PHASE II MS4 ANNUAL REPORT for Permit Year: X 1 2 3 4 5 Other: Istructios for completig this form: Complete Sectios I through V of this Aual Report form ad submit it to the Departmet to fulfill the aual reportig requiremet uder the Geeric Permit for Discharge of Stormwater from Phase II Muicipal Separate Storm Sewer Systems, Rule 62-621.300(7)(a), F.A.C. The umberig ad refereces to Best Maagemet Practices (BMPs) o this Aual Report form should reflect the iformatio give i the Phase II MS4 s Notice of Itet (NOI) form previously submitted to the Departmet. PLEASE REFER TO THE APPROVED PHASE II MS4 NOI SUBMITTAL WHILE COMPLETING SECTION II OF THIS FORM. Proposed chages to the approved SWMP shall be idicated i Sectio III of this form. Whe complete, please submit this Aual Report form to the followig address: NPDES Stormwater Sectio Florida Departmet of Evirometal Protectio 2600 Blair Stoe Road M.S. 2500 Tallahassee, FL 32399-2400 Do NOT iclude ay attachmets except for Moitorig Data i Sectio IV, if applicable. SECTION I. PHASE II MS4 OPERATOR INFORMATION A. Name of the Phase II MS4 Operator: CITY OF CLERMONT B. Name of the Phase II MS4 Resposible Authority: TAMARA RICHARDSON Title: DIRECTOR OF ENGINEERING Departmet: CITY OF CLERMONT ENGINEERING Mailig Address: 685 WEST MONTROSE STREET City: CLERMONT Zip Code: 34711 Couty: LAKE Telephoe Number: (352) 241-7336 E-mail Address: trichardso@clermotfl.org C. Name of the Desigated Phase II MS4 Stormwater Maagemet Program Cotact: TAMARA RICHARDSON Title: DIRECTOR OF ENGINEERING Departmet: ENGINEERING DEPARTMENT Mailig Address: 685 WEST MONTROSE STREET City: CLERMONT Zip Code: 34711 Couty: LAKE Telephoe Number: 352-241-7336 E-mail Address: trichardso@clermotfl.org D. Locatio of the Phase II MS4 (if differet tha the mailig address i Sectio I.C above): Street Address: SAME AS ABOVE City: Zip Code: Couty:
Idicate the Phase II MS4 s status of compliace i terms of achievemet of each of the miimum cotrol measures described i the geeric permit. Refer to the approved NOI for a list of the specific BMPs ad Measurable Goals the Phase II MS4 committed to perform ad track. Chages that will result i deviatio from the NOI should be listed i Sectio III of this form. Iclude activities for all reportig periods (permit years) i this sectio. 1a 01 1a 02 City Web Site Dedicate a area to the City s Storm Water Maagemet ad Pollutio Prevetio Pla. Provide liks to educatioal materials icludig public commet ( 4e-01). Iformatio provided icludes articles ad brochures for dowload. Educatioal Pamphlets City shall use educatioal pamphlets regardig storm water pollutio prevetio for distributio to the public. 1. Develop a Storm Water Maagemet web page. 1. Years 1-2 2. Documet web page visitors. 2. Years 3 5. 1. Idetify the locatios where pamphlets are available. 2. Number of pamphlets distributed. 2. Years 1-5
Idicate the Phase II MS4 s status of compliace i terms of achievemet of each of the miimum cotrol measures described i the geeric permit. Refer to the approved NOI for a list of the specific BMPs ad Measurable Goals the Phase II MS4 committed to perform ad track. Chages that will result i deviatio from the NOI should be listed i Sectio III of this form. Iclude activities for all reportig periods (permit years) i this sectio. 2a 01 Public Participatio A public otice shall be posted i the evet storm water related iformatio is scheduled for discussio at Coucil meetigs or workshops. 1. Number of meetig or workshops posted for public otice where storm water related iformatio is scheduled for discussio. 2. Number of citize attedees. 2. Years 1 5 Public Ivolvemet 2a 02 Lake clea-up. Commuity cleaups of shorelies ad waterways. 1. Number of evets. 2. Number of voluteers. 2. Years 1-5 3. Amout of litter collected. 3. Years 1 5..
Idicate the Phase II MS4 s status of compliace i terms of achievemet of each of the miimum cotrol measures described i the geeric permit. Refer to the approved NOI for a list of the specific BMPs ad Measurable Goals the Phase II MS4 committed to perform ad track. Chages that will result i deviatio from the NOI should be listed i Sectio III of this form. Iclude activities for all reportig periods (permit years) i this sectio. 3a 01 Storm Water System Map 1. Map Outfalls ad poits of discharge to OFW, lake ad surface waters. 1. Years 1 5 Map Outstadig Florida Waters, lakes, receivig waters ad basi boudaries. Map the City s existig storm water system. Illicit Discharge Elimiatio 2. Number of outfalls to surface waters mapped. 2. Years 1 5.. 3b 01 3c 01 3d 01 The City code of Ordiace prohibits o-storm water discharges through Chapter 94, Article V, Divisio 3, Storm Water Maagemet. Illicit Discharge Detectio ad Elimiatio Program Proactive ispectios of the storm water coveyace system. Iformatio to the Geeral Public Regardig Illegal Discharges to the Storm Sewer ad Improper Disposal of Waste. 1. Documet ay chages to existig ordiace. 1. Years 1 5 1. Number of proactive ispectios. 2. Number of illicit discharges idetified. 3. Number of illicit discharges elimiated. 1. Number of brochures distributed. 1.Years 1 5 1.Years 1 5 2. Years 1 5 3. Years 1 5 IDDE: PROTECT Florida s Water STOP! Poitless Persoal Pollutio. 3d 02 Iformatio to City Employees Regardig Illegal Discharges to the Storm Sewer System ad Improper Disposal of Waster IDDE: MUNICIPAL POLLUTION PREVENTION/GOOD HOUSEKEEPING PRACTICES. 1. Number of booklets distributed. 1.Years 1 5
Idicate the Phase II MS4 s status of compliace i terms of achievemet of each of the miimum cotrol measures described i the geeric permit. Refer to the approved NOI for a list of the specific BMPs ad Measurable Goals the Phase II MS4 committed to perform ad track. Chages that will result i deviatio from the NOI should be listed i Sectio III of this form. Iclude activities for all reportig periods (permit years) i this sectio. 3d 03 Iformatio to Busiesses Regardig Illegal Discharges to the Storm Sewer System ad Improper Disposal of Waste SPECIFIC IDDE: After The Storm 1. Number of brochures distributed. 1. Years 1 5
Idicate the Phase II MS4 s status of compliace i terms of achievemet of each of the miimum cotrol measures described i the geeric permit. Refer to the approved NOI for a list of the specific BMPs ad Measurable Goals the Phase II MS4 committed to perform ad track. Chages that will result i deviatio from the NOI should be listed i Sectio III of this form. Iclude activities for all reportig periods (permit years) i this sectio. Costructio Site Storm Water Ruoff Cotrol City Code of Ordiace Chapter 66, Article V, Divisio 3, requires erosio protectio ad sedimet cotrol o all costructio sites. 4a 01 City Code of Ordiaces Chapter 94, Article II ad Article V, requires storm water ruoff to be subjected to best maagemet practices. 1. Report ay modificatio to existig ordiace. 1. Years 1 5 4b 01 City Code of Ordiaces Chapter 106 requires costructio site operators to cotrol waste that may cause adverse impacts to water quality. Costructio Site Requiremets The City requires costructio erosio ad sedimet cotrol best maagemet practices. 1. Number of active costructio sites. 1. Years 1 5
Idicate the Phase II MS4 s status of compliace i terms of achievemet of each of the miimum cotrol measures described i the geeric permit. Refer to the approved NOI for a list of the specific BMPs ad Measurable Goals the Phase II MS4 committed to perform ad track. Chages that will result i deviatio from the NOI should be listed i Sectio III of this form. Iclude activities for all reportig periods (permit years) i this sectio. 4c 01 Costructio Site Water Cotrol The City requires costructio site operators to cotrol waste that may cause adverse impacts to water quality. Site Pla Review 1. Number of active costructio sites operatig uder the waste cotrol requiremets. 4d 01 4e 01 City Code of Ordiace Chapter 94, Article II, Divisio 2 ad Chapter 106, requires a Storm Water Pollutio Prevetio Pla (SWPPP) icluded with all site developmet documets. Procedures for Receipt ad Cosideratio of Public Commet. Dedicate a area o the City s web page to public commet regardig storm water pollutio prevetio. 1. Number of SWPPP s approved. 1. Number of public commets. 1. Years 1 5
Idicate the Phase II MS4 s status of compliace i terms of achievemet of each of the miimum cotrol measures described i the geeric permit. Refer to the approved NOI for a list of the specific BMPs ad Measurable Goals the Phase II MS4 committed to perform ad track. Chages that will result i deviatio from the NOI should be listed i Sectio III of this form. Iclude activities for all reportig periods (permit years) i this sectio. Certified Storm Water Erosio ad Sedimetatio Cotrol Ispector 4f 01 The City is dedicated to havig qualified staff to review plas ad ispect costructio sites. Traiig ad certificatio of City staff through state program, commercially available DVD s or coferece attedace. 1. Number of staff holdig certificatio for storm water ad erosio cotrol ispectio. 1. Years 1 5 Eforcemet of Storm Water Ruoff Cotrol Measures 4f 02 City Code of Ordiace Chapter 2, Article V creates the authority to eforce all costructio site operators to cotrol waste ad storm water ruoff by imposig fies ad other ocrimial pealties. Site Ispectio 1. Number of eforcemet actios. 4f 03 City Code of Ordiace Chapter 105, Sectio 106-15 requires costructio site ispectios icludig erosio protectio, sedimet cotrol ad waste cotrol. 1. Number of site SWPPP ispectios. 1. Years 1 5
Idicate the Phase II MS4 s status of compliace i terms of achievemet of each of the miimum cotrol measures described i the geeric permit. Refer to the approved NOI for a list of the specific BMPs ad Measurable Goals the Phase II MS4 committed to perform ad track. Chages that will result i deviatio from the NOI should be listed i Sectio III of this form. Iclude activities for all reportig periods (permit years) i this sectio. 5a 01 Post-costructio Storm Water Maagemet. The City shall utilize St. Johs River Water Maagemet District s (SJRWMD) Evirometal Resource Permit (ERP) as the mechaism to address postcostructio ru-off from ew ad redevelopmet projects. 1. 2. 3.
Idicate the Phase II MS4 s status of compliace i terms of achievemet of each of the miimum cotrol measures described i the geeric permit. Refer to the approved NOI for a list of the specific BMPs ad Measurable Goals the Phase II MS4 committed to perform ad track. Chages that will result i deviatio from the NOI should be listed i Sectio III of this form. Iclude activities for all reportig periods (permit years) i this sectio. Storm Water System Maiteace 1. Number of structures, legth of pipe cleaed. 6a 01 6a 02 6a 03 6b 01 The City cotiues to clea baffle boxes, catch basis, outfalls, pipes, swales, ditches ad storm water pods regularly to keep clear of debris. Street Sweepig Program The City cotiues its curret practice of street sweepig to clea city streets. Pet Waste Collectio Pet waste collectio statios are located i may City parks. The waste is collected ad properly disposed of by the City. Employee Pollutio Prevetio Educatio Employee traiig to reduce ad prevet storm water pollutio. 2. Estimated amout of debris collected. 2. Years 1 5 1. Miles of gutters swept. 2. Amout of debris collected. 2. Years 1-5 1. Amout of pet waste bags distributed. 1. Number of traiig evets. 1. Years 1 5 2. Number of employees traied. 2. Years 1 5
SECTION III. CHANGES TO STORMWATER MANAGEMENT PROGRAM Assess the appropriateess of each BMP that has bee implemeted ad provide a list of chages i the space below. Iclude proposed chages to BMPs, Measurable Goals, or Implemetatio Schedules, ad justificatio for the chages. Also report ew BMPs that have bee added to the Stormwater Maagemet Program i this sectio. Add pages if more room is eeded. Iclude the ID as it is listed o the approved NOI. The BMP Number should be idicated as listed o the approved NOI, uless a ew BMP is beig proposed. ID BMP Number (where applicable) Proposed Chage or New BMP Descriptio ad Justificatio
SECTION IV. INDEPENDENT MONITORING AND RELIANCE ON ANOTHER ENTITY A. Please idicate whether the Phase II MS4 performed idepedet moitorig. If yes, please attach moitorig data collected durig reportig period. The MS4 performed idepedet moitorig durig the reportig period. (Attach moitorig results to this Aual Report form) The MS4 did NOT perform idepedet moitorig durig the reportig period. B. Please idicate which elemets of the Stormwater Maagemet Pla the Phase II MS4 is relyig o aother etity to satisfy. Iclude ew or revised BMP activities that will be performed by aother etity. NOTE: Ay ew or revised BMP activities that will be performed by aother etity should also be listed i Sectios II or III of this form. ID BMP Number Name of Resposible Etity
Phase II MS4 Permit ID # FLR04E05G57 SECTION V. CERTIFICATION STATEMENT AND SIGNATURE The Resposible Authority listed i Sectio I.B of the Aual Report form must sig the followig certificatio statemet: I certify uder pealty of law that this documet ad all attachmets were prepared uder my directio or supervisio i accordace with a system desiged to assure that qualified persoel properly gathered ad evaluated the iformatio submitted. Based upo my iquiry of the perso or persos who maage the system, or those persos directly resposible for gatherig the iformatio, the iformatio submitted is, to the best of my kowledge ad belief, true, accurate ad complete. I am aware that there are sigificat pealties for submittig false iformatio, icludig the possibility of fie ad imprisomet for kowig violatios. Name of Phase II MS4 Resposible Authority (type or prit): Tamara Richardso, P. E. Title: Director of Egieerig Sigature: Date: / /