completed projects in FY 2009 (Skip to Section E)

For the remainder of Section C, respond to the questions for up to ten
completed projects or all completed projects during FY 2009, whichever
is less, and which meet both of the following criteria:

1.	Your establishment was the owner or general/lead contractor, and

2.	The project was NOT a pipeline or other utility related activity
where the original land cover was replaced at the end of the project

Ten copies of the remainder of Section C are provided for a maximum of
ten projects.  If applicable, provide information on projects in each of
the following size categories: 

0-1 Acre, 

1-5 Acres, 

5-10 Acres, and 

> 10 Acres.

General and Technical Information

C-4	Provide the location of the project.

	Street Name:

	_____________________________________

	Town/City:

	_____________________________________

	State:

	_____________________________________

	ZIP Code:

	_____________________________________

		

C-5	Was your establishment a National Pollutant Discharge Elimination
System 	Notice of Intent (NOI) permit holder for this project?

		□ Yes    CONTINUE to the next question.

		□ No      SKIP to Question C-7.

		

 

C-6	Provide the NOI permit number(s) and attach a copy of each NOI.

	__________________________________________________________

C-7	What was the project start and end dates?

	Start Date _____________	End Date _____________	

		    (MM/DD/YYY)	 	   (MM/DD/YYY)

		

C-8	What was the duration of each phase of the project and the entire
project?

	

Project Duration

Project Phase	Duration (months)

Land Acquisition

	Land Development

	Design

	Building Construction

	Total

	

C-9	Indicate the project type and size for newly developed and
redeveloped sites.		

Developed Area Type	Area of the Project (acres)

Total

	New

Single-Family Residential

	Multifamily Residential

	Commercial 

	Industrial

	Institutional

	Government

	Linear/Transportation

	Other 

	Redeveloped Area

Single-Family Residential

	Multifamily Residential

	Commercial 

	Industrial

	Institutional

	Government

	Linear/Transportation

	Other 

			

C-10 PRE-Construction Land Cover

Indicate the area occupied by each of the following site components.
Fill in information for each site component.  If not applicable write
“NA”.  If info is not available or unknown for a particular site
component, please provide your best estimate or indicate “NK” for
Not Known.

(a) Indicate the area occupied by each of the following impervious site
components. Do not include the footprint of buildings that have a green
roof or disconnected spout leading to an infiltration best management
practice or transportation areas which are constructed of pervious
pavers or other pervious materials. Rather, include these areas in
response to the part b.

			

Acres Covered by Impervious Site Components

Site Component	Area (Acres)

Building Areas/ Rooftops (house, garage, storage structure etc.)

	Transportation Areas (roads, driveways)

	Parking area 

	Other Impervious Area

	

(b) Indicate the area occupied by each of the following pervious site
components.

 

Acres Covered by Pervious Site Components

Site Component	Acres

Green or vegetated rooftops

	Semi-pervious surfaces (such as pervious pavement)

	Open green space (such as grass lawns)

	Infiltration BMPs (such as rain gardens, swales, and wetlands)

	Water bodies including natural ponds and detention BMPs

	Cropland/Pasture

	Natural vegetation and undisturbed areas

	Forest

	Shrubland

	Grassland

	Barren

	Wetlands

	Other:

	Other pervious area

					

				

C-11	POST-Construction Land Cover

Indicate the area occupied by each of the following site components.
Fill in information for each site component.  If not applicable write
“NA”.  If info is not available or unknown for a particular site
component, please provide your best estimate or indicate “NK” for
Not Known.

(a) Indicate the area occupied by each of the following impervious site
components. Do not include the footprint of buildings that have a green
roof or disconnected spout leading to an infiltration best management
practice or transportation areas which are constructed of pervious
pavers or other pervious materials. Rather, include these areas in
response to the part b.

		

	

Acres Covered by Impervious Site Components

Site Component	Area (Acres)

Building Areas/ Rooftops (house, garage, storage structure etc.)

	Transportation Areas (roads, driveways)

	Parking area 

	Other Impervious Area

	

			

(b) Indicate the area occupied by each of the following pervious site
components. 

	

	

Acres Covered by Pervious Site Components

Site Component	Acres

Green or vegetated rooftops

	Semi-pervious surfaces (such as pervious pavement)

	Open green space (such as grass lawns)

	Infiltration BMPs (such as rain gardens, swales, and wetlands)

	Water bodies including natural ponds and detention BMPs

	Cropland/Pasture

	Natural vegetation and undisturbed areas

	Forest

	Shrubland

	Grassland

	Barren

	Wetlands

	Other:

	Other pervious area

	

C-12	Indicate the predominant soil type at this site.

		□ Clayey soils (clay, clay loam)	

		□ Silty soils (silt, silt loam)

		□ Loamy soils (loam, sandy loam)	

		□ Sandy soils (sand, loamy sand)

				

C-13	Provide the percolation rate at this site.

		_____________ minutes/inch

		

		

C-14	Is this site within the boundaries of a regulated MS4?

		□ Yes	□ No

				

C-15	Does this site discharge to an MS4 system?

		□ Yes	□ No

		

C-16	Indicate which of the following specific or numeric stormwater post
construction performance standards and/or design criteria applied to
this project? Check all that apply.

	□ Maximum peak runoff

	Specify: ____________

	□ Maximum total volume of runoff

	Specify: ____________

	□ Minimum size for detention structures

	Specify: ____________

	□ Maximum size for retention structures

	Specify: ____________

	□ Maximum discharge velocity of detention structures

	Specify: ____________

	□ Other channel protection measures 

	Specify: ____________

	□ Maximum percent impervious surface. 

	Specify: ____________

	□ On-site retention requirements for specific storm event:

	Specify: ____________

	□ Maintain predevelopment runoff for a specific storm event. 

	Specify: ____________

	□ Infiltration/groundwater preservation requirement 

	Specify: ____________	

	□ Quality improvement (e.g. solids, nitrogen, phosphorus, etc)	

	Specify: ____________

	□ Limits for effluent concentrations

	Specify: ____________

	□ Land grading requirements or other erosion prevention
specifications

	Specify: ____________

	□ Clustering or other site design requirements

	Specify: ____________

	□ Natural area protection (wetland & upland)

	Specify: ____________

	□ Water conservation requirements

	Specify: ____________

	□ Other: ___________________

	□  None

C-17	Did your firm perform a cost comparison between traditional
stormwater practices 	and retention or pervious stormwater practices
(i.e. green infrastructure 	practices) for this project?

	 Yes 	 No

C-18	Were stormwater retention practices planned for this site?

	□ Yes	□ No

				

C-19	Were stormwater retention practices implemented on this site?

	□ Yes	□ No

C-20	What, if any, challenges did your establishment encounter in
implementing the 	stormwater retention practice? Or if the retention
practices were planned but not 	implemented, what prevented your
establishment from implementing the 	technique(s)?  Check all that
apply.

	□ No retention practices techniques planned or implemented

	□ Zoning ordinances

	□ Local stormwater regulations/permit requirements

	□ Site limitations

	□ Financing requirements

	□ Lack of local providers with retention practice experience (site 
designers/engineers, architects, subcontractors for parts and
installation, etc.)

	□ Lack of desirability by site owner or other project participant

	□ Other ____________________________________________

 	□ Not Applicable

	□ None

		

C-21	If on-site stormwater controls had not been implemented at the
site, how would 	the additionally available land most likely been used? 
Check all that apply.

	□ Larger building footprint

	□ Additional connected impervious area such as parking, driveway, or
garage

	□ Additional disconnected impervious area such as a shed

	□ Additional green space such as lawn

	□ Additional natural vegetation/undisturbed land

	□ Stormwater management technique did not have a footprint

	□ Other _________________________________________

	□ Not Applicable

	□ Unknown

		

C-22	Complete the following information for the design criteria for the
system of 	stormwater controls for this project.

	□ No on-site post-construction stormwater controls at this project
(skip to C-23)

	(a) Indicate the total watershed area for the system (acres):
________________________________

	

	(b) Indicate which design specifications for on-site stormwater
controls were used 	for this project:   		

		□ Containment of storm:

			□ 2-yr	□ 5-yr	□ 10-yr 

			                       

		□Number of inches of; 

			□ rainfall____ 		□ runoff _______

			

		□ Capture and treatment of percentage of stormwater:

			

		□ Other (Please specify): _____________________

				

Indicate the system design capacity (including units):

________________________________________________

C-23	Indicate which of the following post construction stormwater
control components have been installed for this project.  Check all that
apply.  

	□ Detention basins

	□ Curbs and Gutters/Storm Sewers

	□ Catch Basins

	□ Swales

	□ Constructed Wetlands

	□ Underground Detention

□ Underground Infiltration

	□ Manufactured Devices

	□ Tree Boxes

	□ Green Roofs

	□ Bioretention

	□ Infiltration basins/trenches/dry wells

	□ Permeable pavement

	□ None (skip to C-25)

C-24	Provide, if available, an estimate of the total cost of the post
construction stormwater management system associated with this project
and costs for each stormwater control component indicated in C-23.  If
the costs for a specific applicable component are unknown, enter UNK.

		Total Cost: 					$ __________________

		□ Detention basins: 				$ __________________

		□ Curbs and Gutters/Storm Sewers:		$ __________________

		□ Catch Basins:				$ __________________

		□ Swales: 					$ __________________

		□ Constructed Wetlands: 			$ __________________

		□ Underground Detention: 			$ __________________

□ Underground Infiltration: 			$ __________________

		□ Manufactured Devices: 			$ __________________

		□ Tree Boxes: 					$ __________________

		□ Green Roofs: 				$ __________________

		□ Bioretention: 				$ __________________

		□ Infiltration basins/trenches/dry wells: 	$ __________________

		□ Permeable pavement: 			$ __________________

		□ Other:		 			$ __________________

C-25	Fill out one worksheet for each applicable stormwater system
components indicated in C-23.  You may make copies of the worksheet for
multiple components for a single project.  If you do not have detailed
information requested in the worksheet, write UNK.  Leave any worksheet
that is not applicable blank. Project Name and Unit Description:

Capital
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□ Engineering and Overhead Costs:		$ __________________________

□ Site Clearing and Excavation Costs:		$ __________________________

□ Land Cost or Value:				$ __________________________

□ Vegetation and Landscaping Costs:		$ __________________________

□ Other Capital Costs:				$ __________________________

____________________________		

Active Construction Usage

Was this unit installed as part of active construction runoff control?

		□ Yes				□ No

If yes, how much did it cost to convert the unit for post construction
control?

	□ No additional cost	□ $__________________	□ Unknown

Design Basis 

Check and provide information on all applicable design criteria for this
unit

□ Capacity (gallons):  					_______________________	

	

□ Drainage Area (Acres):				_______________________

□ Design Storm Return Interval:	□2-yr      □5-yr      □10-yr    
□Other:______

□ Design Storm Depth (inches):    ________		□Rainfall	□Runoff	

□ Other: ________________________________________________________

Technical Specifications

Area of Pond (acres):						_______________________

Volume of Pond (gallons):					_______________________

Other Technical Data (describe): 
_________________________________________________

Operation and Maintenance Costs

□

Detail of and duration for maintenance activities:	

	

Total Maintenance Costs:					$ ______________________	

Check all elements included in the total maintenance costs and provide
estimates of their individual costs if known.  If unknown, enter UNK. 

□ Revegetation/Maintenance Cost:			$ ______________________

□ Sediment Removal Costs:  				$ ______________________

□Other Costs: _________________			$_______________________			

Project Name and Unit Description:

Capital Costs

Installed Capital Cost: $ ______________________

Year of Cost Data: 	 ______________________ 	  

Check all elements included in your capital cost estimate and provide
estimates of their individual costs if known.  If unknown, enter UNK. 

□ Engineering and Overhead Costs:		$ __________________________

□ Storm Sewer Cost:				$ __________________________

□ Site Clearing and Excavation Costs:		$ __________________________

□ Materials Cost:				$ __________________________

□ Other Capital Costs:				$ __________________________

____________________________

Design Basis 

Check and provide information on the design criteria for this unit

□ Capacity (gallons):  					_______________________	

	

□ Drainage Area (Acres):				_______________________

□ Design Storm Return Interval:	□2-yr      □5-yr      □10-yr    
□Other:______

□ Design Storm Depth (inches):    ________		□Rainfall	□Runoff	

□ Other: ________________________________________________________

Technical Specifications			

Flow Rate Capacity (gal)			____________________________

Length (ft):					____________________________

Other Design Features		□ Curb Cuts	 □ Height (in): _______  

Connects To:  □ Combined Storm   □ Separate Storm       □
Bioretention      □ Pond

            	 Sewer System	        Sewer System	     Basin	

Other Technical Data (describe):
____________________________________________

Operation and Maintenance Costs

If you were responsible for maintaining this unit at any time, provide
the following information.  

□

Detail of and duration for maintenance activities:	

	

Maintenance Costs:					$ ______________________	

Check all elements included in the total maintenance costs and provide
estimates of their individual costs if known.  If unknown, enter UNK. 

□Sediment Removal Costs:  				$ ______________________

□Other Costs: __________________			$ ______________________

______________________________

Project Name and Unit Description:

Capital Costs

Installed Capital Cost: $ ______________________

Year of Cost Data: 	______________________ 	  

Check all elements included in your capital cost estimate and provide
estimates of their individual costs if known.  If unknown, enter UNK. 

□ Engineering and Overhead Costs:		$ __________________________

□ Construction Costs:				$ __________________________

□ Land Cost or Value:				$ __________________________

□ Materials Costs:				$ __________________________

□ Other Capital Costs:				$ __________________________

____________________________

Active Construction Usage

Was this unit installed as part of active construction runoff control?

		□ Yes				□ No

If yes, how much did it cost to convert the unit for post construction
control?

	□ No additional cost	□ $___________________	□ Unknown

Design Basis 

Check and provide information on the design criteria for this unit

□ Flow Rate Capacity (gpm):  				_______________________	

	

□ Drainage Area (acres):				_______________________

□ Containment of Storm:		□2-yr      □5-yr      □10-yr    
□Other:______

□ Design Storm Depth (inches):    ________		□Rainfall	□Runoff	

□Other:_________________________________________________________

Technical Specifications

Connects To:  □ Combined Storm   □ Separate Storm       □
Bioretention      □ Pond

            	 Sewer System	        Sewer System	     Basin	

Operation and Maintenance Costs

If you were responsible for maintaining this unit at any time, provide
the following information.  

If you were not responsible for maintenance please check here □

Detail of and duration for maintenance activities:	

	

Total Maintenance Costs:				$ ______________________	

Provide detail on the activities included in the total maintenance costs
above.  If known, provide costs for the individual activity.  If
unknown, enter UNK.

□Cost component: _________________			$________________	

□Cost component: __________________		$ ________________

□Cost component: __________________		$ ________________

	Project Name and Unit Description:

Capital Costs

Installed Capital Cost: $ ______________________

Year of Cost Data: 	______________________ 	  

Check all elements included in your capital cost estimate and provide
estimates of their individual costs if known.  If unknown, enter UNK. 

□ Engineering and Overhead Costs:		$ __________________________

□ Construction Costs:				$ __________________________

□ Land Cost or Value:				$ __________________________

□ Materials Costs:				$ __________________________

□ Other Capital Costs:				$ __________________________

____________________________

Active Construction Usage

Was this unit installed as part of active construction runoff control?

		□ Yes				□ No

If yes, how much did it cost to convert the unit for post construction
control?

	□ No additional cost	□ $____________________	□ Unknown 

Design Basis 

Check and provide information on the design criteria for this unit

□ Flow Rate Capacity (gpm):  				_______________________	

	

□ Drainage Area (Acres):				_______________________

Check the type of swale (check all that apply):

□ Grassed 	□ Rip-Rap/Rock Lined 	□ Other Vegetation 	□ Other:
__________

Other: _________________________________________________________________

Technical Specifications

Provide dimensions of swale (or attach drawing: ___ Length(ft)  
____Width(ft)	 _____Depth(ft)

Type of Vegetation: _____________________________

Other: ________________________________________

Operation and Maintenance Costs

If you were responsible for maintaining this unit at any time, provide
the following information.  

□

Detail of and duration for maintenance activities:	

	

Total Maintenance Costs:				$ ______________________	

Check all elements included in the total maintenance costs and provide
estimates of their individual costs if known.  If unknown, enter UNK. 

□ Sediment removal					$ ______________________

□ Revegetation						$ ______________________

□ Other ____________________________		$ ______________________

Project Name and Unit Description:

Capital Costs

Installed Capital Cost: $_______________________

Year of Cost Data: 	_______________________ 	  

Check all elements included in your capital cost estimate and provide
estimates of their individual costs if known.  If unknown, enter UNK. 

□ Engineering and Overhead Costs:		$ __________________________

□ Site Clearing and Excavation Costs:		$ __________________________

□ Land Cost or Value:				$ __________________________

□ Vegetation and Landscaping Costs:		$ __________________________

□ Other Capital Costs:				$ __________________________

____________________________

Design Basis 

Check and provide information on the design criteria for this unit	

	

□ Drainage Area (Acres):				_______________________

□ Containment of Storm:		□2-yr      □5-yr      □10-yr      
□Other:______

Other: ________________________________________________________________

Technical Specifications

Area of Pond (acres):					_______________________

Volume of Pond (gal):					_______________________

Type of Vegetation:					_______________________

Other Technical Data:	 _________________________________________________

Operation and Maintenance Costs

If you were responsible for maintaining this unit at any time, provide
the following information.  

□

Detail of and duration for maintenance activities:	

	

Total Maintenance Costs:				$ ______________________	

Check all elements included in the total maintenance costs and provide
estimates of their individual costs if known.  If unknown, enter UNK. 

□ Sediment removal					$ ______________________

□ Revegetation						$ ______________________

□ Other ____________________			$ ______________________

___________________________

Project Name and Unit Description:

Capital Costs

Installed Capital Cost: $ ______________________

Year of Cost Data: 	______________________ 	  

Check all elements included in your capital cost estimate and provide
estimates of their individual costs if known.  If unknown, enter UNK. 

□ Engineering and Overhead Costs:		$ __________________________

□ Site Clearing and Excavation Costs:		$ __________________________

□ Structural Materials Cost:			$ __________________________

□ Structural Control Devices Costs:		$ __________________________

□ Other Capital Costs: ___________		$ __________________________

______________________________

Design Basis 

Check and provide information on the design criteria for this unit	

	

□ Drainage Area (Acres):				_______________________

□ Containment of Storm:		□2-yr      □5-yr      □10-yr    
□Other:______

□ Design Storm Depth (inches):    ________		□Rainfall	□Runoff	

Other: ______________________________________________________________

Technical Specifications

Detention Volume (gal) ___________________

 

Time to Drain (hours) _________________

Other Technical Data:	 _________________________________________________

Operation and Maintenance Costs

If you were responsible for maintaining this unit at any time, provide
the following information.  

□

Detail of and duration for maintenance activities:	

	

Total Maintenance Costs:				$ ______________________	

Check all elements included in the total maintenance costs and provide
estimates of their individual costs if known.  If unknown, enter UNK. 

□Cost component: _________________			$________________	

□Cost component: __________________		$ ________________

□Cost component: __________________		$ ________________

Project Name and Unit Description:

Capital Costs

Installed Capital Cost: $ ______________________

Year of Cost Data: 	______________________ 	  

Check all elements included in your capital cost estimate and provide
estimates of their individual costs if known.  If unknown, enter UNK. 

□ Engineering and Overhead Costs:		$ __________________________

□ Site Clearing and Excavation Costs:		$ __________________________

□ Structural Materials Cost:			$ __________________________

□ Structural Control Devices Costs:		$ __________________________

□ Other Capital Costs: __________		$ __________________________

_____________________________

Design Basis 

Check and provide information on the design criteria for this unit	

	

□ Drainage Area (Acres):				_______________________

□ Containment of Storm:		□2-yr      □5-yr      □10-yr    
□Other:______

□ Design Storm Depth (inches):    ________		□Rainfall	□Runoff	

Other: _______________________________________________________________

Technical Specifications

Infiltration Rate (unit):						_______________________

Time to Drain (hours):						_______________________

Other Technical Data:	
_______________________________________________________

Operation and Maintenance Costs

If you were responsible for maintaining this unit at any time, provide
the following information.  

□

Detail of and duration for maintenance activities:	

	

Total Maintenance Costs:				$ ______________________	

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□Cost component: _________________			$________________	

□Cost component: __________________		$ ________________

□Cost component: __________________		$ ________________

Project Name and Unit Description:

Capital Costs

Installed Capital Cost: $ _______________________

Year of Cost Data: 	 ______________________ 	  

Check all elements included in your capital cost estimate and provide
estimates of their individual costs if known.  If unknown, enter UNK. 

□ Engineering and Overhead Costs:		$ __________________________

□ Land Cost or Value:				$ __________________________

□ Site Clearing and Excavation Costs:		$ __________________________

□ Other Capital Costs: __________		$ __________________________

____________________________

Design Basis 

Please provide as much design detail on the unit as possible

_________________________________________________________

_________________________________________________________

_________________________________________________________

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	□ Settling

	□ Filtration

	□ Absorptive/adsorptive materials

	□ Vortex separation

	□ Other solids removal

	□ Other Pollutant removal  ________________________________	

□ Other _______________________________________________

Other Technical Detail:
_______________________________________________________

Operation and Maintenance Costs

If you were responsible for maintaining this unit at any time, provide
the following information.  

If you were not responsible for maintenance please check here □

Detail of and duration for maintenance activities:	

	

Total Maintenance Costs:				$ ______________________	

Check all elements included in the total maintenance costs and provide
estimates of their individual costs if known.  If unknown, enter UNK. 

□Cost component: _________________			$________________	

□Cost component: __________________		$ ________________

□Cost component: __________________		$ ________________

Project Name and Unit Description:

Capital Costs

Installed Capital Cost: $ ______________________

Year of Cost Data: 	______________________ 	  

Check all elements included in your capital cost estimate and provide
estimates of their individual costs if known.  If unknown, enter UNK. 

□ Site Clearing and Excavation Costs:		$ __________________________

□ Other Capital Costs:__________		$ __________________________

____________________________

Design Basis 

Provide information on the design criteria for this unit	

Technical Specifications

Infiltration Rate (unit):					_______________________

Storage Volume (unit):					_______________________

Tree or Shrub Species and Installed Size (unit):	
_______________________

Other Technical Data:	 _________________________________________________

Operation and Maintenance Costs

□

Detail of and duration for maintenance activities:	

	

Total Maintenance Costs:				$ ______________________	

Check all elements included in the total maintenance costs and provide
estimates of their individual costs if known.  If unknown, enter UNK. 

□Cost component: _________________			$________________	

□Cost component: __________________		$ ________________

□Cost component: __________________		$ ________________

Project Name and Unit Description:

Capital Costs

Installed Capital Cost: $ ______________________

Year of Cost Data: 	 ______________________ 	  

Check all elements included in your capital cost estimate and provide
estimates of their individual costs if known.  If unknown, enter UNK. 

□ Construction Costs:				$__________________________

□ Engineering and Overhead Costs:		$ __________________________

□ Planting Media Costs:				$ __________________________

□ Vegetation Costs:				$ __________________________

□ Irrigation System Costs:			$ __________________________

□ Additional Structural Support Design Costs:	$
__________________________

□ Other Capital Costs: __________		$ __________________________

____________________________

Design Basis 

Provide information on the design criteria for this unit	

Volume Retained:				___________________

Other:						___________________

Technical Specifications

Roof Surface Area		______________________

% of Roof Vegetated		______________________

Type		□ extensive	□ intensive	□ semi-intensive

Depth of soil (inches)		______________________

Depth of media (inches)		______________________

Roof storage capacity (unit)	______________________

Other Technical Data:	 
_________________________________________________

Operation and Maintenance Costs

If you were responsible for maintaining this unit at any time, provide
the following information.  

□

Detail of and duration for maintenance activities:	

	

Total Maintenance Costs:				$ ______________________	

Check all elements included in the total maintenance costs and provide
estimates of their individual costs if known.  If unknown, enter UNK. 

□Cost component: _________________			$________________	

□Cost component: __________________		$ ________________

□Cost component: __________________		$ ________________

 

Project Name and Unit Description:

Capital Costs

Installed Capital Cost: $ ______________________

Year of Cost Data: 	______________________ 	  

Check all elements included in your capital cost estimate and provide
estimates of their individual costs if known.  If unknown, enter UNK. 

□ Construction Costs:				$__________________________

□ Engineering and Overhead Costs:		$ __________________________

□ Site Clearing and Excavation Costs:		$ __________________________

□ Land Costs or Value:				$ __________________________

□ Soil Amendment Materials Costs:		$ __________________________

□ Vegetative and Landscaping Costs:		$ __________________________

□ Other Capital Costs: __________		$ __________________________

____________________________

Active Construction Usage

Was this unit installed as part of active construction runoff control?

		□ Yes				□ No

If yes, how much did it cost to convert the unit for post construction
control?

	□ No additional cost		□ Unknown		□ $__________________

Design Basis 

Check and provide information on the design criteria for this unit

□ Capacity (gallons):  					_______________________	

	

□ Drainage Area (Acres):				_______________________

□ Design Storm:	□2-yr      □5-yr      □10-yr     □Other:______

□ Design Storm Depth (inches):    ________		□Rainfall	□Runoff	

□ Other: _____________________________________________________________

Technical Specifications

Underdrain filter gravel, filter fabric, pipe materials:	
_______________________	

	

Length and thickness/diameter of underdrain, if used (units):
_______________________

Soil mix added, if native soil excavated and replaced:	
_______________________

Amendment materials and percentages of native soil amended in place:
___________________

Types of Vegetation:
_______________________________________________________

Other: ________________________________________________________________

Operation and Maintenance Costs

If you were responsible for maintaining this unit at any time, provide
the following information.  

If you were not responsible for maintenance please check here □

Detail of and duration for maintenance activities:	

	

Total Maintenance Costs:				$ ______________________	

Check all elements included in the total maintenance costs and provide
estimates of their individual costs if known.  If unknown, enter UNK. 

□ Revegetation/Maintenance Cost:			$ ______________________

□ Sediment Removal Costs:  				$ ______________________

□Other Costs: _______________			$ ______________________

___________________________

Project Name and Unit Description:

Capital Costs

Installed Capital Cost: $ ______________________

Year of Cost Data: 	______________________ 	  

Check all elements included in your capital cost estimate and provide
estimates of their individual costs if known.  If unknown, enter UNK. 

□ Construction Costs:				$ __________________________

□ Engineering and Overhead Costs:		$ __________________________

□ Site Clearing and Excavation Costs:		$ __________________________

□ Structural Materials Cost:			$ __________________________

□ Structural Control Devices Costs:		$ __________________________

□ Vegetation and Landscaping Cost:		$ __________________________

□ Other Capital Costs: __________		$ __________________________

____________________________

Active Construction Usage

Was this unit installed as part of active construction runoff control?

		□ Yes				□ No

If yes, how much did it cost to convert the unit for post construction
control?

	□ No additional cost	□ $___________________	□ Unknown 

Design Basis 

Check and provide information on the design criteria for this unit	

	

□ Drainage Area (Acres):				_______________________

□ Containment of Storm:		□2-yr      □5-yr      □10-yr    
□Other:______

□ Design Storm Depth (inches):    ________		□Rainfall	□Runoff	

Other: _________________________________________________________________

Technical Specifications

Infiltrating Surface Area:				_______________________

Infiltration Capacity:					_______________________

Other Technical Data:	
________________________________________________________

□

Detail of and duration for maintenance activities:	

	

Total Maintenance Costs:				$ ______________________	

Check all elements included in the total maintenance costs and provide
estimates of their individual costs if known.  If unknown, enter UNK. 

□Sediment Removal					$ ______________________	

□Other_________________________			$ ______________________

_______________________________

Project Name and Unit Description:

Capital Costs

Installed Capital Cost: $ ______________________

Year of Cost Data: 	______________________ 	  

Check all elements included in your capital cost estimate and provide
estimates of their individual costs if known.  If unknown, enter UNK. 

□ Paving Costs:					$ __________________________

□ Granular Fill Costs:				$ __________________________

□ Engineering and Overhead Costs:		$ __________________________

□ Site Clearing and Excavation Cost:		$ __________________________

□ Other Capital Costs: __________		$ __________________________

_____________________________

Active Construction Usage

Was this unit installed as part of active construction runoff control?

		□ Yes				□ No

If yes, how much did it cost to convert the unit for post construction
control?

	□ No additional cost	□ $_______________	□ Unknown 

Design Basis 

Check and provide information on the design criteria for this unit	

	

Pavement Surface Area:				________________

Maximum Absorption (%):			________________

Permeability (mD):				________________	

Infiltration rate (in/hr):				________________			

Size of underdrain: 				________________

Other: ________________________________________________________

Technical Specifications

Type of Permeable Pavement:

□ Permeable Asphalt		□ Permeable Concrete

□ Permeable Blocks		□ Open Grid Pavement 

□ Other: ________	

Other Technical Data:	 _________________________________________________

Operation and Maintenance Costs

If you were responsible for maintaining this unit at any time, provide
the following information.  

If you were not responsible for maintenance please check here □

Detail of and duration for maintenance activities:	

	

Total Maintenance Costs:				$ ______________________	

Check all elements included in the total maintenance costs and provide
estimates of their individual costs if known.  If unknown, enter UNK. 

□ Sediment Removal					$ ______________________	

□ Other _____________________			$ ______________________

___________________________	

C-26	Provide contact information for the person responsible for
completing the general and technical info in this section.

		Name

		_________________________________________________		

		Title

		_________________________________________________

		Phone/Fax Number

		_________________________________________________

		Email

		_________________________________________________

		Best Time to Contact

		_________________________________________________

Financial Information

+ establishment’s percent share of ownership in the project.		

		__________ %

C-28	Did your establishment conduct services associated with this
project for another 	business entity?

	□ Yes	

	□ No (skip to Question 30)

	 

C-29	Indicate the role of the business (your client) in the project for
which you 	provided services?

	□ Owner/Developer

	□ Owner/Developer & Builder

□ General or Lead Contractor, Construction Manager or Contract Builder

	□ Other Contractor/Subcontractor Role

	□ Other: Please specify: _____________________________

□ CBI	C-30  Provide the following financial information for each phase
of the project. 

		

Land Acquisition and Initial Project Planning and Design

Item	Cost ($)

Raw Land Cost

	Fees - Legal, Accounting, Financing, and Permitting incurred during
land acquisition phase

	Project Design, Architectural Services, etc.

	Interest or other financing costs incurred during this phase

	Establishment’s Overhead

	Other Costs



	Land Development

Item	Cost ($)

Land Development (includes site preparation, site improvements such as
paving, water and sewer connections, erosion and sediment control, land
preservation and planting etc.)

	Fees - Legal, Accounting, Impact Analysis, Other

	Interest or other financing costs incurred during this phase

	Establishment’s Overhead

	Other Costs



	Project Construction

Item	Cost ($)

Fees - Legal, Accounting, Building Permit and Inspection, Other

	Cost of Construction – Materials, Labor, Services, Construction
Contracts, etc.

	Fees/Costs

	Interest or other financing costs Incurred during this phase

	Establishment’s Overhead

	Other Costs



	Completion – Sale or Other Completion Disposition

Item	Cost ($)

Fees - Legal, Accounting, Marketing, Other

	Interest or other financing costs incurred during this phase

	Establishment’s Overhead

	Other Costs

	

□ CBI 	C-31  	Provide information on the financial structure and
financing terms for each phase 	of the project.

		

Financing Information for Each Project Phase

Item	Land Acquisition	Land Development	Construction

Primary Debt Financing (first or senior debt)

Fraction Financed (%):



	Interest Rate, if a fixed rate (%):



	Interest Terms, if not fixed:



	Base Rate (check box):

	□ Prime Rate

□ LIBOR

□ Other:

	□ Prime Rate

□ LIBOR

□ Other:

	□ Prime Rate

□ LIBOR

□ Other:



Increment to Base Rate (%):



	Secondary Debt or Other Fixed Repayment Term Financing

Description:



	Fraction Financed (%):



	Interest Rate, if a fixed rate (%):



	Interest Terms, if not fixed:



	Base Rate (check box):

	□ Prime Rate

□ LIBOR

□ Other:

	□ Prime Rate

□ LIBOR

□ Other:

	□ Prime Rate

□ LIBOR

□ Other:



Increment to Base Rate (%):



	Equity Financing (Owner’s Financing or other Non-Debt, Non-Fixed
Repayment Term Financing)

Fraction Financed (%):



	Equity Financing (Owner’s Financing or other Non-Debt, Non-Fixed
Repayment Term Financing)

Description:



	Fraction Financed (%):



		

□ CBI 	C-32	Indicate the final value of the project?

(For example, the final project sales value or recorded asset value of
completed project when transferred from under-construction status to
completed construction status)

$ __________________________________

C-33	Does your establishments plan to retain ownership of this project
now that it is complete?

	□ Yes

	□ No

	□ Not Applicable

C-34	 Provide contact information for the person responsible for
providing the financial information in this section.

		Name

		_________________________________________________		

		Title

		_________________________________________________

		Phone/Fax Number

		_________________________________________________

		Email

		_________________________________________________

		Best Time to Contact

		_________________________________________________

You have completed the questionnaire. Sign the certification statement
in Section E and refer to instructions for mailing the questionnaire
back to the United States Environmental Protection Agency. Thank you.



Section D Project Level Information for Non-Owners/General Contractors

		

This Section should only be completed by establishments that were
required to respond to Section C and that responded “no” to Question
C-3.  

For Section D, respond to the questions for up to ten completed projects
or all completed projects during FY2009, whichever is less.  Do not
report on pipeline or other utility related activities where the
original land cover was replaced at the end of the project

Ten copies of the remainder of Section D are provided for a maximum of
ten projects.  If applicable, provide information on projects in each of
the following size categories: 

0-1 Acre, 

1-5 Acres, 

5-10 Acres, and 

> 10 Acres.

D-1	Provide the location of the project.

	Street Name:

	_____________________________________

	Town/City:

	_____________________________________

	State:

	_____________________________________

	ZIP Code:

	_____________________________________

D-2	Provide contact information for the business or entity for which
your 	establishment provided services for this project. EPA may need to
seek additional 	financial information regarding the project that will
help the development of a 	more accurate estimate of the impact of any
potential regulation on all potentially 	affected entities.

	Name

	_________________________________________

	Title

	_________________________________________

	Establishment

	_________________________________________

	

	Phone/Fax Number

	_________________________________________

	Email

	_________________________________________

	

D-3	Indicate the role of the business (your client) in the project for
which you 	provided services?

	□ Owner/Developer

	□ Owner/Developer & Builder

	□ General or Lead Contractor, Construction Manager or Contract 		
Builder

	□ Other Contractor/Subcontractor Role

	□ Other; Please specify: _____________________________

D-4	If the business or entity identified in D-1 was not the project
owner,	provide the contact information for the owner of the project, if
known.  

	

	Check here if unknown □	

		Name

		___________________________

		Title

		___________________________

		Establishment

		___________________________

	

		Phone/Fax Number

		___________________________

		Email

		___________________________

	

D-5	What services did your establishment provide? Check all that apply.

			□ Responsible for construction on part of the total project’s
area

			Acreage: __________________

			□ Responsible for specific construction activities, but not overall
project 				management

			Specific Activity: _________________________

			Acreage: ________________________________

			□ Other; Please specify :_______________________________

			Acreage: ___________________________________________

	

□ CBI 	D-6	How much revenue did your establishment receive for the
provided services?

	$ ________________________________	

		

D-7	What was the duration of your establishment’s part of the project?

	________ months

D-8	Provide contact information for the person responsible for
completing this section.

		Name

		_________________________________________________		

		Title

		_________________________________________________

		Phone/Fax Number

		_________________________________________________

		Email

		_________________________________________________

		Best Time to Contact

		_________________________________________________

You have completed the questionnaire. Sign the certification statement
in Section E and refer to instructions for mailing the questionnaire
back to the United States Environmental Protection Agency. Thank you.

Section E:  Certification Statement

The individual responsible for directing or supervising the preparation
of the enclosed Stormwater Discharges from New Developed and Redeveloped
Sites Industry 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
official duly authorized representative. The Certification Statement
must be completed 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 judgment. 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

	OMB Control No. 20XX-XXXX

   	 	Approval expires XX/XX/XX

 PAGE   1 

Industry Questionnaire		Page   PAGE  24  of   NUMPAGES  61 

Survey ID: ________________				             	             OMB Control
No. 20XX-XXXX

      	                                                                 
                                                        Approval expires
XX/XX/XX	

Survey of Industry		Page   PAGE  1  of   NUMPAGES  61 

Detention Basin (Dry Pond) Worksheet

Curb And Gutter/Storm Sewer Worksheet

Catch Basin Worksheet

Swale Worksheet

Constructed Wetland Worksheet

Underground Detention Worksheet

Underground Infiltration Worksheet

Manufactured Device Worksheet

Tree Box Worksheet

Green Roof Worksheet

Bioretention Worksheet

Infiltration Basin / Trench / Dry Well Worksheet

Permeable Pavement Worksheet

