HomeMy WebLinkAboutARMY CORPS OF ENGINEERS PAPERWORKw
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U.S. Army Corps of Engineers (USACE)
FormApproved-
APPLICATION FOR DEPARTMENT OF THE ARMY PE4, Lucie County, Per
tong
MB No. 0710-0003
33 CFR 325. The proponent agency is CECW-CO-R.
picas: 01.08-2018
The public reporting burden for this collection of information, OMB Control Number 0710-0003, is estimated to average 11 hours per response, including the time
for reviewing instructions, searching existing data sources, gathering and maintaining the data needed, and completing and reviewing the collection of
information. Send comments regarding the burden estimate or burden reduction suggestions to the Department of Defense, Washington Headquarters Services,
at whs.mo•alex estl mbx dd-dod-information-collectionsemall mil. Respondents should be aware that notwithstanding any other provision of law, no person shall
be subject to any penalty for failing to comply with a collection of information if it does not display a currently valid OMB control number. PLEASE DO NOT
RETURN YOUR APPLICATION TO THE ABOVE EMAIL.
PRIVACY ACT STATEMENT
Authorities: Rivers and Harbors Act, Section 10, 33 USC 403; Clean Water Act, Section 404, 33 USC 1344; Marine Protection, Research, and Sanctuaries Act,
Section 103, 33 USC 1413; Regulatory Programs of the Corps of Engineers; Final Rule 33 CFR 320-332. Principal Purpose: Information provided on this form
will be used in evaluating the application for a permit. Routine Uses: This information may be shared with the Department of Justice and other federal, state, and
local government agencies, and the public and may be made available as part of a public notice as required by Federal law. Submission of requested information
is voluntary, however, if information is not provided the permit application cannot be evaluated nor can a permit be issued. One set of original drawings or good
reproducible copies which show the location and character of the proposed activity must be attached to this application (see sample drawings and/or instructions)
and be submitted to the District Engineer having jurisdiction over the location of the proposed activity. An application that is not completed in full will be returned.
System of Record Notice (BORN). The information received is entered into our permit tracking database and a SORN has been completed (SORN #A1145b)
and may be accessed at the following website: htto://doold.defense.gov/PriyaW$ORNsindex/DOD-wide-SORN-Artide-View/Articia7Ol 15/al145b-ce.asox
(ITEMS 1 THRU 4 TO BE FILLED BY THE CORPS)
1. APPLICATION NO.
2. FIELD OFFICE CODE
3. DATE RECEIVED
4. DATE APPLICATION COMPLETE
(ITEMS BELOW TO BE FILLED BYAPPLICAN7)
5. APPLICANTS NAME
8. AUTHORIZED AGENT'S NAME AND TITLE (agent is not required)
First - Mike Middle- Last -Baur
First - Bret Middle- Last -Hoskins
Company -
Company - CORE Marine Contractors, Inc. SCANNED
BY
E-mail Address -
E-mail Address-admin@coremci.com
6. APPLICANTS ADDRESS:
9. AGENTS ADDRESS: St. Lucie Guountv
Address- 247 Nettles Blvd
Address- 4370 US Hwy I
City -Jensen Beach State - FL Zip -34957 Country -USA
city- Vero Beach State - FL Zip -32967 Country -USA
7. APPLICANTS PHONE NOs. WARFA CODE
10. AGENTS PHONE NOs. WAREA CODE
a. Residence b. Business c. Fax
a. Residence b. Business c. Fax
401-862-5680
772-234-4250 888-858-1492
STATEMENT OF AUTHORIZATION
11. 1 hereby authorize, Bret Hoskins to act in my behalf as my agent in the processing of this application and to furnish, upon request,
supplemental information in support of this permit application.
SIG ATURE OF APPLICANT DAT 1f
NAME, LOCATION, AND DESCRIPTION OF PROJECT OR ACTIVITY
12. PROJECT NAME OR TITLE (see instructions)
Baur Boat Lift
13. NAME OF WATERBODY, IF KNOWN (if applicable)
14. PROJECT STREET ADDRESS (if applicable)
Jensen Beach to Jupiter Inlet Aquatic Preserve
Address 247 Nettles Blvd
15. LOCATION OF PROJECT
Latitude: -N 27.285480 Longitude: -W-80.226320
City - Jensen Beach State- FL 34957 Zip-
16. OTHER LOCATION DESCRIPTIONS, IF KNOWN (see instructions)
State Tax Parcel ID 4502-501-0433-000-5 Municipality St. Lucie County
Section - Township - Range -
ENG FORM 4345, MAY 2018 PREVIOUS EDITIONS ARE OBSOLETE. Page 3 of 1
,ti
17. DIRECTIONS TO THE SITE
From the Florida Turnpike, head southwest on SW Port St Lucie Blvd toward SW Cameo Blvd, 0.3 mi; Make a U-turn at SW Cameo Blvd,
Pass by KFC (on the right in 0.6 mi), 4.6 mi; Use the right 2 lanes to turn right onto US-1 S, 2.0 mi;
Use the left 2 lanes to turn left onto NW Jensen Beach Blvd, 2.8 mi; At the traffic circle, take the 4th exit onto NE Pineapple Ave, 0.5 mi; At
the traffic circle, continue straight onto NE Causeway Blvd, 1.9 mi; At the traffic circle, take the 3rd exit onto Florida AlA N/S Ocean Dr, 2.3
mi; Drive to Nettles Blvd, 5 min (1.0 mi); Turn left onto Nettles Blvd, Partial restricted usage road, 0.7 mi; Turn right onto S Dakota Ave,
Restricted usage road, 0.1 mi; Turn left onto Michigan Ave, Restricted usage road, 0.1 mi; Turn left onto Nettles Blvd, Restricted usage road;
Destination will be on the left
18. Nature of Activity (Description of project, include all features)
Provide and install (1) Aluminum and Stainless -steel, 250 12,000# Elevator Boat Lift by Neptune on (2) new Marine Grade pilings wrapped
with .030" high density Polyethylene pile wrap.
19. Project Purpose (Describe the reason or purpose of the project, see instructions)
Install a new boat lift at clients residence.
USE BLOCKS 20-23 IF DREDGED AND/OR FILL MATERIAL IS TO BE DISCHARGED
20. Reason(s) for Discharge
21. Type(s) of Material Being Discharged and the Amount of Each Type in Cubic Yards:
Type Type Type
Amount in Cubic Yards Amount in Cubic Yards Amount in Cubic Yards
22. Surface Area in Acres of Wetlands or Other Waters Filled (see instructions)
Acres
or
Linear Feet
23. Description of Avoidance, Minimization, and Compensation (see instructions)
Equipment shall include but not be limited to a motorized construction barge with surface mounted crane. Barge draft varies from 12"
unloaded to 24" at max load capacity.
Construction material and piles will be stored above the MH W line on the uplands or on the barge, never in the water. A turbidity barrier will
be used throughout construction and/or when needed.
ENG FORM 4345, MAY 2018 Page 3 of 2
24. Is Any Portion of the Work Already Complete? Yes ❑X No IF YES, DESCRIBE THE COMPLETED WORK
25. Addresses of Adjoining Property Owners, Lessees, Etc., Whose Property Adjoins the Waterbody (if more uwn=be entered here, please auarh a supplemental fist).
a. Address- 246 Nettles Blvd
City - Jensen Beach State - FL Zip - 34957
b. Address- 248 Nettles Blvd
City - Jensen Beach State - FL Zip - 34957
c. Address -
City - State - Zip -
d. Address -
City - State - Zip -
e. Address -
City - State - Zip -
26. List of Other Certificates or Approvals/Denials received from other Federal, State, or Loral Agencies for Work Described in This Application.
AGENCY TYPE APPROVAL' IDENTIFICATION DATE APPLIED DATE APPROVED DATE DENIED
NUMBER
Would include but is not restricted to zoning, building, and flood plain permits
27. Application is hereby made for permit or permits to authorize the work described in this application. I certify that this information in this application is
complete and accurate. I further certify that I possess the authority to undertake the work described herein or am acting as the duly authorized agent of the
applicant.
-� f O
SIGNATURE OF APPLICANT MATE— SIGNATURE OF AGENT DATE
The Application must be signed by the person who desires to undertake the proposed activity (applicant) or it may be signed by a duly
authorized agent if the statement in block 11 has been filled out and signed.
18 U.S.C. Section 1001 provides that: Whoever, in any manner within the jurisdiction of any department or agency of the United States
knowingly and willfully falsifies, conceals, or covers up any trick, scheme, or disguises a material fact or makes any false, fictitious or fraudulent
statements or representations or makes or uses any false writing or document knowing same to contain any false, fictitious or fraudulent
statements or entry, shall be fined not more than $10,000 or imprisoned not more than five years or both.
ENG FORM 4345, MAY 2018 Page 3 of 3
Part 2: Acknowledgement
I understand this form is being provided solely to seek verification of qualification to use one or more
Environmental Resource Permit (ERP) exemption(s), and that I am NOT requesting the Agency to
process this form as an application for a permit.
I understand that the Agency will make a reasonable effort to determine, within 30 days of receipt of this
form, whether the proposed activities qualify for an exemption. If they do not, the Agency will provide its
determination that the requested activity does not meet the terms and conditions of an ERP exemption, at
which time I may provide a new form with additional or modified information, or I may submit an
application for an ERP. In either case, denial of qualification to use an exemption will be made without
prejudice, pending submittal of clarification of any errors or omissions contained in this form or other
information that demonstrates compliance with the terms and conditions of the exemption.
Typed/Printed Name: Mike Baur Signatur . Date: gamJ1-f
Certification of Sufficient Real Property Interest and Authorization for Staff to Access to the
Property:
1 certify that:
I, or the person I represent, hereby certify that I, or that person, possess sufficient real property interest in
or control, as defined in Section 4.2.3(d) of Applicant's Handbook Volume 1, over the land upon which
the activities described in this form are proposed, and that I have, or that landowner has given me, legal
authority to grant permission for staff of the Agency to access, inspect, and sample the lands and waters
of the property as necessary for the review of the proposed activities specified in this form. If such
sufficient real property interest is based on an entity having the power of eminent domain and
condemnation authority, I/we shall make appropriate arrangements to enable staff of the Agency to
access, inspect, and sample the property as described above.
Typed/Printed Name: Mike Baur Signature✓� Date:,guh f
(Corporate Title if applicable):
Part 3: Submittal and Fees
This form and the appropriate fee should be submitted to the agency having regulatory authority for the activity.
Operating Agreements between the Department and the water management districts spell out which agency
will process any given application. For more information go to https://floridadep.gov/water/submerged-lands-
envi ron mental-resources-coordination/content/s ub mitti ng-erp.
This form may be submitted online; to do so, follow the online submittal requirements of the agency:
• Florida Department of Environmental Protection:
http://www.fldepportal.com/go/
• Northwest Florida Water Management District:
hftps:iipermiffing.sirwmd.com/nwepermifting/J*sp/start.jsp
• Suwannee River Water Management District:
hftps:iipermifting.sjrwmd.com/sreperrnitting/jsp/startjsp
• St Johns River Water Management District:
https://perm itti ng.sj rwm d. comleperm itti ngljsp/AccountOverview.do?com m and=i nit
• Southwest Florida Water Management District:
hftp://www.swf%vmd.state.fl.us/permits/epermiffing/
• South Florida Water Management District:
hftp://my.sfWmd.gov/ePermitting/MainPage.do
Form 62-330.050(1) —Request for Verification of Exemption Under Rule 62-330.051, F.A.C.
Incorporated by reference in subsection 62-330.050(2), F.A.C. (June 1, 2018)
Page 5 of 6
U.S. Army Corps of Engineers (USACE)
Form Approved -
APPLICATION FOR DEPARTMENT OF THE ARMY PERMIT
OMB No. 1-08-2018
Expires: 0.08-208
33 CFR 326. The proponent agency is CECW-CO•R.
The public reporting burden for this collection of information, OMB Control Number 0710-0003, is estimated to average 11 hours per response, including the lime
for reviewing instructions, searching existing data sources, gathering and maintaining the data needed, and completing and reviewing the collection of
information. Send comments regarding the burden estimate or burden reduction suggestions to the Department of Defense, Washington Headquarters Services,
at rihS m�nlex esd mbx dd dod Information collectionaftmall mil. Respondents should be aware that notwithstanding any other provision of law, no person shall
be subject to any penalty for falling to comply with a collection of information if it does not display a currently valid OMB control number. PLEASE DO NOT
RETURN YOUR APPLICATION TO THE ABOVE EMAIL.
PRIVACY ACT STATEMENT
Authorities: Rivers and Harbors Act, Section 10, 33 USC 403; Clean Water Act, Section 404, 33 USC 1344; Maine Protection, Research, and Sanctuaries Act,
Section 103, 33 USC 1413: Regulatory Programs of the Corps of Engineers; Final Rule 33 CFR 320.332. Principal Purpose: Information provided on this form
will be used in evaluating the application fora permit. Routine Uses: This,information maybe shared with the Department of Justice and other federal, state, and
local government agencies; and the public and may be made available as part of apublic notice as required by Federal law. Submission of requested information
is voluntary,. however, if information is not provided the permit application cannot be evaluated nor can a. permit be issued. .One set of original drawings or good
reproducible copies which show the location and character of the proposed activity, must be attached to.this application (see sample drawings and/or instructions)
and be submitted to the Distric(,Engineer having jurisdiction over the location. of the proposed activity. An application that is not completed in full will be returned.
System of Record Notice (BORN). The information received is entered into our permit tracking database and a BORN has been. completed (SORN #A1145b)
and may be accessed at the following website: +j_ttp'iPoodd defense movJPriv@GWSORRalndez/DOD • "de-SORh Adldg MewlArticlei5701151al 145b-ce asox
(ITEMS,1 THRU 4 TO BE FILLED BY THE CORPS)
1. APPLICATION NO.
2..FIELD OFFICE CODE
& DATE RECEIVED
4. DATE APPLICATION COMPLETE
(ITEMS BELOW TO BE FILLED BYAPPLICA"
5. APPLICANTS NAME
8. AUTHORIZED AGENT'S NAME AND TITLE (agent is not. required)
First - Mike Middle- Last -Baur
First - Bret Middle- Last - Hoskins
Company -
Company - CORE Marine Contractors, Inc.
AN
E-mail Address -
te%f%1tl�
E-mail Address-admin@coremci.com
6. APPLICANTS ADDRESS:
9. AGENTS ADDRESS:'
Ym
Address- 247 Nettles Blvd
Y
Address- 4370 US Hwy 1
City- Jensen Beach State- FL Zip-34957 Country -USA
City- Vero Beach State- FL Zip-32967 Country -USA
7. APPLICANTS PHONE NOs. WAREA CODE
10. AGENTS PHONE Nos. w/AREA CODE
a. Residence b. Business c. Fax
a. Residence b. Business c. Fax
772-234-4250 888-858-1492
401-862-5680
STATEMENT OF AUTHORIZATION
11. 1 hereby authorize, .Bret Hoskins to act in my behalf as my agent in the processing of this application and to furnish, upon request,
supplemental information in support of this permit application.
M a- iy
AT
SIG ATUREOFAPPLICANT
NAME, LOCATION, AND DESCRIPTION OF PROJECT OR ACTIVITY
12. PROJECT NAME OR TITLE (see instructions)
Baur Boat Lift
13. NAME OF WATERBODY, IF KNOWN (if applicable)
14. -PROJECT STREET ADDRESS (if applicable)
Jensen Beach to Jupiter Inlet Aquatic Preserve
Address- ,247 Nettles Blvd
City -.Jensen Beach State- FL 34957 Zip-
16. LOCATION OF PROJECT
Latitude: =N 27.285480 Longitude: =W-80.226320
16. OTHER LOCATION DESCRIPTIONS, IF KNOWN (see Instructions)
State Tax Parcel ID 4502-501-0433-000-5 Municipality St. Lucie County
Section - Township - 'Range -
ENG FORM 4345, MAY 2018 PREVIOUS EDITIONS ARE OBSOLETE. rage o m
17. DIRECTIONS TO THE SITE
From the Florida Turnpike, head southwest on SW Port St Lucie Blvd toward SW Cameo Blvd, 0.3 mi; Make a U-tum at SW Cameo Blvd,
Pass by KFC (on the right in 0.6 mi), 4.6 mi; Use the right 2 lanes to mm right onto US-1 S, 2.0 ml;
Use the left 2 lanes to turn left onto NW Jensen Beach Blvd, 2.8 mi; At the traffic circle, take the 4th exit onto NE Pineapple Ave, 0.5 mi; At
the traffic circle, continue straight onto NE Causeway Blvd, 1.9 mi; At the traffic circle, take the 3rd exit onto Florida A I A N/S Ocean Dr, 2.3
mi; Drive to Nettles Blvd, 5 min (1.0 mi); Turnleft onto Nettles Blvd, Partial restricted usage road, 0.7 mi; Tom right onto S Dakota Ave,
Restricted usage road, 0.1 mi; Turn left onto Michigan Ave, Restricted usage road, 0.1 mi; Turn left onto Nettles Blvd, Restricted usage road;
Destination will be on the left
18. Nature of Activity (Description of project, Include all features)
Provide and install (1) Aluminum and Stainless -steel, 250 12,000# Elevator Boat Lift by Neptune on (2) new Marine Grade pilings wrapped
with .030" high density Polyethylene pile wrap.
19. Project Purpose (Describe the reason or Purpose of the project, see Instructions)
Install a new boat lift at clients residence.
USE BLOCKS 20-23.IF DREDGED ANDIOR.FILL MATERIAL IS TO BE DISCHARGED
20. Reason(s) for Discharge
21. Type(s) of Material Being Discharged and the Amount of Each Type in Cubic Yards:
Type Type Type
Amount in Cubic Yards Amount in Cubic Yards Amount in Cubic Yards
22. Surface Area in Acres of Wetlands or Other Waters Filled (see Instructions)
Acres
or
Linear Feet
23. Description of Avoidance, Minimization, and Compensation (see instructions)
Equipment shall include.but not be limited to a motorized construction barge with surface mounted crane. Barge draft varies from 12
unloaded to 24" at max load capacity.
Construction material and piles will be stored above the MHW line on the uplands or on the barge, never in the water. A turbidity barrier will
be used throughout construction and/or when needed.
ENG FORM 4345, MAY2018 Paqu 3 Ul `
24. Is Any Portion of the Work Already Complete? ❑Yes 0 No IF YES, DESCRIBE THE COMPLETED WORK
25. Addresses of Adjoining Property Owners, Lessees, Etc., Whose Property Adjoins the Waterbody (a etas man can be entered here, please stash a supplemertavist).
a. Address- 246 Nettles Blvd
City - Jensen Beach State - FL Zip - 34957
b. Address- 248 Nettles Blvd
City - Jensen Beach State - FL Zip - 34957
c. Address -
City - State - Zip -
d. Address -
City - State - Zip -
e. Address -
City - Stale - Zip -
26. List of Other Certificates or Approvals/Denialsreceived from other Federal, State, or Local Agencies for Work Described in This Application.
AGENCY TYPE APPROVAL' IDENTIFICATION DATEAPPLIED DATEAPPROVED DATE DENIED
NUMBER
• Would include but is not. restricted to zoning, building, and flood plain, permits
27. Application is hereby made for permit or permits to authorize the work described in this application..'I certify that this Information in this application is
complete and accurate. I further certify that I possess the authority to undertake the work described herein or am acting as the duly authorized agent of the
applicant.
NATURE OF APPLICANT DA E SIGNATURE OF AGENT DATE
The Application must be signed by the person who desires to undertake the proposed activity (applicant) or it may be signed by a duly
authorized agent if the statement in block .11 has been filled out and signed.
18 U.S.C. Section 1001 provides that: Whoever, in any manner within the jurisdiction of any department or agency of.the United Stales
knowingly and willfully falsifies, conceals, or, covers,up any trick, scheme,or disguises a material fact or makesany false, fictitious or fraudulent
statements or representations or makes or uses any false writing or document. knowing same to.contain any false, fictitious or fraudulent
statements or entry, shall be fined not more than sto,000 or imprisoned not. more than five years or both.
ENG FORM4345, MAY 2018 Page 3 of 3
Part 2: Acknowledgement
I understand this form is being provided solely to seek verification of qualification to use one or more
Environmental Resource Permit (ERP) exemption(s), and that I am NOT requesting the Agency to
.process this form as an application for a permit.
I understand that the Agency will make a reasonable effort to determine, within 30 days of receipt of this
form, whether the proposed activities qualify for an exemption. If they do not; the Agency will provide its
determination that the requested activity does not meet the terms and conditions of an ERP exemption, at
which time I may provides new form with additional or modified information, or I may submit an
application for an ERP. In either case, denial of qualification to use an exemption will be made without
prejudice,, pending submittal of clarification of any or omissions contained in thisform or other
information that demonstrates compliance with the terms and conditions ofthe exemption•
Typed/Printed Name: Mike Baur Signatur Date;a0%IC�
Certification of Sufficient Real Property, Anterest and Authorization for Staff to Access to the
Property:
1 certify that:
I, or the person I represent, hereby certify that I, or that person, possess sufficient real property interest in
or control, as defined in Section 4.2.3(d)'of Applicant's'Handbook Volume I, over the land upon which
the activities described in this form are proposed, and that I have, or that landowner has given me, legal
authority to grant permission for staff of the Agency to access, inspect, and sample the lands and waters
of the property as necessary for the review of the proposed activities specified in this form. If such
sufficient real property interest is based on an entity having the power of eminent domain and
condemnation authority, I/we shall make appropriate arrangements to enable staff of the Agency to
access, inspect, and sample the property as described above.
Typed/Printed Name: Mike Baur SignatureE��— Date: g&l j
(Corporate Title if applicable):
Part 3: Submittal and Fees
This form and the appropriate fee should be submitted to the agency having regulatory authority for the activity.
Operating Agreements between the Department and the water management districts spell out which agency
will process any given application. For more information go to https:/Ifloddadep.gov/water/submerged-lands-
envi ronmental-resources-coordination/contenUsub miffing-erp.
This form may be submitted online; to do so, follow the online submittal requirements of the agency
• Florida Department of Environmental Protection:
httioWwww.flde pportat.com/go/
• Northwest Florida Water Management District:
https://perm itti ng.sirwmd.cominweperm itti nglisp/start. jsp
• Suwannee River water Management District:
https:/Ipermitting.sjrwmd.com/seepermitfing/J*sptstarLjsp
• St Johns River Water Management District:
South Florida Water
Forth 62-330.050(1) — Request for Verification of Exemption Under Rule 62-330.051, F.A.C.
Incorporated by reference in subsection 62-330.050(2), F.A.C: (June'1, 2018) Page 5 of 6