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HomeMy WebLinkAboutSHX2017-00041 SEP2017-00046 - SHX Permit / Conditions - 10/3/2017 oN.STATE MASON COUNTY BPS C ° Department of Community Services o A o �N Planning Division o N z 615 W Alder St, Shelton, WA 98684 z� N Y Y (360)427-9670 OJ �O 1864 Exemption from Shoreline Management Act Case No.: SHX2017-00041 Substantial Development Permit Requirement The Proposal By: RANDY ROGNLIN 115 REYNVAAN DR ABERDEEN, WA 98520 Parcel Number: 519014400080 Site Address: 100 W FROSTY LN SOUTH SHELTON To undertake the following development: Replace existing dock with new "L" shaped dock, 44' beyond the OHWM. Within LOST LAKE and/or its associated wetlands is exempt from the requirement of substantial development because the development is categorized under WAC 173-27-040(2) as being category: H-dock Please contact Grace Miller at ext 360 if you have any questions. '&"' AL'&" Issued:10/3/2017 Authorized Local Government Official NR SHX2017-00041 October 03, 201; ON_STA MASON COUNTY �P5 C °� Department of Community Services M o s° = Planning Division N T �? 615 W Alder St, Shelton, WA 98584 J Y �,o~ (360)427-9670 1864 DETERMINATION OF NONSIGNIFICANCE (WAC 197-11-340) SEP2017-00046 Description of Proposal: Replace existing dock with new "L" shaped dock, 44' beyond the OHWM. Proponent: RANDY ROGNLIN Location of Proposal: 100 W FROSTY LN SOUTH SHELTON Parcel Number: 519014400080 Legal Description: TR 8 OF GOVT LOT 10 Directions to Site: CLOQUALLUM RD, L ON LOST LAKE RD, L ON FROSTY LN SOUTH TO SITE ADDRESS AT THE END Lead Agency: Mason County The Lead Agency for this proposal has determined that it does not have a probable significant adverse impact on the environment. An Environmental Impact Statement (EIS) is not required under RCW 43.21 C.030(2)(c). This decision was made after review of a completed Environmental Checklist and other information on file with the Lead Agency. This information is available to the public upon request. Please contact Grace Miller at ext. 360 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 determination is final. Comments must be submitted to Dept. of Community Development, 615 W Alder St, Shelton WA 98584 by 10/17/2017. Appeal of this determination must be filed within a 14-day period following this final determination date, per Mason County Code Chapter 15.11 Appeals. Al a4 ,�lt�Lw it ,��1 3-c 17 Authorized Local Government Official Date 9TATg WP T y�2 �k�788s�O STATE OF WASH INGTON bLPARTMENT OF ECOLOGY PO Box 47775 •Olympia, Washington 98504-7775 •(360)407-6300 711 for Washington Relay Service •Persons with a speech disability can call 877-833-6341 October 17,2017 Ms. Grace Miller Mason County Department of Community Devc opment Planning Division PO BOX 279 Shelton, WA 98584 Dear Ms.Miller: Thank you for the opportunity to comment on t e determination of nonsignificance for the Rognlin Dock Replacement Project(SEP2017-)0046 & SHX2017-00041) located at 100 West Frosty Lane South in Shelton as proposed by R mdy Rognlin. The Department of Ecology (Ecology)reviewed the environmental checklist and has the following comment(s): WASTE 2 RESOURCES: Beth Gill(36 )407-6380 The applicant proposes to demolish an exis ing structure that may contain treated wood. Please refer to Ecology's publication "Focu on Treated Wood Exclusion," available at: htt s:Hfortress.wa. ov/ec / blications/ u lications/0304038. df, for suggested best management practices and di posal require ents for treated wood. For additional information or clarification, please contact Dee Williams with Ecology's Hazardous Waste and Toxics Reduction Program at(360)40 -6348. Ecology's comments are based upon information provided by the lead agency. As such,they may not constitute an exhaustive list of the various authorizations that must be obtained or legal requirements that must be fulfilled in order to carry out the proposed action. If you have any questions or would like to respond to these comments,please contact the appropriate reviewing staff listed above. Department of Ecology Southwest Regional Office (SM:201705196) cc: Beth Gill, W2R Randy Rognlin(Proponent) S T . SEPA Environmental Checklist Mason County Permit Center Use: SEP 201 Single Family DNS: $385 Date R•cvd�--,r% -- �►�!- ❑ Other DNS: 0 to 9.99 acres: $630 ,.� a„� 6 „„ 10 to 20 acres: $755 Over 20 acres: $945 SEA"D ' 0 6 2017 ❑ DS/EIS: $2,525+70 Per hr615 W. r * reet Purpose of checklist: Governmental agencies use this checklist to help determine whether the environmental impacts of your proposal are significant. This information is also helpful to determine if available avoidance, minimization or compensatory mitigation measures will address the probable significant impacts or if an environmental impact statement will be prepared to further analyze the proposal. Instructions for applicants: hf eM This environmental checklist asks you to describe some basic information about your proposal. Please answer each question accurately and carefully, to the best of your knowledge. You may need to consult with an agency specialist or private consultant for some questions. You may use "not applicable" or "does not apply" only when you can explain why it does not apply and not when the answer is unknown. You may also attach or incorporate by reference additional studies reports. Complete and accurate answers to these questions often avoid delays with the SEPA process as well as later in the decision- making process. The checklist questions apply to all parts of your proposal, even if you plan to do them over a period of time or on different parcels of land. Attach any additional information that will help describe your proposal or its environmental effects. The agency to which you submit this checklist may ask you to explain your answers or provide additional information reasonably related to determining if there may be significant adverse impact. Instructions for Lead Agencies: Please adjust the format of this template as needed. Additional information may be necessary to evaluate the existing environment, all interrelated aspects of the proposal and an analysis of adverse impacts. The checklist is considered the first but not necessarily the only source of information needed to make an adequate threshold determination. Once a threshold determination is made, the lead agency is responsible for the completeness and accuracy of the checklist and other supporting documents. A. BACKGROUND h 1. Name of proposed project, if applicable: beg!o [`�ISTINg b vCK E OLA EMCI-r�l 2. Name of applicant: nei � 'Kt- Du ' 26GN�� 3. Address and phone number of applicant and contact person: fneM �P'K�b� RP6'\J � c ELL Pig � W C'19S2D SEPA Environmental checklist(WAC 197-11-960)(MC version-non project portion omitted): 2014 Page 1 of 11 a � 4. Date checklist prepared: nel _ _ 1 -7 5. Agency requesting checklist: r,ei rl P�Sot,) co 0,4-T H 6. Proposed timing or schedule (including phasing, if applicable): 1help ( - f - 1 -7 TH2o 8 - ) - ) 7 7. Do you have any plans for future additions, expansion, or further activity related to or connected with this proposal? If yes, explain. h[ M Pb 8. List any environmental information you know about that has been prepared, or will be prepared, directly related to this proposal. of eipl 9. Do you know whether applications are pending for governmental approvals of other proposals directly affecting the property covered by your proposal? If yes, explain. help N� 10. List any government approvals or permits that will be needed for your proposal, if known. hl eM Mf� seP (-o • rSLZ)G . PCZKJT" 11. Give brief, complete description of your proposal, including the proposed uses and the size of the project and site. There are several questions later in this checklist that ask you to describe certain aspects of your proposal. You do not need to repeat those answers on this page. (Lead agencies may modify this form to include additional specific information on project description.) hel Dora 12. Location of the proposal. Give sufficient information for a person to understand the precise location of your proposed project, including a street address, if any, and section, township, and range, if known. If a proposal would occur over a range of area, provide the range or boundaries of the site(s). Provide a legal description, site plan, vicinity map, and topographic map, if reasonably available. While you should submit any plans required by the agency, you are not required to duplicate maps or detailed plans submitted with any permit applications related to this checklist. Jbftio l oo r2oSTl L-ANE S 4&c-ou \_0 ArSH '�SS$'� SEPA Environmental checklist(WAC 197-11-960)(MC version-non project portion omitted): 2014 Page 2 of 11 B. ENVIRONMENTAL ELEMENTS h 1. Earth a. General description of the site 1hel (circle one): Flat, rolling, hilly, steep slopes, mountainous, other: b. What is the steepest slope on the site (approximate percent slope)? L a Oco 2, YO c. What general types of soils are found on the site (for example, clay, sand, gravel, peat, muck)? If you know the classification of agricultural soils, specify them and note any agricultural land of long-term commercial significance and whether the proposal results in removing any of these SOIIS. hj e� d. Are there surface indications or history of unstable soils in the immediate vicinity? If so, describe. 1bgip 0o e. Describe the purpose, type, total area, and approximate quantities and total affected area of any filling, excavation, and grading proposed. Indicate source of fill. hf eM P 0 P& f. Could erosion occur as a result of clearing, construction, or use? If so, generally describe. Lei 00 g. About what percent of the site will be covered with impervious surfaces after project construction (for example, asphalt or buildings)?lbeto N)bPC h. Proposed measures to reduce or control erosion, or other impacts to the earth, if any: lb2m MbNE 2. Air a. What types of emissions to the air would result from the proposal during construction, operation, and maintenance when the project is completed? If any, generally describe and give approximate quantities if known. 111eM �JoNE b. Are there any off-site sources of emissions or odor that may affect your proposal? If so, generally describe. 1hei O I c. Proposed measures to reduce or control emissions or other impacts to air, if any: lbeM NoNL SEPA Environmental checklist(WAC 197-11-960)(MC version-non project portion omitted): 2014 Page 3 of 11 3. Water ' a. Surface Water: lb,eio 1) Is there any surface 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 what stream or river it flows into. h V✓ l DOCK, 04-1, o N S6�i( H C--PD CF LDS LME t►J M MW 2) Will the project require any work over, in, or adjacent to (within 200 feet) the described CO. waters? If yes, please describe and attach available plans. Itg1pJ `I CIS 1 S EE eNF, 3) Estimate the amount of fill and dredge material that would be placed in or removed from surface water or wetlands and indicate the area of the site that would be affected. Indicate the source of fill material. n[ elpl NDN� 4) Will the proposal require surface water withdrawals or diversions? Give general description, purpose, and approximate quantities if known. hf elM ND 5) Does the proposal lie within a 100-year floodplain? If so, note location on the site plan. Ltplp 4v d 6) Does the proposal involve any discharges of waste materials to surface waters? If so, describe the type of waste and anticipated volume of discharge. b ND b. Ground Water: 1) Will groundwater be withdrawn from a well for drinking water or other purposes? If so, give a general description of the well, proposed uses and approximate quantities withdrawn from the well. Will water be discharged to groundwater? Give general description, purpose, and approximate quantities if known. 1heip ND 2) Describe waste material that will be discharged into the ground from septic tanks or other sources, if any (for example: Domestic sewage; industrial, containing the following chemicals. . . ; agricultural; etc.). Describe the general size of the system, the number of such systems, the number of houses to be served (if applicable), or the number of animals or humans the system(s) are expected to serve. h( g1O NDOe c. Water runoff(including stormwater): 1) Describe the source of runoff(including storm water) and method of collection and disposal, if any (include quantities, if known). Where will this water flow? Will this water flow into other waters? If so, describe. nj eM IVC) SEPA Environmental checklist(WAC 197-11-960)(MC version-non project portion omitted): 2014 Page 4 of 11 2) Could waste materials enter ground or surface waters? If so, generally describe. n.[ eel 3) Does the proposal alter or otherwise affect drainage patterns in the vicinity of the site? If so, describe. N� d. Proposed measures to reduce or control surface, ground, and runoff water, and drainage pattern impacts, if any: 4. Plants hei a. Check the types of vegetation found on the site: rI elpl deciduous tree: alder, maple, aspen, other 4-evergreen tree: fir, cedar, pine, other shrubs grass pasture crop or grain orchards, vineyards or other permanent crops wet soil plants: cattail, buttercup, bullrush, skunk cabbage, other water plants: water lily, eelgrass, milfoil, other other types of vegetation b. What kind and amount of vegetation will be removed or altered?jbplo NDNE c. List threatened and endangered species known to be on or near the site. nI el N oNE- d. Proposed landscaping, use of native plants, or other measures to preserve or enhance vegetation on the site, if any: nei NDOL e. List all noxious weeds and invasive species known to be on or near the site. 5. Animals 4 ] D NE a. List any birds and other animals which have been observed on or near the site or are known to be on or near the site. Examples include: nI f� birds: hawk, heron, eagle, songbirds, other: ps-P `P� �fpt�LrC, mammals: deer, bear, elk, beaver, other: fish: bass, salmon, trout, herring, shellfish, other. '� (Z f,.SS SEPA Environmental checklist(WAC 197-11-960)(MC version-non project portion omitted): 2014 Page 5 of 11 b. List any threatened and endangered species known to be on or near the site. n[ epp DOE, c. Is the site part pouf`a migration route? If so, explain. hel IvD d. Proposed measures to preserve or enhance wildlife, if any: hI e �3DNE, e. List any invasive animal species known to be on or near the site. NoN� 6. Energy and natural resources a. What kinds of energy (electric, natural gas, oil, wood stove, solar) will be used to meet the completed project's energy needs? Describe whether it will be used for heating, manufacturing, etc. hel t\3 b. Would your project affect the p tential use of solar energy by adjacent properties? If so, generally describe. hei ND c. What kinds of energy conservation features are included in the plans of this proposal? List other proposed measures to reduce or control energy impacts, if any: h[ e� 7. Environmental health a. Are there any environmental health hazards, including exposure to toxic chemicals, risk of fire and explosion, spill, or hazardous waste, that could occur as a result of this proposal? If so, describe. hel 1) Describe any known or possible contamination at the site from present or past uses. 2) Describe existing hazardous chemicals/conditions that might affect project development and design. This includes underground hazardous liquid and gas transmission pipelines located within the project area and in the vicinity. 3) Describe any toxic or hazardous chemicals that might be stored, used, or produced during the project's development or construction, or at any time during the operating life of the project. 4) Describe special emergency services that might be required. 5) Proposed measures to reduce or control environmental health hazards, if any: SEPA Environmental checklist(WAC 197-11-960)(MC version-non project portion omitted): 2014 Page 6 of 11 b. Noise 1) What types of noise exist in the area which may affect your project (for example: traffic, equipment, operation, other)? hL ?j60;T 2) What types and levels of noise would be created by or associated with the project on a short-term or a long-term basis (for example: traffic, construction, operation, other)? Indi- cate what hours noise would come from the site. 1neM 5 ,D Pm s Cv p Sv ocvop C AA PM 3) Proposed measures to reduce or control noise impacts, if any: fhefp NONE 8. Land and shoreline use a. What is the current use of the site and adjacent properties?Will the proposal affect current land uses on nearby or adjacent properties? If so, describe. Iteip b. Has the project site been used as working farmlands or working forest lands? If so, describe. V� How much agricultural or forest land of long-term commercial significance will be converted to other uses as a result of the proposal, if any? �JoKIE If resource lands have not been designated, how many acres in farmland or forest land tax status will be converted to nonfarm or nonforest use? h Note 1) Will the proposal affect or be affected by surrounding working farm or forest land normal business operations, such as oversize equipment access, the application of pesticides, tilling, and harvesting? If so, how: 1 ► D c. Describe any structures on the site. hI efP d. Will any structures be demolished? If so, what?1hftM omits .6oCK, e. What is the current zoning classification of the site? hf eM R. f. What is the current comprehensive plan designation of the site?JLeM �Z0P-AL_ g. If applicable, what is the current shoreline master program designation of the site? h UP-g-Ap h. Has any part of the site been classified as a critical area by the city or county? If so, specify. hel �J D SEPA Environmental checklist(WAC 197-11-960)(MC version-non project portion omitted): 2014 Page 7 of 11 i. Approximately how many people would reside or work in the completed project?Lqelp OWE j. Approximately how many people would the completed project displace? fhel Owe k. Proposed measures to avoid or reduce displacement impacts, if any: n[ eipl \)oOE L. Proposed measures to ensure the proposal is compatible with existing and projected land uses and plans, if any: hf eM N C) m. Proposed measures to ensure the proposal is compatible with nearby agricultural and forest lands of long-term commercial significance, if any: I '5C) 9. Housing a. Approximately how many units would be provided, if any? Indicate whether high, middle, or low- income housing. lneie ,, `c tJ E b. Approximately how many units, if any, would be eliminated? Indicate whether high, middle, or low-income housing. JheM M bNG c. Proposed measures to reduce or control housing impacts, if any: of eM NWE 10. Aesthetics a. What is the tallest height of any proposed structure(s), not including antennas; what is the principal exterior building material(s) proposed? n[ e� S F U)DDb CD PST20C7'/p-�J b. What views in the immediate vicinity would be altered or obstructed? n �3DME- c. Proposed measures to reduce or control aesthetic impacts, if any: n( em N c*3E 11. Light and glare a. What type of light or glare will the proposal produce? What time of day would it mainly occur?Jbp!pJ N D` E b. Could light or glare from the finished project be a safety hazard or interfere with views? r Ui] �JD c. What existing off-site sources of light or glare may affect your proposal? 1 of N ON d. Proposed measures to reduce or control light and glare impacts, if any: [help] NDNL SEPA Environmental checklist(WAC 197-11-960)(MC version-non project portion omitted): 2014 Page 8 of 11 12. Recreation a. What designated and informal recreational opportunities are in the immediate vicinity?lte10 Po�� N� �lS�tcNG op b. Would the proposed project displace any existing recreational uses? If so, describe. JLelp Iv c. Proposed measures to reduce or control impacts on recreation, including recreation opportunities to be provided by the project or applicant, if any: h( eM N DNS 13. Historic and cultural preservation a. Are there any buildings, structures, or sites, located on or near the site that are over 45 years old listed in or eligible for listing in national, state, or local preservation registers located on or near the site? If so, specifically describe. nI em A h C) b. Are there any landmarks, features, or other evidence of Indian or historic use or occupation? This may include human burials or old cemeteries. Are there any material evidence, artifacts, or areas of cultural importance on or near the site? Please list any professional studies conducted at the site to identify such resources. h( elm ` Iv c. Describe the methods used to assess the potential impacts to cultural and historic resources on or near the project site. Examples include consultation with tribes and the department of archeology and historic preservation, archaeological surveys, historic maps, GIS data, etc. t!g I� D� d. Proposed measures to avoid, minimize, or compensate for loss, changes to, and disturbance to resources. Please include plans for the above and any permits that may be required. 14. Transportation a. Identify public streets and highways serving the site or affected geographic area and describe proposed access to the existing street system. Show on site plans, if any. ILQpij C La qO PO�LA M, To F R.Vs-( f LAO S b. Is the site or affected geographic area currently served by public transit? If so, generally describe. If not, what is the approximate distance to the nearest transit stop? hI em ND c. How many additional parking spaces would the completed project or non-project proposal have? How many would the project or proposal eliminate? hI elpl T\)DNC SEPA Environmental checklist(WAC 197-11-960)(MC version-non project portion omitted): 2014 Page 9 of 11 d. Will the proposal require any new or improvements to existing roads, streets, pedestrian, bicycle or state transportation facilities, not including driveways? If so, generally describe (indicate whether public or private). JLeM M IV e. Will the project or proposal use (or occur in the immediate vicinity of) water, rail, or air transportation? If so, generally describe. LeM C f. How many vehicular trips per day would be generated by the completed project or proposal? If known, indicate when peak volumes would occur and what percentage of the volume would be trucks (such as commercial and nonpassenger vehicles). What data or transportation models were used to make these estimates? hL�l �) pN E. g. Will the proposal interfere with, affect or be affected by the movement of agricultural and forest products on roads or streets in the area? If so, generally describe. N C) h. Proposed measures to reduce or control transportation impacts, if any: nei ! J DNC 15. Public services a. Would the project result in an increased need for public services (for example: fire protection, police protection, public transit, health care, schools, other)? If so, generally describe. of e� NO b. Proposed measures to reduce or control direct impacts on public services, if any. 1bui 16. Utilities a. Circle utilities currently available at the site: hLel electricity, natural gas, water, refuse service, telephone, sanitary sewer, septic system, other b. Describe the utilities that are proposed for the project, the utility providing the service, and the general construction activities on the site or in the immediate vicinity which might be needed. t,( f ip � f k SEPA Environmental checklist(WAC 197-11-960)(MC version-non project portion omitted): 2014 Page 10 Of 11 C. SIGNATURE net The above answers are true and complete to the best of my knowledge. I understand that the lead agency is relying on them to make its decision. Signature: Date Signed: (� Print Name of Signee: Nfl� R'oG U If applicable, Position and Agency/Organization: Date Submitted: fi;�- SEPA Environmental checklist(WAC 197-11-960)(MC version-non project portion omitted): 2014 Page 11 of 11 i---------- ---- ---- ---------------- #r Tate recei�red: , I1sA�Ycorgs ; SEP 4 6 2017 �IVA��I� GTQ STATE SeaeDWul ti Q[n Aquatic Resources Perm� Agency reference�#A Application (JARPA) Form1,2 Tag Parcel#(s): oW4 USE BLACK OR BLUE INK TO ENTER ANSWERS IN THE WHITE SPACES BELOW. ----------------------------- 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] Part 2—Applicant The person and/or organization responsible for the project. h[ eM 2a. Name (Last, First,Middle) Ll 9 2b. Organization (If applicable) 2s:. Mailing Address (Street or PO Box) - Po 6 �D-7 2d. City, State, Zip 2e. Phone 2f. Phone(2) 2g. Fax 2h. E-mail (360 )533-�C 7SU (40 ),OZ 576 kJUXY 5 CC Additional forms may be required for the following permits: • If your project may qualify for Department of the Army authorization through a Regional General Permit(RGP),contact the U.S.Army Corps of Engineers for application information(206)764-3485. • if your project might affect species listed under the Endangered Species Act,you will need to fill out a Specific Project Information Form(SPIF)or prepare a Biological Evaluation. Forms can be found a httQ://www.nws.usace_arm .mil/Missions/Civi[VVorks[R ulato /PermitGuidebook/EndangeredS ecies.as x- • Not all cities and counties accept the JARPA for their I aal Shoreline permits.If you need a Shoreline permit,contact the appropriate city or county govemment to make sure they accept the JARPA. Zfo access an online DARPA form with[help]screens,go to htto://www.epemittina.wa.00v/site/alias resourcecenterfiarpa iarpa form/99B4[larpa form asox. For other help,contact the Governor's office of Regulatory Assistance at 1-800-917-DD43 or heb a(2ora.wa.gov. JARPA Revision 2012.1 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.) kelp 3a. Name (Last,First, Middle) RQGMUO RKtqb� 3b. Organization (if applicable) 3c. Mailing Address (Street or Po'Box) 30-7 3d. City, State, Zip 3e, Phone (1) 3f. Phone(2) �!._ 3g, Fax 3h. E-mail (360 ;3 16GV (3 D �Sg ( 3ZS7 p ps 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. hem 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 DARPA Attachment A for each additional property owner. ❑ 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 dARPA Attachment E I o apply for the Aquatic Use Authorization. 4a.. Name (Last, First, Middle) 4b. Organization (►f applicable) 4c. Mailing.Address (Street or PO Box) 4d. City, State, Zip 4e. Phone(1) 4f. Phone(2) 4g. Fax E-mail JARPA P.evision 2012.1 Page 2 of 14 Part 5—Project Location(s) Identifying information about the property or properties where the project will occur. k ❑ There are multiple project locations (e.g. linear projects). Complete the section below and use JARPA Attachment B for each additional project location. Sa. Indicate the type of ownership of the property. (Check all that apply.) h[ etpj � Private ] Federal ❑ Publicly owned (state, county, city, special 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.) �D RMT%1 L A(PE, S Sc. City, State, Zip (If the project is not in a city or town, provide the name of the nearest city or town.) hei 11 pS axo W A-5 wA &5 5 . County P Soo r(--pVJAY Se. Provide the section, township, and range for the project location. Ekm 1f4 Section Section Township 1 Range 5f. Provide the latitude and longitude of the project location. hf eM Example:47.03922 N lat./-122.89142 W Iong. (Use decimal degrees-NAD 83) 5g. List the tax.parcel number(s) for the project location. h[ eM • The local county assessors office can provide this information. Sl �( DI �j `-` — bbDZ3Cb Sh. Contact information for all adjoining property owners. (If you need more space, use JARPA Attachment C.) hLem Name Mailing Address Tax Parcel# (if known) JARPA Revision 2012.1 Page 3 of 14 Si. List all wetlands on or adjacent to the project location. h[ e� 5j. List all waterbodies (other than wetlands) on or adjacent to the project location. ne! Las( L-Pt KF- 5k. is any part of.the project area within a 100-year floodplain? hey ❑ Yes F'qNa ❑ Don't know 51. Briefly describe she vegetation and habitat conditions on the property. help GfA%J S4ePCEU0 Tt� 5M. Describe how the property is currently used. hey 5n. Describe how the adjacent properties are currently used. he► GCS MM�JZ 4UZATI©PAL ROACS 5o. Describe the structures (above and below ground) on the property, including their purpose(s) and current condition. help TZ 0 C hgltJ Fh 2 co uAi loA-) 5p. Provide driving c€irections from the closest highway to the project location, and attach a map. help (!f La (�O AILLA A 1 D PC�r T UD-X) Pee�TR e ar L u TVA O V.s ��( 5N F P-oq 7 LAx)L T E J Lem �5(`( LAt-TE �l C�b T6 El-b of kOAb JARPA Revision 2012.1 Page 4 of 14 Part 6—Project Description Sa. Briefly summarize the overall project. You can provide more detail in 6b. h[ eM F111-ISTI NCB DOCK 6b. Describe the purpose of the project and why you want or need to perform it. help 6c. Indicate the project category. (Check all that apply) hi elpl ❑ Commercial ❑ Residential ❑ Institutional ❑ Transportation ❑ Recreational ,Maintenance ❑ Environmental Enhancement 6d. Indicate the major elements 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 f.WAX,0& Measurement Device ❑ Boat Lift Dock/ ❑ 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: DARPA Revision 2012.1 Page 5 of 14 fie. Describe hour you plan to construct each project element checked in 6d. Include specific construction methods and equipment to be used. Lego • Identify where each element will occur in relation to the nearest waterbody. Indicate which activities are within the 1 OD-year fioodp.lain. T HeP :SL[D wro 1 LUCRE �`� kAPb �b 6LS F L®Pr(( P6 T`i Pt� 6f. What are the anticipated start and end dates for project construction? (Month/Year) Lei • 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: (v ' 7 End date: Z� — ' ❑ See JARPA Attachment D 6g. Fair market value of the project, including materials., labor, machine rentals, etc. h(ePM 100 Lfob 6€t. Will any portion of the project receive federal funding? help • If yes, list each agency providing funds. ❑ Yes N� No ❑ Don't know Part 7—Wetiands: Impacts and Mitigotion ❑ Check here if there are wetlands or wetland buffers on or adjacent to the project area. (If there are none, skip to Part 8.) helo 7a. Describe how the project has been designed to avoid and minimize adverse impacts to wetlands. h( eM Not applicable 7b. Will the project impact wetlands? help ❑ Yes ❑ No ❑ Don't know JARPA Revision 2012.1 Page 6 of 14 7c. Will the.project impact wetland buffers? h[ elf ❑ Yes No ❑ Don't know 7d. Has a wetland delineation report been prepared? hh p • If Yes,submit the report, including data sheets,with the DARPA package. ❑Yes [� No 7e. Have the wetlands been rated .using the Western Washington or Eastern Washington Wetland Rating System? hl eM �5 j N • If Yes,submit the wetland rating forms and figures with the JARPA package. ❑ Yes ❑ No Don't know 7f. Have you prepared a mitigation plan to compensate for any adverse impacts to wetlands? hf em • If Yes,submit the plan with the JARPA package and answer 7g. • if No,.or Not applicable,explain below why a mitigation plan should not be required. ❑ Yes ❑ No Not applicable �ZE.PLI (4 06 El lS>1-106 I�p CR �*5 PC) E_�lcFECT- o p W G l Lwb--S 7g. Summarize what the mitigation plan is meant to accomplish, and describe how a watershed approach was used to design the plan. h[ eM 7h. Use the table below to list the type and rating of each wetland impacted, the extent and duration of the impact, and the type and amount of mitigation proposed. Or if you are submitting a mitigation plan with a similar table, you can state (below) where we can find this information in the plan. h[ ems] Activity (fill, Wetland Wetland impact duration Proposed Wetland drain, excavate, Name' type and area (sq. of impact3 mitigation mitigation area flood, etc.) rating ft. or type' (sq. ft. or category2 Acres) acres) If no official name for the wetland exists,create a u as a wetland delineation report. nique nar rie(such as"Wetland 1"). The name should be consistent with other project documents,such 2 Ecology wetland category based on current Western Washi r gton or Eastern Washington Wetland Rating System.Provide the wetland rating forms with the DARPA package. 3 Indicate 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: DARPA Revision 2012.1 Pace 7 of 14 7i. For all filling activities identified in 7h, describe the source and nature of the fill material, the amount in cubic yards that will be used, and how and where it will be placed into the wetland. heb 7}. 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. h� eM Part 8—Waterbadies (other than wetlands): Impacts and Mitigation In Part 8, "waterbodies" refers to non-wetland waterbodies. (See Part 7 for information related to wetlands.) EheM ❑ Check here if there are waterbodies on or adjacent to the project area. (If there are none, skip to Part 9.) Sa. Describe how the project is designed to avoid and minimize adverse impacts to the aquatic environment. h ❑ Not applicable �-EPLP-CE No,��'i of ���sTl 6 arc DF Q K ��1 8b. Will your project impact a waterbody or the area around a waterbody? hf g iM ❑ Yes ryZ No JARP^,Revision 2012.1 Page 8 6i 14 Sc. Have you prepared a mitigation plan to compensate for the project's adverse impacts to non-wetland waterbodies? hei • If Yes,submit the plan with the JARPA package and answer 8d. • If No, or Not applicable.,explain below why a mitigation.plan should not be required. ❑ Yes ❑ No Not appficable 5 Sd. Summarize what the mitigation plan is meant to accomplish. Describe how a watershed approach was used to design the plan.. • If you already completed 7g you do not need to restate your answer here. h( t-M V) [k Be. Summarize impact(s) 'to each waterbody in the table below. hf eM Activity (clear, Waterbody Impact Duration Amount of material Area (sq. ft. or dredge, fill, pile narne' location2 of impact3 (cubic yards) to be linear ft.) of drive, etc.) placed in or waterbody removed from directly affected waterbody :ii\j If no official name for the waterbody exists, create a unique name(such as"Stream 1")The name should be consistent with other documents provided. 2 Indicate 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. a Indicate the days,months or years the waterbody will be measurably impacted by the work. Enter"permanent"if applicable. Wk. 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 JARPA Revision 2012.1 Page 9 of 14 €fig. 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. rheipi I v 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. h[ e Agency Name Contact Name Phone Most Recent Date of Contact 9b. 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? h[ elpl • If Yes,list the parameter(s)below. • If you don't know., use Washington.Department of Ecology's Water Quality Assessment tools at: http:llwww-ecV.wa.gov/r)ro,grams/wq/303d/. ❑ Yes No 9E. What U.S. Geological Survey Hydrological Unit Code(HUC) is the project in? [Lem . • Go to httQ://cfpub.epa.gov/surf/locatefiindex.cfm to'help identify the HUC. 9d. What Water Resource inventory Area Number (WRiA#) is the project in? JbLtM « Go to http://www.ecy.wa.gov/services/gis/maps/wia/Wria.htm to find the WRIA#. 1 JARPA R=vision 2012.1 Page 10 of 14 9e. Will the in-water construction work comply with the State of Washington water quality standards for turbidity? ,el • Go to httD://www.ecy.wa.gov/programs/Wo/swgs/criteria.html for the standards. Yes ❑ No ❑ Not applicable 9f. If the project is within the jurisdiction of the Shoreline Management Act, what is the local shoreline environment designation? hfe] • If you don't know, contact the local planning department. • For more information, go to:http://www.ecy.wa:,qov/programs/sea/sma/taws rules/173-26/211 designations html. IVRural ❑ Urban ❑ Natural ❑Aquatic ❑ Conservancy ElOther 9.g. What is the Washington Department of Natural Resources Water Type? rhelpi • Go to http.//www.dnr.wa.gov/B.usinessPermits/Tonics/ForestPracticesAppiications/Pages/fp watertypina aspx 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? hLPj • If No, provide the name of the manual your project is designed to meet. Yes ❑ No - Name of manual: GIL Does the project site have known contaminated sediment? hel • If Yes, please describe below. ❑ Yes No 9j. If you know what the property was used for in the past, describe below. hi elP� �ECP-CATICVAL SuMM C �8! hg 9k. Has a cultural resource (archaeological) survey been performed on the project area? h[ el • If-Yes, attach it to your DARPA package. ❑ Yes No JARPA Revision 2012.1 Page 11 of 14 9.1. Name each species fisted under the federal .Endangered Species Act that occurs in the vicinity of the project area or might be affected by the proposed work. hel 9m. 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. hel l A GLE Part 10—SEPA Compliance and Permits Use the resources and checklist below to identify the permits you are applying for. • Online Project Questionnaire at http://apps.ecy.wa.gov/opas/. • Governor's Office of Regulatory Assistance at (800) 917-0043 or help(d)-ora.wa.gov. • For a list of addresses to send your JARPA to, click on agency addresses for completed JARPA.. 1 Oa. Compliance with the State Environmental Policy Act (SEPA).. (check all.that apply.) hei • For more information about SEPA,go to www ecy wa gov/programs/sea/sepa/e-re\iew,html. ❑ A copy of the SEPA determination or letter of exemption is included with this application. ❑ A SEPA determination is pending with f lkSDe> Ctry4(lead agency). The expected decision date is v ❑ i am applying for a Fish Habitat Enhancement Exemption. (check the.box below in lob.) hell ❑ This project is exempt (choose type of exemption below). ❑ Categorical Exemption. Under what section of the SEPA administrative code (WAC) is it exempt? ❑ Other: ❑ SEPA is pre-empted by federal law. DARPA Revision 2012.1 Page 12 of 14 I Ob. indicate the permits you are applying for. (Check all that apply.) h[ ele) .LOCAL GOVERNMENT Local Government Shoreline permits: ❑ Substantial Development ❑ Conditional Use 0 Variance Lpj Shoreline Exemption Type (explain): NpR M LAN1pMN&oC,E AP,4 WAX Other city/county permits: ❑ Fioodplain Development Permit ❑ Critical Areas Ordinance STATE GOVERNMENT Washington Department of Fish and Wildlife: ❑ Hydraulic Project Approval (HPA) ❑ Fish Habitat Enhancement Exemption—Attach Exemption Form Effective July 10, 2012, 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# Attach check made payable to Washington Department of Fish and Wildlife. ❑Charge to billing account under agreement with WDFW. (Agreement# } ❑My project is exempt from the application fee. (Check appropriate exemption) ❑ HPA processing 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 Authorization Complete JARPA 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 FEDERAL GOVERNMENT United States Department of the Array permits (U.S. Array Corps of Engineers): ❑ Section 404 (discharges into waters of the U.S.) ❑ Section 10 (work in navigable waters) United States Coast Guard permits: ❑ General Bridge Act Permit ❑ Private Aids to Navigation (for non-bridge projects) JARPA Revision 2012.1 Page 13 of 14 Part II—Authorizing Signatures Signatures are required before submitting the JARPA package. The JARPA package includes the JARPA form, project plans, photos., etc. rhelpi 11 a. Applicant Signature (required) rhelpi I certify that to the best of my knowledge and belief, the information provided in this application is true, complete, and accurate. I also certify that i have the authority to carry out the proposed activities, and I agree to start work only after I have received all necessary permits. I hereby autho ' e the agent named in Part 3 of this application to act on my behalf in matters related to this application. ILL (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 entering the property where the project is located to inspect the project site or any work related to the project. _ (initial) Applicant Printed Name Applicant Si ature Da 11 b. Authorized Agent Signature hei 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. Author€zed Agent Printed Name Authorized ent Sig ture Date 11 c. Property Owner Signature (if not applicant). hLeM Not required if project is on existing rights-of-way or easements. I consent to the permitting agencies entering the property where the project is located to inspect the project site or any work. These inspections shall occur at reasonable times and, if practical, with prior notice to the landowner. S Property Owner Printed Name Property Ow Signa u e 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,fiCtIIIOU&, 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$10,0D0 or imprisoned not more than 5 years or both. If you require this document in another format, contact the Govemor's Office of Regulatory Assistance (ORA)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. ORA publication number. ENV-019-09 rev. 06-12 dARPA Revision 2012.1 Page 14 of 14