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HomeMy WebLinkAboutSEPA2010-00057 - SEP Determinations - 10/25/2007 r--------------------------------------- 2 O 0 9 AGENCY USE ONLY 1e� US Army Corps Date received: of Engineers a WASHINGTON STATE SeaMeo�twl Joint Aquatic Resources Permit Application (JARPA) Form Lbpjpj Agency reference# USE BLACK OR BLUE INK TO ENTER ANSWERS IN WHITE SPACES BELOW. Tax Parcel#(s): i i i 1 i i Part 1—Project Identification `---------- -----'-----'------ 1. Project Name(A unique name for your'project that you create.',Examples: Smith's Dock or Seabrook Lane Development) hel 0 C J G N t—.4 M/ L--y 4 f- W—P f—cA ea Part 2—Applicant The person or organization responsible for the project. [heip] 2a. Name.(Last, First,Middle)and Orgat izatiO! (if applicable) Oc.sC—A/�, i14S-,,V f 41V,0.e ti/ 2b. Mailing Address(street or Po Box) 3.2— CO V f' L eV 2c. City, State, Zip 2d. Phone(1) 2e. Phone(2) 2f. Fax 2 . E-mail (34�­ ) q&7 -fvtif ( 36- ) q3� (866 ) 99 Part 3—Authorized Agent or Contact Person authorized to represent the applicant about the project. (Note: Authorized agent(s) must sign 11 b. of this application.) h[gip] 3a. 'Name(Last, First, Middle) and Organization (if applicable) s4m e 3b. Mailing Address(Street or PO Box) 3c. City, State, Zip 3d. Phone(1) 3e. Phone(2) 3f Fax 3 . E-mail' JARPA 2009 Page 1 of 11 Part 4—Property Owner(s) nil Contact information for people or organizations owning the property(ies)where the project will occur. 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 property owners. Complete the section below and use DARPA Attachment A for each additional property owner. 4a. Name(Last, First,Middle)and Organization (if applicable) 4b. Mailing Address(Street or PO Box) 4c. City, State, Zip 4d, Phone(1) :4e. Phone(2) 4f Fax 4 . E-mail Part 5—Project Location(s) Identifying information about the property or properties where the project will occur. hel ❑ There are multiple properties or project locations (e.g., linear projects). Complete the section below and use JARPA Attachment B for each additional property. 5a. Street Address (Cannot be a PO Box. If there is no address,provide other location information in 5n.) hel J L M A/ 5b. City, State, Zip(If the project is not in a city or town,provide the name of the nearest city or town.) [help 5c.:County hel 5d. Provide the section, township, and range for the project location. h( elat 1/4 Section.. Section Township Range 5e. Provide the latitude and longitude of the project location. hel • Example:47,03922'N lat./ 122.89142 W long u A/,S:-f,-rF 5f. List the tax parcel number(s) for the project location. h[ elpi • The local county assessor's office can provide this information. ✓r ( q 0/ jq 600 6�- 5g., Indicate the type of ownership of the property. (Check all that apply.)' hf elpl ❑ State Owned Aquatic Land ❑ Tribal [Private ❑ Other publicly owned (federal, state, county, city,special districts like schools, ports,etc.) JARPA 2009 Page 2 of 11 5h. Contact information for all adjoining property owners, lessees, etc. (if you need more space,use JARPA Attachment G.) h[ ell ] Name Mailing Address Tax Parcel #(if known) Co J-4 126 w F2ws c cN (o LI/ F� ©�J rY I-All v / c� M (G �� ,MGG ��� 5i. Is any part of the project area within a 100-year•flood plain? hei ❑ Yes ❑ No Don't know 5j. Briefly describe the vegetation and habitat conditions on the property. her 5k. Describe how the property is currently used. h[ eip] V4cA-rr .N iFaA- 9-7 51.' Describe how the adjacent properties are currently used. b( em V,4c4-r(-AJ sv �h JARPA 2009 Page 3 of 11 5m. Describe the structures (above and below ground) on the property, including their purpose(s). hC W 5n. Provide driving directions from the closest highway to the project location, and attach a map. n[ eio 61 (a�K� � �tiF !1 �vy Part 6—Project Description 6a. Summarize the overall project. You can provide more detail in 6d. hel 4r,,t 4eG k Y.e b,4 0 -4 I le- v 4 e a 6b: Indicate the project category. (check all that apply.) n[ e ❑ Commercial ❑ Residential ❑ Institutional ❑ Transportation Recreational ❑ Maintenance ❑ Environmental Enhancement 6c. Indicate the major elements of your project. (check all that apply.) hey ❑ Aquaculture ❑ Culvert ❑ Float ❑ Road 'Bank Stabilization ❑ Dam/Weir ❑ Geotechnical Survey ❑ Scientific Measurement ❑ Boat House ❑ Dike/ Levee/Jetty ❑ Land Clearing Device ❑ Boat Launch ❑ Ditch ❑ Marina / Moorage ❑ Stairs ❑ Boat Lift ❑ Dock/ Pier ❑ Mining ❑ Stormwater facility ❑ Bridge ❑ Dredging ❑ Outfall Structure ❑ Swimming Pool Bulkhead ❑ Fence ❑ Piling ❑ Utility Line ❑ Buoy ❑ Ferry Terminal ❑ Retaining Wall (upland) ❑ Channel Modification ❑ Fishway ❑ Other: JARPA 2009 Page 4 of 11 6d. 'Describe how you plan to construct each project element checked in 6c. Include specific construction methods and equipment to be used: hel' • Identify where each element will occur in relation to the nearest waterbody. • Indicate which activities are within the 100-year flood plain. l� f T40 6e. What are the start and end dates for project construction?(month/year) hhr Q!d 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: S c--A-T. End date: QG T - Z /a ❑ See JARPA Attachment D 6f. Describe the purpose of the work and why you"want or need to perform it. tie► /1-fF4Av 1411-1tt 1w4 TFee u�G � O�NG F��,�f �; 4-f,4Pr. Gw G-0 44 400 T! w4/VT T o AJ,4,k--F l� 6g. Fair market value of the project, including materials, labor, machine rentals, etc. LheM 6h. Will any portion of the project receive federal funding? Mid • If yes, list each agency providing funds. ❑ Yes No ❑ 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.) 7a. Describe how the project has been designed to avoid and minimize adverse impacts to wetlands. [bgip] ❑ Not applicable Ceit,te''G7e 1' °.J c,y 4 r-j r- Z-4 --K-7 L j5'JEt,- vC' v%412 T® /Z /aL T L.4kE ,4-r A L JARPA 2009 Page 5 of 11 71b. Will the project impact wetlands? hel Yes ❑ No X Don't know 7c. Will the project impact wetland buffers? [help] VIRYes ❑ No ❑ Don't know 7d. Has a wetland delineation report been prepared? bLgld • If yes,submit the report, including data sheets,with the JARPA package. ❑ Yes No 7e. Have the wetlands been rated using the Western Washington or Eastern'Washington Wetland Rating System? ,[helg] • If yes,submit the wetland rating forms and figures with the JARPA package. ❑ Yes ❑ Non Don't know 7f. Have you prepared a mitigation plan to compensate for any adverse impacts to wetlands? hel • If yes,submit the plan with the JARPA package. ❑ Yes ❑ No ❑ Not applicable 7g. Use the table below to list the type and`rating of each wetland that will be impacted; the extent and duration of the impact; and the type and amount of compensatory mitigation proposed. If you are submitting;a compensatory mitigation plan with a similar table, you may simply state (below) where we can find this information in the mitigation plan. [hhei j Activity causing Wetland type Impact area Duration Proposed Wetland impact(fill, and rating (sq. ft. or acres) of impact2 mitigation mitigation area drain, excavate, category' type' (sq. ft. or acres) flood, etc. Ecology wetland category based on current Western Washington or Eastern Washington Wetland Rating System. Provide the wetland rating forms with the JARPA package. 2 Indicate the time(in months or years, as appropriate)the wetland will be measurably impacted by the activity. Enter"permanent"if applicable. 3 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: 7h. For all filling activities identified in 7g., 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. hel I � 7L For all excavating activities identified in 7g., describe the excavation method, type and amount of material in cubic yards you will remove, and where the material will be disposed. hel I1(GA JARPA 2009 Page 6 of 11 7j. Summarize what the compensatory mitigation plan is meant to accomplish, and describe how a watershed approach was used to design the plan. hel la Part 8—Waterbodies (other than wetlands): Impacts and Mitigation In Part 8, "waterbodies" refers to non-wetland waterbodies. (See Part 7 for information related to wetlands.) EmM 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 project is designed to avoid and minimize adverse impacts to the aquatic:environment. hf elpl ❑ Not applicable p', Q fG �L Ct $b. Will your project impact a waterbody or the area around a waterbody? Pie) ❑ Yes LK No 8c. Summarizeimpact(s)to each waterbody in the table below. {help] Activity causing Waterbody Impact Duration Amount of material Area (sq. ft. or impact (clear, name location' of impact2 to be placed in or linear ft.) of dredge, fill, pile removed from waterbody drive, etc.) waterbody directly affected 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. 2 Indicate the time(in months or years,as appropriate)the waterbody will be measurably impacted by the work. Enter"permanent'if applicable. 8d. Have you prepared a mitigation plan to compensate for the project's adverse impacts to non-wetland waterbodies? he► • If yes,submit the plan with the JARIPA package. ❑ Yes ❑ No `Not applicable 8e.. Summarize what the compensatory mitigation plan is meant to accomplish. Describe how a watershed approach was used to design the plan. • If you already completed 7j.,you do not need to restate your answer here. ft Al JARPA 2009 Page 7 of 11 8f. For all activities identified in Sc., 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. h( e�l 8g For all excavating or dredging activities identified in 8c., describe the method for excavating or dredging, type and amount of material you will remove, and where the material will be disposed. hel LA 1 1k Part 9—Additional Information Any additional information you can provide helps the reviewer(s) understand your project. 9a. If you have already worked with any government agencies on this project, list them below. [help] 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 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://www.ecV.wa.gov/programs/wq/303d,'. ❑ Yes ❑ No 9c. What U.S. Geological Survey Hydrological Unit Code (HUC) is the project in? hf elpl • Go to http://cfpub.ega.aov/surf/locatelindex.cfm to help identify the HUC. 9d. What Water Resource Inventory Area Number(WRIA#) is the project in? he • Go to hftp://www.ecy wa gov/services/gis/maps/wria/wria htm to find the.WRIA#. JARPA 2009 Page 8 of 11 9e.r Will the in-water construction work comply with the State of Washington water quality standards for turbidity? hel "+ Go to hftp://www.ecy.wa.gov/programs/wq/swcls/criteria.html for the standards. ❑ Yes ❑ No [A Not applicable 9f. If the project is within the jurisdiction of the Shoreline Management Act, what is the local shoreline environment designation? lbpip] • If you don't know,contact the local plann;ng department. • For more information,go to: http://www.ecv.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? [helpl • Go to http://www.dnr.wa.gov/BusinessPermitsITopics/ForestPracticesApplications/Pages/fp watertyping aspx for the Forest Practices Water Typing System. t S F ❑ Np ❑ Ns 9h. Will this project be designed to meet the Washington Department of Ecology's most current stormwater manual? nei j • If no, provide the name of the manual your project is designed to meet. 0 Yes ❑ No Name of manual: 9i. If you know what the property was used for in the past, describe below. heI I 54 AA e 9j. Has a cultural resource (archaeological)survey been performed on the project area? 'h[_pjpl • If yes, attach it to your JAR PA package. ❑ Yes Q No 9k. Name each species listed under the federal Endangered Species Act that occurs in the vicinity of the project area or might be affected by the proposed work. hel`` 91. 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 V1(t7� JARPA 2009 Page 9 of 11 Part 10—Identify the Permits You Are Applying For Use the resources and checklist below to identify the permits you are applying for. • Online Project Questionnaire at htti)://apr)s.ecy.wa.aov/opas/. • Governor's Office of Regulatory Assistance at (800) 917-0043 or help ora.wa.gov. 10a. Compliance with the State Environmental Policy Act(SEPA). (Check all that apply.) hel • For more information about SEPA,go to www.ecy,wa.gov/pro.grams/sea/sepa/e-review.html. ❑ A copy of the SEPA determination or letter of exemption is included with this application. A P d termination is pending with JYMcyi Cji:hk (lead agency). The expected decision date is ❑ 1 am applying for a Fish Habitat Enhancement Exemption. (Check the box below in 10b.) • Submit the Fish Habitat Enhancement Project form with this application. The form can be found at: http://www.eperm itti ng.wa.gov/site/alias_resourcenter/jarpa_jarpa_form/9984/j arpa_form.aspx. ❑ 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. hl eip] 10b. Jndicate the permits you are applying for. (Check all that apply.) (he) ) LOCAL GOVERNMENT Local Government Shoreline permits: ❑ Substantial Development ❑ Conditional Use ❑ Variance Shoreline Exemption Type (explain): Other city/county permits: ❑ Floodplain Development Permit ❑ Critical Areas Ordinance STATE GovERNMENT Washington Department of Fish and Wildlife: ❑ Hydraulic Project Approval (HPA) ❑ Fish Habitat Enhancement Exemption Washington Department of Ecology: ❑ Section 401 Water Quality Certification Washington Department of Natural Resources: ❑ Aquatic Resources Use Authorization FEDERAL GOVERNMENT United States Department of the Army permits (U.S. Army Corps of Engineers): ❑ Section 404 (discharges into waters of the U.S.) ❑ Section 10 (work in navigable waters) United States Coast Guard permits: ❑ General Bridge Act Permit ❑ Private Aids to Navigation (for non-bridge projects) JARPA 2009 Page 10 of 11 Part 11—Authorizing Signatures Signatures required before submitting the JARPA package. 11 a. Applicant Signature (required) h[ elpl 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 auth the agent named in Part 3 of this application to act on my behalf in matters related to this application. (initial) By initialing here, I state that I have the authority to grant access to the property. I also give my consent to the permittin agencies enterin property where the project is located to inspect the project site or any work relate o he project. (initial) Ap rit Date 11 b. Authorized Agent Signature h[ em I certify that to the best of my knowledge and belief, the information provided in this application is true, complete, and accurat also certify that I have the authority to carry out the proposed activities and I agree to start work only afte"I ecessary permits have been issued. Authori e Agent Date 11 c. Property Owner Signature (if not applicant) [helps 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 landown Pro caner Date 18 U.S.0§1001 provides that:Whoever, in any manner within the jurisdiction of any department or agency of the United States knowingly falsifies, conceals, or covers up by any trick, scheme, or device a material fact or makes any false, fictitious, or fraudulent statements or representations or makes or uses any false writing or document knowing same to contain any false,fictitious, or fraudulent statement or entry, shall be fined not more than$10,000 or imprisoned not more than 5 years or both. If you require this document in another format, contact The Governor's Office of Regulatory Assistance(ORA). 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 JARPA 2009 Page 11 of 11 ON.STA MASON COUNTY �P5 oc ° DEPARTMENT OF COMMUNITY DEVELOPMENT o s M°u Planning Division i o T Z P O Box 279, Shelton, WA 98584 Y (360)427-9670 186A DETERMINATION OF NONSIGNIFICANCE (WAC 197-11-340) SEP2010-00057 Description of Proposal Remove old railroad tie bulkhead and construct new T tall concrete block bulkhead landward of it. Proponent: JASON OLSEN Location of Proposal: 5 W FROSTY LN NORTH SHELTON Parcel Number: 519014400065 Legal Description: TR 6-E OF GOVT LOT 10 Directions to Site: WEST ON CLOQUALLUM RD LEFT LOST LAKE RD TO LEFT ON FROSTY 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, P.O. Box 279, Shelton WA 98584 by 8/31/2010. 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. Authorized Local Government Official Date Cl�ei,,4. 5 Tr be ON_STA MASON COUNTY C °I!k- DEPARTMENT OF COMMUNITY DEVELOPMENT o A o = Planning Division _ o T z P O Box 279, Shelton, WA 98584 N y Y (360)427-9670 OJ �O 1864 Exemption from Shoreline Management Act Case No.: SHX2010-00044 Substantial Development Permit Requirement The Proposal By: JASON OLSEN 32 COZY LANE WEST ELMA, WA 98541 To undertake the following development: Remove existing railroad tie bulkhead and replace with new 3' tall concrete block bulkhead landward of it. 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 B-normal maintenance Please contact Grace Miller at ext 360 if you have any questions. Issued: 8/17/2010 Expires: 8/17/2012 Authorized Local Government Official cc: APPLICANT WDFW- USACOE WDOE TRIBAL COUNCIL C j/Urict j?,'1� 5 �e:14rr. r Y' off`lk89`" STATE OF wNAS} INGTON DEPARTMENT OF ECOLOGY PO Box 47775 •Olympia; Washington 98504-7775 °(360)407-6300 711 for Washington Pelay Service •Persons with a speech disability car?call 877-833-6341 August 31, 2010 Ms.Grace Miller Your address Mason County Department of Community Development is in the Planning Division Kennedy- PO Box 279 Goldsborough Shelton,WA 98584 watershed Dear Ms. Miller: Thank you for the opportunity to comment on the determination of nonsignificance for the Olsen Bulkhead Removal project(SEP2010-00057) located at 5 West Frosty Lane North in Shelton as proposed by Jason Olsen. The Department of Ecology(Ecology) reviewed the environmental checklist and has the following comment(s): WASTE 2 RESOURCES: Mike Drumright(360)407-6397 The applicant proposes to demolish an existing structure that may contain treated wood. Please refer to Ecology's publication "Focus on Treated Wood Exclusion," available at http://www.ecy.wa.gov/pubs/0304038.pdf,for suggested best management practices and disposal requirements for treated wood. For additional information or clarification, please contact Dee Williams with Ecology's Hazardous Waste and Toxics Reduction program, at(360)407-6348. All removed debris resulting from this project must be disposed of at an approved site. Property owners,developers,and contractors are encouraged to recycle all possible leftover construction, demolition, and land clearing(CDL) materials and reduce waste generated. Recycling construction debris is often less expensive than landfill disposal. Please visit http://1800recycle.wa.gov to find facilities that recycle construction, demolition, and landclearing materials in your area. Please call Ecology's 1-800-RECYCLE hotline for facilities in the area that will accept your CDL materials for reuse or recycling. 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 (S M: 10-4465) cc: Mike Drumright,W2R Jason Olsen (Proponent) MASON CO. ENVIROMENTAL CHECKLIST A. BACKGROUND 1. Name of proposed project, if applicable: QLsFN FAA- i3L4 �-cat 2. Name of applicant: T4 Sfl u o L-J C-,u 3. Address and phone number of applicant and contact person: �Z Go a C-N W U-A 125-Pt/ 4 13-2 - q o4 c Cc ) ��� - ��D �z 6- c 4. Date checklist prepared: -7—( S- z -(� 5. Agency requesting checklist: 6. Proposed timing or schedule (including phasing, if applicable): SrvPT toy s cA2T FNO 7. Do you have any plans for future expansion, or further activity related to or connected with this proposal` If yes, explain. NQ 8. List any environmental information you know about that has been prepared, or will be prepared, directly related to this proposal. F« -"T S i4PA 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. N 'D 10. List any government approvals or permits that will be needed for your proposal, if known. N .� • R MASON CO. ENVIROMENTAL CHECKLIST A. BACKGROUND 1. Name of proposed project, if applicable: QLS%N AAA, 6L4 L.tz- 2. Name of applicant: T4.5'_L.) 0Ls C-u 3. Address and phone number of applicant and contact person: .JZ C� 0-� LN W e1_M'4 r f-A I (t ) 3C-d - -t �z - 4 '4 ( (c ) ?c,' - 4. Date checklist prepared: `7—t s-- z -lam 5. Agency requesting checklist: 6. Proposed timing or schedule (including phasing, if applicable): 7. Do you have any plans for future expansion, or further activity related to or connected with this proposal: If yes, explain. S 0 8. List any environmental information you know about that has been prepared, or will be prepared, directly related to this proposal. f«L-I;Fof �"T S ��PA 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. IV 0 10. List any government approvals or permits that will be needed for your proposal, if known. No r } �-w spy 4o MASON COUNTY Single Family $385 Non-Single Family 0-9.99 Acres$630 ENVIRONMENTAL CHECKLIST 10 to 20 Acres$755 Over 20 Acres$945 Purpose of Checklist: EIS(DS)$2,525+70/hr The State Environmental Policy Act (SEPA), chapter 43.21 C RCW, requires all governmental agencies to consider the environmental impacts of a proposal before making decisions. An environmental impact statement (EIS) must be prepared for all proposals with probable significant adverse impacts on the quality of the environment. The purpose of this checklist is to provide information to help you and the agency identify impacts from your proposal (and to reduce or avoid impacts from the proposal, if it can be done) and to help the agency decide whether an EIS is required. Instructions for Applicants: This environmental checklist asks you to describe some basic information about your proposal. Governmental agencies use this checklist to determine whether the environmental impacts of your proposal are significant, requiring preparation of an EIS. Answer the questions briefly, with the most precise information known, or give the best description you can. You must answer each question accurately and carefully, to the best of your knowledge. In most cases, you should be able to answer the questions from your own observations or project plans without the need to hire experts. If you really do not know the answer, or if a question does not apply to your proposal, write "do not know" or "does not apply". Complete answers to the questions now may avoid unnecessary delays later. Some questions ask about governmental regulations, such as zoning, shoreline, and landmark designations. Answer these questions if you can. If you have problems, the governmental agencies can assist you. 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. Use of Checklist for Non-project Proposals: Complete this checklist for non-project proposals, even though questions may be answered "does not apply". IN ADDITION, complete the SUPPLEMENTAL ACTIONS (part D). There is a fee required, for the processing of the checklist, see above for the appropriate fee. Please make your check payable to "Mason County Treasurer". For non-project actions, the references in the checklist to the works "project", "applicant", and "property or site" should be read as "proposal", "proposer", and "affected geographic area", respectively. 11. Give a 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.) CMS v c� 6 L_� a -eAp 24��R�.4� "Frrs� T4fA"r S Pg7L oO ✓ M FA,N 0-1 6H fr'AT�/t (,iti c � F,4[c..ik O—WA) d /U P--A ,/ 4 l Lo k- 1/✓'4-T P lZ L-i *" c• 4 M(Zo K L- p&-Ctf S0 12. What is the 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. Ffz<,azY LA,--r Ali' DOo 5 B. ENVIRONMENTAL ELEMENTS: 1. EARTH: a. General description of the site (circle one): Flat, rolling, hilly,steep slop mountainous, other b. What is the steepest slope on the site (approximate percent slope)? 1 0`/' 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 prime farmland. 9v-4--e 1 d. Are there surface indications or history of unstable soils in the immediate vicinity: If so, describe. b� k 4 "0 s' Mason County Environmental Checklist Page 2 e. Describe the purpose, type, and approximate quantities of any filling or grading proposed. Indicate source of fill. �941-IL+4F�A,O C0.A4P-4c7"(vA) MOST F�t-� li✓+'LL c 9!, r. FR t,--I t_?(II I-tA.' �16GtNc. i H F f=v',(rrv'�-S . f. Could erosion occur as a result of clearing, construction, or use: If so, generally describe. s- 2C 9-1 7 A,- T 11A1-t,�t g. About what percent of the site will be covered with impervious surfaces after project constructions (for example, asphalt or buildings)? lV o /-tV n F T Mtn: `Tbt ._aE 19 To O.4 7- h. Proposed measures to reduce or control erosion, or other impacts to the earth, if any:2. AIR: a. What types of emissions to the air would result from the proposal (i.e. dust, automobile, odors, industrial wood smoke) during construction and when the project is completed? If any, generally describe and give approximate quantities, if known. 0 �m b. Are there any off-site sources of emissions or odor that may affect your proposal? If so, generally describe. 0�� Mason County Environmental Checklist Page 3 C. Proposed measures to reduce or control emissions or other impacts to air, if any: 3 WATER: a. Surface: 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. I-o f [' L A't--F 2) Will the project require any work over, in, or adjacent to (within 200 feet) the described waters? If yes, please describe and attach available plans. 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. 00 /,-% 4) Will the proposal require surface water withdrawals or diversions? Give general description, purpose, and approximate quantities if known. N J Mason County Environmental Checklist Page 4 5) Does the proposal lie within a 100-year floodplain? If so, note location on the site plan. 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. (V b. Ground: 1) Will ground water be withdrawn, or will water be discharged to ground water? Give general description, purpose, and approximate quantities, if known. 9 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. A o IL-Z C. Water runoff (including storm water): 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 flow into other waters? If so, describe. VI/q 2) Could waste materials enter ground or surface waters: If so, generally describe. vt s Mason County Environmental Checklist Page 5 d. Proposed measures to reduce or control surface, ground, and runoff water impacts, if any: YJLe �✓w( � `'r� 4. PLANTS: a. Check or circle types of vegetation found on the site: deciduous tree: alder, maple, aspen, other X evergreen tree: fir, cedar, pine, other shrubs grass pasture crop or grain 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? (✓-.0 4 J,4 vc�P S' C. List threatened or endangered species known to be on or near the site. vl / t d. Proposed landscaping, use of native plants, or other measures to preserve or enhance vegetation on the site, if any: ®vliC Mason County Environmental Checklist Page 6 5. ANIMALS a. Circle any birds and animals which have been observed on or near the site or are known to be on or near the site: Birds: hawk, heron, ea le songbirds, other Mammals: d bear, elk, beaver, other Fish: bass, salmon, tryherring, shellfish, other b. List any threatened or endangered species known to be on or near the site. Vl D q C C. Is the site part of a migration route? If so, explain. t1 l C^ d. Proposed measures to preserve or enhance wildlife, if any: �l (c 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. b. Would your project affect the potential use of solar energy by adjacent properties: If so, generally describe. 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: K(� Mason County Environmental Checklist Page 7 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. in a 1) Describe special emergency services that might be required. lk 2) Proposed measures to reduce or control environmental health hazards, if any- b. Noise. 1) What types of noise exist in the area which may affect your project (for example: traffic, equipment, operation, other)? h. 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)? Indicate what hour's noise would come from the site. 3) Proposed measures to reduce or control noise impacts, if any: of a 8. LAND AND SHORELINE USE: a. What is the current use of the site and adjacent properties? Mason County Environmental Checklist Page 8 b. Has the site been used for agriculture? If so, describe. P C. Describe any structures on the site. d. Will any structures be demolished? If so, what? I f j d o ( ) � -((L-LLt- e. What is the current zoning classification of the site? f. What is the current comprehensive plan designation of the site? g. If applicable, what is the current Shoreline Master Program designation of the site? h. Has any part of the site been classified as an "environmentally sensitive" area? If so, specify. -1 � i. Approximately how many people would reside or work in the completed project? j. Approximately how many people would the completed project displace? 0 k. Proposed measures to avoid or reduce displacement impacts, if any: Mason County Environmental Checklist Page 9 I. Proposed measures to ensure the proposal is compatible with existing and projected land uses and plans, if any: i1% C' 9. HOUSING: a. Approximately how many units would be provided, if any? Indicate whether high, middle, or low-income housing. Af� b. Approximately how many units, if any, would be eliminated? Indicate whether high, middle, or low-income housing. C. Proposed measures to reduce or control housing impacts, if any: 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? 0/ 4- b. What views in the immediate vicinity would be altered or obstructed? V1l4 C. Proposed measures to reduce or control aesthetic impacts, if any: Mason County Environmental Checklist Page 10 11. LIGHT AND GLARE a. What type of light or glare will the proposal produce? What time of day would it mainly occur? b. Could light or glare from the finished project be a safety hazard or interfere with views? C. What existing off-site sources of light or glare may affect your proposal: d. Proposed measures to reduce or control light and glare impacts, if any: 12. RECREATION: a. What designated and informal recreational opportunities are in the immediate vicinity? - r " f / 4 ' -' `a j / wofe — b. Would the proposed project displace any existing recreational uses? If so, describe. >� w C. Proposed measures to reduce or control impacts on recreation, including recreation opportunities to be provided by the project or applicant, if any: Mason County Environmental Checklist Page 11 13. HISTORIC AND CULTURAL PRESERVATION: P a. Are there any places or objects listed on, or proposed for, national, state, or local preservation registers known to be on or next to the site? If so, generally describe. b. Generally describe any landmarks or evidence of historic, archaeological, scientific, or cultural importance known to be on or next to the site. C. Proposed measures to reduce or control impacts, if any: 14. TRANSPORTATION: V1 It- a. Identify public streets and highways serving the site and describe proposed access to the existing street system. Show on site plans, if any. b. Is site currently served by public transit? If not, what is the approximate distance to the existing street system? Show on site plans, if any. C. How many parking spaces would the completed project have? How many would the project eliminate? d. Will the proposal require any new roads or streets, or improvements to existing roads or streets, not including driveways? If so, generally describe (indicate whether public or private). Mason County Environmental Checklist Page 12 e. Will the project use (or occur in the immediate vicinity of) water, rail, or air transportation? If so, generally describe. f. How many vehicular trips per day would be generated by the completed project: If known, indicate when peak volumes would occur. g. Proposed measures to reduce or control transportation impacts, if any: 15. PUBLIC SERVICES: 1/1 ( e a. Would the project result in an increased need for public service (for example: fire protection, police protection, health care, schools, other)? If so, generally describe: b. Proposed measures to reduce or control direct impacts on public services, if any: Mason County Environmental Checklist Page 13 16. UTILITIES: a. Circle utilities currently available at site: C(elec:tr3icit )natural gas, water, refuse service, telephone, sanitary sewer, septic system ther: 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. Signature: 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 submitted: -71����� Mason County Environmental Checklist Page 14 ESA LISTED SALMONIDS CHECKLIST Applicant Information Protect Information Name t��So ` O Ire Name Phone 3 & $7- - Location Description This worksheet was designed to help project proponents, and government agencies, identify when a project needs further analysis regarding adverse effects on ESA (Endangered Species Act) listed salmonids. Salmonids are salmon, trout and chars, e.g. bull trout. For our purposes, "ESA Listed Salmonids" is defined as fish species listed as endangered, threatened or being considered for listing. i If ESA listed species are present or ever were present in the water shed where your project will be located, your project has the potential for affecting them, and you need to comply with the ESA. The questions in this section will help determine if the ESA listings will impact your project. The Fish Program Manager at the appropriate Department of Fish and Wildlife (DFW) regional office can provide information for the following two questions. 1. Are ESA listed salmonids currently present in the watershed in which your project will be located? YES NO Please describe. 2. Has there ever been an ESA listed salmonid stock present in this watershed? YES NO Uncertain Please describe. Ei If you answered "yes" to either of the above questions, you should complete the remainder of this checklist. April 2003 Mason County Environmental Checklist Page 15 PROJECT SPECIFICES: The questions in this section are specific to the project and vicinity. l. Name of watershed: 2. Name of nearest waterbody: 3. What is the distance from this project to the nearest body of water: 10 t . Often a buffer between the project and a stream can reduce the chance of a negative impact to fish. 4. What is the current land use between the project and the potentially affected water body (parking lots, farmland,etc.)? 5. Is the project above a: * natural permanent barrier(waterfall) YES NO X * natural temporary barrier(beaver pond) YES NO * man-made barrier(culvert, dam) YES NO * other(explain): 6. If yes, are there any resident salmoind populations above the blockage? YES NO Don't know k 7. What percent of the project will be impervious surface (including pavement &roof area)? Mason County Environmental Checklist Page 16 FISH MIGRATION: The following questions will help determine if this project could interfere with migration of adult and juvenile fish. Both increases and decreases in water flows can affect fish migration. 1. Does the project require the withdrawal of: a. Surface water? YES NO X Amount Name of surface water body b. Ground water? YES NO Amount From where Depth of well 2. Will any water be rerouted: YES NO If yes, will this require a channel change? it 3. Will there be retention or detention ponds? YES NO If yes, will this be an infiltration pond or a surface discharge to either a municipal storm water system or a surface water body? If to a surface water discharge,please give the name of the waterbody. 4. Will this project require the building of new roads? YES NO Increased road mileage may affect the timing of wati r reaching a stream and may impact fish habitat. 5. Are culverts proposed as part of this pr ject? YES NO V 6. Will topography changes affect the dur,tion/direction of runoff flows? YES NO _ If yes, des&be the changes. 7. Will the project involve any reduction f the floodway or floodplain by filling or other partial blockage of flows? YES NO X If yes, how will the loss of flood storage be mitigated by your project? I 1 i Mason County Environmental Checklist Page 17 WATER QUALITY: The following qd stions will help determine if this project could Adversely impact water quality. Such impacts can cause problems for listed species. Water quality can be made worse by runoff from impervious surfaces,altering water temperature,discharging contaminants,etc. 1. Do you know of any problems with water quality, in any of the streams, within this watershed? YES NO If yes, describe. 2. Will your project either reduce or increase shade along or over a waterbody? YES NO Y Removal of shading vegetation or the building of structures such as docks or floats often results in a change in shade. 3. Will the project increase nutrient loading or have the potential to increase nutrient loading or contaminants (fertilizers, other waste discharges, or runoff)to the waterbody? YES NO X 4. Will turbidity be increased because of construction of the project or during operation of the project? YES NO _ C� In-water or near water work will often increase turbidity. 5. Will your project require long term maintenance, i.e. bridge cleaning, highway salting, and chemical sprays for vegetation management, clearing of parking lots? YES NO If yes, please describe. Mason County Environmental Checklist Page 18 VEGETATION: The following questions are designed to determine if the project will affect riparian vegetation, thereby, adversely impacting salmon. 1. Will the project involve the removal of any vegetation from the stream banks: YES NO If yes, please describe the existing conditions, and the amount and type of vegetation to be removed. 2. If any vegetation is remo ed, do you plan to re-plant? YES NO If yes, what t es of plants will you use? Mason County Environmental Checklist Page 19