The URL can be used to link to this page

Home My WebLink AboutSHX2011-00005 JARPA - SHX Application - 2/17/2011 AGENCY USE ONLY t 2010 I e_ r Date received: , WASHINGTON STATE of Army Corps of Engineers• Seame Distract Agency reference Joint Aquatic Resources Permit ; Application (DARPA) Form' Tax Parcel#(s): 5a369-5-0 �ddo 9 USE BLACK OR BLUE INK TO ENTER ANSWERS IN WHITE SPACES BELOW. t i t I I ------------------------------------- Part 1—Project Identification 1. Project Name (A name for your project that you create. Examples: Smith's Dock or Seabrook Lane Development) [be, 2 Temporary Ford Part 2—Applicant The person or organization responsible for the project. [help] 2a. Name (Last, First, Middle)and Organization(if applicable) Lake Cushman Maintenance Company 2b. Mailing Address (Street or PO Box) 3740 N. Lake Cushman Road 2c. City, State, Zip Hoodsport, WA 98548 2d. Phone(1) 2e. Phone(2) 2f. Fax 2 . E-mail ( 360) 877-5233 ( ) ( ) 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.) hei 3a. Name (Last, First, Middle) and Organization (if applicable) Gary Knisley— LCMC Board President 3b. Mailing Address (Street or PO Box) �3740 N. Lake Cushman Road Additional forms may be required for the following permits: • If your project may qualify for Department of the Army authorization through a Regional General Permit(RGP),contact the U.S.Army Corps of Engineers for application information(206)764-3495. • If your project might affect species listed under the Endangered Species Act,you will need to fill out a Specific Project Information Form(SPIF)or prepare a Biological Evaluation. Forms can be found at http://www.nws.usace.army.mil/PublicMenu/Menu.cfm?sitename=REG&pagename=mainpage_ESA • If you are applying for an Aquatic Resources Use Authorization you will need to fill out and submit an Application for Authorization to Use State- Owned Aquatic Lands form to DNR,which can be found at http://www.dnr.wa.gov/Publications/agr_use_auth_app.doc • Not all cities and counties accept the JARPA for their local Shoreline permits.If you think you will need a Shoreline permit,contact the appropriate city or county government to make sure they will accept the JARPA. ZTo access an online JARPA form with[help]screens,go to http://www.epermitting.wa.gov/site/alias resourcecenter/jarpa_jarpa_form/9984/jarpa_form.aspx. For other help,contact the Governor's Office of Regulatory Assistance at 1-800-917-0043 or help@ora.wa.gov. JARPA 2010 v1 3/30/2010 Page 1 of 13 3c. City, State, Zip Hoodsport, WA 98548 3d. Phone(1) 3e. Phone(2) 3f. Fax 3 . E-mail (360) 877-5233 ( ) ( ) Part 4—Property Owner(s) Contact information for people or organizations owning the property(ies)where the project will occur. [help] ❑ Same as applicant. (Skip to Part 5.) X❑ 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 fill out JARPA Attachment A for each additional property owner. 4a. Name (Last, First, Middle)and Organization (if applicable) Easement 4b. Mailing Address (Street or PO Box) 4c. City, State, Zip 4d. Phone(1) 4e. Phone(2) 4f. Fax 4 . E-mail Part 5—Project Location(s) Identifying information about the property or properties where the project will occur. heel ) ❑ There are multiple project locations (e.g., linear projects). Complete the section below and use JARPA Attachment B for each additional project location. 5a. Indicate the type of ownership of the property. (Check all that apply.) [hel ❑ State Owned Aquatic Land (If yes or maybe,contact the Department of Natural Resources(DNR)at(360)902-1100) ❑ Federal ❑ Other publicly owned (state,county, city,special districts like schools, ports, etc.) ❑ Tribal X❑ Private 5b. Street Address (Cannot be a PO Box. If there is no address, provide other location information in 5p.) hel At end of Lake take a left over to the right bank. Site is down the road behind a locked gate on the left 5c. City, State, Zip(If the project is not in a city or town, provide the name of the nearest city or town.) hel f/voa�� dot 5d. County help Mason County JARPA 2010 v1 3/30/2010 Page 2 of 13 5e. Provide the section, township, and range for the project location. heel l '/4 Section Section Township Range NW '/4 10 23 N 05 W 5f. Provide the latitude and longitude of the project location. [help] • Example:47.03922 N lat./-122.89142 W long. (NAD 83) Lat. N 47.4996 Lat. W 123.31852 5g. List the tax parcel number(s)for the project location. [help] • The local county assessor's office can provide this information. NA .3&! �-D O1�O 5h. Contact information for all adjoining property owners. (If you need more space, use JARPA Attachment C.) h[�el i Name Mailing Address Tax Parcel # (if known) �A //7 D n`4� 9Go...........�" A� Sa _�—0000 O/ti s A/i9 98'5/ bit 2 a^e l� i�a,w 5so Y /6104 33d9 So a�oo�} .................................................................................._.......................................................................................................................................................... 5i. List all wetlands on or adjacent to the project location. hel None 5j. List all waterbodies (other than wetlands) on or adjacent to the project location. hf eid Dry Creek to Lake Cushman 5k. Is any part of the project area within a 100-year flood plain? Lei ❑ Yes XJ�rNo ❑ Don't know 51. Briefly describe the vegetation and habitat conditions on the property. [hgipj Gravel cobble stream bed with approach roads — unnamed tributary, locally known as Dry Creek JARPA 2010 v1 3/30/2010 Page 3 of 13 5m. Describe how the property is currently used. n�ei Road 5n. Describe how the adjacent properties are currently used. of eio Summer Residences 5o. Describe the structures (above and below ground) on the property, including their purpose(s). of elpl Temporary Ford location used to be a bridge 5p. Provide driving directions from the closest highway to the project location, and attach a map. of eM At end of Lake take a left over to the right bank. Site is down the road behind a locked gate on the left JARPA 2010 v1 3/30/2010 Page 4 of 13 Part 6—Project Description 6a. Summarize the overall project. You can provide more detail in 6d. help] Will be using backhoe/ excavator to grade a roadbed across the dry stream channel. Material will be smoothed out in a 20' right of way width. Not removing gravel or adding gravel. 6b. Indicate the project category. (Check all that apply) [help] ❑ Commercial ❑ Residential ❑ Institutional ❑ Transportation ❑ Recreational X❑ Maintenance ❑ Environmental Enhancement 6c. Indicate the major elements of your project. (Check all that apply) [help] ❑ Aquaculture ❑ Culvert ❑ Float XZf Road ❑ Bank Stabilization ❑ Dam /Weir ❑ Geotechnical Survey ❑ Scientific ❑ Boat House ❑ Dike/ Levee /Jetty ❑ Land Clearing Measurement Device ❑ Boat Launch ❑ Ditch ❑ Marina / Moorage ❑ Stairs ❑ Boat Lift ❑ Dock/ Pier ❑ Mining ❑ Stormwater facility ❑ Bridge ❑ Dredging ❑ Outfall Structure ❑ Swimming Pool ❑ Bulkhead ❑ Fence ❑ Piling ❑ Utility Line ❑ Buoy ❑ Ferry Terminal ❑ Retaining Wall ❑ Channel Modification ❑ Fishway (upland) ❑ Other: 6d. Describe how you plan to construct each project element checked in 6c. Include specific construction methods and equipment to be used. [help] • Identify where each element will occur in relation to the nearest waterbody. • Indicate which activities are within the 100-year flood plain. Will be using backhoe/excavator to grade a roadbed across the dry stream channel. Material will be smoothed out in a 20' right of way width. Not removing gravel or adding gravel. 6e. What are the start and end dates for project construction? (month/year) hf elpl • If the project will be constructed in phases or stages, use JARPA Attachment D to list the start and end dates of each phase or stage. Start date: End date: 0 31 ❑ See JARPA Attachment D JARPA 2010 v1 3/30/2010 Page 5 of 13 6f. Describe the purpose of the project and why you want or need to perform it. hf eU Provide temporary access for residences and emergency vehicles. 6g. Fair market value of the project, including materials, labor, machine rentals, etc. h� eio 6h. Will any portion of the project receive federal funding? [help] • If yes, list each agency providing funds. ❑ Yes X❑ No ❑ Don't know 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.)[help] 7a. Describe how the project has been designed to avoid and minimize adverse impacts to wetlands. h[�el X❑ Not applicable 7b. Will the project impact wetlands? hel ❑ Yes X❑ No ❑ Don't know 7c. Will the project impact wetland buffers? [helps ❑ Yes X❑ No ❑ Don't know 7d. Has a wetland delineation report been prepared? hf eU • If yes, submit the report, including data sheets,with the JARPA package. ❑ Yes X❑ No 7e. Have the wetlands been rated using the Western Washington or Eastern Washington Wetland Rating System? hf elp] • If yes,submit the wetland rating forms and figures with the JARPA package. ❑ Yes X❑ No ❑ Don't know JARPA 2010 v1 3/30/2010 Page 6 of 13 7f. Have you prepared a mitigation plan to compensate for any adverse impacts to wetlands? ihel_] • If yes, submit the plan with the JARPA package and answer 7g. • If No,or Not applicable,explain below why a mitigation plan should not be required. ❑ Yes ❑ No X❑ Not applicable 7g. Summarize what the mitigation plan is meant to accomplish, and describe how a watershed approach was used to design the plan. hel NA 7h. Use the table below to list the type and rating of each wetland impacted; the extent and duration of the impact; and the type and amount of mitigation proposed. Or if you are submitting a mitigation plan with a similar table, you can state (below)where we can find this information in the plan. h[ eid Activity (fill, Wetland Wetland Impact Duration Proposed Wetland drain, excavate, Name' type and area (sq. of impact3 mitigation mitigation area flood, etc.) rating ft. or type (sq. ft. or category2 Acres) acres) If no official name for the wetland exists,create a unique name(such as"Wetland 1"). The name should be consistent with other project documents,such as a wetland delineation report. 2 Ecology wetland category based on current Western Washington or Eastern Washington Wetland Rating System.Provide the wetland rating forms with the JARPA package. 3Indicate the days,months or years 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: 7i. For all filling activities identified in 7h., describe the source and nature of the fill material, the amount in cubic yards that will be used, and how and where it will be placed into the wetland. h( elp] JARPA 2010 v1 3/30/2010 Page 7 of 13 J. For all excavating activities identified in 7h., describe the excavation method, type and amount of material in cubic yards you will remove, and where the material will be disposed. hel 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.) [hel l dCheck 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 designed to avoid and minimize adverse impacts to the aquatic environment. Lel ❑ Not applicable Not bringing in or taking out gravel, not building ledge, not diking. Equipment will be clean of all hydrolic fluids. 8b. Will your project impact a waterbody or the area around a waterbody? hf eU X Yes ❑ No 8c. Have you prepared a mitigation plan to compensate for the project's adverse impacts to non-wetland waterbodies? hel • If yes, submit the plan with the JARPA package and answer 8d. • If No,or Not applicable,explain below why a mitigation plan should not be required. ❑ Yes X No ❑ Not applicable Best management practices JARPA 2010 v1 3/30/2010 Page 8 of 13 8d. Summarize what the mitigation plan is meant to accomplish. Describe how a watershed approach was used to design the plan. • If you already completed 7g.,you do not need to restate your answer here. [help] Will be done during the time when there is no flow of water/ no sediment 8e. Summarize impact(s)to each waterbody in the table below. hf eIp] Activity (clear, Waterbody Impact Duration Amount of material Area (sq. ft. or dredge, fill, pile name' location of impact3 to be placed in or linear ft.) of drive, etc.) removed from waterbody waterbody directly affected Grade Road Unamed Stream 1 day None 100' x 20' Tributa Bed 2000 sf If no official name for the waterbody exists,create a unique name(such as"Stream 1")The name should be consistent with other documents provided. 2Indicate 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. 3Indicate the days,months or years the waterbody will be measurably impacted by the work. Enter"permanent"if applicable. 8f. For all activities identified in 8e., describe the source and nature of the fill material, amount (in cubic yards) you will use, and how and where it will be placed into the waterbody. [help] 8g. For all excavating or dredging activities identified in 8e., describe the method for excavating or dredging, type and amount of material you will remove, and where the material will be disposed. h(�el ] ieDon On11)„A 111n/On1n PanP Q of 11 Part 9-Additional Information Any additional information you can provide helps the reviewer(s) understand your project. Complete as much of this section as you can. It is ok if you cannot answer a question. 9a. If you have already worked with any government agencies on this project, list them below. hf elpl Agency Name Contact Name Phone Most Recent Date of Contact Mason County Planning Rebecca Hersha ( 360) 427-9670 ext 287 9b. Are any of the wetlands or waterbodies identified in Part 7 or Part 8 on the Washington Department of Ecology's 303(d) List? hf elp] • If yes, list the parameter(s)below. • If you don't know, use Washington Department of Ecology's Water Quality Assessment tools at: http://www.ecy.wa._qov/programs/wq/303d/. ❑ Yes X❑ No 9c. What U.S. Geological Survey Hydrological Unit Code (HUC) is the project in? hf elp] • Go to http://cfpub.epa.gov/surf/locate/index.cfm to help identify the HUC. NA /7//od/7 9d. What Water Resource Inventory Area Number(WRIA#) is the project in? [help] • Go to http://www.ecy.wa.gov/services/gis/maps/wria/wria.htm to find the WRIA#. WRIA16.0133 9e. Will the in-water construction work comply with the State of Washington water quality standards for turbidity? heel ] • Go to http://www.ecy.wa. ovq /programs/wcl/swgs/criteria.html for the standards. ❑ Yes ❑ No X❑ Not applicable 9f. If the project is within the jurisdiction of the Shoreline Management Act, what is the local shoreline environment designation? hel • If you don't know,contact the local planning department. • For more information,go to: http://www.ecy.wa.gov/programs/sea/sma/laws rules/173-26/211 desig nations.html. X❑ Rural ❑ Urban ❑ Natural ❑ Aquatic ❑ Conservancy ❑ Other 9g. What is the Washington Department of Natural Resources Water Type? [Lel • Go to http://www.dnr.wa.gov/BusinessPermits[Topics/ForestPracticesApplications/Pages/fp watertyping.aspx for the Forest Practices Water Typing System. ❑ Shoreline X❑ Fish ❑ Non-Fish Perennial ❑ Non-Fish Seasonal JARPA 2010 v1 3/30/2010 Page 10 of 13 91h. Will this project be designed to meet the Washington Department of Ecology's most current stormwater manual? heel j • If no, provide the name of the manual your project is designed to meet. ❑ Yes X❑ No Name of manual: 911. If you know what the property was used for in the past, describe below. hel j Road 9j. Has a cultural resource (archaeological) survey been performed on the project area? hel • If yes,attach it to your JARPA package. ❑ Yes X❑ No 9k. Name each species listed under the fpd=I Endangered Species Act that occurs in the vicinity of the project area or might be affected by the proposed work. heel None 'A..a.k —��1�k�� 91. Name each species or habitat on the Washington Department of Fish and Wildlife's Priority Habitats and Species List that might be affected by the posed work. noel None �h I� T/o�`— •. Gcli v JARPA 2010 v1 3/30/2010 Page 11 of 13 Part 10—SEPA Compliance and Permits 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 help(aD-ora.wa.gov. • For a list of agency addresses to send your application, click on the "where to send your completed JARPA" at http://www.epermitting.wa.gov. 10a. Compliance with the State Environmental Policy Act (SEPA). (check all that apply.) [help] • For more information about SEPA,go to www.ecy.wa.gov/programs/sea/sepa/e-review.html. ❑ A copy of the SEPA determination or letter of exemption is included with this application. Ef'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 10b.) heel ) ❑ 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. 10b. Indicate the permits you are applying for. (Check all that apply.) hel LOCAL GOVERNMENT Local Government Shoreline permits: ❑ Substantial Development ❑ Conditional Use ❑ Variance Shoreline Exemption Type (explain): rcA.��► - Other city/county permits: ❑ Floodplain Development Permit ❑ Critical Areas Ordinance STATE GOVERNMENT 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 FEDERAL GOVERNMENT 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 2010 v1 3/30/2010 Page 12 of 13 Part 11-Authorizing Signatures Signatures are required before submitting the JARPA package. The JARPA package includes the JARPA form, project plans, photos, etc. hf eM 11a. Applicant Signature (required) 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 I have received all necessary permits. I hereby autho I e 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 ent e property where the project is located to inspect the project site or any work . h related to the project. (initial) Applicant Printed Name Applicant Sign a Date 11 b. Authorized Agent Signature h i 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 Printed Name Authorized Agent Signature Date 11 c. Property Owner Signature (if not applicant). hf eM Not required if project is on existing rights-of-way or easements. 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. Ma Property Owner Printed Name Property Ov4kr Signatur 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 2010 v1 3/30/2010 Page 13 of 13 MASON COUNTY, WA 2/23/2011 Building Department 2:30:55PM Environmental Health Department 1r Planning Department f,, Permit status and inspection results can now be checked on the web-www.co.mason.wa.us/permits Building Dept. inspections requests can be made via the web-www.co.mason.wa.us/community_dev Receipt #: S1201100000000000275 Date: 02/23/2011 Line Items: Case No Tran Code Description Revenue Account No Amount Paid SEP2011-00015 Non Single Family 0-9.99 acres 00 1.125.145.345.83.0 1.0000 630.00 -------------------------------------------------------------- PRIMARY APPLICANT FOR SEP2011-00015: LAKE CUSHMAN MAINTENANCE COMPANY SHX20 1 1-00005 Shoreline Exemption Other 001.125.145.345.83.07.0000 510.00 PRIMARY APPLICANT FOR SH3(2011-00005: LAKE CUSHMAN MAINTENANCE COMPANY Line Item Total: $1,140.00 Payments: Method Payer Bank No Account No/Check No Confirm No How Received Amount Paid Check LAKE CUSHMAN MAINTENANCE WEST 17375 In Person 1,140.00 COMPANY Payment Total: $1,140.00 Page 1 of 1 cReceipt rpt r �