SW6220802_O&M Agreement/Plan_20230217

O eratJon. ;&� l pintenance Agreement
Project Name: Champs Convenience Store
Project Location: 8920 US Hwy 401 North Fuquay Varina, N.C. 27526
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:
s onding O&M sheets will be added automatically):
1 Location(s): Northwest portion of front parking lot
Location(s):
Location(s):
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):
Yes Type: [Vegetated swaleslroadside ditches
CLICK TO UPDATE O&M MANUAL
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:
Ankit K Patel
Member) Jay Ambe Shakti LLC
2100 Weaver Forest Way
Morrisville, N.C. 27560
910-988-6049
[e-mail]
Signature: � f\ &JL __ Date: Z t 3 23
I, _ 0.,0V-_ e'L-3 ho � _ r- a Notary Public for the State of
County of Il do hereby certify that l
personally appeared before me this I h day of q-20ZJ and
acknowledge the due execution of the nra7n; and Maintenance Agreement.
Witness my hand and official seal,
Seal
My commission expiresISILAA-e246Z�
STORM-EZ 2/10/2023
Version 1.5 O&M Agreement Page 1 of 1