SW3191101_O&M Agreement_20191119

Operation & Maintenance Agreement
Project Name:
CAMBRIDGE VILLAGE MULTIFAMILY
Cresset Dellinger and N. Pilot Knob Rd.
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 immediately. 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 & c(
Bioretention Cell
Quantity:
Dry Detention Basin
Quantity:
Grassed Swale
Quantity:
Green Roof
Quantity:
Infiltration Basin
Quantity:
Infiltration Trench
Quantity:
Level SpreaderA/FS
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:
ing O&M tables
I Location(
Location(
Location(
Location(
Location(
Location(
Location(
Location(
Location(
Location(
Location(
Location(
Location(
Location(
Location(
will be added automatically):
s):
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s):
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s):
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s): NE and SW Corners of the site
s):
S): I
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:
Title & Organization:
Street address:
City, state, zip:
Phone number(s):
Email:
JASON JACOBSON
NORTH PILOT KNOB ROAD, LLC
176 MINE LAKE COURT, STE. 100
RALEIGH, NC 27615
[phone]
[e-mail]
Date: )01301)9
a Notary Public for the State of Trdko-�-
County of — �Y ' ion do hearby certify that TOLM 0) W\)iU
personally appeared before me this day of 0 and
acknowledge the due execution of the Operations and Maintenance Agreement.
Witness my hand and official seal, diou 0, &LJNri�n
%%%I IT, I I$, 4F,
LORI A Gi
RIMER
,
Public, St
ito of Indiana
.Notary
Shelby C
3unty
SEA%
Commission
# 649274
My Commissim
November
Expires
W 2021
I— I NbJuTip" STOSNWZ My commission expires 10/15/2019
Version 1.4 O&M manual Page 1 of 2