CM-11-03-052ROUND ROCK, TEXAS
PURPOSE. PASSION. PROSPERITY.
Item Caption:
Approval Date:
City Manager Approval Summary Sheet
Consider executing a Recharge and Transition Zone Exception Request with the TCEQ for
the City Hall Plaza Improvements Project.
March 4, 2011
Department: Parks and Recreation
Project Manager: David Buzzell, Park Development Manager
Item Summary:
This item would allow the City's consultant, Hagood Engineering Associates, to submit an Exception Request to
regulations related to Edwards Aquifer Recharge and Transitions Zone. Staff and the consultant believe an
exception request is applicable due to the fact that the site was formally a building and the proposed plaza is
decreasing the impervious cover (compared to the building). Therefore, an exception request is being submitted to
the Texas Commission on Environmental Quality (TCEQ).
Strategic Plan Relevance:
Cost: $0.00
Source of Funds: 2007 General Obligation Bonds
REV. 6/10/10
Agent Authorization Form
For Required Signature
Edwards Aquifer Protection Program
Relating to 30 TAC Chapter 213
Effective June 1, 1999
Steve Norwood
Print Name
City Manager
Title - Owner/President/Other
of City of Round Rock
Corporation/Partnership/Entity Name
have authorized Terry R. Hagood, P.E.
Print Name of Agent/Engineer
of Hagood Engineering Associates
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.
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.
2.
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.
911.-i 1-03- L
TCEQ-0599 (Rev.04/01/2010) Page 1 of 2
SIGNATURE PAGE:
3 J-J,l/ao//
Applicant's Signature Date
THE STATE OF TO VS §
I
County of A) l II I SOV) §
BEFORE ME, the undersigned authority, on this day personally appeared Steve. Nbna&rJ 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 - day of MQjtth. , 2o11.
�`„Fr^1"� MEAGAN M. SPINKS
J Q1l,. B( ry
j •"s.. Notary Public, State of Texas
f My Commission Expires
•V•ts, September 09, 2014
1
M
NO RY UBLIC
ry EAc4d M. SPInt <5
Typed or Printed Name of Notary
MY COMMISSION EXPIRES:
Oemicor-9,20)4-
TCEQ-0599
(Rev.04/01/2010) Page 2 of 2
frosj
TCEQ
TCEQ Core Data Form
TCEQ Use Only
For detailed instructions regarding completion of this form, please read the Core Data Form Instructions or call 512-239-5175.
SECTION I: General Information
1.
❑
Reason for Submission (If other is checked please describe in space provided)
New Permit, Registration or Authorization (Core Data Form should be submitted with the program application)
❑
Renewal (Core Data Form should be submitted with the renewal form)
/1
Other
Recharge Zone Exception Request
2. Attachments Describe Any Attachments: (ex. Title V Application, Waste Transporter Application, etc.)
❑ New Customer ❑ Update to Customer Information
❑Change in Legal Name (Verifiable with the Texas Secretary of State)
❑
/1
Yes No
**lf "No Change" and Section I is complete, skip to Section 111— Regulated Entity Information.
3. Customer Reference Number (if issued)
Follow this link to search
4. Regulated Entity Reference Number (if issued)
CN 600413181
for CN or RN numbers in
RN
Central Registry*"
SECTION II: Customer Information
5. Effective Date for Customer Information Updates (mmlddlyyyy)
6. Customer Role (Proposed or Actual) — as it relates to the Regulated Entity listed on this form. Please check only one of the following:
❑Owner ❑ Operator
❑Occupational Licensee ❑ Responsible Party
'
❑
Owner & Operator
Voluntary Cleanup Applicant ❑Other:
7. General Customer Information
❑ New Customer ❑ Update to Customer Information
❑Change in Legal Name (Verifiable with the Texas Secretary of State)
❑
/1
Change in Regulated Entity Ownership
No Change**
**lf "No Change" and Section I is complete, skip to Section 111— Regulated Entity Information.
8. Type of Customer:
❑ Corporation
❑ Individual
❑ Sole Proprietorship- D.B.A
❑ City Govemment
❑ County Govemment
❑ Federal Govemment
❑ State Government
❑ Other Government
❑ General Partnership
❑ Limited Partnership
❑ Other.
9. Customer Legal Name (!f an individual, last name first: Doe, John) If new Customer, enter previous Customer
print ex: End Date:
below
10. Mailing
Address:
City
State
ZIP
ZIP + 4
11. Country Mailing Information (if outside usA)
12. E -Mail Address (inapplicable)
13. Telephone Number 114. Extension or Code 15. Fax Number (f applicable)
I( )
16. Federal Tax ID (9 digits)
17. TX State Franchise Tax ID (11 digits)
18. DUNS Number(lrappncaue)
19. TX SOS Filing Number (if applicable)
I
20. Number of Employees
❑ 0-20 ❑ 21-100 ❑ 101-250 ❑ 251-500 ■ 501 and higher
21. Independently Owned and Operated?
I ❑ Yes ❑ No
SECTION III: Regulated Entity Information
22. General Regulated Entity Information (If 'New Regulated Entity" is selected below this form should be accompanied by a permit application)
New Regulated Entity El Update to Regulated Entity Name ❑ Update to Regulated Entity Information ❑ No Change*" (See below)
**If "NO CHANGE" is checked and Section I is complete, skip to Section IV, Preparer Information.
23. Regulated Entity Name (name of the site where the regulated action is taking place)
Round Rock City Hall Plaza Improvements
TCEQ-10400 (09/07)
Page 1 of 2
1
1
1
1
1
1
24. Street Address
of the Regulated
Entity:
fNo P.O. Boxes)
City of Round Rock
212 East Main Street
City
Round Rock
State
TX
ZIP
78664
ZIP + 4
■
Degrees
25. Mailing
Address:
City of Round Rock
212 East Main Street
City
Round Rock
State
TX
ZIP
78664
ZIP + 4
36.8436
26. E -Mail Address:
dbuzzell@round-rock.tx.us
27. Telephone Number 28. Extension or Code 29. Fax Number (if applicable)
(512)341-3345
■
(512)218-5548
30. Primary SIC Code (4 digits) 31. Secondary SIC Code (4 digits) 32. Primary NAICS Code 33. Secondary NAICS Code
(5 or 6 digits) (5 or 6 digits)
Sludge
34. What is the Primary Business of this entity? (Please do not repeat the SIC or NAICS description.)
Pedestrian
Questions 34— 37 addr
35. Description to
Physical Location:
--- — — -- -.._ ..._... ,....,....Nr.....,......�.
North on IH35 from Austin, exit HWY620, turn right on Rouck Avenue. Continue past N.
Mays to intersection of E. Main St. and Sheppard St.
36. Nearest City County State Nearest ZIP Code
Round Rock
Williamson
Tx
78664
37. Latitude (N) In Decimal:
(512. )21g -5440/
38. Longitude (W) In Decimal:
■
Degrees
Minutes
Seconds
Degrees
Minutes
Seconds
30
30
31.1898
-97
40
36.8436
39. TCEQ Programs and ID Numbers Check all P ograms and write in the permits/registration numbers that will be affected by the updates submitted on this form or the
updates may not be made. If your Program is not listed, check other and write it in. See the Core Data Form instructions for additional guidance.
•
Dam Safety
IN
Districts
1
Edwards Aquifer
•
Industrial Hazardous Waste
(512. )21g -5440/
Municipal Solid Waste
■
Date:
3/4 11(
■
New Source Review - Air
■
OSSF
•
Petroleum Storage Tank
■
PWS
•
Sludge
•
Stormwater
•
Title V -Air
■
Tires
•
Used Oil
■
Utilities
•
Voluntary Cleanup
•
Waste Water
■
Wastewater Agriculture
•
Water Rights
•
Other:
SECTION IV: Preparer Information
40. Name:
Terry R. Hagood, P.E.
41. Title:
42. Telephone Number 43. ExtJCode
Project Engineer
44. Fax Number 45. E -Mail Address
( 512) 244-1546
12
(512)244-1010
terryh@hea.eng.pro
SECTION V: Authorized Signature
46. By my signature below, I certify, to the best of my knowledge, that the information provided in this form is true and complete,
and that I have signature authority to submit this form on behalf of the entity specified in Section II, Field 9 and/or as required for the
updates to the ID numbers identified in field 39.
(See the Core Data Form instructions for more information on who should sign this for
Company:
&tit. op Round Rte,
Job Title:
Ci
e12an
NamepnPrint):
3-k - Norw •od
Phone:
(512. )21g -5440/
Signature:
';•.."-,7%0121
Date:
3/4 11(
TCEQ-10400 (09/07)
Page 2 of 2