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CM-2025-054 - 3/7/2025 Application Fee Form Texas Commission on Environmental Quality Name of Proposed Regulated Entity: Town Green Regulated Entity Location: 100 W. Main St. Round Rock Texas, 78664 Name of Customer: City of Round Rock Contact Person: Phone: Customer Reference Number (if issued):CN CN600413181 Regulated Entity Reference Number (if issued):RN Austin Regional Office (3373) ❑ Hays ❑ Travis ® Williamson San Antonio Regional Office (3362) ❑ Bexar ❑ Medina ❑ Uvalde ❑ Comal ❑ Kinney Application fees must be paid by check, certified check, or money order, payable to the Texas Commission on Environmental Quality. Your canceled check will serve as your receipt. This form must be submitted with your fee payment. This payment is being submitted to: ® Austin Regional Office ❑ San Antonio Regional Office ❑ Mailed to:TCEQ- Cashier ❑ Overnight Delivery to:TCEQ- Cashier Revenues Section 12100 Park 35 Circle Mail Code 214 Building A, 3rd Floor P.O. Box 13088 Austin, TX 78753 Austin,TX 78711-3088 (512)239-0357 Site Location (Check All That Apply): Recharge Zone ❑ Contributing Zone ❑Transition Zone Type of Plan Size Fee Due Water Pollution Abatement Plan, Contributing Zone Plan: One Single Family Residential Dwelling Acres $ Water Pollution Abatement Plan, Contributing Zone Plan: Multiple Single Family Residential and Parks Acres $ Water Pollution Abatement Plan, Contributing Zone Plan: Non-residential 2.26 Acres $ 4,000.00 Sewage Collection System L.F. $ Lift Stations without sewer lines Acres $ Underground or Aboveground Storage Tank Facility Tanks $ Piping System(s)(only) Each $ Exception Each $ Extension of Time Each $ ''�Signature: .�� Date: - Ll / 209 6 `> 1 oft 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 Project Area in 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 >_ 100 $10,000 Organized Sewage Collection Systems and Modifications Cost per Linear Minimum Fee- Project Foot Maximum Fee Sewage Collection Systems $0.50 $650 - $6,500 Underground and Aboveground Storage Tank System Facility Plans and Modifications Cost per Tank or Minimum Fee- Project Piping System Maximum Fee Underground and Aboveground Storage Tank Facility $650 $650- $6,500 Exception Requests Project Fee Exception Request $500 Extension of Time Requests Project Fee Extension of Time Request $150 2 of 2 TCEQ-0574 (Rev. 02-24-15) Agent Authorization Form For Required Signature Edwards Aquifer Protection Program Relating to 30 TAC Chapter 213 Effective June 1, 1999 Brooks eerintil- Print Name Cr.4 MG.r1CC. tr Title - Owner/President/Other of City of Round Rock Corporation/Partnership/Entity Name have authorized Antonio A. Prete, P.E. Print Name of Agent/Engineer of Waeltz & Prete, Inc. 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. TCEQ-0599(Rev.04101/2010) Page 1 of 2 SIGNATURE PAGE: ©3v 7/Z5 pplicant's Signature Date THE STATE OF Texas § County of Williamson § BEFORE ME, the undersigned authority, on this day personally appeared frO n known to me to be the person whose name is subscribed to the foregoing instrument, and acknowledged to me that (s)he executed same for the purpose and consideration therein expressed. GIVEN under my hand and seal of office on this Z''day of `-HIV 1 /WM 4)4 MONIQUEADAMS OTARY PU IC .: '4 My Notary ID#126257913 ,�r ° � Expires March 22, b/V laGte- yped or Printed Name of Notary 312-7(2 MY COMMISSION EXPIRES: TCEQ-0599(Rev.04/01/2010) Page 2 of 2