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HomeMy WebLinkAboutSHX2008-00059 JARPA, SEP2008-00094 - SHX Permit / Conditions - 7/15/1998 FORM-MUST BE COMPLETED IN INK PLEASE PRESS HARD PERMIT NO.: MASON COUNTY PLUMBING/MECHANICAL PERMIT APPLICATION E426 W.Cedar/P.O.Box 186,Shelton,WA 98584 / 0 Shelton 360 427�670 Belfir 360 275-{467 Elma 360 482-5269 Seattle 206 464-6968 INFORMATIONCONTRACTOR INFORMATION z )k--- Contractor Name ess ,C/ / Mailing Address State Ly"f} Zip CodeC Cit Other Ph.f � Phy State Zip Code lder L---) Other Ph.��Contractor Reg. # Expiration SEPTIC INFORMATION-Connect to New Septic Existing Septic_.�_Connect to Sewer System Name of Sewer System PARCEL INFORMATION-12 digit Tax P rcel No. r%% / `' / 5���� Fire District 3 Legal Description A �l./ � f�l_ �, OF Site Address(Pleas include stree name, str et number nd city) N-i0 ` Directio to site Y) O Is your property within 200' of the following: Body of Water(Name)_ Sa Lake River/Creek Pond Wetland Seasonal Runoff Bluffs Stream S o_ pes orer _ TYPE OF JOB New Add Alt Repair_Other Use of Building Location of Fixtures/Units 1st Floor 2nd Floor Basement Garage Closet PLUMBING FIXTURES(Show Number Q�� MECHANICAL UNITS Fuel Type: Electric Type of Fixture No. of Fixtures (�\, �F s LPG Natural Gas Heatpump Toilets \\ Type of Unit Bath Basins No. of Units Fees Bath Tubs � � � Furnace Showers 1�`� Heatpumps Water Heater LGa Laundry Wsher I S� �N Sinks \ �S Dishwasher �— ���`\ llet Stove Other ?Other Base Fee Base Fee TOTAL PLUMBING TOTAL MECHANICAL A FLOOR PLAN AND PLOT PLAN MAY BE REQUIRED DEPENDING ON THE TYPE OF FIXTURE/UNIT. NOTICE: THIS PERMIT BECOMES NULL&VOID IF WORK OR CONSTRUCTION AUTHORIZED IS NOT COMMENCED WITHIN 180 D]thahe IF CONSTRUCTION WORK IS SUSPENDED OR ABANDONED FOR A PERIOD OF 180 DAYS AT ANY TIME AFTER THE WORK IS COMM . PROOF OF CONTINUATION OF WORK IS BY MEANS OF A PROGRESS INSPECTION. The owner or agent on owner's behalf,represt the information provided is accurate and grants employees of Mason County access to the above described property and structures foand inspection of this project. Acknowledgment of such is by signature below: OWNER AFFIDAVIT-I certify that I am exempt from the requirements of the CONTRACTOR'S AFFIDAVIT-I certify that I am currently regisa Contractor Registration Law RCW 18.27 and am aware of the ordinance contractor in the State of Washington and that I am aware of theerequirements for which this permit is issued and that all work will be done in requirements regulating the work for which this permit is issued orkconformance therewith. No changes shall be made without first obtaining shall be done in conformance therewith. No changes shall be mout approva. first obtaining approval. X Date 7 /" /(f X Date FOR OFFI IA USE BEYOND THIS POINT Accepted b Date 1 ) NRLIubmittal Amount / due �� Receipt No. lo?l(o_ AA#iTMEfHTAI #t£lfW . ...< APFROtFtD t? f+ElEt} Building Department GONQtTIQN::Cflr1�5: Occ Group Type Constr. Planning Department Other Other Per mit F ................:..:::..:::..::............................................................................................................................. ee � Site Inspection Plan Review Fee UFC Plan Review Fee Plumbing&Base Fee Other S�FC Mechanical&Base Fee Other Wood/Gas/Pellet Stove Fee Pre-Paid at Submittal Violation Fee TOTAL FEES J? Page No. 1 CASE HISTORY FOR CASE NO. : MIS98-0363 VAN ARNAM PROPERTY E60 NORTH BAY RD BELFAIR 07/20/98' Action Description Req/ Schd/ End/ Action Notes Disp By Update Upd Code Sent Done Done Date By MISA010 Application received / / / / 07/14/98 07/14/98 SMG MISB135 RLC Checklist Review / / / / / / 07/14/98 SMG Jl 7�1 t_. � (tom �o nod �o , � Gam. ./ Jc•�S r r��✓ c v \�_ �� � r_`--_. -. `_ �--_- _ �c ��L� v v �� � •v U ��ti i oN-SrATF MASON COUNTY c P� a o °N DEPARTMENT OF COMMUNITY DEVELOPMENT s u = Planning Division Z N T P O Box 279, Shelton,WA 98584 �0 Y ~ (360)427-9670 1864 Exemption from Shoreline Management Act Case No.: SHX2008-00059 Substantial Development Permit Requirement The Proposal By: DREW DAVIES PO BOX 1095 ALLYN,WA 98524 To undertake the following development: Repair Bulkhead. Within Case Inlet 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 B-normal maintenance Please contact Rebecca Hersha at ext 593 if you have any questions. Issued: 7/16/08 Expires: 7/16/10 Authorized Local Government Official cc: APPLICANT WDFW USACOE WDOE TRIBAL COUNCIL ;4 AGENCY USE ONLY Agency Reference#: x LC" _ t � Date Received: Ci,-:.W,ed,by: y f i (local govt.,or agency) JOINT AQUATIC RESOURCES PERMIT APPLICATION FORM (JARPA) (for use in Washington State) O PLEASE TYPE OR PRINT IN BLACK INK.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 JARPA 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 Axemption []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 , CtiJ GL vt Qs MAILING A SS 9 .C_ l ®?s 4 // .1 � Z� W K PHONE E-MAIL ADDRES JIJOMEPHONE FAX# ( U.99-2-2738 GfFI/,�Lu �f„ �,�5 � �b 7- 8576 a 7$2 '�7V0 l 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 MAILING ADDRESS WORK PHONE E-MAIL ADDRESS HOME PHONE FAX# 3. Relationship of applicant to property: MILOWNER ❑ PURCHASER ❑ LESSEE ❑ 4. Name, address and phone number of property owner(s)if other than applicant: 5. Location(street address, clung city,��ty, and���de,where proposed activity exists or will occur) O Local government with jurisdiction(city or county) OL.— G p L. ' -T Waterbody you are working in 111j r C. Tributary of WRIA# Is this waterbody on the 303(d)List"* YE NNO If YES,what parameter(s)? "For 303d List, Shoreline designation G,i�Jcf http://www.ecy.wa.gLoy/programs/Wg/303d/index.html Zoning designation Section Section Township Range lGovernmentLot LV Z f) -Z2 DNR stream type if known NI Latitude and Longitude: Tax Parcel Number 222, QsQ Q(� 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 8001917-0043 1 6. Describe the current use of the property, and structures existing on the property. Have you completed any portion of the propo,-tw-d activity on this property? ❑ YES NO For any portion of the proposed activity already completed on this property, indicate month and year of completion. ��,Qrt✓ / f 1;104 -A 15 f=`�� �wJ G edruc2 fnovS� o .. J i3 rA ZX—'Si" Lac.. cret� � w c..c:o k -'- Lc( 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 project, you still must summarize the proposed work here. Attach w separate sheet if additional space is needed. 7�� c e c, e,e 4.: 4-e- �� ; ;s , ..S & 'J ikc,P ;/l ��� �� rem( ro C,,K G u e-c'-G� (� L•r t r C,a,d 6 C- -*",r-, //9 T jJ a , -( -/ -tc�� � 1�Q G -i JC c,e ,( (--ee �o -v e / /t -r roL, /—c y w rr l , /\/O t t-c)r �o .\&- OF,- -rt—� t6d�ch PREPARATION OF DRAWINGS: See sample drawings and guidance for completing the drawings. ONE SET OF ORIGINAL OR GOOD QUALITY REPRODUCIBLE DRAWINGS 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 DRAWINGS ON 8-112 X 11 INCH 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 Ty specific needs that have influenced the design. 70 7 �s -ry (, '2dw yet P.a��s r j e,, 1'.e—r TrI/S i!/e a f!7rc i v`c-T Ot 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. Iden�f' which guidance documents you have used. Attach a separate sheet if additional space is needed. �(,c� Q S l,�v�lJ Iry G �a.� S 7-o -ri-4- 6 e ek d 7-FM1t�.�•�-e� -F*PL T G ( l�AJ-t C-c� CAL C( r S ;n�e'i�Jx O -t- 1v� rj7Glfwi-• dv+ P5 ��$ A rg✓t 7�l�' Cc�v✓�T//iQs S �.5SeS7rCvti5 G/•� e � '�'��G (i D✓� ✓V`'tifttiL- fl � 7d. For in water construction work,will your project be in compliance with the State of Washington water quality stands for turbidity WAC 173.201 A-1 10? ES NO (See USEFUL DEFINITIONS AND INSTRUCTIONS) 8. Will the project be constructed in stages? YES ❑ NO 'X Proposed starting date: Estimated duration of activity: 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 watermark or line for freshwaters? 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) DARPA Contact the State of Washington Office of Regulatory Assistance for latest version or call 360/407-7037 or 800/917-0043 2 11. Will material be placed in wetlands? ❑ YES NO If YES: P 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 all 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 Y.acre in size, orb)tidal wetlands or wetlands adjacent to tidal water. Please submit the JARPA form and mitigation plan to Ecology for an individual 401 certification 9 a)orb)applies. 12. Stormwater Compliance for Nationwide Permits Only: This project is(or will be)designed to meet ecology's most current stormwater manual,Oran Ecology approved local 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 SEPA Lead Agency: 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. 16. Has any agency deni d approval for the activity you're applying for or for any activity directly related to the activity described herein? ❑ YES f 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 6 - Use for Shoreline and Corps of Engineers permits only: 17a.Total cost of project. This means the fair market value of the project, including materials,labor, machine rentals,etc. 17b. If a project or any portion of a project receives funding from a federal agency,that agency is responsible for ESA consultation. Please indicate if you will receive federal funds and what federal agency is providing those funds. See instructions for information on ESA.* FEDERAL FUNDING ❑ YES ❑ NO If YES, please list the federal agency. 18. Local government with jurisdiction: 19. For Corps,Coast Guard and DNR permits, provide names, addresses and telephone numbers of adjoining property owners,lessees, etc. - Please note: Shoreline Management Compliance may require additional notice—consult your local government. NAME ADDRESS PHONE NUMBER SECTION C-This section MUST be completed for any permit covered by this application 0. Application is hereby made for a permit or permits to authorize the activities described herein. I certify that I am familiar with the information contained in this application,and that to the best of my knowledge and belief,such information is true,complete,and accurate. I further certify that I possess the authority to undertake the proposed activities. I hereby grant to the agencies to which this application is made,the ri ht to enter the above-described location to inspect the proposed,in-progress or completed work. I agree st work '924 er II necessary permits have been received. DATE A.1 SIGNATURE OF AP LI T � DATE SIGNATURE OF AUTHORIZED AGENT I HEREBY DESIGNATE TO ACT AS MY AGENT IN MATTERS RELATED TO THIS APPLICATION FOR PERMIT(S). I UNDERSTAND 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 MUST BE SIGNED BY THE APPLICANT AND THE AGENT,IF AN AUTHORIZED AGENT IS DESIGNATED. 18 U.S.0§1001 provides that: 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,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. C0 ;,EtIAQ Bl( L bF1=frKIAL 'A Nature cif the eats rid shtx fiirle D� r be tyke Of shore[he,stich��rh��t�e;,treart�+lake,lagoon,maCsh,bt�g�a ar�►p���bd Ia.trl, t4tl�ivar,retay{ 12rFa� rah as ae�retion,ecoign,f�igh bankz;xltnrark,nr dike,mafena�su h�as gav rock;rprap,a1r tidttt ati +gfktag,if arty) Btrdreaat; hprite lobr nl€ rif tE:atdriia1 tlrtt �arltddttla[s that Meilte hevvblf n the eventhaacth idt fo ue Io e fa1� lbw C fft sppltcsttton rr vc t es€�a©ndi Iinal irs+e orvar<arice,set tolfCi to foil tl of orwn of-thi master prprgr2i1 vv icFt�r rii es hatthe pro�pbsed use many) a Qntjittc�nal use,or,in the case of a vanane ,>`orr>>wh�oh the variance is being Might: These Agencies are Equal Opportunity and Affirmative Action employers. For special accommodation needs,please contact the appropriate agency in the instructions 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 4 UA-, MASON COUNTY_DCD� Sent SEPA �S - to(check all that apply)on Skokomish Tribal Nation © WA Department of Ecology Natural Resources Dept. Environmental Review Section ATTN: Marty Ereth PO BOX 47703 N 541 Tribal Center Rd. Olympia,WA 98504-7703 Shelton,WA 98584 Quinault Indian Nation U.S.Army Corps of Engineers ATTN: Mark Mobbs SEPA Reviewer PO Box 189 PO Box C-3755 Tahola,WA 98587 Seattle,WA 98124 Squaxin Tribal Nation WA Dept.of Fish and Wildlife Natural Resources Dept. ATTN: Margie Schirato(saltwater) 2952 SE Old Olympic Highway 2391 W Deegan Rd. Shelton,WA 98584 Shelton,WA 98584 The Confederated Tribe of the Chehalis WA Dept.of Fish&Wildlife ATTN:SEPA Reviewer ATTN: Gloria Rogers(freshwater) 420 Howanut Rd. PO Box 695 Oakville,WA 98568 Elma,WA 98541 Shannon Soto WA Dept.of Transportation WA DNR,South Puget Sound Region Alana Hess, Development Review Engineer 950 Farman Avenue North P.O. Box 47440 Enumclaw,WA 98022-9282 Olympia,WA 98504-7440 Elizabeth Ellis City of Shelton WA DNR,Aquatic Resources 525 West Cota St. PO BOX 47027 Shelton,WA 98584 Olympia,WA 98504-7027 Office of Archeaology& Historic Preservation Boyd Powers ATTN:Scott Williams WA DNR,SEPA Center P.O. Box 48343 PO BOX 47015 Olympia,WA 98504-8343 Olympia,WA 98504-7015 School District: Olympic Region Clean Air Agency 2940-B Limited Ln. NW Mason Cty Public Works ATTN: Olympia,WA 98502 Mason Cty Env. Health ATTN: Mason County Transit PO Box 1880 , M Agent: Shelton,WA 98584 Applicant: oN-STAr MASON COUNTY �P5 C �� DEPARTMENT OF COMMUNITY DEVELOPMENT 4 MO � s" U Planning Division N N Y ti P O Box 279, Shelton,WA 98584 (360)427-9670 1864 MITIGATED DETERMINATION OF NONSIGNIFICANCE (WAC 197-11-350) SEP2008-00094 Description of Proposal: Replace failing portion (approx 80 feet) of wood and concrete bulkhead with stone bulkhead along Case Inlet. 4 feet in height as measured from natural beach grade. Proponent: DREW DAVIES Site Address(If Assigned): 60 E NORTH BAY RD BELFAIR Directions to Site: Parcel Number: 122205015003 Legal Description: ALLYN BLKS:14-16 PCL 2 OF BLA#92-103 & T.L. Lead Agency: Mason County The Lead Agency for this proposal has determined that it does not have a probable significant adverse impact on the environment. An Environmental Impact Statement (EIS) is not required under RCW 43.21 C.030(2)(c). This decision was made after review of a completed Environmental Checklist and other information on file with the Lead Agency. This information is available to the public upon request. MITIGATED MEASURES ARE ATTACHED. Please contact Rebecca Hersha at ext. 593 with any questions. This DNS is issued under WAC 197-11-340(2). The Lead Agency will not act on this proposal for 14 days from the date shown below, when the determination is final. Comments must be submitted to Dept. of Community Development, P.O. Box 279, Shelton WA 98584 by 7/31/08. Appeal of this determination must be filed within a 14-day period following this final determination date, per Mason County Code Chapter 15.11 Appeals. Authorized Local Government Official Date MITIGATED DETERMINATION OF NONSIGNIFICANCE (WAC 197-11-350) SEP2008-00094 CONDITIONS OF THIS DETERMINATION �) Residential development in shoreline areas should be designed to preserve natural drainage courses. X Debris or deleterious material resulting from construction shall be removed from the beach area and project site and shall not be allowed to enter waters of the State. X Water quality is not to be degraded to the detriment of the aquatic environment as a result of this project. X Residential developers and individuals shall be required to control erosion during construction. Removal of vegetation shall be avoided and any areas disturbed should be restored to prevent erosion and other environmental impacts. X Residential development on shorelines and wetlands should be planned with minimum adverse environmental and visual impact. Structures should be located to not significantly block views of adjacent residences. X All trenches, depressions, or holes created in the intertidal area shall be backfilled prior to inundation by tidal waters. X -, j . � _ _ ,� .` � _ •jA - �'—• � FYI.! i �.. i�y>' r a• _ .. � �A .� P, P' t: 1 :.Yr' i _ - 1,�+ ��.f, � - - t , _� 5 �. � .,r .� �(r r d .1 t �(T > i , tb � ( ':J e ��1�r1� - - � -.. .,� .f •, � hf.� .i�x tom. - - t . �,' ,;�; t. 4 q z'�1# � � �=! ' t { � �pro' � �l'�` �• e, � � w. R. � � ,�k i � ��� , 1 l �, s�, :a �^ `d �� � � '� , �'v .�• 1, i y`1 ti � 1 LL- TF r�U f •1i - . 1 t ! fm on r t � 1 .r 1 7 ! + 1+4 1 Y +�41 a i fir■ _ _..._...____ _._ MASON CO. ENVIROMENTAL CHECKLIST A. BACKGROUND 1. Name of proposed project, if applicable: 2. Name o plicant: 3. Address and phone number of applicant and contact person: /0 ?�- 4// h � 4 Y,9 7 4. Date checklist repay d: G ) 0 6 5. Agency requesting checklist: /J/� k5� ,, (-o�w�� 6. Proposed timing or schedule (including phasing, if applicable): /40 s 01", G 5 IPd65 G 7. Do you have any plans for future expansion, or further activity related to or connected with this proposal: If yes, explain. 8. List any environmental information you know about that has been prepared, or will be prepared, directly related to this proposal. �?- l� K s �� /0 r t--O r o, r a- ci Cl 9. Do you know whether applications are pending for governmental approvals of other proposals directly affecting the property covered by your proposal? If yes, explain. �o h3 3 i 10. List any government approvals or permits that will be needed for your proposal, if known. d � L �v-v w ✓` 11. Give a brief, complete description of your proposal, including the proposed uses and the size of the project and site. There are several questions later in this checklist that ask you to describe certain aspects of your proposal. You do not need to repeat those answers on this page. (Lead agencies may modify this form to include additional specific information on project description.) �v v I 1 �� o r� P �aC-e a!dP rd /c L-t"l v 1 k",e-o-C(i f' ��.. �tS (4 d �lC � S I 12. What is the location of the proposal? Give sufficient information for a person to understand the precise location of your proposed project including a street address, if any, and section, township, and range, if known. If a proposal would occur over a range of area, provide the range or boundaries of the site(s). Provide a legal description, site plan, vicinity map, and topographic map, if reasonably available. While you should submit any plans required by the agency, you are not required to duplicate maps or detailed plans submitted with any permit applications related to this checklist. --/� 6 v � R-r�d re—P e- r � �5 7 -�►-� �� � �. c,L o� �L n o r i e�s� c v� r � � �-G.� s Ole O Alo r li� Ig 7 l/7 (,/,4 leJ y L 1- 222 ©SO /,S 0 03 B. ENVIRONMENTAL ELEMENTS: 1. EARTH: a. General description of the site (circle one): Flat, rolling, hilly, steep slopes, mountainous, other b. What is the steepest slope on the site (approximate percent slope)? l jC. What general types of soils are found on the site (for example, clay, sand, gravel, peat, muck)? If you know the classification of agricultural soils, specify them and note any prime farmland. J/ �,w• d` Se w .Q d. Are there surface indications or history of unstable soils in the immediate vicinity: If so, describe. Mason County Environmental Checklist Page 2 e. Describe the purpose, type, and approximate quantities of any filling or grading proposed. Indicate source of fill. f. Could erosion occur as a result of clearing, construction, or use: If so, generally describe. g. About what percent of the site will be covered with impervious surfaces after project constructions (for example, asphalt or buildings)? h. Proposed measures to reduce or control erosion, or other impacts to the earth, if any: T-V (3 2. AIR: a. What types of emissions to the air would result from the proposal (i.e. dust, automobile, odors, industrial wood smoke) during construction and when the project is completed? If any, generally describe and give approximate quantities, if known. b. Are there any off-site sources of emissions or odor that may affect your proposal? If so, generally describe. A v Mason County Environmental Checklist Page 3 i C. Proposed measures to reduce or control emissions or other impacts to air, if any: 3 WATER: a. Surface: 1) Is there any surface water body on or in the immediate vicinity of the site (including year-round and seasonal streams, saltwater, lakes, ponds, wetlands)? If yes, describe type and provide names. If appropriate, state what stream or river it flows into. /4d� T- 7`0 r 2) Will the project require any work over, in, or adjacent to (within 200 feet)the described waters? If yes, please describe and attach available plans. �5 G tw �� �� � ����� y - 3) Estimate the amount of fill and dredge material that would be placed in or removed from surface water or wetlands and indicate the area of the site that would be affected. Indicate the source of fill material. 4) Will the proposal require surface water withdrawals or diversions? Give general description, purpose, and approximate quantities if known. 9 a A Mason County Environmental Checklist Page 4 5) Does the proposal lie within a 100-year floodplain? If so, note location on the site plan. 6) Does the proposal involve any discharges of waste materials to surface waters? If so, describe the type of waste and anticipated volume of-discharge. b. Ground: 1) Will ground water be withdrawn, or will water be discharged to ground water? Give general description, purpose, and approximate quantities, if known. 2) Describe waste material that will be discharged into the ground from septic tanks or other sources, if any (for example; domestic sewage, industrial, containing the following chemicals..., agricultural, etc.). Describe the general size of the system, the number of such systems, the number of houses to be served (if applicable), or the number of animals or humans the system(s) are expected to serve. C. Water runoff (including storm water): 1) Describe the source of runoff(including storm water) and method of collection and disposal, if any (include quantities, if known). Where will this water flow? Will this flow into other waters? If so, describe. i / i i i E 2) Could waste materials enter ground or surface waters: If so, generally describe. v il 3 P Mason County Environmental Checklist Page 5 d. Proposed measures to reduce or control surface, ground, and runoff water impacts, if any: 4. PLANTS: a. Check or circle types of vegetation found on the sit deciduous tree: alder,0T'a aspen, other cT� evergreen tree: fir,U' m other shrubs grass pasture crop or grain wet soil plants: cattail, buttercup, bullrush, skunk cabbage, other water plants: water lily, eelgrass, milfoil, other other types of vegetation b. What kind and amount of vegetation will be removed or altered? C. List threatened or endangered species known to be on or near the site. f f ' d. Proposed landscaping, use of native plants, or other measures to preserve or enhance vegetation on the site, if any: 5.5 �-� G�- P E k k i� Mason County Environmental Checklist Page 6 5. ANIMALS a. Circle any birds and animals which have been observed on or near the site or are known to be on or near the site: Birds: hawk, heron, eagle, songbirds, other Mammals: deer, begp4k, beaver, other Fish: bass, m , trout, herring, shellfish, other b. List any threatened or endangered species known to be on or near the site. C. Is the site part of a migration route? If so, explain. /Vo d. Proposed measures to preserve or enhance wildlife, if any: 1 1A 6. ENERGY AND NATURAL RESOURCES: a. What kinds of energy (electric, natural gas, oil, wood stove, solar) will be used to meet the completed project's energy needs? Describe whether it will be used for heating, manufacturing, etc. D. Would your project affect the potential use of solar energy by adjacent properties: If so, generally describe. C. What kinds of energy conservation features are included in the plans of this proposal? List other proposed measures to reduce or control energy impacts, if any: JJ Mason County Environmental Checklist Page 7 9 7. ENVIRONMENTAL HEALTH: a. Are there any environmental health hazards, including exposure to toxic chemicals, risk of fire and explosion, spill, or hazardous waste, that could occur as a result of this proposal? If so, describe. 711I>k--k— 1) Describe special emergency services that might be required. 2) Proposed measures to reduce or control environmental health hazards, if any: b. Noise. 1) What types of noise exist in the area which may affect your project (for example: traffic, equipment, operation, other)? / 2) What types and levels of noise would be created by or associated with the project on a short-term or a long-term basis (for example: traffic, construction, operation, other)? Indicate what hour's noise would come from the site. ,(/`D cx - 3) Proposed measures to reduce or control noise impacts, if any: 8. LAND AND SHORELINE USE: a. What is the current use of the site and adjacent properties? !( OL /X_ 5 Mason County Environmental Checklist Page 8 b. Has the site been used for agriculture? If so, describe. .-r e7 r-, c7 + cl z t. rs o, 5 a c. Describe any structures on the site. d. Will any structures be demolished? If so, what? U0 e. What is the current zoning classification of the site? f. What is the current comprehensive plan designation of the site? g. If applicable, what is the current Shoreline Master Program designation of the site? v r 6 h. Has any part of the site been classified as an "environmentally sensitive" area? If so, specify. /1 6 i. Approximately how many people would reside or work in the completed project? j. Approximately how many people would the completed project displace? T k. Proposed measures to avoid or reduce displacement impacts, if any: Mason County Environmental Checklist Page 9 s r I. Proposed measures to ensure the proposal is compatible with existing and projected land uses and plans, if any: 1 9. HOUSING: a. Approximately how many units would be provided, if an y? Indicate wh ether high, middle, or low-income housing.9 b. Approximately how many units, if any, would be eliminated? Indicate whether high, middle, or low-income housing. R"/ C. Proposed measures to reduce or control housing impacts, if any: 10. AESTHETICS: a. What is the tallest height of any proposed structure(s), not including antennas; what is the principal exterior building material(s) pro osed? b. What views in the immediate vicinity would be altered or obstructed? i C. Proposed measures to reduce or control aesthetic impacts, if any: Mason County Environmental Checklist Page 10 i 11. LIGHT AND GLARE a. What type of light or glare will the proposal produce? /JWhat time of day would it mainly occur? /Y� b. Could light or glare from the finished project be a safety hazard or interfere with views? C. What existing off-site sources of light or glare may affect your proposal: d. Proposed measures to reduce or control light and glare impacts, if any: YA 12. RECREATION: a. What designated and informal recreational opportunities are in the immediate vicinity? k f b. Would the proposed project displace any existing recreational uses? If so, describe. I C. Proposed measures to reduce or control impacts on recreation, including recreation opportunities to be provided by the project or applicant, if any: l i I� Mason County Environmental Checklist Page 11 13. HISTORIC AND CULTURAL PRESERVATION: a. Are there any places or objects listed on, or proposed for, national, state, or local preservation registers known to be on or next to-the site? If so, generally describe. //d b. Generally describe any landmarks or evidence of historic, archaeological, scientific, or cultural importance known to be on or next to the site. C. Proposed measures to reduce or control impacts, if any: 14. TRANSPORTATION: a. Identify public streets and highways serving the site and describe proposed access to the existing street system. Show on site plans, if any. //l Y b. Is site.currently served by public transit? If not, what is the approximate distance to the existing street system? Show on site plans, if any. C. How many parking spaces would the completed project have? How many would the project eliminate? - d. Will the proposal require any new roads or streets, or improvements to existing roads or streets, not including driveways? If so, generally describe (indicate whether public or private). Mason County Environmental Checklist Page 12 II e. Will the project use (or occur in the immediate vicinity of) water, rail, or air transportation? If so, generally describe. „ / !i(Ia f. How many vehicular trips per day would be generated by the completed project: If known, indicate when peak volumes would occur. g. Proposed measures to reduce or control transportation impacts, if any: 15. PUBLIC SERVICES: a. Would the project result in an increased need for public service (for example: fire protection, police protection, health care, schools, other)? If so, generally describe: d b. Proposed measures to reduce or control direct impacts on public services, if any: 1X111q Mason County Environmental Checklist Page 13 16. UTILITIES: a. Circle utilities cu ilable at the site: ricit natural gas ter, refuse service, telephone, anitarY se se, ticsY stem other: p b. Describe,the utilities that are proposed for the project, the utility providing the service, and the general construction activities on the site or in the immediate vicinity which might be needed. Signature: The above answers are true and complete to the best of my knowledge. I understand that the lead agency is relying on them to make its decision. Signature: Date submitted: CrA Z'-2 Mason County Environmental Checklist Page 14 ESA LISTED SALMONIDS CHECKLIST Applicant Information Project Information Name Or ew i�S Name 66 A(- .,-a Phone r 6�� '7 $2 9 ? S Location . 4, w A 9*e S z y Description fb 02 ; 4F�15 7,d' 101kkkcy This worksheet was designed to help project proponents, and government agencies, identify when a project needs further analysis regarding adverse effects on ESA (Endangered Species Act) listed salmonids. Salmonids are salmon, trout and chars, e.g. bull trout. For our purposes, "ESA Listed Salmonids" is defined as fish species listed as endangered, threatened or being considered for listing. If ESA listed species are present or ever were present in the water shed where your project will be located, your project has the potential for affecting them, and you need to comply with the ESA. The questions in this section will help determine if the ESA listings will impact your project. The Fish Program Manager at the appropriate Department of Fish and Wildlife (DFW) regional office can provide information for the following two questions. 1. Are ESA listed salmonids currently present in the watershed in which your project will be located? YES NO Please describe. 2. Has there ever been an ESA listed salmonid stock present in this watershed? YES 04- NO _ Uncertain Please describe. If you answered "yes" to either of the above questions, you should complete the remainder of this checklist. April 2003 u Mason County Environmental Checklist Page 15 3 PROJECT SPECIFICES: The questions in this section are specific to the project and vicinity. 1. Name of watershed: 2. Name of nearest waterbody: o 3. What is the distance from this project to the nearest body of water: i G IL-0 .� 'r- . Often a buffer between the project and a stream can reduce a e the chance of gative impact to fish. 4. What is the current land use between the project and the potentially affected water body (parking tots, farmland,etc. j� 2 ,q1<S ax ;a C—t K 7LV e F 5. Is the project above a: * natural permanent barrier(waterfall) YES NO * natural temporary barrier(beaver pond) YES NO * man-made barrier(culvert, dam) YES NO * other(explain): n 6. If yes, are there any resident salmonid populations above the blockage? YES NO Don't know 7. What percent of the project will be impervious surface(including pavement &roof area)? Mason County Environmental Checklist Page 16 FISH MIGRATION: The following questions will help determine if this project could interfere with migration of adult and juvenile fish. Both increases and decreases in water flows can affect fish migration. 1. Does the project require the withdrawal of. a. Surface water? YES NO Amount Name of surface water body b. Ground water? YES NO —21 Amount From where Depth of well 2. Will any water be rerouted: YES NO If yes, will this require a channel change? 3. Will there be retention or detention ponds? YES NO If yes, will this be an infiltration pond or a surface discharge to either a municipal storm water system or a surface water body? If to a surface water discharge,please give the name of the waterbody. 4. Will this project require the building of new roads? YES NO Increased road mileage may affect the timing of water reaching a stream and may impact fish habitat. 5. Are culverts proposed as part of this project? YES NO _2< 6. Will topography changes affect the duration/direction of runoff flows? YES NO If yes, describe the changes. 7. Will the project involve any reduction of the floodway or floodplain by filling or other partial blockage of flows? YES NO y If yes, how will the loss of flood storage be mitigated by your project? Mason County Environmental Checklist Page 17 WATER QUALITY: The following questions will help determine if this project could Adversely impact water quality. Such impacts can cause problems for listed species. Water quality can be made worse by runoff from impervious surfaces,altering water temperature,discharging contaminants,etc. 1. Do you know of any problems with water quality, in any of the streams, within this watershed? YES NO C2!!�_ If yes, describe. 2. Will your project either reduce or increase shade along or over a waterbody? YES NO Removal of shading vegetation or the building of structures such as docks or floats often results in a change in shade. 3. Will the project increase nutrient loading or have the potential to increase nutrient loading or contaminants (fertilizers, other waste discharges, or runoff)to the waterbody? YES NO x 4. Will turbidity be increased because of construction of the project or during operation of the project? YES NO In-water or near water work will often increase turbidity. 5. Will your project require long term maintenance, i.e. bridge cleaning, highway salting, and chemical sprays for vegetation ma agement, clearing of parking lots? YES NO If yes,please describe. Mason County Environmental Checklist Page 18 rr rWm�ar. VEGETATION: The following questions are designed to determine if the project will affect riparian vegetation, thereby, adversely impacting salmon. 1. Will the project involve the removal of any vegetation from the stream banks: YES NO If yes, please describe the existing conditions, and the amount and type of vegetation to be removed. 2. If any vegetation is removed, do you plan to re-plant? YES NO If yes, what types of plants will you use? I i i i i �I R Mason County Environmental Checklist Page 19 g i