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HomeMy WebLinkAboutSHX2021-00032 Mallory Buoy Pickering Passage - SHX Permit / Conditions - 6/14/2022 6/22/2 2�9:24 AM Mail-Gbm@masoncountywa.gov RE: Shoreline Exemption - SHX2021-00032 Shaun Dinubilo <sdinubilo@squaxin.us> Tue 6/21/2022 12:27 PM To:Grace Miller <Gbm@masoncountywa.gov>; Caution:External Email Warning!This email has originated from outside of the Mason County Network. Do not click links or open attachments unless you recognize the sender, are expecting the email, and know the content is safe. If a link sends you to a website where you are asked to validate using your Account and Password, DO NOT DO SO! Instead, report the incident. Hello Grace, Thank you for contacting the Squaxin Island Tribe Cultural Resources Department regarding the above listed project for our review and comment. We have no specific cultural resource concerns for this project. However, if DAHP recommends a survey, or any other additional recommendations, we concur with DAHP's recommendations. We would prefer to receive an electronic copy by email once completed. If any archaeological or cultural resources are uncovered during implementation, please halt work in the area of discovery and contact DAHP and the Squaxin Island Tribe's Archaeologist, Shaun Dinubilo via email at sdinubilo@squaxin.us. Shaun Dinubilo Archaeologist Cultural Resource Department Squaxin Island Tribe 200S.E. Billy Frank Jr. Way ---------------------------------- Shelton, WA 98584 ------------------------- Office Phone: 360-432-3998 Cell Phone: 360-870-6324 Email: sdinubilo@squaxin.us Email is my perferred method of communication. From: Mariah Frazier<MFrazier@masoncountywa.gov> Sent: Wednesday,June 15, 2022 9:49 AM To: r6ssplanning@dfw.wa.gov; and@dnr.wa.gov;jdickson@squaxin.us; Erica Marbet<emarbet@squaxin.us>; Sarah Zaniewski <szaniewski@squaxin.us>; Shaun Dinubilo<sdinubilo@squaxin.us> Cc:Grace Miller<Gbm@masoncountywa.gov>; david.mallory1955@gmail.com Subject: Shoreline Exemption-SHX2021-00032 Good Morning, Please see attached documents regarding SHX2021-00032 Proponent: David Mallory Parcel: 22134-76-90021 If you have any questions, please direct them to Planner Grace Miller at gbm@masoncounty agQvv or(360)427-9670 x360. https://owa.co.mason.wa.us/owa/#path=/mail 1/2 Mason County Planning Division of Community Development y 615 W.Alder St. Bldg.8 �Y'4iaczd?�"� Shelton, WA 98584 360-427-9670 ext 352 www.co.masonma.us FPROJECT 1-00032 SHORELINE EXEMPTION ESCRIPTION: MALLORY BOUY ISSUED: .06/14/2022ESS: 1126 E SUNSET HILL RD SHELTON EXPIRES: 06/14/2027 PARCEL: 221347690021 APPLICANT: MALLORY ET UX DAVID M }:. ,::^ OWNER: 1 MALLORY ET UX DAVID M SHE TON,WA98 84 �`Y' w Ff1lIILA i a ,�" ! SHEL ONMITH WA98584 253-709-9126 c to 6 lq: - - I hereby certify that I have read and examined this application and know the same to be true and correct. All provisions of Laws and Ordinances governing this type of work will be complied with whether specified herein or not. The granting of a permit does not presume to give authority to violate or cancel the provisions of any other state/local law regulating construction or the performance of construction. Issued.By: Contractor or Authorized Agent: Date: rp � � Page 1 of 1 •------------ - [k�^ -------• ♦C G�3T1, 1 � �E 1 I � 1 �- us Arm co 5 ` Date received: WASHINGTON STATE otEngineers� ; t,AAY 2 5 2021 ; Seattle aslrict , r Joint Aquatic Resources Permit Agenc refere6 cP#�• Alder Street Application (JARPA) Form',2 elp Xo2l oOD3 c� 1 USE BLACK OR BLUE INK TO ENTER ANSWERS IN THE WHITE SPACES BELOW. 1 , 1 Tax Parcel#(s):as I-:Sy-76- 9Ma1 1 1 L--------------------------------------1 Part 1—Project Identification 1. Project Name (A name for your project that you create. Examples:Smith's Dock or Seabrook Lane Development) hel Mallory Buoy Part 2—Applicant The person and/or organization responsible for the project. [help] 2a. Name (Last, First, Middle) Mallory, David, M 2b. Organization (If applicable) 2c. Mailing Address (Street or PO Box) 1126 E. Sunset Hill Rd 2d. City, State, Zip Shelton, WA, 98584 2e. Phone(1) 2f. Phone(2) 2g. Fax 2h. E-mail 253-709-9126 david.mallory1955@gmail.com (Additional forms may be required for the following permits: o 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. o Not all cities and counties accept the JARPA for their local Shoreline permits.If you need a Shoreline permit,contact the appropriate city or county government to make sure they accept the JARPA. 2To access an online JARPA form with(help]screens,go to http://vmv epermitting wa gov/site/alias resourcecenter/iarpa iarpa form/9984/jarpa form.asox. For other help,contact the Governor's Office for Regulatory Innovation and Assistance at(800)917-0043 or helo@oria.wa.gov. / ORIA-revised 0212020 Page 1 of 14 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.) h[ ell 3a. Name (Last, First,Middle) 3b. Organization (If applicable) 3c. Mailing Address (Street or Po Box) 3d. City, State, Zip 3e. Phone(a) 3f Phone(2) 39. Fax 3h. E-mall Part 4—Property Owner(s) Contact information for people or organizations owning the property(ies) where the project will occur. Consider both upland and agluatic ownership because the upland owners may not own the adjacent aquatic land. fhelpl 2 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 upland property owners. Complete the section below and fill out JARPA Attachment A for each additional property owner. R Your project is on Department of Natural Resources (DNR)-managed aquatic lands. If you don't know, contact the DNR at (360) 902-1100 to determine aquatic land ownership. If yes, complete JARPA Attachment E to apply for the Aquatic Use Authorization. 4a. Name (Last, First,Middle) 4b. Organization (If applicable) 4c. Mailing Address (Street or PO Box) 4d. City, State, Zip 4e. Phone(1) 4f. Phone(2) 4g. Fax 4h. E-mail ORIA-revised 0212020 Page 2 of 14 Part 6—Project Location(s) Identifying information about the property or properties where the project will occur. (help] ❑ 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.) ,el ❑ Private ❑ Federal ❑ Publicly owned (state,county,city,special districts like schools, ports, etc.) ❑ Tribal ❑x Department of Natural Resources (DNR) —managed aquatic lands (Complete JARPA Attachment E) 5b. Street Address (Cannot be a PO Box. If there is no address, provide other location information in 5p.) helpT 1126 E. Sunset Hill Rd ISLAND: Harstine Island 5c. City, State, Zip(If the project is not in a city or town, provide the name of the nearest city or town.) [help] Shelton, WA, 98584 5d. County (help] Mason 5e. Provide the section, township, and range for the project location. ]help] 1/4 Section Section Township Range 34 21 2W 5f. Provide the latitude and longitude of the project location. eip o Example:47.03922 N lat./-122.89142 W long. (Use decimal degrees-NAD 83) 47.16.04 N lat/-122.55.06 W long Sg. List the tax parcel number(s) for the project location. Delp o The local county assessor's office can provide this information. 22134-76-90021 5h. Contact information for all adjoining property owners. (If you need more space, use JARPA Attachment C.) elp] Name (Nailing Address Tax Parcel #(if known) Scott Foumier/ Jansine Sagen 1128 E Sunset Hill Rd, Shelton WA 98584 22134-76-90024 Larry/Cynthia Ridgway 16213 234th ST CT E, Graham WA 98338 2213-76-90022 ORIA-revised 02/2020 Page 3 of 14 51. List all wetlands on or adjacent to the project location. neM N/A 5j. List all waterbodies (other than wetlands) on or adjacent to the project location. iel i Pickering Passage 5k. Is any part of the project area within a 100-year floodplain? fheipi Yes ❑ No 2 Don't know N/A 51. Briefly describe the vegetation and habitat conditions on the property. Lhem Additionally, describe the Type of Substrate at anchor location:Woodland location, densely populated with Douglas Firs, Cedars, Cascade blueberry bushes, and Salah. Residence, well, and septic installed in 2006/2007. Beach area accessed by stair tower with beach made up of small pepples for first 50', medium rock for next 50', and then sand with minimal rock. Sm. Describe how the property is currently used. ,el ] Year round residence, three bedroom house with private well and spetic system. an. Describe how the adjacent properties are currently used. [help] Property to the North is a year round residence. Property to the South is a undeveloped lot, has not been used for the last 10 months since we've owned our property. So. Describe the structures (above and below ground) on the property, including their purpose(s) and current condition. hel Residence is concrete foundation two story, three bdrm, four bath house, apex 3800 sq ft. Includes two car attached garage. Well is appx 150' deep and fully functional septic which is inspected annually. Structure built in 2006/2007 and is in very good condition. Sp. Provide driving directions from the closest highway to the project location, and attach a map. ,e1 ] From State Route 3/WA-3 turn onto E. Pickering. Rd (Harstine Is turn off) for 3.33 miles, slight left onto Harstine Bridge Rd for .62 miles, left onto E North Island Dr for 2.29 miles, left onto E. Sunset Hill Rd for 1.13 miles, right onto shared driveway into Hidden Acres .15 miles, Residence driveway straight ahead. ORIA-revised 0212020 Page 4 of 14 Part 6—Project Description 6a. Briefly summarize the overall project. You can provide more detail in 6b. hLetp] RECREATIONAL USE MOORING BUOY We are applying for permit to_install_,a Helix embedded anchor/midline float buoy system so that we can purchase a small boat for personal use. We want to enjoy the sights and environment of the South Sound from the water. 6b. Describe the purpose of the project and why you want or need to perform it. h[�ei ] DEPTH OF WATER. AT BUOY LOCATION AT II/IIEAN LOWER LOW WATER (MLLW): 15' LENGTH OF VESSEL:We've not purchased our boat yet but plan to purchase one less than 28' VESSEL REGISTRATION #: TBD II.4iAiNTENANCE PLAN: Will follow manufacturers/installers suggested maintenance schedule 6c. Indicate the project category. (check an that appy) reap ❑ Commercial ❑ Residential ❑ Institutional ❑ Transportation ❑x Recreational ❑ Maintenance ❑ Environmental Enhancement 6d. Indicate the major elements of your project. (Check all that apply) [help] ❑ Aquaculture ❑ Culvert ❑ Float ❑ Retaining Wall [IBank Stabilization ElDam /Weir ❑ Floating Home (upland) ❑ Boat House ❑ Dike/ Levee/Jetty ❑ Geotechnical Survey ❑ Road ❑ Scientific ❑ Boat Launch ❑ Ditch ❑ Land Clearing Measurement Device ❑ Boat Lift ❑ Dock/ Pier ❑ Marina/Moorage ❑ Stairs ❑ Bridge 0 Dredging 0 Mining - ❑ Stormwater facility ❑ Bulkhead ❑ Fence ❑ Outfall Structure ❑ Swimming Pool © Buoy ❑ Ferry Terminal ❑ Piling/Dolphin ❑ Utility Line ❑ Channel Modification ❑ Fishway ❑ Raft ❑ Other: ORIA-revised 0212020 Page 5 of 14 6e. Describe how you plan to construct each project element checked in 6d. Include specific construction methods and equipment to be used. fheipi • Identify where each element will occur in relation to the nearest waterbody.. o Indicate which activities are within the.100-year floodplain. ANCHOR TYPE:Helix Embedded:Anchor, located in DNR Aquatic tidelands adjacent to our property NUMBER OF MID-LANE FLOATS:One BUOY TYPE:Midline float system 6f. What are the anticipated start and end dates for project construction? (MonthNear) [helpl o 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: July 1, 2021 End Date: July 10, 2021 ❑ See JARPA Attachment D 6g. Fair.market value of the project, including materials, labor, machine rentals, etc. Egio Estimate of$2600.00 6h. Will any portion of the project receive federal funding? help] a If yes,list each agency providing funds. ❑ Yes ❑x No ❑ Don't know Pala 7—Wetlands: Impacts and Litigation ❑ Check here if there are wetlands or wetland buffers on or adjacent to the project area. (If there are none, skip to Part 8.) rheipi 7a. Describe how the project has been designed to avoid and minimize adverse impacts to wetlands. lhelp] © Not applicable N/A 7b.Witi the project impact wetlands? Eelp ❑ Yes 2 No ❑ Don't know NIA 7c. Will the project impact wetland buffers? [help] ❑ Yes 2 No ❑ Don't know N/A ORIA-revised 02/2020 Page 6 of 14 7d. Has a wetland delineation report been prepared? Iwo • If Yes,submit the report,including data sheets,with the JARPA package. ❑ Yes 2 No N/A 7e. Have the wetlands been rated using the Western Washington or Eastern Washington Wetland Rating System? hel e If Yes,submit the wetland rating forms and figures with the JARPA package. ❑ Yes 0 No ❑ Don't know N/A 7f. Have you prepared a mitigation plan to compensate for any adverse impacts to wetlands? I,i elnl • If Yes,submit the plan with the JARPA package and answer 7g. o If No, or. Not applicable,explain below why a mitigation plan should not be required. ❑ Yes 2 No ❑ Don't know N/A N/A 79. Summarize what the mitigation plan is meant to accomplish, and describe how a watershed approach was used to design the plan. ,help) NIA 7h. Use the table below to list the type and rating of each wetland impacted, the extent and duration of the impart, and the type and amount of mjtf gafion proposed. Or if you are submifting a mitigation pJan with a similar table, you can state (below) where we can find this information in the plan. h[ elp] 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 catego 2 Acres) acres) N/A N/A N/A N/A N/A N/A N/A 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. 'ccrnbgy-weband cafugury-based on current Obstem b6asNhgton or castem bGasrlington Obtiana'rc"atfng System.F ovine Me 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: ORIA-revised 02I2020 Page 7 of 14 71. 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. hf gio NIA 7j. 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. ,el NJA Part Weterbodies (other than wetlands): Impacts and Mitigation In Part 8, "waterbodies" refers to non-wetland waterbodies. (See Part 7 for information related to wetlands.) [help ® Check here if there are waterbodies on or adjacent to the project area. (If there are none, skip to Part 9.) 8ai. Describe how the project is designed to avoid and minimize adverse impacts to the aquatic environment. help ❑ Not applicable This project would include the installation of a Helix Embedded Anchor, Midline Flaot Buoy system. There will be no fill material used, vegatation removed, or bottom elevation changed. 8b.Will your project impact a waterbody or the area around a waterbody? [heipl 0 Yes ❑ No ORIA-revised 0212020 Page 8 of 14 8c. Have you prepared a mitigation plan to compensate for the project's adverse impacts to non-wetland waterbodies? hei a If Yes,submit the plan with the JARPA package and answer 8d. e If No,or Not applicable,explain below why a mitigation plan should not be required. ❑ Yes 2 No ❑ Don't know WAG 220-660-380 (8) (f) (A) 8d. Summarize what the mitigation plan is meant to-accomplish. Describe how a watershed approach was used to design the plan. o if you already completed 7g you do not need to restate your answer here. hf to N/A 8e. Summarize impact(s) to each waterbody in the table below. Lei Activity (clear, Waterbody Impact Duration Amount of material Area (sq. ft. or dredge, fill, pile name' location of impace (cubic yards)to be linear ft.) of drive, etc.) placed in or removed waterbody from waterbody directly affected Helix Anchor Pickering Pass See 5f Permanent None Buoy swing If no official name for the waterbody exists,create a unique name(such as"Stream V)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. hel NIA - No fill material used that will change the bottom elevation ORIA-revised 0212020 Page 9 of 14 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. U2elp NIA- No soil or vegatation removed. No dredging. 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. hel Agency game Contact Name Phone Most Recent Date of Contact DNR Aquatic Lands DN Cailan Nealer 360-584-8103 May 5th, 12th, and 14th. 91b. Are any of the wetlands or waterbodies identified in Part 7 or Part 8 of this JARPA on the Washington Department of Ecology's 303(d) List? hel © If Yes,list the parameter(s)below. 0 If you don't know, use Washington Department of Ecology's Water Quality Assessment tools at:https:JJecology.wa.govMJater- ShorelinesMater-oualitytillTatar-imi)rovement./Assessment-of state-waters 303d. 1'Yes ❑ No Temperature i 9c. What U.S. Geological Survey Hydrological Unit Code (HUC) is the project in? ,eI a Go to http:Jfcfpub.epa.govlsurglocatelindex.cfm to help identify the HUC. Website above no longer in service. 9d.What Water Resource Inventory Area Number (WRIA#) is the project in? Lelo o Go to httl)s://ecoiocty.wa_oovftflJafier-Shore€ireesNy'at�r-s 1ply ;ester-avai►ebiditvl4'ilatershed-look-up to find the WRIA#. WRIA#14 ORIA-revised 0212020 Page 10 of 14 9e.Will the in-water construction work comply with the State of Washington water quality standards for turbidity? eipel i © Go to hops://ecology.via.govNVater-ShorelinesAAJater-gua€ity/FreshviaterPSurface-water-quality-standards/Criteria for the standards. 42 Yes ❑ No El Not applicable 9f. If the project is within the jurisdiction of the Shoreline Management Act, what is the local shoreline environment designation? fheipi o If you don't know,contact the local planning department. a For more information,go to hops//ecolopy wa govNVater-Shorelines/Shoreline-coastal-rnanag -nent!Shoreline-coastat- DIanning/Sh oreline-laws-rules-and-cases. ❑ Urban ❑ Natural ❑ Aquatic 2 Conservancy ❑ Other: 9g.What is the Washington Department of Natural Resources Water Type? ,el o Go to htto:/NAA,w.dnr.wa.gov/forest-cractices-water-tvi)inq for the Forest Practices Water Typing System. ® Shoreline ❑ Fish ❑ Non-Fish Perennial ❑ Non-Fish Seasonal 9h.Will this project be designed to meet the Washington Department of Ecology's most current stormwater manual? fhelpi © If No, provide the name of the manual your project is designed to meet. ❑ Yes 2 No N/A Name of manual: 91. Does the project site have known contaminated sediment? fhelpl • If Yes, please describe below. ❑ Yes 2 No N/A 9j. If you know what the property was used for in the past, describe below. ,eI NIA Accordiing to our property title documents this piece of land has been used as private property since the 1980's. 9k. Has a cultural resource (archaeological) survey been performed on the project area? Lelpi O If Yes,attach it to your JARPA package. ❑ Yes 2 No ORIA-revised 0212020 Page 11 of 14 91. Name each species listed under the federal Endangered Species Act that occurs in the vicinity of the project area or might be affected by the proposed work. hey N/A S'M. 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 proposed work. fheipi N/A Part 10—SEPA Compliance and Permits Use the resources and checklist below to identify the permits you are applying for. e Online Project Questionnaire at http://aDDs.oria.wa.aoviogas . Governor's Office for Regulatory Innovation and Assistance at (800) 917-0043 or helpftria.wa.aov a For a list of addresses to send your JARPA to, click on agency addresses for completed JARPA. 10a. Compliance with the State Environmental Policy Act (SEPA). (check all that apply.) het a For more information about SEPA,go to httns://ecology vda gov/regalations-liermitsISEPA-environmental-reviev�'. ❑ 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 10b.) hel © This project is exempt (choose type of exemption below). ® Categorical Exemption. Under what section of the SEPA administrative code (WAC) is it exempt? WAC 197-11-800(24)(f) ❑ Other: ❑ SEPA is pre-empted by federal law. Page 12 of 14 ORIA-revised 02/2020 _ ,- } 10b. Indicate the permits you are applying for. (Check all that apply.) Thelpi LOCAL GOVERNMENT Local Government Shoreline permits: ❑ Substantial Development ❑ Conditional Use ❑ Variance x❑ Shoreline Exemption Type (explain): 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—Affach Exemption Form Washington Department of Natural Resources: ® Aquatic Use Authorization Complete DARPA Attachment E and submit a check for$25 payable to the Washington Department of Natural Resources. Do not send cash. Washington Department of Ecology: ❑ Section 401 Water Quality Certification ❑ Non-Federally Regulated Waters FEDERAL AND TRIBAL GOVERNMENT United States Department of the Array (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: For projects or bridges over waters of the United States, contact the U.S.Coast Guard at: d13-pr-d13bridges uscg.mil ❑ Bridge Permit ❑ Private Aids to Navigation (or other non-bridge permits) United States Environmental Protection Agency: ❑ Section 401 Water Quality Certification (discharges into waters of the U.S.) on tribal lands where tribes do not have treatment as a state (TAS) Tribal Permits: (Check with the tribe to see if there are other tribal permits, e.g.,Tribal Environmental Protection Act,Shoreline Permits, Hydraulic Project Permits,or other in addition to CWA Section 401 WQC) ❑ Section 401 Water Quality Certification (discharges into waters of the U.S.) where the tribe has treatment as a state (TAS). ORIA-revised 02/2020 Page 13 of 14 Part 11—Authorizing Signatures Signatures are required before submitting the JARPA package. The JARPA package includes the JARPA form, project plans, photos, etc. lbeipi I I a. Applicant SignalNgikAquired) hel 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 ented property where the project ' located to inspect the project site or any work related to the project. (init j , Applicant Printed Name Applicant Signature Date I I b.Authorized Agent Signature rheipi 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 I I c. Property Owner Signature (if not applicant) nel Not required if project is on existing rights-of-way or easements (provide copy of easement with JARPA). 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 Printed Name P!7015eftyOwner Signature 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 for Regulatory Innovation and Assistance(ORIA) at(800) 917-0043. People with hearing loss can call 711 for Washington Relay Service. People with a speech disability can call (877)833- 6341. ORIA publication number: ORIA-16-011 rev.09/2018 ORIA-revised 0212020 Page 14 of 14 5/1 812 0 2 1 Pickering Rd&WA-3 to 1126 E Sunset Hill Rd,Shelton,WA 98584-7017 Directions-MapQuess YOUR TRIP T& 1126 E Sunset Hill Rd, Shelton, WA 98584-7017 IS MIN I 7A MI Est. fueg cost $1.04 Trip time based on traffic conditions as of 7:56 AM on May 18, Print a full health report of your car with HUM 2021.Current Traffic: Light vehicle diagnostics(800)go6-2501 1. Start out going southeast on E Pickering Rd toward E Spencer Lake Rd. Then 3.33 miles 3.33 total miles 2. Stay straight to go onto E Harstine Bridge Rd. Then 0.60 miles 3.94 total miles 3. Turn left onto E South Island Dr. Then 0.03 miles 3.96 total miles 4. E South Island Dr becomes E North Island Dr. Then 2.29 miles 6.25 total miles 5. Turn left onto E Sunset Hill Rd. E Sunset Hill Rd is 0.8 miles past E Thornton Rd. If you reach E Haskel Hill Rd you've gone about 0.3 miles too far. Then 1.00 miles 7.25 total miles 6. Turn right to stay on E Sunset Hill Rd. E Sunset Hill Rd is just past Sunset Bch. if you are on E Hideaway Ln and reach E Fern Creek Rd you've gone about 0.2 miles too far. Then 0.13 miles 7.38 total miles 7. 1126 E Sunset Hill Rd, Shelton, WA 98584-7017, 1126 E SUNSET HILL RD. " Your destination is at the end of E Sunset Hill Rd. Ob Save to My Maps Use of directions and maps is subject to our Terms of Use.We don't guarantee accuracy,route conditions or usability.You assume all risk of use. https://www.mapquest.com/directions/list/1/us/wa/sheiton/98584/pickering-rd-and-wa-3-47.278682;122.970967/to/us/wa/shelton/98584-7017/1126-a-s... 1/2 5/18/2021 Pickering Rd&WA-3 to 1126 E Sunset Hill Rd,Shelton,WA 98584-7017 Directions-MapQuest .: - r� 3«.:1'rid Qa M �.qJ 112s E' Sunset Full AW Rd, Shelton, ev WA 98584- { � � ® f: 7 17 .s r , s. I T..V . ;. d e a , ' �t https://www.mapquest-com/directions/listtl/us/wa/shelton/98584/pckering-rd-and-wa-3-47.278682;122.970967/to/us/wa/shelton/98584-7017/1126-e-s... 2/2 6128/22, 10:50 AM Mail-Gbm@masoncountywa.gov RE: Mallory buoy SDP exemption SHX2021-00032 Rothwell, Rebecca (ECY) <rebs461 @ECY.WA.GOV> Tue 6/28/202210:47 AM To:Grace Miller <Gbm@masoncountywa.gov>; Caution:External Email Warning!This email has originated from outside of the Mason County Network.Do not click links or open attachments unless you recognize the sender,are expecting the email,and know the content is safe.If a link sends you to a website where you are asked to validate using your Account and Password,DO NOT DO SO! Instead,report the incident. Oh, I missed that!Thanks @ Rebecca 12gthwefC Shoreline Planner WA Department of Ecology. I cell:360-810-0025 This communication is a public record and may be subject to disclosure per RCW 42.56. From:Grace Miller<Gbm@masoncountywa.gov> Sent:Tuesday,June 28, 202210:46 AM To: Rothwell, Rebecca (ECY)<rebs461@ECY.WA.GOV> Subject: Re: Mallory buoy SDP exemption SHX2021-00032 THIS EMAIL ORIGINATED FROM OUTSIDE THE WASHINGTON STATE EMAIL SYSTEM -Take caution not to open attachments or links unless you know the sender AND were expecting the attachment or the link Hi Rebecca, The Mallory buoy is exempt from SDP under WAC 173-27-040(2) (a). The fair market value of the buoy is $2800.00 as stated in JARPA. Thank you. C,;rase,M al e4 1 Pla vuler MWyM C@t"Xy CommwnXy Se" el-wiad, , . yw-9Ov Pho•>�.' (360) 427-9670, eXZ360 From: Rothwell, Rebecca(ECY)<rebs461@ECY.WA.GOV> Sent: Monday,June 27, 2022 1:51 PM To:Grace Miller Subject: Mallory buoy SDP exemption SHX2021-00032 Caution: External Email Warning! This email has originated from outside of the Mason County Network. Do not click links or open attachments unless you recognize the sender, are expecting the email, and know the content is safe. If a link sends you to a website where you are asked to validate using your Account and Password,DO NOT DO SO! Instead,report the incident. V.t+.,o•//...u�—mocnn wn iic/nuin/1fnnth=/mnil An hnv 1/7 6/28/22,10:50 AM Mail-Gbm@masoncountywa.gov Hi Grace, We received your submittal on the Mallory buoy SDP exemption. I'm assuming you processed this under WAC 173-27-040(2) (f). Please note that this SDP exemption is specific to navigational aids and does not apply to mooring buoys. Ecology's Shoreline Permitting Manual says the following on page 30 of the pdf: Construction or modification of navigational aids such as channel markers and anchor buoys, by or under the authority of the Coast Guard or a designated port management authority, are exempt from permit requirements. This exemption covers, those lights,markers, buoys, etc. usually placed in accordance with Coast Guard standards,if not actually placed by the Coast Guard, that provide directions and other information necessary for safe navigation. Moorage structures such as buoys or dolphins are not considered"navigational aids"and would require a substantial development permit. If this was processed under a different exemption, please let me know.Thanks. Rebecca Rothwel�Shoreline Planner WA Department of Ecology. I cell:360-810-0025 This communication is a public record and maybe subject to disclosure per RCW 42.56. ht+ma-1/^—n nn mncnn thin nc/nuia/dfnnth=/mail/inhnv 2/2 x `:. r {;tVt :;Esafia" 'i[, SIldj �} lifa4iE1k 4 e µ. f.�r�E4roty Iftjl► 3 i 1 j!id St r f k E Er�t-Si#t�te � t � <)i � -'sir .. l `' EM ►SEttat IfRi}�E E9ritcc� oA aBa $l9r6 `,,Yl 1 s A. Oakfand JN Art �"''�::: � �� � ?y�. 6�• �t�tlf'.i�tlki' �":�+?R1lE .. *t. • } f . , r a c •S ,.�' '+r4 � � � $dal ��0.� � 7�`` _ � ��t#. ,.,! 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