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CM-07-05-093TCEQ-20022 (12/01/2006) Mk -DI -06 - ('.i Page 1 I.' Notice of Intent (NOI) for Storm Water TCEQ Office Use Only MIEN ' Discharges Associated with Construction PertnitN°': Activity under TPDES General Permit CN: TICK) (TXR150000) Sign up now for on line NOI at bttp://www.tceq.state.tx.us/permitting/steers/steers.html Get Instant Approval Did you know you can pay on line? Go to https://www6.tceq.state.tx.us/epay/ Select Fee Type: GENERAL PERMIT CONSTRUCTION STORM WATER DISCHARGE NOI APPLICATION Application Fee: You must pay the $100 Application Fee to TCEQ for the application to be considered complete. How did you pay this fee? Mailed: Check/Money Order No.: Name Printed on Check: EPAY: Voucher No.: Is the Payment Voucher copy attached? Yes 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. •Missm ille ble or inaccurate items may delay final acknowledgment or coverage under the general permit. I. If the applicant is currently a customer with TCEQ, what is the Customer Number (CN) issued to this entity? CN 2. What is the full Legal Name of the applicant? CITY OF ROUND ROCK (The legal name must be spelled exactly as filed with the Texas Secretary of State, County, or in the legal document forming the entity.) 3. What is the applicant's mailing address as recognized by the US Postal Service? Address: 221 E. MAIN STREET Suite No./Bldg. No./Mail Code: City: ROUND ROCK State: TEXAS ZIP Code: 78664 Country Mailing Information (if outside USA). Country Code: Postal Code: 4. Phone No.: ( 512) 2185410 Extension: 5. Fax No.: ( ) E-mail Address: 6. Indicate the type of Customer: Individual Corporation State Government Other: 1 • • Sole Proprietorship-D.B.A. Federal Government County Government • • • Limited Partnership General Partnership City Government 7. Independent Operator: Yes No R (If governmental entity, subsidiary, or part of a larger corporation, check "No".) S. Number of Employees: ® 0-20; 21-100; 0101-250; l 251-500; or N 501 or higher 9. Customer Business Tax and Filing Numbers (This item is not applicable to Individuals, Government, GP or Sole Proprietor.) REQUIRED for Corporations and Limited Partnerships State Franchise Tax ID Number: Federal Tax ID: TX SOS Charter (filing) Number: DUNS Number (if known): TheOperator is responsiblepaying on forthe annual fee. The annual fee will be assessed to permits active on September 1 of each year. TCEQ will send a a l bill to the address provided in this section. The Operator is responsible for terminating the permit when it is no longer needed. Is the billing address same as the Operator Address? Yes, go to Section C. • No, fill out Section B 1. Billing Mailing Address: Suite No./Bldg. No./Mail Code: City: State: ZIP Code: 2. Country Mailing Information (if outside USA). Territory: Country Code: Postal Code: 3. Billing Contact (Attn or C/O): 4. Phone No.: ( ) Extension: 5. Fax No.: ( ) E-mail Address: TCEQ-20022 (12/01/2006) Mk -DI -06 - ('.i Page 1 TCEQ-20022 (12/01/2006) Page 2 If TCEQ needs additional information regarding this application, who should be contacted? 1. Name: MISTI SHAFER Title: SWP3 MANAGER Company: COMPLIANCE RESOURCES, INC. 2. Phone No.: ( 512 ) 9307733 Extension: 231 3. Fax No.: 512 8647629 E-mail Address: MISTI@COMPLIANCERESOURCESINC.COM a.4s'�t� %ggpas , .s r ax23 &-y 1. TCEQ Issued RE Reference Number (RN) (if available): 2. Name of Project or Site (the name as known by the community where this facility/project is located): EAST WATER TRANSMISSION LINE, PHASE 3B-1 (example: phase and name of subdivision or name of project that's unique to the site) 3. Physical Address of Project or Site: (enter in spaces below) Street Number: N/A Street Name: NAA City: ROUND ROCK ZIP Code: 78664 County (Counties if>1): WILLIAMSON 4. If no physical address (Street Number & Street Name), provide a written location access description to the site: (Ex.: phase 1 of Woodland subdivision located 2 miles west from intersection of Hwy 290 & IH35 accessible on Hwy 290 South) NORTHEAST OF THE INTERSECTION OF FM 1460 AND KIPHEN ROAD 5. Latitude: 30` 33' 20" N Longitude: 097" 38' 43" W 6. What is the primary business of this entity? In your own words, briefly describe the primary business of the Regulated Entity: (Do not repeat the SIC and NAICS code) 7. What is the mailing address and contact information for the regulated entity? Is the RE mailing address the same as the Operator? fl Yes, address is the same as Operator No, provide the address Street Number: Street Name: City: State ZIP Code: .:d.-,xa _. .�4�s�ssz'.*r... »L .tM _vti�3$S}�,F�" .�t .�..i. a:.. � �`bk bd, :e 1. I certify that the project/site is not located on Indian Country Lands? If No, you must obtain authorization through EPA, Region VI. ��r��. �✓r, .N� ii 'Sr""� A 4 tiS i :2&� � � 4 e�' � X�9 �.aF1 ��T�»t Yes ® No 2. Is this NOI being submitted due to a change in Operator? ® Yes fl No 3. What is the Standard Industrial Classification (SIC) code (see instructions for common codes): Primary: 1 623 Secondary: 4. What is the total number of acres disturbed? Is the project site part of a larger common plan of development or sale? If Yes, the total number of acres disturbed can be less than 5 acres. If No, the total number of acres disturbed must be 5 or more. If the total coverage through this Notice of Intent. Coverage will be denied. See $ Yes No 20 ACRES number of acres disturbed is less than 5 then the project site does not qualify for the requirements in the general permit for small construction sites. 5. Discharge Information a What is the name of the first water body to receive the storm water runoff or potential runoff from the site? Chandler Branch and McNutt Creek b. What is the segment number(s) of the classified water body(s) that the discharge or potential discharge will eventually reach? N/A c. Is the discharge into an MS4? Yes • No ROCK MS4 Operator. If Yes, what is the name of the MS4 Operator? CITY OF ROUND Note: The general permit requires you to send a copy of the NOI to the 6. Is the discharge or potential discharge within the Recharge Zone, Contributing Zone, or Contributing Zone within the Transition Zone Plan required by the Edwards Aquifer Rule (30 TAC Chapter 213) must of the Edwards Aquifer? ® Yes fl No If the answer is Yes, please note that a copy of the agency approved be included in the Storm Water Pollution Prevention Plan. TCEQ-20022 (12/01/2006) Page 2 Check "Yes" to the certifications below. Failure to indicate *Yes" to ALL items may result in denial of coverage under the general permit. I certify that I have obtained a copy and understand the terms and conditions of the general permit TX150000. +J Yes I certify that the activities at this site qualify for coverage under the general permit TX150000. 0 Yes I understand that a Notice of Termination (NOT) must be submitted when this authorization is no longer needed.+® Yes I understand that permits active on September 1st of each year will be assessed an Annual Water Quality Fee. ED Yes I certify that a Storm Water Pollution Prevention Plan (SWP3) has been prepared and implemented as required by the general permit. Q Yes ry MR/ )Ai R - Title (Requlreal) 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 au 'zation upon request. Signa 1/ Date: t,!_ .)5-07 111 (Use blue ink) TCEQ-20022 (12/01/2006) Page 3 Storm Water Pollution Prevention Plan For East Water Transmission Line, Phase 3B-1 Joe Bland Construction, LP II. SW3P Certification Authority Signature "I 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 gathered and evaluated 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 that there are significant penalties for submitting false information, including the possibility of fine and imprisonment for knowing violations." Authority Representative Name and Title 7.3-a-mP-fi R., 1.1 ck5e, P. E. City of Round Rock Phone Number 512-218-5410 Signatu)\cd, • Date 5_„5_o7 Page 4 COPYRIGHT © 2004 2005 2006 2007 COMPLIANCE RESOURCES, INC. 1 -888-CRI-SW3P DATE: May 21, 2007 SUBJECT: City Manager Approval- May 25, 2007 ITEM: Action authorizing the City Manager Approval of the Notice of Intent (NOI) for Storm Water discharges associated with construction activity under a TPDES General Permit for the East Water Transmission Line, Phase 3B-1. project. Department: Water and Wastewater Utilities Staff Person: Michael D. Thane, Director of Utilities Justification: This construction project is disturbing greater than five acres of land which requires the completion of a Storm Water Pollution Prevention Plan (SWPPP). In addition, the Texas Commission on Environmental Quality (TCEQ) requires the submittal of a Notice of Intent certifying that the SWPPP has been prepared and implemented for the project. Funding: Cost: $ 100.00 Source of funds: N/A Outside Resources: Joe Bland Construction, LP Compliance Resources Inc. Background Information: As required by Part II.D.3.e of the Texas Commission on Environmental Quality (TCEQ) General Permit Number TXR150000 for discharges of storm water runoff from construction sites. This waterline project is being constructed along CR -112, CR -117, and CR -122 to Kiphen Road. Public Comment: N/A