SW1191202_O&M_signed_1/10/2020

&,Ma1nte_W ce
Project Name:
Project Location:
Circle K Mills River (Jeffress Rd)
NE corner NC 280 (Boylston Hwy) and Jeffress Rd
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 & ci
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:
ding O&M tables wi.
Location(s):
Location(s):
Location(s):
Location(s):
Location(s):
Location(s):
Location(s):
Location(s):
Location(s):
Location(s):
Location(s):
Location(s):
Location(s).-
Location(s):
Location(s):
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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.
Signature:
Responsible Party:
Title & Organization:
Street address:
City, state, zip:
Phone number(s):
Email:
Ha tham Kasem
Construction Manager, Circle K Stores Inc.
2560 W. T ►rota Road, Suite 200
Charlotte, NC 28217
[phone]
hkaseml circlek.com
NDA
Date:
f:n&
County of _ do hearby certify that i_ Hely �15err
personally appeared before me this Z3� day of Vaember-' and
, a Notary Public for the State of
acknowledge the due execution of the 9P erations and Maintena ce Agreement.
Witness my hggV and official seal,
i
pJARY
a
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ST08WZ NlFFN My commission expires ' I r �l �v 12/12/2019
Version 1.4 Page 1 of 3

STORM-EZ 12/1212019
Version 1.4 O&M Manual Page 2 of 3

Section I
Important operation and maintenance procedures:
-'Inspect isolator row for
out isolator row using jetvac process
Replace all covers, grates, filters, and lids; record observations and actions
Inspect and clean basins and manholes upstream of the underground detention system
The system will be visually inspected by the owner/operator at least quarterly. Records of operation and maintenance will be kept
in a known set location and will be available upon request.
Section 2
Inspection activities shall be performed as follows. Any problems that are found shall be repaired immediately.
BNIP element:
Potentialproblem:
How to remediate theproblem:
Isolator row
Sediment
Remove/open lid on nyoplast inline drain on inspection port
Remove and clean flexstorm filter if Installed
Using a flashlight and stadia rod, measure depth of sediment
Record depth of sediment on maintenance to
If sediment is 3" or higher, clean isolator row with 'etvac
Use fixed culvert cleaning nozzle with rear facing spread of 45"+
Apply multiple passes of jetvac until backfiush is clean
Vaccum structure sump as required
Replace all covers, grates, filters, and lid; record observations
Inspect and clean basins and manholes upstream of system
STORM-EZ
1211212019
Version 1.4 O&M Manual Page 3 of 3