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FPA09-19055 - FPA Application - 9/10/1992
170-1111 11-1111) 1 STATE OF WASHINGTON FOREST PRACTICES DEPARTMENT OF NATURAL RESOURCES APPLICATION/NOTIFICATION NOTE TO APPLICANT: Read but DO NOT write in shaded areas. Complete items 1-18. Use additional sheets as needed. SHUTDOWN ZONE BU N ER Z NE A E A DUAPPLICATION/NO IF I �ss� A1r--�A -14 - Fes. .�, /9e55 CHECK BOX FOR ANY REQUEST YOU HAVE. NOTE UPLAND MANAGEMENT AREAS AND RIPARIAN MANAGEMENT ZONES. REQUESTS /�n REQUESTS DELAYED EFFECTIVE DATE / oc- FP APPLICATION RENEWAL NO. ALTERNATE RMZ PLAN El FOREST APPROVAL DATE HYDRAULIC PROJECT APPROVAL❑ FOREST PRACTICE ASSISTANCE ❑ PRE-FILING REVIEW ❑ LANDOWNER WANTS FOREST MANAGEMENT ASSISTANCE❑ DATA UPLAND MANAGEMENT AREAS❑ NOS. ACRES HARVESTING OLD GROWTH ❑ RIPARIAN MANAGEMENT WATER TYPE ""`-NO.UNITS LINEAL FEET STREAM❑ SIDE(S) M or 0 POND/LAKE/BAY❑ ZONES(RMZ)BY: WATER TYPE NO.UNITS LINEAL FEET STREAM❑ SIDE(S) ❑ or 0 POND/LAKE/BAY❑ WATER TYPE NO.UNITS LINEAL FEET STREAM❑ SIDE(S) O or 0 POND/LAKE/BAY❑ (ALSO SHOW UPLAND MANAGEMENT AREAS AND RIPARIAN MANAGEMENT ZONES ON MAP) NOTE- TYPE OR PRINT INFORMATION IN PERMANENT BLACK INK. 1.NAME OF OPERATOR 2.NAME OF LANDOWNER 3.NAME OF TIMBER TAXPAYER(TIMBER OWNER) r S e� ADDRESS ADDRESS ADDRESS fc1l cd /2(l S'G l A:(IC4' lid SIG/ kflldd )e�zt. CITY STATE ZIP CITY STATE ZIP CITY STATE ZIP SAe1 she1 TELEPHONE NUMBER TELEPHONE NUMBER TELEPHONE NUMBER cadC) �a2- 8�2 o (904�) Y ? &290 616G ) WJ—I`2 9 o 4.TIMBER TAXPAYER FULL LEGAL NAME TIMBER TAX REGISTRATION NO. 5.COUNTY T:S e A /1aWe Rq-) Oa 44 lS A'_ TYPE OF F EGAL ENTITY UNIFIED BUSINESS IDENTIFIER 6.WITHIN CITY LIMITS? NO YES❑ SOLE OWNER ZK PARTNERSHIP ❑ CORPORATION❑ OTHER ❑ (n/ W y ? NAME: CALL 1-800-548-TTAX FOR TAX NUMBER OR TAX INFORMATION 7. LAND PLATTED AF,T€R JAN.1,196 (INCLUDES SHORT PLATS) )\)pO p� 8.IN PUBLIC PARK OR WITHIN 500 FT(e.g.PORT,CITY COUNTY,STATE,FED.PARK) (CONTACT Co. s o OR v RI NO OYES ❑ PARK NAME: NO>( YES ❑ 10. SLOPE CONDITION&PERCENT 9. LEGAL SUBDIVISION OF OPERATION(S)—INCLUDE PARCEL OR TAX LOT NUMBER IF CONVERSION OR 1F PLATTED SEC. TWP. RGE.E!W UNSTABLE❑ p HIGHLY ERODIBLE❑ 0 STEEPEST 10%OR SIGNIF.P T F OPERATION B' VC2 Q© 7 00.7 O OERAGE SLOPE AREA % AV C. 11.START DATE END DATE (SHOW ON MAP) q FED.THREAT.AND ENDANG.SPECIES OR CRITICAL WILDLIFE HABITAT:NAME_��� / 12.TYPE OF OPERATION 13.METHOD OF OPERATION AND TYPE OF EQUIPMENT 14A.ACREAGE 14B.ROAD 15. EST.VOLUME TO BE CUT (ALSO SHOW ON MAP) (ALSO SHOW ON MAP) OPERATION MILES A.TOTAL B.PERCENT A. �2 u �' ,' v- F B. C. ROAD ABANDONMENT PROPOSED/PLANNED FOLLOWING COMPLETION OF OPERATION NO YES ❑ (SHOW ON MAP) 16.LOCATION OF WATER OR WATER INTAKES ON OR WITHIN 1/4 MILE OF THE OPERATIONS PLAN FOR ROAD CONSTRUCTION OR IMPROVEMENTS OR HARVEST OF 30%OR MORE OF VOLUME IS WITHIN 200 FT.OF SHORELINE OF THE STATE ❑ OR SHORELINE OF STATEWIDE SIGNIFICANCE❑ (WATER TYPES 1 AND+1,CONTACT LOCAL GOVT.FOR INFORMATION) APPLICANT IS AWARE OF 1 OR MORE INTAKES(DOMESTIC,AGRIC.,INDUSTRY)ON OPERATION NO YES ❑ (SHOW ON MAP) SHOW THE TYPE AND LOCATION OF ALL WATERS ON THE ATTACHED MAP(WATER TYPE MAPS ARE AVAILABLE AT REGIONAL OFFICES OF DEPT.)SHOW SIZE AND LOCATION OF ANY WATER CROSSING STRUCTURES.INDICATE ALL ACTIVITIES PLANNED WITHIN OR ABOVE ORDINARY HIGH-WATER MARKS OF ANY WATER OR CHANNEL AND INDICATE WATER TYPE AND OTHER DETAIL: WATER TYPE WATER TYPE WATER TYPE WATER TYPE WATER TYPE OPERATE EQUIPMENT INSTALL CULVERTS BRIDGES FELL TIMBER SKID OR YARD TIMBER (KIND OF) (SIZE OF) (KIND OF) WATER TYPE —� WATER TYPE I�I WATER TYPE I�I WATER TYPE NONE r ROAD OR LANDING I I SIDECAST,WASTE I I DEBRIS DISPOSAL I I OTHER GIVE APPROXIMATE START AND END DATES FOR THIS WORK: START END (SHOW ACTIVITY&LOCATION ON MAP) 17.LANDOWNER OR PERPETUAL TIMBER OWNER REFORESTATION PLAN OR LANDOWNER CONVERSION PLAN HARVESTED LANDS ARE TO BE REFORESTED EXCEPT WHEN CONVERTED TO AN INCOMPATIBLE NON-FOREST USE OR EXEMPT ACCORDING TO RCW 76.09.060(3)AND WAC 222-34-050.THE LANDOWNER DOES DOES NOT ❑ INTEND TO CLEAR,IMPROVE OR DEVELOP LAND WITHIN THREE YEARS lll� SIX YEARS❑ .IF THE LAND- OWNER INTENDS TO CONVERT OR DEVELOP LAND, ATTACH SEPARATE STATEMENT WITH DETAILS INDICATED IN INSTRUCTION SHEET. LOCAL GOVERNMENT MAY REQUIRE ADDITIONAL INFORMATION.AN ENVIRONMENTAL CHECKLIST MAY BE REQUIRED. 50%OR MORE OF THE MERCHANTABLE TIMBER VOLUME IS TO BE REMOVED NO YES X ADEQUATE STOCKING REQUIRED) LANDOWNER INTENDS TO LEAVE ACCEPTABLE STOCKING NO ❑ YESX SPECIES f�� +P tr AVERAGE NO.STEMS/ACRE OR THE LANDOWNER INTENDS TO REFOREST YES❑ .NO N (ATTACH EXPLANATION OR CONVERSION STATEMENT) OPERATOR OR NAMED ALTERNATE IS TO PREPARE SITE.(LANDOWNER OR PERPETUAL TIMBER OWNER IS RESPONSIBLE FOR REFORESTATION) 'REFORESTATION WILL BE COMPLETED BY /yam N E DATE POST HARVEST SITE PREPARATION WILL BE COMPLETED BY _/��'� NAME DATE DESCRIBE SITE PREPARATION METHOD.(ATTACH SEPARATE STATEMENT IF NEEDED.) METHOD OF REFORESTATION: PLANTING❑ ARTIFICIAL SEEDING❑ NATURAL SEEDING91 OTHER❑ (Specify reforestation on additional sheet) IF PLANTING OR SEEDING: SPECIES STOCKING SIZE PROPOSED STEMS/ACRE IF NATURAL: SEED TREES 1( SEED BLOCKS❑ (SHOW 9N MAP AND IF ON ADJACENT LANDOWNER,ATTACH AGREEMENT.) METHOD TO CONTROL COMPETING VEGATATION: 18. WE AFFIRM THAT THE INFORMATION CONTAINED HER IN IS TRUE tO THE BEST OF OUR KNOWLEDGE AND UNDERSTAND THAT THIS PROPOSED FOREST PRACTICE IS SUBJECT TO THE CURRENT RULES AND REGULATIONS AND THE FOREST PRACTICES ACT. OPERA S SIGNATURE LANDO ER S SIGNATURE TIMBERO S SIGNATURE (12/87) -1352- SEE d (iN►11N ONDYTfONS AND A TSB ' FOREST PRACTICES APPLICATION/NOTIFICATION PROCESS AND CONDITIONS NOTE TO APPLICANT: Read but DO NOT write in shaded areas. Complete items 1-18. Use additional sheets as needed. SHUTDOWN ZONE BURN PERMIT ZONEE RECEIVED DATE DUE APPLICATION/NOTIFIC I N NUM a E a CHECK BOX FOR ANY REQUEST YOU HAVE. NOTE UPLAND MANAGEMENT AREAS AND RIPARIAN MANAGEMENT ZONES. REQUESTS �S REQUESTS DELAYED EFFECTIVE DATE FP APPLICATION RENEWAL NO. ALTERNATE RMZ PLAN ❑ a O EoAPPROVAL DATE HYDRAULIC PROJECT APPROVAL❑ FOREST PRACTICE ASSISTANCE ❑ PRE-FILING REVIEW ❑ LANDOWNER WANTS FOREST MANAGEMENT ASSISTANCE❑ i DATA UPLAND MANAGEMENT AREAS❑ NOs. ACRES HARVESTING OLD GROWTH ❑ RIPARIAN MANAGEMENT WATER TYPE NO.UNITS LINEAL FEET STREAM❑ SIDE(S) ETI or 2 POND/LAKE/BAY❑ ZONES(RMZ)BY: WATER TYPE NO.UNITS LINEAL FEET STREAM❑ SIDE(S) 111 or I] POND/LAKE/BAY❑ WATER TYPE NO.UNITS LINEAL FEET STREAM❑ SIDE(S) O or 10 POND/LAKE/BAY❑ (ALSO SHOW UPLAND MANAGEMENT AREAS AND RIPARIAN MANAGEMENT ZONES ON MAP) NOTE: TYPE OR PRINT INFORMATION IN PERMANENT BLACK INK. 1.NAME OF OPERATOR 2.NAME OF LANDOWNER 3.NAME OF TIMBER TAXPAYER(TIMBER OWNER) ADDRESS— ADDRESS ADDR SS CITY STATE ZIP CITY STATE ZIP CITY STATE ZIP TELEPHONE NUMBER TELEPHONE NUMBER TELEPHONE NUMBER FOR DEPARTMENT USE ONLY=DO NOT WRITE BELOW THIS LINE. RESOURCE MANAGEMENT PLAN ❑ CLASS 11 ❑ 111 ❑ IV GENERAL ALTERNATE PLAN ❑ PRIORITY ISSUE 111 ❑ IV SPECIAL ❑ INTERDISCIPLINARY TEAM ROAD CONSTRUCTION RELATED TO FUTURE,HARVEST❑ REDUCED NO.LEAVE TREES SMALL CC ❑ ',"EASTSIDE PARTIAL CUT ❑ NORTHEAST❑ OTHER ❑ SHADE RETENTION PLAN FOR TEMPERATURE SENSITIVE WATER❑ DiFFiCULT REGENERATION OR LOW PRODUCTIVITY❑ DETAILED OPERATION PLAN REQUIRED ❑ CULTURAL RESOURCE❑ (LANDOWNER MET WITH AFFECTED INDIAN TRIBE) 'DATE PLAN ❑ CONDITION❑ INTERDISCIPLINARY TEAM RECOMMENDATION INCORPORATED ❑ (INDICATE IDT) KNOWN OR RECORDED WATER RIGHT LESS THAN ONE MILE DOWNSTREAM ❑ CONDITIONS TO THIS APPLICATION/NOTIFICATION r _ THIS OPERATION IS SUBJECT TO: HYDRAULICS PROJECT APPROVAL❑ SHORELINES MGT.ACT ❑ OTHER ENVIRONMENTAL CHECKLIST ❑ ADDITIONAL CONDITIONS ATTACHED ❑ CONDITIONS FOLLOW: PRE-FILE REVIEW COMPLETE ❑ APPLICATION INCOMPLETE ❑ APPLICATION COMPLETE ❑ DISAPPROVED ❑ DEPARTMENT OF NATURAL RESOURCES SIGNATURE TITLE DATE INITIAL NAME APPROVED REGION AGENCY COPIES SENT FINAL COPIES SENT EFFECTIVE DATE EXPIRATION DATE REGION FP SPEC. ECOLOGY FISHERIES WILDLIFE LOCAL GOVT. NAME AFFECTED INDIAN TRIBE OTHERS LOCAL GOVT. NAME NAME NAME AFFECTED INDIAN TRIBE-----.. OTHERS LOCAL GOVT. NAME NAME AFFECTED.INDIAN TRIBE OTHERS. DRAINAGE NAME, �nBetxmz i.'w:tdNre:.13Riai4 •i:.atWn+t�..1i1,'.'�:"k{..yssinilM2T7---k5u3sbisFibf'+. .• ...•.. aLCievvw8..i }u/w�'. ,..:M.+..+..a _ — • aY. • f�*s6"€ ,aa i1� i :kY Y t• r , oop �•' •(fit 23� 9' , .. . • . . .. �'•. /* • ' .� :•� .�i. ,'. •• .. .,. ;� ,'fir A __ \ • 4'� gyp'- . , ,,. r +� -Kok, lie 1.0 e,,a!•N3� � b T � t .• r.tg t � � , x,� , _ .� 11� , A� e �• �� i.' it ir' �►., •1 i .'� t f t{`•ii',X e F 4 � .. *E#t'�i 'v 1 � .'Sr`�s,� t>7,kr,.,f� � �' ^s �}•l w �+ , .• •G,f .a.i �>�`; x t y Y.. �, �� 'r%�d 'Si f mot' r.; at 1r r � e� P, .�} .;�•r X.,� +n t1 3 j��?�� } 2�.,'r +�t`;•i,`� '+'�i.v�yf�$`. �J t� }rt,"'E..+' 9 ,.. }M, t"� tn a��c.�er� ''." 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L �cr�/,t.�.�t.>}+fi �4•x`S #.. -ti^',3'"�y�sy, r�"�`..•�. ?.�� � M�i �.�i 'F` A�{��i"i'k�$ '3 ' " {•1x1+y�4�kYF+'rliAX9Mj,;1{R�"-lt �+`r¢'.•b �� r �01, 2 R �h-'YF'�' :� F� r K 4 {J �(�f fj F.•G -'•N rt c � t r; a s -, •',-• J � t r,^i {� e]Y � �k �5����a�'>�� .i R Tt Y t �4 4 ♦ t � T..1' .L �..: :'..� »�,..;,t„ ...�s ice .,v,:."sk ° -:w a �_� <e t -�• ''+. G... t�.i':F'".. ... fin• 1_« .' `�'�„ r .ir c - S c :f <4 a4 „y a. .� �y:� •�. 'a.rea + r >. , . . - •�•,, t. •'r 00 TWP RGE CONTROL NO TP NAME DESCRIPTION LOC/CODE LOCATION WATER SOURCE TRIBUTARY TO: 20 050W G2-*10155 G2*10155 DM 23 _ _- L5 REST HAVEN WELL 20 050W S2-*15019 S2*150190 DM 23 GL-1 I UNN SPR 20 050W S2-*15043 S2*15043C DS 23 GL1 UNN SPR NAHWATZEL LK 20 050W S2--00371 S2-00371C DS 23 L9 LK NAHWATZEL TRACTS NAHWATZEL LK 20 050W 93-002238 NAT HER WETLAND SE1/4 NE1/4 PBB-- 37 72323 3AL INTEREST NAULT =REST 4XIN TRIBE �4 J� '4 .�": .y, .+fig � ZS.� R •.. `r y1 ex• }^ �1'ey ,&� s a - �, ,` t�J�z:� ;14�� +v �, •�: a �,. 'vr: ��` '"t ,.,•. �+7%�"��'i �c3,i�.kir, .�k ' � 'I �. x `� i Y 'VIPWASHINGTON STATE DEPARTMENT OF Natural Resources v BRIAN BOYLE Commissioner of Public Lands South Puget Sound Region c � 28329 SE 448th St. P.O. Box 68 AEG �7 ' +� Enumclaw, WA 98022 �11 (206) 825-1631 MASOt4 co, PLAWwG DEPI. S E P A Lead Agency Notice Re: FP-09- � The department has determined according to WAC 197-11-938 (4) that is the lead agency for purposes of compliance with State Envilronmental Policy Act for the above referenced forest practice application(s) . Should you disagree with this determination, you may petition the Dept. of Ecology to resolve the issue pursuant to WAC 197-11-946. The application(s) are subject to a 30-day period of approval unless you determine a detailed statement under RCW 43.21C.030(2) (c) is required. Please notify our office by the due date on the application your recommendations for approval , disapproval or conditioning of the application by the due date. BC/sc 880510 Equal Opportunity/Affirmative Action Employer