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CM-06-01-013DATE: January 24, 2006 SUBJECT: City Manager Approval - January 27, 2006 ITEM: Consider an action by the City Manager to sign a Notice of Intent (NOI) for Storm Water Discharges Associated with Construction Activity under the TPDES General Permit for the Old Settlers Park Baseball Fields Drainage and Parking Lot Improvements project. Department: Engineering & Development Services Staff Person: Ruth Haberman, P.E. Justification: Baker-Aicklen & Associates has prepared a Stormwater Pollution Prevention Plan (SWPPP) for the Old Settlers Park Baseball Fields Drainage and Parking Lot Improvements project. A Notice of Intent, signed by the City Manager, and the SWPPP for the project must be submitted to the Texas Commission on Environmental Quality (TCEQ) prior to any activity beginning on the project. The NOI is required because the City will be disturbing greater than five acres during the construction of this project. Funding: Cost: -0- Source of funds; N/A Outside Resources: Baker-Aicklen & Associates, Inc. Background Information: The Project: Sports Capital of Texas Plan was developed last year to plan for the necessary upgrades to our existing sports complexes, at Old Settlers Park at Palm Valley, to make them top notch recreational and tournament facilities. As part of the Project, Sports Capital of Texas Plan, drainage throughout the OSPV Baseball Complex will be improved to allow increased playability on the fields after rain. This project also provides increased parking and upgrades for Fields 1-4. Public Comment: N/A TCEQ-20022 (07/12/2004) 0_,m®0(i)-01- O1? Page 1 of 3 Notice of Intent (NOI) for Storm Water INF- ' Discharges Associated with Construction g 111110 Activity under the TPDES General Permit TCEQ Office Use Only TPDES Permit Number: TXR15--I-1-1 GIN Number: 1 1 I II 11 I Fee Receipt No. TCEQ IMPORTANT: •Use the attached INSTRUCTIONS when completing this form. •After completing this form, use the attached CUSTOMER CHECKLIST to make certain all items are complete and accurate. •Missing, illegible, or inaccurate items may delay final acknowledgment or coverage under the general permit. Application Fee: You must submit the $100 NOI Application Fee to TCEQ under separate cover (see instructions) using the attached Application Fee submittal form. (DO NOT SEND A COPY OF THE NOI WITH THE APPLICATION FEE SUBMITTAL FORM) Tell us how you paid for this fee: Check/Money Order No.: Name Printed on Check: A. OPERATOR 1. TCEQ Issued Customer Number (CN) (if available): CN 600413181 2. Legal Name (spelled exactly as filed with the Texas Secretary of State, County, or legal document that was used in forming the entity): City of Round Rock 3. Mailing Address: 221 East Main Street Suite No./Bldg.No.: City: Round Rock State: TX ZIP Code: 78664 4. Phone No.: ( 512 ) 218-5555 Extension: 5. FAX No. 512- 218-5563 E-mail Address: 6. Type of Operator: * Individual Corporation County Government Sole Proprietorship-D.B.A. Federal Government City Government * Partnership State Government * Other: 7. Independent Operator: Yes No (If governmental entity or a subsidiary or part of a larger corporation, check "NO") 8. Number of Employees: 0-20; II 21-100; 101-250; 251-500; or 501 or higher 9. Business Tax and Filing Numbers (not applicable to Individuals, Government, General Partnerships, and Sole Proprietorship-D.B.A): State Franchise Tax ID Number: N/A Federal Tax ID: N/A TX SOS Charter (filing) Number: N/A DUNS Number: N/A (If known) B. BILLING ADDRESS (The Operator is responsible for paying the annual fee.) 12 Same As Operator (check if address is the same, then proceed with Section C.) 1. Billing Mailing Address: Suite No./Bldg.No.: City: State: ZIP Code: 2. Billing Contact (Attn or C/0): 3. Country Mailing Information (if outside USA) Territory: Country Code: Postal Code: 4. Phone No.: ( ) - Extension: 5. FAX No. E-mail Address: �n. TCEQ-20022 (07/12/2004) 0_,m®0(i)-01- O1? Page 1 of 3 C. APPLICATION CONTACT (If TCEQ needs additional information regarding this application, who should be contacted? 1. Name: Antonio A. Prete, P.E. Title: Professional Engineer Company: Baker-Aicklen & Associates, Inc. 2. Phone No.: ( 512 ) 244-9620 Extension: 420 3. FAX No. 512-244-9623 E-mail Address: aprete@b-ainc.com kt$ 6 'z`$ -.1 `#L$ € iS 53e'". �t�:-d t ` •- '�••a 433 i -t c € D. REGULATED ENTITY (RE) INFORMATION ON PROJECT OR SITE 1. TCEQ Issued RE Reference Number (RN) (if available): 2. Name of Project or Site: Old Settlers Park Baseball Fields Drainage Improvements and Parking Lot Improvements 3. Physical Address of Project or Site: (enter in spaces below) Street Number: 3300 Street Name: Palm Valley Blvd. City (nearest to the site): Round Rock ZIP Code (nearest to the site): Texas County (Counties if >1): Williamson County 4. If no physical address (Street Number & Street Name), provide a written location access description that can be used for locating the site: (Ex.: 2 miles west from intersection of Hwy 290 & IH35 on Hwy 290 South) 5. Latitude: 30.524285 N Longitude: 97.634084 W 6. Standard Industrial Classification (SIC) code: 9999 7. Describe the activity related to the need for this authorization at this site (do not repeat the SIC and NAICS code): Construction of one asphalt parking lot w/ granite plaza area, conc. slabs, conc. s/w, stormsewer grading & drng. improvemer 8. Is the project/site located on Indian Country Lands? Yes No If Yes, you must obtain authorization through EPA, Region VI. E. SITE MAILING ADDRESS (address for receiving mail at the site) with Section F.) F4 Same As Operator (check if address is the same, then proceed Mailing Address: Suite No./Bldg.No.: City: State: ZIP Code: '�FI£td F. GENERAL CHARACTERISTICS 1. Has a Pollution Prevention Plan been prepared as required If No, coverage may be denied as the PPP is required at in the general permit? Yes * No the time the NOI is submitted to TCEQ. 2. Provide the estimated area of land disturbed (to the nearest acre): 19.9 Acres 3. Provide the name of the receiving water body (local stream, lake, drainage ditch), MS4 Operator (if applicable) and the segment number where storm water runoff will flow from the construction site. MS4 Operator: N/A Receiving Water Body: Chandler Creek Segment: 1244 TCEQ-20022 (07/12/2004) Page 2 of 3 G. CERTIFICATION Mr. Jim Nuse, P.E. Typed or printed name City Manager Title (Required) certify under penalty of law that this document and all attachments were prepared under my direction or supervision in accordance with a system designed to assure that qualified personnel properly gather and evaluate the information submitted. Based on my inquiry 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 andbelief, true, accurate, and complete. I am aware there are significant penalties for submitting false information, including the possibility of fine and imprisonment for knowing violations. I further certify that I am authorized under 30 Texas Administrative Code §305.44 to sign and submit this document, and canprovide documentation in proof of such authorization upon request. . � Signature: 4 (Use Blue Ink) Date: - 0 Ci TCEQ-20022 (07/12/2004) Page 3 of 3 Texas Commission on Environmental Quality General Permit Payment Submittal Form Use this form to submit your Application Fee. •Complete items 1 through 4 below: •Staple your check in the space provided at the bottom of this document. •Do not mail this form with your NOI form. •Do not mail this form to the same address as your NOI. Instead, mail this form and your check to: BY REGULAR U.S. MAIL BY OVERNIGHT/EXPRESS MAIL Texas Commission on Environmental Quality Texas Commission on Environmental Quality Financial Administration Division Financial Administration Division Cashier's Office, MC -214 Cashier's Office, MC -214 P.O. Box 13088 12100 Park 35 Circle Austin, TX 78711-3088 Austin, TX 78753 To confirm receipt of payment, call the Cashier's office at 512/239- 0357 or 239-0187. Fee Code: GPA General Permit: TXR150000 1. Check / Money Order No: 2. Amount of Check/Money Order: 3. Date of Check or Money Order: 4. Name on Check or Money Order: 5. NOI INFORMATION If the check is for more than one NOI, list each Project/Site (RE) Name and Physical Address exactly as provided on the NOI. DO NOT SUBMIT A COPY OF THE NOI WITH THIS FORM AS IT COULD CAUSE DUPLICATE PERMIT ENTRIES. space is needed, you may attach a list.) ■ See Attached List of Sites (If more Project/Site (RE) Name: Project/Site (RE) Physical Address: Staple Check In This Space TCEQ-20134 (07/12/2004) Page 1 of 1 CONTRACTOR/SUBCONTRACTOR CERTIFICATION I certify under penalty of law that I understand the terms and conditions of the general Texas Pollutant Discharge Elimination System (TPDES) permit that authorized the storm water discharges associated with activity from the construction site identified at the beginning of this document and as noted hereon and that I have read the attached TPDES General Permit TXR 150000. Signatures/Dates: Printed Name ca4 Title Date: iign)ture J 0,61 eS 1� ( V S City of Round Rock Owner Company/Firm RESPONSIBLE FOR: H. Deck Construction Co. General Contractor Operational Control over the Development of the Construction Plans & Specifications, and Day -to -Day Operational Control Printed Name e(4 r Yl cur) taxi er Title Date: I -27 - ©Ge Signature Printed Name Title Date: TNRCC-10258 (5/01/02) Request for City Council/City Manager Action City Council l01 City Manager Submit completed form for AL Department Name: Contact Person: Project Manager/Resource: Project Coordinator: Assigned Attorney: City Manager and City Council approvals. Engineering & Development Services Laths Kumar/Tiffany Calley Ruth Haberman, P.E. Council or City Manager ApprovallAgenda Date: 1/27/2006 Blue Sheet Wording For Administration Use ONLY WI- -6I DI Tag #: Documents: Scan Date: Return to: Ric Bowden Old Settlers Park Baseball Fields Drainage Project Name: and Parking Lot Improvements project ContractorNendor: H. Deck Construction, Inc. Funding Source: N/A Amount N/A Consider an action by the City Manager to sign a Notice of Intent (NOI) for Storm Water Discharges Associated with Construction Activity under the TPDES General Permit for the Old Settlers Park Baseball Fields Drainage and Parking Lot Improvements project. Finance Information Is Funding Required? Finance Approval Finance Finance Purchasing E-JBudget Yes I©1 No Initial Construction Contract Construction Contract Amendment Change Order Change in Quantity Unforeseen Circumstances Initial Professional Services Agreement Supplemental Professional Svcs. Agr. # Purchasing/Service Agreement Purchase Order Item(s) to be purchased: Amount Other (Please clearly identify action on lines below) li✓ai>Ce C+ Tr+ia►.* N%A Date Date Date Date For Submission to ALL Project Mgr. Signature: Dept. Director Signature*: City Attorney Signature*: City Manager Signature: City Council and City Manager Action Items Date: f P,E Date: Updated 6-9-05 Request for City Council/City Manager Action City Council v City Manager For Administration Use ONLY . Tag #: Documents: Scan Date: Return to: Department Name: Contact Person: Engineering & Development Services Latha Kumar/Tiffany Calley Project Manager/Resource: Project Coordinator: Assigned Attorney: Blue Sheet Wording Ruth Haberman, P.E. 1/27/2006 Ric Bowden Old Settlers Park Baseball Fields Drainage Project Name: and Parking Lot Improvements project ContractorNendor: H. Deck Construction, Inc. Funding Source: N/A Amount: N/A Consider an action by the City Manager to sign a Notice of Intent (NOI) for Storm Water Discharges Associated with Construction Activity under the TPDES General Permit for the Old Settlers Park Baseball Fields Drainage and Parking Lot Improvements project. Finance Information Is Funding Required? xxx Finance Approval x❑Finance ElFinance EJPurchasing Budget Yes No Initial Construction Contract Construction Contract Amendment # Change Order # Change in Quantity Unforeseen Circumstances Initial Professional Services Agreement Supplemental Professional Svcs. Agr. # Purchasing/Service Agreement Purchase Order Item(s) to be purchased: Amount Other (Please clearly identify action on lines below) N/A Notice of Intent L. Olsen N/A HB N/A - Robbie Date 1/25/2006 Date Date 1/25/2006 Date 1/25/2006 Project Mgr. Signature: 0.1€10 City Manager Signature: Date: Date: Date: Date: Updated 6-9-05