CM-06-09-173Notice Intent for Storm
Water
Construction
General Permit
TCEQ Office Use Only
TPDES Permit Number: TXR15I—I—I—I—I
GIN Number: I I I I I I I I
Fee Receipt No.
of (NOI)
r Discharges Associated with
111111. Activity under the TPDES
KEG
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 8100 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): CN600413181
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.Bldg.No.:
City: ROUND ROCK
State: TX
ZIP Code: 78664
4. Phone No.: ( 512 ) 218-6605
Extension:
5. FAX No. (512) 218-5563
E-mail Address: rhaberman@round-rock.tx.us
Partnership
State Government
Other:
6. Type of Operator: ■ Individual ■ Sole Proprietorship-D.B.A. ■
Corporation ■ Federal Govemment ■
N County Government ® City Government R
(If governmental entity or a subsidiary or part of a larger corporation, check "NO")
7. Independent Operator: ■ Yes 13 No
higher
8. Number of Employees: ■ 0-20; ■ 21-100; IN 101-250;
■ 251-500; or 0 501 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: Federal Tax ID:
TX SOS Charter (filing) Number: DUNS Number: (If known)
B. BILLING ADDRESS (The Operator is responsible for paying the annual fee.)
with Section C.)
17 Same As Operator (check if address is the same, then proceed
1. Billing Mailing Address: Suite No.Bldg.No.:
City:
State:
ZIP Code:
2. Billing Contact (Attn or C/O):
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)
0 -rel- 04-09-05
Page 1 of 3
C., APPLICATION CONTACT (If TCEQ needs additional information regarding this application, who should be contacted?
1. Name: RUTH HABERMAN, P.E. Title: ENGINEER Company: CITY OF ROUND ROCK
2. Phone No.: ( 512 ) 218-6605
Extension:
3. FAX No. (512) 218-5563
E-mail Address: rhaberman@round-rock.bc.us
D. REGULATED ENTITY (RE) INFORMATION ON PROJECT OR SITE
1. TCEQ Issued RE Reference Number (RN) (if available): N/A
2. Name of Projector Site: SOUTH CREEK CHANNEL IMPROVEMENTS
3. Physical Address of Project or Site: (enter in spaces below)
Street Number: N/A
Street Name: N/A
City (nearest to the site):
N/A
ZIP Code (nearest to the site):
N/A
County (Counties if>1):
N/A
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)
DRY BRANCH TRIBUTARY DOWNSTREAM OF GATTIS SCHOOL ROAD
5. Latitude: 30` 29' 46" N Longitude: -97D 39 ' 4 " W
6. Standard Industrial Classification (SIC) code: 1629
7. Describe the activity related to the need for this authorization at this site (do not repeat the SIC and NAICS code):
CHANNEL IMPROVEMENTS
8. Is the project/site located on Indian Country Lands? ■ Yes t7 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.)
J Same As Operator (check if address is the same, then
Mailing Address: Suite No./Bldg.No.:
City:
State:
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? Lt Yes ■ No
the time the NOI is submitted to TCEQ.
2. Provide the estimated area of land disturbed (to the nearest acre): 19 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 DRY BRANCH TRIB
TCEQ-20022 (07/12/2004)
Page 2 of 3
G. CERTIFICATION
OjcumeKlused
Typed or printed name
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 such thorization upon request.
Signature:
TCEQ-20022 (07/12/2004)
Iue I,*)
Date: ` II 1 a0C40
Page 3 of 3
DATE:
SUBJECT:
ITEM:
August 28, 2006
City Manager Approval - September 1, 2006
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 South Creek Channel Improvements project.
Department:
Staff Person:
Justification:
Engineering & Development Services
Ruth Haberman, P.E.
Espey Consultants, Inc. has prepared a Stormwater Pollution Prevention Plan
(SWPPP) for the South Creek Channel 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: Espey Consultants, Inc.
Background Information:
The Dry Branch Tributary No. 1 channel traversing through South Creek
subdivision is difficult to maintain and is critical for carrying flood waters
safely through the subdivision. This same channel is experiencing
stabilization problems near its intersection with Gattis School Road. Also,
there have been flooding problems in the Greenslopes Subdivision west of
Dry Branch Tributary No. 1 near the intersection of Greenlawn Blvd. and
Parkside Circle. This project will improve the channel and increase the
channel capacity and improve the appearance and maintainability of Dry
Branch Tributary No.1.
Public Comment: N/A