* DEQ: Permit application fees required for Virginia Water Protection permits while detailed in 9VAC25-20 = are conveyed to the applicant by the applicable DEQ office (http:!/www. deq. virginia, gov/Locations. aspx). Complete the Permit Application Fee Form and submit it per the instructions to the address listed on the form. Instructions for submitting any other fees will be provided to the applicant by DEQ staff. * 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 ifthe 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 staff will send the permittee a letter notifying him/her ofthe proper permit fees and submittal requirements. * LWB: Permit fees vary by locality. Contact the LWB for your project area or their website for fee information and submittal requirements. Contact information for LWBs may be found at htplcmvimaedenmis web/guidance/ocal wetlands boards. html. FOR AGENCY USE ONLY DE -- G E - VE Notes: 25030392 MAR 3 1 2025 JPA # 25- SMAA By APPLICANTS Part 1 - General Information PLEASE PRINT OR TYPE ALL ANSWERS: Ifa question does not apply to your project, please print N/A (not applicable) in the space provided. Ifadditional space is needed, attach 8-1/2 X 11 inch sheets of paper. Check all that anply Pre-Construction Notification (PCN) Regional Permit 17 (RP-17) NWP # (For Nationwide Permils ONLY - No DEQ- VWP permit writer will be assigned) County or City in which the project is located: Gioucostor County, Hayos, VA Waterway at project site: Sarah Creek, NW PREVIOUS ACTIONS RELA ATED TO1 THE PROPOSED HORK (Include all federal. state. and local pre application coordination, site visits. previous permits. or applications ohether issued. withdrawi, or denied) Historical information for past permit submittals can be found online with VMRC hitpswebapps. mrc. MIRNISRUPRBEANENVA or VIMS htp/bemaims-edupermshewpemis. htm! Agency Action / Activity Permit/Project number, including any Date of If denied, give reason non-reporting Nationwide permits Action for denial previously used (e. B, NWP 13) Application Revised: October 2019 Part 1 - General Information (continued) t 1. Applicant's legal name* and complete mailing address: Contact Information: Mr. John C. Muerdler Home 2023 Tillage Lane 540 Work Hayes, VA 23072 Fax 272 Cell e-mail lark.muerder8gmaik.com 5550 State Corporation Commission Name and ID Number (if applicable) 2. Property owner(s) legal name* and complete address, if different from applicant: Contact Information: Home Work Fax Cell e-mail State Corporation Commission Name and ID Number (if applicable) 1 3. Authorized agent name* and complete mailing Contact Infomhation: address (if appliçable): Home - Jeff Watkins Work P.O. Box 515 Fax Gloucester, VA 23061 Cell 804 815-0813 e-mail watkhs49@ooxhel State Corporation Commission Name and ID Number (if appliçable) *1 If multiple applicants. property owners and/or agents. each must bel listed and each must sign the applicant signature page, 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 of installation (e.g. hammer, vibratory,, jetted, etc). Ifadditional space is needed, provide a separate sheet of paper with the project description. Shoreline Erosion Control Project Class I rock revetment is to be installed in front of a 100 L.F. of failing timber bulkhead. Access from land. No grading. Class I armor stone over core stone and heavy filter fabric. Application Revised: October 2019 6 Part 1 - General Information (continued) 5. Have you obtained a contractor for the project? x Yes* No. *Ify your answer is "Yes" complete the remainder ofthis question and submit the Applicant's and Contractor's Acknowledgment Form (enclosed) Contractor's name* and complete mailing address: Contact Information: Home Shoreline Structures, LLC Work Jeff Watkins Fax P.O.Box 515 Cell 804 815-0813 Gloucester, VA email Jwatk.hns49@cox.net State Corporation Commission Name and ID Number (if appliçable) * Ifmultiple contractors. eachu must be listed and leach must sien the applicant signature nage 6. List the name, address and telephone number of 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: Telephone number Gazette Journal (804 693-3101 Gloucester VA 7. Give the following project location information: Street Address (911 address if available) 2023 Tillage Lane BPC: 12405 LotBlock/Parcel# M: 1 74-5 Subdivision City / County. Hayes, Gloucester ZIP Code 23072 Latitude and Longitude at Center Point of Project Site (Decimal Degrees): - (Example: 36.41600/-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 property lines and location ofthe proposed project. A. supplemental map showing how the property is to be subdivided should also be provided. 8. What are the primary and secondary purposes ofand the need for the project? For example, the primary purpose may be "to protect property from crosion due to boat wakes" and the secondary purpose may be "to provide safer access to a pier." 1 Control Erosion Application Revised: October 2019 7 Part 1 - 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 oftidal wetlands andlor aquatic resources may require compensatory mitigation. 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 the project drawings. 12. Approximate çost of the entire project (materials, labor, etc.): $ TBD Approximate cost of that portion ofthe project that is channelward of mean low water: $<10k 13. Completion date of the proposed work: Summer 2025 14. Adjacent Property Owner Information: List the name and complete mailing address, including zip code, ofeach 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 the processing of your application by VMRC. 1. Mr. and Mrs. Stuart Fisher: 2033 Tillage Lane, Hayes, VA 23072 2. Mr. William Davis: 2009 Tillage Lane, Hayes, VA 23072 Application Revised: October 2019 8 Part 2 - Signatures 1. Applicants and property owners (if different from applicant). NOTE: REQUIRED FOR ALL PROJECTS AMVACYACISTAINENT The Department of the Army permit program is authorized by Section 10 of the Rivers and Harbors Act of 1899, Section 404 of the Clean Water Act, and Section 103 of the Marine Protection Research and Sanctuaries Act of 1972. These laws require that individuals obtain permits that authorize structures and work in or affecting navigable waters of the United States, the discharge of dredged or fill material into waters of the United States, and the transportation of dredged material for the purpose of dumping it into ocean waters prior to undertaking the activity. Information provided in the Joint Permit Application will be used in the permit review process and is a matter of public record once the application is filed. Disclosure of the requested information is voluntary, but it may not be possible to evaluate the permit application or to issue a permit if the information requested is not provided. CERTIFICATION: I am hereby applying for all permits typically issued by the DEQ, VMRC, USACE, and/or Local Wetlands Boards for the activities I have described herein. I agree to allow the duly authorized representatives of any regulatory or advisory agency to enter upon the premises of the project site at reasonable times to inspect and photograph site conditions, both in reviewing a proposal to issue a permit and after permit issuance to determine compliance with the permit. In addition, I certify under penalty oflaw 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. Tam aware that there are significant penalties for submitting false information, including the possibility of fine and imprisonment for knowing violations. John C. Muerdler Applicant' s Legal Name (printed/typed) (Use if more than one applicant) M. Applicant' 's Signature (Use if more than one applicant) 3-1-25 Date Property Owner's Legal Name (printed/typed) (Use if more than one owner) (If different from Applicant) Property Owner's Signature (Use ifn more than one owner) Date Application Revised: October 2019 Part2-Signatures (continued) 2. Applicants having agents (fa applicable) CERTIFICATION OF AUTHORIZATION Muerdler Jeff Watkins I (we). hereby certify that I (we) have authorized (Applicant' s legal name(s)) (Agent's name(s)) to act on my behalf and take all actions necessary to the processing, issuance and acceptance ofthis permit and any and all standard and special conditions attached. We hereby certify that theinformation submitted in this application is true and accurate to the best of our knowledge. (Agent" Signature)y (Useifmore than one agent) 3-1-77 (Date) I MAppleant's s Signature) (Use if more than one applicant) 3-1-25 (Date) 3. Applicant's having contractors (f applicable) CONTRACTOR ACKNOWLEDGEMENT I(we). Muerdler have contracted Shoreline Structures, LLC (Applicant' s legal name(s)) (Contractor's name(s)) to perform the work described in this Joint Permit Application, signed and dated March 1. 2025 We will read and abide by all conditions set forth in all Federal, State and Local permits as required for this project. We understand that failure to follow the conditions ofthe permits may constitute a violation of applicable Federal, state and local statutes and that we will be liable for any civil and/or criminal penalties imposed by these statutes. In addition, we agree to make available a copy ofany permit to any regulatory representative visiting the project to ensure permit compliance. If we fail to provide the applicable permit upon request, we understand that the representative will have the option ofs stopping our operation until it has been determined that we have aj properly signed and executed permit and are in full compliance with all terms and conditions. Shoreline Structures, LLC P.O. Box 515 Contractor's name or name of firm Contractor's or firms address e Gloucester, VA 23061 suxy Contractor's sibture and title Contractor's License Number CMss Appticant's S signature (use ifmore than one applicant) 3-1-25 Date Application Revised: October 2019 10 Part 3 - 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: It is the policy of the Commonwealth that living shorelines are the preferred altemative for stabilizing tidal shorelines (Va. Code $ 28.2-104.1). Information on non-structural, vegetative alternatives (i.e., Living Shoreline) for shoreline stabilization is available at http:llcerm.vims.cdu/constal zone/living shoreines/nder.htm, 1. Describe each revetment, bulkhead, marsh toe, breakwater, groin, jetty, other structure, or living shoreline project 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: 100 L. F. of rock revetment in front of a failing timber bulkhead. Class I as armor, core stone and heavy filter fabric. 6.5' tall, 12' base, buried toe. No back fill needed. 2. What is the maximum encroachment channelward of mean high water? 12 feet. Channelward of mean low water?5 feet. Channelward of the back edge ofthe dune or beach? NA feet. 3. Please calculate the square footage of encroachment over: Vegetated wetlands 0 square feet Non-vegetated wetlands 700 square feet Subaqueous bottom 500 square feet Dune and/or beach NA square feet 4. For bulkheads, is any part ofthe project maintenance or replacement ofa previously authorized, currently serviceable, existing structure? Yes No. Ifyes, will the construction oft the new bulkhead be no further than two (2) feet channelward of the existing bulkhead? Yes No. Ifno, please provide an explanation for the purpose and need for thc additional encroachment. Application Revised: October 2019 17 Part 3 - Appendices (continued) 5. Describe the type of construction and all materials to be used, including source ofbackfill material, if appliçable (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. Class I quarry stone over core rock and filter fabric 6. Ifusing stone, broken concrete, etc. for your structure(s), what is the average weight of the: Core (inner layer) material 5-10 pounds per stone Class size Gablon Armor (outer layer) material 50-150 pounds per stone Class size I 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 of mean low water cubic yards channelward of mean high water cubic yards landward of mean high water Area to be covered 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 Source of material, composition (e.g. 90% sand, 10% clay): Method of transportation and placement: Describe any proposed vegetative stabilization measures to be used, including planting schedule, spacing, monitoring, etc. Additional guidance is available at htp/hnavvimsdwaboubapinaeholenplamtingeguideines: Application Revised: October 2019 18 Mw Banck SARAH Creek - FLcob ALLET RTR RER EEK Aeo7 100' 12'Bse oG 1 5 Mhw N MA V EXISTINK SJLEHEAN 2 FAILINLZ 100' R 520' & 3-1-75 Jokxe Moerdler 70237 6 4a Hayes JA S7 Access ANO S