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Date Form Completed: Completed by: SCVURPPP C.3. Data Form Page 1 of 5 April 2023 Provision C.3 Data Form 1. Project Information Project Name: # Project Address: Cross Streets: Applicant/Developer Name: Project Phase(s): Engineer: Project Type (Check all that apply): New Development Redevelopment Private Public Large Detached Single-Family Home Residential Commercial Industrial Mixed Use Institutional Other Project Description: Project Watershed/Receiving Water (creek, river or Which Projects Must Comply with Stormwater Requirements? Effective July 1, 2023, the following projects must comply with Stormwater Requirements: • All development/redevelopment projects (except single-family home projects) that create and/or replace 5,000 sq. ft. or more of impervious surface on the project site must fill out this worksheet and submit it with the development project application. • All large single-family home projects that create and/or replace 10,000 sq. ft. or more of impervious surface on the project site must also fill out this worksheet. These projects are called Regulated Projects. The Regulated Project area includes portions of the public right-of- way that are developed or redeveloped as part of the Regulated Project. Excluded Projects - Interior remodeling projects, routine maintenance or repair projects such as re-roofing and re- surfacing, and smaller single-family homes that are not part of a larger plan of development are NOT required to complete this worksheet. What is an Impervious Surface? An impervious surface is a surface covering or pavement that prevents the land’s natural ability to absorb and infiltrate rainfall/stormwater. Impervious surfaces include, but are not limited to rooftops, walkways, paved patios, driveways, parking lots, storage areas, impervious concrete and asphalt, gravel surfaces, and any other continuous watertight pavement or covering. Pervious pavement, underlain with pervious soil and pervious storage material drain rock), that infiltrates rainfall at a rate equal to or greater than surrounding unpaved areas OR that stores and infiltrates the water quality design volume specified in Provision C.3.d of the Municipal Regional Stormwater Permit (MRP), is not considered an impervious surface. For More Information The SCVURPPP C.3 Stormwater Handbook provides more information on selection of site design, source control, and treatment measures for a development project as well as guidance on preparing a stormwater control plan. Choose from list ---PAGE BREAK--- SCVURPPP C.3. Data Form Page 2 of 5 April 2023 2. Project Size a. Total Site Area: b. Total Land Area Disturbed During Construction: (ft2) (including clearing, grading, stockpiling, or excavating) Project Totals Total Existing (Pre- project) Area (ft2) Existing Area Retained1 (ft2) Existing Area Replaced2 (ft2) New Area Created2 (ft2) Total Post- Project Area (ft2) Impervious Area (IA) c. Total on-site IA d. Total off-site IA3 e. Total project IA f. Total new and replaced IA Pervious Area (PA)4 g. Total on-site PA h. Total off-site PA3 i. Total project PA j. Total Project Area k. Percent Replacement of IA in Redevelopment Projects: (Existing on-site IA Replaced ÷ Existing Total on-site IA) x 100% 1“Retained” means to leave existing IA in place. An IA that receives surface treatment pavement resurfacing/slurry seal/grind) only is considered “retained”. This category does not apply to off-site areas. 2 The “new” and “replaced” IA are based on the total project area and not specific locations within the project. Constructed IA on a project that does not exceed the total pre-project IA will be considered “replaced” IA. A project will have “new” IA only if the total post-project IA exceeds the total pre-project IA (total post-project IA – total pre-project IA = New IA). 3 Off-site areas include sidewalks and other parts of the public right-of-way roads, bike lanes, curbs, ramps, park strip) that are being reconstructed as part of the project footprint. Note that gravel is considered an impervious surface. 4 Include bioretention areas, infiltration areas, green roofs, and pervious pavement in PA calculations. 3. State Construction General Permit Applicability: a. Is #2.b. equal to 43,560 ft2 (1 acre) or more? Yes, applicant must obtain coverage under the State Construction General Permit (see ) No, applicant does not need coverage under the State Construction General Permit. 4. MRP Provision C.3 Applicability: a. Is #2.f. equal to 5,000 ft2 or more, or 10,000 ft2 for single family homes? Yes, C.3. source control, site design and treatment requirements apply No, C.3. source control and site design requirements may apply – check with local agency b. For redevelopment projects, is #2.k. equal to 50% or more? Yes, C.3. requirements (site design and source control, as appropriate, and stormwater treatment) apply to the entire on-site area No, C.3. requirements only apply to the impervious area created and/or replaced 5. Hydromodification Management (HM) Applicability: a. Does the project create and/or replace one acre or more of impervious surface AND is the total post-project impervious area greater than the pre-project (existing) impervious area? Yes (continue) No – exempt from HM, go to page 3 b. Is the project located in an area of HM applicability (green area) on the HM Applicability Map? www.scvurppp.org/hmp-map Yes, the project must implement HM requirements No, the project is exempt from HM requirements 0 0 0 0 0 0 0 0 0 0 0 0 ---PAGE BREAK--- SCVURPPP C.3. Data Form Page 3 of 5 April 2023 6. Selection of Specific Stormwater Control Measures: Site Design Measures ❑Minimize land disturbed protect trees and soil) ❑Minimize impervious surfaces reduction in post-project impervious surface) ❑Minimum-impact street or parking lot design parking on top of or under buildings) ❑Cluster structures/ pavement ❑Disconnected downspouts (direct runoff from roofs, sidewalks, patios to landscaped areas) ❑Pervious pavement ❑Green roof ❑Other self-treating5 area landscaped areas) ❑Self-retaining5 area ❑Rainwater harvesting and use rain barrel, cistern for designated use) 6 ❑Preserved open space ❑Protected riparian and wetland areas/buffers ❑Other Source Control Measures ❑Wash area/racks, drain to sanitary sewer7 ❑Covered dumpster area, drain to sanitary sewer7 ❑ Sanitary sewer connection or accessible cleanout for swimming pool/spa/fountain7 ❑Beneficial landscaping (minimize irrigation, runoff, pesticides and fertilizers; promotes treatment) ❑Outdoor material storage protection ❑Covers, drains for loading docks, maintenance bays, fueling areas ❑Maintenance (pavement sweeping, catch basin cleaning, good housekeeping) ❑Storm drain labeling ❑Other Treatment Measures ❑None (all impervious surface drains to self-retaining areas) LID Treatment ❑Bioretention area ❑Flow-through planter ❑Tree Well Filter or Trench with bioretention soils ❑Rainwater harvest/use cistern for designated use, sized for C.3.d treatment) ❑Pervious pavement, sized for C.3.d treatment ❑Infiltration trench ❑Infiltration well/dry well ❑Subsurface Infiltration System vault or large diameter conduit over drain rock) ❑Other Non-LID Treatment Methods ❑Proprietary high flow rate tree box filter8 ❑Proprietary high flow media filter (sand, compost, or proprietary media)8 ❑Vegetated filter strip9 ❑Extended detention basin9 ❑Vegetated swale9 ❑Other Flow Duration Controls for Hydromodification Management (HM) ❑ Extended Detention basin ❑ Underground tank or vault ❑ Bioretention with outlet control ❑ Other 5 See SCVURPPP C.3 Stormwater Handbook for definitions. 6 Optional site design measure; does not have to be sized to comply with Provision C.3.d treatment requirements. 7 Subject to sanitary sewer authority requirements. 8 These treatment measures are only allowed if the project qualifies as a “Special Project”. 9 These treatment measures are only allowed as part of a multi-step treatment process for pretreatment). ---PAGE BREAK--- SCVURPPP C.3. Data Form Page 4 of 5 April 2023 7. Stormwater Treatment Measure (STM) Sizing for Projects with Treatment Requirements Stormwater Treatment Measure (STM) Hydraulic Sizing Criteria Used* *Key: 1a: Volume – WEF Method 1b: Volume – CASQA BMP Handbook Method 2a: Flow – Factored Flood Flow Method 2b: Flow – CASQA BMP Handbook Method 2c: Flow – Uniform Intensity Method 3: Combination Flow and Volume Design Basis 8. Additional Stormwater Treatment of Non-Regulated Areas - Is the project providing stormwater treatment for non-regulated impervious area that is not included in Item 2 Project Size? For example, stormwater treatment of right-of-way areas that are outside the project footprint, or treatment measures that are treating more right-of- way impervious area quantities than required. Yes, complete the table below No Additional Stormwater Treatment of Non-Regulated Areas Non-Regulated Area Draining to Treatment Measure Treatment Measures Hydraulic Sizing Criteria Impervious Area Treated (ft2) Pervious Area Treated (ft2) Total Area Treated (ft2) 9. Alternative Certification: Was the treatment system sizing and design reviewed by a qualified third-party professional that is not a member of the project team or agency staff? Yes No Name of Third-party Choose from list Choose from list Choose from list Choose from list Choose from list Choose from list Choose from list Choose from list Choose from list Choose from list Choose from list Choose from list Choose from list Choose from list Flow-through planter concrete lined w/ u Choose from list Choose from list Choose from list Choose from list Choose from list ---PAGE BREAK--- SCVURPPP C.3. Data Form Page 5 of 5 April 2023 10. Operation & Maintenance Information A. Property Owner’s Name: B. Responsible Party for Stormwater Treatment/Hydromodification Control O&M: a. Name: b. Address: c. Phone/E-mail: This section to be completed by Municipal staff. O&M Responsibility Mechanism Indicate how responsibility for O&M is assured. Check all that apply: O&M Agreement Other mechanism that assigns responsibility (describe below): This section to be completed by Municipal staff (Note: This is an optional section that agencies should modify per their internal review and tracking process.) Reviewed: Community Development Department Public Works Department Planning Division Engineering Building Division Other (Specify) Return form to: Data entry performed by: