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Operation & Maintenance Agreement 4 <br /> Project Name: Efland EMS Station <br /> Project Location: 3800 US 70 W, Efland, NC 27243 <br /> Cover Page <br /> Maintenance records shall be kept on the following SCM(s). This maintenance record shall be kept in a log in a known set location. <br /> Any deficient SCM elements noted in the inspection will be corrected, repaired, or replaced immediately. These deficiencies can <br /> affect the integrity of structures, safety of the public, and the pollutant removal efficiency of the SCM(s). <br /> The SCM(s) on this project include (check all that apply&corres onding O&M sheets will be added automatically): <br /> Infiltration Basin Quantity: Location(s): <br /> Infiltration Trench Quantity: Location(s): <br /> Bioretention Cell Quantity: Location(s): <br /> Wet Pond Quantity: Location(s): <br /> Stormwater Wetland Quantity: Location(s): <br /> Permeable Pavement Quantity: Location(s): <br /> Sand Filter Quantity: Location(s): <br /> Rainwater Harvesting Quantity: Location(s): <br /> Green Roof Quantity: Location(s): <br /> Level Spreader- Filter Strip Quantity: Location(s): <br /> Proprietary System Quantity: Location(s): <br /> Treatment Swale Quantity: Location(s): <br /> Dry Pond Quantity: 1 Location(s): North end of site <br /> Disconnected Impervious Surface Present:911 <br /> Location(s): <br /> User Defined SCM Present: Location(s):Low Density Present: Type: <br /> I acknowledge and agree by my signature below that I am responsible for the performance of the maintenance procedures listed for <br /> 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 <br /> the system or responsible party. <br /> Responsible Party: Travis Myren, in his capacity as County Manager <br /> Title & Organization: Title &Org -County Manager, Orange County <br /> Street address: 300 West Tryon Street <br /> City, state, zip: Hillsborough, NC 27278 <br /> Phone number(s): 919.245.2308 <br /> Email:I tmyren@orangecountync.gov <br /> Signature: Date: <br /> I, a Notary Public for the State of <br /> County of do hereby certify that <br /> personally appeared before me this day of and <br /> acknowledge the due execution of the Operations and Maintenance Agreement . <br /> Witness my hand and official seal, <br /> Seal My commission expires <br /> STORM-EZ 3/10/2025 <br /> Version 1.5 O&M Agreement Page 1 of 1 <br />