SW4190902_O&M Agreement_20191105

Operation 8r Maintenance Agreement
Circle K - R&R 2723188
Rural Hall, NC FORSYTH County
Prepared By: Rick Baker, PE, Timmons Group
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 &
Bioretention Cell
Quantity:
Dry Detention Basin
Quantity:
Grassed Swale
Quantity:
Green Roof
Quantity:
Infiltration Basin
Quantity:
Infiltration Trench
Quantity:
Level SpreaderNFS
Quantity:
Permeable Pavement
Quantity:
Proprietary System
Quantity:
Rainwater Harvesting
Quantity:
Sand Filter
Quantity:
Stormwater Wetland
Quantity:
Wet Detention Basin
Quantity:
Disconnected Impervious Area
Present:
Soil Amendments
Present:
O&M tables will
Location(s):
Location(s):
Location(s):
Location(s):
Location(s):
Location(s):
Location(s): under
Location(s):
Location(s):
Location(s):
Location(s):
Location(s):
Location(s):
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: Will Rice Jr
Title & Organization: Vice President, Circle K Stores, Inc
Street address: 1000 Situs Court, Ste 100
City, state, zip: Raleigh, NC 27606
Phone number(s):
Email:
Signature: Date: '�+y '/5"-/1
I, �i n F Ahrynd a Notary Public for the State of M!:��J ii C.//G1.i oby1Cv
County of (A{ cr,&ge'- do hearby certify that /Me ed;-M A). R/ceoy-
personally appeared before me this 5 day of /CgI'r,(Q,I"1L/ oZ 0/9 and
acknowledge the due execution of the Opgrationcand Mwtenzw Agreement.
Witness my hand and official seal, V.J/"444 // / , _
Johnstoh Coi
North Caroll
Comm colon Explm
Seal
23.2023
My commission expires �jDI'i� p13 �043
STORM-EZ
2/8/2019
Version 14 O&M Manual Page 1 of 2

Proprietary System Maintenance Requirements
How many devices are
ADS BAYFILTERS?
Important operation and maintenance procedures:
- The drainage area will be carefully managed to reduce the sediment load to the BAYFILTER.
- The sedimentation chamber or forebay will be cleaned out whenever sediment depth exceeds six inches.
The BAYFILTER system will be inspected quarterly. Records of operation and maintenance will be kept in a
known set location and will be available upon request.
Inspection activities shall be performed as follows. Any problems that are found shall be repaired immediately.
BMP element:
Potential problem:
How to remediate the problem:
Adjacent pavement (if
applicable)
Trash/debris is present.
Remove the trash/debris.
Flow diversion structure
Sediment is present on the
pavement surface.
Sweep or vacuum the sediment as soon as possible.
StormFilter Cartridges
The structure is clogged.
Unclog the conveyance and dispose of any sediment offsite.
The structure is damaged.
Make any necessary repairs or replace if damage is too large for
Outlet device
Clogging has occurred.
Clean out the outlet device. Dispose of the sediment offsite.
The outlet device is damaged
Repair or replace the outlet device.
Receiving water
Erosion or other signs of
damage have occurred at the
outlet.
Contact the 401 Oversight Unit at 919-733-1786.
All other operation and maintenance activities should be in accordance with ADS'S BAYFILTER Inspection and Maintenance
Procedures document. Any problems that are found shall be repaired immediately. The responsible party shall have received and
understand ADS'S BAYFILTER Inspection and Maintenance Procedures document.
STORM-EZ 2/19/2019
Version 1.4 O&M Manual Page 2 of 2