SW4210302_O&M Agreement/Plan_20210621

Operation & Maintenance Agreement
Project Name: ASU Poplar Grove Child Development Center
Project Location: Boone, NC
Cover Page
Maintenance records shall be kept on the following SCM(s). This maintenance record shall be kept in a log in a known set location.
Any deficient SCM 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 SCM(s).
The SCM(s) on this project include (check all that apply & co
Infiltration Basin
Quantity:
Infiltration Trench
Quantity:
Bioretention Cell
Quantity:
Wet Pond
Quantity:
Stormwater Wetland
Quantity:
Permeable Pavement
Quantity:
Sand Filter
Quantity:
Rainwater Harvesting
Quantity:
Green Roof
Quantity:
Level Spreader - Filter Strip
Quantity:
Proprietary System
Quantity:
Treatment Swale
Quantity:
Dry Pond
Quantity:
Disconnected Impervious Surface
Present:
User Defined SCM
Present:
Low Density
Present:
ing O&M sheets will
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):
Type:
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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 SCM above, and attached O&M tables. I agree to notify NCDEQ 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:
Board of Trustees of the Endowment Fund of Appalachian State Uni
Dr. Sheri Everts (Chancellor) & Paul Forte (VC Business Affairs)
438 Academy Street, BB Dougherty Administration Building
Boone, NC 28608
828-262-2040 & 828-262-2030
[e-mail] & [e-mail]
appstate.edu
She6 goe/fs
Signature: eel
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personally appeared before me this day of and
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of the Operations and Maintenance
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Version 1.5 O&M Agreement
5/28/2021
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