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R-10-11-09-10D1 - 11/9/2010RESOLUTION NO. R -10-11-09-10D1 WHEREAS, the Cities of Round Rock, Austin, and Cedar Park (the "Cities"), and the Lower Colorado River Authority ("LCRA"), entered into a Purchase Agreement on September 10, 2009, whereby the LCRA agreed to transfer the Brushy Creek Regional Wastewater System ("BCRWWS") to the Cities on or about December 8, 2009, and WHEREAS, in order to transfer the Cities' names onto the Texas Commission on Environmental Quality ("TCEQ") wastewater permit, the TCEQ requires proper execution of the core data forms from each of the Cities, and WHEREAS, the City Council of the City of Round Rock wishes to authorize the Mayor to execute any and all documents required for said transfer, Now Therefore BE IT RESOLVED BY THE COUNCIL OF THE CITY OF ROUND ROCK, TEXAS, That the Mayor is hereby authorized and directed to execute on behalf of the City a TCEQ Application to Transfer a Wastewater or CAFO Permit, a copy of same being attached hereto as Exhibits "A" and incorporated herein for all purposes. The City Council hereby finds and declares that written notice of the date, hour, place and subject of the meeting at which this Resolution was adopted was posted and that such meeting was open to the public as required by law at all times during which this Resolution and the subject matter hereof were discussed, considered and formally acted upon, all as required by the Open Meetings Act, Chapter 551, Texas Government Code, as amended. RESOLVED this 9th day of November, 2010. ',1 ALAN MCGRAW, Mayor City of Round Rock, Texas ATTEST: SARA L. WHITE, City Secretary O:\wdox\SCC1nts\0112\1005\MUNICIPAL\00206784.DOC/zmc EXHIBIT "A„ 5mi. APPLICATION TO TRANSFER A WASTEWATER OR CAFO W = PERMIT If you have questions on how to fill out this form please contact the Applications Review and Processing Team at 512/239-4671. If you have questions about the Wastewater Permitting program, TCEQplease contact the Wastewater Permitting Section at 5121239-4671. UBMISS.19CHE TCWEESUBMIT THES�WITH=THE iAPRL CA [Ot , INDICATE IF THE FOLLOWING ARE INCLUDED IN THE APPLICATION. ADDITIONAL BLANK SPACES PROVIDED FOR REFERENCING APPLICANT'S ATTACHMENTS TO THE APPLICATION. ATTACHMENTS Y N REQUIRED SIGNATURE PAGES COPY OF THE CHECK SUBMITTED FOR TRANSFER APPLICATION PROCESSING FEE CORE DATA FORM - required to complete the transfer application LEASE AGREEMENTS - if applicable PROOF OF OWNERSHIP - Required for CAFO Permits Application fees A check or money order for $100.00, made payable to the Texas Commission on Environmental Quality, must be sent under separate cover to: Texas Commission on Environmental Quality Revenues Section (MC 214) P.O. Box 13088 Austin, Texas 78711-3088 COPY OF THE CHECK MUST BE SUBMITTED AS PART OF THE APPLICATION For Commission Use Only Permit Number EPA ID No. Expiration Date County Region (TCEQ - 20031 1012008) Application to Transfer a Wastewater/CAFO Permit Page 4 of 12 1. APPLICANT GENERAL_ INFORMATION a. Facility owner City of Round Rock, City of Cedar Park & City of Austin Mailing address for use on the permit and permit correspondence: Street No. 212 Street name Commerce P.O. Box City Round Rock Telephone number (512) 671-2755 Street type Blvd OR State TX ZIP code 78664 Fax number: (512) 218-3242 Email address: Tax Identification Number issued by the State Comptroller Charter Number issued by the Texas Secretary of State Check one _ The TCEQ has issued this Customer Reference Number to the owner CN 600407951, 600413181, 60013519 8 The owner has not yet received a Customer Reference Number. A complete Core Data Form (TCEQ-1m1 listing the owner as the customer and this facility as the regulated entity is attached to this application. b. Co -Permittee information (complete only if the operator is required to apply as a co -permittee) Facility operator Street No. Street name Street type OR P.O. Box City State ZIP code Telephone number Fax number: Email address: Tax Identification Number issued by the State Comptroller Charter Number issued by the Texas Secretary of State Check one The TCEQ has issued this Customer Reference Number to the owner CN _ The owner has not yet received a Customer Reference Number. A complete Core Data Form (TCEQ-104p listing the owner as the customer and this facility as the regulated entity is attached to this application. c. Individual information (complete only if the facility owner or co -permittee is an individual) Pursuant to the Texas Water Code 26.027(6), please supply the following information when the applicant is an individual Full Legal Name: First Middle Last [Nate ['Female State ID Number: Date of Birth Assumed business or professional name Home address: Street No. Street name Street type City State ZIP code Telephone number Email address: Check one 0 The TCEQ has issued this Customer Reference Number to the owner CN 0 The owner has not yet iaceived a Customer Reference Number. A complete Core Data Form (TCEQ-10400) listing the owner as the customer and this facility as the regulated entity is attached to this application. Page 5 of 12 (TCEQ - 20031 10/2008) Application to Transfer a Wastewater/CAFQ Permit 2 , _ CQNTACT INFORMATIOt` a. Identify the person, including a complete mailing address, telephone number, and fax number, authorized to act for the applicant during the processing ofthe transfer application. The person identified will be the contact if additional informatin is needed during the transfer process. Name Jay Bragg Telephone number (254) 761-3135 Company Brazos River Authority Email ibragg@brazos.org Fax number (254) 761-3205 Street No. Street name Street type OR P.O. Box 7555 City Waco State TX ZIP code 76714-7555 b. identify the person, including a complete mailing address, telephone number, and fax number, that can be contacted bine agency as needed throughout the term of the permit. Name Jay Bragg Telephone number (254) 761-3135 Company Brazos River Authority Email jbragg@brazos.arg Fax number (254) 761-305 Street No. Street name Street type OR P.O. Box 7555 City Waco NIR' NFORM' Tl Permit No. W00010264002 State TX EPA Identification No. TX 010194 ZIP code 76714-7555 Expiration date 12-01-2009 Check one V1 The TCEQ has issued this Regulated Entity Reference Number to the owner RN 100822600 0 No Regulated Entity Reference Number has been received for this facility. One or more completed Core Data Forms (TCEQ-10400) listing this facility as the regulated entity are attached. Check, if applicable (for POTWs only) 0 The permit to be transferred requires implementation of an approved pretreatment program by a POTW. (NOTE: The transferee must contact the Storm Water & Pretreatment Team staff before this application may be processed.) Check, if applicable (for domestic reclaimed water authorizations) J There is a domestic reclaimed water authorization associated with this permit.(NOTE: The domestic reclaimed water authorization associated with this permit will be transferred. If you do not want the domestic reclaimed water authorization transferred, please state this and the authorization will be cancelled on the same date the transfer took place.) _ :til; ;'{.. -, t :H. `?:q;Ti y �yc ,EL. },., 3 ur �4:�1>F'.`CIL.iTY'INFORNIATION�=- _Jz.. �-�.�, .�....t.:�._._-.. ��a�<.u,.��.,�� a..Plant Name Brushy Creek Regional Wastewater Treatment Facility (East County in which the facility is located Williamson b. Owner of land where the facility is/will be City of Round Rock, City of Cedar Park, & City of Austin If not the same as the fadNty owner please see instructions on page 4) Street No. 212 Street name Commerce Street type Blvd OR P.O. Box City Round Rock State TX ZIP code 78664 c. Owner of effluent disposal site (If trot the same as the facility owner please see Instructions on page 4) Street No. Street name Street type OR P.O. Box City State ZIP code (TCEQ - 20031 10/2008) Application to Transfer a Wastewater/CAFO Permit Page 6 of 12 2 .. CONTACT; INFORMATION a. Identify the person, including a complete mailing address, telephone number, and fax number, authorized to act for the applicant during the processing ofthe transfer application. The person identified will be the contact if additional informatin is needed during the transfer process. Name Jay Bragg Telephone number (254) 761-3135 Company. Brazos River Authority Email jbragg@brazos.org Fax number (254) 761-3205 Street No. Street name Street type OR P.O. Box 7555 City Waco State TX ZIP code 76714-7555 b. Identify the person, including a complete mailing address, telephone number, and fax number, that can be contacted b*he agency as needed throughout the term of the permit. Name Jay Bragg Telephone number (254) 761-3135 Company Brazos River Authority Email jbragg@brazos.org Fax number (254) 761-305 Street No. Street name OR P.O. Box 7555 City Waco Street type State TX ZIP code 76714-7555 e5-+^'_�eT::�-.t:r--- '"4 S f. .. I' _ERM ..i �'%: Y.G. . F Mei ; �..: .fz..:..._ ......._.: n....._._:,. �.. .. _ I -.-.l.-. :... .. i., .:.�...�_ 1�. _ _... i..•.. T.- _. s u..:'i�_ Permit No. W00010264002 EPA Identification No. TX 010194 Expiration date 12-01-2009 Check one 16 The TCEQ has issued this Regulated Entity Reference Number to the owner RN 100822600 ❑ No Regulated Entity Reference Number has been received for this facility. One or more completed Core Data Forms (TCEQ-10400) listing this facility as the regulated entity are attached. Check, if applicable (for POTWs only) 0 The permit to be transferred requires implementation of an approved pretreatment program by a POTW. (NOTE: The transferee must contact the Storm Water & Pretreatment Team staff before this application may processed.) Check, if applicable (for domestic reclaimed water authorizations) ca There is a domestic reclaimed water authorization associated with this permit.(NOTE: The domestic reclaimed water authorization associated with this permit will be transferred. If you do not want the domestic reclaimed water authorization transferred, please state this and the authorization will be cancelled on the same date the transfer took place.) i - - eta_ -- : ,,; •_ ::,, - �r,;:: : �:a�� •,;, n M TION - - .. _.�..,r�s° �i�`sl • ;;�; �-.• .. ._..,...>._...... ... ... .. ...: .,.�_e.ria:._:x::._:>u:_..:'s�•1-:.,_e_.._,.....—. ..._ __. .._._.�.....,..::.:..` a.,Plant Name Brushy Creek Regional Wastewater Treatment Facility (East County in which the facility is located Williamson b. Owner of land where the facility is/will be City of Round Rock, City of Cedar Park, & City of Austin If not the same as the facility owner please see Instructions on page 4) Street No. 217 Street name Commerce Street type Blvd OR P.O. Box City Round Rock State TX ZIP code 78664 c. Owner of effluent disposal site (If not the same as the facility owner please see instructions on page 4) Street No. Street name Street type OR P.O. Box City State ZIP code (TCEQ - 20031 1012008) Application to Transfer a Wastewater/CAFO Permit Page 6 of 12 d. FOR CAFOs please provide one of the following: 0 Warranty Deed ❑ Property Tax Records ❑ Lease - includes authorization to use the land for the duration of the permit - owner of land must be co -permittee ❑ Facility size indicated in proof of ownership: acres (should be the same as what is authorized in the current permit) 5 The DateTransferol iwnership/operator Will Occur, Date: Please note that the transfer will be processed once the change in ownership occurs. If the anticipated date of transfer of ownership changes, the transferee or the transferor must notify the Applications Review and Processing Team in writing, prior to the above given date. The transferee assumes complete responsibility of the permit once the permit transfer is issued, unless an executed agreement by the transferor and transferee is provided with the transfer application including payment of any outstanding annual fees. Page 8 of 12 (TCEQ - 20031 10/2008) Application to Transfer a WastewaterlCAFO Permit 16c1E1SigriatarelPage for Transferee`(New.Owiier andlti Operator) (See Regiilrerxterets or Page 4 of4he I, Title (Printed or typed name and lige of executive officer of at least the level of vice president or equivalent) (Name of company) being duly sworn, depose and say: that a flange of ownership of the facilityfor the subject permit has been issued will occuas indicated in the application. As a condition of the transfer, I do hereby declare that The transferee will be the owner of the existing treatment faciljtfrom which wastewater is discharged, deposited or disposethr the facilities required to comply withthe permit will be constructed as described irthe application considered bythe TCEQ Nor to the issuance of the permit. The transferee possesses a copy of the penrtj understands the terms and conditions therein, and does accept and assume all obligations of the permit. The transferee assumes financial responsibilityfor the proper maintenance and operation of all waste treatment andlisposal facilities required by the permit or which may be required to comply with the permit terms and conditions. The transferee certifies that the transfer is not made for the purpose of avoiding liability for improper actions carried out prior to the date of transfer. Neither is the transfer made for the purposeof transferring responsibility for improper operations to an insolvent etity. The transferee certifies under penalty of law that this documents, to the best of myknowledge and belief, true, accurate, and complete. I am aware there are significant penalties for submitting false information, including the possibility of fine and imprisonment for known violations and revocation of this permit. Signature: Date: NOTE: ALL APPLICATIONS MUST BEAR THE SIGNATURE AND SEAL OF NOTARY PUBLIC. SUBSCRIBED AND SWORN to before me by the said on this day of My commission expires on the day of Notary Public (Seal) County, Texas `* Operator is required to sign only if operator is required to be a co -permittee: (TCEQ - 20031 10/2008) Application to Transfer a Wastewater/CAFO Permit Page 9 of 12 7::.Signature:Page_for.-_T.ransferor"(Current,P..ermtttee) (.See Requirements_omP._agei3;ofthe_Ins"}riiai3ons) . Owner of Permitted Facility I, Title (Executive Principal Officer / Ranking Elected Ofciall) consent to the transfer of the permit and I certify under penalty of law that this document and all attachments were prepared under my direction or supervision in accordance w(th a system designed to assurethat qualified personnel properly gather and evaluate the information submitted. Based on myinquiry of the person or persons who manage the system, or those persons directly responsible for gathering the information, the information submitted is, to the best of my knowledge and belief, true, accurate, and complete. I am aware there are significant penaltes for submitting false information, including the possibilityof fine and imprisonment for knowing violations. I further certifythat I am authorized under 30 Texas Administrative Code$305.44 to sign this document and can provide documentation in proof of such authorization upon request. Signature: Date: NOTE: ALL APPLICATIONS MUST BEAR THE SIGNATURE AND SEAL OF NOTARY PUBUC. SUBSCRIBED AND SWORN to before me by the said on this day of My commission expires on the day of (Seal) Notary Public County, Texas Operator of Permitted Facility(Operator's signature is required only if the operator is co -permittee on the current permit). (, Title: (Executive Principal Offer / Ranking Elected Official) consent to the transfer of the permit and I certify under penalty of law that this document and all attachments were prepared under my drection or supervision in accordance oath a system designed to assurethat qualified personnel properly gather and evaluate the information submitted. Based on myinquiry of the person or persons who manage the system, or those persons directly responsible for gathering the information, the information submitted is, to the best of my knowledge and belief, true, accurate, and complete. I am aware there are significant penaites for submitting false information, including the possibilityof fine and imprisonment for knowing violations. I further certifythat 1 am authorized under 30 Texas Administrative Cod§305.44 to sign this document and can provide documentation in proof of such authorization upon request. Signature: Date: NOTE: ALL APPLICATIONS MUST BEAR THE SIGNATURE AND SEAL OF NOTARY PUBLIC. SUBSCRIBED AND SWORN to before me by the said on this day of My commission expires on the day of (Seal) Notary Public County, Texas (TCEQ - 20031 10/2008) Application to Transfer a Wastewater/CAFO Permit Page 10 of 12 8. THIS PAGE IS APPLICABLE TO PERMITS THAT INCLUDE COMPOSTING FACILITIES, LAND APPLICATION AND/OR DISPOSAL OF SEWAGE SLUDGE AND THE TRANSFEREE DOES NOT OWN THE LAND WHERE THE DISPOSAL ACTIVITY IS CONDUCTED. Site Operator 1, Title (Typed or Printed Name) understand that I am responsible for operating the site described in the legal description in accordance with the Texas Commission on Environmental Quality requirements in 30 TAC, eapter 332 and/or 312, the conditions set forth in the wit, and any additional conditions as required by the Texas Commission on Environmental Quality. l also certify under penalty of law that all information submitted is, to the best of my knowledge and belief, true, accurate, and complete. I am aware thatebte are significant penalties for submitting false information, incl uding the possibility of fine, imprisonment for violations, and revocation of this permit. Signature: Date: NOTE: ALL APPLICATIONS MUST BEAR THE SIGNATURE AND SEAL OF NOTARY PUBLIC. SUBSCRIBED AND SWORN to before me by the said on this day of My commission expires on the day of (Seal) Notary Public County, Texas Complete Only If Landowner Is Not the Site Operator 1, Title (Typed or Printed Name) owner of the land described in the attached legal description,have all rights and covenants to authorize, the applicant for tis Permit, to use this site for the composting, disposal and /or land application Facility. I understand that 30 TAC, Chapter 332 and/or 312 requires me to make a reasonable effort to see that the applicant complies to the required operating conditions stated in the above paragraph. I also certify under penalty of iawitat all information submitted is, to the best of my knowledje and belief, true, accurate, and complete. I am aware that there are significant penalties for submitting false information, including the possibility of fine, imprisonment for violations, and revocation of this permit. Signature: Date: NOTE: ALL APPLICATIONS MUST BEAR THE SIGNATURE AND SEAL OF NOTARY PUBLIC. SUBSCRIBED AND SWORN to before me by the said on this day of My commission expires on the day of (Seal) Notary Public County, Texas (TCEQ - 20031 1012008) Application to Transfer a Wastewater/CAFQ Permit Page 11 of 12 All Applicants Should Complete the Following Items 9, ;Miscellaneous Items _ a. Please provide the address for receiving self-reporting/DMR forms. Company Brazos River Authority Department Environmental Services Name Brazos River Authority Street No. Street Name Street Type OR P.O. Box 7555 City Waco State TX ZIP code 767147555 b. Please provide the address for receiving Annual Billing Invoices. Company Brazos River Authority Department Financial Services Name Brazos River Authority Street No. Street Name Street Type OR P.O. Box 7555 c. Delinquent Fees owed. City Waco Do you owe fees to the TCEQ? Yes ✓ No State TX ZIP code 767147555 If yes, please provide the amount past due, the type of fee, and an identifying number. d. Delinquent Penalties owed. Do you owe any penalties to the TCEQ? Yes ✓ No If yes, please provide the amount past due, the type of penalty, and an identifying. number. (TCEQ - 20031 10/2008) Application to Transfer a Wastewater/CAFO Permit Page 12 of 12 TCEQ TCEQ Core Data Form , TCEQ US° Only; 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 (lf other is checkedplease describe in space provided) ;NeviiPerrnit, Registrafidn or Autho4fiOn (Core Data 601 should be submitted with the program application) • New Regulated Entity II Update to Regulated Entity Name CI Update to Regulated Entity Information Renewal (Core Data Form should be submitted with the renewal form) CI Other Transfer of Permit 2. Attachments . Describe Any Attachments: (ez Title V Application, Waste Transporter Apnlication, e(c.) D • Application to Transfer a Wastewater Permit D 1 E414 Yes DNo 3. Customer Reference Number (if issued) Follow this link to search 4. Regulated Entity Reference Number (if issued) CN 600413181 for CN or RN numbers in RN 100822600 Central Reoistrv" SECTION II: Customer Information 5. Effective Date for Customer Information Updates (mmlddlyyyy) by pperm(t application) 0 No Change" (See beim) • New Regulated Entity II Update to Regulated Entity Name CI Update to Regulated Entity Information 6. Customer Role (Proposed orActual)— as it relates to the Regulated Entity listed on this form. Please check only one of the following: E171 Owner Occupational Licensee D • Operator Responsible Party D 1 Owner & Operator Voluntary Cleanup Applicant DOther. 7, General Customer inforrnation New Customer 0 Update to Customer Information 0 Change In Regulated Entity Ownership Change in Legal Name (Verifiable with the Texas Secretary of State) Eg No Charms" "If "No Change" and Section I is complete, skip to Section III— Regulated Entity Information. 8. Type of Customer: 1 Corporation 0 Individual 0 Sole Proprietorship- D.B.A City Government 0 County Govemment D Federal Govemment LJ State Government o Other Government D General Partnership D Limited Partnership 0Other. ):.. lf • new:Ciistomer enter:previous Customer legal Rama 17individual, 9. Customer (if a print last name frisk ex: Doe,jc.i,ilni; -.:.-below...':'-::.:,:. . •-...... End Date: : 10. Mailing Address. City State ZIP ZIP 4. 4 11. Country Mailing Information (i(outside usA) .. . 12. E -Mail Address el eppficabie) 13. Telephone Number ( ) - 14. Extension or Code •:. - : 1 15. Fax Number (if apPlicable) I ( ) - 16. Federal Tax ID (9 digits) I 17. TX State Franchise Tax ID (11 di) I 18. DUNS Numbergrappkabso I 19. TX SOS Filing Number (trapplicable) 20. Number of Employees 0 0-20 0 21-100 0 101-250 0 251-500 0 501 and higher 21. Independently Owned and Operated? 1 0 Yes 0 No SECTION III: Regulated Entity Information 22. General Regulated Entity InforniatiOn0*OgOtatO.Entity° is selected belmktbis form.shogid be accompanied by pperm(t application) 0 No Change" (See beim) • New Regulated Entity II Update to Regulated Entity Name CI Update to Regulated Entity Information "If 'NO CHANGE" is checked and Section I is complete, skip to Section IV, Preparer Information. 23. Regulated Entity Name (name of the site where the regulated action is taking place) . Brushy Creek Regional Wastewater Treatment Plant (East) TCEQ-10400 (09/07) Page 1 of 2 24. Street Address of the Regulated Entity: (No P.O. Boxes) 3939 Palm Valley Blvd 36. Nearest City County State Nearest ZIP Code City Round Rock State TX ZIP 78664 ZIP + 4 Degrees Minutes 25. Mailing Address: 212 Commerce Blvd Minutes Seconds City Round Rock State TX ZIP 78664 ZIP + 4 0 Utilities 26. E -Mail Address: 27. Telephone Number 28. Extension or Code 29. Fax Number (dapprieabre) ( ) - ( ) - 30. Primary SIC„Code (4 digits) 31. Secondary SIC Code (4 digits) 32. Primary NAICS Code 33. Secondary NAICS Code ( 5 of 6 digits) (5 or 6 digits) 4952 1 Water Rights 22132 34. What is the Primary. Business of thls entity? (Please do not repeat the SIC or NAICS description.) Wastewater Treatment Questions 34 - 37 address geographic location. Please refer to the instructions for applic 35. Description to Physical Location: ■ Districts 36. Nearest City County State Nearest ZIP Code • Industrial Hazardous Waste • Municipal Solid Waste ( ) - Signature: 37. Latitude (N) In Decimal: 38. Longitude (W) In Decimal: Degrees Minutes Seconds Degrees Minutes Seconds ■ Stormwater ■ Title V—Air 39. TCEQ Programs and ID Numbers Check all Programs and write in the permits/registration numbers that will be affected by the updates submitted on this form or the updates may not be made. If your Program is not listed, check other and write it in. See the Core Data Form instructions for additional guidance. ❑ Dam Safety ■ Districts ■ Edwards Aquifer • Industrial Hazardous Waste • Municipal Solid Waste ( ) - Signature: Date: ❑ New Source Review—Air ■ OSSF ■ Petroleum Storage Tank • PWS • Sludge ■ Stormwater ■ Title V—Air ■ Tires 1 Used Oil 0 Utilities ■ Voluntary Cleanup ■ Waste Water ■ Wastewater Agriculture 1 Water Rights 1 Other: SECTION IV: Preparer Information 40- Name:. Jay Bragg X41. Title: Regional Environmental Planner 42. TelephoneNumber 43. ExLlCode Fax Number 45. E -Mail Address ( 254) 761-3135 ( 254) 761-3205 jbragg@brazos.org 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 9 and/or as required for the updates to the ID numbers identified in field 39. (See the Core Data Form instructions for more information on who shondd sign this form. Company: City of Round Rock Job Title: Namepn wins) : Phone: ( ) - Signature: Date: TCEQ-10400 (09107) Page 2 of 2 ROUND ROCK, TEXAS PURPOSE. PASSION. PROSPERITY Agenda Item No. *10D1. City Council Agenda Summary Sheet Agenda Caption: Consider a resolution authorizing the Mayor to execute a TCEQ Application to Transfer a Wastewater or CAFO Permit regarding the Brushy Creek Regional Wastewater Treatment Facility (East). Meeting Date: November 9, 2010 Department: Infrastructure Development and Construction Management Staff Person making presentation: Michael Thane, P.E. Director of Infrastructure Management Item Summary: In December 2009, the Cities of Round Rock, Austin and Cedar Park purchased the Brushy Creek Regional Wastewater System (BCRWWS) from the Lower Colorado River Authority (LCRA). The BCRWWS consists of two plants, known as the East Plant and West Plant. The Cities agreed to fully release and discharge LCRA from any further obligations or liability related to the BCRWWS. In order to transfer the three cities' names onto the Texas Commission on Environmental Quality (TCEQ) wastewater permit, the TCEQ requires proper execution of the core data forms including an executive signature from each City. The Cities of Austin and Cedar Park will likewise submit their Core Data Forms which will complete the transfer of the wastewater permit of the BCRWWS East Plant to the Cities. The BCRWWS West Plant has already been transferred to the three Cities. Strategic Plan Relevance: Goal 28.0 "Protect public health and protect the environment through proper waste disposal." Cost: N/A Source of Funds: N/A Date of Public Hearing (if required): N/A Recommended Action: Approval EXECUTED DOCUMENT FOLLOWS TCEQ TCEQ 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 (!f other is checked please describe in space provided) New Permit, Registration or Authonzabon (Cote Data Fog?! Ahould be subm/tted.with the program application) ■ Renewal (Core Data Form should be submitted with the renewal form) /1 Other Transfer of Permit 2. Attachments . `.Describe Any Attachments: (ex idle VApplication, Waste. Transporter Application, etc.) :... Owner ❑ Operator 0 Owner & Operator Licensee 0 Responsible Party ❑ Voluntary Cleanup Applicant ❑Other. Application to Transfer a Wastewater Permit r t Yes • No 3. Customer Reference Number (if issued) Follow this link to search 4. Regulated Entity Reference Number (if issued) CN 600413181 for CN or RN numbers in RN 100822600 Central Regisry`* SECTION II: Customer Information 5. Effective Date for Customer Information Updates (mmlddlyyyy) ■ New Regulated Entity 0 Update to Regulated Entity Name /�1 Update to Regulated Entity Information ■ No Change** (See below) 6. Customer Role (Proposed :or Actual) — as it relates to the Regulated Entity listed on this form. Please check only ona of the following: I ❑Occupational Owner ❑ Operator 0 Owner & Operator Licensee 0 Responsible Party ❑ Voluntary Cleanup Applicant ❑Other. 7, General Customer information :' ❑ New Customer ❑ Update to Customer Information ❑ Change in -Regulated Entity Ownership ❑Change in Legal Name (Verifiable with the Texas Secretary of State) ® No Change** **If "No Change" and Section 1 is complete, skip to Section Ill— Regulated Entity Information. 8. Type of Customer: ❑ Corporation ❑ Individual 0 Sole Proprietorship- D.B,A ❑ City Govemment ❑ County Government ❑ Federal Govemment ❑ State Government ■ Other Government ❑ General Partnership ❑ limited Partnership ❑ Other. ...,.. 7fneWpAtomer,, Legal Name';(if enterbrevious Customer 9. Customer an individual, print last name first: ex: toe, Jofrn) .'' '!: End Date: below:-,; 10. Mailing Address* City State ZIP ZIP + 4 11. Country Mailing Information (if ouisideUSA) 12. E -Mail Address (if applicable) 13. Telephone Number ( ) - 14. Extension or.Code 1 15. Fax Number (if applicable) I( )- 16. Federal Tax ID is digits) 17. TX State Franchise Tax ID irr dies) 18. DUNS Numbererappricaare) 19. TX SOS Filing Number (dappocabe) 20. Number of Employees ❑ 0-20 ❑ 21-100 ■ 101-250 • 21. Independently Owned and Operated? 251-500 ❑ 501 and higher 1 0 Yes ❑ No SECTION III: Regulated Entity Information 22. General Regulated Entity Information (If'NewRegulated.Entftie Is selected below this form_should be accompanied by a permit application) ■ New Regulated Entity 0 Update to Regulated Entity Name /�1 Update to Regulated Entity Information ■ No Change** (See below) **If "NO CHANGE" is checked and Section tis complete, skip to Section IV, Preparer information. 23. Regulated Entity Name (naive of the site where the regulated action is faking piece) Brushy Creek Regional Wastewater Treatment Plant (East) TCEQ-10400 (09/07) Page 1 of 2 24. Street Address of the Regulated Entity: (No P.Q. Boxes) 3939 Palm Valley Blvd 36. Nearest City County State Nearest ZIP Code City Round Rock State TX ZIP 78664 ZIP + 4 Degrees Minutes 25. Mailing Address: 212 Commerce Blvd Minutes City Round Rock State TX ZIP 78664 ZIP + 4 Petroleum Storage Tank 26. E -Mail Address: 27. Telephone Number 28. Extension or Code 29. Fax Number (if applicable) ( ) - Sludge ( ) - 30. Primary SIC Code (4 digits) 31. Secondary SIC Code (4 digits) 32..Primary NAICS Code 33. Secondary NAICS Code (5 or 6 digits) (5 or 6 digits) 4952 22132 34. What is the Primary Business of this entity? (Please do not repeat the SIC or NAICS description.) Wastewater Treatment Questions 34 - 37 address geographic location. Please refer to the instructions for applicability. 35. Description to Physical Location: • 36. Nearest City County State Nearest ZIP Code ■ Edwards Aquifer ■ Industrial Hazardous Waste 37. Latitude (N) In Decimal: 38. Longitude (W) In Decimal: Degrees Minutes Seconds Degrees Minutes Seconds ❑ New Source Review -Air ■ OSSF 1 39. TCEQ Programs and ID Numbers Check alt Programs and write in the permitslregistration numbers that will be affected by the updates submitted on this form or the updates may not be made. If your Program is not listed, check other and write It In. See the Core Data Form Instructions for additional guidance. ❑ Dam Safety • Districts ■ Edwards Aquifer ■ Industrial Hazardous Waste 1 Municipal Sold Waste ❑ New Source Review -Air ■ OSSF 1 Petroleum Storage Tank ■ PWS ■ Sludge ❑ Stormwater • Title V - Air 1 Tires ■ Used Oil 1 Utilities • Voluntary Cleanup ■ Waste Water ■ Wastewater Agriculture ■ Water Rights ■ Other: SECTION IV: Preparer Information 40. Name: Jay Bragg 41. Title: Regional Environmental Planner 42. Telephone Number 43. Ext./Code 44 Fax Number 45. E -Mail Address ( 254) 761-3135 ( 254) 761-3205 jbraggta@brazos.org 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 9 and/or as required for the updates to the ID numbers identified in field 39. (See the Core Data Form instructions for more information on who should sign Mitfora. Company: City of Round Rock Job Title: Name, prinf) : Phone: ( ) - Signature: Date: TCEQ-10400 (09/07) Page 2 of 2 TCEQ APPLICATION TO TRANSFER A WASTEWATER OR CAFO PERMIT If you have questions on how to fill out this form please contact the Applications Review and Processing Team at 5121239-4671. If you have questions about the Wastewater Permitting program, please contact the Wastewater Permitting Section at 5121239-4671. ;UBMISSION CHEC-1 SUB. INDICATE IF THE FOLLOWING ARE INCLUDED IN THE APPLICATION. ADDITIONAL BLANK SPACES PROVIDED FOR REFERENCING APPLICANT'S ATTACHMENTS TO THE APPLICATION. ATTACHMENTS Y N REQUIRED SIGNATURE PAGES COPY OF THE CHECK SUBMITTED FOR TRANSFER APPLICATION PROCESSING FEE CORE DATA FORM - required to complete the transfer application LEASE AGREEMENTS - if applicable PROOF OF OWNERSHIP - Required for CAFO Permits Application fees A check or money order for $100.00, made payable to the Texas Commission on Environmental Quality, must be sent under separate cover to: Texas Commission on Environmental Quality Revenues Section (MC 214) P.O. Box 13088 Austin, Texas 78711-3088 COPY OF THE CHECK MUST BE SUBMITTED AS PART OF THE APPLICATION For Commission Use Only Permit Number EPA ID No. County Region Expiration Date (TCEQ - 20031 10/2008) Application to Transfer a Wastewater/CAFO Penult Page 4 of 12 .. 1: APPLICANT GENERAL INFORMATION a. Facility owner City of Round Rock, City of Cedar Park & City of Austin Mailing address for use on the permit and permit correspondence: Street No. 212 Street name Commerce P.O. Box City Round Rock Telephone number (512) 671-2755 Email address: Street type Blvd OR State TX ZIP code 78664 Fax number: (512) 218-3242 Tax Identification Number issued by the State Comptroller Charter Number issued by the Texas Secretary of State Check one — The TCEQ has issued this Customer Reference Number to the owner CN 600407951, 600413181, 60013511 g The owner has not yet received a Customer Reference Number. A complete Core Data Form (TCEQ-1o1 listing the owner as the customer and this facility as the regulated entity is attached to this application. b. Co -Permittee information (complete only if the operator is required to apply as a co -permittee) Facility operator Street No. Street name Street type OR P.O. Box City State ZIP code Telephone number Fax number. Email address: Tax Identification Number issued by the State Comptroller Charter Number issued by the Texas Secretary of State Check one The TCEQ has issued this Customer Reference Number to the owner CN _ The owner has not yet received a Customer Reference Number. A complete Core Data Form (TCEQ-1049 listing the owner as the customer and this facility as the regulated entity is attached to this application. c. Individual information (complete only if the facility owner or co -permittee is an individual) Pursuant to the Texas Water Code 26.027(b), please supply the following information when the applicant is an individual Full Legal Name: First Middle Last ❑Male ❑Female State ID Number: Date of Birth Assumed business or professional name Home address: Street No. Street name Street type City State ZIP code Telephone number Email address: Check one 0 The TCEQ has issued this Customer Reference Number to the owner CN ❑ The owner has not yet received a Customer Reference Number. A complete Core Data Form (TCEQ-10400) listing the owner as the customer and this facility as the regulated entity is attached to this application. Page 5 of 12 (TCEQ - 20031 10/2008) Application to Transfer a Wastewater/CAFQ Permit 2 CONfACTINFORMATION wry....: :_' ;�_" a. Identify the person, including a complete mailing address, telephone number, and fax number, authorized to act for the applicant during the processing ofthe transfer application. The person identified will be the contact if additional informatin is needed during the transfer process. Name Jay Bragg Telephone number (254) 761-3135 Company Brazos River Authority Email jbragg@brazos.org Fax number (254) 761-3205 Street No. OR P.O. Box 7555 Street name Street type City Waco State TX ZIP code 76714-7555 b. Identify the person, including a complete mailing address, telephone number, and fax number, that can be contacted b jrhe agency as needed throughout the term of the permit. Name Jay Bragg Company Brazos River Authority Street No. Telephone number (254) 761-3135 Email jbragg@brazos.org Fax number (254) 761-305 Street name Street type OR P.O. Box 7555 City Waco State TX ZIP code 76714-7555 v cSn• „s•. .-t.:,. v -rr. rod. -_ is �it3 3. PERMIT��NFORMA�TI�N,. _ ... _. - _ ,_.t.......,.•s.�..,_7�.�ri.�,:�..�<.•- Permit No. WQ0010264002 EPA Identification No. TX 010194 77, u Expiration date 12-01-2009 Check one The TCEQ has issued this Regulated Entity Reference Number to the owner RN 100822600 0 No Regulated Entity Reference Number has been received for this facility. One or more completed Core Data Forms (TCEQ-10400) listing this facility as the regulated entity are attached. Check, if applicable (for POTWs only) 0 The permit to be transferred requires implementation of an approved pretreatment program by a POTW. (NOTE: The transferee must contact the Storm Water & Pretreatment Team staff before this application may be processed.) Check, if applicable (for domestic reclaimed water authorizations) >J There is a domestic reclaimed water authorization associated with this permit(NOTE: The domestic reclaimed water authorization associated with this permit will be transferred. If you do not want the domestic reclaimed water authorization transferred, please state this and the authorization will be cancelled on the same date the transfer took place.) 1�� _ �•i.. p:x; ;:i<<` �, SS i..,.3;b •.: ', 9-s,rt...:.� ''om '4 ��'. �CILIY-tFORMATiO - ,,yas,_� "=:'._. ........_.�.�i.�.u,.:�= :.,,r:`� ,.�. ...._4,. �..........�:.?:..-_ .: �. .. . , !r �+�� =r.e�>.,.y...^ �a., :....t. V�,`r,.... _..:..;''�'• ........ � .pie}_ .sof:;: ��:�i:��_�s'-�:?;,m?. a.,Plant Name Brushy Creek Regional Wastewater Treatment Facility (East, County in which the facility is located Williamson b. Owner of land where the facility is/will be City of Round Rock, City of Cedar Park, & City of Austin it not the same as the facility owner please see instructions an page 4) Street No. 212 Street name Commerce Street type Blvd OR P.O. Box City Round Rock State TX ZIP code 78664 c. Owner of effluent disposal site (11 not the corneas the facility owner please see Instructions on page 4) Street No. Street name Street type OR P.O. Box City State ZIP code (TCEQ - 20031 10/2008) Application to Transfer a Wastewater/CAFO Permit Page 6 of 12 l.ITACT=INFORMATION a. Identify the person, including a complete mailing address, telephone number, and fax number, authorized to act for the applicant during the processing ofthe transfer application. The person identified will be the contact if additional informatin is needed during the transfer process. Name JaY Bragg Telephone number (254) 761-3135 Company. Brazos River Authority Email jbragg@brazos.org Fax number (254) 761-3205 Street No. Street name Street type OR P.O Box 7555 City Waco State TX ZIP code 76714-7555 b. Identify the person, including a complete mailing address, telephone number, and fax number, that can be contacted b jhe agency as needed throughout the term of the permit. Name Jay Bragg Company Brazos River Authority Telephone number (254) 761-3135 Email ibragg@brazos.org Fax number (254) 761-305 Street No. Street name Street type OR P.O. Box 7555 City Waco IWRMItN,FORMaIO Permit No. WQ0010264002 State TX ZIP code 76714-7555 EPA Identification No. TX 010194 Expiration date 12-01-2009 Check one I% The TCEQ has issued this Regulated Entity Reference Number to the owner RN 100822600 0 No Regulated Entity Reference Number has been received for this facility. One or more completed Core Data Forms (TCEQ-10400) listing this facility as the regulated entity are attached. Check, if applicable (for POTWs only) 0 The permit to be transferred requires implementation of an approved pretreatment program by a POTW. (NOTE: The transferee must contact the Storm Water & Pretreatment Team staff before this application may be processed.) Check, if applicable (for domestic reclaimed water authorizations) ® There is a domestic reclaimed water authorization associated with this permit.(NOTE: The domestic reclaimed water authorization associated with this permit will be transferred. If you do not want the domestic reclaimed water authorization transferred, please state this and the authorization will be cancelled on the same date the transfer took place.) a..Plant Name Brushy Creek Regional Wastewater Treatment Facility County in which the facility is located Williamson b. Owner of land where the facility is/wili be City of Round Rock, City of Cedar Park, & City of Austin If not the same as the fadlity owner please see instructions on page 4) Street No. 212 Street name Commerce Street type Blvd OR P.O. Box City Round Rock State c. Owner of effluent disposal site TX ZIP code 78664 (If not the same as the faddy owner please see instructions on page 4) Street No. Street name Street type OR P.O. Box City State ZIP code (rCE1- 20031 10/2008) Application to Transfer a WastewaterlCAFO Permit Page 6 of 12 d. FOR CAFOs please provide one of the following: ❑ Warranty Deed ❑ Property Tax Records 0 Lease - includes authorization to use the land for the duration of the permit - owner of land must be co -permittee 0 Facility size indicated in proof of ownership: acres (should be the same as Wiat is authorized in the current permit) 5 The Date Transfer _ofOwnerst�p/operator Wwll Occur _ Date: Please note that the transfer will be processed once the change in ownership occurs. If the anticipated date of transfer of ownership changes, the transferee or the transferor must notify the Applications Review and Processing Team in writing, prior to the above given date. The transferee assumes complete responsibility of the permit once the permit transfer is issued, unless an executed agreement by the transferor and transferee is provided with the transfer application including payment of any outstanding annual fees. (TCEO - 20031 10/2008) Application to Transfer a Wastewater/CAFO Permit Page 8 of 12 %Rt 16 tStdnafur..elPageFfiter artsferee'(New, Ownerlandlor.Opefator) See Requlrehlenfs. on Page 4 offtie insirueUons") f. ;;F __ .; 1, t" Ct6 V) kte l 4W Title IUI acya (Printed or ty ed nna and tiQe i exe vee7ofttcer of lea$ le of vi president or equivalent) �1 fu/ �L L L4c� (Name of company) being duly sworn, depose and say: that a tiange of ownership of the facilityfor the subject permit has been issued will occuas indicated in the application. As a condition of the transfer, I do hereby declare that: The transferee will be the owner of the existing treatment faciljtfrom which wastewater is discharged, deposited or disposethr the facilities required to comply withthe permit will be constructed as described irthe application considered bythe TCEQ prior to the issuance of the permit. The transferee possesses a copy of the permit understands the terms and conditions therein, and does accept and assume all obligations of the permit. The transferee assumes financial responsibilityfor the proper maintenance and operation of all waste treatment andlisposal facilities required by the permit or which may be required to comply with the permit terms and conditions. The transferee certifies that the transfer is not made for the purpose of avoiding liability for improper actions carried out prior to the date of transfer. Neither is the transfer made for the purposeof transferring responsibility for improper operations to an insolvent etity. The transferee certifies under penalty of law that this documents, to the best of myknowledge and belief, true, accurate, and complete. 1 am aware there are significant penalties for submifting false information, including the possibility of fine and imprisonment for wn violations and revocation of this permit. Signature: Date: J(..10 NOTE: ALL APPLICATIONS MUST BEAR THE SIGNATURE AND SEAL OF NOTARY PUBLIC. SUBSCRIBED AND SWORN to before me by the said this kitille411 (q) My commission expires on the SARA L WHITE MY COMMISSION EXPIRES(vpl .Ally 11,2012 (Seat) 11'6 - it 1 p'Z1 W LUd wy- day of Np'm�-V- 1 Att. on day of t' 11 ti j , 2l Public vv" AtelimM(Vak 0-6 County, Texas `• Operator is required to sign only if operator is required to be a co -permittee. (TCEQ - 20031 10/2008) Application to Transfer a Wastewater/CAFO Permit Page 9 of 12 ....,... �.: .,, ., .. , . .." ., . .._..: r .:-..... • ,�. •- - -,� :, rte:- .: aw.Y .,,-... _ , . .� - • ..:xtt�- 7:: {Signature Page for.Trainsferor"(Current P.eri»ittee�. {See Requirements:on P._age 3 of the Ila } is ons) Owner of Permitted Facility 1, Title (Executive Principal Officer / Ranking Elected Official) consent to the transfer of the permit and I certify under penalty of law that this document and all attachments were prepared under my drection or supervision in accordance Wth a system designed to assurethat qualified personnel properly gather and evaluate the information submitted. Based on myinquiry of the person or persons who manage the system, or those persons directly responsible for gathering the information, the information submitted is, to the best of my knowledge and belief, true, accurate, and complete. I am aware there are significant penalties for submitting false information, including the possibilityof fine and imprisonment for knowing violations. !further certifythat 1 am authorized under 30 Texas Administrative Cod§305.44 to sign this document and can provide documentation in proof of such authorization upon request. Signature: Date: NOTE: ALL APPLICATIONS MUST BEAR THE SIGNATURE AND SEAL OF NOTARY PUBLIC. SUBSCRIBED AND SWORN to before me by the said on this day of My commission expires on the day of (Seal) Notary Public County, Texas Operator of Permitted Facility(Operator's signature is required only if the operator is co -permittee on the current. permit). I, Title: (Executive Pnneipal Officer / Ranking Elected Oficial) consent to the transfer of the permit and I certify under penalty of law that this document and alt attachments were prepared under my di-ection or supervision in accordance with a system designed to assurethat qualified personnel properly gather and evaluate the information submitted. Based on myinquiry of the person or persons who manage the system, or those persons directly responsible for gathering the information, the information submitted is, to the best of my knowledge and belief, true, accurate, and complete. I am aware there are significant penalties for submitting false information, including the possibilityof fine and imprisonment for knowing violations. I further certifythat 1 am authorized under 30 Texas Administrative Cod§305.44 to sign this document and can provide documentation in proof of such authorization upon request. Signature: Date: NOTE: ALL APPLICATIONS MUST BEAR THE SIGNATURE AND SEAL OF NOTARY PUBLIC. SUBSCRIBED AND SWORN to before me by the said on this day of My commission expires on the day of (Seal) Notary Public County, Texas (TCEQ - 20031 10/2008) Application to Transfer a Wastewater/CAFO Permit Page 10 of 12 8. THIS PAGE IS APPLICABLE TO PERMITS THAT INCLUDE COMPOSTING FACILITIES, LAND APPLICATION AND/OR DISPOSAL OF SEWAGE SLUDGE AND THE TRANSFEREE DOES NOT OWN THE LAND WHERE THE DISPOSAL ACTIVITY IS CONDUCTED. Site Operator 1, Title (Typed or Printed Name) understand that I am responsible for operating the site described in the legal description in accordance with the Texas Commission on Environmental Quality requirements in 30 TAC, taapter 332 and/or 312, the conditions set forth in the wit, and any additional conditions as required by the Texas Commission on Environmental Quality. I also certify under penalty of law that all information submitted is, to the best of my knowledge and belief, true, accurate, and complete. I am aware thatste are significant penalties for submitting false information, incl uding the possibility of fine, imprisonment for violations, and revocation of this permit. Signature: Date: NOTE: ALL APPLICATIONS MUST BEAR THE SIGNATURE AND SEAL OF NOTARY PUBLIC. SUBSCRIBED AND SWORN to before me by the said on this day of My commission expires on the day of (Seal) Notary Public County, Texas Complete Only If Landowner Is Not the Site Operator 1. Title (Typed or Printed Name) owner of the land described in the attached legal description,have all rights and covenants to authorize, the applicant for tis Permit, to use this site for the composting, disposal and /or land application Facility. I understand that 30 TAC, Chapter 332 and/or 312 requires me to make a reasonable effort to see that the applicant complies to the required operating conditions stated in the above paragraph. I also certify under penalty of lawltat all information submitted is, to the best of my knowlelle and belief, true, accurate, and complete. I am aware that there are significant penalties for submitting false information, including the possibility of fine, imprisonment for violations, and revocation of this permit. Signature: Date: NOTE: ALL APPLICATIONS MUST BEAR THE SIGNATURE AND SEAL OF NOTARY PUBLIC. SUBSCRIBED AND SWORN to before me by the said on this day of My commission expires on the day of (Seal) Notary Public County, Texas (TCEQ - 20031 10/2008) Application to Transfer a Wastewater/CAFO Permit Page 11 of 12 All Applicants Should Complete the Following Items 9_ Misceilaneousltems - a. Please provide the address for receiving self-reporting/DMR forms. Company Brazos River Authority Department Environmental Services Name Brazos River Authority Street No. Street Name Street Type OR P.O. Box 7555 city Waco State TX ZIP code 76714-7555 b. Please provide the address for receiving Annual Billing Invoices. Company Brazos River Authority Department Financial Services Name Brazos River Authority Street No. Street Name Street Type OR P.O. Box 7555 c. Delinquent Fees owed. City Waco Do you owe fees to the TCEQ? Yes ✓ No State TX ZIP code 76714-7555 If yes, please provide the amount past due, the type of fee, and an identifying number. d. Delinquent Penalties owed. Do you owe any penalties to the TCEQ? Yes ✓ No If yes, please provide the amount past due, the type of penalty, and an identifying. number. (TCEQ - 20031 10!2008) Application to Transfer a Wastewater/CAFO Permit Page 12of12