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CM-2017-1555 - 11/17/2017M TCEQ Use Only X 111�wd TCEQ Core Data Form F_ I 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. Regulated Entity Reference Number if issued Follow this link to search CN 600413181 for CN or RN numbers In RN 102766417 SECTION II: Customer Information Central Registry** 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 ❑Chan a in Legal Name Verifiable with the Texas Secretary of Stale 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). fi. Customer Legal Name (If an individual, print last name first: e,g.: Doe, John) If new Customer enter Previous Customer below: City of Round Rock 7, TX SOSICPA Filing Number 8. TX State Tax ID (It d' its) 9. Federal Tax ID (sdig! tsl 10. DUNS Number gappiicawe) 11. Type of Customer. I ❑ Corporation ❑ Individual Partnership: ❑ General ❑ Limited Govemment:0 City ❑ County❑ Federal El state❑other ❑ Sole Proprietorship ❑ Other. 12. Number of Employees ❑0-20 ❑21-100 ❑101-250 ❑251-500 ❑501 and higher 13. Independently Owned and Operated? ❑ 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 Downer ❑ Operator ❑x Owner & Operator ❑Occupational Licensee ❑ Responsible Party ❑ Voluntary Cleanup Applicant ❑Other 15. Mailing 221 East Main Street Address: City JRound Rock State TX ZIP 178664 ZIP + 4 16. Country Mailing Information iroutside 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 ❑X 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 n ,TC,EO-10400 (04/15) Page 1of 2 23. Street Address of the Regulated Entity: (No PO Boxes) 3220 Sunrise Road 26. Nearest City I StateBarest ZIP Code City I Round Rock State TX ZIP 78665 ZIP + 4 Seconds Degrees 24. County Williamson Enter Physical Location Description if no street address is provided. 25. Description to Physical Location: ❑ Districts 26. Nearest City I StateBarest ZIP Code Round Rock I TX 178665 27. Latitude (N) In Decimal: 130.5483 28. Longitude (W) In Decimal: -97.6773 Degrees Minutes Seconds Degrees Minutes I Seconds 30 32 53 97 40 38 29. Primary SIC Code (4 digits) 30. Secondary SIC Code (4 digits) 31. Primary NAILS Code 32. Secondary NAICS Code 5 or 6 d' its $ or 6 di its 9199 9229 921190 922190 33. What is the Primary Business of this entity? (Do not repeat the SIC or NAILS description) Municipal government departments overseeing planning, operations, and maintenance of public works 34. Mailing Address: 3400 Sunrise Road City Round Rock State TX ZIP 1 78665 ZIP+4 ❑Other 35. E -Mail Address: twilkes@roundrocktexas.gov 36. Telephone Number 37. Extension or Code 38. Fax Number (if applicable) ( 512 ) 671 - 2890 ( ) - 39, TCEQ Programs and ID Numbers Check all Programs and write in the permits/registration numbers that we be affected by the updates submitted on this form. See the Cone Data Form instructions for additional guidance. ❑ Dam Safety ❑ Districts ❑ Edwards Aquifer E] Emissions Inventory Air ❑Industrial Hazardous waste (12) 18 - 234 Sig u Dale ❑ 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 ❑Wastewater Agriculture ❑ Water Rights ❑Other SECTION IV: Preparer Information 40. Name: 41, Title: 42. Telephone Number 43. Ext./Code 44. Fax Number 45. E -Mail Address 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 fort 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: ty of Round Rock Job Title City Manager Name(In F au lie Hadle Phone (12) 18 - 234 Sig u Dale U TCECI10400(04115) Page 2 of 2 111PA ' Luther Nieman Sen -ice Center PERMANENT STORMWATER (TCEQ-0600) ATTACHMENT G INSPECTION, MAINTENANCE, AND RETROFIT PLAN It will be the responsibility of the owner to comply with the Inspection and Maintenance Plan for the proposed project. StormTrooper® Maintenance Guidelines A preventative maintenance cleanout schedule is the most valuable tool for maintaining the proper operation of StormTrooper. Separator maintenance costs will be greatly reduced if a good housekeeping plan for the property is developed i.e., trash pickup, lawn maintenance, dumpster control, etc. StormTrooper separators have no moving parts and no filter cartridges. The manufacturer recommends quarterly ongoing inspections for accumulated pollutants. Pollutant deposition may vary from year to year. Quarterly inspections ensure that the system is serviced at the appropriate times. Table 4 lists recommended maximum capacities of oil and sediment. Professional vacuum services should be considered when capacities exceed these recommended levels. Table 4. StormTrooperp Maintenance Levels Model Number Oil Depth Sediment Depth SWAQ-05 12" 12" SWAQ-10 12" 12" SWAQ-20 12" 12" SWAQ-25 12" 12— SWAQ-40 12" 12" SWAQ-70 12" 12" SWAQ-110 12" 12" Jacobs Engineering l i'PAP Luther Perersar Sen ice Cnrrer It is very useful to keep a record of each inspection. Inspection Procedures 1. Easiest observation and maintenance is best accomplished during non -flow (dry weather) conditions 34 days after the most recent rain. Z. Remove interceptor covers or open hatchway to observe conditions. Remove hatchway safety net ("EnterNet"). Observe for trash and debris and remove if necessary. This is the most important maintenance requirement. if absorbent pillows are utilized, observe their condition. Uniform browning or gray color of the pillow means they should be replaced. Observe baffle debris screen and clean if necessary. 3. Coalescing plates are self-cleaning and seldom require maintenance unless damaged. Do not walk on or stand on plate packs. Call ParkUSA (R88 -611 -PARK) for replacement parts. 4. Check of the depth (level) of oil and sediment %, .n a tank sampler device designed for this purpose. Owner Operator Jerpbr Firgdirrrring Application Fee Form Texas Commission on Environmental Quality Name of Proposed Regulated Entity: Luther Peterson 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) ❑ Mays ❑ 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 ❑ Mailed to: TCEQ- Cashier ❑ San Antonio Regional Office ❑ 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 _ Type off' Plan J Water Pollution Abatement Plan, Contributing Zone Plan: One Single Family Residential Dwelling Water Pollution Abatement Plan, Contributing Zone Plan: Multiple Single Family Residential and Parks _ Water Pollution Abatement Plan, Contributing Zone Pian: Non-residential Sewage Collection System Lift Stations without sewer lines Underground or Aboveground Storage Tank Facilitv Extension of Time Signature: Date: ❑ Transition Zone Size Fee Due Acres J$ Acres 15.6 Acres L.F. Acres Tanks Each Each Each 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 Systems 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 Non-residential (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 a 100 $10,000 Organized Sewage Collection Systems 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 Underground and Aboveground Storage Tank Facility Cost per Tank or Piping System $650 Minimum Fee - Maximum Fee $650 - $6,500 Exception Requests Project Fee Exception Request $500 Extension of Time Requests Project Fee Extension of Time Request $150 2of2 TCEQ-0574 (Rev. 02-24-15) Water Pollution Abatement Plan Application Texas Commission on Environmental Quality for Regulated Activities on the Edwards Aquifer Recharge Zone and Relating to 30 TAC §213.5(b), 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 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 all information requested concerning the proposed regulated activities and methods to protect the Edwards Aquifer. This Water Pollution Abatement Plan Application Form Is hereby submitted for TCEQ review and Executive Director approval. The form was prepared by: Print Name of Customer/Agent:7iP iLs L L1kiss L, } 1 a� %�kpJrv\ ROcA Date: Signature of Customer/Agent: Regulated Entity Name: Luther Peterson Subdivision Regulated Entity Information 1. The type of project Is: ❑ Residential: Number of Lots: ❑ Residential: Number of Living Unit Equivalents: ❑ Commercial ® Industrial ❑ Other: 2. Total site acreage (size of property):15.6 3. Estimated projected population -N/A 4. The amount and type of impervious cover expected after construction are shown below: 1 of 5 TCEQ-0584 (Rev. 02-11-15) Table 1 - Impervious Cover Table Impervious Cover of Proposed Project Sq. Ft. Sq. Ft./Acre Acres Structures/Rooftops 86,100 _ 43,560 = 1.98 Parking 342,353 _ 43,560 = 7.86 Other paved surfaces 27,620 _ 43,560 = 0.63 Total Impervious Cover 456,073 - 43,560 = 10.47 Total Impervious Cover 10.47 _ Total Acreage 15.6 X 100 = 67.1% Impervious Cover 5. ® Attachment A - Factors Affecting Surface Water Quality. A detailed description of all factors that could affect surface water and groundwater quality that addresses ultimate land use is attached. 6. ❑ Only inert materials as defined by 30 TAC §330.2 will be used as fill material. For Road Projects Only Complete questions 7 -12 if this application is exclusively for a road project. 7. Type of project: ❑TXDOT road project. ❑County road or roads built to county specifications. []City thoroughfare or roads to be dedicated to a municipality. ❑Street or road providing access to private driveways. B. Type of pavement or road surface to be used: ❑Concrete ❑Asphaltic concrete pavement ❑Other: 9. Length of Right of Way (R.O.W.): feet. Width of R.O.W.: feet. L x W = Ft2 _ 43,560 Ft2/Acre = 10. Length of pavement area: feet. Width of pavement area: feet. L x W = Ft2 - 43,560 Ft2/Acre = Pavement area acres _ R.O.W. area acres. acres. acres x 100 = % impervious cover. 11. ❑ A rest stop will be included in this project. ❑ A rest stop will not be included in this project. 2 of 5 TCEQ-0584 (Rev. 02-11-15) 12. ❑ Maintenance and repair of existing roadways that do not require approval from the TCEQ Executive Director. Modifications to existing roadways such as widening roads/adding shoulders totaling more than one-half (1/2) the width of one (1) existing lane require prior approval from the TCEQ. Stormwater to be generated by the Proposed Project 13. ® Attachment B - Volume and Character of Stormwater. A detailed description of the volume (quantity) and character (quality) of the stormwater runoff which is expected to occur from the proposed project is attached. The estimates of stormwater runoff quality and quantity are based on the area and type of impervious cover. Include the runoff coefficient of the site for both pre -construction and post -construction conditions. Wastewater to be generated by the Proposed Project 14. The character and volume of wastewater is shown below: % Domestic 100% Industrial % Commingled TOTAL gallons/day 12,060 Average Daily Flow 15. Wastewater will be disposed of by: ❑ On -Site Sewage Facility (OSSF/Septic Tank): Gallons/day 12,060 Averaee Gallons/day Gallons/day ❑ Attachment C - Suitability Letter from Authorized Agent. An on-site sewage facility will be used to treat and dispose of the wastewater from this site. The appropriate licensing authority's (authorized agent) written approval is attached. It states that the land is suitable for the use of private sewage facilities and will meet or exceed the requirements for on-site sewage facilities as specified under 30 TAC Chapter 285 relating to On-site Sewage Facilities. ❑ Each lot in this project/development is at least one (1) acre (43,560 square feet) in size. The system will be designed by a licensed professional engineer or registered sanitarian and installed by a licensed installer in compliance with 30 TAC Chapter 285. ® Sewage Collection System (Sewer Lines): ❑ Private service laterals from the wastewater generating facilities will be connected to an existing SCS. ❑ Private service laterals from the wastewater generating facilities will be connected to a proposed SCS. ❑ The SCS was previously submitted on ® The SCS was submitted with this application. ❑ The SCS will be submitted at a later date. The owner is aware that the SCS may not be installed prior to Executive Director approval. 3 of 5 TCEQ-0584 (Rev. 02-11-15) ® The sewage collection system will convey the wastewater to the City of Round Rock Wastewater (name) Treatment Plant. The treatment facility is: ® Existing. ❑ Proposed. 16. ® All private service laterals will be inspected as required in 30 TAC §213.5. Site Plan Requirements Items 17 — 28 must be included on the Site Plan. 17. ® The Site Plan must have a minimum scale of 1" = 400'. Site Plan Scale: 1" = 60'. 18. 100 -year floodplain boundaries: ❑ Some part(s) of the project site is located within the 100 -year floodplain. The floodplain is shown and labeled. ® No part of the project site is located within the 100 -year floodplain. The 100 -year floodplain boundaries are based on the following specific (including date of material) sources(s): FEMA FIRM 48491C0495E, dated September 26, 2008 19. ® The layout of the development is shown with existing and finished contours at appropriate, but not greater than ten -foot contour intervals. Lots, recreation centers, buildings, roads, open space, etc. are shown on the plan. ❑ The layout of the development is shown with existing contours at appropriate, but not greater than ten -foot intervals. Finished topographic contours will not differ from the existing topographic configuration and are not shown. Lots, recreation centers, buildings, roads, open space, etc. are shown on the site plan. 20. All known wells (oil, water, unplugged, capped and/or abandoned, test holes, etc.): ❑ There are (#) wells present on the project site and the locations are shown and labeled. (Check all of the following that apply) ❑ The wells are not in use and have been properly abandoned. ❑ The wells are not in use and will be properly abandoned. ❑ The wells are in use and comply with 16 TAC §76. ® There are no wells or test holes of any kind known to exist on the project site. 21. Geologic or manmade features which are on the site: ❑ All sensitive geologic or manmade features identified in the Geologic Assessment are shown and labeled. ® No sensitive geologic or manmade features were identified in the Geologic Assessment. ❑ Attachment D - Exception to the Required Geologic Assessment. A request and justification for an exception to a portion of the Geologic Assessment is attached. 4of5 TCEQ-0584 (Rev. 02-11-15) 22. ® The drainage patterns and approximate slopes anticipated after major grading activities. 23. ® Areas of soil disturbance and areas which will not be disturbed. 24. ® Locations of major structural and nonstructural controls. These are the temporary and permanent best management practices. 25. ® Locations where soil stabilization practices are expected to occur. 26. ❑ Surface waters (including wetlands). ® N/A 27. [] Locations where stormwater discharges to surface water or sensitive features are to occur. ® There will be no discharges to surface water or sensitive features. 28. ® Legal boundaries of the site are shown. Administrative Information 29. ® 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. 30. ® Any modification of this WPAP will require Executive Director approval, prior to construction, and may require submission of a revised application, with appropriate fees. 5of5 TCEQ-0584 (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), (B) 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 farm 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 s U Aker C 1-7 a+ �� Date: II Signature of Customer/Agent: 0 pm 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 5. 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 Agent Authorization Form For Required Signature Edwards Aquifer Protection Program Relating to 30 TAC Chapter 213 Effective June 1, 1999 Title - Owner/President/Other of e have authorized Kevin Hunt Print Name of AgenttEngineer 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: 1. 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. fcEt�- 54 ss i- aro�r 0' '�� Page 1 of 2 SIGNATURE PAGE: Applicant's Signatufd THE STATE OF�� § County of SWamyp § (4117 Date BEFORE ME, the undersigned authority, on this day personally appeared 1&& known to me to be the person whose name is subscribed to the foregoing instrument, and ackno ledged to me that (s)he executed same for the purpose and consideration therein expressed. GIVEN under my hand and seal of office on this 11 day of { , 241' . BLANCA GILLIS NOTARY PUBLIC :°�, =Notary Public, State of Texas •�; . rz Comm Expires 03-15-2020 1Lg1 /�. rl Notary Id 130582387 Typed or Printed Name of Notary MY COMMISSION EXPIRES: 3 —1,5 —20 W TCE"599 (Rev.0410112010) Page 2 of 2 Permanent Stormwater Section Texas Commission on Environmental Quality for Regulated Activities on the Edwards Aquifer Recharge Zone and Relating to 30 TAC §213.5(b)(4)(C), (D)(li), (E), and (S), 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 some site and contact person in all farms 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 all information requested concerning the proposed regulated activities and methods to protect the Edwards Aquifer. This Permanent Stormwater Section is hereby submitted for TCEQ review and executive director approval. The application was prepared by: Print Name of Custom er/AgentM--SVAV'ci Gov Of '� p`och Date: f Signature of Customer/Agent Regulated Entity Name: Luther Peterson Service Center Permanent Best Management Practices (BMPs) Permanent best management practices and measures that will be used during and after construction is completed 1. ® Permanent BMPs and measures must be implemented to control the discharge of pollution from regulated activities after the completion of construction. ❑ N/A 2. ® These practices and measures have been designed, and will be constructed, operated, and maintained to insure that 60% of the incremental increase in the annual mass loading of total suspended solids (TSS) from the site caused by the regulated activity is removed. These quantities have been calculated in accordance with technical guidance prepared or accepted by the executive director. ® The TCEQ Technical Guidance Manual (TGM) was used to design permanent BMPs and measures for this site. 1 of 4 TCEQ-0600 (Rev. 02-11-15) ❑ A technical guidance other than the TCEQ TGM was used to design permanent BMPs and measures for this site. The complete citation for the technical guidance that was used is: ❑ N/A 3. ® Owners must insure that permanent BMPs and measures are constructed and function as designed. A Texas Licensed Professional Engineer must certify in writing that the permanent BMPs or measures were constructed as designed. The certification letter must be submitted to the appropriate regional office within 30 days of site completion. ❑ N/A 4. Where a site is used for low density single-family residential development and has 20 % or less impervious cover, other permanent BMPs are not required. This exemption from permanent BMPs must be recorded in the county deed records, with a notice that if the percent impervious cover increases above 20% or land use changes, the exemption for the whole site as described in the property boundaries required by 30 TAC §213.4(g) (relating to Application Processing and Approval), may no longer apply and the property owner must notify the appropriate regional office of these changes. ❑ The site will be used for low density single-family residential development and has 20% or less impervious cover. ❑ The site will be used for low density single-family residential development but has more than 20% impervious cover. ® The site will not be used for low density single-family residential development. 5. The executive director may waive the requirement for other permanent BMPs for multi- family residential developments, schools, or small business sites where 20% or less impervious cover is used at the site. This exemption from permanent BMPs must be recorded in the county deed records, with a notice that if the percent impervious cover increases above 20% or land use changes, the exemption for the whole site as described in the property boundaries required by 30 TAC §213.4(8) (relating to Application Processing and Approval), may no longer apply and the property owner must notify the appropriate regional office of these changes. ❑ Attachment A - 20% or Less Impervious Cover Waiver. The site will be used for multi -family residential developments, schools, or small business sites and has 20% or less impervious cover. A request to waive the requirements for other permanent BMPs and measures is attached. ❑ The site will be used for multi -family residential developments, schools, or small business sites but has more than 20% impervious cover. ® The site will not be used for multi -family residential developments, schools, or small business sites. 6. ® Attachment B - BMPs for Upgradient 5tormwater. 2 of 4 TCEQ-0600 (Rev. 02-11-15) ❑ A description of the BMPs and measures that will be used to prevent pollution of surface water, groundwater, or stormwater that originates upgradient from the site and flows across the site is attached. ❑ No surface water, groundwater or stormwater originates upgradient from the site and flows across the site, and an explanation is attached. ® Permanent BMPs or measures are not required to prevent pollution of surface water, groundwater, or stormwater that originates upgradient from the site and flows across the site, and an explanation is attached. 7. ❑ Attachment C - BMPs for On-site Stormwater. ® A description of the BMPs and measures that will be used to prevent pollution of surface water or groundwater that originates on-site or flows off the site, including pollution caused by contaminated stormwater runoff from the site is attached. ❑ Permanent BMPs or measures are not required to prevent pollution of surface water or groundwater that originates on-site or flows off the site, including pollution caused by contaminated stormwater runoff, and an explanation is attached. 8. ❑ Attachment D - BMPs for Surface Streams. A description of the BMPs and measures that prevent pollutants from entering surface streams, sensitive features, or the aquifer is attached. Each feature identified in the Geologic Assessment as sensitive has been addressed. ® N/A 9. ® The applicant understands that to the extent practicable, BMPs and measures must maintain flow to naturally occurring sensitive features identified in either the geologic assessment, executive director review, or during excavation, blasting, or construction. ® The permanent sealing of or diversion of flow from a naturally -occurring sensitive feature that accepts recharge to the Edwards Aquifer as a permanent pollution abatement measure has not been proposed. ❑ Attachment E - Request to Seal Features. A request to seal a naturally -occurring sensitive feature, that includes, for each feature, a justification as to why no reasonable and practicable alternative exists, is attached. 10. ® Attachment F - Construction Plans. All construction plans and design calculations for the proposed permanent BMP(s) and measures have been prepared by or under the direct supervision of a Texas Licensed Professional Engineer, and are signed, sealed, and dated. The plans are attached and, if applicable include: ® Design calculations (TSS removal calculations) ® TCEQ construction notes ® All geologic features ® All proposed structural BMP(s) plans and specifications ❑ N/A 3of4 TCEQ-0600 (Rev. 02-11-15) 11. ® Attachment G - Inspection, Maintenance, Repair and Retrofit Plan. A plan for the inspection, maintenance, repairs, and, if necessary, retrofit of the permanent BMPs and measures is attached. The plan includes all of the following: ® Prepared and certified by the engineer designing the permanent BMPs and measures ® Signed by the owner or responsible party ® Procedures for documenting inspections, maintenance, repairs, and, if necessary retrofit ® A discussion of record keeping procedures ❑ N/A 12. ❑ Attachment H - Pilot -Scale Field Testing Plan. Pilot studies for BMPs that are not recognized by the Executive Director require prior approval from the TCEQ. A plan for pilot -scale field testing is attached. ® N/A 13. ® Attachment I -Measures for Minimizing Surface Stream Contamination. A description of the measures that will be used to avoid or minimize surface stream contamination and changes in the way in which water enters a stream as a result of the construction and development is attached. The measures address increased stream flashing, the creation of stronger flows and in -stream velocities, and other in -stream effects caused by the regulated activity, which increase erosion that results in water quality degradation. ❑ N/A Responsibility for Maintenance of Permanent BMP(s) Responsibility for maintenance of best management practices and measures after construction is complete. 14. ® The applicant is responsible for maintaining the permanent BMPs after construction until such time as the maintenance obligation is either assumed in writing by another entity having ownership or control of the property (such as without limitation, an owner's association, a new property owner or lessee, a district, or municipality) or the ownership of the property is transferred to the entity. Such entity shall then be responsible for maintenance until another entity assumes such obligations in writing or ownership is transferred. ❑ N/A 15. ® A copy of the transfer of responsibility must be riled with the executive director at the appropriate regional office within 30 days of the transfer if the site is for use as a multiple single-family residential development, a multi -family residential development, or a non-residential development such as commercial, industrial, institutional, schools, and other sites where regulated activities occur. ❑ N/A 4of4 TCEQ-0600 (Rev. 02-11-15) Temporary Stormwater Section Texas Commission on Environmental Quality for Regulated Activities on the Edwards Aquifer Recharge Zone and Relating to 30 TAC §213.5(b)(4)(A), (B), (D)(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 same site and contact person in all farms in the application, and ensure forms are signed by the appropriate party. Note: Including ail 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 Temporary Stormwater Section Is hereby submitted for TCEQ review and executive director approval. The application was prepared by: Print Name of Customer/Agent: —rLIL)• I�Ces � , �y a� P"'W4 9'A Date: j 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. 1 of 5 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 D —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: 2 of 5 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. 3 of 5 TCEQ-0602 (Rev. 02-11-15) Z 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 BMPs and measures are attached. ® N/A 12. ® Attachment I - 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) 18. ® 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 30 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 21% Administrative Review 1. Edwards Aquifer applications 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: htt w%vw ov fi 1 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-058$ Instructions). Technical Review i. 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 go 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. i. Regulated Entity Name: Luther Peterson Subdivision 2. Regulated Entity No.: RN102766417 3. Customer Name: City of Round Rock 4. Customer No.: CN60041318i 5. Project Type: (Please circle/check one) New Modification Extension Exception 6. Plan Type: (Please circle/check on WPAP CZP SCS UST AST EXP EXT Technical Clarification Optional Enhanced Measures �. Land Use: (Please circle/check one) Residential on -residential 8. Site (acres): 15.599 9. Application Fee: $6,5oo 1o. Permanent BMP(s): ParkUSA Water Quality Stormtroopers 11. SCS (Linear Ft.): 12. AST/UST (No. Tanks): 13. County: Williamson 14. Watershed: Chandler Branch — Brushy Creek TCEQ-20705 (Rev. 02-17-17) 2 Of ,J 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 FAPP Boundaries" map found at: >rttp� Jw azw_tce4.texas.�o+. asscks;'puh]icfcorn�,licinc°��}field opsleapp/! kPPN to(rWt'D,%'20ni . tlf. For more detailed boundaries, please contact the conservation district directly. Austin Region County: Hays Travis Williamson Original (i req.) Uvalde Original (i req.)— Region (i req.) e i County(ies) i _Edwards Aquifer County(ics) Authority Groundwater Conservation Distriet(s) —Barton Springs/ gs/ Barton Springs/ Edwards Aquifer Edwards Aquifer NA Edwards Aquifer Hays Trinity EAA EAA Districts) Plum Creek Authority -Medina Austin _Austin Buda Austin _Cedar Park Dripping Springs __ Bee Cave — Florence City(ies) Jurisdiction Kyle ptluerville g —Georgetown Fair Oaks Ranch Mountain City Rollingwood Jerrell Jurisdiction —Hill Country Village Round Rock Leander Antonio ETJ —San Marcos Sunset Valley Liberty Hill _New Braunfels —Wimberley West Lake Hills _ Pflugerville Woodereek Schettz _ . — L Round Rock San Antonio Region County: Bexar Comal Kinney Medina Uvalde Original (i req.)— Region (1 req.)— County(ics) Groundwater Edwards Aquifer Conservation — Authority Edwards Aquifer Kinney EAA EAA Districts) 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) Schettz Shavano Park TCEQ-20705 (Rev. 02-17-17) 3 of 4 I certify that to the best of my knowledge, th application is hereby submitted to TCEQ for LA v�l-<-, 6�� in is complete and accurate.' review and technical review. Print me�am r/ uthOrizeL./�JCgV1 it ` 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 (Y/N): Signed (YIN): Less than go days old (Y/N): Core Data Form Complete (YIN): Core Data Form Incomplete Nos.: TCEQ-20705 (Rev. 02-17-17) 4 of 4 - y City of Round Rock ROUND ROCK TEXA Agenda Item Summary Agenda Number: Title: Consider authorizing a TCEQ Core Data Form for a Storm Water Application at the 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 Storm Water Application - LAF, WPAP Luther Peterson �r Department: General Services Department Text of Legislative File CM -2017-1555 Consider authorizing a TCEQ Core Data Form for a Storm Water Application at the Luther WrAlp Peterson Project. Stormwatwer discharge activities located in the Edward Aquifer recharge must meet requirements. This application will provide TCEQ with that information. City of Round Rock Page 1 Printed on 11/17/2017