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CM-2017-1554 - 11/17/2017F1 0 TCEa Use Only XEQTCEQ Core Data Form For detailed instructions regarding completion of this form, please read the Core Data Form Instructions or call 512-239-5175 SECTION I: General Information 1. Reason for Submission (If other is checked please describe in space provided.) ❑x New Permit, Registration or Authorization (Core Data Form should be submitted with the program application.) ❑ Renewal (Core Data Form should be submitted with the renewal form) I ❑ Other 2. Customer Reference Number (if issued) 3 RAnulated BUN RefprAnre Numher (if bmipril CN 600413181 SECTION II: Customer Information Follow this link to search for CN or RN numbers in RN 102766417 Central_Registryr** 4. General Customer Information 5. Effective Date for Customer Information Updates (mmlddlyyyy) 10/23/2017 ❑ New Customer ❑X Update to Customer information ❑ Change in Regulated Entity Ownership El Change in Legal Name Werifiable with the Texas Secretary of State or Texas Comptroller of Public Accounts The Customer Name submitted here may be updated automatically based on what is current and active with the Texas Secretary of State (SOS) or Texas Comptroller of Public Accounts (CPA). 6. Customer Legal Name (If an individual, print last name first: e.g.: Doe, John) If new Cuslo[ner. enLer arevious Customer, below* City of Round Rack 7. TX SOSICPA Filing Number B. TX State Tax ID ttt digits) 9, Federal Tax ID tsa�ts) 10. DUNS Number (if applicable) 11. T of Customer, ❑ Corporation [EllIndividual Partnership: [I General ❑Limited Government: 0 City ❑ County ❑ Federal ❑ state❑other ❑ Sole Proprietorship ❑ Other. 12. Number of Employees ❑0-20 ❑21-100 ❑101-250 ❑251-500 0501 and higher 13. Independently Owned and Operated? 1 ❑ Yes ❑ No 14. Customer Role (Proposed or Actual) - as it relates to the Regulated Entity listed on this form. Please check one of the following ❑Owner ❑ Operator 9 Owner & Operator ❑Occupational Licensee ❑ Responsible Party ❑ Voluntary Cleanup Applicant ❑Other 15. Mailing 221 East Main Street Address: City I Round Rock State I TX ZIP 178664 ZIP +4 16. Country Mailing information if outside USA 17. E -Mail Address (if applicable) 18. Telephone Number ( 512 ) 218 - 5400 19. Extension or Code 20. Fax Number (if applicable) ( ) - SECTION III: Regulated Entity Information 21. General Regulated Entity Information (if 'New Regulated Entity" is selected below this form should be accompanied by a permit application) ❑ New Regulated Entity ❑ Update to Regulated Entity Name 0 Update to Regulated Entity Information The Regulated Entity Name submitted may be updated in order to meet TCEQ Agency Data Standards (removal of organizational endings such as Inc, LP, or LLC). 22. Regulated Entity Name (Enter name of the site where the regulated action is taking place.) Luther Peterson Subdivision TCEQ-10400 (04115) Page lof 2 C" -Zai']- a4 23. Street Address of the Regulated Entity: {No PO Boxes} 3220 Sunrise Road 26. Nearest City City I Round Rock State TX ZIP 78665 ZIP +4 Seconds DegreesMinutes 24. County Williamson tmer lenysical Location uescnption it no street address is provided. 25. Description to Physical Location: ❑ Districts 26. Nearest City State Barest ZIP Code Round Rock I TX 178665 27. Latitude (N) In Decimal: 130.5483 28. Longitude (W) In Decimal: -97.6773 Degrees Minutes Seconds DegreesMinutes ❑ PWS I Seconds 30 132 53 97 40 138 29. Primary SIC Code (4 digifs) 30. Secondary SIC Code (4 digits) 31. Primary NAICS Code 32. Secondary NAILS Code 5 or 6 di its 5 or 6 di Its 9199 9229 921190 922190 33. What is the Primary Business of this entity? (Do not repeat the SIC or NAICS description.) Municipal government departments overseeing planning, operations, and maintenance of public works 34. Mailing Address: 3400 Sunrise Road ❑Other. City I Round Rock State TX ZIP 1 78665 ZIP +4 35. E -Mail Address: I twilkes@roundrocktexas.gov 36. Telephone Number 37. Extension or Code 38. Fax Number (if applicable) ( 512 ) 671 - 2890 { ) - 39. TCED Pmgrams and ID Numbers Check all Programs and write in the permitslregistration numbers that will be affected by the updates submitted on this form See the Core Data Form instructions for additional guidance ❑ Dam Safety ❑ Districts ❑ Edwards Aquifer ❑Emissions Inventory Air ❑ Industrial Hazardous Waste Name(InP►fnQ: I L ie Hadley Phone (i2 )M -52H] ❑ Municipal Solid Waste []New Source Review Air ❑ OSSF ❑Petroleum Storage Tank ❑ PWS ❑ Sludge ❑ Storm Water ❑ Title V Air ❑ Tires ❑ Used Oil Tim Henne ❑ Voluntary Cleanup ❑ Waste Water E] Wastewater Agriculture ❑ Water Rights ❑Other. SECTION V: Authorized Signature 46. By my signature below, I certify, to the best of my knowledge, that the information provided in this form is true and complete, and that I have signature authority to submit this form on behalf of the entity specified in Section II, Field 6 and/or as required for the updates to the ID numbers identified in field 39. Company: City of Round Rock Job Title. CityManager Name(InP►fnQ: I L ie Hadley Phone (i2 )M -52H] Signature: Date fA TCEO.10400 (04115) Page 2 of 2 Application Fee Form Texas Commission on Environmental Quality Name of Proposed Regulated Entity: Luther p t rson Subdivision Regulated Entity Location: Northwest corner of Luther Peterson Place and Sunrise Drive Name of Customer•. City of Round Rock Contact Person: Travis Wilkes - Phone: (5121671-2890 Customer Reference Number (if issued) -CN 600413181 Regulated Entity Reference Number (if issued) -RN 102766417 Austin Regional Office (3373) ❑ Hays ❑ Travis San Antonio Regional Office (3362) ® Williamson ❑ Bexar ❑ Medina ❑ Uvalde ❑ Comal ❑ Kinney Application fees must be paid by check, certified check, or money order, payable to the Texas Commission on Environmental Quality. Your canceled check will serve as your receipt. This form must be submitted with your fee payment. This payment is being submitted to: ® Austin Regional Office ❑ San Antonio Regional Office ❑ Mailed to: TCEQ - Cashier ❑ Overnight Delivery to. TCEQ- Cashier Revenues Section 12100 Park 35 Circle Mail Code 214 Building A, 3rd Floor P.O. Box 13088 Austin, TX 78753 Austin, TX 78711-3088 (512)239-0357 Site Location (Check All That Apply): ® Recharge Zone ❑ Contributing Zone ❑ Transition Zone _ Type of Plan Sire Fee Due Water Pollution Abatement Plan, Contributing Zone Plan: One Single Family Residential Dwelling Acres $ Water Pollution Abatement Plan, Contributing Zone Plan: Multiple Single Family Residential and Parks Acres $ Water Pollution Abatement Plan, Contributing Zone Plan: Non-residential i Acres $ Sewage Collection System �- 942 L.F. $ 650 Lift Stations_ without sewer lines Acres $ _ Underground or Aboveground Storage Tank Facility Tanks $ Piping S stem(s)(only) Each $ Exception _ Each $ Extension of Time $ Each Signature:, Date: 1 of 2 TCEQ-0574 (Rev. 02-24-15) Application Fee Schedule Texas Commission on Environmental Quality Edwards Aquifer Protection Program 30 TAC Chapter 213 (effective 05/01/2008) Water Pollution Abatement Plans and Modifications Contributing Zone Plans and Modifications Organized Sewage Collection Svstems and Modifications Project Project Area in Minimum Fee - Maximum Fee Project Acres Fee One Single Family Residential Dwelling < 5 $650 Multiple Single Family Residential and Parks < 5 $1,500 5 < 10 $3,000 10 < 40 $4,000 40 < 100 $6,500 100 < 500 $8,000 >_ 500 $10,000 Nonresidential (Commercial, industrial, institutional, < 1 $3,000 multi -family residential, schools, and other sites 1 < 5 $4,000 where regulated activities will occur) 5 < 10 $5,000 10 < 40 $6,500 40 < 100 $8,000 100 1 $10,000 Organized Sewage Collection Svstems and Modifications Project Cost per Linear Foot Minimum Fee - Maximum Fee Sewage Collection Systems $0.50 $650 - $6,500 Underground and Aboveground Storage Tank System Facility Plans and Modifications Project Cost per Tank or Piping System Minimum Fee - Maximum Fee Underground and Aboveground Storage Tank Facility $650 $650 - $6,500 Exception Reguests Project Fee Exception Request $500 Extension of Time Reguests Project Fee Extension of Time Request $150 2of2 TCEQ-0574 (Rev. 02-24-15) Organized Sewage Collection System Application Texas Commission on Environmental Quality For Regulated Activities on the Edwards Aquifer Recharge Zone and Relating to 30 TAC §213.5(c), Effective June 1, 1999 To ensure that the application is administratively complete, confirm that all fields in the form are complete, verify that all requested information is provided, consistently reference the same site and contact person in all forms in the application, and ensure forms are signed by the appropriate party. Note: Including all the information requested in the form and attachments contributes to more streamlined technical reviews. Regulated Entity Name: Luther Peterson Subdivision I. ® Attachment A — SCS Engineering Design Report. This Engineering Design Report is provided to fulfill the requirements of 30 TAC Chapter 217, including 217.10 of Subchapter A, §§217.51— 217.70 of Subchapter C, and Subchapter D as applicable, and is required to be submitted with this SCS Application Form. Customer Information 2. The entity and contact person responsible for providing the required engineering certification of testing for this sewage collection system upon completion (including private service connections) and every five years thereafter to the appropriate TCEQ region office pursuant to 30 TAC §213.5(c) is: Contact Person: Travis Wilkes Entity: City of Round Rock Mailing Address: 212 Commerce Cove City, State: Round Rock, Texas Zip: 78664 Telephone: (512)671-2890 Fax: (512) 218-5576 Email Address: twilkes@roundrocktexas.gov The appropriate regional office must be informed of any changes in this information within 30 days of the change. 3. The engineer responsible for the design of this sewage collection system is: Contact Person: Kevin Hunt Texas Licensed Professional Engineer's Number: 91842 Entity: Jacobs Mailing Address: 911 Central Parkway North, Suite 425 City, State:San Antonio, Texas Zip: 78232 Telephone: 210 494-0088 Fax:(210)494-4525 Email Address:kevin.hunt@jacobs.com 1of10 TCEQ-0582 (Rev. 02-11-15) Project Information 4. Anticipated type of development to be served (estimated future population to be served, plus adequate allowance for institutional and commercial flows): ❑ Residential: Number of single-family lots: ❑ Multi -family: Number of residential units: ❑ Commercial ® Industrial ❑ Off-site system (not associated with any development) ❑ Other: 5. The character and volume of wastewater is shown below: Domestic gallons/day 100% Industrial 12.060 Average gallons/day % Commingled gallons/day Total gallons/day: 12,060 Average Daily Flow 6. Existing and anticipated infiltration/inflow is 18,900 gallons/day. This will be addressed by: designing the sewage collection system based on a peak wet weather flow that includes a peaking factor and the expected I&I. The peak wet weather flow was calculated to be approximately 70,386 gallons/day. 7. A Water Pollution Abatement Plan (WPAP) is required for construction of any associated commercial, industrial or residential project located on the Recharge Zone. ❑ The WPAP application for this development was approved by letter dated A copy of the approval letter is attached. The WPAP application for this development was submitted to the TCEQ on the same date as this SCS . but has not been approved. ❑ A WPAP application is required for an associated project, but it has not been submitted. 0 There is no associated project requiring a WPAP application. 8. Pipe description: Table 1 - Pipe Description Pipe Diameter(Inches) Linear Feet (1) Pipe Material (2) Specifications (3) 8 942 PVC SDR26 City of Round Rock Utility Criteria Manual Total Linear Feet: 942 2of10 TCEQ-0582 (Rev. 02-11-15) (1) Linear feet - Include stub -outs and double service connections. Do not include private service laterals. (2) Pipe Material - If PVC, state SDR value. (3) Specifications - ASTM / ANSI / AWWA specification and class numbers should be included. 9. The sewage collection system will convey the wastewater to the City of Round Rock Wastewater (name) Treatment Plant. The treatment facility is: ® Existing ❑ Proposed 10. All components of this sewage collection system will comply with: ® The City of Round Rock standard specifications. ❑ Other. Specifications are attached. 11. ® No force main(s) and/or lift station(s) are associated with this sewage collection system. ❑ A force main(s) and/or lift station(s) is associated with this sewage collection system and the lift Station/Force Main System Application form (TCEQ- 0624) is included with this application. Alignment 12. ® There are no deviations from uniform grade in this sewage collection system without manholes and with open cut construction. 13. ® There are no deviations from straight alignment in this sewage collection system without manholes. ❑ Attachment B - Justification and Calculations for Deviation in Straight Alignment without Manholes. A justification for deviations from straight alignment in this sewage collection system without manholes with documentation from pipe manufacturer allowing pipe curvature is attached. ❑ For curved sewer lines, all curved sewer line notes (TCEQ-0596) are included on the construction plans for the wastewater collection system. Manholes and Cleanouts 14. ® Manholes or clean -outs exist at the end of each sewer line(s). These locations are listed below: (Please attach additional sheet if necessary) Table 2 - Manholes and Cleanouts Line Shown on Sheet Station Manhole or Clean - out? WW A C-120 Of 13+32.96 Manhole WW A C-120 Of 15+21.08 Manhole WW D C-120 Of 10+97.36 Manhole WWF C-120 Of 13+24.08 Manhole 3 of 10 TCEQ-0582 (Rev. 02-11-15) Line Shown on Sheet Station Manhole or Clean - out? Of Of Of Of Of Of 15. Z Manholes are installed at all Points of Curvature and Points of Termination of a sewer line. 16. ® The maximum spacing between manholes on this project for each pipe diameter is no greater than: Pipe Diameter (inches) Max. Manhole Spacing (feet) 6-15 500 16-30 800 36-48 1000 >_54 2000 ❑ Attachment C — Justification for Variance from Maximum Manhole Spacing. The maximum spacing between manholes on this project (for each pipe diameter used) is greater than listed in the table above. A justification for any variance from the maximum spacing is attached, and must include a letter from the entity which will operate and maintain the system stating that it has the capability to maintain lines with manhole spacing greater than the allowed spacing. 17. ❑ All manholes will be monolithic, cast -in-place concrete. ® The use of pre -cast manholes is requested for this project. The manufacturer's specifications and construction drawings, showing the method of sealing the joints, are attached. Site Plan Requirements Items 18 - 25 must 8e included on the Site Plan. 18. ® The Site Plan must have a minimum scale of 1" = 400'. Site Plan Scale: 1" = 60'. 19. ® The Site Plan must include the sewage collection system general layout, including manholes with station numbers, and sewer pipe stub outs (if any). Site plan must be overlain by topographic contour lines, using a contour interval of not greater than ten feet and showing the area within both the five-year floodplain and the 100 -year floodplain of any drainage way. 4of10 TCEQ-0582 (Rev. 02-11-15) 20. Lateral stub-outs.- F] tub-outs: ❑ The location of all lateral stub -outs are shown and labeled. ® No lateral stub -outs will be installed during the construction of this sewer collection system. 2 1. Location of existing and proposed water lines: ® The entire water distribution system for this project is shown and labeled. ® If not shown on the Site Plan, a Utility Plan is provided showing the entire water and sewer systems. ❑ There will be no water lines associated with this project. 22. 100 -year floodplain: ® After construction is complete, no part of this project will be in or cross a 100 -year floodplain, either naturally occurring or manmade. (Do not include streets or concrete - lined channels constructed above of sewer lines.) ❑ After construction is complete, all sections located within the 100 -year floodplain will have water -tight manholes. These locations are listed in the table below and are shown and labeled on the Site Plan. (Do not include streets or concrete -lined channels constructed above sewer lines.) Table 3 - 100 -Year Floodplain Line I Sheet Station of I to _ rt I - of - _ � to of to ofto 23. 5 -year floodplain: ® After construction is complete, no part of this project will be in or cross a 5 -year floodplain, either naturally occurring or man-made. (Do not include streets or concrete - lined channels constructed above sewer lines.) ❑ After construction is complete, all sections located within the 5 -year floodplain will be encased in concrete or capped with concrete. These locations are listed in the table below and are shown and labeled on the Site Plan. (Do not include streets or concrete - lined channels constructed above sewer lines.) Table 4 - 5 -Year Flondnlain Line Sheet Station of to of to of to of to 5of10 TCEQ-0582 (Rev. 02-11-15) 24. ® Legal boundaries of the site are shown. 25. ® The final plans and technical specifications are submitted for the TCEQ's review. Each sheet of the construction plans and specifications are slated, signed, and sealed by the Texas Licensed Professional Engineer responsible for the design on each sheet. Items 26 - 33 must be included on the Plan and Profile sheets. 26. ® All existing or proposed water line crossings and any parallel water lines within 9 feet of sewer lines are listed in the table below. These lines must have the type of pressure rated pipe to be installed shown on the plan and profile sheets. Any request for a variance from the required pressure rated piping at crossings must include a variance approval from 30 TAC Chapter 290. ❑ There will be no water line crossings. ❑ There will be no water lines within 9 feet of proposed sewer lines. Table 5 - Water Line Crossin s Line Station or closest Point Crossing or Parallel Horizontal Separation Distance Vertical Separation Distance WW A 10+49.38 Crossing 11.68' WW A 14+46.12 Crossing 3.14' WW D 10+49.07 Crossing 2.10' WW F 10+83.05 Crossing 2.26' 27. Vented Manholes- ® No part of this sewer line is within the 100 -year floodplain and vented manholes are not required by 30 TAC Chapter 217. ❑ A portion of this sewer line is within the 100 -year floodplain and vented manholes will be provided at less than 1500 foot intervals. These water -tight manholes are listed in the table below and labeled on the appropriate profile sheets. ❑ A portion of this sewer line is within the 100 -year floodplain and an alternative means of venting shall be provided at less than 1500 feet intervals. A description of the alternative means is described on the following page. ❑ A portion of this sewer line is within the 100 -year floodplain; however, there is no interval longer than 1500 feet located within. No vented manholes will be used. Table 6 - Vented Manholes Line Manhole Station Sheet 6 of 10 TCEQ-0582 (Rev. 02-11-15) Cine Manhole Station Sheet o 28. Drop manholes: ❑There are no drop manholes associated with this project. ® Sewer lines which enter new or existing manholes or "manhole structures" higher than 24 inches above the manhole invert are listed in the table below and labeled on the appropriate profile sheets. These lines meet the requirements of 30 TAC §217.55(I)(2)(H). Table 7 - Drop Manholes Line Manhole Station Sheet WW A A2 13+32.96 C-121 WW D D2 10+97.39 C-121 29. Sewer line stub -outs (For proposed extensions): ® The placement and markings of all sewer line stub -outs are shown and labeled. ❑ No sewer line stub -outs are to be installed during the construction of this sewage collection system. 30. Lateral stub -outs (For proposed private service connections): ❑ The placement and markings of all lateral stub -outs are shown and labeled. ® No lateral stub -outs are to be installed during the construction of this sewage collection system. 31. Minimum flow velocity (From Appendix A) ® Assuming pipes are flowing full; all slopes are designed to produce flows equal to or greater than 2.0 feet per second for this system/line. 32. Maximum flow velocity/slopes (From Appendix A) ® Assuming pipes are flowing full, all slopes are designed to produce maximum flows of less than or equal to 10 feet per second for this system/line. 7of10 TCEQ-0582 (Rev. 02-11-15) ❑ Attachment D — Calculations for Slopes for Flows Greater Than 10.0 Feet per Second. Assuming pipes are flowing full, some slopes produce flows which are greater than 10 feet per second. These locations are listed in the table below. Calculations are attached. Table 8 - Flows Greater Than 10 Feet Per Second Line Profile Sheet Station to Station FPS % Slope Erosion/Shock Protection Alternate method of joining lateral to existing SCS line for potential future connections [Required] of Typical trench cross-sections [Required] C-506 of Bolted manholes [Required] of Sewer Service lateral standard details [Required] of Clean-out at end of line [Required, if used] C-505 of Baffles or concrete encasement for shock/erosion protection [Required, if flow velocity of any section of pipe >10 fps] of 33. Assuming pipes are flowing full, where flows are >_ 10 feet per second, the provisions noted below have been made to protect against pipe displacement by erosion and/or shock under 30 TAC §217.53(1)(2)(B)• ❑ Concrete encasement shown on appropriate Plan and Profile sheets for the locations listed in the table above. ❑ Steel -reinforced, anchored concrete baffles/retards placed every 50 feet shown on appropriate Plan and Profile sheets for the locations listed in the table above. ® N/A Administrative Information 34. ® The final plans and technical specifications are submitted for TCEQ review. Each sheet of the construction plans and specifications are dated, signed, and sealed by the Texas Licensed Professional Engineer responsible for the design on each sheet. 35. ❑ Standard details are shown on the detail sheets, which are dated, signed, and sealed by the Texas Licensed Professional Engineer, as listed in the table below: Table 9 - Standard Details Standard Details Shown on Sheet Lateral stub -out marking [Required] of Manhole, showing inverts comply with 30 TAC §217.55(1)(2) [Required] C-505 of Alternate method of joining lateral to existing SCS line for potential future connections [Required] of Typical trench cross-sections [Required] C-506 of Bolted manholes [Required] of Sewer Service lateral standard details [Required] of Clean-out at end of line [Required, if used] C-505 of Baffles or concrete encasement for shock/erosion protection [Required, if flow velocity of any section of pipe >10 fps] of 8of10 TCEQ-0582 (Rev. 02-11-15) standard Details shown on Sheet Detail showing Wastewater Line/Water Line Crossing [Required, if of crossings are proposed] Mandrel detail or specifications showing compliance with 30 TAC of §217.57(b) and (c) [Required, if Flexible Pipe is used] Drop manholes [Required, if a pipe entering a manhole is more than 24 of inches above manhole invert] 36. ® All organized sewage collection system general construction notes (TCEQ-0596) are included on the construction plans for this sewage collection system. 37. ® All proposed sewer lines will be sufficiently surveyed/staked to allow an assessment prior to TCEQ executive director approval. If the alignments of the proposed sewer lines are not walkable on that date, the application will be deemed incomplete and returned. ® Survey staking was completed on this date: 12/1/2017 38. ® Submit one (1) original and one (1) copy of the application, plus additional copies as needed for each affected incorporated city, groundwater conservation district, and county in which the project will be located. The TCEQ will distribute the additional copies to these jurisdictions. The copies must be submitted to the appropriate regional office. 39. � Any modification of this SCS application will require TCEQ approval, prior to construction, and may require submission of a revised application, with appropriate fees. Signature To the best of my knowledge, the responses to this form accurately reflect all information requested concerning the proposed regulated activities and methods to protect the Edwards Aquifer. This Organized Sewage Collection System Application is hereby submitted for TCEQ review and executive director approval. The system was designed in accordance with the requirements of 30 TAC §213.5(c) and 30 TAC §217 and prepared by: Print Name of Licensed Professional Engineer: Kevin Hunt Date: Place engineer's seal here: Signature of Licensed Professional Engineer: 9of10 TCEQ--0582 (Rev. 02-11-15) Appendix A -Flow Velocity Table Flow Velocity (Flowing pull) All gravity sewer lines on the Edwards Aquifer Recharge Zone shall be designed and constructed with hydraulic slopes sufficient to give a velocity when flowing full of not less than 2.0 feet per second, and not greater than 10 feet per second. The grades shown in the following table are based on Manning's formula and an n factor of 0.013 and shall be the minimum and maximum acceptable slopes unless provisions are made otherwise. Table 10 - Slope Velocity % Slope required for Pipe Diameter(Inches) minimum flow velocity of 2.0 fps % Slope which produces flow velocity of 10.0 fps 6 0.50 12.35 8 0.33 8.40 10 0.25 6.23 12 0.20 4.88 15 0.15 3.62 18 0.11 2.83 21 0.09 2.30 24 0.08 1.93 27 0.06 1.65 30 0.055 1.43 33 0.05 1.26 36 0.045 1.12 39 0.04 1.01 >39 *For lines larger than 39 inches in diameter, the slope may be determined by Manning's formula (as shown below) to maintain a minimum velocity greater than 2.0 feet per second when flowing full and a maximum velocity less than 10 feet per second when flowing full. 10 of 10 TCEQ-0582 (Rev. 02-11-15) 1.49 v= xRlo.67X-�S Figure i - Manning's Formula Where: v = velocity (ft/sec) n = Manning's roughness coefficient (0.013) Rh = hydraulic radius (ft) S = slope (f[/ft) 11 of 10 TCE=Q-0582 (Rev. 02-11-15) General Information Form Texas Commission on Environmental Quality For Regulated Activities on the Edwards Aquifer Recharge and Transition Zones and Relating to 30 TAC §213.4(b) & §213.5(b)(2)(A), (8) Effective June 1, 1999 To ensure that the application Is administratively complete, confirm that all fields In the form are complete, verify that all requested Information Is provided, consistently reference the same site and contact person in all forms In the application, and ensure forms are signed by the appropriate party. Nate: Including all the Information requested In the form and attachments contributes to more streamlined technical reviews. Signature To the best of my knowledge, the responses to this form accurately reflect all information requested concerning the proposed regulated activities and methods to protect the Edwards Aquifer. This General Information Form is hereby submitted for TCEQ review. The application was prepared by: _ Print Name of Customer/Agent: i Jk!J oT P'O'A k Date: 1 Signature of Customer/Agent: Project Information 1. Regulated Entity Name: Luther Peterson Subdivision 2. County: Williamson 3. Stream Basin: Brazos River Basin 4. Groundwater Conservation District (If applicable): N/A S. Edwards Aquifer Zone: ® Recharge Zone ❑ Transition Zone 6. Plan Type: ❑ WPAP ® SCS ❑ Modification TCEQ-0587 (Rev. 02-11-15) ❑ AST ❑ UST ❑ Exception Request 1 of 4 7. Customer (Applicant): Contact Person: Travis Wilkes Entity: City of Round Rock Mailing Address: 212 Commerce Cove City, State: Round Rock, Texas Zip: 78664 Telephone: (512) 671-2890 FAX: (512)_218-5576 Email Address: twilkes@round rocktexas.eoy 8. Agent/Representative (If any): Contact Person: Kevin Hunt Entity: Jacobs Mailing Address: 911 Central Parkway North Suite 425 City, State: San Antonio, Texas Zip: 78232 Telephone: 210 403-5538 FAX: (210) 494-4525 Email Address: kevin.huntPiacobs.com 9. Project Location: ® The project site is located inside the city limits of Round Rock. ❑ The project site is located outside the city limits but inside the ETJ (extra -territorial jurisdiction) of ❑ The project site is not located within any city's limits or ETJ. 10. ® The location of the project site is described below. The description provides sufficient detail and clarity so that the TCEQ's Regional staff can easily locate the project and site boundaries for a field investigation. Luther Peterson Park at the northwest corner of Luther Peterson Place and Sunrise Road in Round Rock, Texas 78665 11. ® Attachment A— Road Map. A road map showing directions to and the location of the project site is attached. The project location and site boundaries are clearly shown on the map. 12. ® Attachment B - USGS / Edwards Recharge Zone Map. A copy of the official 7 % minute USGS Quadrangle Map (Scale: 1" = 2000') of the Edwards Recharge Zone is attached. The map(s) clearly show: ® Project site boundaries. ® USGS Quadrangle Name(s). ® Boundaries of the Recharge Zone (and Transition Zone, if applicable). ® Drainage path from the project site to the boundary of the Recharge Zone. 13. ® The TCEQ must be able to inspect the project site or the application will be returned. Sufficient survey staking is provided on the project to allow TCEQ regional staff to locate the boundaries and alignment of the regulated activities and the geologic or manmade features noted in the Geologic Assessment. 2 of 4 TCEQ-0587 (Rev. 02-11-15) Z Survey staking will be completed by this date: 12/1/2017 14. ® Attachment C — Project Description. Attached at the end of this form is a detailed narrative description of the proposed project. The project description is consistent throughout the application and contains, at a minimum, the following details: ® Area of the site ® Offsite areas ❑ Impervious cover ❑ Permanent BMP(s) ® Proposed site use ® Site history ® Previous development ❑ Area(s) to be demolished 15. Existing project site conditions are noted below: ❑ Existing commercial site ❑ Existing industrial site ❑ Existing residential site ❑ Existing paved and/or unpaved roads ® Undeveloped (Cleared) ❑ Undeveloped (Undisturbed/Uncleared) ❑ Other: Prohibited Activities 16. ® I am aware that the following activities are prohibited on the Recharge Zone and are not proposed for this project: (1) Waste disposal wells regulated under 30 TAC Chapter 331 of this title (relating to Underground Injection Control); (2) New feedlot/concentrated animal feeding operations, as defined in 30 TAC §213.3; (3) Land disposal of Class I wastes, as defined in 30 TAC §335.1; (4) The use of sewage holding tanks as parts of organized collection systems; and (5) New municipal solid waste landfill facilities required to meet and comply with Type standards which are defined in §330.41(b), (c), and (d) of this title (relating to Types of Municipal Solid Waste Facilities). (6) New municipal and industrial wastewater discharges into or adjacent to water in the state that would create additional pollutant loading. 17. ❑ I am aware that the following activities are prohibited on the Transition Zone and are not proposed for this project: (1) Waste disposal wells regulated under 30 TAC Chapter 331 (relating to Underground Injection Control); 3 of 4 TCEQ-0587 (Rev. 02-11-15) (2) Land disposal of Class I wastes, as defined in 30 TAC §335.1; and (3) New municipal solid waste landfill facilities required to meet and comply with Type I standards which are defined in §330.41(b), (c), and (d) of this title. Administrative Information 18. The fee for the plan(s) is based on: ❑ For a Water Pollution Abatement Plan or Modification, the total acreage of the site where regulated activities will occur. ® For an Organized Sewage Collection System Plan or Modification, the total linear footage of all collection system lines. ❑ For a UST Facility Plan or Modification or an AST Facility Plan or Modification, the total number of tanks or piping systems. ❑ A request for an exception to any substantive portion of the regulations related to the protection of water quality. ❑ A request for an extension to a previously approved plan. 19. ® Application fees are due and payable at the time the application is filed. If the correct fee is not submitted, the TCEQ is not required to consider the application until the correct fee is submitted. Both the fee and the Edwards Aquifer Fee Form have been sent to the Commission's: ❑ TCEQ cashier ® Austin Regional Office (for projects in Hays, Travis, and Williamson Counties) ❑ San Antonio Regional Office (for projects in Bexar, Comal, Kinney, Medina, and Uvalde Counties) 20. ® Submit one (1) original and one (1) copy of the application, plus additional copies as needed for each affected incorporated city, groundwater conservation district, and county in which the project will be located. The TCEQ will distribute the additional copies to these jurisdictions. The copies must be submitted to the appropriate regional office. 21. ® No person shall commence any regulated activity until the Edwards Aquifer Protection Plan(s) for the activity has been filed with and approved by the Executive Director. 4 of 4 TCEQ-0587 (Rev. 02-11-15) GT of Agent Authorization Form For Required Signature Edwards Aquifer Protection Program Relating to 30 TAC Chapter 213 Effective June 1, 1999 me rtnership/Entity Name have authorized Kevin Hunt Print Name of Agent/Engineer of Jacobs Print Name of Firm to represent and act on the behalf of the above named Corporation, Partnership, or Entity for the purpose of preparing and submitting this plan application to the Texas Commission on Environmental Quality (TCEQ) for the review and approval consideration of regulated activities. I also understand that: The applicant is responsible for compliance with 30 Texas Administrative Code Chapter 213 and any condition of the TCEQ's approval letter. The TCEQ is authorized to assess administrative penalties of up to $10,000 per day per violation. 2. For those submitting an application who are not the property owner, but who have the right to control and possess the property, additional authorization is required from the owner. 3. Application fees are due and payable at the time the application is submitted. The application fee must be sent to the TCEQ cashier or to the appropriate regional office. The application will not be considered until the correct fee is received by the commission. 4. A notarized copy of the Agent Authorization Form must be provided for the person preparing the application, and this form must accompany the completed application. 5. No person shall commence any regulated activity on the Edwards Aquifer Recharge Zone, Contributing Zone or Transition Zone until the appropriate application for the activity has been filed with and approved by the Executive Director. TCEQ-0599 (Rev.0410112010) Page 1 of 2 SIGNATURE PAGE: xmq) Applicant's Signature THE STATE OF I V § County of M I I I am[Y r § Date BEFORE ME, the undersigned authority, on this day personally appearedkQknown to me to be the person whose name is subscribed to the foregoing instrument, and acknowl dged to me that (s)he executed same for the purpose and consideration therein expressed. GIVEN under my hand and seal of office on this V day of Mcd�, K - MY COMMISSION EXPIRES: 3 —1 S -U20 TCEO-0599 (Rev.0410112010) Page 2 of 2 AAAQ BLANCA GILLIS =Notary Public, of Texas NOT RY PUBLIC n Comm. EExpiress 03- 03-18-2020 9 161 Nolafy ID 130582367 Typed or Printed Name of Notary MY COMMISSION EXPIRES: 3 —1 S -U20 TCEO-0599 (Rev.0410112010) Page 2 of 2 Temporary Stormwater Section Texas Commission on Environmental Quality for Regulated Activities on the Edwards Aquifer Recharge Zone and gelating to 30 TAC §213.5(b)(4)(A), (B), (13)(1) and (G); Effective lune 1, 1999 To ensure that the application Is administratively complete, confirm that all fields in the form are complete, verify that all requested Information is provided, consistently reference the some site and contact person in all forms in the application, and ensure forms are signed by the appropriate party. Note: Including all the Information requested in the form and attachments contributes to more streamlined technical reviews. Signature To the best of my knowledge, the responses to this form accurately reflect ail information requested concerning the proposed regulated activities and methods to protect the Edwards Aquifer. This Temporary Stormwater Section is hereby submitted for TCEQ review and executive director approval. The application was prepared by: Print Name of Customer/Agent: 7hS w kkT e.J G :}l p� kWA V OCA Date: Signature of Customer/Agent: Regulated Entity Name: Luther Peterson Subdivision Project Information Potential Sources of Contamination Examples: Fuel storage and use, chemical storage and use, use of asphaltic products, construction vehicles tracking onto public roads, and existing solid waste. 1. Fuels for construction equipment and hazardous substances which will be used during construction: ® The following fuels and/or hazardous substances will be stored on the site: Hydrocarbon fuel for construction equipment These fuels and/or hazardous substances will be stored in: ® Aboveground storage tanks with a cumulative storage capacity of less than 250 gallons will be stored on the site for less than one (1) year. 1of5 TCEQ-0602 (Rev. 02-11-15) ❑ Aboveground storage tanks with a cumulative storage capacity between 250 gallons and 499 gallons will be stored on the site for less than one (1) year. ❑ Aboveground storage tanks with a cumulative storage capacity of 500 gallons or more will be stored on the site. An Aboveground Storage Tank Facility Plan application must be submitted to the appropriate regional office of the TCEQ prior to moving the tanks onto the project. ❑ Fuels and hazardous substances will not be stored on the site. 2. ® Attachment A - Spill Response Actions. A site specific description of the measures to be taken to contain any spill of hydrocarbons or hazardous substances is attached. 3. ® Temporary aboveground storage tank systems of 250 gallons or more cumulative storage capacity must be located a minimum horizontal distance of 150 feet from any domestic, industrial, irrigation, or public water supply well, or other sensitive feature. 4. ❑ Attachment B - Potential Sources of Contamination. A description of any activities or processes which may be a potential source of contamination affecting surface water quality is attached. Sequence of Construction 5. ® Attachment C - Sequence of Major Activities. A description of the sequence of major activities which will disturb soils for major portions of the site (grubbing, excavation, grading, utilities, and infrastructure installation) is attached. ® For each activity described, an estimate (in acres) of the total area of the site to be disturbed by each activity is given. ® For each activity described, include a description of appropriate temporary control measures and the general timing (or sequence) during the construction process that the measures will be implemented. 6. ® Name the receiving water(s) at or near the site which will be disturbed or which will receive discharges from disturbed areas of the project: Chandler Branch Creek Temporary Best Management Practices (TBMPs) Erosion control examples: tree protection, interceptor swales, level spreaders, outlet stabilization, blankets or matting, mulch, and sod. Sediment control examples: stabilized construction exit, silt fence, filter dikes, rock berms, buffer strips, sediment traps, and sediment basins. Please refer to the Technical Guidance Manual for guidelines and specifications. All structural BMPs must be shown on the site plan. 7. ® Attachment p —Temporary Best Management Practices and Measures. TBMPs and measures will prevent pollution of surface water, groundwater, and stormwater. The construction -phase BMPs for erosion and sediment controls have been designed to retain sediment on site to the extent practicable. The following information is attached: 2of5 TCEQ-0602 (Rev. 02-11-15) ® A description of how BMPs and measures will prevent pollution of surface water, groundwater or stormwater that originates upgradient from the site and flows across the site. ® A description of how BMPs and measures will prevent pollution of surface water or groundwater that originates on-site or flows off site, including pollution caused by contaminated stormwater runoff from the site. ® A description of how BMPs and measures will prevent pollutants from entering surface streams, sensitive features, or the aquifer. ® A description of how, to the maximum extent practicable, BMPs and measures will maintain flow to naturally -occurring sensitive features identified in either the geologic assessment, TCEQ inspections, or during excavation, blasting, or construction. 8. ® The temporary sealing of a naturally -occurring sensitive feature which accepts recharge to the Edwards Aquifer as a temporary pollution abatement measure during active construction should be avoided. ❑ Attachment E - Request to Temporarily Seal a Feature. A request to temporarily seal a feature is attached. The request includes justification as to why no reasonable and practicable alternative exists for each feature. ® There will be no temporary sealing of naturally -occurring sensitive features on the site. 9. ® Attachment F - Structural Practices. A description of the structural practices that will be used to divert flows away from exposed soils, to store flows, or to otherwise limit runoff discharge of pollutants from exposed areas of the site is attached. Placement of structural practices in floodplains has been avoided. 10. ® Attachment G - Drainage Area Map. A drainage area map supporting the following requirements is attached: ❑ For areas that will have more than 10 acres within a common drainage area disturbed at one time, a sediment basin will be provided. ❑ For areas that will have more than 10 acres within a common drainage area disturbed at one time, a smaller sediment basin and/or sediment trap(s) will be used. ❑ For areas that will have more than 10 acres within a common drainage area disturbed at one time, a sediment basin or other equivalent controls are not attainable, but other TBMPs and measures will be used in combination to protect down slope and side slope boundaries of the construction area. ❑ There are no areas greater than 10 acres within a common drainage area that will be disturbed at one time. A smaller sediment basin and/or sediment trap(s) will be used in combination with other erosion and sediment controls within each disturbed drainage area. 3of5 TCEQ-0602 (Rev. 02-11-15) ® There are no areas greater than 10 acres within a common drainage area that will be disturbed at one time. Erosion and sediment controls other than sediment basins or sediment traps within each disturbed drainage area will be used. 11. ❑ Attachment H - Temporary Sediment Pond(s) Plans and Calculations. Temporary sediment pond or basin construction plans and design calculations for a proposed temporary BMP or measure have been prepared by or under the direct supervision of a Texas Licensed Professional Engineer. All construction plans and design information must be signed, sealed, and dated by the Texas Licensed Professional Engineer. Construction plans for the proposed temporary BM Ps and measures are attached. ® N/A 12. ® Attachment 1- Inspection and Maintenance for BMPs. A plan for the inspection of each temporary BMP(s) and measure(s) and for their timely maintenance, repairs, and, if necessary, retrofit is attached. A description of the documentation procedures, recordkeeping practices, and inspection frequency are included in the plan and are specific to the site and/or BMP. 13. ® All control measures must be properly selected, installed, and maintained in accordance with the manufacturer's specifications and good engineering practices. If periodic inspections by the applicant or the executive director, or other information indicate a control has been used inappropriately, or incorrectly, the applicant must replace or modify the control for site situations. 14. ® If sediment escapes the construction site, off-site accumulations of sediment must be removed at a frequency sufficient to minimize offsite impacts to water quality (e.g., fugitive sediment in street being washed into surface streams or sensitive features by the next rain). 15. ® Sediment must be removed from sediment traps or sedimentation ponds not later than when design capacity has been reduced by 50%. A permanent stake will be provided that can indicate when the sediment occupies 50% of the basin volume. 16. ® Litter, construction debris, and construction chemicals exposed to stormwater shall be prevented from becoming a pollutant source for stormwater discharges (e.g., screening outfalls, picked up daily). Soil Stabilization Practices Examples: establishment of temporary vegetation, establishment of permanent vegetation, mulching, geotextiles, sod stabilization, vegetative buffer strips, protection of trees, or preservation of mature vegetation. 17. ® Attachment J - Schedule of Interim and Permanent Soil Stabilization Practices. A schedule of the interim and permanent soil stabilization practices for the site is attached. 4of5 TCEQ-0602 (Rev. 02-11-15) IS. ® Records must be kept at the site of the dates when major grading activities occur, the dates when construction activities temporarily or permanently cease on a portion of the site, and the dates when stabilization measures are initiated. 19. ® Stabilization practices must be initiated as soon as practicable where construction activities have temporarily or permanently ceased. Administrative Information 20. ® All structural controls will be inspected and maintained according to the submitted and approved operation and maintenance plan for the project. 21. ® If any geologic or manmade features, such as caves, faults, sinkholes, etc., are discovered, all regulated activities near the feature will be immediately suspended. The appropriate TCEQ Regional Office shall be immediately notified. Regulated activities must cease and not continue until the TCEQ has reviewed and approved the methods proposed to protect the aquifer from any adverse impacts. 22. ® Silt fences, diversion berms, and other temporary erosion and sediment controls will be constructed and maintained as appropriate to prevent pollutants from entering sensitive features discovered during construction. 5of5 TCEQ-0602 (Rev. 02-11--15) Texas Commission on Environmental Quality Edwards Aquifer Application Cover Page Our Review of Your Application The Edwards Aquifer Program staff conducts an administrative and technical review of all applications. The turnaround time for administrative review can be up to 3o days as outlined in 3o TAC 213.4(e). Generally administrative completeness is determined during the intake meeting or within a few days of receipt. The turnaround time for technical review of an administratively complete Edwards Aquifer application is go days as outlined in 3o TAC 213.4(e). Please know that the review and approval time is directly impacted by the quality and completeness of the initial application that is received. In order to conduct a timely review, it is imperative that the information provided in an Edwards Aquifer application include final plans, be accurate, complete, and in compliance with 3o TAC 21R. Administrative Review 1. Fdwzkr 1 must be deemed administratively complete before a technical review can begin. To be considered administratively complete, the application must contain completed forms and attachments, provide the requested information, and meet all the site plan requirements. The submitted application and plan sheets should be final plans. Please submit one full-size set of plan sheets with the original application, and half-size sets with the additional copies. To ensure that all applicable documents are included in the application, the program has developed tools to guide you and web pages to provide all forms, checklists, and guidance. Please visit the below website for assistance: hUpa/ww%v.t=.texas.gov/fieldlean . 2. This Edwards Aquifer Application Cover Page form (certified by the applicant or agent) must be included in the application and brought to the administrative review meeting. 3. Administrative reviews are scheduled with program staff who will conduct the review. Applicants or their authorized agent should call the appropriate regional office, according to the county in which the project is located, to schedule a review. The average meeting time is one hour. 4. In the meeting, the application is examined for administrative completeness. Deficiencies will be noted by staff and emailed or faxed to the applicant and authorized agent at the end of the meeting, or shortly after. Administrative deficiencies will cause the application to be deemed incomplete and returned. An appointment should be made to resubmit the application. The application is re-examined to ensure all deficiencies are resolved. The application will only be deemed administratively complete when all administrative deficiencies are addressed. 5. If an application is received by mail, courier service, or otherwise submitted without a review meeting, the administrative review will be conducted within 3o days. The applicant and agent will be contacted with the results of the administrative review. If the application is found to be administratively incomplete, it can be retrieved from the regional office or returned by regular mail. If returned by mail, the regional office may require arrangements for return shipping. 6. If the geologic assessment was completed before October 1, 2004 and the site contains "possibly sensitive" features, the assessment must be updated in accordance with the Instructions to Geologists (TCEQ-0585 Instructions). Technical Review 1. When an application is deemed administratively complete, the technical review period begins. The regional office will distribute copies of the application to the identified affected city, county, and groundwater conservation district whose jurisdiction includes the subject site. These entities and the public have 3o days to provide comments on the application to the regional office. All comments received are reviewed by TCEQ. 2. A site assessment is usually conducted as part of the technical review, to evaluate the geologic assessment and observe existing site conditions. The site must be accessible to our staff. The site boundaries should be TCEQ-20705 (Rev. 02-17-17) 1 of 4 clearly marked, features identified in the geologic assessment should be flagged, roadways marked and the alignment of the Sewage Collection System and manholes should be staked at the time the application is submitted. If the site is not marked the application may be returned. 3. We evaluate the application for technical completeness and contact the applicant and agent via Notice of Deficiency (NOD) to request additional information and identify technical deficiencies. There are two deficiency response periods available to the applicant. There are 14 days to resolve deficiencies noted in the first NOD. If a second NOD is issued, there is an additional 14 days to resolve deficiencies. If the response to the second notice is not received, is incomplete or inadequate, or provides new information that is incomplete or inadequate, the application must be withdrawn or will be denied. Please note that because the technical review is underway, whether the application is withdrawn or denied the application fee will be forfeited. 4. The program has 90 calendar days to complete the technical review of the application. If the application is technically adequate, such that it complies with the Edwards Aquifer rules, and is protective of the Edwards Aquifer during and after construction, an approval letter will be issued. Construction or other regulated activity may not begin until an approval is issued. Mid -Review Modifications It is important to have final site plans prior to beginning the permitting process with TCEQ to avoid delays. Occasionally, circumstances arise where you may have significant design and/or site plan changes after your Edwards Aquifer application has been deemed administratively complete by TCEQ. This is considered a "Mid - Review Modification". Mid -Review Modifications may require redistribution of an application that includes the proposed modifications for public comment. If you are proposing a Mid -Review Modification, two options are available: • If the technical review has begun your application can be denied/withdrawn, your fees will be forfeited, and the plan will have to be resubmitted. • TCEQ can continue the technical review of the application as it was submitted, and a modification application can be submitted at a later time. If the application is denied/withdrawn, the resubmitted application will be subject to the administrative and technical review processes and will be treated as a new application. The application will be redistributed to the affected jurisdictions. Please contact the regional office if you have questions. If your project is located in Williamson, Travis, or Hays County, contact TCEQ's Austin Regional Office at 512-339-2929• If your project is in Coma], Bexar, Medina, Uvalde, or Kinney County, contact TCEQ's San Antonio Regional Office at 210-490-3096 Please fill out all required fields below and submit with your application. 1. Regulated Entity Name: Luther Peterson Subdivision 2. Regulated Entity No.: RNio2766417 3. Customer Name: City of Round Rock 4. Customer No.: CN600413181 5. Project Type: (Please circle/check one) New Modification Extension Exception 6. Plan Type: (Please circle/eck one) WPAP CZP Ech UST AST EXP EXT Technical Clarification Optional Enhanced Measures 7. Land Use: (Please circle/check one) Residential on -residential 8. Site (acres): 15.599 9. Application Fee: $650 1o. Permanent BMP(s): 11. SCS (Linear Ft.): 942 12. AST/UST (No. Tanks): 13. County: 7—Twilliamson 14. Watershed: Chandler Branch – Brushy Creek TCEQ-20705 (Rev. 02-17-17) 2 of 4 Application Distribution Instructions: Use the table below to determine the number of applications required. One original and one copy of the application, plus additional copies (as needed) for each affected incorporated city, county, and groundwater conservation district are required. Linear projects or large projects, which cross into multiple jurisdictions, can require additional copies. Refer to the "Texas Groundwater Conservation Districts within the EAPP Boundaries" map found at: httl);?:+ r� �v.tee+ ,taxa;.gok,fa s ss' 4 b i ,'cQmpliancer'field vobTea FAPP �t ' .I u��or�yap ,df For more detailed boundaries, please contact the conservation district directly. Austin Region County: Hays Travis Williamson Original (i req.) Uvalde Original (i req.) i Region (t req.) 0 t County(ies) Edwards Aquifer —Edwards County(ies) Authority Groundwater Conservation Distriet(s)— Barton Springs/ p is/ —Barton Springs/ Edwards Aquifer Edwards Aquifer NA _ Edwards Aquifer Hays Trinity EAA –" c EAA District(s) Plum Creek Authority Medina Austin Austin Buda —Austin ._Cedar Park Springs —Bee Cave Florence City(ies) Jurisdiction _Dripping Kyle _Pflu erville g Georgetown —Fair Oaks Ranch _Rollingwood Jurisdiction —Mountain Mountain City _Round Rock _Jerrell Leander Antonio ETJ Marcos —Sunset Valley Liberty Hill —New Braunfels —Wimberley West Lake Hills Pflugerville Woodcreek —Schertz i Round Rock San Antonio Region County: Bexar Coma] Kinney Medina Uvalde Original (i req.) — Region (i req.) County(ies) Groundwater Edwards Aquifer Conservation — Authority _ Edwards Aquifer Kinne y EAA –" c EAA District(s) Trinity -Glen Rose Authority Medina Uvalde Castle Hills Fair Oaks Ranch _Bulverde City(ies) —Helotes —Fair Oaks Ranch San Jurisdiction _Hill Country Village _Garden Ridge NA Antonio ETJ NA —Hollywood Park —New Braunfels (SAWS) San Antonio (SAWS) —Schertz Shavano Park TCEQ-20705 (Rev. 02-17-17) 3 of 4 I certify that to the best of my knowledge, that the application is complete and accurate. This application is hereby submitted to TCEQ for administrative review and technical review. Print Na e f Customer/Authori d Agent i Signature of Customer/Aut ort ed Agent Date "FOR TCEQ INTERNAL USE ONLY" Date(s)Reviewed: Date Administratively Complete: Received From: Correct Number of Copies: Received By: Distribution Date: EAPP File Number: Complex: Admin. Review(s) (No.): No. AR Rounds: Delinquent Fees (Y/N): Review Time Spent: Lat./Long. Verified: SOS Customer Verification: Agent Authorization Complete/Notarized (Y N): Fee Check: Payable to TCEQ (YIN): Core Data Form Complete (YIN): Signed (YIN): Core Data Form Incomplete Nos.: Less than go days old (Y/N): TCEQ-20705 (Rev. 02-17-17) 4 (,f 4 City of Round Rock IuN1 ROCK XAS Agenda Item Summary Agenda Number: Title: Consider authorizing a TCEQ Core Data Form for Sewage Collection System Application at Luther Peterson Project. Type. City Manager Item Governing Body: City Manager Approval Agenda Date: 11/17/2017 Dept Director: Chad McDowell, General Services Director Cost: Indexes: Attachments: CMAF TCEQ Sewage Collection Application - LAF, SCS Luther Peterson Department: General Services Department Text of Legislative File CM -2017-1554 Consider authorizing a TCEQ Core Data Form for Sewage Collection System Application at Luther Peterson Project. A Sewage Collection System form outlines best practices that will be implemented in order to protect water quality when an organized SCS is constructed in the Edwards Aquifer recharge zone. Cityo! Round Rock Page 1 Prinfed an 77!17/2017