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NOTICE OF TERMINATION for Storm Water Discharges Authorized under the SPDES General Permit for Construction Activity - continued 10d. Has the entity responsible for long-term operation and maintenance been given a copy of the operation and maintenance plan required by the general permit? □ yes □ no 10e. Indicate the method used to ensure long-term operation and maintenance of the post-construction stormwater management practice(s): □ Post-construction stormwater management practice(s) and any right-of-way(s) needed to maintain practice(s) have been deeded to the municipality. □ Executed maintenance agreement is in place with the municipality that will maintain the post-construction stormwater management practice(s). □ For post-construction stormwater management practices that are privately owned, a mechanism is in place that requires operation and maintenance of the practice(s) in accordance with the operation and maintenance plan, such as a deed covenant in the owner or operator’s deed of record. □ For post-construction stormwater management practices that are owned by a public or private institution (e.g. school, university or hospital), government agency or authority, or public utility; policy and procedures are in place that ensures operation and maintenance of the practice(s) in accordance with the operation and maintenance plan. 10f. Provide the total area of impervious surface (i.e. roof, pavement, concrete, gravel, etc.) constructed within the disturbance area? (acres) 11. Is this project subject to the requirements of a regulated, traditional land use control MS4? □ yes □ no (If Yes, complete section VI - “MS4 Acceptance” statement V. Additional Information/Explanation: (Use this section to answer questions 9c. and 10b., if applicable) VI. MS4 Acceptance - MS4 Official (principal executive officer or ranking elected official) or Duly Authorized Representative (Note: Not required when 9b. is checked -transfer of coverage) I have determined that it is acceptable for the owner or operator of the construction project identified in question 5 to submit the Notice of Termination at this time. Printed Name: Title/Position: Signature: Date: Page 2 of 3 Page 961 of 1174