1 JOINT FEDERAL/STATE APPLICATION FOR THE ALTERATION OF ANY FLOODPLAIN, WATERWAY, TIDAL OR NONTIDAL WETLAND IN MARYLAND FOR AGENCY USE ONLY Application Number Date Determined Complete Date(s) Returned Date Received by State Date Received by Corps Date of Field Review Type of State permit needed Type of Corps permit needed Agency Performed Field Review +++++++++++++++++++++++++++++++++++++++++++++++++++++++++++++++++++++++++++++++++++++ • Please submit 1 original and 4 copies of this form, required maps and plans to the Wetlands and Waterways Program as noted on the last page of this form. • Any application which is not completed in full or is accompanied by poor quality drawings may be considered incomplete and result in a time delay to the applicant. Please check one of the following: Resubmittal Application Amendment Modification to an Existing Permit Jurisdictional Determination Only Applying for Authorization Previously Assigned Number (resubmittals & amendments) Date: 1. APPLICANT INFORMATION: Applicant Name Name: B. Daytime Telephone: Company: Address: State: City: Zip: Agent / Engineer Information: Name: B. Telephone: Company: Address: City: Zip: State: Environmental Consultant: Name: B. Telephone: Company: Address: City: State: Zip: Contractor (if known): B. Telephone: Name: Company: Address: City: State: Zip: Principal Contact: Name: B. Telephone: Company: Address: City: State: Zip:
2 2. PROJECT DESCRIPTION Give Written Description of Project: Yes No Has any portion of the project been completed? If yes, explain: Check all activities that are proposed in the wetland, waterway, floodplain, and nontidal wetland buffer as appropriate. Activity: Flooding or impounding water Removing or destroying vegetation Filling . Draining Dredging Building structures Excavating Grading Area for item(s) checked: Wetland (square feet) (square feet) Buffer (Nontidal wetland only) (square feet) Expanded Buffer (Nontidal Wetland Only): (linear feet) Length of stream affected Project Dimensions Type of Projects: For each activity, give overall length and width (in feet), in columns 1 and 2. For multiple activities, give total area of di sturbance in square feet in column 3. For activities in tidal waters, give maximum distance channelward (in feet) in column 4. For dam or small ponds, give average depth (in feet) for the completed project in column 5. Give the volume of fill or dredged material in colu mn 6. Column Column Column Column Column Column 12 3 4 5 6 Ar ea Maximum/Average Volume of fill/dredge Width Channelward Pond material (cubic yards) Length Square (feet) Feet Encroachment (feet) below MHW or OHW Depth Bulkhead* Revetment* Vegetative Stabilization Gabions Groins Jetties Boat Ramp Pier* Breakwater Repair & Maintenance Road Crossing Utility Line Outfall Construction Small Pond Dam Lot Fill Building Structures Culvert Bridge Stream Channelization Parking Area Dredging* New Maintenance Hydraulic Mechanical Other (explain)
3 ****** For projects indicated with an asterisk refer to the sample plans and checklists found in the January 1988 Joint Applicat ion booklet.
4 Give brief written description of the project purpose Project Purpose: PROJECT LOCATION: 3. Location Information: County: City: Name of waterway or closest waterway: State stream use class designation: Site Address or Location: Directions from nearest intersection of two state roads: Is your project located in the Chesapeake Bay Critical Area (generally within 1,000 feet of tidal waters or tidal wetlands)? NO YES County Book Map Coordinates (Alexandria Drafting Co.); Excluding Garrett and Somerset Counties: Map: Number: Letter: (to the nearest tenth) FEMA Floodplain Map Panel Number (if known): Latitude: Longitude: Check one or more of the following as appropriate for the type of wetland/waterway where you are proposing an Activity Location: activity: 100 Year Floodplain (outside stream channel) Tidal Waters River, Lake, Pond Tidal Wetlands Special Aquatic Site (e.g., mudflat, vegetated shallows) Other (Explain): Nontidal Wetland 25-foot buffer (nontidal wetland sonly) 100-foot buffer (nontidal wetland; wetland of special State concern) In-stream Channel: _______Tidal _______ Nontidal Land Use: Current Use of Parcel Is: YES NO Agriculture: Has SCS designate project site as prior converted cropland? Wooded Marsh/Swamp Developed Other : Present Zoning Is: Residential Commercial/Industrial Agriculture Marina Other Project Complies With Current Zoning: NO YES THE FOLLOWING INFORMATION IS REQUIRED BY THE STATE. Check below if any of these apply to your project. Explain measures taken or considered REDUCTION OF IMPACTS: 4. to avoid or minimize wetland losses. Reduced the area of disturbance Reduced size/scope of project Relocated structures Redesigned project Other Explanation
5 Check items that apply to your project. Cost Other regulatory requirement Failure to accomplish project purpose Extensive wetlands on site Engineering/design constraints Safety/public welfare issue Inadequate zoning Other natural features Parcel size Other Describe reasons why impacts were not avoided or reduced. If you are applying for a letter of exemption for activities in nontidal wetlands and/or their buffers, 5. LETTER OF EXEMPTION: explain why the project qualifies: No significant plant or wildlife value & wetland impact: Mitigation Project Less than 5,000 square feet Utility Line: Overhead In an isolated nontidal wetland less than 1 acre in size Repair existing structure/ fill Underground Other (explain) Check here if you are applying for a letter of exemption. not IF YOU ARE APPLYING FOR A LETTER OF EXEMPTION, PROCEED TO “HISTORIC PROPERTIES” (next page) Explain why other sites that were considered for this project were rejected. Also, check 6. ALTERNATIVE SITE ANALYSIS: any items if they apply to your project. (If you are applying for a letter of exemption, do not complete this block): 1 site 5 or more sites 2 - 4 sites Alternative sites were rejected/not considered for the following reason(s): Greater wetlands impact Cost Other: Lack of availability Water dependency Failure to meet project purpose Inadequate zoning Located outside general/ market area Engineering/design constraints Explanation: Describe the public need or benefits that the project will provide. Also, check items that apply to your PUBLIC NEED: 7. project. (If you are applying for a letter of exemption, do not complete this block): Economic Health/welfare Other: Safety Does not provide public benefits Description:
6 8. OTHER APPROVALS NEEDED/GRANTED: Date Decision Other Agency Decision Granted Denied Date Sought Status Please provide the following information: 9. MITIGATION PLAN: Description of a monetary compensation proposal, if applicable (for only). Attach another sheet if necessary: state requirements Give a brief description of the proposed mitigation project. Describe why you selected your proposed mitigation site, including what other areas were considered and why they were rejected. Describe how the mitigation site will be protected in the future. YES NO 10. HAVE ADJACENT PROPERTY OWNERS BEEN NOTIFIED: Provide names and mailing addresses below (Use separate sheet, if necessary): a. b. c. Is your project located in the vicinity of historic properties? (For example, structures over 50 years 11. HISTORIC PROPERTIES: old, archeological sites, shell mounds, Indian, or colonial artifacts). Provide any supplemental information in Section 13. YES No Unknown Use this space for detailed responses to any of the previous items. Attach another sheet if 12. ADDITIONAL INFORMATION: necessary:
7 Check box if data is enclosed for any one or more of the following (see checklist for required information): Soil borings Site plan Field surveys Alternate site analysis Avoidance and minimization analysis Wetland data sheets Photographs Market analysis Other (explain) CERTIFICATION: any I hereby designate and authorize the agent named above to act on my behalf in the processing of this application and to furnish information that is requested. I certify that the information on this form and on the attached plans and specifications is tru e and rks accurate to the best of my knowledge and belief. I understand that any of the agencies involved in authorizing the proposed wo ify that may request information in addition to that set forth herein as may be deemed appropriate in considering this proposal. I cert ineated in all Waters of the United States have been identified and delineated on site, and that all jurisdictional wetlands have been del accordance with the Federal Manual for Identifying and Delineating Jurisdictional Wetlands. I grant permission to the agencies responsible for authorization of this work, or their duly authorized representative, to enter the project site for inspection p urposes during working hours. I will abide by the conditions of the permit or license if issued and will not begin work without the ap propriate authorization. I also certify that the proposed works are consistent with Maryland's Coastal Zone Management Plan. I understa nd that none of the information contained in the application form is confidential and that I may request that additional required infor mation be considered confidential under applicable laws. I further understand that failure of the landowner to sign the application will result in the application being deemed incomplete. LANDOWNER MUST SIGN: DATE: WHERE TO MAIL APPLICATION Maryland Department of the Environment Water Management Administration Regulatory Services Coordination Office 2500 Broening Highway Baltimore, Maryland 21224 Telephone: (410) 631-8087 1-800-876-0200 BEFORE YOU MAIL... DON’T FORGET... • THE APPLICATION. THE LANDOWNER MUST SIGN. SIGN AND DATE • FIVE (5) COPIES OF ALL DOCUMENTS (APPLICATION, PLANS, MAPS, REPORTS, ETC.) MUST BE RECEIVED TO BEGIN OUR REVIEW. • INCLUDE FIVE COPIES OF A VICINITY MAP (LOCATION MAP) WITH THE PROJECT SITE PINPOINTED. [email protected] SAMPLE PLANS MAY BE OBTAINED BY PHONE (1-800-876-0200) OR E-MAIL .
8 Revised 8/98
9 Instructions for Preparing an Application The instructions given below, together with the sample application and drawings, should help in completing the required applica tion lity copies of form. If you have additional questions, do not hesitate to contact the regulatory agencies. One (1) original and four (4) qua the completed application form should be made for submission to the regulatory agencies and one copy retained for your records. If ding block additional space is needed for your information, attach 8 1/2 x 11” paper and label the additional information to the correspon number. Leave this block blank For Agency Use Only: Block 1: Applicant Information Fill in the name, mailing address, and telephone number for the applicant. The telephone number ♦ Applicant Name: eached during business hours. should be where the applicant can be r ♦ It is not necessary to have an agent or engineer represent you. However, if you do, fill in their name, Agent/Engineer: address and telephone number. If your agent is submitting the application for you, you must sign the certification at the bottom of the last page. ♦ Fill in the name, mailing address, and telephone number (during business hours) of the Environmental Consultant: environmental consultant who performed the wetland delineation (if performed). ♦ If you know the name of the contractor you intend to use for the proposed activity, list the contractor's Contractor: name. ♦ List the name, address, and telephone number for the individual who is most knowledgeable about Principal Contact: the proposed activity and will be able to answer any questions from the regulatory agencies. All inquiries and correspondence should be directed through the principal contact. Block 2: Project Description Give a brief explanation of the proposed activity. If it will involve the discharge of dredged or fill ♦ Written Description: material, describe the type (rock, sand, dirt, rubble, etc.), quantity (in cubic yards), and the mode of transportation to the discharge site. ♦ Check all the regulated activities and list the wetland and waterway impact in square feet for all the regulated Activity: activities you are proposing in tidal or nontidal wetlands, nontidal wetland buffers, expanded buffers, waterways, streams, or floodplains. If you propose a single activity, such as only removing vegetation, or flooding a certain area, you should check only those spaces. Note: You will be asked to itemize the impacts (in square feet) for each regulated activity you are pr oposing in a wetland or waterway. This information is useful to the regulatory agencies in processing your application. Check off the type ♦ Type of Project: of project you are proposing and fill in the information concerning the dimensions of the proposed activity. If the activity does not seem to “fit” the brief format provided, please give an explanation at “Other”. ♦ Provide a brief written description of the basic project purpose, explaining why you are proposing the Project Purpose: activity. Block 3: Project Location ♦ This information is used to locate the project site. Provide the name of the county where the Location Information: proposed activity will take place and the name of the waterway or closest waterway. The stream use class designation is available from the Maryland Department of Natural Resources or the Maryland Department of the Environment. Give the street address of the property where the proposed activity will take place. If the site does not have a street address, give the best descriptive location, i.e., name of waterbody, names and/or numbers of roads or highways, and name of nearest community or town. Please also give directions to the proposed activity from the nearest intersection of two State roads. For example: "Go south on Route 2 to intersection of Route 214. Go left on Route 214 to Brown's Store. Make a right onto gravel road across from store and go one mile to red barn. Turn left onto dirt road, go to end of road. Project is directly at the end of the road."
10 If your property is generally within 1,000 feet of tidal waters or tidal wetlands, your project may be in the Chesapeake Bay Critical Area. Your local planning office will be able to assist you and has maps of its critical area. Fill in the map number each block into 10 horizontal and and coordinates from a county map book (Alexandria Drafting Company). Separate of vertical units of equal size and give the location to the nearest unit. For example, if your project is located in the center the B,6 block on map your location would be 25 B.5, 6.5. If the project covers a large area (two or more blocks) 25, estimate the centroid of the polygon and give the location to the nearest tenth of a unit. If this method is not used, give the latitude and longitude coordinates to the nearest second. Federal Emergency Management (FEMA) map numbers are optional items. You may find this information on 7 1/2 minute topographical maps or navigational maps available from the Maryland Geological Survey, or FEMA maps from the Maryland Department of the Environment. ♦ Check off the appropriate spaces for the type of area (wetland, waterway, fl oodplains or buffer) Activity Location: where you are proposing to conduct an activity. Nontidal wetlands of special State concern will be shown on guidance maps available at your local soil conservation district office, designated local government agencies, and the Maryland Department of the Environment. Note: Persons who consult with local governments about other county approvals concurrently or prior to submitting this application may avoid later re-design of their project after the State/federal permit decision is made. ♦ Check off the boxes which most closely describe the current land use and the present zoning. Land Use: If the activity is proposed within a cropped farmland, did the farm participate in the Food Securities Act of 1985? If so, give the designation assigned by the Soil Conservation Service. If the project does not comply with the current zoning, indicate whether you have applied to your local zoning board for a zoning change. Any documentation concerning a zoning change request should be submitted with your application. Blocks 4 through 7 are required by the State for their review: Block 4: Reduction of Impacts ♦ Check the space that best describes any efforts you have undertaken to reduce wetland impacts. Use the space provided or attach an additional 8 1/2 x 11 inch sheet to explain these efforts in greater detail. If you have not reduced wetland impacts, check the space or spaces that best describe the reasons why a reduction is not possible. Use the space provided or attach an additional sheet to explain the reasons in greater detail. Note: If you are proposing a subdivision, commercial/industrial development, major government projects, or activities that impact large areas of nontidal wetlands, you may wish to provide detailed information that already exists regarding avoidance, minimization, and constraints that prevent avoidance and minimization, with the application form to expedite review. Block 5: Letter of Exemption ♦ The activities listed in the block are considered to have minor impacts on wetlands provided that certain conditions are met. Activities include installation of utilities and repair of structures or fills. The most common exemptions are for wetland impacts of less than 5,000 square feet or in isolated wetlands (wetlands that do not border or connect to surface water) that are less than one acre in size. These exemptions include requirements that the wetlands have no significant plant or wildlife value. Wetlands with significant plant or wildlife value which do not quality for letters of exemption under these categories include bogs, springs, seeps, wetlands with threatened or endangered species, and wetlands next to trout streams. The Maryland Department of the Environment may assist you in determining whether or not your wetland is associated with a trout stream. You may check the State nontidal wetlands regulations or contact the Maryland Department of the Environment for additional information about significant plant or wildlife value or other exempted activities. Check the appropriate spaces for the activities for which you are requesting letters of exemption. Use the space provided or attach another sheet for an explanation of why the project qualifies as an exemption. Block 6: Alternative Site Analysis ♦ If you examined any different properties as possible locations for your project, check the space that includes the number of sites you considered. You should check any one or more of the spaces for “alternate sites” that best describe the reason why you rejected other sites or did not consider other sites. Use the space provided under “Explanation” or attach an additional sheet to provide more detail on the reasons for rejecting or not considering other sites. It is not necessary for you to complete this block if your project qualifies for a letter of exemption.
11 Note: If your proposed project is complex or impacts a large wetlands area as described in Block 4, you may wish to submit detailed information with the application form to expedite the review. Block 7: Public Need ♦ If your project provides a benefit to the general public, or meets a need of the general public, check the space that best describes the benefit. Attach another sheet or use the space provided to write a justification for how the project meets or t contributes to meeting a public need. If there is not a public need for your project, or if the general public will not benefi from the project, check the space marked “Does Not Provide Public Benefits”. Block 8: Approvals Needed/Granted ♦ List other agencies that must give approval for your activities and describe the status of other permits which will be necessary for the proposed activity. Block 9: Mitigation Plan The State of Maryland has adopted the goal of achieving "no net loss" of its nontidal wetland resource. Loss of nontidal ♦ wetlands due to agricultural activities or activities requiring permits under State law must be offset by mitigation (creation, restoration or enhancement of nontidal wetlands), or monetary compensation. You will be notified if mitigation (creation, restoration or enhancement) is required under Federal permit evaluation procedures. Monetary compensation is not ordinarily considered a form of mitigation by the Corps of Engineers. The Maryland Department of the Environment requires that a conceptual mitigation plan be submitted as part of a permit application. Detailed information on mitigation is contained in the State nontidal wetlands regulations. Block 10: Have Adjacent Property Owners Been Notified? ♦ You must provide the names and complete mailing addresses of adjoining property owners on your plan drawings and include them in the space provided on the application form. You may use a separate sheet if necessary. This information is usually available at the local tax assessment office. Block 11: Historic Properties ♦ If your project contains historic properties or is likely to impact historic properties, check the appropriate space and provide any supplemental information in section 12. Historic properties include any prehistoric or historic district, site, building, structure or object significant in Maryland's cultural heritage. You may obtain information on known or potential historic properties, upon written request, from the State Historic Preservation Office, Maryland Historical Trust (MHT), 100 Community Place, Crownsville, Maryland 20629, or call (410) 514-7600. The MHT may also assist you in developing measures to avoid and/or mitigate adverse impacts to historic properties. Note: If your project contains or is likely to impact historic properties, you may wish to contact MHT prior to submitting this application and resolve any historic preservation issues in advance of application. Block 12: Additional Information ♦ You may use this space to provide a more detailed answer to any item on the application. If you still need more space, attach more sheets as necessary. If you are submitting with your application a separate document that includes more data for any item on the application, please check the space or spaces that best describe the information. Signature/Certification: ♦ The landowner must always sign each copy of the application form. The agent, engineer, consultant or applicant (if different from the landowner) should not sign for the landowner.
12 DRAWINGS VICINITY MAP Plan, and Elevation - Three types of drawings – Vicinity, The vicinity map you provide will be printed in any are required to accurately depict activities (see examples public notice that is issued and used by the Corps of of proper drawings on the following pages). Engineers and other reviewing agencies to locate the site of the proposed activity. You may use an existing road Submit one original, or good quality copy of all drawings map or U.S. Geological Survey topographic map (scale On 8 1/2 x 11" white paper (tracing cloth or film may be 1:24,000) as the vicinity map. Please include sufficient used). Submit the fewest number of sheets necessary to details to simplify locating the site from both the water adequately show the proposed activity. Drawings should body and from land. Identify the source of the map or be prepared in accordance with the general format of the chart from which the vicinity map was taken and if not samples, using block style lettering. Each page should already shown, please add the following: have a title block. See the checklist below. Drawings do not have to be prepared by an engineer, but professional • Location of activity site (draw an arrow showing the assistance may become necessary if the project is large exact location of the site on the map). or complex. Construction plans must be submitted to the Waterway Permits Division. • Latitude, longitude, and river mile, if known. Leave a one inch margin at the top edge of each sheet for • Name of waterbody and the name of the larger creek, purposes of reproduction and binding. river, bay, etc., into which the waterbody drains. In the title block of each sheet of drawings, identify the • Names, descriptions and locations of landmarks. proposed activity and include the name of the body of • Names of all applicable political (county, city, etc.) water; river mile (if applicable); name of county; name jurisdictions. of applicant; number of the sheet and total number of sheets in the set; and the date the drawing was prepared. • Name of and distance to nearest town, community or other identifying locations. Since drawings must be reproduced, use heavy dark lines. Color shading cannot be used. However, dot • Names or numbers of all roads in the vicinity of the shading, hatching or similar graphic symbols may be site. used to clarify line drawings. • North arrow. • Scale.
14 PLAN VIEW ELEVATION AND / OR CROSS SECTION The plan view shows the proposed activity as if you were VIEW looking straight down on it from above. Your plan view The elevation and/or cross section view is a scale should clearly show the following: drawing that shows the side, front, or rear of the proposed activity. If a section view is shown, it • Name of waterbody (river, creek, lake, wetland, etc.) represents the proposed structure as it would appear if and river mile (if known)at the location of the cut internally for display. Your elevation should clearly activity. show the following: • Existing shorelines. • Water elevations as shown in the plan view (mean high water line, mean low water line, etc.) • Mean high and mean low water lines and maximum (spring) high tide line in tidal areas. • Water depths in the area of the proposed activity. If dredging is proposed, dredging depths and estimated • Ordinary high water line and ordinary low water line disposal quantities. if the proposed activity is located on a nontidal waterbody. • Dimensions from the mean high water line (tidal waters) for pile supported platforms, float, or high • Average water depths around the activity. tide line for proposed fill. Describe any structures to be built on the platform. • Dimensions of the activity and distance it extends from the high water line into the water. • Cross-section of excavation or fill, including approximate side slopes. • Distances to nearby Federal or State projects, if any. • Graphic or numerical scale. • Distance between proposed activity and navigation channel, where applicable. • Principal dimensions of the activity. • Delineation of any wetland (marshes, swamps, tidal NOTES ON DRAWINGS flats, 100-year flood plains, etc.) • Names of adjacent property owners who may be affected should be shown on the drawings. • North arrow • Scale. • A legal property description including the number, name of subdivision, block and lot number, etc. • Description of dredged material involved. You must should be shown on the drawings. describe the type of material, number of cubic yards, method of handling, the location of fill and spoil • Photographs of the site are not required. However, disposal area, and the type of dredging. The drawing pictures are helpful and may decrease the amount of should show proposed retention dikes, weirs, and/or time needed to process your application. other means for retaining hydraulically placed materials. • Drawings should be as clear and simple as possible (i.e., not too "busy"). • Mark the drawing to indicate previously completed portions of the activity. • Construction Plans should be submitted with the application to the Waterway Permits Division. • Mark the drawing to indicate storm water management facilities for marinas, residential and commercial developments.
15 SUPPLEMENTARY INFORMATION TO BE INCLUDED ON PLANS, DRAWINGS, OR VICINITY MAPS In addition to the information indicated on the previous pages, you should include the following on the 8 1/2 x 11” site plans and any blueprints you have submitted: Delineation of any wetland buffers or expanded buffers, clearly marked and differentiated. 1. Location of mitigation area, if proposed on the same site as the project. 2. Note: If you are proposing a complex project you may wish to submit engineering blueprints of your project with the application form to expedite review. Mitigation Location Map: If you are proposing that nontidal wetland mitigation be done at a different location than the proposed project, you should submit a map showing the location of the mitigation site in relation to the proposed nontidal wetland losses. WETLAND DELINEATION Wetlands should be identified according to methods described in the publication Federal Manual Identifying and Delineating Jurisdictional Wetlands. Copies of the manual may be obtained by calling the U. S. Government Printing Office at 202-783-3238 and requesting document #024-010-00-683-8 at a cost of $7.50. Wetlands must be shown on all plans submitted with the application. All wetlands on site must be delineated and shown on the overall site plan. 8 1/2 x 11 inch plans with topography showing relation of the wetlands and project impacts must be submitted. Copies of the wetland reports and data sheets used in making the determination be included with your application submittal. REGULATORY AGENCIES Federal Permits State Authorizations U.S. Army Corps of Engineers Maryland Department of the Environment Baltimore District Water Management Admininstration Attn: CENAB-OP-R Tidal Wetlands Division P.O. Box 1715 2500 Broening Highway Baltimore, MD. 21203-1715 Baltimore, MD. 21224 Phone: 410-962-3670 Phone: 410-631-8075 Coastal Zone Consistency Statement Maryland Department of the Environment Water Management Administration Maryland Department of the Environment Nontidal Wetlands and Waterways Division Water Management Administration 2500 Broening Highway Wetlands and Waterways Program Baltimore, MD. 21224 2500 Broening Highway Phone: 410-631-8094 Baltimore, MD. 21224 Phone: 410-631-8093
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