Ridgecrest-PT120912___. ...... — ... -...... _ .
"lT(111Q Office Use Only
Notice of intent (N01) for Storm Water t'ermit No.: `rXR I ti
Discharges Associated with Construction RN:
Activity under TPDES General Permit C'N:
TCEQ JXR1 5000 Ref No:
Sian up tiow fot• t fit r torts o I itt _ ...
i� Gvt Itlstatttt hermit .tt� t °�a,t. and €rtal�� aat� a �'�� pi�llc.atlttttt fee,
tl"Irirng;r paper NCl1 yora c to pay tfie application fee on Iarae? (lo to www.Iceu.sta1c.1x.US/eP11V
Select 1'ee 1 ype: {&k NER.M PER4t1 t ( `)NS 1 ttE1C' I ION' SI'C)ItM W`A't t ti [ASC ltAW.A: hC }t APPt.1C A 1100
19 wbiwa =.tarza 136jwr N( M, coveraagc under the geocraI permit starts seven (7) days of €cr the date postmarked for deliver}, to
TC FQ;
IMPORTANT:
-Use the INSTRUCTIONS to fill out each question in this form,
Use the attached C1.STOl4'il~'R CHE:CKLISix to nmake certain all you failed out all required information.
•Incontple €e applications WILL delay approval or result in autocratic; Denial.
Renewal of General Permit
Is this NOI to renew an ACTIVE permit'?
Yes - What is your permit number? Permit No. 'l`;?GR15
c, ]No - a permit number a -ill be issued,
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Application Fee if mailing a paper NOI:
You must Luray the $325 Application Fee to hC I: Q for the application tc be considered complete,.
1'ayivent and. NOI n1uSL lure mailed to separate adclres.ses. See instructions for correct trailing addresses,
Provide: your payment information below, for us to �,e_rify payment: of the application fee:
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Made Check �lonev Order No.. � � Cornpuny Name on checking account:
t �
EPAY; 4orrcher i lu.: is the Pay�tneot Voucher copy atrached" Yes
A. i1i'i!;.IUATOR(applicant)
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1, If the applicant is currently a customee u tilt I C';l, {). what i rite Customer Number (C'N) issued to this entity`?
C;1\ t?E ^oar s:Is Cezatr.al t2ea istr r)
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2. What is the I .egal Name of the entity (applicant) applying for this permit`?
Classic Neighborhood - FC Holdings, 1_.i_.C.
The foal name rnuvt he si eh .d r:xt ra3?v as iaed with site 1'sxas ,Secrerury t / State. C,,, ay, or rn ?d•r.- legal dot:r uxR�nt,;ar�n;;i�g the Erxr,tt�.j
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3. What is the rtarne and title of the person signing thc, application`?
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(`Me person must he an official nice tang .signtatory requirerncnits ira't 305,43(a))
Name:
i
4, What is the Operator's (applicant) mailing address as recognized by the US Postal Set - vice'? ivcrik ut USPS.cofnl
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Address: 1 i POST T } f� �;d * etc No B1d .No.;'N•7ail Code:
City: HOUSTON Shat Texans � %11' Code: 770355 -7310
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Country Mailing 11oformation (if outside I SA), {.reentry Code: 1'iastttl Code:
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Extension'.
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_ . 1 hone No.: (1372 ? 323 -7503
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6. Fax No.: t ) Fi. -n ilArt {irass:ljaci jackson@dwhomes.com
dwhC3ri es.com
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". Indicate the type of Cusiorrter.
([Individual [ Scale .Proprietorslmip- f)._F3.A._ [I- ittmitedPartnership
[C_orporation [hederal Cio vern meat [{general Partnership
[State Government [:JCounry Government [City Government
[Other Government [C ?ther (describe):
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3(a) What is the total IlUmbet a
of titres disturbed? 7
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1(b) Is the pro ect site part of 'a larger common plan of development or sate'' Fs Y cs, E]No
If Yes, the total number of acre 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
I)r0ieCL site, does not qualify for coverage through this Notice of Intent. Coverage will be denied. See the requirements in the
—construcclon Sites. . .. . ............ ... ..... . .............. -.- ......
4.,"Dis6A'ig'e, Information is , it laformatIan MUST bc, pr0vided-or the l,p
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4(a) What is the name ofthe N-vate r bodv(s) to receive the storm water runciff or potential runoff from the site"
Denton Creek
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4(b) What is the segyflient number(s) of the tied water body(s) that the discharge or potential discharge will eventually
reach? 0825
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4(c) Are any of the surface water bodies receiving,, discharges from the constrUCtion site on the latest EPA-approved CWA
303(4) list of impaired waters?
0 Yes E] No
If Yes, provide the name of tile impaired watet body(s),
4(d) Is the discharge into an MS4? DYes E]Nk)
H'Yes, what is the numc ol'the MS4 operator?Qit. of C ppell
Notc The general pennit 'you to send a Cs)Py of the \01 to dic MS4 Operator,
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al discharge within the Recharge Contributing Zone. orConiribUtillgZ011C "ithinthe
4(e) Isthedischaigeorpownti, ge Zone, Conti
Transition Zone of the Edwards Aquifer')
Yes No
If the answer is Yes, please note that a copy of the agency approved Plan required by the Ed\,\,ards Aquif4r Rule (30 TAC Chapter 2t3) must
be included or referenced in the Storm \,V'ater Pollution Prevention Plan.
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E. CERTIFICATION
Check "Yes" to the certifications below. V �1 11 1 es uit in denial. �tifure to cerdCy or all ilemb 'i
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Y-
I certify that I have obtained a copy and understand the tei -nis and conditions ofthe general permitjjNR 150000
Yes
1 1 certifv that the full legal narne of the entity (Operator) applying for this permit has been provided and is legally
itithorizod to do [)U'SineSS 1.
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Yes lderstand that a Notice of 'I erritination (NOT) inust be SUNnitted when this authorization is no longer needed.
FV I ui
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Yes I certify that a storm water pollution prevention plan hazy been developed and implemented prior to construction,
anti that is compliant with any applicable local sediment and erosion control plans and prepared and. implemented
as required in the general permit TXIT 150000�
Operator Certification:
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'I ypod or printed ume Fitic (Neq f;PcW 'K legibie)
oerfify under penalty that ;.tits document acid all altachmcnts vt, ,Vre, prepwvd under Tin direction or supervision in accordance with a system desigm-d
to BsUre that quaiii-ied personnel properly gather and evaluate the information submitted. l3ased on my inquiry ol'the person or persons who manage the
system, or those jwrsons directly responsible for gadw� ing, (lie information, the inl'ommtion submitted is, to the best of knowledge and, belief' true,
accurate, and complete. f ami aware [here arc ignit'ic"Int 1-,wnahies Ckw submitting false irli n nzitiott, including the possibility of'fine and imprisonment l'or
knowing violations.
I ffirdler certify I hat 1 '11), "-luffiorized under 311 TcxmN _ dnjiqisfmlil C Ld(A 05.44 to sign and submit ljlis docunlenl� and car, provide docurnewation in
Proof'of'such
Signature: Dtite: ............................................................................... ............
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WFIQ-2002 (0.-J)V2008) Page 3
Texas C"orninission on Environmental Quality
General Perinit Payment Submittal Form
$325 lot, jiaper Construction M.)JApplication Fee
*Staple your check in the space provided at the bottom ofthis document.
*Do not rnail this I�on-r with your NO[ lbrm,
*Do not mail this 0.4,11 to the same address as vour NOL
Mail this form ind your check to:
BY REGULAR U.S. MAIL
BY OVERNIGIIT/EXPRF,,SS MAIL
Texas Commission on Environmental QUality
Financial Administr-ation Division
Texas Commission on Environmental Quality
Financial Administration Division
Cashier's Office, MC-214
Cashier's Office, MC-214
P.O. Box 13088
12 100 Park 3 5 Circle
Ausfin, TX 787 11-3088
Austin,TX 7875'
Fee Code: CPA General Permit:TXR150000
3. Date o� ChLck or Monev Order:
5. N01INFORMAHON
Ifflie check is fZ)r more than one NOL list each.Project,,"Sitc (RE) Name and Physical Address exactly as provided on the NOL W) NOT SUBMIT
A COPY OF THE NOI WITI I FFIJS FORNI AS ITCOULD CAUSE DI �PIACA IT,' PERMIT ENTRIFIS.
Ridgecrest Estates
Prq�lect/Site (RE) Physical Address:
Northeast Corner of Sandy Lake Road and Lodge Road
Coppell, Texas 75019
Dallas County
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Bank *f America 70372
MANUALACCOUNT
I 111 NORTH POST OAK ROAD
HOUSTON, TX 77055 9/10/2012
PAY TO THE Texas Coryrnission On Environmental Qualit
ORDER OF 32500
Three Hundred Twenty-Five and 3
DOLLARS
MEMO