NOI For Storm Water Discharge Permit
Notice of Intent (NOI) for Storm Water
Discharges from Small Municipal Separate
Storm Sewer Systems (MS4) under the TPDES
Phase II MS4 General Permit (TXR040000)
TCEQ Office Use Only.
Permit No.:
RN:
CN:
~
~
Application Fee: You must pay the $100 Application Fee to TCEQ for the application to be considered complete.
How did ou a this fee?
[2] Mailed: CheckIMone Order No.: 166
D EPAY: Voucher No.:
IMPORT ANT:
oUse the attached INSTRUCTIONS when completing this form.
oAfter completing this form, use the attached CUSTOMER CHECKLIST to make certain all items are complete and
accurate.
oMissin , ille ible, or inaccurate items ma dela final acknowled ent or covera e under the eneral ermit.
One (1) copy of the NOI and SWMP with the completed SWMP Cover Sheet MUST be submitted with the original
NOI and SWMP.
Did you know you can pay on line? Go to www.tceq.state.tx.us/ePav
Select Fee Type: GENERAL PERMIT MS4 PHASE II STORM WATER DISCHARGE NO! APPLICA nON
DYes
Is the co attached? [{] Yes
A. OPERATOR a lieant
I. If the applicant is currently a customer with TCEQ, what is the Customer Number (CN) issued to this entity?
CN 600656649
2. What is the full Legal Name of the applicant?
City of Coppell
(The exact Ie al name must be rovided.)
3. What is the a licant's mailin address as reco nized b the US Postal Service?
Address: 255 Parkway Blvd. Suite No./Bldg. NO./Mail Code:
City: Cappel! State: TX ZIP Code: 75019
Postal Code:
Information if outside USA).
4. 462-0022
5. Fax No.: (972 ) 304-7041
6. Indicate the type of Customer:
DFederal Government
mCit Government
7. Number of Em 10 ees:
B. BILLING ADDRESS
The Operator is responsible for paying the annual fee. The annual fee will be assessed to permits active on September 1 of
each year. TCEQ will send a bill to the address provided in this section. The Operator is responsible for terminating the
ermit when it is no Ion er needed.
Is the billin address same as the 0 erator Address?
I. Billin Mailin Address:
Cit : State:
2. Country Mailing Information (if outside USA).
3. Billing Contact (Attn or CIO):
4. Phone No.: ( )
5. Fax No.: ( )
o State Government
D Other Government
DO-20; 021-100; CJlOl-250;
o County Government
1:Z125l-500; or 0 501 or hi er
Country Code:
Extension:
E-mail Address:
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c. REGULAtED EN'l'.'l'Y(lQ]~INFORMAtION
1. Has the TCEQ issued a Regulated Entity Reference Number (RN) for the regulated MS4 ?
Yes. What is the RN? RN
No - TCEQ will assign the RN number after the NOI is submitted.
2. Name that is used to identify the small MS4 (Regulated Entity).
(Example: City of XXX MS4) City of CaDDell MS4
3. Provide a brief description of the regulated MS4 boundaries:
(Example: Area within the City of XXX X limits that is located within the xxx (e.g. Dallas) urbanized area.)
Area within the Citv of CaDDell citv boundarv lines located in the Denton-Lewisville urbanized area.
4. a. What is the county where the largest residential population exists within the regulated MS4 boundaries?
Dallas County
b. Is the MS4 located within additional counties? f1] Yes DNo
If yes, what county(s)? Denton County
5. What is the latitude and longitude of the approximate center of the regulated portion of the small MS4?
Latitude: 32 58 10 N Longitude: 96 59 00 W
6. What is the mailing address for the regulated entity?
Is the RE mailing address the same as the Operator? [Z]Yes, go to Section F. DNo, provide the address.
Street Number: I Street Name:
City: I State: I ZIP Code:
D. GENERAL. CHARACTERISTICS
1. I certify that any portion of the regulated MS4 is not located on Indian Country Lands. mYes DNo
If No, you must obtain authorization through EPA, Region VI.
2. What is the Standard Industrial Classification (SIC) code (see instructions for common codes): 9111
3. Has TCEQ "designated" the small MS4 as needing coverage under this general permit? [J Yes IZI No
If "No" and no portion of the Small MS4 is located within an Urbanized Area as determined by the 2000 Decennial Census
by the U.S. Bureau of Census requiring a NO! be submitted, the operator is not eligible for coverage under this general permit
through the NOr.
4. Storm Water Management Program (SWMP)
a. I certify that the SWMP submitted with this Notice ofIntent has been developed according to the provisions of this
general permit TXR040000. III Yes D No
b. I certify that the SWMP Cover Sheet is completed and attached to the front of the SWMP. El Yes DNo
If No to question a. or b. the application is considered incomplete and may be returned.
b. Who is the person responsible for implementing or coordinating implementation of the SWMP?
(Note: All contact information requested below is required.)
Name: Ken Griffin I Title: City Enaineer 1 Company:
Address: 255 Parkwav Blvd. I Suite No./Bldg. NO./Mail Code:
City: Connell I State: TX I ZIP Code: 75019
Phone No.: ( 972 ) 304-3679 I Extension:
Fax No.: ( 972 ) 304-7041 I E-mail Address: kgriffin@cLcoppell.tx.us
5. Seventh Minimum Control Measure (MCM) for Municipal Construction Activities
a. Is the Minimum Control Measure for authorization to discharge storm water from municipal construction activities
included with the attached SWMP? DYes [Z]No
b. If you answered "Yes" to 5.a., what are the boundaries within which those activities will occur?
Note: If the boundaries are located outside of the urbanized area, then the entire SWMP must also incorporate the additional
areas.
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c. Is the discharge or potential discharge from regulated construction activities within the Recharge Zone, Contributing Zone,
or Contributing zone within the Transition zone of the Edwards Aquifer? DYes [!INo
If the answer is "Yes", please note that a copy of the agency approved Plan required by the Edwards Aquifer Rule (30 TAC
. Cha ter 213) must be either included or referenced in the construction storm water ollution revention Ian s .
6. Discharge Information
a What is the name of the receiving water body(s) from the MS4?
Denton Creek; Cottonwood Creek;Grapevine Creek; Elm Fork Trinity River
b. What is the classified segment(s) that receives discharges, directly or indirectly, from the small MS4?
Denton Creek Seg. 0825; Elm Fork of the Trinity River Seg. 0822
c. Are any of the surface water bodies receiving discharges from the small MS4 on the latest EPA-approved CWA ~ 303(d)
list of impaired waters? DYes [!I No
If Yes, what is the name of the impaired water body(s) receiving the discharges from the small MS4?
d. Is the discharge into any other MS4 prior to discharge into surface water in the state?
I f Yes, what is the name of the MS4 Operator?
DYes
IZ]No
7. Edwards A uifer
Is the discharge or potential discharge from the MS4 within the Rech~ Zone, Contributing Zone, or Contributing Zone
within the Transition Zone of the Edwards Aquifer? 0 Yes WNo
If the answer is Yes, please note that a copy of the agency approved Plan required by the Edwards Aquifer Rule (30 TAC
Cha ter 213 for activities also re ulated under this eneral ermit must be either included or referenced in the SWMP.
8. Public Partici ation Process
The Office of Chief Clerk will send the operator or person responsible for publishing notice, the notice ofthe executive
director's preliminary determination of the NOI and SWMP, for publishing in a newspaper of largest circulation in the county
where the small MS4 is located. If multiple counties, notice must be published at least once in the newspaper oflargest
circulation in the county containing the largest resident population.
No
Code: 75019
Address of Public Place: 255 Parkway Blvd., Coppell, TX 75019
County of Public Place: Dallas
TCEQ- 20368 (08/14/2007)
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E. CERTIFICATION
Check "Yes" to the certifications below. Failure to indicate "Yes" to ALL items may result in denial of coverage under the
general permit.
I certify that I have obtained a copy and understand the terms and conditions of the general permit TXR040000.
I certify that the small MS4 qualifies for coverage under the general permit TXR040000.
] understarid that a Notice of Termination (NOT) must be submitted when this authorization is no longer needed.
] understand that ermits active on Se tember 1st of each ear wiII be assessed an Annual Water uaJi Fee.
o erator Certllcation:
[Z] Yes
[Z] Yes
[Z] Yes
[Z] Yes
I,
Jim Witt
Typed or printed name
City Manager
Title
certify under penalty ofIaw 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, accurate, and complete. ] am aware
there are significant penalties for submitting false information, including the possibility of fine and imprisonment for knowing
violations.
I further certify that I am authorized under 30 Texas Administrative Code ~305.44 to sign and submit this document, and
can provide documentation in p~f su au!bmization upon request.
.../- I ~.../
Signature:
Date:
/',-3 F- [l ("
.
TCEQ- 20368 (08/14/2007)
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