SW6221007_O&M Agreement/Plan_20221102

Operation & Maintenance Agreement
Project Name:
Project Location:
Spout Springs Self Storage and Miracle Movers Warehouse
Cameron, 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 & cc
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:
> onding O&M sheets will
Location(s):
Location(s):
Location(s):
1 Location(s):
Location(s).-
Location(s):
Location(s):
Location(s):
Location(s):
Location(s):
Location(s):
Location(s):
Location(s):
No Location(s).-
No Location(s):
No Type:
ut; duueu autornaucai
ect
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:
Signature:
County of
personally appeared before me this
Kenneth Donald Terrell
Property Owner
170 Mayer Road
Cameron, NC 28326
910-515-7985
[e-mail]
At
Date: A1'112-02.7-
a Notary Public for the State of lvO 74` lC"�
do hereby certify that Leith hOrf�7 7 °
day of 2a.24 and
acknowledge the due execution of the Op a ions and M intenance Agreement.
Witness my hand and official seal,
My commission expires 22, 2017
STORM-EZ 10/10/2022
Version 1.5 O&M Agreement Page 1 of 1