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HomeMy WebLinkAboutNOITCEQ Office Use Only _ Notice of Intent (NOI) for Storm Water Permit No.: TXR15 ® Discharges Associated with Construction RN: HIM al Activity under TPDES General Permit CN: TCEQ (TXR150000) Ref No: Sign up now for ePermits NOI at Itttns:/hvww6.teeti.state.tx.usfsteers/ Get Instant Permit Coverage and only pay a $225 application fee. ��}o'f'' If filing a paper Not you can pay the application fee on line? Coto https://wwNv6.tceq.state.tx.us/epay/ IF ce`fyuc, GENERAI, PERMIT CONSTRUCIIQN STORM WATER D19CHARGEN01 APPLICATION —Selpet 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 information. -Incomplete applications WILL delay approval or result in automatic Denial. Renewal of General Permit Is this NOI to renew an ACTIVE permit? Yes - What is your permit number? Permit No. TXR15 [ENo - a permit number will be issued. Application Fee if mailing a paper NOI: You must pay the 5325 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: 11 Mailed: Check/Momey Order No.: Company Name on checking account: ElEPAY: Voucher No.: Is the Payment Voucher copy attached? ❑ Yes A. OPERATOR (applicant) 1. If the applicant is currently a customer with TCEQ, what is the Customer Number (CN) issued to this entity? CN (Search Central Reeishw) 2. What is the Legal Name of the entity (applicant) applying for this permit? Davis Brothers Construction (The legal oarue nrosl lo, sli fled emefly as filed will, the Texas Secretary of Stole. Couooq or in the legal document forming the entity) 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: Robert Davis Job Title: Member I 4. What is the Operator's (applicant) mailing address as recognized by the US Postal Service? (verify at USPS.comt Address: 2200 Louetta Suite No.Bldg. No./Mail Code: city: Spring state:TX z1P Cnde:77388 Country Mailing Information (if outside USA). Country Code: Postal Code: 5. Phone No.: (281 ) 355-3800 Ex erasion: 6. Fax No.: (281 ) 355-3800 E-mailAddress:bob@davisbros.net 7. Indicate the type of Customer: ❑Individual ❑Sole Proprietorship-D.B.A. ❑Limited Partnership ❑Corporation ❑Federal Government ❑General Partnership ❑State Government ❑County Government ❑City Government ❑Other Government ❑Other (describe): TCEQ-20022 (03/05/2008) Page I 8. Independent Operator: ElYes ©No (if governmental entity, subsidiary, or part of a larger corporation, check "No".) 9. Number of Employees: ©' 0-20; ❑21-100; ❑101-250; 0251-500; or 0501 or higher 10. Customer Business Tax and Filing Numbers (This iron is not applicable to l)dividaals, Government, GP or Sole Proprielor.) REQUIRED for Co orations and Limited Partnershi s ( veriti' Ote entity's status and filing no, wins l'X SOS all 5121-103-5555 I State Franchise Tax ID Number: Federal Tax ID: TX SOS Charter (filing) Number. DUNS Number (if known): R, APPLICATION CONTACT If TCEQ needs additional information regarding this application, who should be contacted? 1. Name: Rabon A. Metcalf, P.E. Tifle Owner 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) INFORMATION ON PROJECT OR SITE' 1. TCEQ Issued RE Reference Number (RN): RN (Search Central Redstrv) 2. Name of Project or Site (the name as known by the community where this facility/project is located): Callaway Villa Apartments II (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 SecgotiA for a physical address. If No, complete $eaigp 0 for site location information. Seet(§a A~ Enter the physical address for the site. (vet ifc it with USPS.com or other dctivcry source) Street Number: 101 street Name: Luther Street CityCollege Station, TX ZIP Code: 77840 Section.SE Enter the site location information. If no 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 & IH35 accessible on Hwy 290 South) City where the site is located or nearest city to site: ZIP Cade where site is located: 4. Identify the county where the site is located: Brazos 5. Latitude: 30°35'48.74"N I Longitude: 96°20'9.10"W 6. What is the primary business of this entity? In your own words, briefly describe the primary business of the Regulated Entity: (Do not repeat the SIC and NAICS code) Multi -Family Residential Development 7. What is the mailing address for the regulated entity? Is the RE mailing address the same as the Operator? Yes, address is the same as Operator No, provide the address Street Number: Street Name: City: State: ZIP Code: D.GENERAL CHARACTERISTICS -. 1. Is the site located on Indian Country Lands? QNo If the site is on Indian country lands, you must obtain authorization QYes — If Yes, do not submit this NOI. Contact EPA, Region VI through EPA, Region VI. 2. What is the Standard Industrial Classification (SIC) code (see instructions for common codes): (4careh Osha.nov) Primary: 1522 Secondary: TCEQ-20022 (03/0512008) - Page 2 3(a) What is the total number of acres disturbed? 15.0 acres 3(b) Is the project site part of a larger common plan of development or sale? ❑Yes ']No 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. A, Diseh' 11nfolifi- mtbrmatitin 1UST k'v,pruvidea or thi jtce hit ivj11 be d-1 eat 4(a) What is the name of the water body(s) to receive the storm water runoff or potential runoff from the site? Bee Creek 4(b) What is the segment number(s) of the classified water body(s) that the discharge or potential discharge will eventually reach? 1209C 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? '.. Dyes ❑r No '.. If Yes, provide the name of the impaired water body(s). 4(d) Is the discharge into an MS4? nYes ❑No If Yes, what is the name of the MS4 Operator`! City of College Station Note: The general permit requires you to send a copy of the NOI to the MS4 Operator. 4(e) Is the discharge or potential discharge within the Recharge Zone, Contributing Zone, or Contributing Zone within the Transition Zone of the Edwards Aquifer? ❑Yes QNo 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 certifv to all items will result in denial. El Yes 1 certify that I have obtained a copy and understand the terms and conditions of the general permit (TXR150000). Yes I 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. Yes I understand that a Notice of Termination (NOT) must be submitted when this authorization is no longer needed. 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 re uired in the eneral permit TXR150000. Operator Certification: Robert N. Davis member Typed orprinted name (Required d- urcit he legible) Title (Required .4 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 to assure that qualified personnel properly gather and evaluate the information submitted. Based on my inquiry of the person or persons who manage the system, or those persons directly responsible for gathering the information, the information submitted is, to the best of my knowledge and belief, true, accurate, and complete. I am aware there are significant penalties for submitting false information, including the possibility of fine and imprisonment for knowing violations. I further certify that 1 am authorized under 30 Texas Adminish alive Code 305.44 to sign and submit this document, and can provide documentation in proof of such authorization o equest. Signature: 1 i' r (�.z�(/rn' Date:_ /J -�? r — (Use blue ink) TCEQ-20022 (03/05/2009) Page 3