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HomeMy WebLinkAboutTCEQTCEQ Office Use Only If -'I Notice of Intent (NOi) for Storm Water Permit No.: TXRIS !l ""11! Discharges Associated with Construction RN: . -----. -Activity under TPDES General Permit CN: TCEQ (TXR150000) Ref o: ~~ Sign up now for ePcrmits NOi at https://w"w6.tceg.state.tx.us/stecrs/ Get Instant Permit Coverage and onl) pay a S225 application fee. If filing a paper NOi you can pa y the application fee on line'! Go to https://www6.tceq.state.tx.us/e pay/ · ... <:nln~t ...... Tv~n· r.l'NFR A I PFIH~l"I' rnN<:TRI J('TlnN ST()IH.A WATFR n1<.;rllAR(;f: NOi A PPI Ir ATION IMPORTANT: •Use the INSTRUCTIONS to fill out each question in this form. •Use the attached CUSTOMER CHECKLIST to make certain all you filled out all required infonnation. •Incomplete aoolications WILL delay annroval or result in automatic Denial. Renewal of General Permit Is this NOi to renew an ACTIVE permit? 0Yes -What is your permit number? Permit No. TXR15 CJ No -a permit number will be issued. Application Fee if mailing a paper NOi: You must pay the $325 Application Fee to TCEQ for the application to be considered complete. Payment and NOi must be mailed to separate addresses. See instructions for correct mailing addresses. Provide your payment information below, for us to verify payment of the application fee: 0Mailed: Check/Money Order No.: Company Name on checking account: 0 EPAY: Voucher No.: Is the Payment Voucher copy attached? oves A. OPERA TOR (applica nt) I. If the applicant is currently a customer with TCEQ, what is the Customer Number (CN) issued to this entity? CN (~carch Central Revistn•) 2. What is the Legal Name of the entity (applicant) applying for this permit? Creek Meadows Partners, LP. (Tire legal name mus/ be spelled e:raclly as flied witlr lire Texas Secre/ary of Stare. Cowuy, or 1111he legal doc11men1 forming lire e111i1y.) 3. What is the name and title of the person signing the application? (The person must be an official meeting signatory requirements in TAC 305.43(a).) Name: Randall K. Lowry Jr. I Job Title: President, Union Gas Corp., General Partner 4. What is the Operator's (applicant) mailing address as recognized by the US Postal Service?("-',-;~, at USP~.com) Address: 2800 South Texas Avenue, Ste 401 I Suite No./Bldg. o./Mail Code: City: Bryan I Statc:rx I ZIP Code: 77802 Country Mailing Information (if outside USA). Country Code: Postal Code: 5. Phone No.: ( 979 ) 268-2000 Extension: 6. Fax No.: ( 979 ) 846-7020 E-mail Address: chris@oldhamgoodwin.com 7. Indicate the type of Customer: D Individu al Dsole Proprietorship-D.B.A. 0Limited Partnership D corporation 0Federal Government 0General Partnership D State Government CT:ounty Government D e ity Government O:>ther Government 0 0ther (describe): TCEQ-20022 (03/05/2008) Page I 8. Independent Operator: 0 Ycs 0 No (If governmental entity, subsidiary, or part ofa larger corporation, check" o"'.) 9. Number of Employees: 0 0-20; 0 21-100; O t01-2so; 0 251-500; or 0 50 I or higher I 0. Customer Business Tax and Fi ling Numbers (771is item is nor applicable to Individuals, Go1•ernment, GP or Sole Proprietor.) REQUIRED for Corporations and Limited Partnerships ( \ crif~ the t•ntit"'' Malu\ and filin!( no. "ith fX SOS at 512/-Uu-5555 l State Franchise Tax ID Number: Federal Tax ID: TX SOS Charter (filing) Number: DUNS Number (if known): B. APPLICATION CONTACT IfTCEQ needs additional information regarding this application, who should be contacted? 1. Name: Rabon A Metcalf, P.E. I Title: Owner I Company: RME Consulting Engineers 2. Phone No.: ( 979 ) 764-0704 Extension: 3. Fax No.: 979 764-0704 E-mail Address: rabon@rmengineer.com c. REGULATED ENTITY (RE) INFORMAT ION ON PROJ ECT OR SITE I. TCEQ Issued RE Reference Num ber (RN): RN (Search ( entral lk1:i,tn) 2. Name of Project or Site (the name as known by the community where this facility/project is located): Creek Meadows - Grad ing & Drainage Improvements (Ponds 1-4) (example: phase and name of subdivision or name of project that"s unique to the site) 3. Does the site have a physical address? If Yes. complete Section A for a physical address. If No. complete Section B for site location infom1ation. Section A: Enter the physical address for the site. (' edt~ it \\ ith I ._,P~.com or other deli-l''! •ource) Street Number: I Street Name: City: ColleQe Station, TX I ZIP Code: Section B: Enter the site location information. lfno physical address (Street Number & Street Name), provide a written location access description to the site: (Ex.: phase I of Woodland subdivision located 2 miles west from intersection of Hwy 290 & H-135 accessible on Hwy 290 South) Located between Greens Prairie Trail and Greens Prairie Road W. City where the site is located or nearest city to site: I Zl P Code where site is located: College Station, TX 77845 4. Identify the county where the site is located: Brazos 5. Latitude: 30°31 '42.43"N Longitude: 96°17'35. 73W 6. What is the primary business o f this entity? In your own words, brieOy describe the primary business of the Regulated Entity: (Do not repeat the SIC and AIC code) High density residential development 7. What is the mailing address for the regulated entity? Is the RE mailing address the same as the Operator? l:JYes, address is the same as Operator LJ No, provide the address Street umber: I Street Name: City: I State: I ZIP Code: D. GENERAL CHARACTERISTICS I. ls the site located on Ind ian Country Lands? [)No D Y es -If Yes, do not submit this 01. Contact EPA, Region VI If the site is on Indian country lands, you must obtain authorization through EPA, Region VJ. 2. What is the Standard Industrial Classification (S IC) code (see instructions for common codes): (Sc:irrh Chila.gm) Primary: 1521 Secondary: rcEQ-20022 (03/05/2008) Page 2 .. 3(a) What is the total number of acres disturbed? 10 acres 3(b) Is the project site part of a larger common plan of development or sale? 0Ycs LJNo If Yes, the total number of acres disturbed can be less than 5 acres. If No, the total number of acres disturbed must be 5 or more. If the total number of acres disturbed is less than 5 then the project site does not qualify for coverage through this Notice of Intent. Coverage will be denied. See the requirements in the general permit for small construction sites. 4. Discharge Information (all information MUST be provided or the permit ·will be denied) 4(a) What is the name of the water body(s) to receive the storm water runoff or potential runoff from the site? Tributary 20 of South Peach Creek 4(b) What is the segment number(s) of the classified water body(s) that the discharge or potential discharge will eventually reach? 1242 4(c) Are any of the surface water bodies receiving discharges from the construction site on the latest EPA-approved CWA 303(d) list of impaired waters? 0Yes 0No If Yes, provide the name of the impaired water body(s). 4(d) Is the discharge into an MS4? ~Yes 0No If Yes, what is the name ofU1e MS4 Operator? City of College Station Note: The genernl permit requires you lo send a copy of the 01 to the MS4 Operator. 4(e) ls the discharge or potential discharge within the Recharge Zone, Contributing Zone, or Contributing Zone within the Transition Zone of the Edwards Aquifer? 0Yes 0 No If the answer is Yes, please note that a copy of the agency approved Plan required by the Edwards Aquifer Rule (30 TAC Chapter 213) must be included or referenced in the Storm Water Pollution Prevention Plan. E. CERTIFICATION Check "Yes" to the certifications below. Failure to certify to all items will result in denial. D Yes I certify that I have obtained a copy and understand the terms and condit ions of the general 12ermit (TXR 150000). 0 Yes 1 certify that the full legal name of the entity (Operator) applying for this permit has been provided and is legally authorized to do business in Texas. D Yes I understand that a Notice of Termination (NOT) must be submitted when this authorization is no longer needed . GJ Yes I certify that a storm water pollution prevention plan has been developed and implemented prior to construction, and that is compliant with any applicable local sediment and erosion control plans and prepared and implemented as required in the general permit TXR150000. Operator Certification: I, El~LU;lr.lll ~. ~g~L:ll: Jc E!Ui~~jg~cl Ucigc ~Q~ "gcg ~~IJ~Cgl f:!glllJ~C Typed or printed name (Required d'. 11111\f be fl!Kible) Title (Req11ired & legible) certify under penalty of law that this document and all attachments were prepared under my direction or supervision in accordance with a system designed 10 assure that qualified personnel properly gather and evaluate the infomiation submitted. Based on my inquiry of the person or persons who manage the system. or those persons directly responsible for gathering the information, the infonnation submitted is, to the best of my knowledge and belief. true. accurate, and complete. I am aware there arc significant penalties for submilling false information, including the possibility of fine and imprisonment for knowing violations. I further certify that I am authorized under JO ·1 l'\U~ \dmini,11·a1 i' r ( ·udr §JH.'.\..l.t to sign and submit this document, and can prov ide documentation in proof of such authori.rntion~ ./ Signature: :,....---Date: z~~//2... / {~blu~n"'1' ~ TCEQ-20022 (03/05/2008) Page 3 CONSTRUCTION SITE NOTICE FOR THE Texas Commission on Environmental Quality (TCEQ) Storm Water Progr am TPDES GENERAL PERMIT TXR150000 The following information is posted in compliance with Part 11.D.2. of the TCEQ General Permit Number TXRI 50000 for discharges of storm water runoff from construction sites. Additional information regarding the TCEQ storm water permit program may be found on the internet at: http://www.tceq.state.tx.us/permitting/water quality/stormwater/TXRI 5 AIR.html -- Contact Name and Phone Number: Chris Rhodes (979) 268-2000 Project Descri ption: Creek Meadows -Grading & Drainage Improvements (Ponds 1-4) Located between Greens Prairie Trail & Greens Prairie Road W. (Physical address or description of the site's location, estimated start date and projected end Estimated Start Date: 3/15/12 date, or date that disturbed soils will be Estimated End Date: 6/1112 stabilized) Locati on of Storm Water Pollution RME Consulting Engineers P.O. Box 9253 Prevention Plan : College Station, TX 77842 For Construction Sites Authorized Under Part 11 .0 .2. (Obtaining Authorization to Discharge) the following certification must be completed: Randall K. Lowry, Jr. (T)pCd or Printed Name Person Completing This Certification) certify under penalty of Jaw that I have read and understand the eligibility requirements for claiming an authorization under Part 11.D.2. of TPDES General Permit TXR150000 and agree to comply with the terms of this permit. A storm water pollution prevention plan has been developed and implemented according to permit requirements. A copy of this signed notice is supplied to the operator of the MS4 if discharges enter an MS4 system. I am aware there are significant penalties for providing false~· nfor ation or for conducting unauthorized discharges, including the possibility of fine and impris owin iolations. zft.zdL.