HomeMy WebLinkAboutSHX2008-000-75; JARPA; SEP2008-00127; SEP00-8955 - SHX Permit / Conditions -� AGENCY USE ONLY
Agency Reference#: Date Received: 7
5J
Circulated by: (local.gout.or agency)
JOINT AQUATIC RESOURCES PERMIT APPLICATION FORM (JARPA)
(for use in Washington State)
M PLEASE TYPE OR PRINT IN BLACK INK. R�,,, ^
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 Exemption ❑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
MAILING ADDRESS
P, () . 6&X l-)'i'7 '3eLftuA, , c�.A 07
WORK PHONE E-MAIL ADDRESS HOME PHONE FAX#WHt A) , c
��-Z7�y-�1v 1 )tJ (e� �' �1cf;�rr�dc¢•C Ic 1 -Z .S` 3 k' 34cC 275-36
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
MAILING ADDRESS
WORK PHONE E-MAIL ADDRESS HOME PHONE FAX#
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 zip code,where proposed activity exists or will occur)
E,qO 405E r°r I-AA;
Local government with jurisdiction(city or coup -L_V;A# ' A S0.AJ l"0 �sz a
Waterbody you are working in >Nt�`XfI� e/�ti;+q L Tributary of WRIA#
Is this waterbody on the 303(d)List" YES ❑ NO ❑
If YES,what parameter(s)?
"For 303d List, Shoreline designation
http://www,ecy.wa.gov/programs/wg/303d/index.html '
Zoning designation
Y.Section Section Township Range Government Lot
f' -�2_ 1 DNR stream type if known
Latitude and Longitude: Tax Parcel Number 2Z?,i Z -
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
1
11. Will material be placed in wetlands? ❑ YES NO
.> -If 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 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 9 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 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 Jq 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 Og 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 denied approval for the activity you're applying for or for any activity directly related to the activity described herein?
❑ YES j�' 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
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 g NO
For any portion of the proposed activity already completed on this property, indicate month and year of completion.
5j/UC+r-61 eA U24U-
Is the property agricultural land? ❑ YES R1 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 a separate sheet if additional space is needed.
AAA K ON.D&-IM 01 6b psi cAj --yZ c)Csf 6AJ D of
AL�uRrr & X�i,� �� 1�C'k�r� ��r u e (!�-! .���� } R 6PAf�n7lr C�si c�
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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 any specific needs that
have influenced the design. pP
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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.S>`A WAU HOLDS DS 010 My Zi'AIA3 fie--cb ��FTIc.� AJOA-> ALSO PoeEV&jM
�-/�.o�,n n.! � �= �'►'��` P�� r'�Ea2.T� i�Jrc .'ram cad ti!�/���4 v� �¢-cTi v�i
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? Of YES NO (See USEFUL DEFINITIONS AND INSTRUCTIONS)
8. Will the project be constructed in stages? YES ❑ NO
Proposed starting date: /}SA ff
Estimated duration of activity: j --°2, '04 S
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) C��N�TiQt?�T" I��Z� X '��' +WTI-ANG ��I U r
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
2
SECTION B - 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 right to enter the above-described location to inspect the proposed,in-progress or completed work. I
agree to start work ONLY after all necessary permits have been received.
DATE
SIGNATURE OF APPLICANT
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(EXCEPTY'UBLIC 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.
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B Irk#hi~,sidrit fht any of#ham ldfrj�s or struetues wrti exceed a ttar ht rlf#Illrty fl/ fed#atxartere Bite tyel
trrdce he� ttltfate lotlf� r of redbrtrftw�( f'tri � ei.
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tron rnvdlue a-aondrfibn l e tr vai°iahge,setTgAn fit;�1i t of�rtion of the master Oct"
prdviiies.that he
17r�I�bb ;tZ be a petnditjotil tl ate in the case c#f a variant,#rant Uvheh thetanance is bcirlg stught
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
Page 1 of 1
Rebecca Hersha - seawall repair on south shore hood canal
From: Rebecca Hersha
To: schirmms@dfw.wa.gov
Date: 8/25/2008 2:05 PM
Subject: seawall repair on south shore hood canal
Hi Margie,
I spoke with Fred Philipson today. He has submitted a Shoreline Exemption application with SEPA and building
permit for what he feels is an emergency situation. He said that you will be coming out to look at it. If so,
could you tell me what you find? Whether it really is an emergency. Also, that new footing proposed - is that
normal for a footing to come up above the beach level? Maybe I am reading the plans incorrectly.
Thanks for your help!
Rebecca Hersha, Planner II
Mason County Department of Community Development
(360) 427-9670, Ext. 593
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�N.STATE MASON COUNTY
�P5 ° DEPARTMENT OF COMMUNITY DEVELOPMENT
o n O cn Planning Division
> s N = P O Box 279,Shelton,WA 98584
N Y ti (36027-9670
OJ �O
1864
Exemption from Shoreline Management Act
Case No.: SHX2008-00075 Substantial Development Permit Requirement
The Proposal By: FREDERICKPHILLIPSEN
PO BOX 2097
BELFAIR,WA 98528
To undertake the following development:
Emergency bulkhead repair.
Within HOOD CANAL 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
D-emerciencv construction
Please contact Rebecca Hersha at ext 593 if you have any ti s.
Issued: 8/27/2008
Expires: 8/27/2010 Authorized Local Government Official
cc: APPLICANT WDFW USACOE WDOE TRIBAL COUNCIL
PyoN_srgTFo� MASON COUNTY
C 'k- DEPARTMENT OF COMMUNITY DEVELOPMENT
AL o n°u y= Planning Division
o T z' P O Box 279,Shelton,WA 98584
N �
�0J Y �DY (360)427-9670
1864
MITIGATED
DETERMINATION OF NONSIGNIFICANCE
(WAC 197-11-350)
SEP2008-00127
Description of Proposal: CONCRETE BULKHEAD REPAIR.
Proponent: FREDERICK PHILLIPSEN
Site Address(If Assigned): 90 E ROSE POINT LN BELFAIR
Directions to Site:
Parcel Number: 222125600003
Legal Description: ROSE240INT TRACTS, EDDYS TR 3-4 & 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 9/18/2008. Appeal of this determination
must be filed within a 14-day period following this final determination date, per Mason County
Code Chapter 15.11 App, als.
A Authorized Local Government Official Date
MITIGATED
DETERMINATION OF NONSIGNIFICANCE
(WAC 197-11-350)
SEP2008-00127
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 should be minimized 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
All concrete shall be poured in the dry and allowed to cure a minimum of 7 days before
contact with water.
X
MASON CO. ENVIROMENTAL CHECKLIST
V��
A. BACKGROUND J�
1. Name of proposed project, if applicable:
2. Name of applicant:
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3. Address and phone number of applicant and contact person:
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4. Date checklist prepared:
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5. Agency requesting checklist:
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6. Proposed timing or schedule (including phasing, if applicable):
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7. Do you have any plans for future expansion, or further activity related to or connected with this
proposal: If yes, explain.
AJO
8. List any environmental information you know about that has been prepared, or will be
prepared, directly related to this proposal.
A/6/04�-
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.
A/0
10. List any government approvals or permits that will be needed for your proposal, if known.
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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.)
IE'�f'it��. E=!'..G s f�a' ;�- /�t,jGK�+�A� f��L=. ; f�f'P��K !•�F •�i d N C�3ES;
�''� � ��uf�-e.�., .�:D r� N�-c�1 f'�c+r�'� �Pa�fix.. t'�z. •��r �� v N���
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Y✓��� t,�-z, tJ i �- `�'I jny j 01- *L5 00, -7 7 V &,4ST �4 l� l�1 Cc► f.
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.
a. 9C�. /tC� Pt�I� LA-sJ�, LC1E. G;7 ►�1 S0�/fr-� Si-l.rl Of e-tp�zr� e• n/RL
a � �kust� 1��� Affect . i - �( m��c -f��rrt y,_1 sE.~-fr��. cr -
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B. ENVIRONMENTAL ELEMENTS:
1. EARTH:
a. General description of the site (circle one): Flat, rolling, hilly, steep slopes, mountainous, other
56A .AT- TI b& L.A-A►D 61>6-E_
b. What is the steepest slope on the site (approximate percent slope)?
C. 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.
d. Are there surface indications or history of unstable soils in the immediate vicinity: If so,
describe. ND
Mason County Environmental Checklist Page 2
e. Describe the purpose, type, and approximate quantities of any filling or grading proposed.
Indicate source of fill.
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f. Could erosion occur as a result of clearing, construction, or use: If so, generally describe.
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g. About what percent of the site will be covered with impervious surfaces after project
constructions (for example, asphalt or buildings)?
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h. Proposed measures to reduce or control erosion, or other impacts to the earth, if any:
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.
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b. Are there any off-site sources of emissions or odor that may affect your proposal? If so,
generally describe.
AP +0
Mason County Environmental Checklist Page 3
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.
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.
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.
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4) Will the proposal require surface water withdrawals or diversions? Give general
description, purpose, and approximate quantities if known.
NO
Mason County Environmental Checklist Page 4
5) Does the proposal lie within a 100-year floodplain? If so, note location on the site plan.
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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.
X(�
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.
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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.
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2) Could waste materials enter ground or surface waters: If so, generally describe.
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 site:
deciduous tree: alder, maple, aspen, other
evergreen tree: fir, cedar, pine, 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.
d. Proposed landscaping, use of native plants, or other measures to preserve or enhance
vegetation on the site, if any:
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: dee , ear, e , eaver, other SCR L S
Fish: bass, almon, trout, herring, shellfis other
b. List any threatened or endangered species known to be on or near the site.
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C. Is the site part of a migration route? If so, explain.
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d. Proposed measures to preserve or enhance wildlife, if any:
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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.
NprJ(
b. Would your project affect the potential use of solar energy by adjacent properties: If so,
generally describe.
A,J 0
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:
S7R,er3(-- ni i-K 4e:!7 b --7?4, r Svf�',iF'raf�Ts �'.A -
Mason County Environmental Checklist Page 7
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.
, /D
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)?
NVA/41--11
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.
,i.JC/&C I .Dr&&iAJ(, i t0u7Ti,,U&- OP ketn5
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?
Mason County Envirorunental Checklist Page 8
b. Has the site been used for agriculture? If so, describe.
/V(9
C. Describe any structures on the site.
/Vt)tit & &x-c -� G!�<5 i c�.' ,�i►�i< � ?�
d. Will any structures be demolished? If so, what?
No
e. What is the current zoning classification of the site?
Rai�:-A,r1-1-+Z--
f. What is the current comprehensive plan designation of the site?
Na
g. If applicable, what is the current Shoreline Master Program designation of the site?
Og 4 -JO L'
h. Has any part of the site been classified as an "environmentally sensitive" area? If so, specify.
ti?)
i. Approximately how many people would reside or work in the completed project?
17
j. Approximately how many people would the completed project displace?
N0 A1<—_,
k. Proposed measures to avoid or reduce displacement impacts, if any:
qA
Mason County Environmental Checklist Page 9
I. Proposed measures to ensure the proposal is compatible with existing and projected land uses
and plans, if any:
S-7 'k�-x��T/fits' f-
9. HOUSING:
a. Approximately how many units would be provided, if any? Indicate whether high, middle, or
low-income housing.
/LtCnx-
b. Approximately how many units, if any, would be eliminated? Indicate whether high, middle, or
low-income housing.
A)cxz,
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) proposed?
b. What views in the immediate vicinity would be altered or obstructed?
k0A)
C. Proposed measures to reduce or control aesthetic impacts, if any:
14A
Mason County Environmental Checklist Page 10
11. LIGHT AND GLARE
a. What type of light or glare will the proposal produce? What time of day would it mainly occur?
A)M—f-.
b. Could light or glare from the finished project be a safety hazard or interfere with views?
A;C)
C. What existing off-site sources of light or glare may affect your proposal:
/V GTJti—
d. Proposed measures to reduce or control light and glare impacts, if any:
A)c71,
12. RECREATION:
a. What designated and informal recreational opportunities are in the immediate vicinity?
&)A-T.AD& , Ct.sa//JG , 1- s-Pnore S
b. Would the proposed project displace any existing recreational uses? If so, describe.
ki 0
C. Proposed measures to reduce or control impacts on recreation, including recreation
opportunities to be provided by the project or applicant, if any:
A)/14
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.
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:
�C)1A
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.
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.
tv v
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).
NO
Mason County Environmental Checklist Page 12
e. Will the project use (or occur in the immediate vicinity of) water, rail, or air transportation? If
so, generally describe.
Ai 0
f. How many vehicular trips per day would be generated by the completed project: If known,
indicate when peak volumes would occur.
/V cox k,
g. Proposed measures to reduce or control transportation impacts, if any:
A)IA
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:
tiO
b. Proposed measures to reduce or control direct impacts on public services, if any:
Nlq
Mason County Environmental Checklist Page 13
16. UTILITIES:
a. Circe _ ilities currently ava' , ite: electricit natural ga wate�efuse service,
ele hon"anitary sewe , septic syY oth
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.
At,ON'& R E-
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.
I � r ♦ a
Signature:
Date submitted: ' 2z �p
Mason County Environmental Checklist Page 14
ESA LISTED SALMONIDS CHECKLIST
Applicantt�information Project Information
Name 71�r'- PHIL J0:Se�
Phone 3&Ln - 7' - 7 Location '�. PA/�
Description /24E10.41/z L)Avbc�jeLlk E,E,C4,irAj)
Of SeA IV.
.AADJAtiE NCa�
��tSri�tC 13�,�tclL •r E/�sit�ti?
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.
I. Are ESA listed salmonids currently present in the watershed in which your project will be located?
YES .k NO Please describe.
2. Has there ever been an ESA listed salmonid stock present in this watershed?
YES �i _ NO Uncertain Please describe.
If you answered "yes" to either of the above questions, you should complete the remainder of this
checklist.
April 2003
Mason County Environmental Checklist Page 15
PROJECT SPECIFICES: The questions in this section are specific to the project and vicinity.
l. Name of watershed: 1�IOD � 1V�EL
2. Name of nearest waterbody: ¢/pn,,I� C=AiyAC.
3. What is the distance from this project to the nearest body of water:
Often a buffer between the project and a stream can reduce
the chance of a negative impact to fish.
4. What is the current land use between the project and the potentially affected water body (parking lots,
farmland,etc.)?
&A) Lcf,4T'�
5. Is the project above a:
* natural permanent barrier(waterfall) YES NO X'
* natural temporary barrier(beaver pond) YES NO :) —
* man-made barrier(culvert, dam) YES NO
* other(explain):
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 1�
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
6. Will topography Ch affect the duration/direction of runoff flows?
ang
YES NO If yes, describe the changes.
7. Will the project involve any reducti of the floodway or floodplain by filling or other partial blockage
of flows? YES NO 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 ny problems with water quality, in any of the streams, within this watershed? YES
NO A 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
4. Will turbidity be incre ed 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 nagement, clearing of parking lots?
YES NO If yes, please describe.
Mason County Environmental Checklist Page 18
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?
Mason County Environmental Checklist Page 19
t
MASON COUNTY
DEPARTMENT OF COMMUNITY DEVELOPMENT
P.O. Box 279
Shelton, WA 98584
Telephone: (360) 427-9670
THE SHORELINE PERMIT PROCESS
WITH APPLICATION
Complete the application form and Environmental Checklist,where applicable, and submit to the
Department of Community Development. Other permits may be required by State and Federal
agencies for shoreline development(see list of contacts below).
Legal notice is placed in the"Shelton-Mason County Journal"for two consecutive weeks.
Publication cost is the responsibility of the applicant. Final permit processing will not occur
until advertising fees have been paid to the newspaper.
A thirty(30) day public comment period begins from the second legal notice publication date;
notices are sent to all adjacent property owners within 300 feet of applicant's property boundary
lines.
For Substantial Development Permits, Conditional Use Permits or Variance requests a public
hearing is typically held before the Mason County Hearing Examiner. Hearings are scheduled
on the first regularly scheduled Tuesday hearing day following the 30 day public comment
period.
Following the Hearing Examiner hearing and decisions,the permit and findings are transmitted
to the applicant,Department of Ecology, and the Attorney General. A twenty-one to thirty(21-
30)day review period commences when the Department of Ecology receives the permit, during
which appeals to local government decisions can be made. Construction pursuant to the permit
shall not begin, and is not authorized,until twenty-one(21)days from the date of filing with
Ecology.
If there is no appeal to the permit decisions, either by the Department of Ecology or by other, the
Department of Ecology will allow the decision of the local government to stand and at the end of
the twenty-one (21) day period, if the local government decision was to approve. If no other
permits are needed or other required permits have been granted, the project may proceed. The
Department of Ecology will render and transmit to the County and applicant its final decision
approving, approving with conditions or disapproving the permit within thirty(30) days of the
date of submittal in the case of Conditional Use and Variance permits. The final action to
approve,deny, or modify, the Variance and Conditional Use request is determined by the
Department of Ecology. Should there be an appeal, the project applied for may not begin until
all appeals are settled by the State of Washington Shorelines Hearings Board.
No permit authorizing construction shall extend for a term of more than five (5) years. If actual
construction of a development, for which a permit has been granted,has not begun within two
Page 1 of 6
I:commondrive\PLANNING\PACshorelinepermit.app
2/16/05
3) height of existing structure
4) height of proposed structures
e. Where appropriate,proposed land contours using five foot intervals in water area
and ten foot intervals on areas landward of ordinary high water mark, if
development involves grading, cutting, filling or other alteration of land contours.
Contours shall be at intervals sufficient to accurately determine the existing
character of the property and the extent of the proposed change to the land that is
necessary for the development. Areas within the boundary that will not be altered
by the development may be indicated as such and contours applied.
f. A delineation of all wetland areas that will be altered or used as part of the
development.
g. A general indication of the characters of vegetation found on site.
h. Show the dimensions and locations of all existing structures which will be
maintained, including; but,not limited to buildings,paved or graveled areas,
roads, utilities, septic tanks and drainfields,material stockpiles or surcharge, and
stormwater management facilities.
i. A landscaping plan for the project.
j. Where applicable,plans for development of areas on or off the site as mitigation
for impacts associated with the proposed project shall be included and contain
information consistent with the requirements of this section.
k. Quantity, source, and composition of any fill material that is to be placed on the
site whether temporary or permanent.
1. Quantity, source, and destination of any excavated or dredged material.
M. A vicinity map showing the relationship of the property and proposed
development or use to roads, utilities, existing developments and uses on adjacent
properties.
n. Where applicable, a depiction of the impacts to views from existing residential
uses.
o. On all variance applications, the plan shall clearly indicate where development
could occur without approval of a variance, the physical features and
circumstances on the property that provides a basis for the request, and the
location of adjacent structures and uses.
2. Vicinity M p
a. Indicate site location using natural points of reference (roads, state highways,
prominent landmarks, etc.).
Page 3 of 6
I: commondrive\PLANNING\PACshorelinepernut.app
2/16/05
Applicant must sign and date the attached acknowledgment indicating that they understand this
to be their responsibility. Applicant must submit the signed page as part of application in order
for it to be considered complete.
Publication cost is the responsibility of the applicant. Final permit processing will not occur
until advertising fees have been paid to the newspaper by the applicant. The Shelton-Mason
County Journal will bill the applicant directly.
UWE understand that UWE must sign and date the attached acknowledgement indicating that
1/WE understand that is MY/OUR responsibility. UWE must submit the signed page as part of
this application in order for it to be considered as complete.
2-2-
DATE
2A_
OWNER
APPLICANT
Page 5 of 6
I:commondrive\PLANNING\PACshorelinepernut.app
2/16/05
LIST OF ADJACENT PROPERTY OWNERS
WITHIN 300 FEET OF YOUR PROPERTY BOUNDARIES
FOR CONDITIONAL USE AND VARIANCE
Addresses may be obtained from the Mason County Assessor's Office,Building I, Second Floor.
Page 6 of 6
I: commondrive\PLANNING\PACshorelinepermit.app
2/16/05
t MASON COUNTY
DEPARTMENT OF COMMUNITY DEVELOPMENT
Building III—426 west Cedar Street
P.O.Box 186,Shelton,WA 98584
(360)427-9670—Ext.352
SHORELINE PERMIT APPLICATION
PERMIT NO. SHORELINE SUBSTANTIAL DEVELOPMENT
SHORELINE VARIANCE
DATE RECEIVED SHORELINE CONDITIONAL USE
SHORELINE EXEMPTION
The Washington State Shoreline Management Act (RCW 90.58) requires that substantial developments within
designated shorelines of the state comply with its administrative procedures(WAC 173-14)and the provisions of the
Mason County Shoreline Management Master Program.The purpose of this Act and local program is to protect the
state's shoreline resources. The program requires that substantial development(any development of which the total
cost or fair market value exceeds $5,000.00 or materially interferes with the normal public use of the water or
shorelines of the State be reviewed with the goals, polices, and performance standards established in the Master
Program
Answer all questions completely. Attach any additional information that my further describe the proposed
development. Incomplete applications will be returned.
APPLICANT: "rR�(�G72)GEC. 0�
ADDRESS: �- �0 Ros& /`O/N'i LAN6
(street)
(city) (state) (zip)
TELEPHONE: 2 %S ` 31(,g S+fyke
(home) (business)
AUTHORIZED REPRESENTATIVE:
ADDRESS:
(street)
TELEPHONE: (city) (state) (zip)
PROPERTY DESCRIPTION:
General location(include property address,water body and associated wetlands—identify the name of the
shoreline):
r�L AILS GAsT O-r S4) klAe7,4CH
MASON COUNTY DCD
Sent SEPA L'J���� to(check all that apply)onMOM r
75-
Skokomish Tribal Nation � WA Department of Ecology
Natural Resources Dept. Environmental Review Section U
ATTN: Marty Ereth PO BOX 47703
N 541 Tribal Center Rd. Olympia,WA 98504-7703
Shelton,WA 98584
QQuinault 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 Agent:
Shelton,WA 98584
Applicant:
f StATf
JOSEPH R. BLUM
Director
'�INP9 a
STATE OF WASHINGTON
DEPARTMENT OF FISHERIES
715 General Administration Building • Olympia, Washington 98504 • (206) 753-66(�Q � (�EAN) 234-6600
July 13, 1989
•- i9�J
Mason County Department of General Services
Attention: Mike Byrne
P.O. Box 186
Shelton, Washington 98584
SUBJECT: Determination of Non-Significance - Fred Philipsen - Bulkhead,
South Shore Hood Canal, i'ributaty to Aruxalty Inlet,
Section 12, Township 22 North, Range 2 West, Mason County,
SEPA Log Number 00-8955, WRIA 14.MARI
Dear Mr. Byrne:
The Washington Department of Fisheries (WDF) has reviewed the above-
referenced Determination of Non-Significance and offers the following
comments.
1. A Hydraulic Project Approval (RCW 75.20.100, WAC 220-110)
administered by the Department of Fisheries is required prior to the
performance of construction activities below the ordinary high water
mark.
2. The bulkhead site is located on documented surf smelt spawning
grounds. Therefore to minimize impacts to this habitat,
encroachment on to the beach should be limited to the width of the
new bulkhead. The five foot encroachment as illustrated in the
checklist is not acceptable to WDF.
Thank you for the opportunity to provide these comments. If you have
any questions please contact me at 586-2193.
Sincerely,
PIK-
Thom Hooper
Regional Habitat Manager
TGH:th
cc: Fred Philipsen, w/application
MASON COUNTY
DEPARTMENT of GENERAL SERVICES
i
Courthouse Annex I N. Fourth & W. Cedar
1-1 P.O. Box 186 Shelton, Washington 98584
(206) 427-9670
building environmental health maintenance landfill parks&recreation fair/convention center planning sewer&water
DETM"4124,TION OF NONSI&NIFICANCE
(WAC 197-11-340)
Description of Proposal: Erosion control bulkhead 50 ' long by
5 ' -6 ' high with 10 ' recessed stairway.
Proponent: Fred Philipsen
Iocation of Proposal, including street address, if any: E90 Rose Pt . Lane
Sec 12, Twn 22n; R2W. Eddy ' s Rose Point Tract 3-4.
Itad 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 Fhvironmental
Impact Statement (EIS) is not required under RCM 43.21C.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 on request.
There is no comment period for this DNS.
X This DNS is issued under 197-11-340(2) ; the lead agency will not act
on tFiis proposal for 15 days from the date below. Comments must be
submitted by July 13 , 19 8 9
Responsible Official: Mike Byrne
206-427-9670
Position/Title: Director of General Services Telephone: ct
Address: P.O. Box 186, Shelton, WA. 8584
Date: June 28, 1989 Signature: _VA-/dq, J'��
CC: DOE
WDF
WDW
DNR
;?-Skokomish Tribe
Applicant