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r il l Notice of Intent (NOI) for Storm Water Permit No.: TXR15
Discharges Associated with Construction RN:
Activity under TPDES General Permit CN:
TCEC (TXR150000) Ref No:
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CONSTRIJCTION STORM WATER DISCHARGE NOI APPLICATION
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
Is this NOI
General Permit
to renew an ACTIVE permit?
- What is your permit number? Permit No. TXR15
- a permit number will be issued.
1 Yes
No
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:
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 (Search Central Registry)
2. What is the Legal Name of the entity (applicant) applying for this permit?
Bert Wheeler, Inc.
(The legal name must be 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 TAC 305.43(a).)
Name: Ronald Cowe
Job Title: Property Manager
4. What is the Operator's (applicant) mailing address as recognized
by the US Postal Service? ('erif), at USPS.com)
Address: 1919 Whitney, Suite 100 Suite No./Bldg. No./Mail Code:
Cit Houston State:TX ZIP Code: 77006
Country Mailing Information (if outside USA). Country Code: Postal Code:
5. Phone No.: (71 3 ) 355 -5355
Extension:
6. Fax No.: ( )
E -mail Address: garcia @mdwheelercompanies.com
7. Indicate
the type of Customer:
❑ Individual ❑Sole
Proprietorship-
Government
Government
(describe):
D.B.A. • Limited Partnership
1 Corporation ❑Federal
NI General Partnership
❑ State Government County
■ City Government
/Other Government ❑Other
TCEQ -20022 (03/05/2008)
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8. Independent Operator: !J Yes ■ No (If governmental entity, subsidiary, or part of a larger corporation, check "No ".)
9. Number of Employees: a 0 -20; • 21 -100; ■ 101 -250; • 251 -500; or 0501 or higher
10. Customer Business Tax and Filing Numbers (This item is not applicable to Individuals, Government, GP or Sole Proprietor.)
REQUIRED for Corporations and Limited Partnerships ( Verify the entity's status and filing no. with TX SOS at 512/463 -5555 )
State Franchise Tax ID Number:
Federal Tax ID:
TX SOS Charter (filing) Number:
DUNS Number (if known):
B. APPLICATION CONTACT
If TCEQ needs additional information regarding this application, who should be contacted?
1. Name: Rabon A. Metcalf, P.E.
Title: Owner
Company: RME Consulting Engineers
2. Phone No.: ( 97 9 ) 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 Registry)
2. Name of Project or Site (the name as known by the community where this facility /project is located):
MDW Centre - Detention Facility
(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 information.
Section A: Enter the physical address for the site. (verify it with 1 SPS.com or other delivery source)
Street Number: 1150
Street Name: University Drive
City: College Station, TX
ZIP Code: 77840
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 1 of Woodland subdivision located 2 miles west from intersection of Hwy 290 & 11135 accessible on Hwy 290 South)
City where the site is located or nearest city to site:
ZIP Code where site is located:
4. Identify the county where the site is located: Brazos
5. Latitude: 30 °38'6.57 "N
Longitude: 96 °19'11.67 "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) Commercial 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? i No Yes — If Yes, do not submit this NOI. 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.gov)
Primary: 1522 Secondary:
TCEQ -20022 (03/05/2008)
Page 2
3(a) What is the
total number of acres disturbed? 2.0 acres
3(b) Is the project
If Yes, the total
If No, the total
project site does
general permit
site of a larger common plan of development or sale? ❑ Yes " No
part
number of acres disturbed can be less than 5 acres.
number of acres disturbed must be 5 or more. If the total number of acres disturbed is less than 5 then the
not qualify for coverage through this Notice of Intent. Coverage will be denied. See the requirements in the
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?
Burton 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
303(d) list of
❑ Yes
If Yes, provide
of the surface water bodies receiving discharges from the construction site on the latest EPA - approved CWA
impaired waters?
/ No
the name of the impaired water body(s).. _
4(d) Is the discharge
If Yes, what
Note: The
into an MS4? GI Yes No
is the name of the MS4 Operator? City Of COIIeQe Station
general permit requires you to send a copy of the NOI to the MS4 Operator.
4(e) Is the discharge
Transition Zone
❑ Yes
If the answer is
be included or
or potential discharge within the Recharge Zone, Contributing Zone, or Contributing Zone within the
of the Edwards Aquifer?
' No
Yes, please note that a copy of the agency approved Plan required by the Edwards Aquifer Rule (30 TAC Chapter 213) must
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.
Yes
I certify that I have obtained a copy and understand the terms and conditions of the general permit (TXR150000).
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.
i I Yes
I understand that a Notice of Termination (NOT) must be submitted when this authorization is no longer needed.
17, I 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.
I i I Yes
Operator Certification:
1, Ronald Cowe Property Manaaer
certify under penalty
to assure that qualified
system, or those
accurate, and complete.
knowing violations.
I further certify
proof of such authorization
Signature:
Typed or printed name (Required & must be legible) Title (Required & legible)
of law that this document and all attachments were prepared under my direction or supervision in accordance with a system designed
personnel properly gather and evaluate the information submitted. Based on my inquiry of the person or persons who manage the
persons directly responsible for gathering the information, the information submitted is, to the best of my knowledge and belief, true,
I am aware there are significant penalties for submitting false information, including the possibility of fine and imprisonment for
that I am authorized under 30 'Texas :1.dministrative ('ode §305.4.4 to sign and submit this document, and can provide documentation in
upon request.
Date:
(Use blue ink)
TCEQ -20022 (03/05/2008)
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