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Home My WebLink AboutSHX2016-00073 JARPA - SHX Application - 10/24/2016 a ss 66 --------------------------------------- AGENCY USE ONLY Date received: RECEIVED us Army Corps ; WASHINGTON STATE ^ ^��- OCT 2 4 2016 Joint Aquatic Resources Permit ; agency reference#:.JF�XZOIIt�-'CX�C'r1 Application (JARPA) Form Tax Parcel#(s): 615 W. AlderStreet 3a01 Af - o� u USE BLACK OR BLUE INK TO ENTER ANSWERS IN THE WHITE SPACES BELOW. ----------------------------- Part 1—Project Identification 1. Project Name (A name for your project that you create. Examples: Smith's Dock or Seabrook Lane Development) hel Part 2—Applicant The person and/or organization responsible for the project. h[ eep7 2a. Name (Last, First, Middle) Rau F �4 a gz*' 2b. Organi ation (If applicable) 2c. Mailing Address (Street or PO Box) 2d. City, State, Zip &),l I DYE 2e. Phone(1) 2f. Phone (2) 2g. Fax 2h. E-mail 1/L v Additional forms may be required for the following permits: • If your project may qualify for Department of the Army authorization through a Regional General Permit(RGP),contact the U.S.Army Corps of Engineers for application information(206)764-3495. • If your project might affect species listed under the Endangered Species Act,you will need to fill out a Specific Project Information Form(SPIF)or prepare a Biological Evaluation. Forms can be found at httD://www.nws.usace.armv.mi1/Missions/CiviWorks/Reaulatorv/Permi Guidet)oak/EndanoeredSpecies aspx. • Not all cities and counties accept the JARPA for their local Shoreline permits. If you need a Shoreline permit,contact the appropriate city or county government to make sure they accept the JARPA. -7o access an online JARPA form with[help]screens, go to httc:/lwm,w.eoemittina.wa.00v/site/alias resourcecenterfiiaroa iarpa form/9984flarpe form asox. For other help,contact the Governor's Office of Regulatory Assistance at 1-800-917-0043 or helot ora.wE.00v. JARPA Revision 2012.1 Paoe 1 of 14 Part 3—Authorized Agent or Contact Person authorized to represent the applicant about the project. (Note: Authorized agent(s) must sign 11 b of this application.) [hel 3a. Name (Last, First, Middle) 3b. Organization (tf applicable) 3c. Mailing Address (Street or PO Box) 3d. City, State, Zip 3e. Phone (i) 3f. Phone (2) 3g. Fax 3h. E-mail Part 4—Property Owner(s) Contact information for people or organizations owning the property(ies) where the project will occur. Consider both- upland and aquatic ownership because the upland owners may not own the adjacent aquatic land. el Same as applicant. (Skip to Part 5.) ❑ Repair or maintenance activities on existing rights-of-way or easements. (Skip to Part 5.) ❑ There are multiple upland property owners. Complete the section below and fill out JARPA Attachment A for each additional property owner. ❑ Your project is on Department of Natural Resources (DNR)-managed aquatic lands. If you don't know, contact the DNR at (360) 902-1100 to determine aquatic land ownership. If yes, complete JARPA Attachment E to apply for the Aquatic Use Authorization. 4a. Name (Last, First, Middle) 4b. Organization (if applicable) 4c. Mailing Address (Street or PO Box) 4d. City, State, Zip 4e. Phone(T) 4f. Phone (2) 4 . Fax 4h. E-mail DARPA Revision 2012.1 Page 2 of 14 Part s 5—Project Location 1 ( ) Identifying information about the property or properties where the project will occur. rheipi ❑ There are multiple project locations (e.g. linear projects). Complete the section below and use JARPA Attachment B for each additional project location. 5a. Indicate the type of ownership of the property. (Check all that apply.) rhelDl Private ❑ Federal ❑ Publicly owned (state, county, city, special districts like schools, ports, etc.) ❑ Tribal ❑ Department of Natural Resources (DNR) — managed aquatic lands (Complete JARPA Attachment E) 5b. Street Address (Cannot be a PO Box. If there is no address, provide other location information in 5p.) hel a 5c. City, State, Zip (If the project is not in a city or town, provide the name of the nearest city or town.) hel 5d. County rheipi �04 5e. Provide the section, township, and range for the project location. help '/4 Section Section Township Range /VA-c 5f. Provide the latitude and longitude of the project location. [hel • Example:47.0392-2 N lat./-122.89142 W long. (Use decimal degrees- NAD 83) 5g. List the tax.parcel number(s) for the project location. [hel • The local county assessor's office can provide this information. c�—3 3 -- Duo r5h- Contact information for all adjoining property owners. (if you need more space, use DARPA Attachment C.) hf elpl Name Mailing Address Tax Parcel # (if known) Z)av aV Ur c�o42-3 -Ooo DARPA Revision 2012.1 Paae 3 of 14 5i. List all wetlands on or adjacent to the project location. ne iv,"el,--�h e,5 e art e a" �, Ma3S ZILWA lq 5j. List all waterbodies (other than wetlands) on or adjacent to the project location. ne vl/Gr- e0 d //0 0 h 5k. Is any part of the project area within a 100-year floodplain? ne es ❑ No ❑ Don't know 51. Briefly describe the vegetation and habitat conditions on the property. hf elpl 5M. Describe how the property is currently used. neia 0 C,6 C4 CO-7 i �I�� s OYl 14 9 5n. Describe how the adjacent properties are currently used. nei 14eu V��h n 5o. Describe the structures (above and below ground) on the property, including their purpose(s) and current condition. net y /q C,a /z)f 9 5p. Provide driving directions from the closest highway to the project location, and attach a map. n[ el 1`y f e" M JARPA Revision 2012.1 Page 4 of 14 Part 6-Project Description 6a. Briefly summarize the overall project. You can provide more detail in 6b. hel �J1-9i 0T a / 9 01 6b. Describe the purpose of the project and why you want or need to perform it. Lpipj /) e,rn A i ki ( 4--7T 4,4e ke-t,, -,01 1�c� t, , 7�1 n e,,,-J 114f 14 6c. Indicate the project category. (Check all that apply) hel ❑ Commercial Residential ❑ Institutional ❑ Transportation ❑ Recreational ❑ Maintenance ❑ Environmental Enhancement 6d. Indicate the major elements of your project. (Check all that apply) [help] ❑ Aquaculture ❑ Culvert ❑ Float ❑ Retaining Wall ❑ Bank Stabilization ❑ Dam /Weir ❑ Floating Home (upland) ❑ Boat House ❑ Dike / Levee / Jetty ❑ Geotechnical Survey ❑ Road ❑ Boat Launch ❑ Ditch ❑ Land Clearing ❑ Scientific Measurement Device ❑ Boat Lift X`5ock/ Pier ElMarina / Moorage ❑ Stairs ❑ Bridge ❑ Dredging ❑ Mining ❑ Bulkhead ❑ Stormwater facility ❑ Fence ❑ Outfall Structure ❑ Swimming Pool ❑ Buoy ❑ Ferry Terminal ❑ Piling/Dolphin ❑ Utility Line ❑ Channel Modification ❑ Fishway ❑ Raft ❑ Other. JARPA Revision 2012.1 Page 5 of 14 6e. Describe how you plan to construct each project element checked in 6d. Include specific construction methods and equipment to be used. [bpjpj • Identify where each element will occur in relation to the nearest waterbody. • Indicate which activities are within the 104-year floodplain. �e � 0ck qL� la_G� 6f. What are the anticipated start and end dates for project construction? (Month/Year) hel • If the project will be constructed in phases or stages, use JARPA Attachment D to list the start and end dates of each phase or stage. Start date: // f End date: See JARPA Attachment D 6g. Fair market value of the project, including materials., labor, machine rentals, etc. help 170 Ideal 61h. Will any portion of the project receive federal funding? (helps • If yes, list each agency providing funds. ❑ Yes JjrNo ❑ Don't know Part 7—Wetiands: Impacts and Mitigation ❑ Check here if there are wetlands or wetland buffers on or adjacent to the project area. (if there are none, skip to Part 8.) rheipi 7a. Describe how the project has been designed to avoid and minimize adverse impacts to wetlands. [hel ❑ Not applicable 7b. Will the project impact wetlands? hel ❑ Yes ❑ No ❑ Don't know DARPA Revision 2012.1 Page 6 of 14 7c. Will the project impact wetland buffers? hel ❑ Yes C:7 No ❑ Don't know 7d. Has a wetland delineation report been prepared? hel • If Yes, submit the report, including data sheets, with the JARPA package. ❑ Yes a No 7e. Have the wetlands been rated using the Western Washington or Eastern Washington Wetland Rating System? hf of • If Yes, submit the wetland rating forms and figures with the JARPA package. ❑ Yes ❑ No ❑ Don't know 7f. Have you prepared a mitigation plan to compensate for any adverse impacts to wetlands? hf eM • If Yes,submit the plan with the JARPA package and answer 7g. • If No, or Not applicable, explain below why a mitigation plan should not be required. ❑ Yes ❑ No ❑ Not applicable 7g. Summarize what the mitigation plan is meant to accomplish, and describe how a watershed approach was used to design the plan. [hel 7h. Use the table below to list the type and rating of each wetland impacted, the extent and duration of the impact, and the type and amount of mitigation proposed. Or if you are submitting a mitigation plan with a similar table, you can state (below) where we can find this information in the plan. [hel Activity (fill, Wetland Wetland Impact Duration Proposed Wetland drain, excavate, Name' type and area (sq. of impact3 mitigation mitigation area flood, etc.) rating ft. or type' (sq. ft. or category2 Acres) acres) If no official name for the wetland exists,create a unique name(such as"V1letkand 1"). The name should be consistent with other project documents,such as a wetland delineation report. 2 Ecology wetland category based on current Western Washington or Eastern Washington Wetland Rating System. Provide the wetland rating forms with the JARPA package. 'Indicate the days,months or years the wetland will be measurably impacted by the activity. Enter"permanent'if applicable. `Creation(C), Re-establishment/Rehabilitation(R), Enhancement(E), Preservation (P),Mitigation Bank/ln-lieu fee(B) Page number(s) for similar information in the mitigation plan, if available: JARPA Revision 2012.1 Page 7 of 14 7i. For all filling activities identified in 7h, describe the source and nature of the fill material, the amount in cubic yards that will be used, and how and where it will be placed into the wetland. [help] 7j. For all excavating activities identified in 7h, describe the excavation method, type and amount of material in cubic yards you will remove, and where the material will be disposed. [hel Part 8—Waterbodies (other than wetlands): Impacts and Mitigation In Part 8, "waterbodies" refers to non-wetland waterbodies. (See Part 7 for information related to wetlands.) rheipl X"Check here if there are waterbodies on or adjacent to the project area. (if there are none, skip to Part 9.) 8a. Describe how the project is designed to avoid and minimize adverse impacts to the aquatic environment. hel Not applicable 8b. Will your project impact a waterbody or the area around a waterbody? hei ❑ Yes No JARPA Revision 2012.1 Paoe 8 o`14 8c. Have you prepared a mitigation plan to compensate for the project's adverse impacts to non-wetland waterbodies? ELLeI • If Yes, submit the plan with the JARPA package and answer 8d. • If No, or Not applicable, explain below why a mitigation plan should not be required. ❑ Yes ❑ No XNot applicable 8d. Summarize what the mitigation plan is meant to accomplish. Describe how a watershed approach was used to design the plan. • If you already completed 7g you do not need to restate your answer here. hel Be. Summarize impact(s) to each waterbody in the table below. hel Activity (clear, Waterbody Impact Duration Amount of material Area (sq. ft. or dredge, fill, pile name' location of impact' (cubic yards) to be linear ft.) of drive, etc.) placed in or waterbody removed from directly affected waterbody Rive, C I If no official name for the waterbody exists, create a unique name(such as"Stream 17 The name should be consistent with other documents provided. 2 Indicate whether the impact will occur in or adjacent to the waterbody. If adjacent, provide the distance between the impact and the waterbody and indicate whether the impact will occur within the 100-year flood plain. s Indicate the days,months or years the waterbody will be measurably impacted by the work. Enter`permanent"if applicable. 8f. For all activities identified in 8e, describe the source and nature of the fill material, amount (in cubic yards) you will use, and how and where it will be placed into the waterbody. LetM CZ JARPA Revision 2017.1 Page 9 of 14 8g. For all excavating or dredging activities identified in Be, describe the method for excavating or dredging, type and amount of material you will remove, and where the material will be disposed. fhelpl Part 9—Additional Information Any additional information you can provide helps the reviewer(s) understand your project. Complete as much of this section as you can. It is ok if you cannot answer a question. 9a. if you have already worked with any government agencies on this project, list them below. rhelDl Agency Name Contact Name Phone Most Recent Date of Contact 9b. Are any of the wetlands or waterbodies identified in Part 7 or Part 8 of this DARPA on the Washington Department of Ecology's 303(d) Lists hel • If Yes, list the parameter(s) below. • If you don't know, use Washington Department of Ecology's Water Quality Assessment tools at: http://www.ecy.wa.gov/pro_qrams/wq/303d/. Yes ❑ No 9c. What U.S. Geological Survey Hydrological Unit Code .(HUC) is the project in? hel • Go to http://cfpub.epa.gov/surf/iocatefindex.cfm to help identify the HUC. / Vkr/g 9d. What Water Resource Inventory Area Number (WRIA#) is the project in? hem • Go to http://www.ecy.wa.gov/services/gis/maps/wria/wria.htmto find the WRIA#. DARPA Revision 2012.1 Page 10 of 14 9e. Will the in-water construction work comply with the State of Washington water quality standards for turbidity? help • Go to http://www.ecy.wa.gov/programs/wq/swgs/criteda.html for the standards. es ❑ No ❑ Not applicable 9f. If the project is within the jurisdiction of the Shoreline Management Act, what is the local shoreline environment designation? h[ p_!0 • If you don't know, contact the local planning department. • For more information, go to: http://www.ecy.wa.gov/programs/sea/sma/laws rules/173-26/211 designations.html. Rural ❑ Urban ❑ Natural ❑ Aquatic ❑ Conservancy ❑ Other 9g. What is the Washington Department of Natural Resources Water Type? fheipl • Go to http//www dnr wa gov/BusinessPermits/Topics/ForestPracticesApplications/Pages/fp watertypinq aspx for the Forest Practices Water Typing System. Shoreline ❑ Fish ❑ Non-Fish Perennial ❑ Non-Fish Seasonal 9h. Will this project be designed to meet the Washington Department of Ecology's most current stormwater manual? Etpipj • If No, provide the name of the manual your project is designed to meet. Yes ❑ No Name of manual: 9i. Does the project site have known contaminated sediment? LtLel • If Yes, please describe below. ❑ Yes ZNo 9j. If you know what the property was used for in the past, describe below. [hel ot 9k. Has a cultural resource (archaeological) survey been performed on the project area? Lttlp • If Yes, attach it your JARPA package. ❑ Yes No DARPA Revision 2012.1 Paoe 11 of 14 91. Name each species listed under the federal Endangered Species Act that occurs in the vicinity of the project area or might be affected by the proposed work. el el- a Ai J c0/ 9m. Name each species or habitat on the Washington Department of Fish and Wildlife's Priority Habitats and Species List that might be affected by the proposed work. hel 071 � c a �eU)/ed r-, Part 10—SEPA Compliance and Permits Use the resources and checklist below to identify the permits you are applying for. • Online Project Questionnaire at http://apps.ecy.wa.gov/opas/. • Governor's Office of Regulatory Assistance at (800) 917-0043 or heip(a-_)ora.wa.gov. • For a list of addresses to send your JARPA to, click on agency addresses for completed JARPA. 1 tea. Compliance with the State Environmental Policy Act (SEPA).. (check all that apply.) n[ elpl • For more information about SEPA, go to www.ecy.wa.gDv/programs/sea/sepa/e-review.html. ❑ A copy of the SEPA determination or letter of exemption is included with this application. ❑ A SEPA determination is pending with (lead agency). The expected decision date is ❑ I am applying for a Fish Habitat Enhancement Exemption. (Check the box below in 1 ob.) hel ❑ This project is exempt (choose type of exemption below). ❑ Categorical Exemption. Under what section of the SEPA administrative code (WAC) is it exempt? ❑ Other: ❑ SEPA is pre-empted by federal law. JARPA Revision 2012.1 Page 12 of 14 10b. Indicate the permits you are applying for. (Check all that apply.) rhelpl LOCAL GOVERNMENT Local Government Shoreline permits: ❑ Substantial Development ❑ Conditional Use ❑ Variance ❑ Shoreline Exemption Type (explain): Other city/county permits: ❑ Fioodplain Development Permit ❑ Critical Areas Ordinance STATE GOVERNMENT Washington Department of Fish and Wildlife: ❑ Hydraulic Project Approval (HPA) ❑ Fish Habitat Enhancement Exemption —Attach Exemption Form Effective July 10, 2012, you must submit a check for $150 to Washington Department of Fish and Wildlife, unless your project qualifies for an exemption or alternative payment method below. Do not send cash. Check the appropriate boxes: ❑$150 check enclosed. (Check# Attach check made payable to Washington Department of Fish and Wildlife. ❑Charge to billing account under agreement with WDFW. (Agreement# ) ❑ My project is exempt from the application fee. (Check appropriate exemption) ❑ HPA processing is conducted by applicant-funded WDFW staff. (Agreement # ) ❑ Mineral prospecting and mining. ❑ Project occurs on farm and agricultural land. (Attach a copy of current land use classification recorded with the county auditor,or other proof of current land use.) ❑ Project is a modification of an existing HPA originally applied for, prior to July 10, 2012. (HPA# ) Washington Department of Natural Resources: ❑ Aquatic Use Authorization Complete JARPA Attachment E and submit a check for$25 payable to the Washington Department of Natural Resources. Do not send cash. - - - Washington Department of Ecology: ❑ Section 401 Water Quality Certification FEDERAL GOVERNMENT United States Department of the Army permits (U.S. Army Corps of EngineersJ: ❑ Section 404 (discharges into waters of the U.S.) ❑ Section 10 (work in navigable waters) United States Coast Guard permits: ❑ General Bridge Act Permit ❑ Private Aids to Navigation (for non-bridge projects) JARPA Revision 2012.1 Page 13 of 14 L Part 11—Authorizing Signatures Signatures are required before submitting the JARPA package. The DARPA package includes the JARPA form, project plans, photos, etc. rheipl 11a. Applicant Signature (required) rheipi i certify that to the best of my knowledge and belief, the information provided in this application is true, complete, and accurate. I also certify that I have the authority to carry out the proposed activities, and I agree to start work only after I have received all necessary permits. I hereby authorize the agent named in Part 3 of this application to act on my behalf in matters related to this application. (initial) By initialing here, I state that l have the authority to grant access to the property. I also give my consent to the permitting agencies entering the property where the project is located to inspect the project site or any work related to the project. 0 (initial) Applli/ic''ant Printed Narn6 r Appbcant Signature Date 11 b. Authorize Agent Signature [hel I certify that to the best of my knowledge and belief, the information provided in this application is true, complete, and accurate. I also certify that I have the authority to carry out the proposed activities and I agree to start work only after all necessary permits have been issued. Authorized Agent Printed Name Authorized Agent Signature Date 11 c. Property Owner Signature (if not applicant). [hel Not required if project is on existing rights-of-way or easements. I consent to the permitting agencies entering the property where the project is located to inspect the project site or any work. These inspections shall occur at reasonable times and, if practical, with prior notice to the landowner. /-5�7. (7 1P Property Owner Prin d Name/l Property Owner Sig ature Date CtOAP 18 U.S.0 §1001 provides that:Whoevdr, in any manner withirythe jurisdiction of?ny department or agency of the United States knowingly falsifies, conceals, or covers up by any trick, scheme, or device 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 statement or entry, shall be fined not more than $10,000 or imprisoned not more than 5 years or both. If you require this document in another format, contact the Governor's Office of Regulatory Assistance (ORA) at(800) 917-0043. People with hearing loss can call 711 for Washington Relay Service. People with a speech disability can call (877) 833-6341. ORA publication number: ENV-019-09 rev. 06-12 DARPA Revision 2012.1 Page 14 of 14 DAVID C. BAYLEY P. O. BOX 337 UNION, WA 98592 (360)-490-2492 David.Wmasoncountytitlexom October 17,2016 Community Development Department Of Mason County Attn: Permit Center: Sepa Application Shelton, WA 98584 RE: Bayley Piling Replacement RE: Dock Maintenance Location: South Shore of Hood Canal Parcel No. 32233-44-00020 (Title in name of Clark Jerome, a partnership) Address: 7627 E. S.R.No. 106, Union, WA 98592 Dear Sirs: Please find enclosed the following: 1) A Septa Checklist; 2) A JARPA form partially filled out; 3) A letter to the Washington Dept of Fish and Wildlife asking for the HPA; 4) A survey of the dock facility showing the location of the piling replacement project; and 5) A check payable to the Mason County Treasurer in the amount of$300.00 I have asked for an Emergency HPA and submitted same to the Dept of Fish and Wildlife since the piling that holds the southeast comer of the floating dock(see map)has broken off near its bottom and floated away. The Fish Biologist(Josh Benton)visited the site on October 13, 2016 (last Thursday) at low tide and agreed that the permit process could be expedited. On Friday October 14, 2016,the piling in question broke off and floated away. Sinc ely avid C. Bayley