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HomeMy WebLinkAboutSHX2009-00029 - SHX Application - 6/29/2009 51 A200q—OCDc 9 O AGENCY t1SE;ONLY ,ya I of Ar nee srp- ; Date reCelyed WASHINGTON STATE $� ,�� Ro Joint Aquatic Resources Permit Application (DARPA) Formh[ 1 � gcy.reference# Tax Parcel#(s) USE BLACK OR BLUE INK TO ENTER ANSWERS IN WHITE SPACES BELOW. Part 1—Project Identification - " Unique project information that makes it easy to identify. [Lem --=---=------ ---- ------- "------- 'ta, gt,o Rrnjart Irig�tifler;NUCnber n IPI ) [hei ti VA • Don,t have one yet2 bet one at,http/lWWW.4 ermlttl Wa orucall the Was oCr Governar'-;'x offj e of Regulatory Assrstarr '. at-(80©),917 004 : x 1b: PrQ)eGt Name (Examples Smltll�s`D©ck c�rSeal3roo laneueloprrlent) Ali( rkp} 1,5 W �e_ , o Part 2—Applicant The person or organization legally responsible for the project. h[ eM 2a: Name (Last; First, nnl'ctdle)and Organization(If app��cabie) 2b. Mailing Address (Street o'r -10(B x) ,I Z 69 2c. City, State, Zip :2d. Phone(i) 2e. P�honO 2f 2g. Part 3—Authorized Agent or Contact Person authorized to represent the applicant about the project. (Note: Authorized agent(s) must sign 11 b. of this application.) hl e 3a. Nan e:(Last, First,-, iddle and, rganrzatinn (if appilcable a 3b, Mailing Address (street Or PQ Box) 3C. City, State,:Zip - 3d,: Phone(�j 3e: Phone(2) 3f:;`Fax =mail ; JARPA 2009 Page 1 of 11 i Part 4-Property Owner(s) hem Contact information for people or organizations owning the property(ies)where the project will occur. hem Same as applicant. (Skip to Part 5.) ❑ Repair or maintenance activities on existing rights-of-way or easements. (Skip to Part 5.) ❑ There are multiple property owners. Complete the section below and use JARPA Attachment A for each additional property owner. 4a:' Name`,`(L'ast; First Tvtitldle)and Organization (if applicable} 4b Mailing Add (street or PQ Box); M 4c:=City, State, ip7777777 r W . 4d.. ve(�) 4e :Phone(2} 4fi " Fax ` 4 ��mal Part 5-Project Location(s) Identifying information about the property or properties where the project will occur. h( ems ❑ There are multiple properties or project locations (e.g., linear projects). Complete the section below and use JARPA Attachment B for each additional property. 5a = - Street Address (cannot be a O,Box I there is no address,prau�de other ocatian ijtfor tatlon�n 5r ) hel ., .. ._ State, Zlp(If the project is not in a city or town,provide the namNK e of the nearest city or town) t7et 5c; County j jPJ fe 5d. Provide the section,township, and range for the project location het 'f4 Section Section,,: f Township 77 Range , IV 5e. _Provide the latitude and longitude of the project locAN ation. hei • °example;47.03922 N lat L: 122.89142�W long N v 5f. -List the tax;p mber(arcel nus);for:,the cat project Iolan. h( ems; 3y: • The local"county assessor's office can provide this information. v . 5g. Indicate tfie,type.of,ownership;oftheproperty (checkalithatapply.) hf etT y; " ❑ State Owned Land Aquatic q ❑ Tribal (Private 6.1f--�, ❑ Other publicly owned (federal,state,county,city,special districts like schools, ports,etc.) JARPA 2009 Page 2 of 11 5h. .Confact informatGan forll adjoining properky3'owners, lessees, etc (�tyou need more space use Attachment C.) hel Name �Mai1�K�g p►ddress Faz Faroe #(ifI�nowi ) olfla,�o� Si. is any,part of thy; prafect araswithina 1 � eod�plafr? ❑ Yes 6] No ❑ Don't know 5j. Briefly'describe theuegetation and h3abitat c©td�ti�ris on the property, ni WC Va\j Q h;r2� R O\r." G1v�c�1 W\` O,ke n 5k.' D.escrioe how the property is c rrentlyFtased hey &C"40A 51. Describe how'the:'adfacertt,ptbperties are rcurentl!.used. e�'' a EGA DARPA 2009 Page 3 of 11 5m. Describe the°structures (above and below ground)pn the=prdperty, mclud�c�g th �r purposes) hel (Qx,- kC', "'Ott'-W 01 U GZ (ak bRol v1 5na Provide driving directions from the.closest highway to the profept locat�vn, and attach a map tri Part 6—Project Description 6a ;:Summarize the overall project;Yqu can pr`ouide m©re deta,it ins 6°c hei a e G�OC S �c A"1 �f���: l�lv�-1-E)t` l��e 4 L ja5 v\ v tr-- � e 6b. Indicate the project category. (Check a�i that app►y) hel ❑ Commercial Residential ❑ Institutional ❑ Transportation [Recreational Maintenance ❑ Environmental Enhancement ndicte Alhe,major elements of,y' checklatl that ap�lr ' t�el h x . uaculture ❑ Culvert ❑ Float ❑ Road ❑ Bank Stabilization ❑ Dam/Weir ❑ Geotechnical Survey ❑ Scientific Measurement ❑ Boat House ❑ Dike/ Levee/Jetty ❑ Land Clearing Device ❑ Boat Launch ❑ Ditch ❑ Marina / Moorage ❑ Stairs ❑ Boat Lift Dock/ Pier ❑ Mining ❑ Stormwater facility ❑ Bridge 9Dredging ❑ Outfall Structure ❑ Swimming Pool ❑ Bulkhead ❑ Fence ❑ Piling ❑ Utility Line ❑ Buoy ❑ Ferry Terminal ❑ Retaining Wall (upland) ❑ Channel Modification ❑ Fishway ❑ Other: JARPA 2009 Page 4 of 11 WN 6d.:1 Describe have you plan tconstrtUcf eachroject elerr�ent chck €iIrtG Include spectflc conructlonr , methods and equlpmeirtt#cr be used hel ` Identify whe chG0 ea elem t will occur ins rel tian to the nearest waterbQdy w Indicate wti ch activities are within this0 year flo"c!plain _ - { 6e.'. What are the start'and en),,d dates for proaect constructlon� (mbnth�yar) held • If the project will,be.cnnsruteti m phas dF stages use JARPA #tahrent D to listhe start and enddates of e�aehta �r Start date: "' _ End date (��_ ❑ See JARPA Attachment D 11 6f. Describe th'e purpose of,the work and why you wa'nt3ar ne-d to.perforft't hL J 4 } C� � 6g. Fair market Kafue of the.pro)ect; lnclu-d►ng materials; A- labor;rriachne rentals, etc hei` W. 000 Ow 6h. ,Will any"portlon of the P_,r, t recelue federalrfundrr • If.yes;list each'agency I#r`oitling funtls ❑ Yes ❑ No tg Don't know FUJ�,k� aq�>PVJ Part 7—Wetlands: Impacts and Mitigation Check here if there are wetlands or wetland buffers on or adjacent to the project area. (If there are none, skip to Part 8.) 7a D.escribe how the projeefi has been=dest�n6:d, o arc ld and m�ni►i�ize adverse impacts to weilandsc,_ h ❑ Not applicable 4 4W-4,� r JARPA 2009 Page 5 of 11 kk Will the pro'e pact wetlands'? hel jqj Ej Yes rANo Don't know 7c: Willthe p mpact Wet landbuffers? ihelpT; . 64s o [?Don't know Td. ;Has a-wetland`delineation rep ort,been prepared? hLl • if ye emit the teport iricludirig data sheets with fhe JARF'A package ih ❑ Ye No 7e. Have the ands been rated using tfie Western Washington or Eastern Washington Wetland Rating System? h • If,yes,supqgQhe wetland rating forms 2nd figures.with the DARPA package,¢ ❑ Yes Don't know 7f Have yo pared a mitigation plan to eompnsate,for any adverse Iripacts t� etla�tds? fi If yes,su he'jilan with the JAF2PA r f ❑ Yes 'N ❑ Not applicable 7g:. Use tl'e to le below to°list the type anc#rating of each wetland thatwill be Impacted,the extent and duration of the mpactk, and the=type and amount-of compensatory mitigation proposed `lfyou are submitting a -com`pensatory miti,gation,pian with a simrlar table you may-almply�state (below �iuhere we can flntl this " information inthe=mitigation plan; h Y Activity causing Wetland type Impact area Duration Proposed Wetland impact (fill, and rating (sq. ft. or acres) of impact2 mitigation mitigation area drain, excavate, category' type' (sq. ft. or acres) flood, etc. Ecology wetland category based on current Western Washington or Eastern Washington Wetland Rating System. Provide the wetland rating forms with the JARPA package. 2 Indicate the time(in months or years,as appropriate)the wetland will be measurably impacted by the activity. Enter"permanent"if applicable. 'Creation(C), Re-establishment/Rehabilitation(R), Enhancement(E), Preservation(P),Mitigation Bank/In-lieu fee(B) Page number(s)for similar information in the mitigation plan, if available: 7h. For all filling activities identified n°7g., describe the,source:and natbre:c f the#ill material, the amount in cubic ards that:will be used, and how and where it wil[be placed into the wetland.. ihhe►p] 7i: For all excavating activities identified in7g., describe the excavatto method, type and amopnt of rilateria in cubic yards=you will remove, and where the material.Will be`disposed E hel JARPA 2009 Page 6 of 11 7j. Summarize,what the.compenstory mitgaftonplan is meant to apcomplish, and describe how a watershed approach was used to design lan., nel �AR, 0,\SP—X A",v) Part 8—Waterbodies (other than wetlands): Impacts and Mitigation In Part 8, "waterbodies" refers to non-wetland waterbodies. (See Part 7 for information related to wetlands.) h[ eM Check here if there are waterbodies on or adjacent to the project area. (If there are none, skip to Part 9.) 8a. _Describe how the project is d signe-16 avoid and minimize adverse ►mpacts to the¢aquatic envrrot nen r r ❑ Not applicable 8b Will our projec# impact"a waterbody orthe area around a Yes ❑ No 8c Sumrrtanze:impacts)to`each waterbody isle table below hei Activity igW dy Impact Duration Amount material Area ( ft. or impact (clear, name location' of impact' o be placed in or linear ft.) of dredge, fill, pile removed from waterbody drive, etc. waterbody directly affected Indicate whether the impact will occur in or adjacent to the waterbody. If adjacent,provide the distance between the impact and the waterbody and indicate whether the impact will occur within the 100-year flood plain. 2 Indicate the time(in months or years,as appropriate)the waterbody will be measurably impacted by the work. Enter"permanent"if applicable. 8d. Have:you prepared`a rnitigatior plan:t©compensate forJhe praject's adverse impacts#oE,non wetland waterbodies? hel • If yes,submit the plan with'the JARPA package. K'Yes ❑ No ❑ Not applicable Q�MS - 8e.' Summa approach rize what the compensatory mitigation plan is meant4 add push Describe how a watershed Wasused to design=theplan ." If you already eornpleted 7j',you"do.not need to restate, our answer here, y v�j o-7 C�t�r'rn� on �ro JARPA 2009 Page 7 of 11 8f. ,For aEl activities rdentrf- in 8c:; describe the,source and nature of#he.fill material, amount: cukiicyards) you will use,:andlhow aril where rt wrll'be placed tnto the Water hek } g , ,. z 8g.'.For ail excaua#ing or dredgrngactivities identified in 8c;, describe the one#hod for excaua#rng or dredging,` Type and amota°nt of material you will rernpVe, anei where the material will be disposed h( elpl_ e-- Part 9—Additional Information Any additional information you can provide helps the reviewer(s) understand your project. 9a: If jio►a have already worked with any goverr r en�agencres oii this project,Ifiskt'ther�i below Agency Na " Contact Name Phone 4 , Most Recent t f . Date o Contact Ltz-'I Q � ��C) 4 9b. Are any of the we#lands.or waterbotlJi,es identified jn Part 7=or Para on the Wshrngton Department'of Ecology's:3Q3(d)"List? • If yes,list the paramefer(s)below. • you don't know,use Washing#on Repar#'nent of Ecology` ,Water Qualityrgssessrrien togls at, hffp�1/www ery wa:nov/programs/wo/3E�3d/. ❑ Yes No 9c. What'U.S, G-00,00cal Surrey HydrologicahUnrt Code (HUG}is the prciject in? • . Go to hftp:l/cfp b.eaa,crov/surf/locate/index,cf�,ta help liienftfy the,HIJc. 1711,0017 9d. What Water'Resource Inventory Area Numt3er(WRIA#) is the project th— h[ elp] • Go to http.[/wwwiecy.wa.gav/services/gis/maps/wrialwria f7fm to find;tlje WRIA# U/ JARPA 2009 Page 8 of 11 9e. Will the , water.construct on work comply wifh the State 4f Washington water ,ualityi;,and'ards ferY turbidity? hei : Go.,to htto://-w w e-Cy.wa pov/progr�msfwgfswasfonter htmi=46r the,standa�ds r_ Ye s ❑ No ❑ Not applicable 9f. if the project is within the jurisdiction of the Shoreline;Management Act,what is=the local shnrelrne r= environment designation? hel ` F • If you:don't know,contaot the local planning depar#ment.. " ; • For more information,go to;http$ff�nrwuv ecy''wa you prograrrtsfseafsmaffaws rulW171-26f211 desicZnat�ans:html Rural ❑ Urban ❑ Natural Aquatic ❑ Conservancy ❑ Other 9g. What is the Vllashington Department o1�Naturaf Resqurces Water Type` hei k � • Go,to httfwww.dnr we' c�vfBusmess 'ermsf Eo icsforestPret�csA ication�ja eslf watert 1n as for the�orest `: PracticeUaterTypngySystm . F '4S ❑ F ❑ Np ❑ Ns 9h: :Will this praject be deslgrtectto'rgeei tte 1lasnntorr Department ofcology' .mos currentstormwate rrtanual? hel • If no provide the name of the manual your,prolect is designed to meet, r : u ,< Wes o Name of manual: 9L !f you knouv°what the property was use'c#for�ri.the past, cjescrlb below: 9': Has aieulfural resource:arChaeota ical s roe_ been erf r, ed on the pro ect area; 1 g ) �! Y p R j • ,If ye's attach itfo'your JARPA package: , ❑ Yes No 9k, Name;each species listed under:the federal :ridangered Species;Act that occurs in the vicinity of�the projeet1 areasor might be affected by "..,proposed work. h( u�0 7 91. Rlame each species or habitat on the Washington Department of Flsh and Wildjlfe's,`Pr�or�ty=Habitats ands Species List'that might be affected by the proposed'work. n ; /- LmLiv /�snd f*�.-f' 5; f wv�i✓ � ��5 JARPA 2009 Page 9 of 11 Part 10—Identify the Permits You Are Applying For Use the resources and checklist below to identify the permits you are applying for. • Online Project Questionnaire at http://apps.ecy.wa.gov/opas/. • Governor's Office of Regulatory Assistance at (800) 917-0043 or helpaora.wa.gov. 1.Oa Compliance with the State Enuironmental`I?ohcy=Act(SEPAL (Checlau;thatapply) ham£ • Far more infaimation about SEPA go to wu ecu:wa you/pragrarrtslseeJsepa/ rUlew htm( ;,, LME?q A copy of the SEPA determination or letter of exemption is included with this application. ❑ A SEPA determination is pending with (lead agency). The expected decision date is ❑ I am applying for a Fish Habitat Enhancement Exemption. (Check the box below in 1 ob.) • Submit the Fish Habitat Enhancement Project form with this application. The form can be found at http//www epermitting wa gov/Portals/ JarpaResourceCenter/images/defaulUfishenhan cement.doc ❑ This project is exempt(choose type of exemption below). ❑ Categorical Exemption. Under what section of the SEPA administrative code (WAC) is it exempt? ❑ Other: ❑ SEPA is pre-empted by federal law. h[ eip] 10b Cndicate thopermits you are applying=for (�Checlall tha �ty) h � Local GOUERnr=�i� - , .a, Local Government Shoreline permits: ❑ Substantial Development ❑ Conditional Use ❑ Variance / [Shoreline Exemption Type (explain): Other city/county permits: / ❑ Floodplain Development Permit ❑ Critical Areas Ordinance STAT ERtVME1�7. : s 7 4 Washington Department of Fish and Wildlife: Hydraulic Project Approval (HPA) ❑ Fish Habitat Enhancement Exemption Washington Department of Ecology: ❑ Section 401 Water Quality Certification Washington Department of Natural Resources: ❑ Aquatic Resources Use Authorization FEDER`AI:Gou�RNM�KIT f United States Department of the Army permits (U.S. Army Corps of Engineers): ❑ Section 404 (discharges into waters of the U.S.) ❑ Section 10 (work in navigable waters) United States Coast Guard permits: ❑ General Bridge Act Permit ❑ Private Aids to Navigation (for non-bridge projects) JARPA 2009 Page 10 of 11 Part 11—Authorizing Signatures Signatures required before submitting the JARPA package. 11 a. Applicant Signature (required) h( gio I certify that to the best of my knowledge and belief, the information provided in this application is true, complete, and accurate. I also certify that I have the authority to carry out the proposed activities, and I agree to start work only after I have received all necessary permits. I hereby authorize the agent named in Part 3 of this application to act on my behalf in matters related to this application. (initial) By initialing here, I state that I have the authority to grant access to the property. I also give my consent to the permitting agencies entering the property where the project is located to inspect the project site or any work related o the project. (initial) r r Ap ica Date 11 b. Authorized Agent Signature hem I certify that to the best of my knowledge and belief, the information provided in this application is true, complete, and accurate. I also certify that I have the authority to carry out the proposed activities and I agree to start work only after all necessary permits have been issued. Authorized Agent Date 11 c. Property Owner Signature (if not applicant) [Dpipj I consent to the permitting agencies entering the property where the project is located to inspect the project site or any work. These inspections shall occur at reasonable times and, if practical, with prior notice to the landowner. Property Owner Date 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. If you require this document in another format,contact The Governor's Office of Regulatory Assistance(ORA). People with hearing loss can call 711 for Washington Relay Service. People with a speech disability can call(877)833-6341. ORA publication number: ENV-019-09 JARPA 2009 Page 11 of 11