Okaloosa County BOCC — May 20, 2014 — reading text

REPORT AND POST-DEPLOYMENT NOTIFICATION To Be Completed For Each Deployment Location or Date of Deployment County or Municipality:_____________________________________ Date of Placement:_________________________ Grant No. FWC - ________________________________ U.S. Army Corps (if applicable) Permit No.: _______________________________ Total project cost: $___________ (Funding Source(s) and Amount(s): FWC $____________ Local $ __________ Other $________) Name of Permitted Location Name Reef Site: ________________________________ for This Deployment:________________________ ° Latitude:_____ ______.___ ___ ___’ North Longitude:______ °_______.___ ___ ___’ West Degrees minutes decimal minutes Degrees minutes decimal minutes GPS Brand:__________________ GPS Model number:___________ Geographical Location: ______________ at __________degrees from ___________________________________ (nautical miles) (bearing) (reference inlet) Water Depth:________ feet (minus) Max. Material Height: ________feet (equals) Actual Vertical Clearance: ______feet TYPE AND AMOUNT OF MATERIAL DEPLOYED AT THE LOCATION DESCRIBED ABOVE: (ATTACH A PHOTOGRAPH OF THE MATERIAL ON THE BARGE IMMEDIATELY PRIOR TO DEPLOYMENT) Primary Type of Material:____________________________________________ Number of Pieces:__________ Dimensions:________________________________________________________________________________ Secondary Type of Material:_________________________________________ Number of Pieces:__________ Dimensions:________________________________________________________________________________ How was tonnage calculated?(Check all that apply, attach additional sheets if necessary): Before & after barge draft calculation Known weight of individual pieces TOTAL TONNAGE FOR THIS DEPLOYMENT: _______________________ Trucking receipts I DO HEREBY CERTIFY THAT THE ABOVE INFORMATION IS TRUE AND CORRECT TO THE BEST OF MY KNOWLEDGE Observer’s Name: _________________________________ Title: _________________________________ (PLEASE PRINT) (PLEASE PRINT) Observer’s Signature: _______________________________ Date: __________________________________ Observer’s Remarks: __________________________________________________________________________ ___________________________________________________________________________________________ I DO HEREBY CERTIFY THAT THE ABOVE INFORMATION COMPLIES WITH THE ABOVE REFERENCED PERMIT CONDITIONS Permittee’s Staff Name: _________________________________ Title: __________________________________ (PLEASE PRINT) (PLEASE PRINT) Permittee’s Staff Signature: ______________________________ Date: _________________________________ Local Tracking number ______________ FWC Tracking number _______________ Entered by _________ on _________ Rev. 4/23/2007 FWC initials date Packet Pg. 741  SELF-CERTIFICATION STATEMENT OF COMPLIANCE Permit Number: SAJ-2012-02734 (SP-SWA) Permittee’s Name & Address (please print or type): __________________________________________ _____________________________________________________________________________________ _____________________________________________________________________________________ Telephone Number: ____________________________________________________________________ Location of the Work: __________________________________________________________________ _____________________________________________________________________________________ Date Work Started: __________________________ Date Work Completed: ______________________ Description of the Work (e.g. bank stabilization, residential or commercial filling, docks, dredging, etc.): _____________________________________________________________________________________ _____________________________________________________________________________________ _____________________________________________________________________________________ Acreage or Square Feet of Impacts to Waters of the United States: _______________________________ Describe Mitigation completed (if applicable): ______________________________________________ _____________________________________________________________________________________ _____________________________________________________________________________________ Describe any Deviations from the Permit (attach drawing(s) depicting the deviations): _____________________________________________________________________________________ _____________________________________________________________________________________ I certify that all work, and mitigation (if applicable) was done in accordance with the limitations and conditions as described in the permit. Any deviations as described above are depicted on the attached drawing(s). ______________________________ Signature of Permittee ______________________________ Date Packet Pg. 742  N MID BA Y BRID GE RD EMERALD COAS T PKWY (US HWY 98) FDEP RANGE MONUMENTS (TYP) HENDERSON BEACH STATE PARK R-034 R-036 MEAN HIGH WATER LINE (+0.77') R-037 4/4/2012 2:28:35 PM R-035 R-038 0 R-039 R-040 0 R-041 R-042 ANTON FLEWELLING X:\SYS\PROJECTS\P2012-015 OKALOOSA CO SNORKEL REEF\PERMIT\P2012-015-P-OVERVIEW.DWG R-043 -10 0 -10 -20 -10 -20