HomeMy WebLinkAboutSHX97-0046 Lake Outlet Ditch Maintenence - SHX Permit / Conditions - 10/9/1997 MASON COUNTY
DEPARTMENT OF COMMUNITY DEVELOPMENT
Planning-Landfill-Utilities S4A 97--Ca�,
EXEMPTION FROM SHORELINE MANAGEMENT ACT � .1
SUBSTANTIAL DEVELOPMENT PERMIT REQUIREMENT
The Proposal by: ELMA COUNTRY CLUB
ATTN: JOHN HILL
103 HERITAGE DRIVE
ELMA WA 98541
To undertake the following development :
perform maintenence cleaning of 3 foot wide drainage ditch swale at
southerly end of Lost Lake, to provide unobstructed flow for overflow
water from Lost Lake during winter storm events. Ditch will be
immediately reseeded.
within LOST LAKE )) Olt Cloquallum Road to 10 mile marker, right
on Lake Forest Labe, at fork in road turn right on Lake Forest Lane East .
Project is on left at W 99 Lake Forest Lane East .
and/or its associated wetlands is exempt from the requirement of
substantial development because the development is Maintenance & Repair
WAC 173 -14-040- (B) .
Corps Public Notice Reference
W'--la ,
((ftw'wp�
ISSUED: 10/09/97 EXPIRE: 10/09/99
This exemption authorizing construction shall be valid for two (2) years
provided construction has begun within two (2) years of approval date.
This exemption may be extended to five (5) years upon request prior to
expiration.
A�4" /o - 9-S
Authorized Wcal Government Official
QLI)OA m/PC#E"-
cc : APPLICANT WDFW "- USACOE
WDOE WDW CMMRS/DIRECTOR OF DCD
TRIBAL COUNCIL
(QWAc-)(J►� )
SHX_FORM, rev: 03/24/92
Conditions of this Case are listed below:
Case No.:SHX97-0046
1 ) Erosion control measures such as straw bales and silt fences
shall be in place prior to start of project and shall remain in
place until danger of erosion is past.
2) Revegetation of drainage swale shall occur immediately after
project completion and ongoing maintenance and care shall occur to
ensure the success of revegetation.
3) If necessary this project may require additional measures to
control erosion of swale during storm events prior to successful
revegetation. These measures may need to include placement of and
securing geotextile or similar on bed of drainage swale to prevent
silt entering wetlands.
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JARPA FORM •ten
(for usa in Washington State) /�
PLEASE TYPE OR PRINT IN BLUE OR BLACK INK q—7
Based on the preceding checklist,I am sending copies of this application to the following: (check all that apply) 1
Local Government for shoreline: ❑Substantial Development ❑Conditional Use ❑Variance ❑Exemption;or,if applicable
❑FloodpWn Management ❑Critical Areas Ordinance
Washington Department of Fish and Wildlife for HPA
❑ Washington Department of Ecology for. ❑Approval to Allow Temporary Exceedance of dater Quality Standards
❑401 Water Quality Certification Nationwide Permits
❑ Washington Department of Natural Resources for.❑Aquatic Resources Use Authorization Notification
I r"I Corps Engineers for ❑Section 404 ❑Section I110 permit
❑ Coast Guard for. ❑Section 9 Bridge Permit
SECnON A -Use for all permits covered by this application. Be sure to also complete Section C(Signature Block)for all permit
applications.
1.APPLICANT X
MAILING ADDRESS J LA
err, r c'(. p
WORK PHONE HOME PHONE FAX 4
: ` 3
If an agent is acting for the applicant during the permit process,complete#2.
2 AUTHORIZED AGENT
MAILING ADDRESS
WORKPHONE HOMEPHONE FAX#
3.RELATIONSHIP OF APPLICANT TO PROPERTY: OWNER ❑PURCHASER 17 LESSEE 0 OTHER:
4.NAME,ADDRESS,AND PHONE NUMBER OF PROPERTY OWNER(S),IF OTHER THAN APPLICANT:
L
5.LOCATION(STREET ADDRESS,INCLUDING CITY,COUNTY AND ZIP CODE,WHERE PROPOSED ACTIVITY EXISTS OR WILL OCCUR)
WATERBODY TRIBUTARY OF
1/4 SECTION TOWNSHIP RANGE GOVERNMENT LOT SHORELINE DESIGNATION
J „ / J L,f? - -nt a71 f�L
ZONING DESIGNATION
TAX PARCEL NO.: DNR STREAM TYPE,IF KNOWN
CMVVVf-�"'V'
Application Page 1 of 4
8 DESCRIBE THE CURRENT USE OF THE PROPERTY.AND STRUCTURES EXISTING ON THE PROPERTY. IF ANY PORTION OF THE PROPOSED ACTIVITY IS ALREADY COMPLETED r
ON THIS PROPERTY.INDICATE MONTH AND YEAR OF COMPLETION.
IcoP tJn`� ser rtcuCc�v7rnr �7e��es
IS THE PROPERTY AGRICULTURAL LAND?0 YES 0 NO ARE YOU A USDA PROGRAM PARTICIPANT? ❑YES 0 NO
7a. DESCRIBE THE PROPOSED WORK:COMPLETE PLANS AND SPECIFICATIONS SHOULD BE PROVIDED FOR ALL WORK WATERWARD OF THE ORDINARY HIGH WATER MARK OR
AS dfSCLA.SSQ, JOWL W ILC3C'�M ��Y1r C G r' c
work `fio p e' 'r►�^� tr� �- o R Cu trer1t
&610 o z-i�t-j Is rx -mie- "t I auwve k 4 E t
�� -- e�'�, 0�v Tk' S 'M� -� �- o- �T t a.tce rC� art .
1� Ices
�`S C�rY�n� ��C3[t �C;�11� 1 S c��a�r�X�rn w��� 3 W 4� '�- �'►'1�
A �p 0 r•pC"110 A 0
th a �r'T�,�Sen.�� pl�Uec��cY, cXncC 1��otS iYt �`he
C, c"N ey� t h eh 66sT/We4T pi'veL�i`�e Road.
�Yal� S®h'ti� Lt�'in� J,
d VYW1 P Ic h%4)'k wCk�Qr tt r»�s. i vcc`I�f V_ v '�►-� l'�I S rm>✓I �� °
G��(ve� -f owJ ttAr .�Y— i'Sc1�c-tft'S cr��i� Thy' I,,r TO
7b.DESCRIBE THE PURPOSE OF THE PROPOSED WORK.
Iliie pjkr ose o-A Ti-ke pmIg ryd oork y,s— to p(r4r MCItA4tf1ck
ekrmnT �� 7V P
We er dL4ni1 PHh've. TC' 1p�
7c. DESCRIBE THE POTENTIAL IMPACTS TO CHARACTERISTIC USES OF THE WATER BODY. THESE USES MAY INCLUDE FISH AND AQUATIC LIFE,WATER DUALITY.WATER
SUPPLY,RECREATION,and AESTHETICS. IDENTIFY PROPOSED ACTIONS TO AVOID,MINIMIZE,AND MITIGATE DETRIMENTAL IMPACTS,AND PROVIDE PROPER PROTECTION
PREPARATION OF DRAWINGS: SEE APPENDIX A-SAMPLE DRAWINGS AND CHECKLIST FOR COMPLETING THE DRAWINGS. ONE SET OF ORIGINAL OR GOOD OUALITY
REPRODUCIBLE DRAWINGS MUST BE ATTACHED. NOTE: APPLICANTS ARE ENCOURAGED TO SUBMIT PHOTOGRAPHS OF THE PROJECT SITE:,BUT THESE DO NOT SUBSTITUTE
FOR DRAWINGS. THE CORPS OF ENGINEERS AND COAST GUARD REQUIRED RA WINGS ON 8-112 X 11 INCH SHEETS. LARGER DRAWINGS MAYBE REQUIRED BY OTHER
AGENCIES
8,WILL THE PROJECT BE CONSTRUCTED IN STAGES? ❑YES NO
PROPOSED STARTING DATE:
Application Page 2 of 4
SECTION B-Use for Shoreline and Corps of Epgineers permits gnly:
I& TOTAL COST OF PROJECT.THIS MEANS THE FAIR MARIO:T VALUE OF THE PROJECT,INCLUDING MATERIALS,LABOR,MACHINE RENTALS,ETC.
r r tknar Q, CL w m t a.
17. LOCALGOVERNMENTWITH IISDOW
1& FOR CORPS,COAST GUARD,AND DNR PERMITS,PROVIDE NAMES,ADDRESSES.AND TELEPHONE NUMBERS OF ADJOINING PROPERTY OWNERS,LESSEES,ETC,p E
NOTE:SHORELINE MANAGEMENT COMPLIANCE MAY REOUIRRADDITIONAL NOTICE—CONSULT YOUR LOCH.GOVERNMENT.
NAME ADDRESS PHONE NUMBER
-------------
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SECTION C-This section MUST be completed for any permit covered by this application.
1D. APPLICATION IS HEREBY MADE FOR A PERMIT OR PERMITS TO AUTHORIZE THE ACTIVITIES DESCRIBED HEREIN. 1 CERTIFY THAT I AM FAMILIAR WITH THE
INFORMATION CONTAINED IN THIS APPUCATION,AND THAT TO THE BEST OF W'KNOWLEDGE AND BELIEF,SUCH INFORMATION IS TRUE,COMPLETE,AND
ACCURATE. 1 FURTHER CERTIFY THAT I POSSESS THE AUTHORITY TO UNDERTAKE THE PROPOSED ACTIVITIES. 1 HEREBY GRANT TO THE AGENCIES TO
WHICH THIS APPLICATION IS MADE,THE RIGHT TO ENTER THE ABOVE-DESCRIBED LOCATION TO INSPECT THE PROPOSED,IN-PROGRESS OR COMPLETED
WORK 1 AGREE TO START WORKMY AFTER ALL NECESSARY PERMITS HAVE BEEN RECET!ED.
SIGNATURE OF APPLICANT ORAUTHORIfED AGENT L_h '4
t DATE 7
1 HEREBY DESIGNATE 61
TO ACT AS MY AGENT IN MATTERS RELATED TO THIS APPLICATION FOR PERMIT(S). I UNDERSTAND THAT IF A FEDERAL PERMIT IS ISSUED.I MUST SIGN THE PERMIT.
SIGNATURE OF APPLICANT DATE
SIGNATURE OF LANDOWNER(EXCEPT PUBLIC ENTRY LANDOWNERS.E.G.
DATE
eI 9(rt f c Av
THIS APPLICATION MUST BE SIGNED BY THEAPPLICANT AND THE AN AUTHORIZED AGENT IS DE .
IS U.S.0 61001 provides that: Whoever,in any roamer within the Jurisdiction of arty department or agency of the Unked States
deNa a material fact or makes any false,fictitious.or trauduleM statements or 9tY falsifies,oatoeals,or covers up by any trick scheme.or
fraudulxn statement or entry,shall be fined not more than$i O,tXX1 or kn or makes or uses any false writing or do=*M knowing same to oonten any false.fiddious,or
prisoned not mare than 5 years or both.
3
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a..:•r f� � �� �. �x�•��. s ., � s��._£� r�yx,. �� �� � � .: r2 t,� � �� � ' a.Js � r`�s� .::,�'�S y�„wa„�'°����,..t. �'�` i :� � ��
:a,,,✓ �, ,.€,,a. .v. � a,,,.,r,,:,: 't,�;'... �,�; . fi � x� � s gg �s x k� � s,s yam,c
These Agencies are Equal Opportunity and Affirmative Action employers.
For speraal accommodation needs,please contact the appropriate agency from Appendix B.
Application Pape 4 o1 4
r ESTIWtTED DURATION OF ACTIVITY'
f
Di.CHECK IF ANYSTRUCTURES WILL BE PLACED:
Q WATERWARD OF THE ORDINARY HIGH WATER MARK OR LINE FOR FRESH OR TIDAL WATERS:AND/OR
O HIGH
WATERWARD OF THE MEAN HH WATER LINE IN TIDAL WATERS
10.WILL FILL MATERIAL(ROCK,FILL,BULKHEAD.PILINGS OR OTHER MATERUQ BE PLACED:'
Q WATERWARD OF THE ORDINARY HIGH WATER MARK OR LINE FOR FREI:H WATERS? IF YES,VOLUME(CUBIC YARDS) /AREA (ACRES
17 WATERWARD OF THE MEAN HIGHER HIGH WATER FOR TIDAL WATERS? IF YES,VOLUME(CUBIC YARDS) /AREA (ACRES)
11.WILL MATERIAL BE PLACED IN WETLANDS? El YES, NO
IF YES-
A.IMPACTED AREA IN ACRES:
B.HAS A DELINEATION BEEN COMPLETED? IF YES.PLEASE SUBMIT WITH APPLICATION. E3 YES, /
C.HAS A WETLAND REPORT BEEN PREPARED? IF YES,PLEASE SUBMIT WITH APPLICATION. O YES,*NO
D.TYPE AND COMPOSITION OF FILL MATERIAL(E.G.,SAND.ETC.):
E.MATERIAL SOURCE:
F.LIST ALL SOIL SERIES(TYPE OF SOIL)LOCATED AT THE PROJECT SITE.&INDICATE IF THEY ARE ON THE COUNTY'S LIST OF HYDRIC SOILS. SOILS INFORMATION CAN BE
OBTAINED FROM THE NATURAL RESOURCES CONSERVATION SERVICE(tom x
IZ WILL PROPOSED ACTIVITY CAUSE FLOODING OR DRAINING OF WETLANDS? ---�— 0 YES R110
IF YES,IMPACTED AREA IS_ACRES
IS.WILL EXCAVATION OR DREDGING BE REQUIRED IN WATER OR WETLANDS? C3 YES. O.
IF YES:
A.VOLUME:_(CUBIC YARDS)/AREA_(ACRES)
B.COMPOSITION OF MATERIAL TO BE REMOVED:
C.DISPOSAL SITE FOR EXCAVATED MATERIAL-
D.METHOD OF DREDGING:
14.UST OTHER APPLICATIONS.APPROVALS,OR CERTIFICATIONS FROM OTH(=R FEDERAL,STATE OR LOCAL AGENCIES FOR ANY STRUCTURES,CONSTRUCTION,DISCHARGES,
OR OTHER ACTIVITIES DESCRIBED IN THE APPLICATION(I.E.PRELIMINARY PLAT APPROVAL.HEALTH DISTRICT APPROVAL,BUILDING PERMIT,SEPA REVIEW,FERC LICENSE,
FOREST PRACTICES APPLICATION,ETC.)ALSO INDICATE WHETHER WORK HAS BEEN COMPLETED AND INDICATE ALL EXISTING WORK ON DRAWINGS.
TYPE OF APPROVAL ISSUING AGENCY IDENTIFICATION NO. DATE OF APPLICATION DATE APPROVED COMPLETED?
SEPAL EAD AGENCYSEPA DECISION: SEPA DECISION DATE
;5 HAS ANY AGENCY DENIED APPROVP-' FOR THE ACTIVITY DESCRIBED HEREIN OR FOR ANY ACTIVITY DIRECTLY RELATED TO THE ACTIVITY
DESCRIBED HEREIN?❑YES`04�0 IF YES,EXPLAIN:
Application Pape 3 o1 4