CM-12-11-246ROUND ROCK, TEXAS
PURPOSE PASSION PROSPERITY
£14_I2—!I_z?EcEjvED
NOV142012
City Manager Approval Form
Consider executing TCEQ forms (1) "Agent Authorization Form For Required Signature Edwards Auifer Protection Program
Relating to 30 TAC Chapter 213" authorizing Kelly Morrelli, CP&Y, Inc., to represent and act on behalf of the City, (2) TCEQ
Item Caption: Core Data Forrn, and
(_) FORM TCEQ-06n0 Attachment G Storm Trooper regarding the Chisholm Trail - Ph sP 3 Project
Approval Date: November 16, 2012
Department Name: Transportation Department
Project Manager:
Bill Stablein
Assigned Attorney: Steve Sheets
Item Summary:
The scope of Chisholm Trail Road - Phase 3 is to improve Chisholm Trail Road between the limits of IH -35 frontage road on the
north to Wolle Lane on the south, where it will tie in with the existing five lane section of Chisholm Trail. The widening will
consist of a five lane curb and gutter section with pedestrian facilities. In addition, this work will include a second driveway to
the Sports Complex site. Because the additional impervious cover will eliminate some of the existing water quality features for
this section of Chisholm Trail Road and all of the existing water quality features for the Sports Complex, new water quality
features need to be constructed to meet TCEQ requirements
The Agent Authorization Form, TCEQ Core Data Form, and Attachenment G, Storm Trooper Maintenance Form, are part of the
Edwards Aquifer Recharge Zone Water Pollution Abatement Plan submittal, which includes the water quality treatment for the
Sports Complex and Chisholm Trail Road - Phase 3.
City Manager approval of these three (3) forms is needed before construction of these improvements can begin.
No. of Originals Submitted: Two
Project Name:
Cost:
Source of Funds:
Chisholm Trail Road - Phase 3
N/A
Select Source Fund
Source of Funds (if applicable): Select Source Fund
Account Number:
Finance Director Approval: L. Olsen for C. Delaney
Date: 11-14-12
Department Director Approval: Gary Hudder
Date: 11/7/12
CIP ❑ Budget
N/A OK
E ❑
N/A OK
Purchasing
Ell El
N/A OK
Accounting
❑ ❑
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
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, Texas
Corporation/Partnership/Entity Name
have authorized Kelly Morrelli, P.E.
Print Name of Agent/Engineer
of CP&Y, Inc.
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.
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)
CM -i2- I - zL.(Co
Page 1 of 2
SIGNATURE PAGE:
A • plicant's Sig : ture
/1-/5-//
Date
THE STATE OF rex/1/45 §
County of WILLI Arylspr( §
BEFORE ME, the undersigned authority, on this day personally appeared LA(,(ZEuEle 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
.\X\\\N
TCEQ-0599 (Rev.04/01/2010)
day ofjDW 1 ,202.
NOTARY P
dYieA0Arl 111.S '(rlf
Typed or Printed Name of Notary
MY COMMISSION EXPIRES: q-ci-J4--
Page 2 of 2
lag
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 (Com Data Form should be submitted with the program application)
Renewal (Core Data Form should be submitted with the renewal form) I ❑ Other
2. Attachments Describe Any Attachments: (ex. Title VApplication, Waste Transporter Application, etc.)
Water Pollution Abatement Plan
0
®Yes ❑No
3. Customer Reference Number (if issued)
CN 600413181
SECTION II: Customer Information
Follow this link to search
for CN or RN numbers in
Central Registry**
4. Regulated Entity Reference Number (if issued)
RN
5. Effective Date for Customer Information Updates (mm/dd/yyyy) I
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 ® Owner & Operator
❑Occupational Licensee 0 Responsible Party 0 Voluntary Cleanup Applicant ['Other:
7. General Customer Information
0 New Customer ❑ Update to Customer Information ❑ Change in Regulated Entity Ownership
❑Change in Legal Name (Verifiable with the Texas Secretary of State) ® No Change**
"If "No Change" and Section 1 is complete, skip to Section 111- Regulated Entity Information.
8. Type of Customer:
0 Corporation
0 Individual
0 City Government
0 County Government
0 Federal Government
0 Other Government
0 General Partnership
0 Limited Partnership
0 Sole Proprietorship- D.B.A
0 State Government
0 Other:
9. Customer Legal Name (If an individual, print last name first: ex: Doe, John) If new Customer, enter previous Customer
below
End Date:
10. Mailing
Address:
City
State
ZIP
ZIP + 4
11. Country Mailing Information (if outside usA)
13. Telephone Number
)
12. E -Mail Address (dappiicab/e)
14. Extension or Code 15. Fax Number (if applicable)
16. Federal Tax ID (9digits) 17. TX State Franchise Tax ID (m1 digts) 18. DUNS Numberflappricable) )19. TX SOS FilingNumber Sa r
( PP icabk)
20. Number of Employees
0 0-20 ❑ 21-100 0 101-250 ❑ 251-500 ❑ 501 and higher1
SECTION III: Regulated Entity Information
21. Independently Owned and Operated?
❑ Yes ❑ No
22. General Regulated Entity Information (If 'New Regulated Entity' is selected below this form should be accompanied by a permit application)
® New Regulated Entity ❑ Update to Regulated Entity Name ❑ Update to Regulated Entity Information ❑ No Change** (See below)
"If "NO CHANGE" is checked and Section 1 is complete, skip to Section IV, Preparer Information.
23. Regulated Entity Name (name of the site where the regulated action is taking place)
Chisholm Trail Road & Access Drive
TCEQ-10400 (09/07)
Page 1 of 2
ti
24. Street Address
of the Regulated
Entity:
JNo P.O. Boxes)
City I I State
25. Mailing
Address:
City of Round Rock, c/o Steve Norwood
1 ZIP 1 I ZIP + 4 1
221 E. Main Street
City I Round Rock I State TX I ZIP 178664 1 ZIP + 4 5299
26. E -Mail Address: snorwood@round-rock.tx.us
27. Telephone Number
(512)218-5410
28. Extension or Code 29. Fax Number (if applicable)
1 ( 512) 218-7097
30. Primary SIC Code (4 digits) 31. Secondary SIC Code (4 digits) 32. Primary NAICS Code
1611
1611
(5 or 6 digits)
237310
34. What is the Primary Business of this entity? (Please do not repeat the SIC or NAICS description.)
Construction of public roadway improvements
33. Secondary NAICS Code
(5 or 6 digits)
237310
35. Description to
Physical Location:
36. Nearest City
Questions 34 - 37 address geographic location. Please refer to the instructions for applicability.
West of IH 35 from 600' north of Old Settler's Blvd (FM 3406) to .50 miles north of Old
Settler's Blvd
County
State
Round Rock
37. Latitude (N) In Decimal: 130.538
Degrees
Minutes
I Williamson
Seconds
Nearest ZIP Code
178665
38. Longitude (W) In Decimal: -97.695
Degrees
Tx
Minutes
30
32
18
-97
41
Seconds
41
39. TCEQ Programs and ID Numbers Check all Programs 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 irt cf f
•
Dam Safety
■
Districts
►4
Edwards Aquifer
s ru
ions or adddional guidance.
Industrial Hazardous Waste
•
WPAP
•
New Source Review - Air
■
OSSF
■
Petroleum Storage Tank
PWS
•
•
Stormwater
■
Title V - Air
■
Tires
•
Used Oil
■
Voluntary Cleanup
•
Waste Water
•
Wastewater Agriculture
•
Water Rights
SECTION IV: Preparer Information
0 Municipal Solid Waste
0 Sludge
0 Utilities
0 Other:
40. Name:
Kelly Morrelli, P.E. CP&Y, Inc.
41. Title:
42. Telephone Number 43. Ext.ICode
Project Engineer
44. Fax Number 45. E -Mail Address
( 512 ) 349-0700
126
( 512) 349-0727
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 form.)
kmorrelli@cpyi.com
Company:
Namepn Pnnf) :
Signature:
TCEQ-10400 (09/07)
City of Round Rock
Steve , orwood
Job Title:
City Manager
Phone:
Date:
(512) 218-5410
//-45-/-2_
Page 2 of 2
Form TCEQ-0600 ATTACHMENT G
Maintenance Plan and Schedule for Permanent Erosion Controls
StormTooper
PROJECT NAME Chisholm Trail Road. Access Drive. & Sports Complex
LOCATION West of IH 35 from 600' north of FM 3406 to IH 35 southbound frontage
road .5 miles north of FM
CITY, STATE ZIP Round Rock. Texas 78665
StormTrooper Maintenance Guidelines:
A preventative maintenance cleanout schedule is the most valuable tool for maintain the proper
operation of StormTrooper. Separator maintenance costs will be greatly reduced if a good housekeeping
plan for the property is developed i.e., trash pickup, lawn maintenance, dumpster control, etc.
StormTrooper separators have no moving parts and no filter cartridges. The manufacturer recommends
quarterly ongoing inspections for accumulated pollutants. Pollutant deposition may vary from year to
year. Quarterly inpsections ensure that the system is serviced at the appropriate times. Table 4 lists
recommended maximum capacities of oil and sediment. Professional vacuum services should be
considered when capacities exceed these recommended levels.
Table 4. StormTrooner
Maintenance Lei els
Model
Number
Oil
Depth
Sediment
Depth
SWAQ-05
12"
12"
SW'AQ-10
12"
12"
SWAQ-20
12"
12"
SWAQ-25
12"
12"
SWAQ-40
12"
12"
SWAQ-70
12"
12"
SWAQ-110
12"
12"
Inspection Procedures
1. Easiest observation and maintenance is best accomplished during non -flow (dry weather)
conditions 3-4 days after the most recent rain.
2. Remove interceptor covers or open hatchway to observe conditions. Remove hatchway
safety net ("EnterNet"). Observe for trash and debris and remove if necessary. This is the
most important maintenance requirement. If absorbent pillows ar utilized, observe their
condition. Uniform browning or gray color of the pillow means they should be replaced.
Observe baffle debris screen and clean if necessary.
3. Coalescing plates are self-cleaning and seldom require maintenance unless damaged. Do
not walk or stand on plate packs. Call ParkUSA (888 -611 -PARK) for replacement parts.
4. Check the depth level of oil and sediment with a tank sampler device designed for this
purpose.
Attachment G - Maintenance Plan Sheet 1 of 2
Documentation: All activity preformed on the batch detention pond shall be maintained in
one consolidated file which indicates, at minimum:
• Inspection/Maintenance Date
• Indication all items presented above have been checked
• Description of any maintenance items provided
• Expected date of next inspection
An amended copy of this document will be provided to the TCEQ within thirty (30) days of
any changes in the following information.
Responsible Party for Maintenance City of Round Rock
Contact Person Steve Norwood
Address 221 E. Main Street
City, State Zip Round Rock, Texas 78664
Telephone Number 512-218- 410
Signature of e/
Responsible Party
Attachment G - Maintenance Plan Sheet 2 of 2