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Home My WebLink AboutNOI TCEQ Office Use Only r 91 Notice of Intent (NO1) for Storm Water Permit No.: TXR15 Discharges Associated with Construction RN: Activity under TPDES General Permit CN: TCEQ (TXR150000) Ref No: Sign up now for el'ermits NO1 at wN!`w 6.tccti.statc.tx.us /steers Cut Instant Permit Coverage and onl■ pay a S225 application fee. ,o � If filing a paper NOI you can pay the application fee on line? Go to https: /hs11 ∎y6.tcegstate.ts.us /epay/ 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? Ycs - What is your permit number? Permit No. TXR15 ✓ No - a permit number will be issued. Application Fee if mailing a paper NOI: You must pay the S325 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: Mailed: Check/Money Order No.: Company Name on checking account: EPAY: 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 CN603691007 (Starch Central Reeistn) 2. What is the Legal Name of the entity (applicant) applying for this permit? CVCS, LLC (The legal none (nnict he spelled exactly as filed with the Texas Secretary of State. County. 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 fAC 305.43(a).) Name: Kevin McGraw Job Title: President 4. What is the Operator's (applicant) mailing address as recognized by the US Postal Service? (veritc at t SPS.com Address: 4520 N. Grand River Avenue Suite No./Bldg. No./Mail Code: City: Lansing state: Michigan 1 ZIP Code: 48906 Country Mailing Information (if outside USA). Country Code: Postal Code: 5. Phone No.: ( 517) 703 -2132 Extension: 6. Fax No.: ( 517) 703 -2152 1 -mail Address: kmcgraw @eaddisdev.eom 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): I'CEQ -20022 (03/05/2008) Page 1 8. Independent Operator: 151 Yes ❑No (If governmental entity. subsidiary. or part of a larger corporation, check -- No' ".) 9. Number of Employees: p 0 -20: 021 -100: 0101 -250: 0251 -500: or 0501 or higher 10. Customer Business Tax and Filing Numbers (This item is nor applicable to Individuals, Government, GP or Sole Proprietor.) REQUIRED for Corporations and Limited Partnerships t \ crit. the entit■ 's status and tiling no. «ith I . SOS at 512/463 -5555 State Franchise Tax ID Number: 32040869920 Federal Tax ID: , S 7 _ / 9 / _3 %7 g v / 1 X SOS Charter (filing) Number: 0801207836 DUNS Number (if known): B. APPLICATION CONTACT If TCEQ needs additional information regarding this application, who should be contacted? 1. Name: Kevin Gaskey, P.E. Title: Principal Company: Kimley -Horn & Assoc., Inc. 2. Phone No.: ( 97 2 ) 770 -1300 Extension: 3. Fax No.: 972 239 -3820 E-mail Address: kevin.gaskey @kimley - horn.com C. REGULATED ENTITY (RE) INFORMATION ON PROJECT OR SITE 1. TCEQ Issued RE Reference Number (RN): RN RN 1 05953830 (ticarch Central Registry 2. Name of Project or Site (the name as known by the community where this facility /project is located): Campus Village Apartments - Phase 1B (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 Ves. complete Section A for a physical address. If No. complete Section B for site location information. Section A: Enter the physical address for the site. t tit') it n ith t "SPS.cnm or other deli% ern source! Street Number: Street Name: City: ZIP Code: 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.: phase I of Woodland subdivision located 2 miles west from intersection of Hwy 290 & IH35 accessible on Hwy 290 South) At Northeast corner of intersection of Harvey Mitchell Parway and Wellborn Road City where the site is located or nearest city to site: ZIP Code where site is located: College Station, TX 77840 4. Identify the county where the site is located: Brazos 5. Latitude: 30 °35'17.18 "N Longitude: 96 °19'27.03 "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) Owner of Multi - Family Developement 7. What is the mailing address for the regulated entity? Is the RE mailing address the same as the Operator? [!JYes. address is the same as Operator ❑ No. provide the address Street Number: Street Name: City: State: I ZIP Code: D. GENERAL CHARACTERISTICS 1. Is the site located on Indian Country Lands? El No DYes — If Yes, do not submit this NO1. Contact EPA, Region VI If the site is on Indian country lands. you must obtain authorization through EPA, Region VI. 2. What is the Standard Industrial Classification (SIC) code (see instructions for common codes): (Search Osha.eo\ l Primary: 1541 Secondary: TCEQ -20022 (03/05/2008) Page 2 3(a) What is . the total number of acres disturbed? 7 3(b) Is the project site part of a larger common plan of development or sale? D 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. 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 B to 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? 1209 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? ❑ Yes 11111 No If Yes, provide the name of the impaired water body(s). _ 4(d) Is the discharge into an MS4? U Yes ❑No If Yes, what is the name of the MS4 Operator? The City of College Station Note: The general permit requires you to send a copy of the NO1 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? p Yes CI 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. lig Yes I certify that 1 have obtained a copy and understand the terms and conditions of the general permit (TXR 150000). fl 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. Q Yes 1 understand that a Notice of "Termination (NOT) must be submitted when this authorization is no longer needed. 0 Yes 1 certify that a storm water pollution prevention plan has been developed and will be implemented prior to construction, and that is compliant with any applicable local sediment and erosion control plans, as required in the general permit TXRI50000. Operator Certification: I. , Kevin McGraw , President Typed or printed name (Required must be legible) Title (Required & 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 infonnation 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 tine and imprisonment for knowing violations. 1 further certify that 1 amnuthorize.. nder 30 I'e as a ■,dministrativc ('ode §305.44 to sign and submit this document, and can provide documentation in z t proof of such aut ori on upo - ., est. / Signature: Date:_ � ( - 1 --- ,__— .-- - - - - -. (Use blue ink) TCEQ -20022 (03/05 /2008) Page 3