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SEP2018-00067 SHX2018-00067 Dock, Pier, Ramp - SEP Determinations - 9/17/2018
PeoN-srArFo MASON COUNTY C Department of Community Services so U y= Planning Division N Y 1P 615 W Alder St, Shelton,WA 98584 of moo~ (360)427-9670 1864 DETERMINATION OF NONSIGNIFICANCE (WAC 197-11-340) SEP2018-00067 Description of Drop al: NEW DOCK WITH FIXED PIER (3.5 X 24), RAMP (3.5 X16) AND FLOAT (10X16), 14 PILINGS, STAIRS (3.5 X 6) AND LANDING (4 X 4) SEE BLD2018-00795 Proponent: DAVE KOCH Location of Orop al: 160 N DISCOVERY DR HOODSPORT Parc I oum er: 423185000041 Legal DesNcript n: LAKE CUSHMAN #3 TR 41 Directi 4 to 4. ite: LAKE CUSHMAN Le dAge cy: Mason County The Lead Agency f r this 1 roposal has determined that it does not have a probable significant adverse impact on tie en ironment. An Environmental Impact Statement (EIS) is not required under RCW 43.21 .030( (c). This decision was made after review of a completed Environmental Checklist aid other information on file with the Lead Agency. This information is available to the public upoi request. Please contact Marissa Watson at ext. 367 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 de ermin ition is final. Comments must be submitted to Dept. of Community Development, 615 Ald St, Shelton WA 98584 by 10/1/2018. Appeal of this determination must be filed within'a 14-c ay period following this final determination date, per Mason County Code Chapter 15.1 AppE 31s. /7 /e Au ri ed I ocal Government Official Date r SEPA CHECKLIST $385-Single Famil (Mason County Permit Center Use) $630-Non-Single rlily 0 to 9.99 Acres SEP $755-10 to 20 Acr $945-fiver 20 Acr Date Rcvd: 9 • l e) $2 525 +701hr- EIS {pS} I'I PfV: .2:3 16 -50 - oUoq I Purpose of Checkii t: The State Environment 1 Poll Act(SEPA), chapter 43.21 C RCW, requires all governmental agencies to consider the environmental impacts o a pf Dposal before making decisions, An environmental impact statement (EiS) must be prepared for all propos la!with 3robable significant adverse impacts on the quality of the environment. The purpose of this checklist is to provl Je'info ation to help you and the agency identify Impacts from your proposal(and to reduce or avoid impacts from the 4pos )and to help the agency decide whether an EIS is required. Instructions for Ap Iran : Governmental agencies y se I its checklist to determine whether the environmental impacts of your proposal are significant, requiring prepiratic i of an EIS. Answer the questions briefly, with the most precise Information known, or give the best descriptioi i you You must answer each questio accurately and carefully,to the best of your knowledge. In most cases,you should be able to answer the qu 'tions your own observations or project plans without the need to hire experts. If you realty do not know the answ r, or if question does not apply to your proposal, write "do not know" or"does not apply". Complete answers to quest ns now may avoid unnecessary delays later. Some questions ask a ut gov mmentat regulations, such as zoning, shoreline, and landmark designations. Answer these questions if you n� if yo have problems,the governmental agencies can assist you. The checklist question apply all parts of your proposal, even if you plan to do them over a period of time or on different parcels of land. Attect any additional information that will help describe your proposal or its envirorunental effects. The agency to which I ou submit this checklist may ask you to explain your answers or provide additional Information reasonably reloted W determining if there may be significant adverse Impact. There is a fee required,for the rocessing of the checklist, see above for the appropriate fee. Please make your check payable to"Mason Cou ty"Tre urer". A. BACKGROUND I. Name of proposed 0 roject: Aooh-D- oc-k- 2. Name of applicant: Property owner: . 3. Applicant mailingaddress: 1�111�/ I"� 'c_...Ys ► ,CQ. �t � v�l q �gJ`� Applicant phone nu bars: - to._.__alit (_-^�qa�-��3�•�`�f_.,.(��gd 4. Date cheddist prepared: _ - 25 5. Agency requesting c hapkilst150 Yt wµ Q yy �M h Mason County SEPA Checklist klist 1 6. Proposed timing or sched l e(including phasing,If applicable): 9 pp ) 7. Do you have any p arts for Wure expansion,or further actively related to or connected with this proposal? If es, explain. AA y !fib 8. List any environme itol inf ation you know about that has been prepared,or will be prepared,directly related to this proposal NfA- 9. Do you know whetter ap tions are pending for governmental approvals of other proposals directly affecting the property covered by your pi oposal? If yes, explain. �© 10. List any governme app als or permits that will be needed for your proposal,if known. -�t.i►<,4.rr� m � -dram t�lasar C --k� 11. Give a brief,cwompli to desc'ption of your proposal, including the proposed uses and the size of the project and site. There are several l qu tions later in this checklist that ask you to describe certain aspects of your proposal. You do not need to repeat ose answers on this page. (Lead agencies may modify this form to Include additional specific information on prof ct description.) �� kes+d dc)cv,, i r�Ctudih� a '�-'Y-ect ptex i ` X • and a lb* -Floa-- . S 2S r ' J�•E I �P�htD 1 r�G t 7"v774/ oYC l -0 l t 3 12. What Is the location of the p roposal? Give sufficient Information for a person to understand the precise location of your proposed projoct Incluc€ng a street address,if any,and section,township,and range,If known, If a proposal would occur over a range a area, provide the range or boundaries of the site(s). Provide a legal description,site plan,vicinity map, d topo Iraphic map, If reasonably available. While you should submit any plans required by the agency,you are n�,It req #red to duplicate maps or detailed plans submitted with any permit applications related to this checklist. t to o tJ . -01 ewe- � - �-I DiSd or-1r q 5y ?a'rc LA Mason County SEPA Ct iec4dist i 2 B. ENVIRONMENTAL ELEMENTSI I. EARTH: a. General desc tion of he site(circle one): Flat, rolling,hilly,steep slopes,mountainou , other explain). b. What is the ste apest s pe on the site(approximate percent slope)? 5 c. What general types of ils are found on the site(for example,clay,sand,gravel,peat, muck)? If you know the classification of agi icultural soils,specify them and note any prime farmland. G rav�eA l� d. Are there surfslco indic ions or history of unstable soils in the immediate vicinity? If so,describe. �0 e. Describe the pirpose, pe, and approximate quantities of any filling or grading proposed. Indicate sour ce of fill. , lAr f. Could erosion Dccur ai a result of clearing, construction,or use? if so, generally describe. 00 About u what ent of he site will be covered with impervious surf 9 Races after project constructions(for example,asphalt orb idings)? 0 h. Proposed measures to reduce or control erosion,or other impacts to the earth, if any: 2. AIR: a. What types of amissioi is to the air would result from the proposal(i.e.dust,automobile, odors, industrial wood smoke)during constr tion and when the project is completed? If any,generally describe and give approximate q jantities, if known. NIA- b. Are there an ffsite urces of emissions or odor that may affect our r Y Y Y proposal? If so,generally describe. Mason County SEPA hecklis 3 c. Proposed me ures to reduce or control emissions or other impacts to air, if any: 4 3 WATE R: a. Surface: 1) Is there any surfac 3 water body on or in the immediate vicinity of the site(including year-round and seasonal streams, saltwater,lakes, ponds,wetlands)? if yes,describe type and provide names. if appropriate,State i vhat stream or river it flows into, �2S- Lea CAA AXM81--t, z Wil l i the projerpt re ire any work over,in,or adjacent to(within 200 feet)the described waters? If yes, please describe a attach available plans. 3) Estimate tt a amo t of fill and dredge material that would be placed in or removed from surface water or wetlands t#indi to the area of the site that would be affected. Indicate the source of fill material. 4) Will the p osal re uire surface water withdrawals or diversio ns? Give general:description, purpose, and approximal e quant Iles if known. Na a'I 5) Does the posal ie within a 1 QO-year floodplain? If so,note location on the site plan. 6) Does the pioposal nvolve any discharges of waste materials to surface waters? If so, describe the type of waste and anticipal d volume of discharge. NU b. Ground: 1) Will ground water withdrawn, or will water be discharged to ground water? Give general description, purpose,arid app ximate quantities,if known. Mason Count y SEPA Criecklist 4 2) Describe waste mi terial that will be discharged Into the round from g g septic tanks or other sources,if any (for example:dom istic sewage, industrial,containing the following chemicals..., agricultural, etc.). Describe egene al size of the system,the number of such systems,the number of houses to be served (if applicable),or tl a number of animals or humans the system(s)are expected to serve. 1v� c. Water runoff(h cluding storm water): 1) Describe the sourc3 of runoff(including storm water)and method of collection and disposal, If any(include quantities, f known). Where will this water flow? Will this flow into other waters? �I 2 Could wasle mat I IS enter round or surface waters: if s 9 0,generally describe. No d. Proposed mew wres to reduce or control surface, ground, and runoff water impacts,if any: 4. PL ANTS: a. Check or cir cle es ve getation egeta#ion found on the site: deciduous tree alder maple, aspen, other evergr n tree: tr, cedar, pine, other shrubs, N 0 e� a i an t�nert pasture Occur. crop or grain wet soil plants: cattail, buttercup, bullrush, skunk cabbage, other water ants: Ivaterilly, eelgrass, milfoil, other other types of getation b. What kind and ►mount 4 vegetation will be removed or altered? Mason County A C e itl SEP qkl s i 5 a. List threatened or endg gered species known to be on or near the site. d. Pr oposed ian �pin ,I use of native plants, or other measures to preserve or®Whence vegetation on the site, if any: 5. ANIMALS a. Circle any birds and and mats which have been observed on or near the site or are known to be on or near the site: Birds: aw heron bngbi s, other Mammals: beer, beaver, Fish: - ass, aimon, trout herring, shellfish, other b. List any threate riod or e dangered species known to be on or near the site. c. Is the site part if a mi ion route? if so,explain. N© d. Proposed meas ures to Oreserve or enhance wildlife, if any: 6. ENERGY AND NAJ URAL I SOURCES: a. What kinds of energy(a ectric, natural gas,oil,wood stove, solar)will be used to meet the completed projects energy needs? Dsscdb a whether it will be used for heating,manufacturing,etc. b. Would your pro act aff the potential use of solar energy by adjacent properties: If so,generally describe. h � 9 Y Rl c. What kinds of energy conservation features are included In the plans of this proposal? List other proposed measures to red uoe or c ontrol energy impacts,if any: 1V`k Mason County SEPA Ct eaklist 6 II 7. ENVIRONMENTAL HEAL H: a. Are there any environmental health hazards,including exposure to toxic chemicals, risk of fire and explosion, spill,or hazard us was a that could occur as a result of this proposal? If so,describe. 1) Describe a Decial a nergency services that might be required. 2) Proposed easures to reduce or control environmental health hazards,if any: � J b. Noise. 1) What typw of not exist in the area that may affect your project for example: traffi c,equipment, operation,other)? 2) What typeq and leN els of noise would be created by or associated with the project on a short-term or a long-term basis(fo,example: traffic, construction, operation,other)? Indicate what hour's noise would come from,the site Sorb . hand held fJowt r' -boys �aek hax�m er b�-kwe ex, qw— 5prn MOYN-¢r► . 3) Proposed inessure to reduce or control noise impacts,if any: N I� 8. LAND N AND SHORELINE I.I SE: a. What is the current use of the site and adjacent properties? u,ndeV6 1 and Ac�3cte-,& t-: i T7-cf--c Hc4-110" b. Has the site been used for agriculture? If so,describe. IV 0 c. Describe any ructu on the site. d. Will any structures be molished7 if so,what? Mason County SEPA C hacklist 7 e. What is the cu rent zor ing classification of the site? f. What is the cuirent cor iprehensive plan designation of the site? g. If applicable,what is th current Shoreline Master Program designation of the site? �r1L"L'�%Jt� h. Has any part a I the s' been ciassified as an"environmentally sensitive"area? If so,specify. . i. Approximately ioW me iy people would reside or work in the completed project? , j. Approximately *me people would the completed project displace? 0 k. P posed measures to void or reduce displacement impacts,If any: a LM IV I I I -fhV-CL',- 000()L-] ALL 64 tult-1 cJ Ae;f zi')fie- 1. Proposed meaI to ensure the pro osal is compatible with existing and projected I uses plans: �h iNvi (+5 be-Fire, emskir wm S�aAs. 9. HOUSING: a. Approximately how,maj y units would be provided,if any? Indicate whether high,middle,or low-income housing. b. Approximately liow mai y units,if any,would be eliminated? Indicate whether high, middle,or low-income housing. c. Proposed mea urNes to educe or control housing impacts,if any: /it 10. AESTHETICS: a. What is the tallest heigt t of any proposed structure(s), not including antennas;what is the principal exterior building material(a)proposed? b. What views in tI1e:lmmQ diate vicinity would be altered or obstructed? c. Proposed mea ures to duce or control aesthetic impacts, if any: N J A- Mason County SEPA Cliecklist 8 I. LIGHT AND GLAS E a. What type of li ht or g14 ire will the proposal produce? What time of day would it mainly occur? Nk b. Could tight or g IaM fro the finished project be a safety h ? Prot Y hazard or interfere with views? NJ0 c. Wha t existing - urc AA }} S i#e es of light or glare may affect your proposal: IV IA— d. Proposed mew uses to educe or control light and glare impacts, if any: WA- 12. RECREATION: a. What designate and i rmal recreational opportunities are In the immediate vicinity? 5w+m.m in f -Ps vl� ba�►bt+ng b. Would the proposed p displace any existing recreational uses? If so, describe. WD c. Proposed meas ures to i duce or control impacts on recreation, including recreation opportunities to be provided by the project or applicant, if any: 13. HISTORIC AND CULTURA PRESERVATION: a. Are there any places or b}ects listed on,or proposed for, national,state, or local preservation registers known to be on or next to the sl le? if so,generally describe. b. Generally desc el any I ndmarks or evidence of historic,archaeological,scientific,or cultural importance known to be on or next M the site. tQ c. Proposed measures to Wuce or control impacts, if any: N/A- Mason County SEPA Coscidist 9 14. TRANSPORTATI : a. Identify public s raets a id highways serving the site and describe proposed access to the existing street system. Show rt,site ans,if any. ��uC*� will No pubs C S E't1S Or Irti�hwac S serve.--h�e. 5% . OCCU-C shore. b. Is site currently i served y public transit? If not,what is the approximate distance to the existing street system? Show on site plans, if ai ly. No c. How many par inn s ms would the completed project have? How many would the project eliminate? d. Will the proposal r quln i any new roads or streets,or improvements to existing roads or streets,not including driveways? If ,penei ally describe(indicate whether public or private). e. Will the project ise(or r in the vicinity of)water,rail,or air transportation? if so en p ,generally describe. No f. How many vehil ular tri per day would be generated by the completed project? If known, indicate when peak vplumes would o ur. g. Proposed measures to i uce or control transportation impacts, if any: NIA. 15. PUBLIC SERVICES: a. Would the prof ct resull in an increased need for public service(for example: fire protection,police protection, health care,sc ools,o er)? If so,generally describe: b. Proposed meas urss to educe or control direct impacts on public services, if any: 16. UTILITIES: a. Circle utilities ct rrently vailable at the site: electricity, natural gas, water, refuse service, telephone, sanitary sewer, septic system, other. N I 6v\t b. Describe the uti hies ths t are proposed for the project,the utility providing the service, and the general construction acl Ivities oi i the site or in the immediate vicinity that might be needed. The above answers are tnNe an complete to the best of my knowledge. I understand that the lead agency is relying on them to make its dec Islon. Applicant Signature: Date: /U Mason County SEPA C eckiist 10 PypN.STATF MASON COUNTY M ooc DEPARTMENT OF COMMUNITY DEVELOPMENT o N Planning Division N Y ti 615 W Alder St, Shelton,WA 98684 (360)427-9670 1864 Site Inspection May 24, 201 BARBARA&I J SE H BOYD 160 N DISCQ\)ERY DR OLYMPIA WA 98502 C s° No. SP12017-00033 Pa c I No. 423185000041 Project Des r' tion PLANNING PRE-INSPECTION FOR FUTURE CONSTRUCTION OF SFR Dear Applicants Pursuant to yok r appli ation, a site pre-inspection (SPI)was performed on your property. Below you will find comments made regarding the proposed development and its critical values. In some cases, setbac s for development from shorelines, steep slopes, streams, and wetlands must be includ d in yo ir specific proposal; these setbacks are included as part of the comments listed below. This information:hange ba d on County and State regulations as they exist to date. These regulations may and may affect the requirements for development of the subject property. Please contact me at( 60)427-9670, ext. 365 if you have questions. Sincerely, L�c Tz. Kell Rowen V Land Use Plan er Mason County Plannir g Department 5/24/2017 Page 1 of 3 SP12017-00033 Site Inspection 5/24/2017 Case No.: SP12017-00033 Comments: Site Pre-inspection Notes Project #: SP12017-00033 for the purpose of determining setbacks for residential construction on tax parcel #:42318-50-00041 Date of Site Visit Meeting: May 16, 2017 Zoning: The zoning designation for the site is Rural Residential 5 (RR5). Standard setbacks for this zone are a 25-foot front yard setback and a 20-foot setback for side and back yards. The front yard refers to the lot line adjacent to the property access, including access easements. The setbacks are measured from structures above grade such as roof overhangs (roof gutters), and other structures/appurtenances, including heat pumps etc. When the lot width is less than 100 feet, setbacks would equal 10% of the lot width. An administrative variance can be applied for to get a reduction in the required setbacks (minimum of 5 feet for sides, minimum of 10 feet for front and rear) if the lot meets certain criteria. Other setbacks can apply when critical areas are present, see below. All setbacks are measured from the furthest projection of the structure (including roof eves and gutters). Height limit per Mason County Development Regulations 17.04.224.0 is 35 feet. Streams: There is a stream that runs east to west into a culvert from the landward side of North Discovery Drive, runs under the road and continues through the subject property in a covered culvert until it daylights at the Ordinary High Water Mark (OHWM). The covered portion of the stream is not jurisdictional and there are no additional setbacks required. Shorelines: Shoreline Designation under the Mason County Shoreline Master Program (MCSMP) 17.50.070 is Urban. Minimum building setback is 15' per the MCSMP 17.50.060 Residential Development table. However the Mason County Resource Ordinance (MCRO) has stricter provisions: per 17.01.110 D.2. The following are special provisions for buffers and setbacks on lots created prior to December 5, 1996, and which are located on a Type 1 water that is a saltwater or is a freshwater lake. As stated in Table 3, there shall be a standard 100-foot buffer for a total of 100 feet as measured from the ordinary high 5/24/2017 Page 2 of 3 SP12017-00033 Site Inspection 5/24/2017 { Case No.: SP12017-00033 water mark (OHWM). Provided, however, that in the following circumstances, these special provisions apply instead of the standard buffer and setback requirement. a. Sp cial provision for view protection on subject lots. Applications for single-family residential construction and meeting the f lowing conditions shall have buffers and setbacks as descr bed below: 1) W1 ere an existing residence is on one side of and within 150 feet o the lot line of the subject lot, and no more than 200 feet from tie shoreline OHWM, the setback on the subject lot is deter deterr iined by an imaginary common line drawn across the subje t lot which connects the shore-side roof lines of the adjacent existing residence to the standard 100 foot setback. Apy portion of the new structure, including decks, balconies, and r ofli s, must be behind this common line. Waterward of the COMMDn line for 15 feet is an area that may be used for lawns, patios or landscaping (development at grade level). The common line setback for the subject parcel is 80 feet from the IOIHW . ptivit allowed without permit: IB�ffer alterations for view corridors are allowed with emphasis placec on limbing and with selective timber removal minimized to he ex ent possible. Proposed alterations shall be the minimum to fford views within the buffer and shall minimize shrub vegetation removal and ground disturbance while maintaining the large mature trees. Under this provision, no more than 10 percent of trees in the buffer less than six inches in diameter at breast height ay b cut without specific authorization from Mason County, Mich ay allow removal up to 20 percent. :)IeaSE check with the Environmental Health Department egard ng issues related to water and sewage disposal and with he Bu Iding Department regarding buildings codes. hope that you find this information helpful and informative as you roce through the permitting process. If you have any esti ns or concerns regarding these notes, please do not wsitata to contact me directly at (360) 427.9670 Ext. 365. 3pecift development standards contained in County Codes may eM fouiid at the County web address HERE. Thank you and we ook fo ward to working with you. 5/24/2017 Page 3 of 3 SP12017-00033 STATED h MASON COUNTY �P C Department of Community Services o n v �N Planning Division o T Z 615 W Alder St, Shelton, WA 98584 N Y ti (360)427-9670 OJ C1Q 1864 Exemption from Shoreline Management Act Case No.: SHX2018 0 06 Substantial Development Permit Requirement The Proposal By PROJECT LCMC CULVERT REPLACEMENT & RELOCATE 3740 N LAKE CUSHMAN RD HOO DSPORT, WA 98548 Parcel Number: 423lE5900041 Site Address: 160 N DISCOVERY DR HOODSPORT To undertake the folloo iog development: REPLACEMENT & RE OCA ION OF EXISTING STORMWATER DRAINAGE LINE Within LAKE CUSHMA and)or its associated wetlands is exempt from the requirement of substantial development because t e dev lopment is categorized under WAC 173-27-040(2) as being category: B-normal maintenance, Please contact Marissa Watsc n at ext 367 if you have any questions. Issu ed:11/5/2018 Authorized Local Government e ent Official i SHX2018-00067 November 05, 201E i I ------------------ ---- - --- -' AGENCY USE `A Bate received: W SHII GTON STATE g Joint A u ti Resources Permit Agency reference#:.--"U1@"Opd(# 1,2 Tax Parcel#(s) Applic ion (JARPA) Form I USE BLACK OR BL INk TO EN ER ANSWERS I qES BELOW. r� ------------------------ SEP 1 � (e e u Part 1—Project Id ntifi ation 1. Project Name(Anal neffor yot r project that you create.Examples;Smith's Dock or Seabrook Lane Development) elpl LCMC Culvert Re 1 cem ent and Relocation Project Part 2—Applicant! The person and/or organization responsible for the project. h( eipi 2a. Name(Last,First,M dle) Nix, Aaron 2b. Organization(if ap licabfe) Lake Cushman Management Company 2c. Mailing Address(4,treiptor PD Box) 3740 N Lake Cushma i Road 2d' City, State,Zip i Hoodsport, WA 9854 2e. Phone(1) 2f. P ne(2) 2 .,. Fax 2h. E-mail (360) 877-5233 x18 ( ( ) ANix@LakeCushmanMC.com tAdditional forms may be required for the ollowing permits: • If your project may qualib for Depa ent of the Army authorization through a Regional General Permit(RGP),contact the U.S.Army Corps of Engineers for application nformat (206)764-3495. • If your project might affe species It ted under the Endangered Species Act,you will need to fill out a`Specific-Project Information Form(SPIF)or prepare a Biological Eval ation. Foi rs can be found at htt :liwww nws.usace.a il/kIls ns/Civilworks/Re ulato IPermitGuidebooktEndan eredS ecies.as x. • Not all cities and countie accept t JARPA for their local Shoreline permits.If you need a Shoreline permit,contact the appropriate city or county government to make sur they acc t the JARPA. 2To access an online JARPA fo m with[h ]screens,go to httP:!/www.ePermittinqwa. ovJ tel lias sourcecenter/iar a iarpa fomU9984,'ar a form.as x. For other help,contact the Gov rnor's Offs a of Regulatory Assistance at 1.800-917-0043 or helpca.ora.wa.gov. JARPA Revision 2012.1 Page 1 of 14 Part 3—Authoriz d Ag nt or Contact Person authorized to r pr sent the applicant about the project. (Note:Authorized agent(s) must sign 11 b of this application.) o 3a. Name(Last,First, `dale) Brownell, Chevon 3b. Organization(if ao pfiiable), Lake Cushman Managemeni Company 3c. Mailing Address(,treet or 40 Box) 3740 N Lake Cushman Roadi 3d. City, State,Zip Hoodsport,WA 985413 3e. Phone 1 P one 2 3 . Fax 3h. E-mail (360) 877-5233 x17 CBrownell@LakeCushmanMC.com Part 4—Property Owner(s) Contact information for ipeople r organizations owning the property(ies)where the project will occur. Consider both upland and aquatic ovinershir because the upland owners may not own the adjacent aquatic land. bgjpj ❑ Same as applicant. Skip to Part 5.) Repair or maintenance acti`I ties on existing rights-of-way or easements. (Skip to Part 5.) ❑ There are multiple L Dland pi perty owners. Complete the section below and fill out JARPA Attachment A for each additional pro erty o ' er. ❑ Your project is on I ieparLm 3,nt of Natural Resources(D'NR)-managed aquatic lands. If you don't know, contact the DNR at(3 0)902 100 to determine aquatic land ownership. If yes, complete JARPA Attachment E to apply for the Aquati. Use A thorization. 4a. Name Last First iddle I 4b. Organization(if al Iplicable)' Lake Cushman Main enanci Company 4c. Mailing Address ( treet or O Box) 3740 N Lake Cushman Roa 4d. City,State,Zip Hoodsport, WA 985413 4e. Phone(1) 4f. one t2} 4g. Fax ' 4h. E-mail (360) 877-5233 x18 ( ) ( ) ANix@LakeCushmanMC.com DARPA Revision 2012.1 Page 2 of 14 i 5—Project � cati s Part 5—P '� { ) Identifying information about the property or properties where the project will occur. hero ❑ There are multiple p oject to ations (e.g. linear projects). Complete the section below and use DARPA Attachment B for each add[ional project location. 5a. Indicate the type of wne ship of the property. (Check all that apply.) el x❑ Private ❑ Federal I ❑ Publicly owned (sta ,county)city,special districts like schools,ports,etc.) ❑ Tribal ❑ Department of Naft ral Resl urces(DNR)—managed aquatic lands(Complete JARPA Attachment E) 5b. Street Address( ,not be i PO Box. If there is no address,provide other location information in 5p.) hf elp] 160 N Discovery Dri 5c. City, State,Zip(If he projecl is not in a city or town,provide the name of the nearest city or town.) el Hoodsport, WA 9854 5d. County b9ipi Mason 5e. Provide the sectic n,tow hip, and range for the project location. Dgipj 1/4 Section Section Township Range 18 23N 04W 5f. Provide the latitudnaand lolgitudeof the project location. Lpipi • Example.47.0392 2 lat.f 122,89142 W lone.(Use decimal degrees-NAD 83) 47.48689 N -123.244264W 5g. List the tax.parcet n0mbe s)for the project location. them • The local county a sdssor ffice can provide this information: 42318-50-00041 &42 18-51- 0148 5h. Contact informati n for at adjoining property owners.(If you need more space,use JARPA Attachment C) FhelDl Name Mailing Address Tax Parcel#(if known) BLY, ROGER BERTR M & 6545 SW SEYMOUR ST 423185000040 JENNIFER ANN MAJ WSKI PORTLAND OR 97225 _........ JARPA Revision 2012.1 Page 3 of 14 P 51. List all wetlands on car adj, cent to the project location.JtLeM 5j. List all waterbodie s iothe'than wetlands)on or adjacent to the project location.Eel Lake Cushman 5k. Is any part of the reject rea within a 100-year floodplain7 `ei ❑ Yes X❑ No ❑ on't know 51. Briefly describe the vege<,ition and habitat conditions on the property. fheIDI The proposed project site is located on a private, heavily forested 0.51 acre Lake Cushman waterfront lot and on a heavily veg tatted -3.46 acre lot that is used as a common area and owned by the Lake Cushman Maintenanlre Corr pany. 5m. Describe how the prope is currently used. h[ elpl The private lot has an existi ig septic system that the owners are planning to move. The LCMC lot is a common area that s poorts an area cleared of large trees to maintain a view corridor, an access trail to the shoreline, and th a Olvis n 4 Community Park(the latter located on the north half of the parcel). 5n. Describe how the.; djace properties are currently used. [help] I Adjacent properties o the s utheast and northwest support residential structures. Other adjacent properties consist p rnarily, f undeveloped forest land. 5o. Describe the structures ibove and below ground)on the property„including their purpose(s)and current condition. Leip There is an existing orrega ed metal pipe (CMP) culvert running beneath Discovery Drive and onto the proposed project site into a existing 18" CMP culvert for approx. 172 feet. 5p. Provide driving di eetion from the closest highway to the project location, and attach a map. ftetpi From Shelton, take SIR 101 florth to Hoods,ort, turn left on Lake Cushman Rd and follow up the hill to JARPA Revision 2012.1 Page 4 of 14 Division 2 and turn left; Mount Church Drive bears left and becomes Mount Tebo Way.Turn left at the stop sign at the bottern of t e hill onto Potlatch Drive North.When the road forks, bear right onto Discovery Drive. Site; is appiox. 0.15 mi. on the right. Part 6-Project Description 6a. Briefly summariZ4 t e overall project. You can provide more detail in 6b. Fhem The proposed action it the eplacement and relocation of an existing stormwater drainage line. 61b. Describe the puqore ofhe project and why you want or need to perform it. [tLei The existing stormwater lln� is old and failing, above ground, and lacks catch basins and an outfall with a drainage i nfi Itrati o i pad. 6c. Indicate the projoct"Ge iory. (Check all that apply) te-JIPJ x❑ Commercial F-1 sidential ❑ Institutional ❑Transportation ❑ Recreational v nmental El Maintenance F� ro Enhancement 6d. Indicate the maj r Oleme, nts of your project. (Check all that apply)- [helpl ❑ Aquaculture x❑ Culvert El Float ❑ Retaining Wall F-1 Bank Stabilization ❑ Dam/Weir E:1 Floating Home (upland) F-1 Boat House ❑ Dike/Levee/Jetty [] Geotechnical survey El Road ❑ F1 Boat Launch F� Ditch El Land Clearing Scientific Measurement Device f-j Boat Lift r-1 Dock/ Pier ❑ Marina/ Moorage ❑ Stairs F1 Bridge El Dredging ❑ Mining ❑ Stormwater facility ❑ Bulkhead E-1 Fence M Outfall Structure F] Swimming Pool M Buoy 0 Ferry Terminal El Piling/Dolphin F-1 Utility Line F-1 Channel Modific tion El Fishway E] Raft M Other: JARPA Revision 2012.1 Page 5 of 14 q 6e. Describe how yot an t' construct each project element checked in,6d. Include specific construction methods and equ p ent I o be used. he! • Identify where eac i OIlemen,will occur in relation to the nearest waterbody. • Indicate which act vitles are 'thin the 100-year floodplain. The proposed replac ment tulvert system will connect with an existing 24" CMP culvert that runs beneath Discovery Drive fro an ephemeral drainage. An existing 18" CMP culvert(approx. 173 ) will be removed, and a type Catc-11 basin(CB), a type 2 CB, 173 feet of 18" CMP culvert, and a ten by ten-foot outfall drainage infilt ation I ad with a minimum of 24 inches of 6 to 8 inch quarry spalls will be installed. The culvert will be i tailed 4 inches below grade. Please see plans(#17883 Sitts& Hill Engineers, Inc.). Note: the property owners ill be moving an existing septic drainfield within 100 feet of the proposed CMP culvert system., The nearest waterbo y;is L ke Cushman. 6f. What are the antic ip,,ted start and end dates for project construction?(Monthffear) h[ elot • If the project will b,-mnstructed in phases or stages,use JARPA Attachment D to list the start and end dates of each phase or stage. Start date: Unknown-after issuance of all required permits. End date:_ASAP ❑ See JARPA Attachment D 6g. Fair market value a the oject, including materials, labor, machine rentals, etc. ftAi Unknown. 6h. Will any portion o the pro ect receive federal funding? et • If yes,list each ag nq pro' ding funds. ❑ Yes x❑ No ❑ Do t know Part 7—Wetlands:) I Mnpa is and Mitigation ❑ Check here if there arii wet) inds or wetland buffers on or adjacent to the project area. (If there are none, sip to P'irt 8.) het 7a. Describe how the project ias been designed to avoid and minimize adverse impacts to wetlands. x❑ Not applicable JARPA Revision 2012.1 Page 6 of 14 I 71b. Will the project i et w l(lands? hel p p ❑ Yes ❑ No ! ❑ n't know 7e. Will the project iry pact w4 tland buffers? ibev ❑ Yes ❑ No ❑ D n't know 7d. Has a wetland delinleatioH I report been prepared? ftM « If Yes,submit the,report,i `hiding data sheets,with the DARPA package. ❑ Yes ❑ No 7e. Have the wetlands teen'ated using the Western Washington or Eastem Washington Wetland Rating System? Mpj « If Yes,submit the' efland r iting forms and figures with the DARPA package. ❑ Yes ❑ No ❑ D 'n't know 7f. Have you prepared a mit gation plan to compensate for any adverse impacts to wetlands? nel • If Yes,submit the Aar with;he DARPA package and answer 7g. • If No,or Not appi cable,a lain below why a mitigation plan should not be required'. ❑ Yes ❑ No ❑ Not applicable 7 . Summarize what h mit" ation plan is meant to accomplish,g p p ,.and how a watershed approach was used to design t plan. fhelgi 7h. Use the table bel w°to lis the type and rating of each wetland impacted,the extent and duration of the impact,and the type and mount of mitigation proposed. Or if you are submitting a mitigation plan with a similar table,you n stat (below)where we can find this information in the plan. ;hl eel l Activity (fill, Wetl d Wetland Impact Duration Proposed Wetland drain, excavate, Nam 1 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, reate a unique name(such as"Wetland t'). The name should be consistent with other project documents,such as a wetland delineation report. 2 Ecology wetland category ba d on curr t Western Washington or Eastern Washington Wetland Rating System.Provide the wetland rating forms with the JARPA pa kage. 'Indicate the days,months or ars the tland will be measurably impacted by the activity.Enter"permanent"if applicable. JARPA Revision 2012.1 Page 7 of 14 4 Creation(C).Re-esLablishmeit/Rehabili ation(R),Enhancement(E),Preservation(P),Mitigation Bank/In-lieu fee(B) Page number(s) for simN r information in the mitigation plan, if available: 7L For all filling activilie� ider tified in 7h, describe the source and nature of the fill material, the amount in cubic yards that will be u5eiJ-, an how and where it will be placed into the wetland. L[1q!W 7j. For all excavating ac4ivitiei identified in 7h,describe the excavation method,type and amount of material in cubic yards youIrmove, and where the material will be disposed. LLeU Part 8—Waterbodles (o her than wetlands): Impacts and Mitigation In Part 8, "waterbodies" refers I non-wetland waterbodies. (See Part 7 for information related to wetlands,) LLJO 7 Check here if there are wate bodies on or adjacent to the project area. (if there are none, skip to Part 9.) ,8a. Describe how the project i 5 designed to avoid and minimize adverse impacts to the aquatic environment. be-1pi El Not applicable Best Management Pr cllices BMPs) shall be followed during construction to protect water quality at the site. 8b. Will your project inipact a aterbody or the area around a waterbody? rheipi xO Yes E] No JARPA Revision 2012.1 Page 8 of 14 P 8c. Have you preparil d mit gation plan to compensate for the projects adverse impacts to non-wetland waterbodies? heI w • If Yes,submit the lan with the JARPA package and answer 8d. • If No,or Not applic4ble,eo plain below why a mitigation plan should not be required. ❑ Yes X❑ N xF� N t applicable The project is the replacement and relocation of a failing culvert for an ephemeral drainage. The project will bei Wit the environment by installing an outfail with the ability to facilitate the infiltration of rtormwater runoff to groundwater. The existing culvert does not have an outfail. 8d. Summarize what he mitil lation plan is meant to accomplish. Describe how a watershed approach was used to design#e plan. • If you already com plated 7 'you do not need to restate your answer here. hel l A watershed approach is an analytical process for making compensatory mitigation decisions that support sustainability or improvement of aquatic resources in a watershed (33 CFR 332.2). This generally involves large pro ects that impact wetlands. This project will not impact any wetlands. This project will be an impr vement over the existing culvert (see 8c.). 11 8e. Summarize imps t(3)to, ch waterbody,in the table below. heI Activity(clear, Water body impact Duration Amount of material Area(sq.ft. or dredge, fill, pile nary et location of impact3 (cubic yards)to be Linear ft.) of drive, etc.) placed in or waterbody removed from directly affected waterbody Untina d Forested Approx. Approx. 3 culyds of 173 feet ephem ral slope several quarry spails draina a days If no official name for the wat rbody exis s,create a unique name(such as"Stream V)The name should be consistent with other documents provided. 'Indicate whether the impact ill occur in r adjacent to the waterbody. If adjacent,provide the distance between the impact and the waterbody and indicate whether the impactw tl oiccur wi in the 100-year flood plain: 'Indicate the days,months or ears the m 3terbodywill be measurably impacted by the wort. Enter"permanent"if applicable. 8f. For all activities identified n 8e,describe the source and nature of the fill material, amount(in cubic yards) you will use, and h ult and here it will be placed into the waterbody. hCheM JARPA Revision 2012.1 Page 9 of 14 I I Approx. 3 culyds.of 4juarry palls will be used at the outfail. i 8g. For all excavatinc or dre ging activities identified in 8e,describe the method for excavating or dredging, type and amount 1>f mate al you will remove, and where the material will be disposed. bgjpj A trench for the reph icomen culvert system will be excavated (approx.2' in depth). The excavated sediments will be us d to bt ry the culvert. Part 9-Additional Inforl ation Any additional information you dan provide helps the reviewer(s)understand your project. Complete as much of this section as you can. It is ok f you cannot answer a question. 9'a. If you have alreaJyworkpd with any government agencies on this project, list them below. fh t� Agency Name Contact Name Phone Most Recent Date of Contact I 9b. Are any of the we tiands or waterbodies identified in Part 7 or Part 8 of this JARPA on the Washington Department of E lggy's 03(d) List? hei • If Yes,list the par4 md�ter(s) slow. • If you don't know, se Was ngton Department of Ecology's Water Quality Assessment tools at: h :/www. c .wa' o ! ro" s!w /303d/. ❑ Yes ❑ No Pa e 10 of 14 JARPA Revision 2012.1 9 I 9c. What U.S. Geoio ical Sui vey Hydrological Unit Code(HUC) is the project in? h€ eigi * Go to htto://etoub.' ovt rfilocate/index.cfm to help identify the HUC. 17110018 9d. What Water Resource Inventory Area Number(WRIA#)is the project in? fheipi Go to htt :hvvww. .wa. o /serviced islma s/usriadvwia.htm.to find the WPJA#. WRIA 16 9e. Will the in-water tlstru on work comply with the State of Washington water quality standards for turbidity? hel * Go to htt ':1/wwxv. a, a r rams/w sw s/crite0a.htmlforthe standards. x❑ Yes ❑ N ❑ Not applicable 9f. If the project is wit iin the j irisdiGtion of the Shoreline Management Act,what is the local shoreline environment desk nation? Tel * If you don't know,contact tl e local planning department * For more informs'on go to, hitp:t/wvvw.ecv:wa.cfov/programstsea/sma/laws rules/173-26i211 designations.htrnl. ❑ Rural ❑ Ui ban ❑ Natural ❑ Aquatic ❑ Conservancy X❑Other Unknown 9g. What is the Was noton E partent of Natural Resources Water Type? hel- * Go to hti ://'wwvr. ir.vva.qo BusinessPermits(To icsiForestPracticesA lications/P esif watertyping.aspx for the Forest Practices Water T ing Sy x❑ Shoreline ❑ Fish ❑ Non-Fish Perennial ❑ Non-Fish Seasonal 11 9'h. Will this project b desig d to meet the Washington Department of Ecology's most current stormwater manual? fbeirg * If No,provide the qarTie of manual your project is designed to meet. x❑ Yes [:] No Name of manual: Stormyater Management Manual for Western Washington. 91. Does the project sl e have nown contaminated sediment? bpipj • If Yes,please des 'ble belom ❑ Yes x❑ No 9j. If you know what the proprty was used for in the past,describe below. nei Forest land. 9k. Has a cultural resource(a chaeological)survey been perforated on the project area? hei` * If Yes,attach it toour JAR package. ❑ Yes x❑ No 91. Name each species listed i inder the federal Endangered Species Act that occurs in the vicinity of the project area or might be aflected b the proposed work. beli2l JARPA Revision 2012.1 Page 11 of 14 The Chinook salmon, the bull trout,the marbled murrelet, and the Northern spotted owl are some of the ESA list Dd aquatic threatened or endangered species in the area. 11 9m. Name each spec ie or h bitat on the Washington Department of Fish and Wildlife's Priority Habitats and Species List that m ght affected by the proposed work. MM The Chinook salmon and :he Puget Sound/Coastal cutthroat trout. Part 10—SEPA Compliance and Permits Use the resources and checkli 5t below to identify the permits you are applying for. • Online Project Questio inaire at http://apps.ecy.wa.gov/ogas/. • Governor's Offi,,ei of Regulatory Assistance at(800) 917-0043 or help 6�ora.wa.qov. • For a list of ad c ruses o send your JARPA to, click on agency addresses for completed JARPA. i: 1 Oa. Compliance with t State Environmental Policy Act(SEPA). (Check all that apply.) Lelp 1 • For more informatiOn labout4 EPA,go to www.ecy.wa.gov/programslsea/seaale-review.html. ❑ A copy of the SEPA de+rmination or letter of exemption is included with this application. ❑A SEPA determination i5 pending with—Mason County (lead agency). The expected decision date is El I am applying for a Fish Habitat Enhancement Exemption. (Check the box below in 1 Ob.)fhelp] xE] This project is mempt 'choose type of exemption below). ❑ Categorical =_xempt n. Under what section of the SEPA administrative code(WAC) is it exempt? WAC 173-27-040 0 Other: 10b. Indicate the penlifts you are applying-for. (Check all that apply.I el LOCAL GOVERNMENT Local Government Shorelina permits: M Substantial Devalopmei it F-1 Conditional Use D Variance x7 Shoreline Exellripition I ype (explain): WAC 173-27-040 Other city/county', armiti: ❑ Floodplain Dev lopmen:Permit F Critical Areas Ordinance STATE GOVERNMENT JARPA Revision 2012.1 Page 12 of 14 Washington Depa rtment of Fish and Wildlife: x[I Hydraulic Project ApplDval (HPA) Fj Fish Habitat Enhancement Exemption—Attach Exernotion Form Effective July 10, 201.2, you m st submit a check for$150 to Washington Department of Fish and Wildlife, unless your project q uplifies fo an exemption or alternative payment method below. Do not send cash. Check the appropriates boxes:. F-I $150 check enclosed. (Cl,eck 9 Attach check mace payablo to Washington Department of Fish and Wildlife. Fj Charge to billing accou it under agreement with WDFW. (Agreement # ❑My project is exempt from the application fee. (Check appropriate exemption) El HPA processing is conducted by applicant-funded WDFW staff, (Agreement # ❑ Mineral prospecting and mining. Fj Project occurs on f arm and agricultural land. (Attach a cop v of curs e it land Use classification recorded with the county auditor,or other proof of current land use.) E] Project is a rrlodifi tion of an existing HPA originally applied for, prior to July 10, 2012. (HPA# Washington Depart Anent of Natural Resources: R Aquatic Use Autliclrizatlen Complete DARPA Attgchnn v E and submit a check for$25 payable to the Washington Department of Natural Resources. Do not send cash. Washington Depa Imeat A Ecology: ❑ Section 401 Wa:er Qua ity Certification F�DERALGOVERNIVI'gkf United States Departrii of the Army permits(U.S. Army Corps of Engineers): ❑ Section 404 (discharges i to waters of the U.S.) ❑ Section 10 (work in navigable waters) United States CoastGuar d permits: F-1 General Bridge Act Perri,it ❑ Private Aids to Navigation(for non-bridge projects) El SEPA is pre-em)ted by�ederal law. JARPA Revision 2012.1 Page 13 of 14 Part 1 1-Authorizing S gnatures Signatures are required befog f submitting the JARPA package. The JARPA package includes the JARPA form, project plans, photos, etc, rheic 11 a. Applicant Signature(req ired) Leip j I certify that to the best ot my nowledge and belief, the information provided in this application is true, complete, and accurate. I also certify thal I have the authority to carry out the proposed activities, and I agree to start work only after I have received!all n cessary permits. I hereby authortze he agent n4 imed 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 I iave the authority to grant access to the property. I also give my consent to the permitting agencies enA, n g t a property where the project is located to inspect the project site or any work related to the project. (initial) illl&AJ Ah� Applicant Printed Name Applicant Signature 11 b. Authorized Ageril Signat�ire (tpipj I certify that to the best of my k owledge and belief, the information provided in this application is true, complete, and accurate. I also cedify 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 Nome QOrized 4gen ignatur-e Date 11 c. Property Owner ignatun., (if not applicant). [LeM Not required if pr)ject is i n existing rights-of-way or easements. I I consent to the permitti ig age cies entering the property where the project is located to inspect the project site I or any work. These inspection 11 shall occur at reasonable times and, if practical,with prior notice to the s landowner. Property Owner Printed Na Property Owner Signature Date 18 U.S.0§1001 provides thal:Whoevir,in any manner within the jurisdiction of any department or agency of the United States knowingly falsifies,conceals,or covers vp by any trick,scheme,or device a material fact or makes any false,fictitious,or fraudulent statements or representations or makes or uses any I Ise writing or document knowing same to contain any false,fictitious,or fraudulent statement or entry,shall be fined not more than$10: 00 or imprisoned not more than 5 years or both. I If you require this document in another ormat,contact the Governor's Office of Regulatory Assistance(ORA)at(800)917-0041 People with hearing loss can all 711 h r Washington Relay Service.People with a speech disability can call(877)833-6341. ORA publication number: EN V-01 9-09[rev.06-12 JARPA Revision 2012.1 Page 14 of 14