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CM-06-01-014DATE: 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 Kiphen Road Phase II project. Department: Transportation Services Staff Person: Thomas G. Martin, P.E., Director of Transportation Services Justification: Chaing, Patel, & Yerby, Inc., has prepared a Stormwater Pollution Prevention Plan (SWPPP) for the Kiphen Road Phase II 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: Source of funds: N/A Outside Resources: Chaing, Patel & Yerby, Inc. Background Information: Due to state regulatory mandates the NOI must be submitted prior to construction. We are compliance with state regulations. A notice to proceed will be issued once the NOI is approved. Public Comment: N/A Notice Intent (NOI) for Storm Water Construction General Permit TCEQ Office Use Only TPDES Permit Number: TXR151-1-1-1-1 GIN Number: 1 1 1 I 1 1 I 1 Fee Receipt No. of Discharges Associated with IIIIIIIN Activity under the TPDES E1 td 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 I. TCEQ Issued Customer Number (CN) (if available): 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: 2008 ENTERPRISE DRIVE Suite No.B1dg.No.: City: ROUND ROCK State: TX ZIP Code: 78664 4. Phone No.: ( 512 ) 218 -5555 Extension: 5. FAX No. 512-218-7097 E-mail Address: bstablein@round-rock.tX.us 6. Type of Operator: Individual ®Sole Proprietorship-D.B.A. M Corporation II Federal Government li County Government ] City Government Ir Partnership State Government Other: (If governmental entity or a subsidiary or part of a larger corporation, check "NO") 7. Independent Operator: ® Yes a No higher 8. Number of Employees: 0 0-20; 21-100; 0101-250; Il 251-500; or II 501 or 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: 26-001074 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.) []✓ Same As Operator (check if address is the same, then proceed with Section C.) 1. Billing Mailing Address: Suite No.BIdg.No.: City: State: ZIP Code: 2. Billing Contact (Attn or CIO): 3. Country Mailing Information (if outside USA) Territory: Country Code: Postal Code: 4. Phone No.: ( ) - Extension: 5. FAX No. E-mail Address: TCEQ-20022 (07/12/2004) urn-oL0-01-0/4-- Page 1 of 3 C. APPLICATION CONTACT (If TCEQ needs additional information regarding this application, who should be contacted? 1. Name: JESSE PENN Title: PROJECT ENGINEER Company: CPY, INC. 2. Phone No.: ( 512 ) 349 - 0700 Extension: 3. FAX No. 512 - 349-0727 E-mail Address: jpenn@cpylcom D. REGULATED ENTITY (RE) INFORMATION ON PROJECT OR SITE 1. TCEQ Issued RE Reference Number (RN) (if available): 2. Name of Project or Site: KIPHEN ROAD PHASE 11 IMPROVEMENTS 3. Physical Address of Project or Site: (enter in spaces below) Street Number: Street Name: KIPHEN ROAD City (nearest to the site): ROUND ROCK ZIP Code (nearest to the site): 78664 County (Counties if >1): WILLIAMSON 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 & 11135 on Hwy 290 South) 1/2 MILE EAST OF FM 1460 ON KIPHEN ROAD 5. Latitude: 30°32'48" N Longitude: 097°38'23" W 6. Standard Industrial Classification (SIC) code: 1623 7. Describe the activity related to the need for this authorization at this site (do not repeat the SIC and NAICS code): STREET IMPROVEMENTS 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) proceed with Section F.) al Same As Operator (check if uJdress is the same, then Mailing Address: Suite No.BIdg.No.: City: I State: I ZIP Code: 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? U Yes • No the time the NOI is submitted to TCEQ. 2. Provide the estimated area of land disturbed (to the nearest acre): 27 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: CITY OF ROUND ROCK Receiving Water Body: BRUSHY CREEK Segment: (1244) TCEQ-20022 (07/12/2004) Page 2 of 3 CER I1NICATION JAMES R. NUSE 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 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 knowing violations. I further certify that I am authorized under 30 Texas Administrative Code §305.44 to sign and submit this document, and can provide documentation in proof of sgch authorization upon request. Signature; (Use Blue Ink) Date: )-a`1-o0 TCEQ-20022 (07/12/2004) Page 3 of 3 Request for City Council/City Mani 61) Ip 1 City Council Er5-1 City Manager '0 For Administration Use ONLY CTh-®i -&l - 014" Tag #: Documents: Submit C0/11_,n for ALL City Manager and City Council approvals. Scan Date: Return to: Ric Bowden Department Name: Transportation Services Project Name: Kiphen Road Phase 11 Contact Person: Cindy Fronk (CM ONLY)/Latha Kumar ContractorNendor: TCEQ Project Manager/Resource: Bill Stabiein Funding Source: Project Coordinator: Thomas G. Martin, P.E., Director of Transportation Amount Eo.00 Assigned Attorney: Barbara Bouleware-Wells Council or City Manager Approval/Agenda Date: 1/27/2006 Blue Sheet Wording 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 Kiphen Road Phase 11 project. Finance Information Is Funding Required? Yes0 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 ltem(s) to be purchased: Amount pXX)00000( Other (Please clearly identify action on lines below) NOl for Storm Water Discharges associated with construction Kiphen Rd Ph Finance Approval Finance ®Finance ®Purchasing ®Budget L. Olsen N/A HB N/A Robbie Date Date Date Date 1/25/2006 1/25/2006 1/25/2006 For Submission to ALL CitLCouncil and City Manager Action Items `tt'S't Project Mgr. Signature: Dept. Director Signature*: City Attorney Signature*: City Manager Signature: B ablein Date: 1/24/2006 Thom G. Martin P.E., Director of TS Date: Date: / Date: I -21-©(p 1/24/2006 * Dept Director and Lege Approval and Is required for ALL items requesting Clay Manager/City Council approval. Updated 6-9-05 -ROUND ROCK, TEXAS PURPOSE. PASSION. PROSPERITY. CITY OF ROUND ROCK INTEROFFICE MEMORANDUM DATE: January 25, 2006 TO: Steve Sheets City Attorney FROM: Thomas G. Martin, P.E. / Transportation Services Director RE: Request for City Manager Action — Kiphen Road Phase II: TCEQ NOI Attached please find the Notice of Intent (NOI) for Storm Water Discharges Associated with Construction Activity forms for City Manager signature. As well, a City Manager action request blue sheet and Finance approval action form are attached for approval. We would like to have these items approved as soon as possible. If there are any problems with this item or you have any questions, please contact either Bill Stablein or me at 218-5562. cc: Bill Stablein, Project Manager Project File Public Works Department