CM-08-01-001Notice of Termination (NOT) for Storm
vow
Water Discharges Associated with
now
Construction Activity under the TPDES
10211
Construction General Permit (TXR150000)
TCEQF0 help completing this application, read the TXR150000 NOI Instructions (TCEQ-20023-instructions).
TCEQ Office Use Only
TPDES Permit Number: TXR15•• •• •• •• ••- NO
GINNumber: •• •• •• •• •• •• •• ••
A. TPDES Permit Number: TXR15 CP39
B. Construction Site Operator
Name: City of Round Rock
Customer Reference Number: CN 600413181
Mailing Address: 2008 Enterprise Drive
City: Round Rock
State: TX Zip Code: 78664
Country Mailing Information (if outside USA) Territory: NA Country Code: NA
Postal Code: NA
Phone Number: (512) 218-5555 Extension: NA Fax Number: (512) 218-5563
E-mail Address: NA
C. Project / Site Information
Name: Forest Creek Detention Pond
Regulated Entity Reference Number: RN NA
Physical Address: NA
Location Access Description: On Lot Adiacent To Forest Creek Elementary School
City: Round Rock. Texas County: WILLIAMSON
Zip Code: 78664
D. Contact - If the TCEQ needs additional information regarding this termination, who should be contacted?
Name: Mr. Danny Halden Title: City Engineer
Phone Number: (512) 218-6610 Extension: NA Fax Number: (512) 218-5563
E-mail Address: dhaldenCc�round-rock.tx.us
E. Certification
I certify under penalty of law that authorization under the TPDES Construction General Permit (TXR150000) is no longer
necessary based on the provisions of the general permit. I understand that by submitting this Notice of Termination, I am
no longer authorized to discharge storm water associated with construction activity under the general permit TXR150000,
and that discharging pollutants in storm water associated with construction activity to waters of the U.S. is unlawful under
the Clean Water Act where the discharge is not authorized by a TPDES permit. I also understand that the submittal of this
Notice of Termination does not release an operator from liability for any violations of this permit or the Clean Water Act.
Construction Site Operator Representative:
Prefix: Mr. First: James Middle: R.
Last: Nuse Suffix: NA
Title: City . nager
Signature: Date: 1 ''\""0)
If you have tions on how to fill out this form or about the storm water program, please contact us at (512) 239-4671.
Individuals are entitled to request and review their personal information that the agency gathers on its forms. They may
also have any errors in their information corrected. To review such information, contact us at (512) 239-3282.
The completed NOT must be mailed to the following address:
Texas Commission on Environmental Quality
Storm Water & General Permits Team; MC - 228
P.O. Box 13087
Austin, Texas 78711-3087
DATE: December 28, 2007
SUBJECT: City Manager Approval - January 4, 2008
ITEM: Action authorizing the City Manager to execute a Notice of
Termination (NOT) for storm water discharges associated with
construction activity to the Texas Commission on Environmental
Quality (TCEQ) for the Forest Creek Detention Pond.
Department: Engineering & Development Services
Staff Person: Danny Halden, P.E., City Engineer
Justification:
The NOT is needed to notify the TCEQ the construction activity for the Forest Creek
Detention Pond has been completed.
Funding:
Cost: $0.00
Source of funds: N/A
Outside Resources: J'OB Site Construction
Background Information:
Construction on this project was completed May 5, 2006.
Public Comment: N/A
Blue Sheet Format
Updated 01/20/04
Com -D cob l -QC)