Standard Urban Storm Water Mitigation Plan
Evaluation Form

1

City of:

2

Project Name

3

Name/Title of Project Evaluator

4

Date of Evaluation (mm/dd/yyyy)

5

Name of Project Applicant

6

Project Location

7

Estimated Date of Completion (mm/dd/yyyy)

8

Area of Soil Disturbance (by grading, clearing and/or excavating) in square feet or acres

9

Will original line and grade disturbed? (yes/no)

10

Will original purpose of the project be maintained?

11

Is the project located in or adjacent to an ESA?

12

If project is located in or adjacent to an ESA, describe what environmental characteristic makes it an ESA and where is located relative to the project

13

Will a parking area be added that is 25-space or more or greater than 5,000 square feet that does not change original line and grade? (yes/no)

10-plus Home Subdivision any subdivision: developed for 10 or more single-family or multi-family dwelling units.
1 Acre (43,560 sq. ft.) Industrial/Commercial Development: any industrial/commercial development that disturbes 1 acre (43,560 sq. ft.) or more of surface area, including parking areas.
Restaurant: a stand-alone facility that sells prepared foods and drinks for consumption, including stationary lunch counters and refreshment stands selling prepared foods and drinks for immediate consumption -- SIC code 5812 only).
Automotive Repair Shop: any facility that is typed by any of the following Standard Industrial Classification (SIC) codes 5013, 5014, 5541, 7352-7534.
Retail Gasoline Outlet: any facility engaged in selling gasoline and lubricating oils.
Single-family Hillside Residence: Any hillside single-family new development located in an area with known erosive soil conditions, where grading is contemplated on any natural slope that is 25% or greater.
Parking Lot: Any impervious land area or facility used for the temporary parking or storage of motor vehicles used personally for business or for commerce with a lot size of 5,000 square feet or more, or with 25 or more parking spaces.
Redevelopment: On any already developed site, any of the foregoing subject categories that results in the creation or addition of at least 5,000 square feet of impervious surface that does not disturb original line and grade or is a maintenance project.
If "no" to any of the above, the project IS NOT SUBJECT TO STANDARD URBAN STORM WATER MITIGATION MEASURES. No further evaluation is necessary.