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TCEQ Office Use Only
Permit No.:
RN:
CN:
Region:
11111110
TCEO Notice of Intent (NOI) for Stormwater Discharges
Associated with Construction Activity under TPDES
General Permit (TXR15oo00)
IMPORTANT:
Use the INSTRUCTIONS to fill out each question in this form.
Use the CHECKLIST to make certain all you filled out all required information.
Incomplete applications WILL delay approval or result in automatic denial.
Once processed your permit can be viewed at:
http://www2.tceq.texas.gov/wq dpa/index.cfm
ePERMITS: Sign up now for online NOI: https://www3.tceq.texas.gov/steers/index.cfm
Pay a$225 reduced application fee by using ePermits.
APPLICATION FEE:
You must pay the$325 Application Fee to TCEQ for the paper application to be
complete.
Payment and NOI must be mailed to separate addresses.
Did you know you can pay on line?
Go to https://www3.tceq.texas.gov/epay/index.cfui
Select Fee Type: GENERAL PERMIT CONSTRUCTION STORM WATER
DISCHARGE NOI APPLICATION
Provide your payment information below,for verification of payment:
Mailed Check/Money Order No.:
Name Printed on Check:
EPAY Voucher No.:
Is the Payment Voucher copy attached? 0 Yes
RENEWAL: Is this NOI a Renewal of an existing General Permit Authorization?
Note:A permit cannot be renewed after June 3, 2013.)
Yes The Permit number is:TXR15
If a permit number is not provided, a new number will be assigned.)
No
1) OPERATOR (Applicant)
a) If the applicant is currently a customer with TCEQ,what is the Customer Number(CN)
issued to this entity? You may search for your CN at:
http://wwwt 2.tceq.texas.gov/crpub/i ndex.cfm?fuseacti on=cust.CustS earth
CN
TCEQ 20022(03/05/2013) Page 1
b) What is the Legal Name of the entity(applicant)applying for this permit?
Oldham Goodwin Group,LLC
The legal name must be spelled exactly as filed with the Texas Secretary of State,County,or
in the legal document forming the entity.)
c) What is the name and title of the person signing the application? The person must be an
executive official meeting signatory requirements in TAC 305.44(a).
Prefix(Mr.Ms. Miss): Mr.
First/Last Name: Chris Rhodes Suffix:
Title: VP-Construction Management Credential:
d) What is the Operator Contact's(Responsible Authority)contact information and mailing
address as recognized by the US Postal Service(USPS)? You may verify the address at:
http://zip4.usps.comJzip4/welcome.jsp
Phone#:(979)268-2000 ext: Fax#: (979) 846-7020
E-mail: chris@oldhamgoodwin.com
Mailing Address:2800 South Texas Avenue,Ste.401
Internal Routing(Mail Code,Etc.):
City: Bryan State:TX ZIP Code:77802
If outside USA: Territory: Country Code: Postal Code:
e) Indicate the type of Customer(The instructions will help determine your customer type):
Individual 0 Limited Partnership 0 Sole Proprietorship-DBA
Joint Venture 0 General Partnership 0 Corporation
0 Trust 0 Estate 0 Federal Government
State Government 0 County Government 0 City Government
Other Government
f) Independent Operator?E Yes 0 No
If governmental entity,subsidiary,or part of a larger corporation,check"No".)
g) Number of Employees:
0-20; 021-100; 0101-250; 0 251-500; or 501 or higher
h) Customer Business Tax and Filing Numbers:
REQUIRED for Corporations and Limited Partnerships. Not Required for Individuals,
Government,or Sole Proprietors)
State Franchise Tax ID Number:
Federal Tax ID:
Texas Secretary of State Charter(filing)Number:
DUNS Number(if known):
2) AP1'LI('_VI'ION ('oNTA("I
If TCEQ needs additional information regarding this application,who should be contacted?
Is the application contact the same as the applicant identified above?
0 Yes,go to Section 3). No,complete section below.
Prefix(Mr.Ms.Miss): Mr.
First/Last Name: Rabon Metcalf Suffix:
Title: Owner Credential: PE,CFM
TCEQ 20022(03/05/2013) Page 2
Organization Name: RME Consulting Engineers
Phone No.: (979)764-0704 ext: Fax Number:(979)764-0704
E-mail: rabon@rmengineer.com
Mailing Address: PO Box 9253
Internal Routing(Mail Code,Etc.):
City: College Station State:TX ZIP Code:77842
Mailing Information if outside USA:
Territory: Country Code: Postal Code:
3) RF(; _'1..1'I'ITD ENTI'T'Y (RE) IN Mini TION ON PROJECT OR SITE
If the site of your business is part of a larger business site or if other businesses were located at
this site before yours,a Regulated Entity Number(RN)may already be assigned for the larger
site. Use the RN assigned for the larger site. Search TCEQ's Central Registry to see if the larger
site may already be registered as a regulated site at:
http://www12.tceq.texas.gov/crpub/index.cfm?fuseaction=regent.RNSearch.
If the site is found,provide the assigned Regulated Entity Reference Number and provide the
information for the site to be authorized through this application below. The site information
for this authorization may vary from the larger site information.
a) TCEQ issued RE Reference Number(RN):RN
b) Name of project or site(the name known by the community where located):
Creek Meadows- Section 7, Phase One
c) In your own words,briefly describe the primary business of the Regulated Entity: (Do not
repeat the SIC and NAICS code):
Urban residential subdivision development
d) County(or counties if> 1) Brazos
e) Latitude: 30°31'42.54"N Longitude: 96°17'14.18"W
t) Does the site have a physical address?
Yes, complete Section A for a physical address.
No,complete Section B for site location information.
Section A: Enter the physical address for the site.
Verify the address with USPS. If the address is not recognized as a delivery address,provide
the address as identified for overnight mail delivery,911 emergency or other online map
tools to confirm an address.
Physical Address of Project or Site:
Street Number: Street Name:
City: State: ZIP Code:
TCEQ 20022(03/05/2013) Page 3
Section B: Enter the site location information.
If no physical address(Street Number&Street Name),provide a written location access
description to the site. (Ex.: located 2 miles west from intersection of Hwy 290&IH35
accessible on Hwy 290 South)
On the southeast side of Greens Prairie Trail and approximately 1825 L.F. north of
its intersection with Royder Road.
City where the site is located or,if not in a city,what is the nearest city:
College Station
State: Texas ZIP Code where the site is located: 77845
4) G I:N I:R_11, (1 IAR_A(" I RIS'I'1('S
a) Is the project/site located on Indian Country Lands?
Yes-If the answer is Yes,you must obtain authorization through EPA,Region 6.
0 No
b) Is your construction activity associated with a facility that,when completed,would be
associated with the exploration,development,or production of oil or gas or geothermal
resources?
Yes-If the answer is Yes,you may be under jurisdiction of the Railroad Commission
ofTexas and may need to obtain authorization through EPA,Region 6.
I No
c) What is the Primary Standard Industrial Classification(SIC)Code that best describes the
construction activity being conducted at the site?
Primary SIC Code: 1521
d) If applicable,what is the Secondary SIC Code(s):
e) What is the total number of acres disturbed? 13
f) Is the project site part of a larger common plan of development or sale?
El Yes-If the answer is Yes,the total number of acres disturbed can be less than 5 acres.
El No -If the answer is 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.
g) What is the name ofthe first water body(s)to receive the stormwater runoff or potential
runoff from the site?
Peach Creek Tributary 16.4.3
h) What is the segment number(s)of the classified water body(s)that the discharge will
eventually reach?
1242
TCEQ 20022(03/05/2013) Page 4
i) Is the discharge into an MS4?
Yes-If the answer is Yes,provide the name of the MS4 operator below.
No
If Yes,provide 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.
j) 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?
0 Yes-If the answer is Yes,provide the name(s)of the impaired water body(s)below.
i No
If Yes,provide the name(s)of the impaired water body(s):
k) Is the discharge or potential discharge within the Recharge Zone,Contributing Zone,or
Contributing Zone within the Transition Zone of the Edwards Aquifer as defined in 3o TAC
Chapter 213?
Yes-If the answer is Yes,complete certification below by checking"Yes."
No
I certify that a copy of the TCEQ approved Plan required by the Edwards Aquifer Rule
30 TAC Chapter 213)is either included or referenced in the Stormwater Pollution
Prevention Plan.
Yes
TCEQ 20022(03/05/2013) Page 5
5) CERTIFICATION
Check Yes to the certifications below. Failure to indicate Yes to ALL items may result in denial
of coverage under the general permit.
a) I certify that I have obtained a copy and understand the terms and conditions of the
Construction General Permit(TXR150000). Yes
b) I certify that the full legal name of the entity applying for this permit has been provided
and is legally authorized to do business in Texas. DYes
c) I understand that a Notice of Termination(NOT)must be submitted when this
authorization is no longer needed. 1Yes
d) I certify that a Stormwater Pollution Prevention Plan has been developed,will be
implemented prior to construction and to the best of my knowledge and belief is
compliant with any applicable local sediment and erosion control plans,as required in
the general permit TXR1.50000. Note:For multiple operators who prepare a shared
SWP3,the confirmation of an operator maybe limited to its obligations under the
SWP3 provided all obligations are confirmed by at least one operator. EYes
Operator Certification:
I Chris Rhodes VP-Construction Management
Typed or printed name Title
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 I am authorized under 30 Texas Administrative Code 305.44 to sign and
submit this document,and can provide documentation in proof of such authorization upon
request.
Signature:Com /(' / J Date:K2_,/&-
Use blue ink)
TCEQ 20022(03/05/2013) Page 6
NOTICE OF INTENT CIIECKLIST (`I`\Rl30000)
Did you complete everything? Use this checklist to be sure!
Are you ready to mail your form to TCEQ? Go to the General Information Section ofthe
Instructions for mailing addresses.
This checklist is for use by the operator to ensure a complete application. Missing information
may result in denial of coverage under the general permit. (See NOI process description in the
Instructions)
Application Fee:
If paying by Check:
E Check was mailed separately to the TCEQs Cashier's Office.(See Instructions for
Cashier's address and Application address.)
Check number and name on check is provided in this application.
If using ePay:
The voucher number is provided in this application or a copy of the voucher is attached.
PERMIT NUMBER:
17 Permit number provided—if this application is for renewal of an existing authorization.
OPERATOR INFORMATION-Confirm each item is complete:
El Customer Number(CN)issued by TCEQ Central Registry
E Legal name as filed to do business in Texas (Call TX SOS 512/463-5555)
E Name and title of responsible authority signing the application
Mailing address is complete&verifiable with USPS. www.usps.com
ED Phone numbers/e-mail address
ED Type of operator(entity type)
E Independent operator
E Number of employees
0 For corporations or limited partnerships—Tax ID and SOS filing numbers
1 Application contact and address is complete&verifiable with USPS.http://www.usps.com
REGULATED ENTITY(RE)INFORMATION ON PROJECT OR SITE-Confirm each item is
complete:
J Regulated Entity Reference Number(RN)(if site is already regulated by TCEQ)
El Site/project name/regulated entity
0 Latitude and longitude http://www.tceq.texas.gov/gis/sqmaview.html
p County
Site/project physical address. Do not use a rural route or post office box.
Business description
GENERAL CHARACTERISTICS-Confirm each item is complete:
D Indian Country Lands—the facility is not on Indian Country Lands
2 Construction activity related to facility associated to oil,gas,or geothermal resources
Standard Industrial Classification(SIC)Code www.osha.gov/oshstats/sicser.html
E Acres disturbed is provided and qualifies for coverage through a NOI
Common plan of development or sale
Receiving water body(s)
Segment number(s)
ED Impaired water body(s)
ED MS4 operator
f] Edwards Aquifer rule
CERTIFICATION
l Certification statements have been checked indicating"Yes"
Signature meets 3o Texas Administrative Code(TAC)305.44 and is original.
TCEQ-20022 Instructions(03/05/2013)Page 1
MEW —11111.11111M
MWM
imp
MO
MNCONSTRUCTIONSITENOTICE
FOR THE
Texas Commission on Environmental Quality(TCEQ)
Storm Water Program
TPDES GENERAL PERMIT TXR150000
The following information is posted in compliance with Part H.D.2. of the TCEQ General Permit Number
TXR150000 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/TXR15 AIR.html
Contact Name and Phone Number:Chris Rhodes
979)260-2800
Creek Meadows-Section 7,Phase One
Project Description:
Located southeast of Greens Prairie Trail and north of Royder Road.
Physical address or description of the site's
location,estimated start date and projected end Estimated Start Date:5/1/15
date, or date that disturbed soils will be
Estimated End Date: 12/31/15
stabilized)
Location of Storm Water Pollution RME Consulting Engineers
P.O.Box 9253
Prevention Plan : College Station,TX 77842
For Construction Sites Authorized Under Part II.D.2. (Obtaining Authorization to Discharge) the following
certification must be completed:
Chris Rhodes Typed or Printed Name Person Completing This Certification)certify under penalty of
law that I have read and understand the eligibility requirements for claiming an authorization under Part II.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 information or for conducting unauthorized discharges,including the possibility of fine
and imprisonment for knowing violations.
40 /4 idet
3/ 5//
Signature and Title Date