HomeMy WebLinkAboutAPPROVED, 20210420-PERMIT
Regulatory Division
South Branch
Palm Beach Gardens Section
SAJ-2020-00849(GP-LCK)
Pelican Pointe Homeowners’ West Association, Inc.
Attn: Michael Irey
111 SE Federal Highway, #100
Stuart, Florida, 33994
Dear Mr. Irey:
The U.S. Army Corps of Engineers (Corps) assigned your application for a
Department of the Army permit, which the Corps received on March 19, 2021, the file
number SAJ-2020-00849(GP-LCK). A review of the information and drawings provided
indicates that the proposed work is to install a 12-foot by 12-foot boat lift with four (4)
associated wood piles (12” diameter), within Slip 6 of the existing marina. The activities
subject to this permit are authorized pursuant to authorities under Section 10 of the
Rivers and Harbors Act of 1899 (33 U.S.C. § 403). The project is located within the tidal
waters of the Indian River adjacent to the Pelican Pointe residential marina at South
Ocean Drive, Jenson Beach (Section 22, Township 36 South, Range 41 East), Martin
County Florida (27.3236, -80.2318).
Your project, as depicted on the enclosed drawings, is authorized by Regional
General Permit (GP) SAJ-20 and its subsequent modifications, if applicable. This
authorization is valid until March 27, 2023. Please access the Corps' Jacksonville
District Regulatory Division Internet page to view the special and general conditions for
SAJ-20, which apply specifically to this authorization. The Internet URL address is:
http://www.saj.usace.army.mil/Missions/Regulatory.aspx
Please be aware this Internet address is case sensitive; and, you will need to enter it
exactly as it appears above. Once there you will need to click on “Source Book”; and,
then click on “General Permits.” Then you will need to click on the specific SAJ permit
noted above. You must comply with all of the special and general conditions of the
permit; and, any project-specific conditions noted below, or you may be subject to
enforcement action. The following project-specific conditions are included with this
authorization:
DEPARTMENT OF THE ARMY
CORPS OF ENGINEERS, JACKSONVILLE DISTRICT
4400 PGA BOULEVARD, SUITE 500
PALM BEACH GARDENS, FL 33410 April 20, 2021
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1. Reporting Address: The Permittee shall submit all reports, notifications,
documentation and correspondence required by the general and special
conditions of this permit to the following address:
a. For standard mail: U.S. Army Corps of Engineers, Regulatory Division,
Special Projects and Enforcement Branch, 4400 PGA Boulevard, Suite 500,
Palm Beach Gardens, Florida 33410.
b. For electronic mail SAJ-RD-Enforcement@usace.army.mil (not to exceed 10
MB).
The Permittee shall reference this permit number, SAJ-2020-00849 (RGP-LCK),
on all submittals.
2. Self –Certification
3. Cultural Resources/Historic Properties:
a.No structure or work shall adversely affect impact or disturb properties listed in
the National Register of Historic Places (NRHP) or those eligible for inclusion in
the NRHP.
b. If during the ground disturbing activities and construction work within the
permit area, there are archaeological/cultural materials encountered which were
not the subject of a previous cultural resources assessment survey (and which
shall include, but not be limited to: pottery, modified shell, flora, fauna, human
remains, ceramics, stone tools or metal implements, dugout canoes, evidence of
structures or any other physical remains that could be associated with Native
American cultures or early colonial or American settlement), the Permittee shall
immediately stop all work and ground-disturbing activities within a 100-meter
diameter of the discovery and notify the Corps within the same business day (8
hours). The Corps shall then notify the Florida State Historic Preservation Officer
(SHPO) and the appropriate Tribal Historic Preservation Officer(s) (THPO(s)) to
assess the significance of the discovery and devise appropriate actions.
c. Additional cultural resources assessments may be required of the permit
area in the case of unanticipated discoveries as referenced in accordance with
the above Special Condition ; and if deemed necessary by the SHPO, THPO(s),
or Corps, in accordance with 36 CFR 800 or 33 CFR 325, Appendix C (5).
Based, on the circumstances of the discovery, equity to all parties, and
considerations of the public interest, the Corps may modify, suspend or revoke
the permit in accordance with 33 CFR Part 325.7. Such activity shall not resume
on non-federal lands without written authorization from the SHPO for finds under
his or her jurisdiction, and from the Corps.
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d. In the unlikely event that unmarked human remains are identified on
nonfederal lands, they will be treated in accordance with Section 872.05 Florida
Statutes. All work and ground disturbing activities within a 100-meter diameter of
the unmarked human remains shall immediately cease and the Permittee shall
immediately notify the medical examiner, Corps, and State Archaeologist within
the same business day (8-hours). The Corps shall then notify the appropriate
SHPO and THPO(s). Based, on the circumstances of the discovery, equity to all
parties, and considerations of the public interest, the Corps may modify, suspend
or revoke the permit in accordance with 33 CFR Part 325.7. Such activity shall
not resume without written authorization from the State Archaeologist and from
the Corps.
4. Assurance of Navigation and Maintenance: The Permittee understands and
agrees that, if future operations by the United States require the removal,
relocation, or other alteration, of the structures or work herein authorized, or if in
the opinion of the Secretary of the Army or his authorized representative, said
structure or work shall cause unreasonable obstruction to the free navigation of
the navigable waters, the Permittee will be required, upon due notice from the
Corps of Engineers, to remove, relocate, or alter the structural work or
obstructions caused thereby, without expense to the United States. No claim
shall be made against the United States on account of any such removal or
alteration.
5. Project Design Criteria (PDCs) for In-Water Activities: The Permittee shall
comply with National Marine Fisheries Service’s “PDCs for In-Water Activities”
dated November 20, 2017 (Attachment).
6. Daylight Hours: All activities must be completed during daylight hours.
7. Construction Location: Project construction shall take place from floating
equipment (e.g., barge) or over-water structure; prop or wheel-washing is
prohibited.
8. Manatee Conditions: The Permittee shall comply with the “Standard Manatee
Conditions for In-Water Work – 2011” (Attachment).
9. Commencement Notification: Within 10 days from the date of initiating the
work authorized by this permit the Permittee shall submit a completed
“Commencement Notification” Form (Attachment).
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10. North Atlantic Right Whale Educational Handout: The Attachment
describes the presence of North Atlantic right whales in the area and the
Federal regulations governing the approach to North Atlantic right whales.
This authorization does not obviate the necessity to obtain any other Federal, State,
or local permits, which may be required. Prior to the initiation of any construction,
projects qualifying for this NWP/RGP permit must qualify for an exemption under
section 403.813(1), F.S. or 373.406, F.S., or otherwise be authorized by the applicable
permit required under Part IV of Chapter 373, F.S., by the Department of Environmental
Protection, a water management district under section 373.069, F.S., or a local
government with delegated authority under section 373.441, F.S., and receive Water
Quality Certification (WQC) and applicable Coastal Zone Consistency Concurrence
(CZCC) or waiver thereto, as well as any authorizations required for the use of state-
owned submerged lands under Chapter 253, F.S., and, as applicable, Chapter 258, F.S.
You should check State-permitting requirements with the Florida Department of
Environmental Protection or the appropriate water management district.
This authorization does not include conditions that would prevent the ‘take’ of a state-
listed fish or wildlife species. These species are protected under sec. 379.411, Florida
Statutes, and listed under Rule 68A-27, Florida Administrative Code. With regard to fish
and wildlife species designated as species of special concern or threatened by the State
of Florida, you are responsible for coordinating directly with the Florida Fish and Wildlife
Conservation Commission (FWC). You can visit the FWC license and permitting
webpage (http://www.myfwc.com/license/wildlife/) for more information, including a list
of those fish and wildlife species designated as species of special concern or
threatened. The Florida Natural Areas Inventory (http://www.fnai.org/) also maintains
updated lists, by county, of documented occurrences of those species.
This authorization does not give absolute Federal authority to perform the work as
specified on your application. The proposed work may be subject to local building
restrictions mandated by the National Flood Insurance Program. You should contact
your local office that issues building permits to determine if your site is located in a
flood-prone area, and if you must comply with the local building requirements mandated
by the National Flood Insurance Program.
If you are unable to access the internet or require a hardcopy of any of the conditions,
limitations, or expiration date for the above RGP(s), please contact Linda Knoeck by
telephone at 561-472-3531 or by email at Linda.C.Knoeck@usace.army.mil.
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Thank you for your cooperation with our permit program. The Corps’ Jacksonville
District Regulatory Division is committed to improving service to our customers. We
strive to perform our duty in a friendly and timely manner while working to preserve our
environment. We invite you to complete our automated Customer Service Survey at
https://regulatory.ops.usace.army.mil/customer-service-survey/. Please be aware this
Internet address is case sensitive; and, you will need to enter it exactly as it appears
above. Your input is appreciated – favorable or otherwise.
Sincerely,
Linda C. Knoeck
Project Manager
Enclosures:
Drawings
Commencement Notification Form
Self-Certification Form
Manatee Conditions
NMFS PDCs
Right Whale Conditions
cc:
danna@dlsenvironmentalservices.com
GENERAL CONDITIONS
33 CFR PART 320-330
1. The time limit for completing the work authorized ends on the dates identified in the
letter.
2. You must maintain the activity authorized by this permit in good condition and in
conformance with the terms and conditions of this permit. You are not relieved of this
requirement if you abandon the permitted activity, although you may make a good faith
transfer to a third party in compliance with General Condition 4 below. Should you wish
to cease to maintain the authorized activity or should you desire to abandon it without a
good faith transfer, you must obtain a modification of this permit from this office, which
may require restoration of the area.
3. If you discover any previously unknown historic or archeological remains while
accomplishing the activity authorized by this permit, you must immediately notify this
office of what you have found. We will initiate the Federal and state coordination
required to determine if the remains warrant a recovery effort or if the site is eligible for
listing in the National Register of Historic Places.
4. If you sell the property associated with this permit you must obtain the signature of
the new owner in the space provided and forward a copy of the permit to this office to
validate the transfer of this authorization.
5. If a conditioned water quality certification has been issued for your project, you must
comply with the conditions specified in the certification as special conditions to this
permit. For your convenience, a copy of the certification is attached if it contains such
conditions.
6. You must allow a representative from this office to inspect the authorized activity at
any time deemed necessary to ensure that it is being or has been accomplished in
accordance with the terms and conditions of your permit.
DEPARTMENT OF THE ARMY PERMIT TRANSFER REQUEST
PERMIT NUMBER: SAJ-2020-00849(GP-LCK)
When the structures or work authorized by this permit are still in existence at the time
the property is transferred, the terms and conditions of this permit will continue to be
binding on the new owner(s) of the property. Although the construction period for works
authorized by Department of the Army permits is finite, the permit itself, with its
limitations, does not expire.
To validate the transfer of this permit and the associated responsibilities associated
with compliance with its terms and conditions, have the transferee sign and date below
and mail to the U.S. Army Corps of Engineers, Enforcement Section, P.O. Box 4970,
Jacksonville, FL 32232-0019 or by electronic mail at
saj-rd-enforcement@usace.army.mil.
___________________________________ ___________________________
(TRANSFEREE-SIGNATURE) (SUBDIVISION)
___________________________________ ___________ ____________
(DATE) (LOT) (BLOCK)
__________________________
__________________________________ (STREET ADDRESS)
(NAME-PRINTED)
___________________________________
___________________________________
(MAILING ADDRESS)
___________________________________
(CITY, STATE, ZIP CODE)
SCALE:
1901 SW Yellowtail Avenue
Port Saint Lucie, FL 34953
Phone: 772-215-3997 Fax: 772-879-4520
www.dlsenvironmentalservices.com
Pelican Pointe West HOA, Inc.
Slip #6 - Pelican Pointe Drive
Jensen Beach, Florida
N.T.S. SHEET 1
ST. LUCIE COUNTY
SECTION 22, TOWNSHIP 36 SOUTH, RANGE 41 EAST
PROJECT SITE
PROJECT SITE
MARCH 2021
Location Map
SCALE:
1901 SW Yellowtail Avenue
Port Saint Lucie, FL 34953
Phone: 772-215-3997 Fax: 772-879-4520
www.dlsenvironmentalservices.com
Pelican Pointe West HOA, Inc.
Slip #6 - Pelican Pointe Drive
Jensen Beach, Florida
2018 Aerial
N.T.S. MARCH 2021 SHEET 2 of 4
PROJECT
SITE
N.T.S.
INDIAN RIVER
SCALE:
1901 SW Yellowtail Avenue
Port Saint Lucie, FL 34953
Phone: 772-215-3997 Fax: 772-879-4520
www.dlsenvironmentalservices.com
Pelican Pointe West HOA, Inc.
Slip #6 - Pelican Pointe Drive
Jensen Beach, Florida
INDIAN RIVER
WATERBODY WIDTH
10,950’±
APPROX. MHW
LINE
MANGROVES
1” = 30’
Existing Plan View with Proposed Boat Lift
MARCH 2021 SHEET 3 of 4
PROPOSED 12’± X 12’±
BOAT LIFT
NOTES:
1. ELEVATION DATUM MLW
MLW = -1.33 NAVD88 MHW = -0.33 NAVD88
2. PROPOSED WORK IS TO INSTALL A BOAT LIFT IN SLIP #6
3. BOAT LIFT PILES (4) 10ӯ WOOD PILES
4. NO RESOURCES PRESENT IN PROJECT AREA
SCALE:
1901 SW Yellowtail Avenue
Port Saint Lucie, FL 34953
Phone: 772-215-3997 Fax: 772-879-4520
www.dlsenvironmentalservices.com
Pelican Pointe West HOA, Inc.
Slip #6 - Pelican Pointe Drive
Jensen Beach, Florida
Cross Section View – Slip #6
1” = 3’ SHEET 4 of 4 MARCH 2021
SUBSTRATE
MHW
MLW
12’±
BOAT LIFT
4’±
4’±
4’
FINGER PIER
NOTES:
1. ELEVATION DATUM MLW
MLW = -1.33 NAVD88 MHW = -0.33 NAVD88
2. PROPOSED WORK IS TO INSTALL A BOAT LIFT IN SLIP #6
3. BOAT LIFT PILES (4) 10ӯ WOOD PILES
4. NO RESOURCES PRESENT IN PROJECT AREA
Dated 9/18/2019
COMMENCEMENT NOTIFICATION
Within ten (10) days of initiating the authorized work, submit this form via electronic mail to
saj-rd-enforcement@usace.army.mil (preferred, not to exceed 15 MB) or by standard mail
to U.S. Army Corps of Engineers, Enforcement Section, P.O. Box 4970, Jacksonville, FL
32232-0019.
1. Department of the Army Permit Number: SAJ- - ( - )
2. Permittee Information:
Name: __________________________________________
Email: __________________________________________
Address: __________________________________________
__________________________________________
Phone: __________________________________________
3. Construction Start Date: ______________________
4. Contact to Schedule Inspection:
Name: __________________________________________
Email: __________________________________________
Phone: __________________________________________
______________________________
Signature of Permittee
______________________________
Printed Name of Permittee
______________________________
Date
STANDARD MANATEE CONDITIONS FOR IN-WATER WORK
2011
The permittee shall comply with the following conditions intended to protect manatees from direct project
effects:
a. All personnel associated with the project shall be instructed about the presence of manatees and
manatee speed zones, and the need to avoid collisions with and injury to manatees. The
permittee shall advise all construction personnel that there are civil and criminal penalties for
harming, harassing, or killing manatees which are protected under the Marine Mammal Protection
Act, the Endangered Species Act, and the Florida Manatee Sanctuary Act.
b. All vessels associated with the construction project shall operate at "Idle Speed/No Wake” at all
times while in the immediate area and while in water where the draft of the vessel provides less
than a four-foot clearance from the bottom. All vessels will follow routes of deep water whenever
possible.
c. Siltation or turbidity barriers shall be made of material in which manatees cannot become
entangled, shall be properly secured, and shall be regularly monitored to avoid manatee
entanglement or entrapment. Barriers must not impede manatee movement.
d. All on-site project personnel are responsible for observing water-related activities for the presence
of manatee(s). All in-water operations, including vessels, must be shutdown if a manatee(s)
comes within 50 feet of the operation. Activities will not resume until the manatee(s) has moved
beyond the 50-foot radius of the project operation, or until 30 minutes elapses if the manatee(s)
has not reappeared within 50 feet of the operation. Animals must not be herded away or harassed
into leaving.
e. Any collision with or injury to a manatee shall be reported immediately to the Florida Fish and
Wildlife Conservation Commission (FWC) Hotline at 1-888-404-3922. Collision and/or injury
should also be reported to the U.S. Fish and Wildlife Service in Jacksonville (1-904-731-3336) for
north Florida or Vero Beach (1-772-562-3909) for south Florida, and to FWC at
ImperiledSpecies@myFWC.com
f. Temporary signs concerning manatees shall be posted prior to and during all in-water project
activities. All signs are to be removed by the permittee upon completion of the project. Temporary
signs that have already been approved for this use by the FWC must be used. One sign which
reads Caution: Boaters must be posted. A second sign measuring at least 8 ½” by 11" explaining
the requirements for “Idle Speed/No Wake” and the shut down of in-water operations must be
posted in a location prominently visible to all personnel engaged in water-related activities. These
signs can be viewed at MyFWC.com/manatee. Questions concerning these signs can be sent to
the email address listed above.
CAUTION: MANATEE HABITAT
All project vessels
IDLE SPEED / NO WAKE
When a manatee is within 50 feet of work
all in-water activities must
SHUT DOWN
Report any collision with or injury to a manatee:
Wildlife Alert:
1-888-404-FWCC (3922)
cell * FWC or #FWC
U.S. Army Corps of Engineers Jacksonville District's Programmatic Biological
Opinion (JaxBO) Project Design Criteria (PDCs) for In-Water Activities
November 20, 2017
1) (AP.7.) Education and Observation: The permittee must ensure that all personnel
associated with the project are instructed about the potential presence of species
protected under the ESA and the Marine Mammal Protection Act (MMPA). All on-site
project personnel are responsible for observing water-related activities for the
presence of protected species. All personnel shall be advised that there are civil and
criminal penalties for harming, harassing, or killing ESA-listed species or marine
mammals. To determine which species may be found in the project area, please
review the relevant Protected Species List at:
http://sero.nmfs.noaa.gov/protected_resources/section_7/threatened_endangered/in
dex.html
2) (AP.8.) Reporting of interactions with protected species:
a) Any collision(s) with and/or injury to any sea turtle, sawfish, whale, or sturgeon
occurring during the construction of a project, shall be reported immediately to
NMFS’s Protected Resources Division (PRD) at (1-727-824-5312) or by email to
takereport.nmfsser@noaa.gov and SAJ-RD-Enforcement@usace.army.mil.
b) Smalltooth sawfish: Report sightings to 1-844-SAWFISH or email
Sawfish@MyFWC.com
c) Sturgeon: Report dead sturgeon to 1-844-STURG 911 (1-844-788-7491) or email
nmfs.ser.sturgeonnetwork@noaa.gov
d) Sea turtles and marine mammals: Report stranded, injured, or dead animals to 1-
877-WHALE HELP (1-877-942-5343).
e) North Atlantic right whale: Report injured, dead, or entangled right whales to the
USCG via VHF Channel 16.
3) (AP.9.) Vessel Traffic and Construction Equipment: All vessel operators must
watch for and avoid collision with species protected under the ESA and MMPA.
Vessel operators must avoid potential interactions with protected species and
operate in accordance with the following protective measures:
a) Construction Equipment:
i) All vessels associated with the construction project shall operate at “Idle
Speed/No Wake” at all times while operating in water depths where the draft
of the vessel provides less than a 4-foot (ft) clearance from the bottom, and in
all depths after a protected species has been observed in and has departed
the area.
ii) All vessels will follow marked channels and/or routes using the maximum
water depth whenever possible.
iii) Operation of any mechanical construction equipment, including vessels, shall
cease immediately if a listed species is observed within a 50-ft radius of
construction equipment and shall not resume until the species has departed
the area of its own volition.
iv) If the detection of species is not possible during certain weather conditions
(e.g., fog, rain, wind), then in-water operations will cease until weather
conditions improve and detection is again feasible.
b) All Vessels:
i) Sea turtles: Maintain a minimum distance of 150 ft.
ii) North Atlantic right whale: Maintain a minimum 1,500-ft distance (500 yards).
iii) Vessels 65 ft in length or longer must comply with the Right Whale Ship Strike
Reduction Rule (50 CFR 224.105) which includes reducing speeds to 10
knots or less in Seasonal Management Areas
(http://www.fisheries.noaa.gov/pr/shipstrike/).
iv) Mariners shall check various communication media for general information
regarding avoiding ship strikes and specific information regarding right whale
sightings in the area. These include NOAA weather radio, USCG NAVTEX
broadcasts, and Notices to Mariners.
v) Marine mammals (i.e., dolphins, whales [other than North Atlantic right
whales], and porpoises): Maintain a minimum distance of 300 ft.
vi) When these animals are sighted while the vessel is underway (e.g., bow-
riding), attempt to remain parallel to the animal’s course. Avoid excessive
speed or abrupt changes in direction until they have left the area.
vii) Reduce speed to 10 knots or less when mother/calf pairs or groups of marine
mammals are observed, when safety permits.
4) (AP.10.) Turbidity Control Measures during Construction: Turbidity must be
monitored and controlled. Prior to initiating any of the work covered under this
Opinion, the Permittee shall install turbidity curtains as described below. In some
instances, the use of turbidity curtains may be waived by the USACE project
manager if the project is deemed too minimal to generate turbidity (e.g., certain
ATON installation, scientific survey device placement, marine debris removal) or if
the current is too strong for the curtains to stay in place. Turbidity curtains
specifications:
a) Install floating turbidity barriers with weighted skirts that extend to within 1 ft of
the bottom around all work areas that are in, or adjacent to, surface waters.
b) Use these turbidity barriers throughout construction to control erosion and
siltation and ensure that turbidity levels within the project area do not exceed
background conditions.
c) Position turbidity barriers in a way that does not block species’ entry to or exit
from designated critical habitat.
d) Monitor and maintain turbidity barriers in place until the authorized work has
been completed and the water quality in the project area has returned to
background conditions.
e) In the range of ESA-listed corals (St. Lucie Inlet, Martin County south to the Dry
Tortugas and the U.S. Caribbean) and Johnson’s seagrass (Turkey Creek/Palm
Bay south to central Biscayne Bay in the lagoon systems on the east coast of
Florida):
i) Projects that include upland earth moving (e.g., grading to install a building or
parking lot associated with a dock and seawall project), must install sediment
control barriers to prevent any upland sediments from reaching estuarine or
marine waters.
ii) The turbidity curtain requirement cannot be waived for any project that moves
or removes sediment (e.g., dredging, auger to create a pile, trenching to
install a cableline). If turbidity curtains are not feasible in an area based on
site conditions such as water current, high wave action, or stormy conditions,
the project must undergo individual Section 7 consultation and is not covered
under this Programmatic Opinion.
5) (AP.11.) Entanglement: All turbidity curtains and other in-water equipment must be
properly secured with materials that reduce the risk of entanglement of marine
species (described below). Turbidity curtains likewise must be made of materials
that reduce the risk of entanglement of marine species.
a) In-water lines (rope, chain, and cable, including the lines to secure turbidity
curtains) must be stiff, taut, and non-looping. Examples of such lines are heavy
metal chains or heavy cables that do not readily loop and tangle. Flexible in-
water lines, such as nylon rope or any lines that could loop or tangle, must be
enclosed in a plastic or rubber sleeve/tube to add rigidity and prevent the line
from looping and tangling. In all instances, no excess line is allowed in the water.
b) Turbidity curtains and other in-water equipment must be placed in a manner that
does not entrap species within the construction area or block access for them to
navigate around the construction area.
North Atlantic Right Whale Information Form
Federal Regulations Governing the Approach to North Atlantic Right Whales
1. Federal regulations governing the approach to North Atlantic right whales can be found at
50 CFR 224.103(c). It is illegal to approach and remain within 500 yards of right whales;
500 yards is equal to the distance of 5 football fields.
Prohibitions on approaching right whales are as follows
(Excerpts from 50 CFR 224.103(c), available at
www.ecfr.gov): Unless otherwise lawfully allowed or
unless doing so would create an imminent and serious
threat to a person or vessel, it is unlawful to:
(i) Approach (including by interception) within 500
yards (460 m) of a right whale by vessel
(ii) Fail to undertake required right whale avoidance
measures. If underway, a vessel must steer a course away from the right whale and
immediately leave the area at a slow safe speed.
2. Updates can be downloaded from:
a. http://www.nmfs.noaa.gov/pr/species/mammals/cetaceans/rightwhale_northatlantic.htm,
or
b. www.ecfr.gov
SELF-CERTIFICATION STATEMENT OF COMPLIANCE
Permit Number: SAJ- - (LCK)
Permittee’s Name & Address (please print or type):___________________________________
____________________________________________________________________________
____________________________________________________________________________
Telephone Number:____________________________________________________________
Location of the Work:___________________________________________________________
____________________________________________________________________________
Date Work Started:____________________ Date Work Completed:______________________
PROPERTY IS INACCESSIBLE WITHOUT PRIOR NOTIFICATION: YES ______ NO_______
TO SCHEDULE AN INSPECTION PLEASE CONTACT _______________________________
AT __________________________
Description of the Work (e.g. bank stabilization, residential or commercial filling, docks, dredging,
etc.):________________________________________________________________________
____________________________________________________________________________
____________________________________________________________________________
Acreage or Square Feet of Impacts to Waters of the United States: ______________________
Describe Mitigation completed (if applicable): ________________________________________
____________________________________________________________________________
____________________________________________________________________________
Describe any Deviations from Permit (attach drawing(s) depicting the deviations):
____________________________________________________________________________
____________________________________________________________________________
********************
I certify that all work, and mitigation (if applicable) was done in accordance with the limitations and
conditions as described in the permit. Any deviations as described above are depicted on the
attached drawing(s).
______________________________
Signature of Permittee
______________________________
Date