Maine General Permit (GP)
Category 1 Notification Form

PROVIDE STATE INFORMATION BELOW:

State Permit Number:

Date of State Permit:

State Project Manager:

PROVIDE PERMITTEE INFORMATION BELOW:

Permittee:

Permittee Address 1:

Permittee Address 2:

City:

State:

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Zip Code:

Telephone:

Fax:

Email:

PROVIDE CONTRACTOR INFORMATION BELOW:

Contractor:

Address 1:

Address 2:

City:

- Please Select - Alabama Alaska Arizona Arkansas California Colorado Connecticut Delaware District of Columbia Florida Georgia Hawaii Idaho Illinois Indiana Iowa Kansas Kentucky Louisiana Maine Maryland Massachusetts Michigan Minnesota Mississippi Missouri Montana Nebraska Nevada New Hampshire New Jersey New Mexico New York North Carolina North Dakota Ohio Oklahoma Oregon Pennsylvania Rhode Island South Carolina South Dakota Tennessee Texas Utah Vermont Virginia Washington West Virginia Wisconsin Wyoming Other

Zip Code:

Telephone:

Fax:

Email:

PROVIDE CONSULTANT/ENGINEER/DESIGNER INFORMATION BELOW:

Consultant/Engineer/Designer:

Address 1:

Address 2:

City:

- Please Select - Alabama Alaska Arizona Arkansas California Colorado Connecticut Delaware District of Columbia Florida Georgia Hawaii Idaho Illinois Indiana Iowa Kansas Kentucky Louisiana Maine Maryland Massachusetts Michigan Minnesota Mississippi Missouri Montana Nebraska Nevada New Hampshire New Jersey New Mexico New York North Carolina North Dakota Ohio Oklahoma Oregon Pennsylvania Rhode Island South Carolina South Dakota Tennessee Texas Utah Vermont Virginia Washington West Virginia Wisconsin Wyoming Other

Zip Code:

Telephone:

Fax:

Email:

PROVIDE WETLAND/VERNAL POOL CONSULTANT INFORMATION BELOW:

Wetland/Vernal Pool Consultant:

Address 1:

Address 2:

City:

- Please Select - Alabama Alaska Arizona Arkansas California Colorado Connecticut Delaware District of Columbia Florida Georgia Hawaii Idaho Illinois Indiana Iowa Kansas Kentucky Louisiana Maine Maryland Massachusetts Michigan Minnesota Mississippi Missouri Montana Nebraska Nevada New Hampshire New Jersey New Mexico New York North Carolina North Dakota Ohio Oklahoma Oregon Pennsylvania Rhode Island South Carolina South Dakota Tennessee Texas Utah Vermont Virginia Washington West Virginia Wisconsin Wyoming Other

Zip Code:

Telephone:

Fax:

Email:

PROVIDE PROJECT INFORMATION BELOW:

Project Location:

Project Description:

Latitude Coordinate:

Longitude Coordinate:

Project Address:

Project City:

Project State:

- Please Select - Alabama Alaska Arizona Arkansas California Colorado Connecticut Delaware District of Columbia Florida Georgia Hawaii Idaho Illinois Indiana Iowa Kansas Kentucky Louisiana Maine Maryland Massachusetts Michigan Minnesota Mississippi Missouri Montana Nebraska Nevada New Hampshire New Jersey New Mexico New York North Carolina North Dakota Ohio Oklahoma Oregon Pennsylvania Rhode Island South Carolina South Dakota Tennessee Texas Utah Vermont Virginia Washington West Virginia Wisconsin Wyoming Other

Project Zip Code

Waterway Name:

Work Description:

Provide any prior Corps permit numbers:

Proposed Work Start Date:

Proposed Work Finish Date:

Area of wetland impact:

square feet (SF)
(leave blank if work involves structures & no fill in Navigable Waters)

Area of waterway impact:

square feet (SF)
(leave blank if work involves structures & no fill in Navigable Waters)

Area of compensatory mitigation provided:

square feet (SF)

Work will be done under the following Appendix A categories (check all that apply):
(please refer to the Maine General Permit, Appendix A for detailed explanation for each category)

I. Inland Waters & Wetlands:

  a   NEW FILL/EXCAVATION DISCHARGES
  b   BANK STABILIZATION PROJECTS
  c   RIVER/STREAM/BROOK WORK AND CROSSINGS AND WETLAND CROSSINGS
  d   REPAIR AND MAINTENANCE OF AUTHORIZED FILLS
  e   MISCELLANEOUS

II. Navigable Waters:

  a   FILL
  b   REPAIR AND MAINTENANCE WORK
  c   DREDGING/EXCAVATION AND ASSOCIATED DISPOSAL
  d   MOORINGS
  e   PILE-SUPPORTED STRUCTURES AND FLOATS
  f   MISCELLANEOUS

AUTHENTICATION:     Checking here, as permittee, indicates that you accept and agree to comply with the terms, eligibility criteria, and general condition of Category 1 of the Maine General Permit.