OMB Control No. 20XX-XXXX Approval expires XX/XX/XX United States Environmental Protection Agency Stormwater Management Including Discharges for Newly Developed and Redeveloped Sites Industry Questionnaire Survey ID: Industry Questionnaire Page 1 of 61 ------- OMB Control No. 20XX-XXXX Approval expires XX/XX/XX 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: > Section B: > Section C: > Section D: General Information Firm Financial Information Project Level Information for Owners/General Contractors Project Level Information for Non-Owners/General Contractors > Section E: Certification Industry Questionnaire Page 2 of 61 ------- OMB Control No. 20XX-XXXX Approval expires XX/XX/XX 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 Industry Questionnaire Page 3 of 61 ------- OMB Control No. 20XX-XXXX Approval expires XX/XX/XX 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. Industry Questionnaire Page 4 of 61 ------- OMB Control No. 20XX-XXXX Approval expires XX/XX/XX 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. Industry Questionnaire Page 5 of 61 ------- OMB Control No. 20XX-XXXX Approval expires XX/XX/XX 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. Industry Questionnaire Page 6 of 61 ------- OMB Control No. 20XX-XXXX Approval expires XX/XX/XX 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 Industry Questionnaire Page 7 of 61 ------- OMB Control No. 20XX-XXXX Approval expires XX/XX/XX 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 Industry Questionnaire Page 8 of 61 ------- OMB Control No. 20XX-XXXX Approval expires XX/XX/XX 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. Industry Questionnaire Page 9 of 61 ------- OMB Control No. 20XX-XXXX Approval expires XX/XX/XX Section A: General Information A-l 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 Industry Questionnaire Page 10 of 61 ------- OMB Control No. 20XX-XXXX Approval expires XX/XX/XX 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) Industry Questionnaire Page 11 of 61 ------- OMB Control No. 20XX-XXXX Approval expires XX/XX/XX Section B: Firm Financial B-l 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) Industry Questionnaire Page 12 of 61 ------- OMB Control No. 20XX-XXXX Approval expires XX/XX/XX B-6 Indicate the number of months in each year listed below for which you have financial information for your firm. In some cases, such as for new businesses, financial records may include only part of a year. Firm Months of Financial Data Fiscal Year 2005 2006 2007 2008 2009 ~ 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 ($) Item Fiscal Year 2005 2006 2007 2008 2009 Assets Cash, cash equivalents, and accounts receivable Inventories Completed construction projects Construction projects in progress Landfor current or future development Other Other Current Assets Net Fixed Assets Completed construction projects held for the firm's own accounts (e.g., commercial investment property) Other net fixed assets Goodwill and Other Intangibles Industry Questionnaire Page 13 of 61 ------- OMB Control No. 20XX-XXXX Approval expires XX/XX/XX Other Non-Current Assets Total Assets (Sum of the above) Liabilities and Net Worth Total Current Liabilities Long-Term Debt Deferred Taxes All Other Non- Current Liabilities Total Liabilities (Sum of the above) Net Worth ~ CBI B-8 Complete the following table with information from your firm's income statement. Provide values to the nearest dollar and fill-in all values, indicating not applicable categories with a "0". Firm Income Statement Data ($) 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 Industry Questionnaire Page 14 of 61 ------- OMB Control No. 20XX-XXXX Approval expires XX/XX/XX 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 ($) Fiscal Year Item 2005 2006 2007 2008 2009 Cash Flows from Operating Activities Income from Operations Depreciation Non- Cash Charges Net Change in Accounts Receivable Accounts Payable Change in Inventories Net Change in Other Current Assets Current Liabilities Net Cash Provided by Operating A ctivities Cash Flows from Investing Activities Capital Expenditures Investments Other Cash Flows from Investing Activities Cash Flows from Financing Activities Net Increase/Decrease in Cash Industry Questionnaire Page 15 of 61 ------- OMB Control No. 20XX-XXXX Approval expires XX/XX/XX ~ CBI B-10 How much of your firm's revenue was generated by performing each of the following roles during the period FY 2005 through FY 2009? Provide values to the nearest dollar and fill-in all values, indicating not applicable categories with a "0". Revenue ($) 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-l 1 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". Revenue ($) Category Fiscal Year 2005 2006 2007 2008 2009 New Construction Redevelopment Other; Please specify: ~ CBI B-12 How much of your firm's revenue came from the following categories of activities during the period from FY 2005 through FY 2009? Provide values to the nearest dollar and fill-in all values, indicating not applicable categories with a "0". Revenue ($) Category Fiscal Year 2005 2006 2007 2008 2009 Single-Family Residential Multifamily Residential Commercial/Institutional Industrial Industry Questionnaire Page 16 of 61 ------- OMB Control No. 20XX-XXXX Approval expires XX/XX/XX 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 Industry Questionnaire Page 17 of 61 ------- OMB Control No. 20XX-XXXX Approval expires XX/XX/XX Section C Project Level Information C-l 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 Pro jects 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/Institutio nal 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. Industry Questionnaire Page 18 of 61 ------- OMB Control No. 20XX-XXXX Approval expires XX/XX/XX 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 Pro ject Phase Duration (months) Land Acquisition Land Development Design Building Construction Total Industry Questionnaire Page 19 of 61 ------- OMB Control No. 20XX-XXXX Approval expires XX/XX/XX C-9 Indicate the project type and size for newly developed and redeveloped sites. Developed Area Type Area of the Pro ject (acres) Total New Single-Family Residential Multifamily Residential Commercial Industrial Institutional Government Linear/T ransportation Other Redeveloped Area Single-Family Residential Multifamily Residential Commercial Industrial Institutional Government Linear/T ransportation 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 Industry Questionnaire Page 20 of 61 ------- OMB Control No. 20XX-XXXX Approval expires XX/XX/XX (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 Shnibland Grassland Barren Wetlands Other: Other pervious area C-l 1 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. Industry Questionnaire Page 21 of 61 ------- OMB Control No. 20XX-XXXX Approval expires XX/XX/XX (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 Shntbland Grassland Barren Wetlands Other: Other pervious area Industry Questionnaire Page 22 of 61 ------- OMB Control No. 20XX-XXXX Approval expires XX/XX/XX 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-. Industry Questionnaire Page 23 of 61 ------- OMB Control No. 20XX-XXXX Approval expires XX/XX/XX ~ 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 Industry Questionnaire Page 24 of 61 ------- OMB Control No. 20XX-XXXX Approval expires XX/XX/XX C-22 Complete the following information for the design criteria for the system of storm water 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 ~ Capture and treatment of percentage of stormwater: ~ Other (Please specify): (c) 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. ~Number of inches of; ~ rainfall ~ runoff Total Cost: ~ Detention basins: ~ Curbs and Gutters/Storm Sewers: $ $ $ Industry Questionnaire Page 25 of 61 ------- OMB Control No. 20XX-XXXX Approval expires XX/XX/XX ~ 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. Industry Questionnaire Page 26 of 61 ------- Detention Basin (Dry Pond) Worksheet 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: $ 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: m2-yr m5-yr mlO-yr mOther: ~ Design Storm Depth (inches): ~ Rainfall ~ Runoff ~ Other: Technical Specifications Area of Pond (acres): Volume of Pond (gallons): Other Technical Data (describe): Industry Questionnaire Page 27 of 61 ------- Detention Basin (Dry Pond) Worksheet 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: $ Industry Questionnaire Page 28 of 61 ------- Curb And Gutter/Storm Sewer Worksheet 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 d ssign criteria for this unit ~ Capacity (gallons): ~ Drainage Area (Acres): ~ Design Storm Return Interval: m2-yr ~5-yr mlO-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 Sewer System ~ Separate Storm ~ Bioretention ~ Pond Sewer System Basin Other Technical Data (describe): Industry Questionnaire Page 29 of 61 ------- Curb And Gutter/Storm Sewer Worksheet 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: 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: $ Industry Questionnaire Page 30 of 61 ------- Catch Basin Worksheet 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 c iesign criteria for this unit ~ Flow Rate Capacity (gpm): ~ Drainage Area (acres): ~ Containment of Storm: ~2-yr n5-yr nlO-yr ~Other: ~ Design Storm Depth (inches): ~Rainfall ~Runoff ~Other: Technical Specifications Connects To: ~ Combined Storm ~ Separate Storm ~ Bioretention ~ Pond Sewer System Sewer System Basin Industry Questionnaire Page 31 of 61 ------- Catch Basin Worksheet 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: $ Industry Questionnaire Page 32 of 61 ------- Swale Worksheet 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: Industry Questionnaire Page 33 of 61 ------- Swale Worksheet 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 $ ~ Revegetation $ ~ Other $ Industry Questionnaire Page 34 of 61 ------- Constructed Wetland Worksheet 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: m2-yr m5-yr mlO-yr mOther: Other: Technical Specifications Area of Pond (acres): Volume of Pond (gal): Type of Vegetation: Other Technical Data: Industry Questionnaire Page 35 of 61 ------- Constructed Wetland Worksheet 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 $ ~ Revegetation $ ~ Other $ Industry Questionnaire Page 36 of 61 ------- Underground Detention Worksheet 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 c iesign criteria for this unit ~ Drainage Area (Acres): ~ Containment of Storm: ~2-yr n5-yr mlO-yr ~Other: ~ Design Storm Depth (inches): ~Rainfall ~Runoff Other: Technical Specifications Detention Volume (gal) Time to Drain (hours) Other Technical Data: Industry Questionnaire Page 37 of 61 ------- Underground Detention Worksheet 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: $ Industry Questionnaire Page 38 of 61 ------- Underground Infiltration Worksheet 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: m2-yr m5-yr mlO-yr mOther: ~ Design Storm Depth (inches): ~ Rainfall ~Runoff Other: Technical Specifications Infiltration Rate (unit): Time to Drain (hours): Other Technical Data: Industry Questionnaire Page 39 of 61 ------- Underground Infiltration Worksheet 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: $ Industry Questionnaire Page 40 of 61 ------- Manufactured Device Worksheet 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 Technical Specifications Maximum Treatment capacity (unit): _ Device Function (check all that apply): ~ Settling ~ Filtration ~ Absorptive/adsorptive materials ~ Vortex separation ~ Other solids removal ~ Other Pollutant removal ~ Other Other Technical Detail: Industry Questionnaire Page 41 of 61 ------- Manufactured Device Worksheet 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: $ Industry Questionnaire Page 42 of 61 ------- Tree Box Worksheet 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 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: $ Industry Questionnaire Page 43 of 61 ------- Green Roof Worksheet 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: Industry Questionnaire Page 44 of 61 ------- Green Roof Worksheet 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: $ Industry Questionnaire Page 45 of 61 ------- Bioretention Worksheet 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 de sign criteria for this unit ~ Capacity (gallons): ~ Drainage Area (Acres): ~ Design Storm: n2-yr n5-yr ~ 10-yr ~ Other: ~ Design Storm Depth (inches): ~Rainfall ~Runoff ~ Other: Industry Questionnaire Page 46 of 61 ------- Bioretention Worksheet 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: $ Industry Questionnaire Page 47 of 61 ------- Infiltration Basin / Trench / Dry Well Worksheet 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 m5-yr mlO-yr mOther: ~ Design Storm Depth (inches): ~Rainfall ~ Runoff Other: Technical Specifications Infiltrating Surface Area: Infiltration Capacity: Other Technical Data: Industry Questionnaire Page 48 of 61 ------- Infiltration Basin / Trench / Dry Well Worksheet 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 $ Industry Questionnaire Page 49 of 61 ------- Permeable Pavement Worksheet 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: Industry Questionnaire Page 50 of 61 ------- Permeable Pavement Worksheet 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 $ Industry Questionnaire Page 51 of 61 ------- 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 Industry Questionnaire Page 52 of 61 ------- Financial Information C-27 Indicate your 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/Sub contract or 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 ($) Raw Land Cost Fees - Legal, Accounting, Financing, and Permitting incurred during land acquisition phase Project Design, Architectural Services, etc. Interest or other financing costs incurred during this phase Establishment's Overhead Other Costs Industry Questionnaire Page 53 of 61 ------- Land Development Item Cost ($) 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 Industry Questionnaire Page 54 of 61 ------- ~ 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 Ferms, if not fixed: Base Rate (checkbox): ~ Prime Rate ~ LIBOR ~ Other: ~ Prime Rate ~ LIBOR ~ Other: ~ Prime Rate ~ LIBOR ~ Other: Increment to Base Rate (%): Secondary Debt or Other Fixed Repayment Ferm Financing Description: Fraction Financed (%): Interest Rate, if a fixed rate (%): Interest Ferms, if not fixed: Base Rate (checkbox): ~ 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 Ferm Financing) Fraction Financed (%): Equity Financing (Owner's Financing or other Non-Debt, Non-Fixed Repayment Ferm 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) $ Industry Questionnaire Page 55 of 61 ------- 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. Industry Questionnaire Page 56 of 61 ------- 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. Industry Questionnaire Page 57 of 61 ------- D-l 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: Industry Questionnaire Page 58 of 61 ------- D-4 If the business or entity identified in D-l 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 Industry Questionnaire Page 59 of 61 ------- 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. Industry Questionnaire Page 60 of 61 ------- 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 offines 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 Industry Questionnaire Page 61 of 61 ------- |