Loading...
HomeMy WebLinkAboutNOI(10/7/2009) Erika Bridges - College Station #2 HEB - Applications From: To: CC: Date: Subject: Attachments: "Johnson, Mark" <mjohnson @burypartners.com> "Erika Bridges" <Ebridges @cstx.gov> "Chuck Ellison" <Chuck @ellisonlaw.com >, "Sharp, Michael" <msharp @burypar... 10/6/2009 5:15 PM College Station #2 HEB - Applications 20091006170750977.pdf The attached NOI form was not included in the submittal to the City. Please let me know if this is an acceptable means of transmitting this to you or if we need to forward the original to you. Thank you for all of your help. Thanks. mj Mark R. Johnson, P.E., LEED® AP Principal /Senior Project Manager Bury+Partners Engineering Solutions TBPE F1048 922 Isom Road, Suite 100 San Antonio, TX 78216 -4135 Phone: (210) 525 -9090 Fax: (210) 525 -0529 www.burypartners.com CONFIDENTIALITY NOTE: This e-mail and any files transmitted with it contain privileged and confidential information and are intended solely for the use of the individual or entity to which they are addressed. If you are not the intended recipient or the person responsible for delivering the e-mail to the intended recipient, you are hereby notified that any dissemination or copying of this e-mail or any of its attachment(s) is strictly prohibited. If you have received this e-mail in error, please immediately notify the sending individual or entity by e -mail and permanently delete the original e-mail and attachment(s) from your computer system. Page 1 TCEQ Office Use Only Notice of Intent (NOI) for Storm Water PermitNo.: TXR15 at Discharges Associated with Construction RN: RE Activity under TPDES General Permit CN: TCEQ (TXR150000) Ref No: Sign up now for ePermits NOI Get Instant Permit Coverage • °d If filing a paper NOI you can pay the at www6.tceq.state.tx.us /steers and only pay a $225 application fee. application fee on line? Go to https: //www6.tceq.state.tx.us /epay/ i:M PO:RTANT: *Lisa the INSTRUC1 IONS to fill taut eat h ya .soon in tl�t Icartn. *Use the attached ('USTOl .I.EIt C:IIF.0 IC.LIST to make certain all you filled tart ail required inform tic tl. *Irt .iimplcte 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 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: Mailed: Check/Money Order No.: Company Name on checking account: EPAY: A. OPER Voucher No.: Is the Payment Voucher copy attached? Yes pl lle:ant 1. If the applicant is currently a customer with TCEQ, what is the Customer Number (CN) issued to this entity? CN 602649634 (Search Central Reei 2. What is the Legal Name of the entity (applicant) applying for this permit? Mr. Kris Mickshaw / Spaw Glass Construction Corporation (The legal name must be spelled exactly as f led 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: Kris Mickshaw Job Title: 4. What is the Operator's (applicant) mailing address as recognized by the U ostal Service? (verify at tJSPS.com) Address: 13800 West Road Suite No./Bldg. No. /Mail Code: City: Houston state:Texas ZIP Code: 77041 -1114 Country Mailing Information (if outside USA). Country Code: Postal Code: 5. Phone No.: ( 281 ) 970 -0300 Extension: 6. Fax No.: ( 281) 970 -5310 E - mail Address: k @spawglass.com 7. Indicate the type of Customer: Proprietorship- Government Government (describe): • Individual ❑Sole D.B.A. I Limited Partnership ❑ Corporation /Federal /General Partnership ❑ State Government ❑County /City Government ❑Other Government IR Other • TCEQ -20022 (03/05/2008) Page 1 8. Independent Operator: t Yes No (If governmental entity, subsidiary, or part of a Larger corporation, check "No ".) 9. Number of Employees: 00 S 21 -100; In 101 -250; 112 251 -500; or • 501 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: Title: Company: 2. Phone No.: ( ) Extension: 3. Fax No.: E -mail Address: '. REGULATED ENT II' (l.) l v't)Rtr't'12' ON PROJECT OR Si 1 I. TCEQ Issued RE Reference Number (RN): RN 105729180 (Search Central Registry) 2. Name of Project or Site (the name as known by the community where this facility /project is located): Tower Point Subdivision - HEB College Station No. 2 Store (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 action A for a physical address. If No, complete Scriirm 13 for site location information. Section a: Enter the physical address for the site. (verify it with USPS.com or other delivery source) Street Number: Street Name: City: ZIP Code: Section Il :: 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 & 1H35 accessible on Hwy 290 South) West intersection of SH 6 & SH 40 City where the site is located or nearest city to site: College Station ZIP Code where site is located: 77845 4. Identify the county where the site is located: Brazos 5. Latitude: 30degrees 33' 00" Longitude: 96 degrees 38' 00" 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 Retail 7. What is the mailing address for the regulated entity? Is the RE mailing address the same as the Operator? LJYes, address is the same as Operator SI No, provide the address Street Number: I Street Name: City: I State: ZIP Code: R A I, K.A(. 1 ' II Iii I`IC! I . Is the site located on Indian Country Lands? • No 111 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.eov) Primary: 1 542 Secondary: 1 623 TCEQ-20022 (03/05/2008) Page 2 3(a) What is the total number of acres disturbed? 12.5 3(b) Is the project If Yes, the total If No, the total project site does :eneral permit site part of a larger common plan of development or sale? U Yes ONo 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. Diaclliar a information (al infa rip ation t1S °l` he 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? Navasota River Below Lewisville 4(b) What is the segment number(s) of the classified water body(s) that the discharge or potential discharge will eventually reach? 1202 4(c) Are any 303(d) list of © Yes If Yes, •rovide 4(d) Is the discharge If Yes, what Note: The of the surface water bodies receiving discharges from the construction site on the latest EPA- approved CWA impaired waters? Mil No the name of the impaired water bod s . __.. into an MS4? a Yes NI No is the name of the MS4 Operator? College Station Utilities 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? III Yes IM No If the answer is be included or E. CERTiFIC 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. A`l'ION 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). 1,/ 1 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. 0 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 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 TXR150000. O perator Certification: 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 Administrative Code §305.44 to sign and submit this document, and can provide documentation in upan request. 4 ' Date: 0w se blue ink TCEQ -20022 (03/05/2008) Page 3 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 of the Instructions for mailing addresses. TCEQ -20022 Checklist (03/05/2008) Page I Customer GP Notice of Intent Checklist TXR150000 d This checklist is for use by the operator to ensure a complete application. Missing information may result in denial of coverage under the permit. (See NOI Process description in the Instructions) in Application Fee of $325.00 was mailed separately to TCEQ's Cashiers's Office (separate from the NOI) or the EPAY payment voucher is attached. :❑❑❑❑❑❑❑❑ OPERATOR INFORMATION - Confirm each item is complete: d Customer Number (CN) issued by TCEQ Central Registry Legal Name as filed to do business in Texas (Call TX SOS 512/463 -5555) Name and Title of person signing the application. This person must meet signatory requirements in 30 TAC Section 305.43 Operator Mailing Address is complete & verifiable with USPS. www.usps.com Phone Numbers/E -mail Address Type of Operator (Entity Type) Independent Operator Number of Employees For Corporations or Limited Partnerships — Tax ID and SOS Filing numbers are REQUIRED Application Contact person we can call for questions about this application. I ❑❑❑o❑❑❑ 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) Site/Project Name/Regulated Entity Site/Project (RE) Physical Address Please do not use a rural route or post office box for a site location Or if no physical address, the location information that includes description, zip code and city is listed. Latitude and Longitude TCEQi SUS Topographic Map Viewer or TerraServer -USA Business description Site Mailing Address (checked same as operator or complete & verifiable with USPS. www.usps.com) _ 1 i MODOOMEIE GENERAL CHARACTERISTICS - Confirm each item is complete: d Indian Country Lands the facility is not on Indian Country Lands Standard Industrial Classification (SIC) code www .osha.aov /oshstats/sicser.html Acres Disturbed is provided and qualifies for coverage through a NOI. Common plan of development or for sale? Discharge Information: receiving water body segment number(s) is REQUIRED water body on the latest EPA - Approved Clean Water Act 303(d) list of impaired waters MS4 Operator Edwards Aquifer Rule _ CERTIFICATION Certification statements have been checked indicating "Yes" Signature meets 30 Texas Administrative Code (TAC) §305.44 and is original and has been provided for the Operator. 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 of the Instructions for mailing addresses. TCEQ -20022 Checklist (03/05/2008) Page I Notice of Intent (NOI) for Storm Water Discharges Associated with Construction Activity under TPDES General Permit (TXR150000) General Information and Instructions GENERAL INFORMATION Where to Send the Notice of Intent (NOI) and other related forms: BY REGULAR U.S. MAIL BY OVERNIGHT/EXPRESS MAIL Texas Commission on Environmental Quality Texas Commission on Environmental Quality Storm Water Processing Center (MC228) Storm Water Processing Center (MC228) P.O. Box 13087 12100 Park 35 Circle Austin, TX 78711 -3087 Austin, TX 78753 TCEQ Contact list: Application Processing Questions relating to the status and form requirements: 512/239 -3700, 512/245 -0130 or swpermit@toeq.state.tx.us Technical Questions relating to the general permit: 512/239 -4671 or swga@tceq.state.tx.us Environmental Law Division: 512/239 -0600 Records Management for obtaining copies of fonns submitted to TCEQ: 512/239 -0900 Information Services for obtaining reports from program data bases (as available): 512/239 -DATA (3282) Financial Administration's Cashier's office: 512/239 -0357 or 512/239 -0187 Notice of Intent Process: When your NOI is received by the program, the form will be processed as follows: 1. Administrative Review: Each item on the form will be reviewed for a complete response. In addition, the operator's legal name must be verified with Texas Secretary of State as valid and active (if applicable). The address(s) on the form must be verified with the US Postal service as an address receiving regular mail delivery. Never give an overnight/express mailing address. 2. Notice of Deficiency: If an item is incomplete or not verifiable as indicated above, a notice of deficiency (NOD) will be mailed to the operator. The operator will have 30 days to respond to the NOD. The response will be reviewed for completeness. 3. Acknowledgment of Coverage: An Acknowledgment Certificate will be mailed to the operator. This certificate acknowledges coverage under the general permit. -or^ Denial of Coverage: If the application is too incomplete to process, or the operator fails to respond to the NOD or the response is inadequate, coverage under the general permit may be denied. If coverage is denied, the operator will be notified. General Permit (Your Permit) If filing the NOI through ePermits online application, coverage under the general permit begins the day the NOT is submitted to TCEQ through epermits. Sign up now for on line NOI at https: / /www6.tceq.state.tx.us /steers/ If mailing a paper NOI, coverage under the general permit begins seven (7) days after a completed NOI is postmarked for delivery to the TCEQ. You should have a copy of your general permit when submitting your application. You may view and print your permit for which you are seeking coverage, on the TCEQ web site http: / /www.tceq .state.tx.us /permitting/water quality /stormwater/TXR15 AIR.html. General Permit Forms The Notice of Intent (NOI), Notice of Termination (NOT), and Notice of Change (NOC) #20391 with instructions are available in Adobe Acrobat PDF format on the TCEQ web site http: / /www.tceq .state.tx.us/permitting /water quality /stormwater/TXR15 AIR.html. Sign up now for on line Notice of Termination application at https: / /www6.tceq.state.tx.us /steers/ Change in Operator An authorization under the general permit is not transferable. lithe operator or owner of the regulated entity changes, the present permittee must submit a Notice of Termination and the new operator must submit a Notice of Intent. The NOT and NOI must be submitted not later than 10 days prior to the change in Operator status. TCEQ -20022 Instructions (03/05/2008) Page 1 TCEQ Central Registry Core Data Form The Core Data Form has been incorporated into this form. Do not send a core data form to TCEQ. After final acknowledgment of coverage under the general permit, the program will assign a Customer Number (CN) and Regulated Entity Number (RN). For Construction Permits, a new RN will be assigned for each Notice of Intent filed with TCEQ, since construction project sites can overlap with other Customers. The RN assigned to your construction project will not be assigned to any other TCEQ authorization. You can find the information on the Central Registry web site at www4.tceq.state.tx.us/croub. You can search by the Regulated Entity (RN), Customer Number (CN) or Name ( Permittee), or by your permit number under the search field labeled "Additional ID". Capitalize all letters in the permit number. The Customer (Permittee) is responsible for providing consistent information to the TCEQ, and for updating all CN and RN data for all authorizations as changes occur. For General Permits, a Notice of Change form must be submitted to the program area. Application Fees: $225.00 application fee if submitting the NOI through ePermits. $325.00 application fee if submitting a paper NOI for processing. The application fee is required to be paid at the time the NOI is submitted. Failure to submit payment at the time the application is filed will cause delays in acknowledgment or denial of coverage under the general permit. • Mailed Payments: DO NOT mail your check with the original Notice of Intent application. Use the attached Application Fee payment submittal form is mailing the payment. Do not include a copy of the NOI. BY REGULAR U.S. MAIL Texas Commission on Environmental Quality Financial Administration Division Cashier's Office, MC -214 P.O. Box 13088 Austin, TX 78711 -3088 BY OVERNIGHT/EXPRESS MAIL Texas Commission on Environmental Quality Financial Administration Division Cashier's Office, MC -214 12100 Park 35 Circle Austin, TX 78753 • ePAY Electronic Payment: Go to https : / /www6.tceq.state.tx.us/epay/ Select Water Quality, then select the fee category "GENERAL PERMIT CONSTRUCTION STORM WATER DISCHARGE NOl APPLICATION ". You must include a copy of the payment voucher with your NOI. Your NOT will not be considered complete without the payment voucher. The Annual Water Quality Fee has been consolidated into the Application Fee effective March 5, 2008. An annual fee will not be assessed and billed to operators on 9/1/2008. This does not relieve the operator of fees due for prior fiscal year assessments. The operator will continue to receive an invoice for payment of any past due annual fee. A 5% penalty will be assessed if the payment is received by TCEQ after the due date. Annual fee assessments cannot be waived as long as the authorization under the general permit was active on September 1 of the FY billed. TCEQ -20022 Instructions (03/05/2008) Page 2 INSTRUCTIONS FOR FILLING OUT THE NOI FORM - OPERATOR Os defined nil the es sercdpermti 1. TCEQ Issued Customer Number (CN) TCEQ's Central Registry will assign each customer a number that begins with "CN," followed by nine digits. This is not a permit number, registration number, or license number. • If this customer has not been assigned a Customer Reference Number, leave the space for the Customer Reference Number blank. • If this customer has already been assigned this number, enter the operator's Customer Reference Number in the space provided. 2. Legal Name Provide the legal name of the facility operator, as authorized to do business in Texas. The name must be provided exactly as filed with the Texas Secretary of State (SOS), or on other legal documents forming the entity, that is filed in the county where doing business. You may contact the SOS at 512/463 -5555, or go to httn:// www. sos .state.tx.us/corp /contactshtml for more information related to filing in Texas. If filed in the county where doing business, provide a copy of the legal documents showing the legal name. 3. Name and Title of person signing the Notice of Intent application form. Signature meets 30 Texas Administrative Code (TAC) §305.44 4. Operator Mailing Address Provide a complete mailing address for receiving mail from the TCEQ. The address must be verifiable with the US Postal Service at www.usps.com, for regular mail delivery (not overnight express mail). If you find that the address is not verifiable using the USPS web search, please indicate the address is used by the USPS for regular mail delivery. 5. Phone Number This number should correspond to this customer's mailing address given earlier. Enter the area code and phone number here. Leave "Extension" blank if this customer's phone system lacks this feature. 6. Fax Number and E -mail Address This number and E -mail address should correspond to operator's mailing address provided earlier. (Optional Information) 7. Type of Entity Check only one box that identifies the type of entity. Use the descriptions below to identify the appropriate entity type: Individual is a customer who has not established a business, but conducts an activity that needs to be regulated by the TCEQ. Sole Proprietorship— D.B.A. is a customer that is owned by only one person and has not been incorporated. This business may: • be under the person's name • have its own name ("doing business as," or d.b.a.) • have any number of employees Partnership is a customer that is established as a partnership as defined by the Texas Secretary of State's Office. Corporation the customer meets all of these conditions: • is a legally incorporated entity under the laws of any state or country • is recognized as a corporation by the Texas Secretary of State • has proper operating authority to operate in Texas. Government- Federal, state, county, or city government (as appropriate) the customer is either an agency of one of these levels of government or the governmental body itself. Other is Estate, Trust, etc. the customer does not fit one of the above descriptions. Enter a short description of the type of customer in the blank provided. 8. Independent Operator Check "No" if this customer is a subsidiary, part of a larger company, or is a governmental entity. Otherwise, check "Yes." 9. Number of Employees Check one box to show the number of employees for this customer's entire company, at all locations. This is not necessarily the number of employees at the site named in the NOI. 10. State Franchise Tax ID Number Corporations and limited liability companies that operate in Texas are issued a franchise tax identification number. If this customer is a corporation or limited liability company, enter this number here. Federal Tax ID All businesses, except for some small sole proprietors, individuals, or general partnerships should have a federal taxpayer identification number (TIN). Enter this number here. Use no prefixes, dashes, or hyphens. Sole proprietors, individuals, or general partnerships do not need to provide a federal tax ID. TX SOS Charter (filing) Number Corporations and Limited Partnerships required to register with the Texas Secretary of State are issued a charter or filing number. You may obtain further information by callin• SOS at 512/463 -5555 h .: / /www.sos.state.tx.us /co • contact.shtml. TCEQ -20022 Instructions (03/05/2008) Page 3 DUNS Number Most businesses have a DUNS (Data Universal Numbering System) number issued by Dun and Bradstreet Corp. If this customer has one, enter it here. B. Application Contact Provide the name, title and conununication information of the person that TCEQ can contact for additional information regarding this application. If theapplicationis j_nissin: information and there is no contact • erson to call. the application maybe denied. C. REM 11.A117.0 ENTLIN (RE) INFORMA`noN ON PROJECT OR SI1 E 1. Regulated Entity Reference Number (RN) This is a number issued by TCEQ's Central Registry to sites (a location where a regulated activity occurs) regulated by TCEQ. This is not a permit number, registration number, or license number. • If this Regulated Entity has not been assigned a Regulated Entity Number, leave this space blank. • If this customer has been assigned this number, enter the operator's Regulated Entity Number, 2. Site/Project Name/Regulated Entity If the site is already regulated by TCEQ, use the same name as on the existing Regulated Entity Reference Number (RN). If new, provide the name of the site as known by the public in the area where the site is located. The name you provide on this application will be used in the TCEQ Central Registry as the Regulated Entity. 3. Site/Project (RE) Physical Address Section A: Enter the complete physical address of where the site is located. This must be a street number and street name for a complete physical address. This address must be validated through US Postal Service or your local police (911 service) as a valid address. Please confirm this to be a complete and valid address. In some rural areas, new addresses are being assigned to replace rural route addresses. Please do not use a rural route or post office box for a site location. Section B: If a site does not have an actual physical address that includes a street number and street name, then provide a complete written location access description, and the zip code and city where the site is located. For example: The site is located 2 miles west from intersection of Hwy 290 & 11135, located on the southwest comer of the Hwy 290 South bound lane." This includes authorizations for construction projects such as highways and subdivision. 4. Identify the County where the site is located. If the site covers more than one county, provide the county that is most affected by the authorized activity and list the additional county(s) as secondary. 5. Latitude and Longitude Enter the latitude and longitude of the site in either degrees, minutes, and seconds or decimal form. For help obtaining the latitude and longitude, go to: TCEQ USGS Topographic Map Viewer or TerraServer-USA 6. Description of Activity Regulated In your own words, briefly describe the primary business being conducted at the site. (A description specific to what you are doing that requires this authorization - Do not repeat the SIC Code(s).) S i l l MAILING ADDRESS Provide a complete mailing address to be used by TCEQ for receiving mail at the site. In most cases, the address is the same as the operator. If so, simply place a check mark in the box. If you provide a different address, please verify the address with USPS as instructed above for the operator address. 1), GF.11 Cif Sit 4.0 11:141SI ICS I. Indian Country Lands If your site is located on Indian Country Lands, the TCEQ does not have authority to process your application. You must obtain authorization through EPA, Region VI, Dallas. Do not submit this form to TCEQ. Indian Country means (1) all land within the limits of any American Indian reservation under the jurisdiction of the U.S. government, notwithstanding the issuance of any patent, and including rights-of-way running throughout the reservation; (2) all dependent Indian communities within the borders of the United States whether within the original or subsequently acquired territory thereof, and whether within or outside the limits of a State; and (3) all Indian allotments, the Indian titles which have not been extinguished, including rights-of-way running through the same. Indian Tribe means any Indian Tribe, band, nation, or community recognized by the Secretary of the Interior and exercising substantial governmental duties and powers. 2. Standard Industrial Classification (SIC) code Provide the SIC code that best describes the construction activity being conducted at the site. Common SIC Codes related to construction activities include: 1521 Construction of Single Family Homes; 1522 Construction of Residential Bldgs. Other than Single Family Homes; 1541 Construction of Industrial Bldgs. and Warehouses; 1542 Construction of Non-residential Bldgs. other than Industrial Bldgs. and Warehouses; 1611 Highway & Street Construction, except Highway Construction; 1622 Bridge, Tunnel, & Elevated Highway Construction; 1623 Water, Sewer, Pipeline & Communications, and Power Line Construction. For help with SIC codes, go to: wvvw.osha.gov/oshstats/sicser.htn1 TCEQ-20022 Instructions (03/05/2008) Page 4 3. Estimated Area of Land Disturbed 3(a). Provide the approximate number of acres that the construction site will disturb. 3(b). Indicate is the site is part of a common plan of development or for sale. Construction activities that disturb less than one acre, unless they are part of a larger common plan that disturbs more than one acre, do not require permit coverage. Construction activities that disturb between one and five acre, unless they are part of a common plan that disturbs five acres or more acres, do not require submission of an NOI. Therefore, the estimated area of land disturbed should not be less than five, unless the project is part of a larger common plan that disturbs five or more acres. "Disturb" means any clearing, grading, excavating, or other similar activities. If you have any questions about this item, please call the storm water technical staff at (512)239 -4671. 4. Discharge Information 4 (a). The storm water may be discharged directly to a receiving stream or through a MS4* from your site. It eventually reaches a receiving water body such as a local stream or lake, possibly via a drainage ditch. You must provide the name of the water body that receives the discharge from the site (a local stream or lake). 4 (b). The classified segment number(s) is REQUIRED to get coverage. Go to the link to find the segment number of the classified water body where storm water will flow http: / /www.tceq. state. tx. us /compliance /monitoring/ water / quality /data/wom/viewer /viewer.html . Call Water Quality Assessments at 512/239 -4671 for further assistance. Another source for segments is: http: / /www.tceq. state. tx. us /comet exec/formsJrubs/pubs/gi/gi- 316 /index.html 4 (c). If any surface water body(s) receiving discharges from the construction site are on the latest EPA - approved CWA § 303(d) list of impaired waters, provide the name(s) of the water body(s). EPA approved CWA 303d list of impaired waters can be found at: Texas Water Quality Inventory and 303(d) List - Texas Commission on Environmental Quality - www.tceq.state.tx.us 4 (d). Identify the MS4* Operator name if the storm water discharge is into an MS4. *MS4 is an acronym for Municipal separate storm sewer system. MS4 is defined as a separate storm sewer system owned or operated by a state, city, town, county, district, association, or other public body (created by or pursuant to state law) having jurisdiction over disposal of sewage, industrial wastes, storm water, or other wastes, including special districts under state law such as a sewer district, flood control or drainage district, or similar entity, or an Indian tribe or an authorized Indian tribal organization, that discharges to water in the state. For assistance, you may call the technical staff of the Water Quality Assessment & Standards Section at 512/239 -4671. 4 (e). Edwards Aquifer Rule See maps on the TCEQ website to determine if the site is located within the Recharge Zone, Contributing Zone, or Contributing Zone within the Transition Zone of the Edwards Aquifer at http: / /www.tceq.state.tx.us/comnliance/field ops /eapp /viewer.html. If the discharge or potential discharge is within the Recharge Zone, Contributing Zone, or Contributing Zone within the Transition Zone of the Edwards Aquifer, a site specific authorization approved by the Executive Director under the Edwards Aquifer Protection Program (30 TAC Chapter 213) is required before construction can begin. The general permit requires the approved Contributing Zone Plan or Water Pollution Abatement Plan to be included as a part of the Storm Water Pollution Prevention Plan. The certification must be answered "Yes" for coverage under the general permit. t"t "RTIFit, °, TIONNS _ F Failure to indicate "Yes" to ALL of the certification items may result in denial of coverage under the general permit. The certification must bear an original signature of a person meeting the signatory requirements specified under 30 Texas Administrative Code §305.44 IF YOU ARE A CORPORATION: The regulation that controls who may sign an NOI or similar form is 30 Texas Administrative Code §305.44(a)(1) (see below). According to this code provision, any corporate representative may sign an NOT or similar form so long as the authority to sign such a document has been delegated to that person in accordance with corporate procedures. By signing the NOI or similar form, you are certifying that such authority has been delegated to you. The TCEQ may request documentation evidencing such authority. IF YOU ARE A MUNICIPALITY OR OTHER GOVERNMENT ENTITY: The regulation that controls who may sign an NOI or similar form is 30 Texas Administrative Code §305.44(a)(3) (see below). According to this code provision, only a ranking elected official or principal executive officer may sign an NOI or similar form. Persons such as the City Mayor or County Commissioner will be considered ranking elected officials. In order to identify the principal executive officer of your government entity, it may be beneficial to consult our ci charter, coun or ci ordinances, or the Texas statue s under which our : overnment enti was formed. An NOT or TCEQ -20022 Instructions (03/05/2008) Page 5 similar document that is signed by a government official who is not a ranking elected official or principal executive officer does not conform to §305.44(ax3). The signatory requirement may not be delegated to a government representative other than those identified in the regulation. By signing the NOI or similar form, you are certifying that you are either a ranking elected official or principal executive officer as required by the administrative code. Documentation demonstrating your position as a ranking elected official or principal executive officer may be requested by the TCEQ. If you have any questions or need additional information concerning the signatory requirements discussed above, please contact the Texas Commission on Environmental Quality's Environmental Law Division at 512/239 -0600. 30 Texas Administrative Code §305.44. Signatories to Applications. (a) All applications shall be signed as follows. (1) For a corporation, the application shall be signed by a responsible corporate officer. For purposes of this paragraph, a responsible corporate officer means a president, secretary, treasurer, or vice- president of the corporation in charge of a principal business function, or any other person who performs similar policy or decision - making functions for the corporation; or the manager of one or more manufacturing, production, or operating facilities employing more than 250 persons or having gross annual sales or expenditures exceeding $25 million (in second - quarter 1980 dollars), if authority to sign documents has been assigned or delegated to the manager in accordance with corporate procedures. Corporate procedures governing authority to sign permit or post - closure order applications may provide for assignment or delegation to applicable corporate positions rather than to specific individuals. (2) For a partnership or sole proprietorship, the application shall be signed by a general partner or the proprietor, respectively. (3) For a municipality, state, federal, or other public agency, the application shall be signed by either a principal executive officer or a ranking elected official. For purposes of this paragraph, a principal executive officer of a federal agency includes the chief executive officer of the agency, or a senior executive officer having responsibility for the overall operations of a principal geographic unit of the agency (e.g., regional administrator of the EPA). TCEQ -20022 Instructions (03/05/2008) Page 6 Texas Commission on Environmental Quality General Permit Payment Submittal Form $325 for a paper Construction NOI Application Fee Use this form to submit your Application Fee only if you are mailing your payment. *Complete items 1 through 5 below: •Staple your check in the space provided at the bottom of this document. • Do not mail this form with your NOI form. • Do not mail this form to the same address as your NOI. Mail this form and your check to: BY REGULAR U.S. MAIL Texas Commission on Environmental Quality Financial Administration Division Cashier's Office, MC -214 P.O. Box 13088 Austin, TX 78711 -3088 BY OVERNIGHT/EXPRESS MAIL Texas Commission on Environmental Quality Financial Administration Division Cashier's Office, MC -214 12100 Park 35 Circle Austin, TX 78753 Fee Code: GPA General Permit: TXR150000 1. Check / Money Order No: 2. Amount of Check/Money Order: 3. Date of Check or Money Order: 4. Name on Check or Money Order: 5. NOI INFORMATION If the check is for more than one NOT, list each Project/Site (RE) Name and Physical Address exactly as provided on the NOI. DO NOT SUBMIT A COPY OF THE NOI WITH THIS FORM AS IT COULD CAUSE DUPLICATE PERMIT ENTRIES. See Attached List of Sites (If more space is needed, you may attach a list.) Project/Site (RE) Name: Project/Site (RE) Physical Address: Staple Check In This Space TCEQ -20134 (3/05/2008) Page 1