CM-12-01-009C0(_0oc'
RECEIVED
JAN 1a 7012
ROUND ROCK, TEXAS City Manager Approval Form
Consider executing TCEQ forms (1) Application Fee form for Water Pollution Abatement Plan, Contributing Zone Plan:
Item Caption: Non -Residential and (2) Agent Authorization Form For Required Signature Edwards Aquifer Protection Program Relating to 30
TeC Ch*pter 213 2uthorizirlg Rilly L Hugginc to rapresant and mr't on behalf of Ow City for the. Mays $treat - Downtown li
Approval Date: 1/20/12
Department Name: Transportation Department
Project Manager Todd Keltgen
Assigned Attorney: Steve Sheets
Item Summary:
Mays Street Reconstruction Phase 1 provides for widening North Mays Street from a four lane arterial to a five lane section
including wide sidewalks; street trees and lighting; utility relocations; and gateway features.
The Water Pollution Abatement Plan, Contributing Zone Plan: Non -Residential is required by the Texas Commission on
Environmental Quality as part of the Edwards Aquifer Protection Program.
No. of Originals Submitted: Two
Project Name: Mays Street Reconstruction Phase 1
Cost: $500.00
Source of Funds: RR Trans Dev Corp Construction
Source of Funds (if applicable): Select Source Fund
Account Number.
Finance Director Approval: S. Carter for Cheryl Delaney Date: 01/18/2012
Department Director Approval: Gary Hudder Date: 1/10/12
**Electronic signature by the Director is acceptable. Please only submit ONE approval form per item. **
CIP I I EJ Budget
N/A OK N/A O❑K
Purchasing111 [11 Accounting El
N/A OK N/A OK
ITEMS WILL NOT BE PLACED ON THE COUNCIL OR CM AGENDA W/OUT PRIOR FINANCE AND/OR LEGAL APPROVAL
REV. 6/20/11
No Text
Texas Commission on Environmental Quality
Edwards Aquifer Protection Program
Application Fee Form
NAME OF PROPOSED REGULATED ENTITY: Mays St. (Downtown)
REGULATED ENTITY LOCATION:
NAME OF CUSTOMER: City of Round Rock
CONTACT PERSON: Todd Keltgen PHONE: 512-218-5583
(Please Print)
Customer Reference Number (if issued): CN (nine digits)
Regulated Entity Reference Number(if issued): RN (nine digits)
Austin Regional Office (3373) ❑ Hays 9 Travis X Williamson
San Antonio Regional Office (3362) ❑ Bexar ❑ Comal 9 Medina 9 Kinney 9 Uvalde
Application fees must be paid by check, certified check, or money order, payable to the Texas Commission on
Environmental Quality. Your canceled check will serve as your receipt. This form must be submitted with
your fee payment. This payment is being submitted to (Check One):
❑ Austin Regional Office
❑ Mailed to TCEQ:
TCEQ — Cashier
Revenues Section
Mail Code 214
P.O. Box 13088
Austin, TX 78711-3088
❑ San Antonio Regional Office
O Overnight Delivery to TCEQ:
TCEQ - Cashier
12100 Park 35 Circle
Building A, 3rd Floor
Austin, TX 78753
512/239-0347
Site Location (Check All That Apply): 9 Recharge Zone ❑ Contributing Zone
0 Transition Zone
Signature
ei �2— Date
If you have questions on how to fill out this form or about the Edwards Aquifer protection program, please contact us at 210/490-
3096 for projects located in the San Antonio Region or 512/339-2929 for projects located in the Austin Region.
Individuals are entitled to request and review their personal information that the agency gathers on its forms. They may also have any errors
TCEQ-0574 (Rev. 4/25/08) Page 1 of 2
OM -12,-01-0o°'
Type of Plan
Size
Fee Due
Water Pollution Abatement Plan, Contributing Zone
Pian: One Single Family Residential Dwelling
Acres
$
Water Pollution Abatement Plan, Contributing Zone
Plan: Multiple Single Family Residential and Parks
Acres
$
Water Pollution Abatement Pian, Contributing Zone
Plan: Non-residential
N/A (exception request)
Acres
$500.00
Sewage Collection System
L.F.
$
Lift Stations without sewer lines
Acres
$
Underground or Aboveground Storage Tank Facility
Tanks
$
Piping System(s)(only)
Each
$
Exception
Each
$
Extension of Time
Each
$
Signature
ei �2— Date
If you have questions on how to fill out this form or about the Edwards Aquifer protection program, please contact us at 210/490-
3096 for projects located in the San Antonio Region or 512/339-2929 for projects located in the Austin Region.
Individuals are entitled to request and review their personal information that the agency gathers on its forms. They may also have any errors
TCEQ-0574 (Rev. 4/25/08) Page 1 of 2
OM -12,-01-0o°'
No Text
in their information corrected. To review such information, contact us at 512/239-3282.
Texas Commission on Environmental Quality
Edwards Aquifer Protection Program
Application Fee Schedule
30 TAC Chapter 213 (effective 05/01/2008)
Water Pollution Abatement Plans and Modifications
-----• •_-......J w..v . .a..a o. 1V nwUln%aIIVn5
PROJECT
PROJECT AREA IN ACRES
FEE
One Single Family Residential Dwelling
Sewage Collection Systems
<
5
$650
Multiple Single Family Residential and Parks
<
5
$1,500
5
<
10
$3,000
10
<
40
$4,000
40
<
100
$6,500
100
<
500
$8,000
>-
500
$10,000
Non-residential (Commercial, industrial, institutional,
multi -family residential, schools, and other sites where
1
<
<
1
5
$3,000
$4,000
regulated activities will occur)
5
<
10
$5,000
10
<
40
$6,500
40
<
100
$8,000
>-
100
$10,000
Underground
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PROJECT
PROJECT
COST PER LINEAR FOOT
MINIMUM FEE
MAXIMUM FEE
Sewage Collection Systems
$0.50
$650 - $6,500
Underground
- - --- - - - - ------ -----a_ . —. vway... . ay...ay rIa110 a1IY 1111VYIIIGaHVnS
PROJECT
COST PER TANK OR PIPING
SYSTEM
MINIMUM FEE
MAXIMUM FEE
Underground and Aboveground Storage Tank Facility
$650
$650 - $6,500
Exception Requests
PROJECT
FEE
Exception Request
$500
Extension of Time Requests
PROJECT
FEE
Extension of Time Request
$150
TCEQ-0574 (Rev. 4/25/08)
Page 2 of 2
No Text
Agent Authorization Form
For Required Signature
Edwards Aquifer Protection Program
Relating to 30 TAC Chapter 213
Effective June 1, 1999
Steve Norwood
of
have authorized
Print Name
City Manager
Title - Owner/President/Other
City of Round Rock. Texas
Corporation/Partnership/Entity Name
Billy L. Huggins
Print Name of Agent/Engineer
of Huggins/Seiler & Associates. LP
Print Name of Firm
to represent and act on the behalf of the above named Corporation, Partnership, or Entity for
the purpose of preparing and submitting this plan application to the Texas Commission on
Environmental Quality (TCEQ) for the review and approval consideration of regulated
activities.
I also understand that:
1. The applicant is responsible for compliance with 30 Texas Administrative Code
Chapter 213 and any condition of the TCEQ's approval letter. The TCEQ is authorized
to assess administrative penalties of up to $10,000 per day per violation.
2. For those submitting an application who are not the property owner, but who have the
right to control and possess the property, additional authorization is required from the
owner.
3. Application fees are due and payable at the time the application is submitted. The
application fee must be sent to the TCEQ cashier or to the appropriate regional office.
The application will not be considered until the correct fee is received by the
commission.
4. A notarized copy of the Agent Authorization Form must be provided for the person
preparing the application, and this form must accompany the completed application.
5. No person shall commence any regulated activity on the Edwards Aquifer Recharge
Zone, Contributing Zone or Transition Zone until the appropriate application for the
activity has been filed with and approved by the Executive Director.
TCEQ-0599 (Rev.04/01/2010) Page 1 of 2
CM_ 12---01-000/
b.
1
SIGNATURE PAGE:
Applicant's Signature
THE STATE OF r- §
County of VOLIA M0'1§
BEFORE ME, the undersigned authority, on this day personally appeared known
to me to be the person whose name is subscribed to the foregoing instrument, and acknowledged to
me that (s)he executed same for the purpose and consideration therein expressed.
GIVEN under my hand and seal of office on this 'Uay of Adiviffry
L WHITE
M�YC0MMISSION EXPIRES
*11,2012
1
N A Y PUBLI
Cla I
Niti
Typed or Printed Name of Notary
MY COMMISSION EXPIRES: 511/
1 (/2D12.
TCEQ-0599 (Rev.04/01/2010) Page 2 of 2
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