Project-Specific WQMP Summary Data Form Applicant Information Name and Company Email Project Information Project Name (as on project application/project-specific WQMP) Street Address Nearest Cross Streets Municipality (City or Unincorporated County) Zip Code Number(s) and/or Assessor Parcel Number(s) Other (other information to help identify location of project) Indicate type of project. Priority Development Projects (Use an "X" in cell preceding project type): SF hillside residence; impervious area 10,000 sq. ft.; Slope 25% ≥ ≥ SF hillside residence; impervious area 10,000 sq. ft.; Slope 10% & erosive soils ≥ ≥ Commercial or Industrial 100,000 sq. ft. ≥ Automotive repair shop Retail Gasoline Outlet disturbing > 5,000 sq. ft. Restaurant disturbing > 5,000 sq. ft. Home subdivision 10 housing units ≥ Parking lot 5,000 sq. ft. or 25 parking spaces ≥ ≥ Date Project-Specific WQMP Submitted Size of Project Area (nearest 0.1 acre) Will the project replace more than 50% of the impervious surfaces on an existing developed site? Project Area managed with LID/Site Design BMPs (nearest 0.1 acre) Are Treatment Control BMPs required? Is the project subject to onsite retention by ordinance or policy? Did the project meet the 100% LID/Site Design Measurable Goal? Name of the entity that will implement, operate, and maintain the post-construction BMPs Contact Name Street or Mailing Address City Zip Code Space Below for Use by City/County Staff Only Preceding Information Verified by Name: (consistent with information in project-specific WQMP) Date: Date Project-Specific WQMP Approved: Data Entered by Name: Date: Other Comments
Project-Specific WQMP Summary Data Form Applicant Information Name and Company Email Project Information Project Name (as on project application/project-specific WQMP) Street Address Nearest Cross Streets Municipality (City or Unincorporated County) Zip Code Number(s) and/or Assessor Parcel Number(s) Other (other information to help identify location of project) Indicate type of project. Priority Development Projects (Use an "X" in cell preceding project type): SF hillside residence; impervious area ≥ 10,000 sq. ft.; Slope ≥ 25% SF hillside residence; impervious area ≥ 10,000 sq. ft.; Slope ≥ 10% & erosive soils Commercial or Industrial ≥ 100,000 sq. ft. Automotive repair shop Retail Gasoline Outlet disturbing > 5,000 sq. ft. Restaurant disturbing > 5,000 sq. ft. Home subdivision ≥ 10 housing units Parking lot ≥ 5,000 sq. ft. or ≥ 25 parking spaces Date Project-Specific WQMP Submitted Size of Project Area (nearest 0.1 acre) Will the project replace more than 50% of the impervious surfaces on an existing developed site? Project Area managed with LID/Site Design BMPs (nearest 0.1 acre) Are Treatment Control BMPs required? Is the project subject to onsite retention by ordinance or policy? Did the project meet the 100% LID/Site Design Measurable Goal? Name of the entity that will implement, operate, and maintain the post-construction BMPs Contact Name Street or Mailing Address City Zip Code Space Below for Use by City/County Staff Only Preceding Information Verified by (consistent with information in project-specific WQMP) Name: Date: Date Project-Specific WQMP Approved: Data Entered by Name: Date: Other Comments
WWR_WQMP_Template_Jan15_2015.docx