Clarksville, TN APPENDIX C STORM WATER AND BMP MAINTENANCE AGREEMENTS AND INSPECTIONS FORMS

STORM WATER MAINTENANCE AGREEMENT Grading Permit No.: Tax Map and Parcel No.: Project Name: THIS AGREEMENT, made and entered into this day of, of the year, by and between (hereinafter called the "Landowner") and the, Tennessee (hereinafter called the "City"): WITNESSETH, that WHEREAS, Ordinance No. 3-2000-01 was adopted August 3, 2000 by the Clarksville City Council, and established maintenance responsibilities for storm water drainage systems; and WHEREAS, under said ordinance the Director of Streets shall have the authority to inspect private drainage systems within the City, and to order such corrective actions to said private storm water drainage systems as are necessary to maintain properly the drainage systems within the City; and WHEREAS, under said ordinance it is provided that private storm water drainage systems must be maintained by the property owner, and a maintenance agreement must be executed before the development plan is approved; and WHEREAS, the Landowner is the owner of certain real property, more particularly described as as recorded by deed in the land records of Montgomery County, Tennessee in Deed Book at Page (hereinafter called the "Property"); and WHEREAS, the Landowner is proceeding to build on and develop the property; and WHEREAS, Site Plan/Subdivision Plan, prepared by dated, on file at the Street Department (hereinafter called the "Plan"), which is expressly made a part hereof, as approved or to be approved by the Street Department, provides for the construction of storm water drainage systems; and WHEREAS, the City and the Landowner agree that the health, safety, and general welfare of the residents of Clarksville require that storm water drainage systems be constructed and maintained on the property; and October 2004 Page 1

WHEREAS, the City requires that storm water drainage systems as shown on Plan be constructed and adequately maintained by the Landowner; NOW, THEREFORE, in consideration of the foregoing premises, the mutual covenants contained herein, and the following terms and conditions, the parties hereto agree as follows: 1. The storm water drainage systems shall be constructed by the Landowner in accordance with the plans and specifications identified in Plan. 2. The Landowner shall maintain the storm water drainage systems as shown on Plan in good working order acceptable to the Street Department. 3. In the event the Landowner fails to maintain storm water detention facilities as shown on Plan in good working order acceptable to the Street Department, the Street Department may enter the property and take whatever steps it deems necessary to maintain said storm water drainage systems. It is expressly understood and agreed that the Street Department is under no obligation to maintain or repair said facilities, and in no event shall this Agreement be construed to impose any such obligation on the City of Clarksville. 4. In the event the, pursuant to this Agreement, performs work of any nature, or expends any funds in performance of said work for labor, use of equipment, supplies, or materials, the Landowner shall reimburse the City upon demand, within a time frame specified by the City for all costs incurred, including reasonable attorney s fees in the event that an action to collect such costs must be instituted. 5. It is the intent of this Agreement to insure the proper maintenance of storm water drainage systems by the Landowner; provided, however, that this Agreement shall not be deemed to create or effect any additional liability of any party for damage alleged to result from or be caused by storm water management. 6. The Landowner, its executors, administrators, assigns, and any other successors in interest, shall indemnify and hold the City and its agents and employees harmless for any and all damages, accidents, casualties, occurrences, or claims which might arise or be asserted against the City from the construction, presence, existence, or maintenance of the storm water drainage systems by the Landowner or the City. In the event a claim is asserted against the City, its agents, or employees, the City shall notify the Landowner and the Landowner shall defend at his own expense any suit based on such claim. If any judgment or claims against the City, its agents, or employees shall be allowed, the Landowner shall pay all costs and expenses in connection therewith. 7. This Agreement shall be recorded among the land records of Montgomery County, Tennessee, and shall constitute a covenant running with the land, and shall be binding on the Landowner, its administrators, executors, assigns, heirs, and any other successors in interest. October 2004 Page 2

WITNESS the following signatures and seals: THE CITY OF CLARKSVILLE, TENNESSEE By Director of Streets By Landowner ATTEST: Prepared by: I,, a Notary Public in and for the County and State aforesaid, whose commission expires on the day of, of the year, do certify that whose names are signed to the foregoing Agreement bearing date of the day of, of the year, have acknowledged the same before me in my said County and State aforesaid. GIVEN under my hand this day of, of the year. Notary Public October 2004 Page 3

Storm Water Pond Operation and Maintenance Agreement Must Include: Owner Inspection Checklist Recordable Responsibility Statement October 2004 Page 4

Storm Water Pond Inspection Checklist for BMP Owners Site name: Owner Change since last inspection? Y N Owner Name, Address, Phone Number Location: Site Status: Date: Time: Inspector: Maintenance Item Satisfactory/ Unsatisfactory Comments Embankment and Emergency Spillway (Inspect annually and after major storms) 1. Vegetation 2. Erosion on embankment 3. Animal burrows 4. Cracking, bulging or sliding of dam A. Location: B. Describe 5. Drains clear and functioning 6. Leaks or seeps on embankment A. Location B. Describe 7. Slope protection failure 8. Emergency spillway clear of obstructions 9. Other (describe) October 2004 Page 5

Maintenance Item Satisfactory/ Unsatisfactory Comments Riser and Principal spillway (Inspect annually) Circle Type: Reinforced concrete, corrugated pipe, masonry 1. Low flow orifice blocked 2. Trash rack A. debris removal needed B. corrosion noted 3. Excessive sediment buildup in riser 4. Concrete/Masonry condition A. cracks or displacement B. spalling 5. Metal pipe condition 6. Control Valve operational 7. Pond drain valve operational 8. Outfall channels functioning 9. Other (describe) Permanent Pool (Inspect monthly) 1. Undesirable vegetative growth 2. Floatable debris removal needed 3. Visible pollution 4. Shoreline problem 5. Other (describe) Maintenance Item Satisfactory/ Unsatisfactory Comments October 2004 Page 6

Sediment Forebays 1. Sedimentation noted 2. Sediment cleanout needed (over 50% full) Other (Inspect monthly) 1. Erosion at outfalls into pond 2. Headwalls and endwalls 3. Encroachment into pond or easement area 4. Complaints from residents 5. Public hazards (describe) Additional Comments Actions to be taken: Timeframe: October 2004 Page 7

Operation and Maintenance Agreement Acceptance of Responsibility to Maintain I,, hereby acknowledge that I am the financially responsible party for maintenance and inspection of this storm water quality pond. I will perform the maintenance as outlined in this Operation and Maintenance Agreement, to comply with the Storm Water Management Ordinance, the Storm Water Management Manual and the Storm Water Quality Permit received for this project. Furthermore, I attest that this Operation and Maintenance Agreement is on file with the Register of Deeds. Signature Date I,, a Notary Public for the state of, County of, do hereby certify that personally appeared before me this day of, 20, and acknowledge the due execution of the foregoing instrument. Witness my hand and official seal, Seal My commission expires October 2004 Page 8

Constructed Wetlands Operation and Maintenance Agreement Must Include: Owner Inspection Checklist Recordable Responsibility Statement October 2004 Page 9

Inspection Checklist for BMP Owners Constructed Wetlands Site Name: Owner changed since last inspection? Y N Owner name, address, phone number: Location: Site Status: Date: Time: Inspector Name: Maintenance Item Satisfactory/ Unsatisfactory Comments Embankment and Emergency Spillway (Inspect annually and after major storms) 1. Vegetation 2. Erosion on embankment 3. Animal burrows 4. Cracking, bulging or sliding of dam A. Location: B. Describe 5. Drains clear and functioning 6. Leaks or seeps on embankment A. Location B. Describe 7. Slope protection failure 8. Emergency spillway clear of obstructions 9. Other (describe) October 2004 Page 10

Maintenance Item Satisfactory/ Unsatisfactory Comments Riser and Principal spillway (Inspect annually) Circle Type: Reinforced concrete, corrugated pipe, masonry 1. Low flow orifice blocked 2. Trash rack A. debris removal needed B. Corrosion noted 3. Excessive sediment buildup in riser 4. Concrete/Masonry condition A. cracks or displacement B. spalling 5. Metal pipe condition 6. Control Valve operational 7. Pond drain valve operational 8. Outfall channels functioning 9. Other (describe) Permanent Pool (Inspect monthly) 1. Undesirable vegetative growth 2. Floatable debris removal needed 3. Visible pollution 4. Shoreline problem 5. Other (describe) 6. Sediment cleanout needed (over 50% full) October 2004 Page 11

Sediment Forebays 1. Sedimentation noted Maintenance Item Other (Inspect monthly) Satisfactory/ Unsatisfactory Comments 1. Erosion at outfalls 2. Headwalls and endwalls 3. Encroachment into easement area 4. Complaints from residents 5. Public hazards (describe) Constructed Wetland Area (Inspect annually) 1. Vegetation healthy and growing 2. Evidence of invasive species 3. Excessive sediment in wetland area (clean out when 50% full or when vegetation damage noted) Additional Comments Actions to be taken: Timeframe: October 2004 Page 12

Operation and Maintenance Agreement Acceptance of Responsibility to Maintain I,, hereby acknowledge that I am the financially responsible party for maintenance and inspection of this constructed wetland. I will perform the maintenance as outlined in this Operation and Maintenance Agreement, to comply with the Storm Water Management Ordinance, the Storm Water Management Manual and the Storm Water Quality Permit received for this project. Furthermore, I attest that this Operation and Maintenance Agreement is on file with the Register of Deeds. Signature Date I,, a Notary Public for the state of, County of, do hereby certify that personally appeared before me this day of, 20, and acknowledge the due execution of the foregoing instrument. Witness my hand and official seal, Seal My commission expires October 2004 Page 13

Bioretention Operation and Maintenance Agreement Must Include: Owner Inspection Checklist Recordable Responsibility Statement October 2004 Page 14

Inspection Checklist for BMP Owners Bioretention Site Name: Owner changed since last inspection? Y N Owner name, address and phone number: Location: Site Status: Date: Time: Inspector Name: Maintenance Item Debris Cleanout (Inspect monthly) 1. Bioretention area and contributing areas clean of debris 2. Litter (branches, etc.) has been removed Satisfactory/ Unsatisfactory Comments Vegetation (Inspect monthly) 1. Plant height note less than design ponding depth 2. Plant composition according to approved plan 3. Grass height not more than 6 inches 4. No evidence of erosion Additional Comments and Actions to be Taken Timeframe: October 2004 Page 15

Operation and Maintenance Agreement Acceptance of Responsibility to Maintain I,, hereby acknowledge that I am the financially responsible party for maintenance and inspection of this bioretention facility. I will perform the maintenance as outlined in this Operation and Maintenance Agreement, to comply with the Storm Water Management Ordinance, the Storm Water Management Manual and the Storm Water Quality Permit received for this project. Furthermore, I attest that this Operation and Maintenance Agreement is on file with the Register of Deeds. Signature Date I,, a Notary Public for the state of, County of, do hereby certify that personally appeared before me this day of, 20, and acknowledge the due execution of the foregoing instrument. Witness my hand and official seal, Seal My commission expires October 2004 Page 16

Sand Filter Operation and Maintenance Agreement Must Include: Owner Inspection Checklist Recordable Responsibility Statement October 2004 Page 17

Inspection Checklist for BMP Owners Sand Filter Site Name: Owner changed since last inspection? Y N Owner name, address and phone number: Location: Site Status: Date: Time: Inspector Name: Maintenance Item Debris Cleanout (Inspect monthly) Satisfactory/ Unsatisfactory Comments 1. Filtration facility 2. Inlet and outlet Oil and Grease (Inspect monthly) 1. Evidence of filter surface clogging Vegetation (Inspect monthly) 1. Surrounding areas stabilized 2. Evidence of erosion Water retention where required (Inspect monthly) 1. Water holding chambers at normal pool 2. No evidence of leaking Sediment Deposition (Inspect annually) 1. Filter chamber free of sediments 2. Sedimentation chamber not more than 50% full October 2004 Page 18

Maintenance Item Structural Components (Inspect annually) Satisfactory/ Unsatisfactory Comments 1. Structural soundness (deterioration evident) 2. Grates in good condition 3. No evidence of structural spalling or cracking Outlet/Overflow Spillway (Inspect annually) 1. Good condition, no need for repairs 2. No evidence of erosion Other (Inspect annually) 1. No odors 2. Evidence of flow bypassing the filter Additional Comments Actions to be taken: Timeframe: October 2004 Page 19

Operation and Maintenance Agreement Acceptance of Responsibility to Maintain I,, hereby acknowledge that I am the financially responsible party for maintenance and inspection of this sand filter system. I will perform the maintenance as outlined in this Operation and Maintenance Agreement, to comply with the Storm Water Management Ordinance, the Storm Water Management Manual and the Storm Water Quality Permit received for this project. Furthermore, I attest that this Operation and Maintenance Agreement is on file with the Register of Deeds. Signature Date I,, a Notary Public for the state of, County of, do hereby certify that personally appeared before me this day of, 20, and acknowledge the due execution of the foregoing instrument. Witness my hand and official seal, Seal My commission expires October 2004 Page 20

Infiltration Trench Operation and Maintenance Agreement Must Include: Owner Inspection Checklist Recordable Responsibility Statement October 2004 Page 21

Inspection Checklist for BMP Owners Infiltration Trench Site Name: Owner changed since last inspection? Y N Owner name, address and phone number: Location: Site Status: Date: Time: Inspector Name: Maintenance Item Monthly Activity Ensure that contributing area, facility and inlets are clear of debris Ensure that the contributing area is stabilized. Remove sediment and oil/grease from pretreatment devices, as well as overflow structures. Mow grass filter strips should be mowed as necessary. Remove grass clippings. Semi-Annual Inspection Check observation wells following 3 days of dry weather. Failure to percolate within this time period indicates clogging. Inspect pretreatment devices and diversion structures for sediment build-up and structural damage. Remove trees that start to grow in the vicinity of the trench. As Needed Replace pea gravel/topsoil and top surface filter fabric (when clogged). Upon Failure Perform total rehabilitation of the trench to maintain design storage capacity. Excavate trench walls to expose clean soil. Maintenance Item Satisfactory/ Unsatisfactory Comments October 2004 Page 22

Additional Comments and Actions to be Taken Timeframe: October 2004 Page 23

Water Quality Swale Operation and Maintenance Agreement Must Include: Owner Inspection Checklist Recordable Responsibility Statement October 2004 Page 25

Water Quality Swale Inspection Checklist for BMP Owners Site Name: Owner changed since last inspection? Y N Owner name, address and phone number: Location: Site Status: Date: Time: Inspector Name: Maintenance Item Debris Cleanout (Inspect monthly) Satisfactory/ Unsatisfactory Comments 1. Contributing drainage areas free from debris Vegetation (Inspect monthly) 1. Mowing done when needed 2. No evidence of erosion Check Dams or Energy Dissipators (Inspect annually) 1. No evidence of flow going around structure 2. No evidence of erosion at the downstream toe 3. Soil permeability Sediment Forebay 1. Sediment cleanout needed (clean out when 50% full) Additional Comments and Actions to be Taken: Timeframe: October 2004 Page 26

Operation and Maintenance Agreement Acceptance of Responsibility to Maintain I,, hereby acknowledge that I am the financially responsible party for maintenance and inspection of all water quality swales on this site. I will perform the maintenance as outlined in this Operation and Maintenance Agreement, to comply with the Storm Water Management Ordinance, the Storm Water Management Manual and the Storm Water Quality Permit received for this project. Furthermore, I attest that this Operation and Maintenance Agreement is on file with the Register of Deeds. Signature Date I,, a Notary Public for the state of, County of, do hereby certify that personally appeared before me this day of, 20, and acknowledge the due execution of the foregoing instrument. Witness my hand and official seal, Seal My commission expires October 2004 Page 27

Biofilters and Buffers Operation and Maintenance Agreement Must Include: Owner Inspection Checklist Recordable Responsibility Statement October 2004 Page 28

Biofilter and Buffer Inspection Checklist for BMP Owners Site Name: Owner changed since last inspection? Y N Owner name, address and phone number: Location: Site Status: Date: Time: Inspector Name: Maintenance Item Vegetation (Inspect monthly) Satisfactory/ Unsatisfactory Comments 1. Plant composition according to approved plan 2. Vegetation is healthy 3. Grass height not more than 6 inches 4. No evidence of erosion Level spreader (Inspect monthly) 1. Vegetation is healthy 2. Lip of spreader showing no signs of erosion 3. Sediment noted in spreader? Additional Comments and Actions to be Taken: Timeframe: October 2004 Page 29

Operation and Maintenance Agreement Acceptance of Responsibility to Maintain I,, hereby acknowledge that I am the financially responsible party for maintenance and inspection of any biofilters/buffers on this site. I will perform the maintenance as outlined in this Operation and Maintenance Agreement, to comply with the Storm Water Management Ordinance, the Storm Water Management Manual and the Storm Water Quality Permit received for this project. Furthermore, I attest that this Operation and Maintenance Agreement is on file with the Register of Deeds. Signature Date I,, a Notary Public for the state of, County of, do hereby certify that personally appeared before me this day of, 20, and acknowledge the due execution of the foregoing instrument. Witness my hand and official seal, Seal My commission expires October 2004 Page 30

Other Proprietary BMP Operation and Maintenance Agreement Must Include: Owner Inspection Checklist (to be provided by manufacturer) Recordable Responsibility Statement October 2004 Page 31