HomeMy WebLinkAboutSHX2007-00076 Replace Seawall Bulkhead - SHX Permit / Conditions AGENCY USE ONi
=AgemyR #: Date Received: '4v 4t
'! !(local govt.or agency)
JOINT AQUATIC RESOURCES PERMIT APPLICATION FORM (DARPA)
(for use in Washington State) a
"�" PLEASE TYPE OR PRINT IN BLACK INK. L
TO FILL IN ELECTRONICALLY USE F11 TO MOVE THROUGH THE FORM
❑ Application for a Fish Habitat Enhancement Project per requirements of RCW 77.55.290. You must submit a copy of this
completed JARPA application form and the (Fish Habitat Enhancement DARPA Addition)to your local Government
Planning Department and Washington Department of Fish &Wildlife Area Habitat Biologist on the same day.
NOTE: LOCAL GOVERNMENTS-You must submit any comments on these projects to WDFW within 15 working days.
Based on the instructions provided, I am sending copies of this application to the following: (check all that apply)
❑ Local Government for shoreline: ❑Substantial Development []Conditional Use []Variance oExemption []Revision
❑Floodplain Management []Critical Areas Ordinance
Washington Department of Fish and Wildlife for HPA(Submit 3 copies to WDFW Region)
❑ Washington Department of Ecology for 401 Water Quality Certification(to Regional Office-Federal Permit Unit)
❑ Washington Department of Natural Resources for Aquatic Resources Use Authorization Notification
❑ Corps of Engineers for: ❑ Section 404 ❑ Section 10 permit
❑ Coast Guard for: ❑ General Bridge Act Permit ❑ Private Aids to Navigation(for non-bridge projects)
❑ For Department of Transportation projects only: This project will be designed to meet conditions of the most current
Ecology/Department of Transportation Water Quality Implementing Agreement
SECTION A-Use for all permits covered by this application. Be sure to ALSO complete Section C(Signature Block)for all
permit applications.
1.APPLICANT V2%A i t TOsI E I�t LL_ ET1 E2
MAILING ADDRESS
I I-t iol 797" AVE C.i Nw &I& HAZG09, wA Ol F 3zq- ctZv$
WORK PHONE EMAIL ADDRESS HOME PHONE FAX#
253- -0051- 0)5-4L-
If an agent is acting for the applicant during the permit process,complete#2. Be sure agent signs Section C(Signature Block)
for all permit applications
2.AUTHORIZED AGENT -T-IFS,tELJJ C'� nlSJ t2-�cT1afo COwtPA*/Ir" 'T-nlL,
MAILING ADDRESS f2O f6OX '��
A-t�.YrJ, WA CI SS Zy-
WORK PHONE E-MAIL ADDRESS HOME PHONE FAX#
3bo -2.75'- 66`64- 1 196o - 2767 -37S/
3. Relationship of applicant to property: OWNER ❑ PURCHASER ❑ LESSEE ❑
4. Name, address and phone number of property owner(s)if other than applicant:
5. Location (street address,including city,county and zi code,where proposed activity exists or will occur)
Lll 3 b0 1. S;AT6 e-E 3oZ , 9a�r-41rr- , wA ctv 7-,6
Local government with jurisdiction(city or county) 144 A-5 o pl CO.
Waterbody you are working in a4se --rnl L-F7- Tributary of WRIA#
Is this waterbody on the 303(d)List" YES NO PJ G t i s O J.J t L-
If YES,what parameter(s)?
"For 303d List, Shoreline designation 0 r-J ( �t Dd.tJ-0 A,L-
hftp://www.ecv,wa.gov/i)ro,gramsLw
A/303d/index html
Zoning designation z-
-
Y,Sec�j'on Section Township Range Government Lot
rjLi I) Z� J D I\AJ DNR stream type if known
Latitude and Longitude: L 7- '5'753 2- I,)I i ZZ, . 161 bag W Tax Parcel Number 12.2 Z. 1
ECY 070-15(Rev. 11104) JARPA Contact the State of Washington Office of Regulatory Assistance for latest version or call 360/407-7037 or 800/917-0043
1
6. '.Describe the current use of the property,and structures existing on the property. Have you completed any portion of the proposed
activity on this property? ❑ YES ,N NO
For any portion of the proposed activity already completed on this property,indicate month and year of completion.
S1r\[&LF FAMILY �t1S,AriJ;JhL vS�, CD�2t:Ni t_Y k k5 H0/ t t= OA1
Sty
Is the property agricultural land? ❑ YES '� NO Are you a USDA program participant? ❑ YES NO
7a. Describe the proposed work that needs aquatic permits: Complete plans and specifications should be provided for all work waterward
of the ordinary high water mark or line,including types of equipment to be used, if applying for a shoreline permit,describe all work
within and beyond 200 feet of the ordinary high water mark. If you have provided attached materials to describe your roject,you still
must summarize the proposed work here. Attach a separate sheet if additional space is needed. �Co,J5Ti2✓CT (LFP�A GE
Ex,
S-IIPJG R,)CK 1;E4vAL--L Lail-}-I f} Q-)CK wALt_ ev►.)S ROCr6D F2oKA 1.A(Z& CoLvMS+A
9-1VM Gt2AtJITf 12o CK. AFPLAGt?,-.tF tr w4L.L. t,liw- 09- fin! THE SPrw1F );oo i P2,tJT' A-S TH E
E-,V nW(, wA,t-L, (JRII`l0 L r&-ET bt Low OCA<." 6-e.ADr:. ZNC-LvDtS
Q.EM,o-IAL 0r- CO3,Jc46-r-E W1N(s t,/Ptrk-L- A JD Q-EPLACEt+ esa wITH t20C1C , wpP-1C
WILL- B K2FofLe^r'D (Y GA&rF 74,kcK HoE t" and TltirvAZ. APPRQIt $31 of 04&otnl u//tv.t-
PREPARATION OF DRAWINGS: See sample drawings and guidance for completing the drawings. ONE SET OF ORIGINAL OR GOOD QUALITY REPRODUCIBLE
DRAWWGS MUST BE ATTACHED. NOTE: Applicants are encouraged to submit photographs of the project site,but these DO NOT substitute for drawings. THE CORPS
OF ENGINEERS AND COAST GUARD REQUIRE DRAWWGS ON 8-112 X 111NCH SHEETS. LARGER DRAWINGS MAYBE REQUIRED BY OTHER AGENCIES.
7b. Describe the purpose of the proposed work and why you want or need to perform it at the site. Please explain any specific needs that
have influenced the design.
PE Co a 5,2-J LT x l 5►1 nl G t✓R L-t. ?o p>2c V t; r2T}1
7c, Describe the potential impacts to characteristic uses of the water body. These uses may include fish and aquatic life,water quality,
water supply, recreation and aesthetics. Identify proposed actions to avoid,minimize,and mitigate detrimental impacts and provide
proper protection of fish and aquatic life. Identify which guidance documents you have used. Attach a separate sheet if additional
space is needed. I N f n��,L -�1��C t�� x Pe"z i�,� . l t:W P o 0+4v(LY S,✓C 2&It5 E 1 A/ w
Tv d1Dr-rY pv21�1G Co.Is�IL✓cn�Co�JMoi.�D wIT7-t -fcTE2 i-+4�3RIc Sr9rIDJ�(Lp [3t-�T
tM A nl q 'M+:J; PQfk TJ ct"S ,N2 'jam#>(F d F G✓�R K ►-il L cr l3 C i o�-t. trJt�
7d, For in water construction work,will your project be in compliance with the State of Washington water quality standards for turbidity
WAC 173.201A-110? YES NO (See USEFUL DEFINITIONS AND INSTRUCTIONS)
8. Will the project be constructed in stages? YES ❑ NO JM
Proposed starting date: RSA P
Estimated duration of activity: 2- W6-6"K$
9. Check if any temporary or permanent structures will be placed:
❑ Waterward of the ordinary high water mark or line for fresh or tidal waters AND/OR
❑ Waterward of the mean higher high water for tidal waters?
10.Will fill material(rock,fill,bulkhead,or other material)be placed:
❑ Waterward of the ordinary high water mark or line for fresh waters?
If YES,VOLUME(cubic yards) /AREA (acres)
❑ Waterward of the mean higher high water for tidal waters?
If YES,VOLUME(cubic yards) /AREA (acres)
ECY 070-15(Rev. 11/04) JARPA Contact the State of Washington Office of Regulatory Assistance for latest version or call 3601407-7037 or 800/917-0043
2
'11. Will material be placed in wetlands? ❑ YES DQ NO
•Jf YES:
A. Impacted area in acres:
B. Has a delineation been completed? If YES, please submit with application. ❑ YES ❑ NO
C. Has a wetland report been prepared? If YES,please submit with application ❑ YES ❑ NO
D. Type and composition of fill material(e.g.,sand, etc.)
E. Material source:
F. List ail soil series(type of soil)located at the project site,and indicate if they are on the county's list of hydric soils. Soils information
can be obtained from the natural Resources Conservation Service (NRCS).
G. WILL PROPOSED ACTIVITY CAUSE FLOODING OR DRAINING OF WETLANDS? ❑ YES ❑ NO
If YES, IMPACTED AREA IS ACRES OF DRAINED WETLANDS.
NOTE:If your project will impact greater than%of an acre of wetland,submit a mitigation plan to the Corps and Ecology for approval along with the JARPA form.
NOTE:A 401 water quality certification will be required from Ecology in addition to an approved mitigation plan if your project impacts wetlands that are: a)greater than%acre in size,
or b)tidal wetlands or wetlands adjacent to tidal water. Please submit the JARPA form and mitigation plan to Ecology for an individual 401 certification if a)or b)applies.
12. Stormwater Compliance for Nationwide Permits Only: This project is(or will be)designed to meet ecology's most current
stormwater manual,or an Ecology approved focal stormwater manual. ❑ YES ❑ NO
If YES-Which manual will your project be designed to meet?
If NO-For clean water act Section 401 and 404 permits only-Please submit to Ecology for approval, along with this JARPA
application,documentation that demonstrates the stormwater runoff from your project or activity will comply with the water quality
standards,WAC 173.201(A)
13.Will excavation or dredging be required in water or wetlands? ❑ YES NO
If YES:
A. Volume: (cubic yards)/area (acre)
B. Composition of material to be removed:
C. Disposal site for excavated material:
D. Method of dredging:
14. Has the State Environmental Policy Act(SEPA)been completed ❑ YES ❑ NO APL-1 ev fv 2. f o/Y-4 7
SEPA Lead Agency: M4%o J COJ,JTI(
SEPA Decision: DNS,MDNS,EIS,Adoption, Exemption Decision Date(end of comment period)
SUBMIT A COPY OF YOUR SEPA DECISION LETTER TO WDFW AS REQUIRED FOR A COMPLETE APPLICATION
15. List other Applications,approvals or certifications from other federal,state or local agencies for any structures,construction discharges
or other activities described in the application(i.e.preliminary plat approval,health district approval,building permit,SEPA review,
federal energy regulatory commission license(FERC),Forest practices application,etc.). Also,indicate whether work has been
completed and indicate all existing work on drawings. NOTE:For use with Corps Nationwide Permits,identify whether your project has
or will need an NPDES permit for discharging wastewater and/or stormwater.
TYPE OF APPROVAL ISSUING AGENCY IDENTIFICATION DATE OF APPLICATION DATE APPROVED COMPLETED?
NO.
SEF4 R.Ev►t v.J MASo iJ CoJ rJ%Y /C `+- o
av La I n1 L- t 2 r^ M SD i CO J O T Y 1 '7
16. Has any agency denied approval for the activity you're applying for or for any activity directly related to the activity described herein?
❑ YES NO
If YES,explain:
ECY 070-15(Rev. 11/04) JARPA Contact the State of Washington Office of Regulatory Assistance for latest version or call 360/407-7037 or 800/917-0043
3
SECTION B - Usp for shoreline and Carps of Engineers permits only:
1117a.Total rQst of project. This means the fair marketjvaiue of the project,including materials,labor, machine rentals,etc, �
f L 00 i
1
117b. If a project or any portlorl of a project recelves ful-iding from a federal agency,that agency is responsibie fix ESA consultation. Please
)indicate if_You will receive feci6ral funds and what fedt sal agency is providing those funds. See instructians for informal n Qn ESA-'
!FEDERAL I-UNDING 'ES NO It YES,please fist the federal Wericy.
118. Local government with jurisdiction: WJAS�)#Jl
ri 9. For C::orosi Coast Guard abd DNR permits,provid6 names,addresses and telephone numbers of adjoining property owners,lessees,
t etc. Please note: Sh-re nre kmnagement Compliance may require additional notice—consult your local government.
I.._. NAME ADDRESS ,.. � PHONE NUMBER
SECTION C-This section MUST be completed fOr,lany ermit covered by this application
0. Application is hereby matte for a permit or permit-to authorize the activities described herein. I certify that l am familiar with the
information contained In I is application.and thatito the best of my knowledge and belief,such Infdrmation is true,complete,and
accurate- I further certify{that I possess the authc rity to undertake the proposed activities. I hereby grant to the agencies to which
this application is made,1. a right to enter the abcly�described location to insp�t the proposed,in-progress or completed work, l
agree to start work ON�`t�after all necessary permits have been recelved-
DATE
SIGNATURE OF APPLICANT
DATE
SIGNATURE OF AUT14ORIZED AGENT
f HEREBY DESIC L-t,.i;�' Cf� CL��5�O ACT AS MY AGENT 1N MATTERS RELATED TO THIS APPLIC;ATIGN FOR
PERMIT(S)- I UNDERSTAI D THAT IF A FEDERAL PERMIT IS ISSUED,I MUST SIGN THE PERMIT.
SIGNATURE OF APPLICANT -- - DATE
SIGNATURE OF LANDOWNER(EXCEPT PUBLIC,ENTITY LANDOWNERS,E.G. DNR)
THIS APPLICATION TI{7HI MUS 'BE SIGAIEt3 HY Ft#F 'WMIDANT AND THE AGENT,IF AN AUTHOR►ZED AGENT IS DESIGNA�ED.
18 U-S-O§1001 provides that:i Whoever,in any manner within the Jurisdiction of any department or agency of the United States knowingly
falsifies,conceals,or covers up by any"trick,scheme,fir device a material fact or makes any false,fictitious,or fraudulent statements or
representations or makes or uses any false writing or diocument knowing same to contain any false,fictitious,or fraudulent statement or
entry,shelf be fined not snore than$10,000 or JmprisonOd not more than 5 years or both-
i
A. Nature cif2he bxisttrig sho 006 Iy ,`,,, '" j' ,� go p,'m r�sb} �' ,1 d
woto IYPe oil shor&Qiri$,iSrCC 'B tl elf)'�,.1 i 1'
plain,flaocwyr d$tjat tYRd rlfeaGhat� )ss �erQsaorl.,�iIff'bataica f#rn!kk,rr (i(tp mattaliich'a 'f y! d.clsy;.
rack,riprap;. i:eteritd fp 4Ir3trlltk% dr lnig,,lf'arry) 4
S. in the event#ht3t any of1hi,prlupbC�buEldrngs flr;ktruc#ur y+iili excee[I a, rlgftt of tt(ifiw.e ft ataove tN ,aQt a;gde level,
} irxilcat$:#tfe apptrnum Joca40 of mid rttii'isbLr ail xe�ideri#Ial.Uhas,�a�st66*( 06#etif�a),#hat wtN hti'e: t1�d tCt�te vldw:
C. If the zpplication involves I conditional use or Ntai rl n.c*,set I'dittt In furl tf`it-po rdttt�litc't►i Vises that the
proposed Uae moy be a condi6o'nal use;or,In the of a aari,6 41,front whr�h tea yatiance is being.�ug�t:
�j These Agencies arelEquaf Opportunity and Affinnetive Action ermpiayer3'. '
Fob"special accommodation n4eds,please contact this appropriate agency in the Instructions
FCY 07p-1 d(Rev. 11/04) 3ARPAIContact the State of lftshfngton Office of R iAL t�,ar Asslstan0 for latest version of call 3&31407-7037 or 8001917-W43
4
STA MASON COUNTY
�P C DEPARTMENT OF COMMUNITY DEVELOPMENT
M
o A o = Planning Division
r o T z P O Box 279, Shelton,WA 98584
Zoo x Y o~ (360)427-9670
J �
1864
Exemption from Shoreline Management Act
Case No.: SHX2007-00076 Substantial Development Permit Requirement
The Proposal By: JESFIELD CONSTRUCTION
P.O. BOX 1590
ALLYN,WA 98524
To undertake the following development:
RECONSTRUCT EXISTING ROCK SEAWALL WITH NEW ROCK.
Within North Bay and/or its associated wetlands is exempt from the requirement of substantial development because
the development is categorized under WAC 173-27-040(2)as being category
C-normal protective bulkhead
Please contact Kell McAboy at ext 363 if you have aVy questions.
Issued: 12/18/2007 /�& C4 .
Expires: 12/18/2009 Authorized Local Government Official
cc: APPLICANT WDFW USACOE WDOE TRIBAL COUNCIL