U.S. ARMY CORPS OF ENGINEERS APPLICATION FOR DEPARTMENT OF THE ARMY PERMIT 33 CFR 325. The proponent agency is CECW-CO-R. Form Approved - OMB No. 0710

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15 U.S. ARMY CORPS OF ENGINEERS APPLICATION FOR DEPARTMENT OF THE ARMY PERMIT 33 CFR 325. The proponent agency is CECW-CO-R. Form Approved - OMB No Expires: 30-SEPTEMBER-2015 Public reporting for this collection of information 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 this burden estimate or any other aspect of the collection of information, including suggestions for reducing this burden, to Department of Defense, Washington Headquarters, Executive Services and Communications Directorate, Information Management Division and to the Office of Management and Budget, Paperwork Reduction Project ( ). 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 form to either of those addresses. Completed applications must be submitted to the District Engineer having jurisdiction over the location of the proposed activity. 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 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. (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 BY APPLICANT) 5. APPLICANT'S NAME 8. AUTHORIZED AGENT'S NAME AND TITLE (agent is not required) First - Marlene/Wm Middle - Last - Wagner First - Carter Middle - Last - Becker Company - Company - Falls Point Marine, Inc. Address - mar26wagner@gmail.com Address - 6. APPLICANT'S ADDRESS: Address- 17 Marshview Circle City - Yarmouth State - Me Zip Country - 7. APPLICANT'S PHONE NOs. w/area CODE 9. AGENT'S ADDRESS: Address- PO Box 61 City - So.Freeport State - Me Zip Country AGENTS PHONE NOs. w/area CODE a. Residence b. Business c. Fax a. Residence b. Business c. Fax STATEMENT OF AUTHORIZATION 11. I hereby authorize, Falls Point Marine, Inc. 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. SIGNATURE OF APPLICANT DATE NAME, LOCATION, AND DESCRIPTION OF PROJECT OR ACTIVITY 12. PROJECT NAME OR TITLE (see instructions) Wagner Dock 13. NAME OF WATERBODY, IF KNOWN (if applicable) 14. PROJECT STREET ADDRESS (if applicable) Cousins River, Casco Bay Address 17 Marshview Circle 15. LOCATION OF PROJECT Latitude: N 43 48' 15.8" Longitude: W 70 09' 21.6" 16. OTHER LOCATION DESCRIPTIONS, IF KNOWN (see instructions) City - Yarmouth State- Me Zip State Tax Parcel ID Yarmouth Tax Map 27 Lot 17 Municipality Yarmouth Section - Township - Range - ENG FORM 4345, DEC 2014

16 17. DIRECTIONS TO THE SITE Rt 1, Yarmouth to Rt 88 to Bayview Street to Sisquisic Trail to Marshview Circle. Park at Marshview Circle - destination straight ahead. 18. Nature of Activity (Description of project, include all features) The project proposes to construct a residential dock at 17 Marshview Circle in Yarmouth. The applicants have over 300 of shore frontage. There have been no prior shoreline alterations. The proposed purpose is for safe kayak access to the Cousins River. Currently the applicants drag their kayaks to the river. Permanent: The footprint of the permanent portion is 85 sq. ft. Stair 3 x15 Pierhead 4 x10 Seasonal: The footprint of the seasonal portion is 340 sq. ft. Gangway 2.5x40 Float - 12x20 In the winter months, the gangways will be stored in the adjacent cove above HAT. 19. Project Purpose (Describe the reason or purpose of the project, see instructions) Safe access to the Cousins River with a kayak. 20. Reason(s) for Discharge USE BLOCKS IF DREDGED AND/OR FILL MATERIAL IS TO BE DISCHARGED 21. Type(s) of Material Being Discharged and the Amount of Each Type in Cubic Yards: Type Amount in Cubic Yards Type Amount in Cubic Yards Type 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) The lot is 5.4 acres and the shoreline extends over feet. The setback requirements are easily met. The system as proposed will allow for water access for approximately 50-60% of the tide cycle. The system begins at an existing footpath where the inlet to the Cousins river bends closest to the shore. The site was chosen as it is the shortest distance to the river.

17 24. Is Any Portion of the Work Already Complete? Yes No IF YES, DESCRIBE THE COMPLETED WORK 25. Addresses of Adjoining Property Owners, Lessees, Etc., Whose Property Adjoins the Waterbody (if more than can be entered here, please attach a supplemental list). a. Address- MOHNKERN KENT W 191 SISQUISIC TRAIL YARMOUTH, ME Map 027 Lot 014 City - State - Zip - b. Address- KENDRICK GEORGE C III 34 SPAR CIRCLE YARMOUTH, ME Map City - State - Zip - c. Address- City - State - Zip - d. Address- City - State - Zip - e. Address- City - State - Zip List of Other Certificates or Approvals/Denials received from other Federal, State, or Local Agencies for Work Described in This Application. DEP AGENCY TYPE APPROVAL* PBR IDENTIFICATION NUMBER DATE APPLIED DATE APPROVED DATE DENIED 6/30/2017 Planning Board Yarmo Shoreland Zoning 6/30/2017 * 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. SIGNATURE OF APPLICANT DATE 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.

18 12/2006 DEPARTMENT OF ENVIRONMENTAL PROTECTION PERMIT BY RULE NOTIFICATION FORM (For use with DEP Regulation, Chapter 305) PLEASE TYPE OR PRINT IN BLACK INK ONLY Name of Applicant: (owner) Applicant Mailing Address: Town/City: Yarmouth State: Maine Daytime Telephone No: Project Location: Zip Code: (include area code) (town) Yarmouth County: Cumberland Map #: 27 Lot #: 17 Name of Wetland or Waterbody: Name of Agent: Agent s Telephone No: Falls Point Marine, Inc (include area code) Cousins River, Casco Bay Detailed Directions to Site: Rt 1 Yarmouth to Rt 88 Bayview Street to Sisquisic Trail to end destination - 17 Marshview Circle Description of Project: Marlene and William Wagner UTM Northing: (if known) 17 Marshview Circle N Seasonal, Residential Dock for Kayak access to the Cousins River UTM Easting: (if known) E Above HAT - 3 x15 embankment stairs, 4 x10 pier Below HAT seasonal x40 gangway, 12 x20 float Part of a larger project? Yes No No (CHECK ONE) This project: does does not involve work below mean low water. I am filing notice of my intent to carry out work which meets the requirements for Permit By Rule (PBR) under DEP Rules, Chapter 305. I and my agents, if any, have read and will comply with all of the standards in the Sections checked below. Sec. (2) Act. Adj. to Protected Natural Res. Sec.(10) Stream Crossing Sec. (17) Transfers/Permit Extension Sec. (3) Intake Pipes Sec. (11) State Transportation Facil. Sec. (18) Maintenance Dredging Sec. (4) Replacement of Structures Sec. (12) Restoration of Natural Areas Sec. (19) Activities in/on/over Sec. (5) REPEALED Sec. (13) F&W Creation/Enhance/Water significant vernal pool habitat Sec. (6) Movement of Rocks or Vegetation Quality Improvement Sec. (20) Activities in existing dev. Sec. (7) Outfall Pipes Sec. (14) REPEALED areas located in/on/over high or Sec. (8) Shoreline stabilization Sec. (15) Public Boat Ramps moderate value inland waterfowl & Sec. (9) Utility Crossing Sec. (16) Coastal Sand Dune Projects wading bird habitat or shorebird nesting, feeding & staging areas I authorize staff of the Departments of Environmental Protection, Inland Fisheries & Wildlife, and Marine Resources to access the project site for the purpose of determining compliance with the rules. I also understand that this permit is not valid until approved by the Department or 14 days after receipt by the Department, whichever is less. I have attached the following required submittals. NOTIFICATION FORMS CANNOT BE ACCEPTED WITHOUT THE NECESSARY ATTACHMENTS: Attach a check for $55 made payable to: "Treasurer, State of Maine". Attach a U.S.G.S. topo map or Maine Atlas & Gazetteer map with the project site clearly marked. Attach all other required submissions as outlined in the PBR Sections checked above. By signing this Notification Form, I represent that the project meets all applicability requirements and standards in the rule and that the applicant has sufficient title, right, or interest in the property where the activity takes place. Signature of Agent or Applicant: Keep a copy as a record of permit. Send the form with attachments via certified mail or hand deliver to the Maine Dept. of Environmental Protection at the appropriate regional office listed below. The DEP will send a copy to the Town Office as evidence of the DEP's receipt of notification. No further authorization by DEP will be issued after receipt of notice. Permits are valid for two years. Work carried out in violation of any standard is subject to enforcement action. AUGUSTA DEP 17 STATE HOUSE STATION AUGUSTA, ME (207) PORTLAND DEP 312 CANCO ROAD PORTLAND, ME (207) Date: BANGOR DEP 106 HOGAN ROAD BANGOR, ME (207) OFFICE USE ONLY Ck.# Staff Staff PRESQUE ISLE DEP 1235 CENTRAL DRIVE PRESQUE ISLE, ME (207) PBR # FP Date Acc. Date DEPLW0309-K2006 Def. Date After Photos

19 6/27/2017 Maine Historic Preservation Commission (MHPC) 65 State House Station Augusta, Maine To Whom It May Concern: At the request of the US Dept of the Army, Falls Point Marine, Inc. is forwarding information regarding a proposal for a residential dock. This installation is for Marlene and William Wagner at 17 Marshview Circle in Yarmouth, Me Tax Map 27 Lot 17. Enclosed you will find a map and a drawing of the project. There are no shipwrecks in the area. The one structure on the property was constructed in We hope that this project will not affect any historic resources and meets with your approval. Please do not hesitate to call if you require any further information. Sincerely, Kathleen Keegan Falls Point Marine, Inc. PO Box 61 So. Freeport, Me kathy@fallspoint.com cc: Aroostook Band of Micmacs Passamaquoddy Tribe of Indians (x2) Houlton Band of Maliseet Indians Penobscot Indian Nation MHPC PO Box 61, South Freeport, Me