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Copy of Record Page 1 of 6
Texas Commission on Environmental Quality
Construction Notice of Intent
Site Information (Regulated Entity)
What is the name of the site to be authorized? WEST SANDY LAKE ROAD PH 2A&2B
Does the site have a physical address? No
Because there is no physical address, NORTH COPPELL ROAD TO SOUTH
describe how to locate this site: COPPELL ROAD SOUTH COPPELL ROAD
TO DENTON TAP ROAD
City COPPELL
State TX
ZIP 75019
County DALLAS
Latitude(N) (##.######) 32.581
Longitude(W)(-###.#######) -97.075
Primary SIC Code 1611
Secondary SIC Code 1623
Primary NAICS Code
Secondary NAICS Code
Regulated Entity Site Information
What is the Regulated Entity's Number(RN)?
What is the name of the Regulated Entity WEST SANDY LAKE ROAD PH 2A&2B
(RE)?
Does the RE site have a physical address? No
Because there is no physical address, NORTH COPPELL ROAD TO SOUTH
describe how to locate this site: COPPELL ROAD SOUTH COPPELL ROAD
TO DENTON TAP ROAD
City COPPELL
State TX
ZIP 75019
County DALLAS
Latitude(N) (##. FIF#) 32.581
Longitude(W) (-###.#######) -97.075
What is the primary business of this entity? STREET IMPROVEMENTS
TISEO P-Customer (Applicant) Information
How is this applicant associated with this site? OPERATOR
Copy of Record Page 2 of 6
What is the applicant's Customer Number CN600426225
(CN)?
Type of Customer Corporation
Full legal name of the applicant:
Legal Name TISEO PAVING CO
Texas SOS Filing Number 5138606
Federal Tax ID 382209998
State Franchise Tax ID 13822099985
DUNS Number
Number of Employees 21-100
Independently Owned and Operated? Yes
I certify that the full legal name of the entity Yes
applying for this permit has been provided and
is legally authorized to do business in Texas.
Responsible Authority Contact
Organization Name TISEO PAVING CO
Prefix
First ROBERT
Middle
Last CAUDILL
Suffix
Title VICE PRESIDENT
Responsible Authority Mailing Address
Enter new address or copy one from list:
Address Type Domestic
Mailing Address(include Suite or Bldg. here, if PO BOX 270040
applicable)
Routing(such as Mail Code, Dept.,or Attn:)
City DALLAS
State TX
ZIP 75227
Phone(###-###-####) 9722890723
Extension
Alternate Phone(###-###-ly###)
Fax(#44-#44-#041) 9722165637
E-mail RCAUDILL @TISEOPAVING.COM
Application Contact
Copy of Record Page 3 of 6
Person TCEQ should contact for questions
about this application:
Same as another contact? TISEO PAVING CO
Organization Name TISEO PAVING CO
Prefix
First MATT
Middle
Last WALKER
Suffix
Title ESTIMATOR
Enter new address or copy one from list: TISEO PAVING CO
Mailing Address
Address Type Domestic
Mailing Address(include Suite or Bldg. here, if PO BOX 270040
applicable)
Routing(such as Mail Code, Dept.,or Attn:)
City DALLAS
State TX
ZIP 75227
Phone(#t#1#-###-#####) 9722890723
Extension
Alternate Phone(###-###-##i##)
Fax(###4144-####) 9722165637
E-mail MWALKER @TISEOPAVING.COM
CNOI General Characteristics
1) Is the project located on Indian Country No
Lands?
2) Is your construction activity associated with No
a facility that,when completed,would be
associated with the exploration, development,
or production of oil or gas or geothermal
resources?
3)What is the Primary Standard Industrial 1611
Classification(SIC)Code that best describes
the construction activity being conducted at the
site?
4) If applicable,what is the Secondary SIC 1623,1629
Code(s)?
No
Copy of Record Page 4 of 6
5) Is the project site part of a larger common
plan of development or sale?
6)What is the total number of acres disturbed? 18.77
7)What is the name of the first water body(s) COTTONWOOD CREEK
to receive the stormwater runoff or potential
runoff from the site?
8)What is the segment number(s) of the 0825
classified water body(s)that the discharge will
eventually reach?
9) Is the discharge into an MS4? Yes
9.1.What is the name of the MS4 Operator? CITY OF COPPELL
10)Are any of the surface water bodies No
receiving discharges from the construction site
on the latest EPA-approved CWA 303(d) List
of impaired waters?
11) Is the discharge or potential discharge No
within the Recharge Zone, Contributing zone,
or Contributing zone within the Transition zone
of the Edwards Aquifer, as defined in 30 TAC
Chapter 213?
12) I certify that a stormwater pollution Yes
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
TXR150000. Note: For multiple operators who
prepare a shared SWP3,the confirmation of
an operator may be limited to its obligations
under the SWP3 provided all obligations are
confirmed by at least one operator.
13) I certify that I have obtained a copy and Yes
understand the terms and conditions of the
Construction General Permit(TXR150000).
14) I understand that a Notice of Termination Yes
(NOT)must be submitted when this
authorization is no longer needed.
Certification
I certify that I am authorized under 30 Texas Administrative Code Subchapter 305.44 to sign this document and can
provide documentation in proof of such authorization upon request.
I 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,
•
Copy of Record Page 5 of 6
accurate,and complete. I am aware there are significant penalties for submitting false information, including the
possibility of fine and imprisonment for knowing violations.
1. I am Louie Tiseo,the owner of the STEERS account ER012996.
2. I have the authority to sign this data on behalf of the applicant named above.
3. I have personally examined the foregoing and am familiar with its content and the content of any
attachments, and based upon my personal knowledge and/or inquiry of any individual responsible for
information contained herein,that this information is true, accurate, and complete.
4. I further certify that I have not violated any term in my TCEQ STEERS participation agreement and that I
have no reason to believe that the confidentiality or use of my password has been compromised at any
time.
5. I understand that use of my password constitutes an electronic signature legally equivalent to my written
signature.
6. I also understand that the attestations of fact contained herein pertain to the implementation, oversight
and enforcement of a state and/or federal environmental program and must be true and complete to the
best of my knowledge.
7. I am aware that criminal penalties may be imposed for statements or omissions that I know or have
reason to believe are untrue or misleading.
8. I am knowingly and intentionally signing Construction Notice of Intent.
9. My signature indicates that I am in agreement with the information on this form, and authorize its
submittal to the TCEQ.
OPERATOR Signature: Louie Tiseo OPERATOR
Account Number: ER012996
Signature IP Address: 216.201.216.170
Signature Date: 2013-06-24
Signature Hash: A3A07BC32CFBBE3C9042696B070B219B0248EAB776056B8EAAF832EDCEFF6411
Form Hash Code at time 6536CFDE048A8FC7EE355BB4261 D898B490A767330BABB659DCFAC97D82C467E
of Signature:
Fee Payment
Transaction by: The application fee payment transaction was
made by ER012996/Louie Tiseo
Paid by: The application fee was paid by ARTHUR
TISEO
Fee Amount: $225.00
Paid Date: The application fee was paid on 2013-06-24
TransactionNoucher number: The transaction number is 582EA000145482
and the voucher number is 183737
Submission
Reference Number: The application reference number is 70899
Copy of Record Page 6 of 6
Submitted by: The application was submitted by
ER012996/Louie Tiseo
Submitted Timestamp: The application was submitted on 2013-06-24
at 15:25:03 CDT
Submitted From: The application was submitted from IP address
216.201.216.170
Confirmation Number: The confirmation number is 73115
Steers Version: The STEERS version is 5.90
Additional Information
Application Creator:This account was created by Louie Tiseo