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Irby Addition-PN150611SECTION 1: SWP3 Signature Documents For Operator: % (�e`gY Iif(lilfi�lt, A. Operator Certification Statement B. TCEQ Construction Site Notice (CSN) C. TCEQ Delegation Letter D. Endangered Species and Historic Places Acknowledgement INSTRUCTIONS Note: Read the next page titled "Signature Requirement defined by 30 TAC §305.44" to determine who can provide an authorized signature. A Sign Operator(s) Certification Statement and file in the SWP3 Record B Operator(s) TCEQ Construction Site Notice (CSN). 1. Review for accuracy and sign. 2. Follow instructions for distribution. C Sign the TCEQ Delegation of Authorized Signature letter and send by certify mail to the TCEQ address shown. D Read and sign the Endangered Species and Historic Places Acknowledgement and file in the SWP3 Record. Signature Requirement defined by 30 TAC §305.44 The purpose of this document is to clarify the signature requirements for SWPPP Certification Statements, Notice of Intent application, TCEQ Construction Site Notice , Notice of Termination and TCEQ Signature Delegation Letter subject to 30 Texas Administrative Code (TAC) section (§)305.44. Signature on these documents must meet the requirements as defined below: For Corporations: The regulation governing who may sign an application form is 30 TAC §305.44(a)(1). According to this provision, any corporate representative may sign an application 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 application form, you are certifying that such authority has been delegated to you. The TCEQ may request documentation evidencing such authority. For Municipality or other Government Entity: The regulation governing who may sign an application form is 30 Texas Administrative Code §305.44(a)(3). According to this provision, only a ranking elected official or principal executive officer may sign an application form. Persons such as the City Mayor or County Commissioner are ranking elected officials. The principal executive officer may be identified in your city charter, county or city ordinances, or the Texas statute(s) under which your governmental entity was formed. An application form that is signed by a governmental official who is not a ranking elected official or principal executive officer does not conform to §305.44(a)(3). The signatory requirement may not be delegated to a government representative other than those identified in the regulation. By signing the application, you are certifying that you are either a ranking elected official or principal executive officer. Documentation demonstrating your position as a ranking elected official or principal executive officer may be requested by the TCEQ. 30 Texas Administrative Code §305.44. Signatories to Applications. 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). A.1.OPERATOR CERTIFICATION STATEMENT Instructions: Sign the following certification and file in the SWPPP Manual. Do Not Send to TCEQ. The following Operator has control of those items marked with an W: Operator Name Northville Development, LLC Project Name NINE OAKS (IRBY Addition Phase 11) Operational Control Control over construction plans & specifications, including the ability to make modifications to X those plans and specifications (e.g. the Developer or Owner) permit as found in 30 TAC 305.44. Refer to prior "Signature Requirement' in this section of the Control of day-to-day operational control of those activities at the project to ensure compliance X with a SWPPP for the site or other permit conditions (e.g., General Contractor) properly gathered and evaluate the information submitted. Based on my inquiry of the person or Certification Statement • Sign the following certification prior to the beginning of earth disturbing activities. • Persons signing this certification must do so in compliance with the signatory requirements of the permit as found in 30 TAC 305.44. Refer to prior "Signature Requirement' in this section of the manual for definition. "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 gathered 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, accurate, and complete. I am aware there are specific penalties for submitting false information, including the possibilities of fine and imprisonment for knowing violations." Signature Printed Name © 5 Date B. TCEQ CONSTRUCTION SITE NOTICE Site (CSN) Instructions: Complete the following. 1 CSN Permit: The following CSN (Construction Site Notice) for all Operators must be filed in the SWPPP Manual. Do not send to TCEQ. 2 SWP3 Sign: Post a copy of all Operators CSN at the construction site in a location where it is safely and readily available for viewing by the general public, local, state and federal authorities, prior to commencing construction and maintain the notice in that location until completion of the construction activity. Linear projects such as roads or pipelines may be relocated as necessary. Note: If Terradyne Group is providing the sign, fax a copy of the signed CSN (s) to 972-618- 1224 or scan and email to talle ny tex@aol.com 3 Submittal of CSN copv Small Construction Activity: Sites with disturbed areas over 1 acre but less than 5 acres (include offsite areas). All Operators, provide a copy of the signed CSN at least 2 days prior to commencing construction activities to: • All MS4s receiving storm water discharge. • All other Operators and any new Operator. Large Construction Activity: Sites with disturbed areas over 5 acre or that are part of a larger common plan of development over 5 acres (include offsite areas). All Operators, provide a copy of the signed CSN at least 7 days prior to commencing construction activities to: son • Any `Secondary Operator(s)' • All other Operators and any new Operator. Note: Copy all mailed documents and proof of postmark to the SWP3 Record Note: Provisional Authorization Period *Small are provisionally authorized immediately. *Large sites are provisionally authorized immediately with NOI submittal through the TCEQ STEERS website or after 7 days of postmark submittal by mail. SMALL CONSTRUCTION SITE NOTICE FOR THE Texas Commission on Environmental Quality (TCEQ) Storm Water Program TPDES GENERAL PERMIT TXR150000 The following information is posted in compliance with Part II.E.2. of the TCEQ General Permit Number TXR150000 for discharges of storm water runoff from small construction sites. Additional information regarding the TCEQ storm water permit program may be found on the internet at: http://www.tceq.state.tx.us/nav/permits/wq_construction.html Operator Name: Northville Development, LLC Ram Sunkavalli 214-989-6566 Contact Name and Phone Number: ramsunkavalii@,gmaii.com Prolect Name NINE OAKS (IRBY Addition Phase II) Project Description: Physical address or description Location of the site=s location, estimated start date and West end of Oak Grove Drive in Coppell, Tx 75019 projected end date, or date that disturbed soils will Project Activity be stabilized Construct 9 builder lots for single family housing. Start: 05/30/15 End: 011/30/15 Call: Ram Sunkavalli 214-989-6566 Location of Storm Water Pollution Prevention Plan ramsunkavalllina= gmail.com For Small Construction Activities Authorized Under Part II.E.2. (Obtaining Authorization to Discharge) the following certification must be completed: t I f�a-w1 O S�-n KgMat)� t (Typed or Printed Name Person Completing This Certification) certify under penalty of law that I have read and understand the eligibility requirements for claiming an authorization under Part II.D.2. of TPDES General Permit TXR150000 and agree to comply with the terms of this permit. A storm water pollution prevention plan has been developed and will be implemented prior to construction, according to permit requirements. A copy of this signed notice is supplied to the operator of the MS4 if discharges enter an MS4. I am aware there are significant penalties for providing false information or for conducting unauthorized discharges, including the possibility of fine and imprisonment for knowing violations. Signature and Title ''16 DcN MC .A4t-.' Date 0; 9-S 2.;j IS Date Notice Removed _MS4 operator notified per Part II.F.3. C. Delegation of Authorized Signature Instructions: Use the following sample letter to delegate SWP3 responsibilities. SWP3 delegated responsibilities may include: • Owner Operator delegating to the General Contractor the implementation of SWP3 BMPs, control installation/maintenance, record keeping, stabilization of site, etc. This should also include signature authority for providing record keeping, signing reports and documenting revisions to the SWP3. • Owner Operator or General Contractor delegating to a person or position the signature authority to provide and sign SWP3 Site Inspection Reports. C. Delegation of Authorized Signature Instructions: Keep certified mail receipt 1) On your company letterhead, complete and send via certified mail to the TCEQ address shown 2) Must meet 30 TAC 305.44 Signatory Requirement. Executive Director Texas Commission on Environmental Quality Storm Water General Permits Team, MC -148 P.O. Box 13087, Austin, Texas 78711-3087 Re: TPDES Storm Water General Permit / Authorized Signatory Delegation Dear Director: In accordance with 30 TAC §305.128, this letter delegates the specifically described positions or persons as authorized for signing reports and performing activities required by the Director or Texas Pollutant Discharge Elimination System (TPDES) General Permit. This authorization cannot be used for signing Notice of Intent (NOI) forms, Notice of Termination (NOT) forms, Notice of Change (NOC) letters, or Construction Site Notices (CSN). I delegate the following authorized position(s) for signing required SWPPP documents required by the TPDES Permit for the referenced project: Position: V Party Terradyne Group Inspector for providing SWP3 Manual Logs entries, revisions, drawing notation and inspection reports. By signing below, I certify the following statement and additionally confirm that I meet the signature qualification defined in the Texas Administrative Code (TAC) specified in Title 30, Part 1, Chapter 305, Subchapter C, Rule 305.44(a): "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 gathered and evaluated 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, accurate and complete. I am aware there are significant penalties for submitting false information, including the possibility of fine and imprisonment for knowing violations." Owner Operator operator Northville Development, LLC Signature Name Date O S / a 0 / 715 Print R0.v d A\t Name t 100, Project Name NINE OAKS (IRBY Addition Phase II) Location West end of Oak Grove Drive in Coppell, TX 75019 A Endangered Species and Historical Places Instructions: Sign the following `acknowledgement statement' and keep on -rile in the SWPPP Manual. Project Name NINE OAKS (IRBY Addition Phase II) Location West end of Oak Grove Drive in Coppell, TX 75019 Impact on Endangered Species It is the Operator's responsibility to protect endangered or threatened species of animals, fish or plants and their habitat in or near the construction activity area. The Operator(s) will review the list of Federal and State endangered or threatened species located in the SWP3 Manual and assure by means of pre -construction and on-going site inspection that construction activities do not result in jeopardy to any of the listed species in or near the construction activity area. Site personnel should report to their management immediately any signs of endangered or threatened species or habitat and contact U.S. Fish and Wildlife and Texas Parks and Wildlife to determine appropriate action. Impact on Historical Places It is the Operator's responsibility to assure that construction activities and the discharge storm water from this site will not adversely affect registered Historic Places. Review the list located in the SWP3 Manual. Pre -construction site inspections should be conducted and personnel should report immediately any historic places found and contact the preservation agencies to determine appropriate action. Operator must comply with the National Historic Preservation Act and a) assure storm water discharge does not adversely affect a listed property or a property eligible for listing with the National Historic Register or b) obtain and comply with a written agreement between the Operator and the State Historic Preservation Officer that outlines all measures to be undertaken by the applicant to mitigate or prevent adverse affects to the historic property. A duly authorized representative of all Operators must sign the following acknowledgement statement. Persons signing this certification must do so in compliance with the signatory requirements of the permit as found in 30 TAC 305.44. Refer to "Signature Delegation" for definition. The above acknowledged by: OPERATOR Operator Name Northville Development, LLC Signature Printed Name {_a.v^n D 90+1Kava1%r Date C) 5 12 i�) 15