* DEQ: Permit application fees required for Virginia Water Protection permits - while detailed in atp/wawdeuvininin oVlLocationsaspx) Complete the Permit Application Fee Form and submit it per the instructions to the address listed on the form. Instructions for submitting any other VMRC: An application fee of$300 may be required for projects impacting tidal wetlands, beaches and/or dunes when VMRC acts as the LWB. VMRC will notify the applicant in writing ift the fee is required. Permit fees involving subaqueous lands are $25.00 for projects costing $10,000 or less and $100 for projects costing more than $10,000. Royalties may also be required for some projects. The proper permit fee and any required royalty is paid at the time of permit issuance by VMRC. VMRC staffwill send the permittee a letter notifying him/her ofthe proper permit fees and submittal LWB: Permit fees vary by locality. Contact the LWB for your project area or their website for fee information and submittal requirements. Contact information forLWBs may be found at htp/semimscduemis web/guidancellocal wetlands boards. html. 9VAC25-20 - are conveyed to the applicant by the applicable DEQ office fees will be provided to the applicant by DEQ staff. requirements. FOR AGENCY USE ONLY DECEIVEN DEC:31-2024 - BY CNcE Notes: JPA# Rct2-120214 25-0008 APPLICANTS Part 1- General Information PLEASE PRINT ORTYPE ALL. ANSWERS: Ifaquestion does not apply to your project, please print N/A (not applicable) in the space provided. Ifadditional space is needed, attach 8-1/2x 11 inch sheets of paper. Check al! that apply Regional Permit 17(RP-17 Pre-Construction Notification (PCN) L (For Nationwide Permits ONLY-Nol DEQ- VWP permil writer will be assigned) NWP# County or City in which the project is located:Gloucester Waterway at project site: Severn River Willetts Creek PREI/OLS_ICTIONS RELATED TO THE PROPOSED HORK (Include all federal. state, and luc al pre-upplication coordination, site visits, previous permits, or applications whether issued, withdran, or denied) Historical information for past permit submittals can bet found online with VMRC https/webapps. mrc.virginia. oVpublichabitat- or VIMS http:/ccrm. vims. cuparms.newpemis. html non-reporting Nationwide permits previously used (e.g g. NWP 13) Agency Action/ 1 Activity Permit/Project number, including any Date of Ifdenied, give reason Action for denial Application Revised: September 2018 Part 1- General/nformation (continued) 1. Applicant'sl legal name* and complete mailing address: Contact Information: Home Work Fax Christopher Cruz 3403 Stonewall Road, Hayes, VA 23072 Cell (757 )880-2288 e-mail chris.cruz@cox.net State Corporation Commission Name and ID! Number (if applicable) 2. Property owner(s) legal name* and complete address, ifdifferent from applicant: Contact Information: Home Work Fax Cell e-mail State Corporation Commission Name and ID Number (ifapplicable) 3. Authorized agent name* and complete mailing Jeff Watkins, Shoreline Structures, LLC Contact Information: Home @ Work (804 815-0813 Fax Cell e-mail watkins49@cox.net. address (if applicable): P.O. Box 515 Gloucester, VA 23061 State Corporation Commission Name and ID Number (ifa applicable) *Ifmultiple applicants, property owners.and/or; agents.cach must bel listed and each must sign the applicant 4. Provide a detailed description of the project in the space below, including the type of project, its dimensions, materials, and method of construction. Be sure to include how the construction site will be: accessed and whether tree clearing and/or grading will be required, including the total acreage. If the project requires pilings, please be sure to include the total number, type (e.g. wood, steel, etc), diameter, and method ofinstallation (e.g. hammer, vibratory,jetted, etc). Ifadditional space is signature page. needed, provide a separate sheet of paper with the project description. Shoreline Erosion Control Project. Two, 100' long stone breakwaters, 65' long stone spur breakwater, and 118' stone sill. 1200 cyds of sand nourishment with spartina plantings at appropriate elevations. Access from land. Application Revised: September 2018 Part - 1- General Information (continued) 5. Have you obtained a contractor for the project? Acknowledgment Form (enclosed) Contractor's name* and complete mailing address: Shoreline Structures, LLC Jeff Watkins P.O. Box 515 Gloucester. VA 23061 Yes*x No. *Ifyour answer is "Yes" complete the remainder ofthis question and submit the Applicant's and Contractor's Contact Information: Home ( Work (804 )815-0813 Fax Cell email watkins49@coxnet: State Corporation Commission Name and ID Number (if applicable). Tfmultiple contractors. each must be listed and each must sign the applicant signature page. 6. List the name, address and telephone number oft the newspaper having general circulation in the area ofthe project. Failure to complete this question may delay local and State processing. Name and complete mailing address: Gloucester Mathews Gazette Journal Post Office Box 2060, Gloucester, VA 23061 7. Give the following project location information: Street Address (911 address ifavailable)3403 Stonewall Road Lol/Block/Parcelf 47-88D pc: 29008 Telephone number (804 693-3101 Subdivision City/County Gloucester 37.304662 ZIP Code 23072 Latitude and Longitude at Center Point of Project Site (Decimal Degrees): -76.453056 (Example: 36.416001-76.30733) Ifthe project is located in a rural area, please provide driving directions giving distances from the best and nearest visible landmarks or major intersections. Note: ifthe project is in an undeveloped subdivision or property, clearly stake and identify properly lines and location of the proposed project. A. supplemental. map. showing how the properly is to be: subdivided. should also be provided. The project is located at 3403 Stonewall Road in Gloucester, VA. 8. What are the primary and secondary purposes ofand the need fort the project? For example, the primary purpose may be "toj protect property from erosion due tol boat wakes" and the secondary purpose may be "to provide safer access to a pier." The project is for erosion control. Application Revised: Scptember 2018 Part1- General Information (continued) 9. Proposed use (check one): X Single user (private, non-commercial, residential) Multi-user (community, commercial, industrial, government) 10. Describe alternatives considered and the measures that will be taken to avoid and minimize impacts, to the maximum extent practicable, to wetlands, surface waters, submerged lands, and buffer areas associated with any disturbance (clearing, grading, excavating) during and after project construction. Please be advised that unavoidable losses oftidalwetlands and or aquatic resources may require The sill will be constructed from the upland with no grading or clearing required. The sill with sand nourishment and wetland planting is a preferred alternative for controlling compensatory mitigation. shoreline erosion. 11. Is this application being submitted for after-the-fact authorization for work which has already begun or been completed? Yes X No. Ifyes, be sure to clearly depict the portions of the project which are already complete in thej project drawings. 12. Approximate cost of the entire project (materials, labor, etc.): $TBD Approximate cost of that portion oft the project that is channelward ofmean low water: STBD 13. Completion date oft the proposed work: 2025 14, Adjacent Property Owner Information: List the name and complete mailing address, including zip code, ofe each adjacent property owner to the project. (NOTE: Ifyou own the adjacent lot, provide the requested information for the first adjacent parcel beyond your property line.)Failure to provide this information may result in a delay in thej processing ofyour application by VMRC. 3398 Stonewall Road: Quayside Investments, LLC 295 Enon Hall White Stone, VA: 22578 3459 Stonewall Road: 3459 Stonewall Road Hayes, VA23072 Ronald Dale Tucker and Britt Annette Jackman Application Revised: September 2018 Part 2-Signatures I. Applicants and property owners (ifdifferent frum mpplicant). NOTE: REQUIRED FOR. ALI.PROJECTS VACTATSTATAENT: The Department af the Army permit program is authorlad by Section 100f the Riversand Harburs Act of 1899, Seetion 404nfile Clean Waler Act,and Section H3 of the Marine Protection Research and Sancluries Act of 1972. These lns resuire that individuals obtin permits ilat authorize structares and work in or affecting navipable walers of the Lnited States. the discharge of dredyed or fill material into waters of the United Stales, and the trasporlation ofdredger materin! fur the purpose of dumping ir into acean wuters prior In underlaking the activity. luformntion provided in the Joint Permit Application will he used in ile permit review process andl isa matter of public record unce (he application is filed. Disclusure of the intornation is voluntary, hut it may not le possihle to evaluate the permit application or loi issue requested a permit ifthe CERTIPICATION: lam herehy applying for all permits lypically issued hy the DEQ, VMRC, USACE. aud/ur Local Wetlands Boards for the sctivi itics I lave deseribed herein. lagree lo allow the duly aufhorized representatives: of: any regulatory or advisory ageney 10 enter upon (he premises af the project site at reasonable times toi iuspert and phologrph site conditions, hutl in reviewi ing a praposal lu issue # permit and afler permit ln: addition, I eertify under penalty of law that this document and all attachmnents were prepared uder direction or supervision in accordance with a sisten designed to assure that sualificd persnnel properly my and evaluate thei information submitted. Based 0n my inquiry of the person or persons who manage thes sysien gather or those persons direetly respunsible lor gathering the information, thei information submitted is. to the hest of my knowledye and heliet, true, aecurate. and complete. lan aware that there are significant penalties for submittiug fale information. including the passibility of fine ad imprisonmen! for kuowing violations. information reyuested is 10! provided. issuance to determine compliance wilh the permit. Christopher Cruz Applicant's! Lcpal Nape (printediyped) (Usei il'more than one applicant) - Applicant's Signature (L.seifmore than one applicant) Date 2.R Property Ownér's lepal Name (printed/typed) (Ifdifferent froip Applicant) Property Owiyer's Signature rinA CKus (Useifmore thant one owner) (liseifmore than one NLCiwy owner) Date pplicatn Revinal: Seplemly NIIN Part2-Signatures (continued) 2. Applicants having agents (fapplicable) CERTIFICATION OF AUTHORIZATION (Applicant'sl legal name(s) standard and special conditions attached. I(we), CROZ hereby certify that I(we) have authorized Jefclartias (Agènt's name(s)) to act on my behalfandt take all actions necessary to the processing, issuance and acceptance ofthis permit and any and all Wel hereby certify that thei information submittedi in this application ist true and accurate to the best of our knowledge. Apent' s. Signature) 12-7-27 (Date) (Usei ifmore than one agent) (Applicant'ss Signature) (Usei ifmore than one applicant) (Date) 3. Applicant's having contractors @f applicable) CONTRACTOR. ACKNOWLEDCEMENT I(we), C222 (Applicant's legal name(s)) Slorolne Sruvetivas CLC have contracted (Contraclor'smamct9), to perform the work described in this. Joint Permit Application, signed and dated "12-7-24 Wev will read and abide by all conditions set forth in all Federal, State and Local permits as required for this project. We understand that failuret to follow the conditions ofthe permits may constitute a violation ofapplicable Federal, state and local statutes and that we will bel liable for any civil and/or criminal penalties imposed by these statutes. In addition, we agree to make availables a copy of any permit to any regulatory representative visiting the project to ensure permit compliançe. Ifwe fail to provide the applicable permit upon request, we understand that the representative willl have the option ofs stopping our operation until it has been determined that wel have a properly signed and executed permit and are in full compliance with all terms and conditions. Shulne - Smocut Contractor's name or name of firm -Aw hS15 GbosesTeu VA Contractor's or firms address Contractor's! Licensc Number (usei ifmore than one applicant) 23oc! Applicant'ss signature Date Application Revised: October 2019 10 Part3-Appendices (continued) Appendix B: Projects for Shoreline Stabilization in tidal wetlands, tidal waters and dunes/beaches including riprap revetments and associated backfill, marsh toe stabilization, bulkheads and associated backfill, breakwaters, beach nourishment, groins, jetties, and living shoreline projects. Answer all questions that apply. Please provide any reports provided from the Shoreline Erosion Advisory Service or VIMS. NOTE:Itist the policy of the Commonwealth that living shorelines are the preferred alternative for stabilizing tidal shorelines (Va. Code $28.2-104.1). Information on non-structural, vegetative: alternatives (ie., Living Shoreline) for shoreline stabilization is available at tasmaimsadusmial zone/living horelines/ndexhtml 1. Describe each revetment, bulkhead, marsh toe, breakwater, groin, jetty, other structure, or living shoreline projects separately in the space below. Include the overall length in linear feet, the amount of impacts in acres, and volume of associated backfill below mean high water and/or ordinary high water in cubic yards, as applicable: 2. Whati is the maximum encroachment channelward of mean high water? feet. feet. Channelward of mean low water? Channelward of the back edge oft the dune or beach? feet. 3. Please calculate the square footage of encroachment over: - Vegetated wetlands - Non-vegetated wetlands Subaqueous bottom Dune and/or beach serviçeable, existing structure? square feet square feet square feet square feet 4. For bulkheads, is any part ofthe project maintenance or replacement ofap previously authorized, currently Ifyes, will the construction of the new bulkhead be no further than two (2) feet channelward oft the existing Ifno, please provide an explanation for the purpose and need for the additional encroachment. Yes_ No. bulkhead? Yes No. Application Revised: October 2019 17 Part3-Appendices (continued) 5. Describe the type of construction and all materials to be used, including source ofbackfill material, if applicable (e.g., vinyl sheet-pile bulkhead, timber stringers and butt piles, 100% sand backfill from upland source; broken concrete core material with Class II quarry stone armor over filter cloth). NOTE: Drawings must include construction details, including dimensions, design and all materials, including fittings if used. 6, Ifusing stone, broken concrete, etc. for your structure(s), what is the average weight ofthe: Core (inner layer) material 5-zpounds per stone Class size Armor (outer layer) material 15D-pDpounds per stone Class size 7. For beach nourishment, including that associated with breakwaters, groins or other structures, provide the following: Volume of material cubic yards channelward of mean low water cubic yards landward ofmean low water cubic yards channelward of mean high water cubic yards landward of mean high water square feet channelward of mean low water square feet landward of mean low water cubic yards channelward of mean high water cubic yards landward of mean high water Area to be covered Source of material, composition (e.g. 90% sand, 10% clay): Method of transportation and placement: Describe any proposed vegetative stabilization measures tol be used, inçluding planting schedule, spacing, monitoring, etc. Additional guidance is available at htp/wwwvimsedwbouhsaschiisslerplantingtsudeinss Application Revised: October 2019 18 RT 620 V y - D VAUGAN B 100009€ 2 0091.AE SILLE 9998 deyv suior