CM-2016-1264 - 12/19/2016 Agent Authorization Form
For Required Signature
Edwards Aquifer Protection Program
Relating to 30 TAC Chapter 213
Effective June 1, 1999
I AAf �Aill
Print Name
LI n01
Title - Owner/Presiders Other
of CA4
Corporation/Partnership/Entity Name
have authorized Nichoias G. Keir;
Print Name of Agent/Engineer
of Walker Partners Enaineers I Survev,)rs
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 submittingthis Ian application to the Texas Commission on
Environmental Quality (TCEQ) for threview and pa approval consideration of regulated
activities.
PP 9
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
q 9
Zone, Contributing Zone or Transition Zone until the appropriate application for the
activity has been filed with and approved by the Executive Director.
W-1 20[b. I2b4
TCEQ-0599(Rev.04/01/2010) Page 1 of 2
SIGNATURE PAGE:
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Applicant's Signature Date
THE STATE OF f' 5 §
County of 'O-Mso §
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 LC[4day of lewtber, o (�,
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TCEQ-0599(Rev.04/01/2010) Page 2 of 2
City of Round Rock
ROUND ROCK Agenda Item Summary
Agenda Number:
Title: Consider executing TCEQ "Agent Authorization Form For Required
Signature Edwards Aquifer Protection Program RElating to 30 TAC
Chapter 213" authorizing Nicholas G. Kehl to represent and act on behald
of the City Reagrding the�ushy Creek Wastewater Line Upgrade Project.
Type: City Manager Item
Governing Body: City Manager Approval
Agenda Date: 12/16/2016
Dept Director: Michael Thane, Director of Utilities and Environmental Services
Cost: $650.00
Indexes: Self-Financed Wastewater Construction
Attachments: TCEQ Agent Authorization Form.pdf,
LAF_TCEQ_AgentAuthorization_CM 12.16.16.pdf
Department: Utilities and Environmental Services
Text of Legislative File CM-2016-1264
Consider executing TCEQ "Agent Authorization Form For Required Signature Edwards
Aquifer Protection Program RElating to 30 TAC Chapter 213" authorizing Nicholas G.
Kehl to represent and act on behald of the City Reagrding the Vrushy Creek
Wastewater Line Upgrade Project.
This contract will provide for the engineering design, bidding and construction phase
services for the Brushy Creek Phase 5 Wastewater Improvements project. The
wastewater line improvements consist of construction of approximately 600 linear feet
of new 8-inch diameter wastewater main beginning just east of the intersection of
Sunset Drive and Chisholm Trail Road heading west across Chisholm Trail Road into
city-owned property. The line then turns south and runs through the city-owned
property and joining an existing 8-inch wastewater line. This new line will replace a
portion of an existing 6-inch clay tile wastewater line which runs north and south
parallel to Chisholm Trail Road. This new line will not only be upsized and provide
newer pipe materials for the area, but it will also reduce the likelihood of future road
closures along Chisholm Trail Road by routing the flow away from the street. The
portion of 6-inch line will be properly abandoned along Chisholm Trail Road.
The City of Round Rock is required by the Texas Commission on Environmental
Quality (TCEQ) to obtain an Organized Sewer Collection System (SCS) approval from
City of Round Rock Page 1 Printed on 1211312016
Agenda Item Summary Continued(CM-2016-1264)
TCEQ prior to conducting work over the Edwards Aquifer Recharge Zone (EARZ). The
Brushy Creek Phase 5 Wastewater Improvements Project is located over the EARZ
and as a result, the City must address the EARZ requirements. By the City executing
the Agent Authorization form, this will authorize the City's consultant, Nichols Kehl of
Walker Partners, LLC, to act as an agent to the City and submit the application for
approval of the SCS for this project.
Staff Recommends Approval.
City of Round Rock Page 2 Printed on 1211312016