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HomeMy WebLinkAboutSHX2015-00074 SEPA2015-00080 - SHX Inspections - 9/25/2015 AGENCY USE ONLY I "*" Date received:US Army Corps trict WASHINGTON STATE • e• gos" r Joint Aquatic Resources Permit Agency reference#: -Xa01J� 1-4 Application (JARPA) Form1'2 Tax Parcel#(s): 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) rhel k. f \CONN\\\ri " -\\ v\ SCR aNi Part 2—Applicant The person and/or organization responsible for the project. Ihelpi 2a. Name (Last, First, Middle) 0--x•s\IN.;\� �� �( �, 2b. Organization (If applicable)g V O�i ��ta�v�_ca �e� S\(\KY`Gs� cX.\1V,.i 2c. Mailing Address (Street o PO Box) C7 C3c3. ` N L. \ 2d. City, State, Zip 2e. Phone(1) j 2f. Phoneo (2) 2g. Fax 2h. E-mail (3l. 1 v f t' .fir 3�i 1 \`�� )c ( \ Y�< 'l �-' Go.tQ .. Cv'ir�. '. 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)764-3495. • If your project might affect species listed under the endangered Species Act,you will need to fill out a Specific Project Information Form(SPlF)or prepare a Biological Evaluation. Forms can be found at http://www.nws.usace.armv.millMissions/CiviNVorks/Regulatory/PermitGuidebook/EndangeredSpecies.aspx. • Not all cities and counties accept the JARPA for their local Shoreline permits. If you need a Shoreline permit,contact the appropriate city or county government to make sure they accept the JARPA. 27o access an online JARPA form with[help]screens,go to htto://www.epermittinq.wa.govisitefaiias resourcecenter/i2rpa iarpa formi9984/jarpa form.aspx. For other help,contact the Governor's Office of Regulatory Assistance at 1-800-917-0043 or heloAora.wa.00v. JARPA Revision 2012.1 Page 1 of 14crf 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.) (helpl 3a. Name (Last, First, Middle) 3b. Organization (if applicable) 3c. Mailing Address (Street or PO Box) \q \ e5 X (7-i, \ 3d. City, State, Zip c s(s c / CS. , S`Q) 3e. Phone(1) 3f. Phone (2) 3g. Fax 3h. E-mail ( 36c) S 7 R-S3 ( 2 6 ) 813 -2Sc17 ( ) V`nca u� � � c c> colt- e-cscrcf 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. ihelpi g Same as applicant. (Skip to Part 5.) E Repair or maintenance activities on existing rights-of-way or easements. (Skip to Part 5.) There are multiple upland property owners. Complete the section below and fill out JARPA Attachment A for each additional 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 JARPA Attachment E to apply for the Aquatic Use Authorization. 4a. Name (Last, First, Middle) 4b. Organization (If applicable) 4c. Mailing Address (Street or PO Box) 4d. City, State, Zip 4e. Phone(i) 4f. Phone(2) 4g. Fax 4h. E-mail JARPA Revision 2012.1 Page 2 of 14 • Part 5—Project Location(s) Identifying information about the property or properties where the project will occur. lheipl ❑ There are multiple project locations (e.g. linear projects). Complete the section below and use JARPA Attachment B for each additional project location. 5a. Indicate the type of ownership of the property. (Check all that apply.) [heipl '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.) [helpl 1.-\ ‘c— C� � - � G \CO Cam' 5c. City, State, Zip(If the project is not in a city or town, provide the name of the nearest city or town) fhelpl 5d. County [heipi 5e. Provide the section, township, and range for the project location. [helpl 1/4 Section Section Township Range //,4 2-3 9 5f. Provide the latitude and longitude of the project location. [helpi • Example:47.03922 N lat./-122.89142 W long. (Use decimal degrees- NAD 83) 14! `/a, 1-3 ��_ - , 2. 3_, /Lr77 5g. List the tax:parcel number(s) for the project location. [helps • The local county assessor's office can provfce this information. trk-3 Act- s v v c)c5 1 "7 5h. Contact information for all adjoining property owners. (If you need more space, use JARPA Attachment C.) [helpl Name I Mailing Address Tax Parcel# (if known) 4z o c C ,(3._\lJC'\ �� 5�'y` K,i g <'w c�.cK 1�l ♦jamct - 4 0 cs JARPA Revision 2012.1 Page 3 of 14 Si. List all wetlands on or adjacent to the project location. [helps 5j. List all waterbodies (other than wetlands) on or adjacent to the project location. [help] 5k. Is any part of the project area within a 100-year floodplain? [help1 ❑ Yes ❑ No 2 Don't know 51. Briefly describe the vegetation and habitat conditions on the property. [help] cscc..v Q/1 c, ti�c�vatic. v 5m. Describe how the property is currently used. [help] ACC 5v-� \CM",\ cs � rc� Cv � VcN-t- \o 5n. Describe how the adjacent properties are currently used. [help] 0.\v'v\ 5o. Describe the structures (above and below ground) on the property, including their purpose(s) and current condition. [help; C_c�.�j\r cc rLr�cc�e c ��`r -7L17-- \ �0 5p. Provide driving directions from the closest highway to the project location, and attach a map. [hei 1 \� C"�'S c r �-� w�f \G\ i 1\. 1 U Cam, k \rr \�h r GYM G� C c c\ `C c�� � o �e Q, �� cs•aY S\ K'1 \t L „ JARPA Revision 2012.1 Page 4 of 14 Part 6—Project Description 6a. Briefly summarize the overall project. You can provide more detail in 6b. [help} (a-AA, 6b. Describe the purpose of the project and why you want or need to perform it. chelpl s -6 \pc, 6c. Indicate the project category. (Check all that apply) [help] E Commercial E Residential E Institutional E Transportation F2, Recreational E Maintenance ri Environmental Enhancement 6d. Indicate the major elements of your project. (Check all that apply) [help] E Aquaculture E Culvert E] Float Retaining Wall Bank Stabilization 7 Dam /Weir 7 Floating Home (upland) LI Boat House E Dike / Levee /Jetty Geotechnical Su —1 Roadey ri Boat Launch 111 Ditch ri Land Clearing El Scientific Measurement Device 111 Boat Lift g Dock/ Pier El Marina / Moorage I-1 Stairs Bridge 1111 Dredging 11111 Mining Stormwater facility E Bulkhead E Fence E Outfall Structure — Swimming Pool .1,1 Buoy ____ Ferry Terminal Li Piling/Dolphin E Utility Line fl Channel Modification — Fishway E Raft E Other: JARPA Revision 2012.1 Page 5 of 14 • 6e. Describe how you plan to construct each project element checked in 6d. Include specific construction methods and equipment to be used. (helpl • Identify where each element will occur in relation to the nearest waterbody. • Indicate which activities are within the 100-year floodplain. cosAc� � �`vA ec .� �� v L 'P, c . - aAs 6f. What are the anticipated start and end dates for project construction? (Month/Year) [helpl • 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: \\ - \ End date: S --`1 7 See JARPA Attachment D 6g. Fair market value of the project, including materials, labor, machine rentals, etc. Iheipi r (3 6h. Will any portion of the project receive federal funding? (helpl • If yes, list each agency providing funds. C- Yes IX No L Don't know Part 7—Wetlands: Impacts and Mitigation f Check here if there are wetlands or wetland buffers on or adjacent to the project area. (If there are none, skip to Part 8.) [helpl 7a. Describe how the project has been designed to avoid and minimize adverse impacts to wetlands. (helpi Ug Not applicable 7b. Will the project impact wetlands? (helot E Yes 1 No Don't know JARPA Revision 2012.1 Page 6 of 14 7c. Will the project impact wetland buffers? [help} C Yes t: No ❑ Don't know 7d. Has a wetland delineation report been prepared? [helps • If Yes, submit the report,including data sheets,with the JARPA package. ❑ Yes ❑ No \\-i p* 7e. Have the wetlands been rated using the Western Washington or Eastern Washington Wetland Rating System? [help} • If Yes,submit the wetland rating forms and figures with the JARPA package. ❑ Yes allo ❑ Don't know 7f. Have you prepared a mitigation plan to compensate for any adverse impacts to wetlands? [help} • If Yes,submit the plan with the JARPA package and answer 7g. • If No,or Not applicable, explain below whya mitigation plan should not be required. L] Yes U No 1g Not applicable 7g. Summarize what the mitigation plan is meant to accomplish, and describe how a watershed approach was used to design the plan. [help} NfA 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. [help} 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 type4 (sq. ft. or category2 Acres) acres) � I If no official name for the wetland exists,create a unique name(such as'Wetland 1"). The name should be consistent with other project documents,such as a wetland delineation report. 2 Ecology wetland category based on current Western Washington or Eastern Washington Wetland Rating System.Provide the wetland rating forms with the JARPA 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: JARPA Revision 2012.1 Page 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. rheipi 7j. 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. (heipi 0 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.) iheipi 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. {help _ Not applicable 8b. Will your project impact a waterbody or the area around a waterbody? iheip1 Yes No c\ v eaA• JARPA Revision 2012,1 Page 8 of 14 8c. Have you prepared a mitigation plan to compensate for the projects adverse impacts to non-wetland waterbodies? (helpl • 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. E Yes _ No ® Not applicable 8d. 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. [help' Be. Summarize impact(s) to each waterbody in the table below. [helpl Activity (clear, Waterbody Impact Duration Amount of material Area(sq. ft. or dredge, fill, pile name' location2 of impact (cubic yards) to be linear ft.) of drive, etc.) placed in or waterbody removed from directly affected �s(� waterbody • 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. '`Indicate the days,months or years the waterbody will be measurably impacted by the work. Enter"permanent"if applicable. 8f. 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. (helpl JARPA Revision 2012.1 Page 9 of 14 8g. For all excavating or dredging activities identified in 8e, describe the method for excavating or dredging, type and.amount of material you will remove, and where the material will be disposed. rhe►p1 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. [heipi 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? fhelpl • If Yes, list the parameter(s)below. • If you don't know, use Washington Department of Ecology's Water Quality Assessment tools at: http:!/ww w.ecy.wa.cov!programs/wq/303d/. _ Yes in No 9c. What U.S. Geological Survey Hydrological Unit Code (HUC) is the project in? [help; • Go to http://cfpub.epa,gov/surf/locate!index.cfm to help identify the HUC. "7 t \ 9d. What Water Resource Inventory Area Number (WRIA#) is the project in? fhelpl • Go to http://www.ecy.wa.gov/services/qis/maps/wria/wria.htm to find the WRIA#. \0 JARPA Revision 2012.1 Page 10 of 14 9e. Will the in-water construction work comply with the State of Washington water quality standards for turbidity? Ihelpi • Go to http://www.ecy.wa.gov/programs/wq/swgs/criteria.html for the standards. Yes ❑ No ►2 Not applicable 9f. If the project is within the jurisdiction of the Shoreline Management Act, what is the local shoreline environment designation? Ihelpi • If you don't know, contact the local planning department. • For more information,go to: http://www.ecywa.gov/programs/sea/sma/laws rules/173-26/211 designations.html. Rural ❑ Urban ❑ Natural ❑ Aquatic ❑ Conservancy 7 Other 9g. What is the Washington Department of Natural Resources Water Type? Ihe►pl • Go to http://www.dnr.wa.gov/BusinessPermits/Topics/ForestPracticesApplications/Pages/fp watertypinq.aspx for the Forest Practices Water Typing System. E Shoreline 7 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? Ihelpi • If No, provide the name of the manual your project is designed to meet. EYes ❑ No Name of manual: 9i. Does the project site have known contaminated sediment? Ihelp) • If Yes, please describe below. ❑ Yes 17 No 9j. If you know what the property was used for in the past, describe below. [help] `^�, � � � � \-\ � y aps 9k. Has a cultural resource (archaeological) survey been performed on the project area? Ihelpi • If Yes, attach it to your DARPA package. 7 Yes VI No JARPA Revision 2012.1 Page 11 of 14 91. 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. fhelpl 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. fhelpl 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:i/apps.ecy.wa.gov/opas/. • Governor's Office of Regulatory Assistance at (800) 917-0043 or help(cr�ora.wa.gov. • For a list of addresses to send your JARPA to, click on agency addresses for completed JARPA. 10a. Compliance with the State Environmental Policy Act (SEPA). (Check all that apply.) fhelpl • For more information about SEPA, go to www.ecy.wa.bov/programs/sea/sepa/e-review.html. ❑ A copy of the SEPA determination or letter of exemption is included with this application. Ezi A SEPA determination is pending with -c'\_seyr. ( .,, y(iead agency). The expected decision date is ❑ I am applying for a Fish Habitat Enhancement Exemption. (Check the box below in lob.) fhelpl This project is exempt (choose type of exemption below). E Categorical Exemption. Under what section of the SEPA administrative code (WAC) is it exempt? Other: SEPA is pre-empted by federal law. JARPA Revision 2012.1 Page 12 of 14 1 Ob. Indicate the permits you are applying for. (Check all that apply.) (help] LOCAL GOVERNMENT Local Government Shoreline permits: E Substantial Development ❑ Conditional Use ❑ Variance ❑ Shoreline Exemption Type (explain): Other city/county permits: I� Floodplain 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: E$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.) n Project is a modification of an existing HPA originally applied for, prior to July 10, 2012. (HPA# Washington Department of Natural Resources: (j 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 .r9 5c� s > 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) t-s Cs 22 l5 LLB,c S United States Coast Guard permits: General Bridge Act Permit I Private Aids to Navigation (for non-bridge projects) JARPA Revision 2012.1 Page 13 of 14 Part 11—Authorizing Signatures Signatures are required before submitting the JARPA package. The JARPA package includes the JARPA form, project plans, photos, etc. [helpl 11 a. Applicant Signature (required) ihe►p1 ! 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 authorize 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 permitting agencies ent i Wth property where the project is located to inspect the project site or any work related to the project. (initial) I !1 J f.- cf. 1 i Applicant Printed Name Applicant Signature D 11 b. Authorized Agent Signature [he►pi 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. 4a/d 4). 117,m7,:)/7 Authorized Agent Printed Name Akthorized Agent Sign re Date s f f 11 C. Property Owner Signature (if not applicant). [helpl 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. Property Owner Printed Name Property Owner Signature Date 18 U.S.0 §1001 provides that:Whoever, in any manner within the jurisdiction of any department or agency of the United States knowingly falsifies, conceals, or covers up by any trick,scheme, or device a material fact or makes any false,fictitious, or fraudulent statements or 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) 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 JARPA Revision 2012.1 Page 14 of 14 PSON_sTA 7;›, MASON COUNTY 7 c DEPARTMENT OF COMMUNITY DEVELOPMENT O A U u� U Planning Division i o 8 426 W Cedar St, Shelton, WA 98584 N �o� 8 �,o~ (360)427-9670 1864 DETERMINATION OF NONSIGNIFICANCE (WAC 197-11-340) SEP2015-00080 Description of Proposal: Repllace floating dock and add hand rail for safety to stationary portion of dock. Changing dock size from 18'X18' to 10'X20'. Proponent: MANNING CUSHMAN FAMILY LLC Location of Proposal: 43 N PARK CREEK PL HOODSPORT Parcel Number: 423295000017 Legal Description: LAKE CUSHMAN #1 TR 17 Directions to Site: 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 43.21C.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 10/26/2015. 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. '' r/ ro-/a-t5 Authorized Local Government Official Date 1 N2 iffiveAittr- , Pset_STATk-O MASON COUNTY DEPARTMENT OF COMMUNITY DEVELOPMENT MO 7 o A N Planning Division Y o N z 426 W Cedar St, Shelton, WA 98584 7 N Y ti (360)427-9670 Oo +O 1864 Exemption from Shoreline Management Act Case No.: SHX2015-00074 Substantial Development Permit Requirement The Proposal By: MANNING CUSHMAN FAMILY LLC PO BOX 261 HOODSPORT, WA 98548 To undertake the following development: Replacing floating dock and adding railing to the stationary dock (landing). Existing dock since 1974. Exisiting dock is 8' x 18' - replacement/new dock will be 10' x 20' in size. Within Lake Cushman 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: 10/12/2015 -` `e'`'Vai-17 Expires: 10/12/2017 Authorized Local Government Official cc: APPLICANT WDFW 'DKA WDOE TRIBAL COUNCIL. sec,( w,.31.1—�.,,L SEPA Environmental Checklist Mason County Permit Center Use: SEP QOl5owO 621. Single Family DNS: $385 Date Revd: ❑ Other DNS: 0 to 9.99 acres: $630 �y 10 to 20 acres: $755 .E E Over 20 acres: $945 ❑ DS/EIS: $2,525 ±70 Per hr SEP 2 9 2015 426 w rrn:AR ST. 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: rhelol 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 informati n reasonably related to determining if there may be significant adverse impact. Instructions for Lead Agencies: Please adjust the format of this templa 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 rhe)oi 1. Name of proposed project, if applicable: 1hefal 0 2. Name of applicant: fhebai V\an. k r.o C �•rn.o-r cv vn 3. Address and phone number of app icant and contact person: ihelpi 2L6-x_c2ce. ‘r(\c,.Y.n.�.� (tea c 1-j-3 ?ac' C\c._ `tet - � Sct-7 A qg S SEPA Environmental checklist(WAC 197-11-960)(MC versior-non project portion omitted): 2014 Page 1 of 11 4. Date checklist prepared: [helot q- - .S r 5. Agency requesting checklist: [hem 6. Proposed timing or schedule (including phasing, if applicable): them 7. Do you have any plans for future additions, expansion, or further activity related to or connected with this proposal? If yes, explain. rhe&pi 8. List any environmental information you know about that has been prepared, or will be prepared, directly related to this proposal. Them ,, 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. [helm 10. List any government approvals or permits that will be needed for your proposal, if known. Ihebi <S S s „co f ��o vY.c� � ,, . 15. S A cLr+r.. Cow o s r� � r.e e< s 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.) Them Ic c c 5'1 v.Q) 20 � Jr l01 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. rhetpi - \. ) rJ t.r) 1 ) ` 1.� �z -7 'oc Cce Y� C �Cl� ��OC1�S' O rA. SEPA Environmental checklist(WAC 197-11-960)(MC version-non project portion omitted): 2014 Page 2 of 11 B. ENVIRONMENTAL ELEMENTS rheEpl 1. Earth a. General description of the site rhelpl (circle one): Flat, rolling, hilly, steep slopes, mountainous, other: b. What is the steepest slope on the site (approximate percent slope)? [heipl 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 soils. [hefei S��r.� * c_b,cuv d. Are there surface indications of history of unstable soils in the immediate vicinity? If so, describe. Iheipi ti,c 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. [hebpi y\_o e f. Could erosion occur as a result of clearing, construction, or use? If so, generally describe. [help' g. About what percent of the site will be covered with impervious surfaces after project construction (for example, asphalt or buildings)? [helpi h. Proposed measures to reduce or control erosion, or other impacts to the earth, if any: [hebl 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. rhelpl b. Are there any off-site sources or emissions or odor that may affect your proposal? If so, generally describe. rhebi rd c. Proposed measures to reduce or control emissions or other impacts to air, if any: Ihebj !/r SEPA Environmental checklist(WAC 197-11-960)(MC version-non project portion omitted): 2014 Page 3 of 11 3. Water a. Surface Water: ihelol 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. {helot C,1\Y Chi-2-;;()-c._ct.>c c 1v<�cd y \k c7`� C Cv���vv�c�.n \C"-S\ �..r r�+t � \v� C c,\\\ A.i�s��:•c \ 01.\ S-Z 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. Jheipl y 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. (heipl 4) Will the proposal require surface water withdrawals or diversions? Give general description, purpose, and approximate quantities if known. fheipj 5) Does the proposal lie within a 100-year floodplain? If so, note location on the site plan. fheipi 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. iheIDi 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. rheipl 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. (.hebl r1 0 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. iheipi 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. rhelDi e'u 3) Does the proposal alter or otherwise affect drainage patterns in the vicinity of the site? If so, describe. (1 d. Proposed measures to reduce or control surface, ground, and runoff water, and drainage pattern impacts, if any: 1 A 4. Plants ihelpl _ ey a e o.\c...._be4 cro.v cX scrLN.c\ a. Check the types of vegetation and on the site: rhelpl deciduous tree: alder, maple, aspen, other 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 veget tion will be removed or altered? [help] ii c. List threatened and endangere species known to be on or near the site. rhea i L( �� d. Proposed landscaping, use of native plants, or other measures to preserve or enhance vegetation on the site, if any: rheipl v.c Y.e e. List all noxious weeds and invasive species known to be on or near the site. 5. Animals 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: rhebi birds: hawk, heron, eagle, songbirds, other: uc�S Gle�s�.. q. t_ ss\r.s b mammals: deer, bear, elk, beaver, other: YZ c,h.e.- I fish: bass, saimo , trou , erring, shellfish, other: c'. A- \k ;ems 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. fheipl yL\- C. Is the site part of a migration route? If so, explain. fhelpi d. Proposed measures to preserve or enhance wildlife, if any: fheipi ncsk2 e. List any invasive animal species known to be on or near the site. �Asn � 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. fheipj \(1ct i c�} a`.� � r- -\-:s^N5 b. Would your project affect the potential use of solar energy by adjacent properties? If so, generally describe. fheb i )...1.c.ve- 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: fheipl 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. rhelpi 1) Describe any known or possible contamination at the site from present or past uses. �� �v._ 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. r(.3 cue 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. r�r� 5) Proposed measures to reduce or control environmental health hazards, if any: M/P 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)? ihelpi ,�,; 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. [help] ,,e 3) Proposed measures to reduce or control noise impacts, if any: fhelpl \(\.0.vyn ort.ec i sa.w a 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. fheipl c .G C cca \.G+v\ i w i Vv. W.i arcs cs c>.�i my b. Has the project site been used as working farmlands or working forest lands? If so, describe. 1,1t 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? 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? [heipi 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: c. Describe any structures on the site. jheipl ,.9-'r°r'''^� `� �`� � d. Will any structures be demolished? If so, what?jhelpi y y c-.)-+' c.,,e.. "c� e. What is the current zoning classification of the site? rheipl f. What is the current comprehensive plan designation of the site? [helpl g. If applicable, what is the current shoreline master program designation of the site? ihelpi h. Has any part of the site been classified as a critical area by the city or county? If so, specify. Iheipi SEPA Environmental checklist AC 197-11-960 (MC version-non projectportion omitted): 2014 Page 7 of 11 c st(W ) ) 9 i. Approximately how many people would reside or work in the completed project? rhelpl 0 j. Approximately how many people would the completed project displace? rhelal k. Proposed measures to avoid or reduce displacement impacts, if any: rhelDi (1'J/f L. Proposed measures to ensure the proposal is compatible with existing and projected land uses and plans, if any: rhelpj mac) a v-v m. Proposed measures to ensure the proposal is compatible with nearby agricultural and forest lands of long-term commercial significance, if any: 1A 9. Housing a. Approximately how many units would be provided, if any? Indicate whether high, middle, or low- income housing. (help' Ly A b. Approximately how many units, if any, would be eliminated? Indicate whether high, middle, or low-income housing. rheiDi Lifer c. Proposed measures to reduce or control housing impacts, if any: [hem 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? (helpl © -7 38 -1 a bo C b. What views in the immediate vicinity would be altered or obstructed? rhelpi c. Proposed measures to reduce or control aesthetic impacts, if any: rheiDi 11. Light and glare a. What type of light or glare will the proposal produce? What time of day would it mainly occur? (help]. b. Could light or glare from the finished project be a safety hazard or interfere with views? Ihetpl / ram c. What existing off-site sources of light or glare may affect your proposal? rhelaj d. Proposed measures to reduce or control light and glare impacts, if any: [help] ti/ A 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? rheipi r I S \CI W V b. Would the proposed project displace any existing recreational uses? If so, describe. [heir)]. c. Proposed measures to reduce or control impacts on recreation, including recreation opportunities to be provided by the project or applicant, if any: rheipi e'trs 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. rheipi \© 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. rheb i 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. rheipi 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. toip 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. rhelpl 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?IheiDi tom%A c. How many additional parking spaces would the completed project or non-project proposal have? How many would the project or proposal eliminate? pleb] 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). [hefpi r� e. Will the project or proposal use (or occur in the immediate vicinity of) water, rail, or air transportation? If so, generally describe. ihelpl 'C.. 0 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? [helpl o y� 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. h. Proposed measures to reduce or control transportation impacts, if any: [hero] 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. pleb' %(-•c b. Proposed measures to reduce or control direct impacts on public services, if any. [help] V-J 11 16. Utilities a. Circle utilities currently available at the site: [help' 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. [helpl 4ta � SEPA Environmental checklist(WAC 197-11-960)(MC version-non project portion omitted): 2014 Page 10 of 11 C. SIGNATURE rheipi 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: l f,. �"�,l Zir21._ A.Q/3.d.., Date Signed: Print Name of Signee: ` 116-./71F 8, A7/s,, /1?'�j- If applicable, Position and Agency/Organization: fir- i T /11 )j C/ 7 } ,Rr7� Date Submitted: SEPA Environmental checklist(WAC 197-11-960)(MC version-non project portion omitted): 2014 Page 11 of 11 , „ _ . , .. ,....,,, c -te 1 9 r fjj , ( a"Raw 1 i , , ...?) r, r? ,,,,__?,.r._-..k# ----- ......" 1` ,1"/ (.0) 1 rb 1 gr? , I I 7 if,,�-yam,yJ. , -9./."749 0'''‘ii,/A f 1 '41".7.f1:7 Li / ecc,..c. ...„ -9N-z- ..-0,..„,.. ziii,„,:••- - 6. - --027.<-2....,-- . 000r -5:-Je 4.2ra.a ..%,,.,„,,,... --ra f. -4/-°"f--v-1-107.2- 76'Or ........esex . ............ 329...,94? .. 40*„.57,- z.,„:„.7e, /,,/,„.y.- .4/ s .cP':?1 %.'` IN l's.,'I ii N tk : ,—,%\t1;44- is , k`l: 4'414 \ 1‘\?" I 4. 4. 401 \G v r\%) NI 44. NI k ' . 'IN‘ ;Si ti1 1C$ "\ -4\k\ L. -t-f' --17e0j; (3ir 017 "4%, z.. , f :ef; %'•vil 09 • 4 ,,iyi N %4 M4•1/ . '0,,f'4,0#74,H Az ,,c, _ , ilie , • 5 „7e • • � 31 a Z . - , , i '.1. kr) . , '' ', ,,i, T! '; , , . , . • ' ' -)/ ' - .4 . . . . . ., , I 1 T f l?I I j7f Yr , r------i_t_t.........,......-1 ; i r I . T i . ___• .,. _. ___ .. .. i 9.1 ; 1 i ,•- III _ � � II 1 I, FLOATING DOCK CONSTRUCTION INFORMATION The floating dock will be 20 feet by 1P feet for a total square footage of 200 feet. It will be attached to existing pilings so no soil disturbance. The lumber to be used will be either cedar or approved pressure treated wood,depending on availability. The floatation devices will be 9 PermaFloat model#1624 Dock System Float drums. The drums hav 'a .150 inch thick polyethylene shell and will be attached using a combination of 2" by 4" and 2" by 6" lumber for framing chambers. The decking will be 3i inch marine grade plywood. The existing dock built in 1974 will be removed and disposed of at a wood recycling company. The new dock will built on the footprint of the existing dock plus 2 feet additional width and 2 feet additional length. / 1- A ro i... \'x... _ yt t f CI Csv ,( t 4:' it !f A + /' 4 fir!/ 1 l a�� r 'f/ t'y.iL A • [`_ ,r 4, 1 tt' I '1' Y /'a �.,> ` •.4, l J • 3::a,,, ,'§' .s7+,. ij1t'- 'go- r w -.h _ 'tom'.S+q. t� �- 4 a.;. iEtJ,. ,.NVrrt, ,f.+ . d' ,, : - ` A., pRz f S �.. » w �}3j. w.? r!'.-a rt �- t .j�:'� ' v, F' ,,'} ,�"" f` mow:. e r tie' Imo,- Y x: �, � ..em # yywVt*. 4 . p - 1 $: r,_ yy f,3 .r ' r� -V� J,��".' ;'S . _ ,. •`e_ 1, �,� ^ti - '4MR fi At ,. {yam�;y ,'t J'.'F.4 y . m.a j' is : ' ` -" ytit , t.. • 4 • • t ate. r^d' .o