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Home My WebLink AboutSHX2016-00067 Perry Cook Dock Replacement - SHX Application - 10/20/2016 __01CQ - oo� LQ l t--------------------------------------- ' AGENCY USE ONLY t � 'M1�e�a Date received: WAS INGTON STATE Army Corps of Engineers Se t Seattle District Joint Aquatic Resources Permit Agency reference#: cr7>4'hCZOtCp-OGb(D'f Applicatio (DARPA) Form' ,2 hel T x Parcel#(s): o Qaoa3 USE BLACK OR BLUE INK TO ENTER ANSWERS IN THE WHITE SPACES BELOW. ' t -------------------------------- t t Via. "CIS Part 1—Project Identification 1. Project Name (A name for your project that you create.Examples: Smith's Dock or Seabrook Lane Development) h[ elp) PerryCook Dock Replacement Part 2—Applicant The person and/or organization responsible for the project. hel 2a. Name (Last,First,Middle) PerryCook, Jay, Anthony 2b. Organization(if applicab e) Eagle Commercial Service , Inc. 2c. Mailing Address (Street,Dr PO Box) 1026 26th Ave NW Suite C 2d. City, State, Zip Gig Harbor, WA 98335 2e. Phone(1) 2f' Phone(2) 2g. Fax 2h. E-mail ( 253 ) 209-3890 ( ) ( ) jay@ecsperforms.com (Additional forms may be required for the following permits: • If your project may qualify for epartment of the Army authorization through a Regional General Permit(RGP),contact the U.S.Army Corps of Engineers for application info ation(206)764-3495. • If your project might affect sp ies listed under the Endangered Species Act,you will need to fill out a Specific Project Information Form(SPIF)or prepare a Biological Evaluatio i. Forms can be found at http://www.nws.usace.armv.rr I/M issio ns/Civi R/Vo rks/Requlato /Perm itG u idebook/E nd a nq e red Species.as x. • Not all cities and counties acc,pt the JARPA for their local Shoreline permits. If you need a Shoreline permit,contact the appropriate city or county government to make sure the accept the JARPA. 2To access an online JARPA form with[help]screens,go to http://www.epermitting.wa.aov/site/alias resourcecenter/mar a war pa form/9984/"ar a form.as x. For other help,contact the Governor's Office for Regulatory Innovation and Assistance at(800)917-0043 or help(a)-oria.wa.gov. JARPA Revision 2015.1 Page 1 of 16 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.) [hel 3a. Name (Last, First,Middle) N/A 3b. Organization (if applicable) 3c. Mailing Address (street r PO Box) 3d. City, State, Zip 3e. Phone(1) 3f. Phone(2) 3g. Fax 3h. E-mail Part 4—Property Owner(s) Contact information for people or organizations owning the property(ies) where the project will occur. Consider both upland and aquatic ownership because the upland owners may not own the adjacent aquatic land. hel ® Same as applicant. (Ski 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 propert owner. ❑ Your project is on Department of Natural Resources (DNR)-managed aquatic lands. If you don't know, contact the DNR at (360) 02-1100 to determine aquatic land ownership. If yes, complete JARPA Attachment E to apply for the Aquatic Us a Authorization. 4a. Name (Last,First,Middle 4b. Organization (if appliea le) 4c. Mailing Address (streets or PO Box) 4d. City, State, Zip 4e. Phone(1) _4 . Phone(2) 4g. Fax 4h. E-mail JARPA Revision 2015.1 Page 2 of 16 Part 5—Project Location(s) Identifying information aboull the property or properties where the project will occur. hel ❑ 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 ® Private ❑ Federal Publicly owned (state,co nty,(city, ecial districts like schools, ports, etc.) ❑ Tribal ❑ 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.) hel 2850 W Cushman Ridge R 5c. City, State, Zip(If the,pr ject is not in a city or town,provide the name of the nearest city or town.) ell Hoodsport, WA 98548 5d. County hel Mason 5e. Provide the section, to Nnshj,p, and range for the project location. h(,ems '/4 Section Section Township Range 9 23N 4W 5f. Provide the latitude and longitude of the project location. nel • Example:47.03922 N I at./-122.89142 W long.(Use decimal degrees-NAD 83) 47,46591 N lat/-1 23.244E 1 W long 59. List the tax parcel nu ber($)for the project location. nel • The local county assessors office can provide this information. 42331-50-02023 5h. Contact information fo all adjoining property owners. (If you need more space,use JARPA Attachment C.) [helpi Name Mailing Address Tax Parcel #of known) Russ and Roberta Salton 3710 101st St Ct NW 42331-50-02024 ...............................................................................................................................--....................................._........................................................... ........... Gig Harbor, WA 98332 Richard and Debra Haynie 9835 Case Rd SW 42331-50-02022 Tumwater, WA 98512 JARPA Revision 2015.1 Page 3 of 16 T 'acent to the project location. nei 5i. List all.wetlands on or a � p ) L�el N/A 5j. List all waterbodies (other than wetlands) on or adjacent to the project location. hel Lake Cushman 5k. Is any part of the project area within a 100-year floodplain? nei ❑ Yes ® No El Don't know 51. Briefly describe the veg tation and habitat conditions on the property. [tLei Sloped wooded shoreline with cedars, firs and native shrubs 5m. Describe how the pro erty',is currently used. nei Private recreational 5n. Describe how the adj cent properties are currently used. MOO Private recreational 5o. Describe the structure (above and below ground) on the property, including their purpose(s) and current condition. hei A 12' x 16' permitted storage shed and a wooden dock (to be replaced by this project) 5p. Provide driving directi ns from the closest highway to the project location, and attach a map. nei From intersection of Hwy 01 and W Skokomish Valley Rd north of Shelton WA, go west on Skokomish Valley Rd. 5.6 miles to Govey Rd. Slight right on Govey Rd for 1.8 miles and then slight left on NF-23 for'/z mile, right on NF-2340 for 9.1 miles to pipe gate marked "Cushman Ridge Road". Through the locked gate for 3.8 miles to site on right. JARPA Revision 2015.1 Page 4 of 16 Part 6—Project Desc iption 6a. Briefly summarize the i iverall project. You can provide more detail in 6b. h[ ei� Remove existing wooden fixed dock that is non-compliant and install new compliant dock. 6b. Describe the purpose f the project and why you want or need to perform it. h( ei Property is for recreational use. The existing dock is not structurally sound and is out of compliance with Tacoma Power, Mason County and DFW. We would like to replace the existing dock with a compliant fixed dock and an attached float for property access by watercraft. 6c. Indicate the project ca egory. (Check all that apply) h[ e�pl ❑ Commercial El Residential ❑ Institutional ❑ Transportation ® Recreational ❑ Maintenance Environmental Enhancement 6d. Indicate the major ele ients of your project. (Check all that apply) [help] ❑ Aquaculture ❑ Culvert ® Float ❑ Retaining Wall ❑ Bank Stabilization ❑ Dam /Weir ❑ Floating Home (upland) ❑ Boat House ❑ Dike / Levee/Jetty ❑ Geotechnical Survey ❑ Road ❑ Boat Launch ❑ Ditch ❑ Land Clearing ❑ Scientific Measurement Device ❑ Boat Lift ® Dock/ Pier ❑ Marina/ Moorage ❑ Stairs ❑ Bridge ❑ Dredging ❑ Mining ❑ Stormwater facility ❑ Bulkhead ❑ Fence ❑ Outfall Structure ❑ Swimming Pool ❑ Buoy ❑ Ferry Terminal ❑ Piling/Dolphin ❑ Utility Line ❑ Channel Modification ❑ Fishway ❑ Raft ❑ Other: JARPA Revision 2015.1 Page 5 of 16 6e. Describe how you plan to construct each project element checked in 6d. Include specific construction methods and equipment to be used. h[ eid • Identify where each ele" ent will occur in relation to the nearest waterbody. • Indicate which activitiesllare within the 100-year floodplain. Six separate concrete footings will be required for this design. One will be above the OHW line as a tie back and attachment point to the shoreline. The other five will be imbedded in the lake bed approximately 5', 22' and 42' from the OHW contour. The (5) footings in the lake bed will be (2) 1' —6" diameter x 4' — 0" deep drilled piers, (2) 3'-0" diameter x 6'-0" deep drilled piers and (1) 4'-0" x 4'-0" x 8'-0" grade beam. Four of these piers will support the fixed portion of the dock. The outer most pair will serve as a stop for the float during low water season. 6f.What are the anticipate start and end dates for project construction?(Month/Year) het p . project + If the project will be oo tructed in phases or stages,use JARPA Attachment D to list the start and end dates of each phase or stage. Start date:2/1/17 End date: 5/1/17 ❑ See JARPA Attachment D 6g. Fair market value of1h a project, including materials, labor, machine rentals, etc. h[ elpl $6,000.00 6h.Will any portion of the roject receive federal funding? MU • If yes,list each agency providing funds. ❑ Yes ® No F 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.) hf pm 7a. Describe how the proj ct has been designed to avoid and minimize adverse impacts to wetlands. h( gipl ® Not applicable JARPA Revision 2015.1 Page 6 of 16 7b. Will the project impact' etlands? h[ elpl ❑ Yes ❑ No F Don't know 7c. Will the project impact ivetland buffers? ❑ Yes ❑ No F, Don't know 7d. Has a wetland delineal ion report been prepared? hel • If Yes,submit the repo ,including data sheets,with the JARPA package. ❑ Yes ❑ No 7e. Have the wetlands beE n rated using the Western Washington or Eastern Washington Wetland Rating System? hel • If Yes,submit the wetla rid rating forms and figures with the JARPA package. ❑ Yes ❑ No El Don't know 7f. Have you prepared a Mitigation plan to compensate for any adverse impacts to wetlands? nei • If Yes,submit the plan i with the JARPA package and answer 7g. • If No,or Not applicable,explain below why a mitigation plan should not be required. ❑ Yes ❑ No Not applicable 7g. Summarize what the litigation plan is meant to accomplish, and describe how a watershed approach was used to design the pI in. L 7h. Use the table below tc 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 5tate,(below) where we can find this information in the plan. Lei Activity (fill, Wetland Wetland Impact Duration Proposed Wetland drain, excavate, hlamel type and area (sq. of impact3 mitigation mitigation area flood, etc.) rating ft. or type' (sq. ft. or category2 Acres) acres) JARPA Revision 2015.1 Page 7 of 16 1 '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 or current Western Washington or Eastern Washington Wetland Rating System.Provide the wetland rating forms with the JARPA package. 3Indicate the days,months or years he wetland will be measurably impacted by the activity.Enter"permanent"if applicable. °Creation(C), Re-establishment/Re abilitation(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 i entified in 7h, describe the source and nature of the fill material, the amount in cubic yards that will be used, and show and where it will be placed into the wetland. ei 7j. For all excavating activities identified in 7h, describe the excavation method, type and amount of material in cubic yards you will re ove and where the material will be disposed. LeAi Part 8—Waterbodie (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.) 8a. Describe how the prof ct is designed to avoid and minimize adverse impacts to the aquatic environment. hel ❑ Not applicable JARPA Revision 2015.1 Page 8 of 16 The supporting footings will be placed below lake bed grade. The six support posts will be made of hot dipped galvanized steel to eliminate any degradation of materials into water body. All dock surfaces will be synthetic grating for light transfer. 8b.Will your project imps t a waterbody or the area around a waterbody? h[ ei ® Yes ❑ No JARPA Revision 2015.1 Page 9 of 16 8c. Have you prepared a nPitigation plan to compensate for the project's adverse impacts to non-wetland waterbodies? LbLeM • If Yes,submit the plan with the JARPA package and answer 8d. • If No,or Not applicabl ,explain below why a mitigation plan should not be required. ❑ Yes ❑ No ® Not applicable Installation is very small scale and improves the current structure's impact on the waterbody. 8d. Summarize what the 4itigation plan is meant to accomplish. Describe how a watershed approach was used to design the plan. • If you already complete4 7g you do not need to restate your answer here. h[ ell N/A 8e. Summarize impact(s) to each waterbody in the table below. hel Activity (clear, Waterbody Impact Duration of Amount of material Area (sq. ft. or dredge, fill, pilename' location impact3 (cubic yards) to be linear ft.) of drive, etc.) placed in or waterbody removed from directly affected waterbody Excavate Lak In 5 days 8 cubic yards 50 square feet Cusman waterbody Place concrete Lake In permanent 8 cubic yards 50 square feet Cushman waterbody 'If no official name for the waterbod 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 occir within the 100-year flood plain. 3Indicate the days,months or years he waterbody will be measurably impacted by the work. Enter"permanent"if applicable. 8f. For all activities identifi d in 8e, describe the source and nature of the fill material,amount (in cubic yards) you will use, and how z nd Where it will be placed into the waterbody. hel JARPA Revision 2015.1 Page 10 of 16 Approximately 8 cubic yards of concrete will be placed by concrete pump. 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. [Lelpi Approximately 8 cubic yards of lake bed material consisting of rock cobble, sand and soil will be excavated by auger mounted to a mini excavator with rubber tracks. It would be preferred to grade excavated material around new concrete footings and left in place. If required, material can be exported with small dump trailer to an approved dump facility. 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 w rked with any government agencies on this project,list them below. nel Agency Name Contact Name Phone Most Recent Date of Contact Tacoma Power �Kyrra Wilson (253) 686-0904 04/21/16 Tacoma Power �Wynnae Wright (253) 318-2527 05/12/16 � Mason County R>=b Abo (360) 427-9670 K �(o S 01/12/16 9b. Are any of the wetlan s or yvaterbodies identified in Part 7 or Part 8 of this JARPA on the Washington Department of Ecolpg''s 303(d) List? hf elpl • If Yes,list the paramet r(s)below. • If you don't know,use ashington Department of Ecology's Water Quality Assessment tools at: hftp://www.ec-y.wa.(iov/)roarams/w J303d/. ❑ Yes ® No JARPA Revision 2015.1 Page 11 of 16 9c. What U.S. Geological Survey Hydrological Unit Code (HUC) is the project in? hel • Go to htt ://cf ub.e a. v/surf/locate/index.cfm to help identify the HUC. Skokomish Watershed 171 0017 9d. What Water Resource nventory Area Number(WRIA#) is the project in? bpi • Go to hftp://www.ecy.wEi.00v/services/gis/maps/Wria/Wria.htm to find the WRIA#. d �} 9e. Will the in-water con*uction work comply with the State of Washington water quality standards for turbidity? het • Go to htti)://www.ecv.wi.gov/programs/wq/swqs/criteria.html for the standards. ❑ Yes ❑ No ® Not applicable 9f. If the project is within tt e jurisdiction of the Shoreline Management Act, what is the local shoreline environment designation? net • If you don't know,cunt ict the local planning department. • For more information,Jo to: hftp://www.egy.wa.gov/programs/sea/sma/laws rules/173-26/211 designations html. ❑ Rural ❑ Urban ❑ Natural ❑ Aquatic ❑ Conservancy ❑ Other 9g.What is the Washington Department of Natural Resources Water Type? hel • Go to hftp://www.dnr.wE.aovtforeSt-Dractices-water-typing 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? hel • If No,provide the name of the,manual your project is designed to meet. ❑ Yes ❑ No Name of manual: 9i. Does the project site fi ve known contaminated sediment? heI • If Yes,please describe beioW,. ❑ Yes ® No 9j. If you know what the.p operty was used for in the past, describe below. hLelp7 Recreational JARPA Revision 2015.1 Page 12 of 16 9k. Has a cultural resource, (archaeological) surrey been performed on the project area? [hel • If Yes, attach it to your ARPA,package. ❑ Yes ® No DARPA Revision 2015.1 Page 13 of 16 91. Name each species list d under the federal Endangered Species Act that occurs in the vicinity of the project area or might be affected by the proposed work. hf elpl Scc 9m. Name each species o' habitat on the Washington Department of Fish and Wildlife's Priority Habitats and Species List that mg t be effected by the proposed work. hel 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.oria.wa.gov/opas/. • Governor's Office for Regulatory Innovation and Assistance at (800) 917-0043 or helpCa)_oria.wa.gov. • For a list of addresses to send your JARPA to, click on agency addresses for completed JARPA. 1 Oa. Compliance with the tate!Environmental Policy Act(SEPA). (Check all that apply.) h[ elp] • For more information ab ut SEPA, go to www.egy.wa.gov/programs/sea/sepa/e-review.htmi. ❑ A copy of the SEPA determination or letter of exemption is included with this application. ® A SEPA determinati n is pending with Mason County (lead agency). The expected decision date is December 2016. ❑ 1 am applying fora Fish Habitat Enhancement Exemption. (check the box below in 10b.) hf elp] ❑ This project is exem t (choose type of exemption below). ❑ Categorical Exe ption. Under what section of the SEPA administrative code (WAC) is it exempt? t ❑ Other: ❑ SEPA is pre-empted by federal law. JARPA Revision 2015.1 Page 14 of 16 I I Ob. Indicate the permits you are applying for. (Check all that apply.) hel LOCAL GOVERNMENT Local Government Shoreline permits: ❑ Substantial Development ❑ Conditional Use ❑ Variance `Shoreline ExemptionType (explain): Nlt6v_4,iA !'r i�a�-�✓ '�'�w ,L`�1.D�� (Other City/County permits: ❑ Floodplain Development Permit (Inpritical Areas Ordinance STATE GOVERNMENT Washington Department of Fish and Wildlife: ® Hydraulic Project Approval (HPA) ❑ Fish Habitat Enhancement Exemption —Attach Exemption Form You must submit a check for$150 to Washington Department of Fish and Wildlife, unless your project qualifies for an exemption or alternative payment method below. Do not send cash. Check the appropriate boxes: ®$150 check enclosed. Check# 940 Attach check made pa lable to Washington Department of Fish and Wildlife. ❑My project is exem t from the application fee. (Check appropriate exemption) ❑ HPA processirg is conducted by applicant-funded WDFW staff. Agreement# ❑ Mineral prospecting and mining. ❑ Project occurs on farm and agricultural land. (Attach a copy of current land use classification recorded with the county auditor,or other proof of current land use.) ❑ Project is a modification of an existing HPA originally applied for, prior to July 10, 2012. HPA# Washington Department of Natural Resources: ❑ Aquatic Use Autho zation Complete JARPA Atta hment 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 FEDERAL GOVERNMENT United States Department of the Army permits (U.S. Army Corps of Engineers): ® Section 404 (dischar 3es into waters of the U.S.) ❑ Section 10 (work in navigable waters) United States Coast Guard permits: ❑ Private Aids to Navigation (for non-bridge projects) JARPA Revision 2015.1 Page 15 of 16 Part 11—Authorizing Signatures Signatures are required before submitting the JARPA package. The JARPA package includes the JARPA form, project plans, photos, etc. [help] 11a. Applicant Signature (required) 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 II 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. (ini ial) By initialing here, I state that I have the authority to grant access to the property. I also give my consent to the permitting agencies entering the property where the project is located to inspect the project site or any work related to the project. JP (initial) Jay Per Cook 09/27/16 Applicant Printed Name Applicant Signature Date 11 b. Authorized Agent Signature [help] 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 11c. Property Owner Sign ature (if not applicant) f M Not required if proje t 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 inspec ions shall occur at reasonable times and, if practical, with prior notice to the landowner. Property Owner Printed Name Property Owner 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 n knowing same to contain an false fictitious or fraudulent statement or representations or makes or use any false writing or document o g y , 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: ENV 019-09 rev.09/2015 JARPA Revision 2015.1 Page 16 of 16