SW5200601_3- Signed O and M_20200605

Operation & Maintenance Agreement
Project Name:
Project Location:
Charter Furniture Parking and Building
50 Industrial Drive, Siler City, NC
Cover Page
Maintenance records shall be kept on the following BMP(s)- This maintenance record shall be kept In a log in a known set location.
Any deficient BMP elements noted in the inspection will be corrected, repaired, or replaced immediate' These deficiencies can
affect the integrity of structures, safety of the public, and the pollutant removal efficiency of the BMP(s).
The BMP(s) on this project include (check all that apply & coi
Bioretention Cell
Quantity:
Dry Detention Basin
Quantity:
Grassed Swale
Quantity:
Green Roof
Quantity:
Infiltration Basin
Quantity:
Infiltration Trench
Quantity:
Level Spreader/VFS
Quantity:
Permeable Pavement
Quantity:
Proprietary System
Quantity:
Rainwater Harvesting
Quantity:
Sand Filter
Quantity:
Stormwater Wetland
Quantity:
Wet Detention Basin
Quantity:
Disconnected Impervious Area
Present:
User Defined BMP
Present:
O&M tables will be added automatically):
Location(s):
Location(s): South Portion of lot.
Location(s): South Portion of lot. Draining to BMP
Location(s):
Location(s):
Location(s):
Location(s):
Location(s):
Location(s):
Location(s):
Location(s):
Location(s):
Location(s):
Location(s):
Location(s):
CLICK TO UPDATE O&M MANUAL
I acknowledge and agree by my signature below that I am responsible for the performance of the maintenance procedures listed for
each BMP above, and attached O&M tables. I agree to notify NCDENR of any problems with the system or prior to any changes to
the system or responsible party.
* Responsible Party: Lodging by Liberty, Inc
Title & Organization:
Street address: 476 West Town Place Suite 200
City, state, zip: St. Augustine FL, 32092
Phone number(s): 336-622-2201
Email: n/a
Signature:
Date: �-
a Notary Public for the State of r
County of do hearby certify that+z►
personally appeared before me this 1 day of CJ and
acknowledge the due execution of the O e ions a enanr 6g pement .
Witness my hand and official seal,
C
. Y
Seal
ADAM Gj WOOD
Notary unlit
My Commission Expires
Jan 31, 2025
My commission expires
1�3 (/202S
STORM-EZ
5112/2020