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HomeMy WebLinkAboutSHX2010-00006 JARPA - SHX Permit / Conditions - 2/1/2010 srATFo� MASON COUNTY C DEPARTMENT OF COMMUNITY DEVELOPMENT o n u rN Planning Division o T z P O Box 279, Shelton,WA 98684 Zoo N Y o~ (360)427-9670 lqr 1864 Exemption from Shoreline Management Act Case No.: SHX2010-00006 Substantial Development Permit Requirement The Proposal By: LAKESHORE CONSTRUCTION �� sk"'w�e vtdt. Res°' P.O. BOX 1058 BELFAIR,WA 98528 w� 58s8g To undertake the following development: Shoreline exemption submitted to replace 3 pilings that were broken by storm damage 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-emergency construction Please contact Grace Miller at ext 360 if you have any questions. Issued: 2/1/2010 .l��', � a' Expires: 2/1/2012 Authorized Local Government Official cc: APPLICANT WDFW USACOE WDOE TRIBAL COUNCIL S�col�w.ti�T.ob, Jan 25 10 07:48p p.2 AL �N''X �Ott _ t�f�� V �0•°� AGENCY LSE ONLY fi$cgcy ReCereaccalc Datc Ricdiictl: 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 THE FORM ❑ Applicafion for a Fish Habitat Enhancement Project per requirements of RCW 77.56.290, You must submit a copy of IN 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 JWyemption []Revision ❑Floodplain Management ❑Critical Areas Ordinance Washington Department of Fish and Wildlife for HPA(Submit 3 copies to WDF1N 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 ❑ Prfvate 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 d-Ma for all permits covered by this application. Be sure to ALSO complete Section C(Signature Black)for all permit applications_ 1.APPLICANT t YV\VV_\L� MA1LI ' V_ u �� k �� !! r l �o�h� 6 S 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 permit applicaBons 2.AUTHORIZED AGENT i I n"A MAILING ADDR C) WORK PHONE E-MAIL ADDRESS HOME PHONE # 3. Relationship of applicant to property: OWNER PURCHASER ❑ LGSSEE ❑ 4.Name, address and phone number of property owner(s)if other than applicant: �~ 5, Location (street address,including city, un and zip code,where proposed activity exists or will occur) E��$ t�lo -hSt2 erzxh VJcc q$s E5. PA�c�r�C��un k� �r ' Local govemment with jurisdiction(ci or county) .o Cp V Waterbody you are working in ri utary pf j WRIA Is this waterbody on the 303(d)List" YES Na .. \JYt If YES,what parameter(s)? For 303d List, Shoreline designation ;hltal/www.ecy.wa govlorograms/wo/303d/index html !(.Sect i 3ecq_fi_onF3T Zoning designation Sec roverrimentot DNR stream type if known 2 Latitude and Longitude: Tax Parcel Number -3',CI fs 0 t00 ECY 070-15(Rev, 11104) JARPA Contact the State Of Was'lington Office of Reoulatory assistance for Intesi va-i-nr rali..iP"&n7_7rM7 r,.Anni017-nne• Jan 25 10 07:48p p.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 ® NO For any portion of the proposed activity already completed on this property, indicate month and year of completion. Ck Is the property agdculturat land? YES NO Are youa,USDA pmmjramparticipant? YES NO 7a. Describe the proposed work that needs aquatic permits: Complete plans and specifications should be provided for all work watorw of the ordinary high water mark or line,including types of equipment to be used. If applying for a shoreline permit,describe all war within and beyond 200 feet of the ordinary high water mark. If you have provided attached materials to describe your project,you must summarize the proposed work here. Attach a separate sheet if additional space is needed. Jarv\,oL b,-4 PREPARATION OF DRAWINGS: See sample drawings and gulderee for eomplaUng the drgwrngs. ONE SET OF ORIGINAL OR GOOD QUALITY REPRODUCIBLE DRA WINGS MUST BEATTACHEM NOTE: Appricants are encouraged b swim photographs of the project site,but these DO NOT substilute for drawings. THE CC Or-ENGINEERS AND COAST GUARD REQUIRE DRAm4VGS ON 0-112 X 11 R(CH SHEETS. LARGER DRAINWOS MAYBE RE IMED 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 t have influenced the design. r 1^\ SO - Rc)ct--kr�l go a 7c. Describe the potential impacts to characteristic uses of the water body.. These uses may Include fish and aquatic fife,water quality water supply, recreation and aesthetics. Identify proposed actions to avoid, mirwmtze,and mitigate detrimental impacts and pmvid proper protection of fish and aquatic fife. identify which guidance documents you have used. Attach a separate sheet If additional space is needed. t� 7d. For in water construction worts,will your project 6o in compliance with tiro Slat@ of Washington water quality standards fvr turbidity WAG 173.201A-110? M YES 11 NO See USEFUL DEFIN17IONS AND INSTRUCTIONS 8. WHI the project be constructed in stages? YES [] NO Proposed starting date: Estimated duration of activity: 9. Check if any temporary or permanent structures will be placed: ❑ Waterward of the ordinary high water marts or line for fresh or tidal waters AND/OR Yvaterward of the mean higher high water for tidal waters? 10.Will fill material(rock,fill,bulkhead,or other material)be placed: 0 ❑ 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,VOWME(cubic yards) t AREA (acres) ECY 070-15(Rev. 11/04) JARPA Contact the State of Washington Office of Regulatory Assistance for latest version or Cali 360!407-7037 or 8001917- i Jan 25 10 07:49p p.4 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.) I-. Material source: F. List all soil series(type of soil)located at the project site,and indicate 9 they are on the county's list of hydric soils. Soils informs can be obtained from the natural Resources Conservation Service(NRCS). G. WILL PROPOSED ACTIVITY CAUSE FLOODING OR DRAINING OF WETLANDS? ❑ YES ® NO If YES, IMPACTED AREA IS ACRES OF DRAINED WETLANDS. NOTE:Ii your project will impact greater Than Y:s f an acre of wetland,sutxntl a mitigation plan to the Corps and Eootogy Wr approval along with the JARPA IomL NOTE:A 401 waterquafity owtillmlilion will be required from Ecology h addition b an approved m1ligation plan if your pmjW Impacts wetlands that are: a)greater than%am In size. orb)tidal wetlands or wetlands adjacent to tidal water. I'llme subri t the JARPA fwm and ntiilga6on plan to Eou9y bran individual 401 certification Ka)orb)appiim. 12. Soormwater 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 i 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,WAG 173.201(A) 13.Will excavation or dredging be required in water or wetlands? ❑ YES NO If YES: A. Volume: (cubic yards)/area (acre) j B. Composition of material to be removed: C. Disposal site for excavated material: D. Method of dredging: 14. Has the State Environmental Policy A�it(SEPA)been completed ® YES NO SEPA Lead Agency: jtd rjI Uv1 OtJY\ 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,wn*truWon d1whar5 or other activities described in the application(i.e.preliminary plat approval, health district approval,building perml� SEPA review, federal energy regulatory commission llcense(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 1 or will need-an NPDES permit for discharging wastewater and/or stormwater. TYPE OF APPROVAL ISSUINGAGENCY IDENTIFICATION DATE OFAPPLrATION DATEAPPROVEO OOMPLE 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 NO If YES,explain~:: i i i ECY 070-15(Rev. 11104) JARPA Contact the State o€Washington Office of Ragdat"Assistance for latest version or call 360/407-7037 or 800(917-0. Jan 25 10 07:49p P.5 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. i 7b. If a project or any portion of a project receives funding from a federal agency,that agency is responsible for ESA consultation. Plea indicate if you will receive federal funds and what federal agency is providing those funds. See instructions for information on ESA.* FEDERAL FUNDING Q 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: Shorerne Management Compliance may require adalitional notice-consult your local government_ NAME ADDRESS PHONE NUMBER SECTION C- This section MUST be completed for any Permit covered by this applicatfon Application Is hereby made for a permit or permits to authorize the activities described herein. 1 certify that I am familiar with the information contained in this application,and that to the best of my knowledge and relief.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 stift wo ONLY after Pt rpWcessary permits have been received. DATE SIGNATURE APPLICAN DATE 51GNA E Q AUTHORIZED AGENT - 2- I HEREBY SIGNATE y :e TO ACT AS MY AGENT IN MATTERS RELATED TO THIS APPLICATION FOR IT(S). UND .R TAND THIkT. t ,A FEDERAL PERMIT IS ISSUED, I MUST SIGN THE PERMIT. t f SIGNATURE O PPLICAN DATE SIGNATURE OF LANDOWNER(EXCEPT PUBLIC ENTFTY LANDOWNERS, E.G.DNR) THIS APPUCAtI01V MUST BE SIGNED BY THEAPPLICANT AND ME AGENT, IFAN AUTHORIZED A GENTIS DESIGNATED. U.S.0§1001 provides that: Whoever,in any manner within the jurisdiction of any department or agency of the United States knowingi falsifies,conceals,or covers up by any trick,scheme,or device a material fact or makes any false,fictitious,or fraudulent statements or presentations or makes or uses any false writing ordocument knowing same to contain any false,fictitious, or fraudulent statement or Iry,shall be Tined not more than$10,000 or imprisoned not more than 5 years or both. ;h 77 G- ,.; a -0 tiie= 's �l ,:... 9. t3� am .:Y .$=• .. I:J�� � he�i;:fiakti,:aa ois.rt;tji�fsl - -�'vtira4»�':tioiiti ,plaint, tic ';t3 1?.. '. . C1idi1;`:>taioa.;fi libtik`. '=1a` i,' ik _':m,v� . _l � r d:ri; a(e(iaiiic , s= anc;_gravel; iTaud,,�iay, rbCk;tiprap; ii�..E terffa f 1j C b l ,i€ariyy $: tije event fh�itany of th'e rt `WJ iifldi R ;,,;.,,.n9S pr`$tritetures +r111: xc ecY a: i Fit of th =fN646het at}o�rg�t}ie aver e: reds levelppu*b8te ben often iienti f L. . ..;: ! : . ... ; 9 -tinifs; #istrrlg: t%d j5tst�iiW iliat Will dVD 56VE sta lji�ed;irie�hr: ihe:aW ication.in Valves a az aiti3't'al:;fise dr varianpe, set fortjt;.tn:iltl het.-portiion of the°master pTio.grarTj Wi [bti-:pto.vides that the proposed rise relay tie a or3nttttlonal•i1.Sb orient the case ryf a va tiiipl3,.f[4rrt w, foh t�e .' am`s being sau}yti(; These Agencies are Equal Opportunity and Affirmative Action employers. For special accommodation needs.please contact the appropriate agency in the instructions I#CY 070-15(Rev. 11104) JARPA Contact the State of Washington Office of Reaulatory Assistance for latest version or call 3601407-7037 or 8001917-004 Jan 25 10 07:49p p.6 a g8�9� NO1�h11}�SdM 'KJ.(1Hb'1 Nco 133HS ova 'Tye- T� CxCA a ! L 1_,�__� 48 w z LLI � (n in x zp I w i ,. Jan 25 10 07:50p p.7 n m �1 ;A ui u5� _ 9M dl'is Ta df'ISlot bn d175 c� i o p i f 4 h u