SW3231104_O&M Agreement/Plan_20240318

Operation & Maintenance Agreement
Project Name: Holy Spirit Catholic Church
Project Location: 537 N NC 16 Business Hwy, Denver, NC 28037
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& corresponding O&M sheets will be added automatically):
Infiltration Basin Quantity: _ Location(s):
Infiltration Trench Quantity: Location(s):
Bioretention Cell Quantity: Location(s):
Wet Pond Quantity: Location(s):
Stormwater Wetland Quantity: Location(s):
Permeable Pavement Quantity: Location(s):
Sand Filter Quantity: 1 Location(s): SW corner(State)
Rainwater Harvesting Quantity: Location(s):
Green Roof Quantity: Location(s):
Level Spreader-Filter Strip Quantity: Location(s):
Proprietary System Quantity: Location(s):
Treatment Swale Quantity: Location(s):
Dry Pond Quantity: Location(s):
Disconnected Impervious Surface Present: No Location(s):
User Defined SCM Present: No Location(s):
Low Density Present: No Type:
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: . 1 'i/ ;)J I r1)V') 4,;4;y ; ,(.,
Title& Organization: A a y'�" ,6jy6i/cps�n rye✓ Roman Catholic Diocese of Chariot
Street address: 1123 g Church St.
City, state, zip: Charlotte, NC 28203
Phone number(s):
Email:
LSignature: Date:
I, 0-et'i ' MGvt e r I'e• , a Notary Public for the State of Ivor44-' Cet.t,1,
County of pi tic41h/ ,EI , do hereby certify that /lASr Per-t^LIc—,�t 1ni!✓bi/ow
personally appeared before me this j 2- day of /14 Cz' ( ZJy-1 J and
)
acknowledge the due execution of the Operations and Maintenance Agreement .
Witness myjtaridlarticofficial seal, C,tl I/tDk-• :e_-' '-> .
• Q:
0; Mecklenburg Co. '..1--A
: My Comm.Expires
▪ Oct.20,2024
"itiT�'CAR
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Seal My commission expires PI 2 I"o-tJ
STORM-EZ 2/29/2024
Version 1.5 O&M Agreement Page 1 of 1