CM-06-09-185Notice of Intent (NOI) for Storm
Water
Construction
General Permit
TCEQ Office Use Only
TPDES Permit Number: TXR15I—I—I—I—I
GIN Number: I 1 1 1 1 1 1 1
Fee Receipt No.
Discharges Associated with
Activity under the TPDES
la
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): 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.B1dg.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 Government •
• County Government 0 City Government ■
(If govenunental entity or a subsidiary or part of a larger corporation, check "NO")
7. Independent Operator: • Yes 0 No
higher
8. Number of Employees: • 0-20; ■ 21-100; ■ 101-250;
■ 251-500; or U 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.)
IS Same As Operator (check if address is the same, then proceed
1. Billing Mailing Address: Suite No.B1dg.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)
e -occ cif.
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.tx.us
D. REGULATED ENTITY (RE) INFORMATION ON PROJECT OR SITE
1. TCEQ Issued RE Reference Number (RN) (if available):
2. Name of Project or Site: SOUTHWEST DOWNTOWN DISTRICT INFRASTRUCTURE IMPROVEMENTS — /-y43e- /,4
3. Physical Address of Project or Site: (enter in spaces below)
Street Number:
Street Name:
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 & IH35 on Hwy 290 South)
5. Latitude: 30.5078 N Longitude: -97.6796 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):
DRAINAGE PROJECT CONSTRUCTION - GENERAL CONTRACTORS
8. Is the project/site located on Indian Country Lands? ■ Yes 0 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.)
Fi Same As Operator (check if address is the same, then
Mailing Address: Suite No.B1dg.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? 0 Yes • No
the time the NOI is submitted to TCEQ.
2. Provide the estimated area of land disturbed (to the nearest acre): 4.6 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: Lake Creek Segment: 1244
TCEQ-20022 (07/12/2004)
Page 2 of 3
CERTIFICATION
1, (Ames I€. NUSE, Pe.
C'or'y mRaiPa-62
Typed or printed name 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 • f such authorization upon request.
Signature.•'
(Use Blue Ink)
Date: 9-a-oe.0
TCEQ-20022 (07/12/2004)
Page 3 of 3
DATE: September 15, 2006
SUBJECT: City Manager Approval - September 22, 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 Southwest Downtown District Infrastructure
Improvements Project - Phase 1A.
Department: Engineering & Development Services
Staff Person: Ruth Haberman, P.E.
Justification:
Page Southerland Page, LP has prepared a Stormwater Pollution Prevention
Plan (SWPPP) for the Southwest Downtown District Infrastructure
Improvements Project - Phase 1A. 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 although the City will be
disturbing less than five acres during the construction of this project, the
project is a part of a greater plan of development.
Funding:
Cost: -0-
Source of funds: N/A
Outside Resources: Page Southerland Page, LP
Chasco Contracting
Background Information:
The Southwest Downtown District project will provide critical infrastructure
improvements to the streets bound by Lake Creek, Round Rock Avenue,
North Mays Street, McNeil Road and IH -35 on the west side. Improvements
include the construction of streets, sidewalks, a regional water quality pond,
water and wastewater utilities, underground dry utilities, and storm drainage
improvements for the area.
Public Comment: N/A