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MEP2008-00034, SHX2008-00043 JARPA, SEP2008-00068 - PLN General
ON.STA MASON COUNTY PS O,e o A o N DEPARTMENT OF COMMUNITY DEVELOPMENT o NU Planning Division i� N Y ti P O Box 279, Shelton,WA 98584 1864 (360)427-9670 MASON ENVIRONMENTAL PERMIT July 11, 2008 Parcel No.: 223305000186 Issued: 7/11/2008 Case No.: MEP2008-00034 Project Description: Replacing existing pilings,dock and enlarging slightly(8 ft. X 50 ft.)freshwater. The following critical areas are present on this property: Long-Term Commercial Forest FWHCA Ch. 17.10.060; Ch. 17.01.110; Mineral Resource Lands requently Flooded Areas Ch. 17.01.066; Ch. 17.01.090; Inholding Lands Landslide Hazard Areas Ch. 17.01.062; Ch. 17.01.100; Wetlands Seismic Hazard Areas Ch. 17.01.070; Ch. 17.01.102; Critical Aquifer Recharge Erosion Hazard Areas Ch. 17.01.080; Ch. 17.01.104. This permit, with conditions, is granted pursuant to the Mason County Resource Ordinance (Chapter 17.01 MCC.) Nothing in this permit shall excuse the applicant from compliance with any other federal, state, or local statutes, ordinances, or regulations applicable to this project. This permit may be rescinded if the permitee fails to complete the project as proposed or fails to comply with a standards of this ordinance. Authorized Local Government Official Date R P�oN.STAtFo� MASON COUNTY o a° H DEPARTMENT OF COMMUNITY DEVELOPMENT s U Planning Division N N T y P O Box 279, Shelton,WA 98584 (360)427-9670 1864 MEP2008-00034 NOTICE OF MASON ENVIRONMENTAL PERMIT Notice is hereby given that ROBERT MERZ, who is the owner of the described property, has filed an application on 05/15/2008 for a Mason Environmental Permit for the development of: Replacing existing pilings,dock and enlarging slightly(8 ft. X 50 ft.)freshwater. A determination of completeness was made on: 6/19/2008 Site Address: 250 NE LAKE DR TAHUYA Parcel Number: 223305000186 Location of Project: St Rt 3 to Belfair, L on St Rt 300, R on Belfair Tahuya Rd, R on Haven Wy, follow to Lake Dr and look for site address. Within: NW (quarter section) of Section: 30 Township: 23 N Range: 2 W, W.M. in, Mason County Washington. Said development is proposed at 250 NE LAKE DR, TAHUYA. Any person desiring to express their view or to be notified of the action taken on the application should notify: MASON COUNTY DEPARTMENT OF COMMUNITY DEVELOPMENT P O BOX 279 SHELTON,WA 98584 Written comments must be received by 7/11/2008. A decision on the application will be made within 120 days of the date of completeness A Determination of Nonsignificance was issued under WAC 197-11-340. Written comments regarding this determination must be received by 7/11/2008. MEP2008-0003 RkCEiVED MAY 15 2009 PERMIT NO.:HEJ0,:QQ08'aoo 3� BELFAIR OFFICE MASON COUNTY DATE RECEIVED: 5- I5-d8 DEPARTMENT OF COMMUNITY DEVELOPMENT RESOURCE ORDINANCE (Chapter 17.01 MCC) 411 N. 5TH Street/P.O. Box 279, Shelton, WA 98584 ENVIRONMENTAL PERMIT APPLICATION MASON ENVIRONMENTAL PERMIT IN CONDITIONAL USE ❑ The purpose of the Resource Ordinance is to protect Mason County's natural resource lands and critical areas and is under the authority of Chapters 36.32, 36.70A, 39.34, 58.17, 76.09, 84.33, 84.34 and 90.58 RCW. PLEASE PRINT 1. Owner: fiobe-Ct M C r Z. Owner Mailing Address: fi� :7 1 r 4v-e AI Site Address: LL p �.qkC bf, City:/�Jf(k ►1�l' State:44 _Zip:?8, ,?3 City:`�f c t�jt�yQ State I Zip:%Jk ien/Title Holder Phone: Daytime(3&0 2 75- Address: Fire District#: City: State: Zip: Signature: 2 Parcel Number:2 2 33 O - - bl (R Legal description: I—oi- t e Parcel Size: 4fwrrcled y6h)P% ic- Ll 094-e I , 3. Directions to 51tte: /� / c 3elku.1 Al Llat o K�� 4,f D+Z del/ K U , e,( o i 1 State what sections require a permit: In-Holding Lands,Chapter 17.01.062 ❑ 4. .Long-Term Commercial Forest,Chapter 17.10.060 ❑ Wetlands, Chapter 17.01.070 ❑ Mineral Resource Lands, Chapter 17.01.066 ❑ Frequently Flooded Areas, Chapter 17.01.090 ❑ Aquifer Recharge Areas,Chapter 17.01.080 ❑ Landslide Hazard Areas, Chapter 17.01.100 ❑ Erosion Hazard Areas, Chapter 17.01.104 ❑ Seismic Hazard Areas,Chapter 17.01.102 ❑ Fish and Wildlife Habitat Conservation Areas, Chapter 17.01.110 lit I i 4 5. Identify p y pjurrent use o ro w,}th exis 'ne '� i ents: �+(�re�t7Eao�Tian e ►�C� c - p rov n'f Are 5 fq�•li 6. Identify and describe the proposed project, including the type of materials to be used, construction methods,principle dimensions and other pertinent information(Attach additional sheets if need ad): ina�-r- o� 1 i *W /I / Uhf Qriv l.' M ago 7. Will there be an alteration of a wetland and/or wetland vegetation area? Yes ❑ No 8. Any water on or adjacent to property: Saltwater ❑ Lake t River ❑ Pond ❑ Wetland ❑ Seasonal Runoff 0 Other g. If septic is located on project site,include records. Connect to septic? $ Community Septic? ❑ Public Water Supply? ❑ Well? 6 10. Type of Job: New * Add ❑ Alt 0 Repair J1 Demolition ® Other This permit is granted pursuant to the Resource Ordinance (Chapter 17.01 MCC) and nothing in this permit shall excuse the applicant from compliance with any other federal, state, or local statutes, ordinances, or regulations applicable to this project, but not inconsistent with the Resource Ordinance. The permit may be rescinded pursuant to the event the permittee fails to comply with the conditions of this ordinance. MASON ENVIRONMENTAL PERMIT: $560.00/$335.00(with another permit) MASON CONDITIONAL USE ENVIR.PERMIT: $1,350.00 HABITAT MANAGEMENT PLAN: $395.00 Show the following on the site plan Lot Dimensions Flood Zones Existing Structures Fences Water Lines Driveways Drainage Plans Shorelines Septic System Topography Indicate Direction by(N,S,E,W,etc.) Proposed Improvements Easements In relation to plot plan Name if Flanking Street e4/1 S t'o'is APPLICAN TOO DRAVWIT&2PLA64 : Hgveh LQ o aY, Ate-�e�l ore. t ' T0 Re 1<,�usfi J QC ucdts `Cub�'h �O APPLICANT TO DRAW TOPOGRAPHY BELOW: or Lqk� I i I MASON COUNTY RESOURCE ORDINANCE July 2003 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. I /WE understand that I /WE must sign and date the attached acknowledgment indicating and that I / WE understand that is MY/ OUR responsibility. I /WE must submit the signed page as part of application in order for it to be considered as complete. DATE OWNER i j APPLI T i i I i Mason Environmental Permit 7/11/2008 Case No.: MEP2008-00034 Conditions: 1.) All Best Manaagement Practices must be strictly adhered to throughout the proposed development.X 2.) All upland areas disturbed or newly created by construction activities shall be seeded, vegetated or given an equivalent type of erosion protection (silt fencing or straw matting). 3.) All construction and demolition debris must be removed from the beach after project completion. Proper disposal of construction debris must be on land in such a manner that debris cannot enter or cause water quality degredation of State waters. 4.) Temporary erosion control measures must be implemented to prevent water quality degradation of adjacent waters or wetlands. Silt fencing must be installed and maintained until upland vegetation has become established. 5.) A Hydraulic Project Approval from the Washington Department of Fish and Wildlife shall be obtained prior to work on the banks of or within the waters of the State. X 7/11/2008 Page 2 of 2 MEP2008-00034 !N STA MASON COUNTY A_c DEPARTMENT OF COMMUNITY DEVELOPMENT o n v >,i Planning Division o T ', = P O Box 279, Shelton,WA 98584 Zoo N Y o~ (360)427-9670 J � 1864 Exemption from Shoreline Management Act Case No.: SHX2008-00043 Substantial Development Permit Requirement The Proposal By: ROBERT MERZ 7319 126TH AVE NE KIRKLAND,WA 98033 To undertake the following development: Removing old pile and dock replacing with new (slightly larger) 8 ft. X 50 ft dock. Joint Aquatic Resources permit application form (JARPA) turned in for pile and dock replacement (slightly larger) . Within Haven Lake 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 A-does not exceed $5,000 Please contact James Scholz at ext 294 if you have any questions. Issued: 7/11/2008 `'� Expires: 7/11/2010 Authorized Local Government Official cc: APPLICANT WDFW USACOE WDOE TRIBAL COUNCIL i -J-1m AGENC �USE UNLyy JOINT AQUATIC RESOURCES PERMIT APPLICATION FORM (JARPA) (for use in Washington State) PLEASE TYPE OR PRINT IN BLACK INK TO FILL IN ELECTRONICALLY USE F11 TO MOVE THROUGH TH E 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 '*xemption []Revision ❑Fioodplain 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 , SECT/ON A- Use for all permits covered by this application. Be sure to ALSO complete Section C(Signature Block)for all Permit applications. 1.APPLICANT R MAILING ADDRESS I 3t 2-��� �-V G �1,YK �a a 033 WORK PHONE E-MAIL ADDRESS HOME PHONE FAX"' # If an agent is acting for the applicant during the permit process,complete#2. Be sure agent signs Section C(Signature Block) for all pennit applications ?.AUTHORIZED AGENT i"trIC T-Ltl L�„ MAILING ADDRESS WORK RHONE E-MAIL ADDRESS HOME PHONE FAX# I2W-�ci t. Relationship of applicant to property: OWNER ❑ PURCHASER ❑ LESSEE [] Name, address and phone number of property owner(s)if other than applicant: ocation street ddress Includingcity,county and zi ty, code where proposed tY P p posed a ivity exis or 'N occur) L. ) Local government with'urlsdiction or u Watertwdy you are working in Trib tary of WRIA# Is this waterbody on the 303(d)List" YES NO (� If YES,what parameter(s)7 "For 303d List, Shoreline designation htti):/iwww.ecy.wa oov/nroarams/wa/303d/index html oning designation G Section Sects nshjp Range Government Lot �( DNR stream type if known ..]atitude and Longitude: ax Parcel Number �1 o7 33 So 00 1 E(g CY 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 1 6. Describe;he current use of the property, and structures existing on the property. Have you completed any portion of the ro activity on this property? ❑ YES ® NO proposed For an%pWIon of the proposed activity already completed on this property,indicate month and year of completion. Is the property agricultural land? YES 19 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. Re mov E e".t s+t n $u 3 ® -0od."'t oLr\d ( `"-i rnQLO PREPARATION OF DRAWINGS: See sample drawings and guidance for completing the drawings. ONE SET OF ORIGINAL OR GOOD QUALITY REPRODUCIBLE DRAININGS HM BE ATTACHED. NOTE: Applicants are encouraged to submit photographs Of the PMJect site,but these DO NOT substitute for drawings. THE CORPS OF ENGINEERS AND COAST GUARD REQUIRE DRAWINGS ON 8-1/2 X 11 INCH MEETS. LARGER DRAWINGS M4Y BE 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. To &0(3- .. -00cy-- But�6 t\,Q-uj dodK 40 tZkP[6LQk ()T�sa�e- 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 uments you have used. Attach a separate sheet if additional spaces needed. � , m �-y�� {�,-1-Z) -_ t�`I „n 1 41 . 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 3. Will the project be constructed in stages? YES ❑ NO ❑ Proposed starting date:J U t12 3 o Estimated duration of activity: I W�>K 3. 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: �(D ❑ 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) :CY 070-15(Rev. 11/04) JARPA Contact the State of Washington Office of Reoulatory Assistance for latest version or call 360/407-7037 or 8001917-0043 2 If YES: + A. Impacted area in acres: P. Has a delineation been completed? H YES,please submit with application. ❑ YES NO C. Has a wetiand 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? '0 YES NO If YES,IMPACTED AREA IS ACRES OF DRAINED WETLANDS. NOTE:If your project will impact greater than%of an acre of wetiand,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 lo an approved mitigation plan if your project inpads wetlands that are: a)greater than%acre in size, orb)tidal wetlands or wetlands adjacent to tidal water. Please submit the DARPA form and mtiigation plan to Ecology for an individual 401 certification if 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,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 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 g YES ❑ NO SEPA Lead Agency: µ A4G;0A C0UYIJ4 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 16. 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 dischan ling wastewater and/or stormwater. TYPE OF APPROVAL ISSUING AGENCY IDENTIFICATION DATE OF APPLICATION DATE APPROVED COMPLETED? NO. V� t n YY�,L Sc>Y1 �Dn i 16. Has any agency denied approval for the activity you're applying for or for any activity directly related to the activity ctivity described herein? If YES,explain: =CY 070-16(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 3 -. _...... ...... .,.,,M� �,� cl.yi,ieers permits on 17a:?Totat%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 ndicate if you will receive federal funds and what federal agency is providing hose funds See insttruency is ctiions fornsible information ESA on ESA.'Please FEDERAL FUNDING ❑ YES IN 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 adjoins ng etc. - Please Mote: Shoreline Management Compliance may require additional notice—consult your local government. Hers,lessees, NAME ADDRESS PHONE NUMBER SECTION C-This section MUST be completed torapy permit covered oy this application 0. Application is hereby made for a permit or permits to authorize the activities described herein. I certify information contained in this application,and-that to the best of my knowledge and belief,such informa on is true,complI am familiar ete,,and accurate. I further certify that I possess he authority to undertake the proposed activities. 1 hereby grant to the agencies to which his 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 r DATE SIGNATURE AU ORIZED AGENT I HEREBY DESIGNATE ..f 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) i THIS APPLICATION MUST BE SIGNED By THE APPLICANT AND THE AGENT,IFAN 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. ¢ S" :7 t ,a These Agendas are Equal Opportunity and Affirmative Acton 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 pN.srATF MASON COUNTY BPS c �� DEPARTMENT OF COMMUNITY DEVELOPMENT 4 MO � ° A U =_ Planning Division ° N T z P O Box 279, Shelton,WA 98584 �oJ Y ~ (360)427-9670 1864 MITIGATED DETERMINATION OF NONSIGNIFICANCE (WAC 197-11-350) SEP2008-00068 Description of Proposal: Removing old pile and dock replacing with new (slightly larger) 8 ft. X 50 ft dock. Proponent: ROBERT MERZ Site Address(If Assigned): 250 NE LAKE DR TAHUYA Directions to Site: St Rt 3 to Belfair, L on St Rt 300, R on Belfair Tahuya Rd, R on Haven Wy, follow to Lake Dr and look for site address. Parcel Number: 223305000186 Legal Description: HAVEN LAKE TR. 186 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 James Scholz at ext. 294 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 7/11/2008. Appeal of this determination must be filed within a 14-day period following this final determination date, per Mason County Code Chapter 15.11 Appeals. '4'j&&' 4,Authorized Local Govemment Official Date k 1 r MITIGATED DETERMINATION OF NONSIGNIFICANCE (WAC 197-11-350) SEP2008-00068 CONDITIONS OF THIS DETERMINATION f must be strict) adhered to throughout the proposed All Best Management Practices y g p p development. 2) 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 3) 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 4) Water quality is not to be degraded to the detriment of the aquatic environment as a result of this project. X Description of Proposal: Removing old pile and dock replacing with new (slightly larger) 8 ft. X 50 ft dock. ' MASON CO. ENVIROMENTAL CHECKLIST A. BACKGROUND 1. Name of proposed project, if applicable: 2. Name of applicant: k cbe(4 �� 3. Address and phone number of applicant and contact person: -7 3 t a t 2l�- '� n 1 ► 4 K ►v,K to-4Ad W Q t Q g©33 /gL-7,S-- S o aq 4. Date checklist prepared: 5 -13-0? 5. Agency requesting checklist: 6. Proposed timing or schedule (including phasing, if applicable): J cx\�P-- 3o 2.008 7. Do you have any plans for future expansion, or further activity related to or connected with this proposal: If yes, explain. n 1 I 8. List any environmental information you know about that has been prepared, or will be prepared, directly related to this proposal. �lo� 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. 10. List any government approvals or permits that will be needed for your proposal, if known. z i 11. lGive 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.) FbcA Av-� f W-L 14 fvpw ptco c��d �� �al�C� AW0001014" 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. 2 Sv l akQ 0r \K B. ENVIRONMENTAL ELEMENTS: 1. EARTH: a. General description of the site (circle one): Flat, rolling, hilly, stee slopes, ountainous, other b. What is the steepest slope on the site (approximate percent slope)? 3 �0 C. What general types of soils are found on the site (for example, clay, an A�vel eat, 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. no 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)? T) 0 n-Q- 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. �10 U- b. Are there any off-site sources of emissions or odor that may affect your proposal? If so, generally describe. no 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,(ake , 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. c) 4) Will the proposal require surface water withdrawals or diversions? Give general description, purpose, and approximate quantities if known. I� 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. RO 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. 0 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. � / Iv 2) Could waste materials enter ground or surface waters: If so, generally describe. Y L� 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 xQnpitation found on the site: 7 deciduous treeOir Fedar, aple, aspen, other evergreen tree: me, ther -- shrubs _ x 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. RDV\_Q_ 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: deer, bear, elk, beaver, other Fish: bass, salmon trout, erring, 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. n 0 d. Pr oposed measures to preserve or enhance wildlife, if any: l0ML 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. V Y 1U� b. Would your project affect the potential use of solar energy by adjacent properties: If so, generally describe. 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: 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. CD 1) Describe special emergency services that might be required. 2) Proposed measures to reduce or control environmental health hazards, if any: IV . b. Noise. 1) What types of noise exist in the area which may affect your project (for example: traffic, equipment, operation, other)? d11N� 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. kcau.) notes (2)'-00 A M 3 00PA4 3) Proposed measures to reduce or control noise impacts, if any: YAo L 8. LAND AND SHORELINE USE: a. What is the current use of the site and adjacent properties? Mason County Environmental Checklist Page 8 b. 'Has the site been used for agriculture? If so, describe. no C. Describe any structures on the site. 0-0-b- d. Will any structure�s be demolished? If so, what? {{V��C`(�vU� O`lam► boct e. What is the current zoning classification of the site? f. What is the current comprehensive plan designation of the site? �.')�C g. If applicable, what is the current Shoreline Master Program designation of the site? r Vl � � h. Has any part of the site been classified as an "environmentally sensitive" area? If so, specify. 00 i. Approximately how many people would reside or work in the completed project? N I or j. Approximately how many people would the complete project displace? P k. Proposed measures to avoid or reduce displacement i l pacts, if any: IV 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: mso N CoiaAki G(J�&Q_ (LUS 9. HOUSING: a. Approximately how many units would be provided, if any? Indicate whether high, middle, or low-income housing. N f Iv . b. Approximately how many units, if any, would be eliminated? Indicate whether high, middle, or low-income housing. 9� Iv C. Proposed measures to reduce or control I iousing 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? VV 10, b. What views in the immediate vicinity would be altered or obstructed? yAokL C. Proposed measures to reduce or control aesthetic impacts, if any: n C� 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? 0 1 or b. Could light or glare from the finished project be a safety ha and or interfere with views? �U A C. What existing off-site sources of light or glare may affect your proposal: r) P d. Proposed measures to reduce or control light and glare impacts, if any: 0114 12. RECREATION: a. What designated and informal recreational opportunities are in the immediate vicinity? b. Would the proposed project displace any existing recreational uses? If so, describe. f) (-) C. Proposed measures to reduce or control impacts on recreation, including recreation opportunities to be provided by the project or applicant, if any: 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. no b. Generally describe any landmarks or evidence of historic, archaeological, scientific, or cultural importance known to be on or next to the site. iA C. Proposed measures to reduce or control impacts, if any: �� I 14. TRANSPORTATION: a. Identify public streets and highways serving the site and describe proposed access to the g p p existing street system. Show on site plans, if any. n M-L 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 e. WiW the project use (or occur in the immediate vicinity of) water, rail, or air transportation? If so, generally describe. f. How many vehicular trips per day would be generated by the completed project: If known, indicate when peak volumes would occur. ham 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)? n 0 If so, generally describe: b. Proposed measures to reduce or control direct impacts on public services, if any: nbu Mason County Environmental Checklist Page 13 16. . UTILITIES: a. Circle utilities currently availa a site: lectricity, natural gas, ater, refuse service, telephone, sanitary sewer, eptic system, other: 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: i 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: Mason County Environmental Checklist Page 14 'r ESA LISTED SALMONIDS CHECKLIST Applicant Information Project Information Name F nb (-� Name Phone Location �AQA Qn-LAtQ- Description 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 sal o ids currently present in the watershed in which your project will be located? YES NO Please describe. i 2. Has there ever bee ESA listed salmonid stock present in this watershed? YES NO Uncertain Please describe. If you answered "yes" to either of the above questions, you should complete the remainder of this checklist. April 2003 I Mason County Environmental Checklist Page 15 y PROJECT SPECIFICES: The questions in this section are specific to the project and vicinity. 1. Name of watershed: 2. Name of nearest waterbody: 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.)? 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): 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)? i 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 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 changes affect the duration/direction of runoff flows? YES NO If yes, describe the changes. i 7. Will the project involve any reduction 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 WATVR 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 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 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 management, 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 N1ar1 ta`. la'3K� �+ s MASON COUNTY DCD L�� to(check all that apply)on ©6 2(0 Okomish 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 985044703 Shelton,WA 98584 0 Quinault Indian Nation 03 U.S.Army Corps of Engineers ATTN: Mark Mobbs SEPA Reviewer PO Box 189 PO Box C-3755 Tahola,WA 98587 Seattle,WA 98124 a Squaxin Tribal Nation WA Dept.of Fish and Wildlite Natural Resources Dept. ATTN: Margie Schirato(saltwater) 2952 SE Old Olympic Highway 2391 W Deegan Rd. Shelton,WA 98584 Shelton,WA 98584 a The Confederated Tribe of the Chehalis M/'W"A 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 0 WA Dept.of Transportation WA DNR,South Puget Sound Region Alana Hess,Development Review Engineer 950 Farman Avenue North P.O.Box 47440 umclaw,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:Stephanie Kramer 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 1, 2940-B Limited Ln. NW a Mason Cty Public Works ATTN: Olympia,WA 98502 Mason Cty Env. Health ATTN: �l Mason County Transit PO Box 1880 Agent: Shelton,WA 98584 Applicant: P � vs& o ,7 Lc 0STAT TO BE KEPT IN THE Hh�N� AlP'� � ;-'Ltl�it�llf�G PARCEL FILE STATE OF WASHINGTON p n � DEPARTMENT OF ECOLOGY 0-�csx PO Box 47775 . Olympia, Washington 98504-7775 • (360) 407-6300 2z, _11D - So -- ®oc � � July 11,2008 Mr.James Scholz Your address Mason County Department of Community Development IS in the Planning Division Kitsap PO Box 279 watershed Shelton,WA 98584 Dear Mr. Scholz: Thank you for the opportunity to comment on the mitigated determination of nonsignificance for the Merz Old Pile Removal&Dock Replacement project(SEP2008-00068)located at 250 Northeast Lake Drive in Tahuya as proposed by Robert Merz. The Department of Ecology(Ecology)reviewed the environmental checklist and has the following comment(s): SOLID WASTE &FINANCIAL ASSISTANCE: Anya Caudill(360)407-6084 The applicant proposes to remove a structure(s)that may contain treated wood. Please refer to Ecology's publication"Focus on Treated Wood Exclusion," available at hiLtp://www.egy.wa.goy/pubs/0304038.pdf,for suggested best management practices and disposal requirements for treated wood. For additional information or clarification,please contact Dee Williams with Ecology's Hazardous Waste and Toxics Reduction program,at(360)407-6348. Property owners,developers,and contractors are encouraged to recycle all possible leftover construction,demolition,and land clearing(CDL)materials and reduce waste generated. Recycling construction debris is often less expensive than landfill disposal. Please call Ecology's 1-800- RECYCLE hotline for facilities in the area that will accept your CDL materials for reuse or recycling. WATER QUALITY: Roberta Woods(360)407-6269 Any discharge of sediment-laden runoff or other pollutants to waters of the state is in violation of Chapter 90.48 RCW,Water Pollution Control,and WAC 173-201A,Water Quality Standards for Surface Waters of the State of Washington,and is subject to enforcement action. Erosion control measures must be in place prior to any clearing, grading,or construction. These control measures must be effective to prevent stormwater runoff from carrying soil and other pollutants into surface water or storm drains that lead to waters of the state. Sand,silt,clay particles, and soil will damage aquatic habitat and are considered to be pollutants. Proper disposal of construction debris must be on land in such a manner that debris cannot enter the Haven Lake or cause water quality degradation of state waters. During construction,all releases of oils,hydraulic fluids,fuels, other petroleum products,paints, solvents,and other deleterious materials must be contained and removed in a manner that will prevent their discharge to waters and soils of the state. The cleanup of spills should take precedence over other work on the site. _4901. Z�A ► July 11,2008 Page 2 The applicant should consider alternatives to treated wood or other chemically treated wood for in- water construction of wooden structures. Over time,treated wood may contaminate nearby sediment and cause toxicity for aquatic organisms. Ecology's comments are based upon information provided by the lead agency. As such,they do not constitute an exhaustive list of the various authorizations that must be obtained or legal requirements that must be fulfilled in order to carry out the proposed action. If you have any questions or would like to respond to these comments please contact the appropriate reviewing staff listed above. Department of Ecology Southwest Regional Office (SM: 08-4788) cc: Anya Caudill, SW&FAP Roberta Woods,WQ Robert Mertz(Applicant) Tim Zech(Contact)