<br />Exhibit A <br /> <br />FORM O & M: OPERATIONS & MAINTENANCE PLAN <br />REQUIRED IN ACCORDANCE WITH THE CITY CODE <br /> <br />Project Building Application No._________________________________ <br /> <br />Owner’s Name: _______________________________________________ <br /> <br />Phone No. ___________________________________________________ <br /> <br />Mailing Address: ______________________________________________ <br /> <br />Site Address: _________________________________________________ <br /> <br />1704251201000 <br />Site Map and Tax lot No. _______________________________________ <br /> <br />Requirements <br /> <br />1)Stormwater Management Site Plan, (min. 8 ½” x 11” attached to this form) showing the location of <br />the facility(ies) in relation to building structures or other permanent monuments on the site, sources <br />of runoff entering the facility(ies), and where stormwater will be discharged to after leaving the <br />facility(ies). <br /> <br />The stormwater management facility(ies) shown on the site plan are a required condition of e site plan are a required condition of e site plan are a required condition of <br />building permit approval for the identified property. The owner of the identified property is <br />y. The owner of the identified property is y. The owner of the identified property is <br />required to operate and maintain the facility(ies) in accordance with the Operations and in accordance with the Operations and in accordance with the Operations and <br />required to operate and maintain the facility(ies) <br />Maintenance (O&M) Plan on file with the City. The O&M Plan for the facility(ies) is/are available <br />Maintenance (O&M) Plan on file with the City. The OMaintenance (O&M) Plan on file with the City. The O&M Plan for the facility(ies) is/are available &M Plan for the facility(ies) is/are <br /> available <br />at the Public Works Department, located at 1820 Roosevelt, Eugene, Oregon between the hours of <br />at the Public Works Department, located at 1820 Rooat the Public Works Department, located at 1820 Roosevelt, Eugene, Oregon between the hours of sevelt, Eugene, Oregon between the hours <br /> of <br />8 a.m. and 5 p.m., Monday through Friday. Call (5418 a.m. and 5 p.m., Monday through Friday. Call (5418 a.m. and 5 p.m., Monday through Friday. Call (541)(682-4800). )(682-4800). )(682-4800). <br /> <br /> <br />2)Description of the financial method used to cover fDescription of the financial method used to cover fDescription of the financial method used to cover future operations and maintenance. <br /> Check One <br /> <br />X <br /> Homeowner’s Association Property Owner Account <br /> Homeowner’s Association Homeowner’s Association <br /> <br /> Other (described)_________________________________________________________ <br /> <br />3)Party(ies) responsible for maintenance (only if other than owner). <br />Daytime Phone no. (____) ____-_____ <br />Emergency/After-hours contact phone no. (____) _____-____ <br /> <br />Maintenance Contact party(ies) Name & Address: <br /> <br /> <br />4)Maintenance practices and schedule for the stormwater facility is included in the facility- <br />specific O&M Plan filed with the Public Works Department, City of Eugene. The operation and <br />maintenance practices are based on the publication date of the City of Eugene’s Stormwater <br />Management Manual. <br /> <br />October <br />17 <br />Preparation Date:______________________________, 20___ <br /> <br />Revision Date: ________________________________, 20___ <br />Estimated Date of Installation ____________________, 20___ <br /> <br />By signing below, filer accepts and agrees to the terms and conditions contained in the operations & <br />maintenance plan and in any document executed by filer and recorded with it. <br /> <br /> <br />Signature of Filer: _________________________________________________________________ <br /> <br />Print Name: _____________________________________________________________________ <br /> <br />