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Home My WebLink AboutSHX2018-00009 JARPA - SHX Permit / Conditions - 2/2/2018 MASON COUNTY �oN_srA F o P , Department of Community Services �t o Planning Division o A v i 615 W Alder St, Shelton,WA 98584 y o T (360)427-9670 y ti of �O 1864 Exemption from Shoreline Management Act Case No.: SHX2018-00009 Substantial Development Permit Requirement The Proposal By: DABNEY ROUSH 281 N POTLATCH DR NORTH HOODSPORT, WA 98548 Parcel Number: 423075000026 Site Address: 281 N POTLATCH DR NORTH HOODSPORT To undertake the following development: PERFORM MINIMUM REPAIRS TO EXISTING PIER AND DOCK TO MEET SAFETY STANDARDS. I 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: D-emergencv construction Please contact Kell Rowen at ext 365 if you have any questions. Issued:2/2/2018 Authorized Local Government Official February 02, 201 f SHX2018-00009 i � w \ +1 w N w N ct a o tiv""iNyvi vivih a o°, � oc000 WyN+000 �q�� o E Ow0 O-IxC:4 < ce W W0 O OF e cLu Zu mG0 Q Q a bdS O O wwz .�o��w 3 Wx FW- j o n.UEw. Roo Nrn 33EW4 .. F 3 n10. . _ wOOw cdOIN �6 p Q W03 G <¢ a p > a� 3 ) an U ci4au¢uvwi� Zp w O to «s ( wand. o yw O w A { f acly Z: �i aC�VdQ t/10.i�Q � ^ Wm �o�W° oa�O r w C, L j 'C3 m t-y b Li N k dam00 ON Ji t <aa i o d � s3 4 c f -_ Ga .� O ____ -- P i V m 0 .I -- ------_-- z 8.. i4 -a 00 q N �Q tl UO yy 6t3 yp� a! g 4 Zz <� V< Oy I i= U i �. m O r 4C I sc9 33 ! I i m OmYz U en O mo ` O.av .ui? i I i ! S Fuld zuUO .a 8 � ! a .8.�= Oy } I Ol Ol i 1 6 .F l yzc 00 CI�M t I o z i �ii o U �t o I z ° vo �o CC' < galp1 n ��GG y. j� 7'.___ may- -"1�;•:�r .�9 !! Ol yVww �;V�OO 101 m 1 } W r+ A I z<NN N 4 I ?id a S N o `.Ol r yZ I :1 en yo J cd p v y 1 C i xj= 1 §zo Qz a0 Z2 0 1 `.\ 1 1 1 1 i r y MASON COUNTY • COMMUNITY SERVICES Building,Planning,Environmental Health,Community Health February 2,2018 � Dabney Roush 2510 208th Ave SE Sammamish, WA 98075 RE: Roush Pier-Dock Repair To Whom It May Concern: Mason County finds the activity of repairing the existing pier and dock as described in SHX2018- 00009 as allowed with a Hydraulic Project Approval to be exempt from SEPA per WAC 197-11- 800(3)(c). For additional information, please contact the Mason County Planning Department at 360.427.9670 ext. 365. Sincerely, Kell McAboy, Senior Planner Mason County-CSD Public Health community Development (community Health/Environmental Health) (Permit Assistance Center/Building/Planning) 415 N.6tn Street—Shelton,WA 98584 615 W.Alder Street—Shelton,WA 98584 Shelton:360-427-9670,Ext.352 Shelton:360-427-9670,Ext.400 Belfair:360-275-4467,Ext.352 Belfair:360-275-4467,Ext.400 Elma:360-482-5269,Ext.352 Elma:360-482-5269,Ext.400 -------- -f - - , O ; Date received US Army Corps of Engineers WASHINGTON STATE I , Seattle Distract Agency ret'er`ence Joint Aquatic Resources Permit Tax Parcel#(s): ��1- Sa-� Gi'�2to Application (DARPA) Form1,2 , USE BLACK OR BLUE INK TO ENTER ANSWERS IN THE WHITE SPACES BE OW. --`--- -------------------------------- Part 1—Project Identification 1. Project Name (A name for your project that you create. Example Smith's Dock or Seabrook Lane Development) [hel pl Roush Repair Work Part 2—Applicant The person and/or organization responsible for the project. [help, 2a. Name(Last, First,Middle) Roush, Jeff&Dabney 2b. Organization(If applicable) 2c. Mailing Address(Street or PO Box) 2510 208t' Ave SE 2d. City, State, Zip Sammamish,Wa, 98075 2e. Phone(1) 2f. Phone(2) 2 . Fax 2h. E-mail , Additional forms may be required for the following permits: • If your project may qualify for Department of the Army authorization throu h 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(BPIF)or prepare a Biological Evaluation. Forms can be found at httq//www nws usace army mil/Missions/CivilWorks/Regulatory/PermitGidebook/EndanaeredSaecies.asox. • Not all cities and counties accept the JARPA for their local Shoreline per its.If you need a Shoreline permit,contact the appropriate city or county government to make sure they accept the JARPA. 2To access an online JARPA form with[help]screens,go to http*//www.epermitting.wa.gov/site/alias resourcecenterfaroa iarpa form/9981 jaroa form.asox. For other help,contact the Governor's office of Regulatory Assistance at 1-800-917-0043 or helpora.wa.aov. Page 1 of 12 JARPA Revision 2012.1 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.) [help] 3a. Name(Last, First, Middle) Valdeman, Caralyn 3b. Organization (If applicable) Integrated NW Construction, LLC EM. ailing Address(Street or PO Box) ake Cushman Rd, Suite 109 ity, State, Zip Hoodsport, WA 98584 3e."Phone(1) 3f.`Phone(2) 3 . Fax 3h. ,E-mail (253) 888-5314 (206) 319-4239 caralyn@integratednwconstruction.com 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. hel ❑ Same as applicant. (Skip to Part 5.) ❑ Repair or maintenance activities on existing rights-of-way or easements. (Skip to Part 5.) ❑ There are multiple upland property owners. Complete the section below and fill out DARPA Attachment A for each additional property owner. ❑ Your project is on Department of Natural Resources (DNR)-managed aquatic lands. If you don't know, contact the DNR at(360) 902-1100 to determine aquatic land ownership. If yes, complete JARPA Attachment E to apply for the Aquatic Use Authorization. 4a. Name(Last; First, Middle)' 4b. Organization (if applicable) Tacoma Power 4c." Mailing Address(street or PO Box) P.O. Box 11007 4d. City, State, Zip Tacoma, WA 98411-0007 4e. Phone(1) 4f. Phone(2-) 4 `. Fax 4h. E-mail JARPA Revision 2012.1 Page 2 of 12 Part 5—Project Location(s) Identifying information about the property or properties where the project will occur. [helms] ❑ There are multiple project locations (e.g. linear projects). Complete the section below and use DARPA Attachment B for each additional project location. 5a. Indicate the type of ownership of the property. (check all that apply.) [tPIPJ ® 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,pr vide other location information in 5p.) [help] 281 N Potlatch Dr North 5c. City, State, Zip(If the project is not in a city or town, provide the name of the nearest city or town.) [help] Hoodsport,WA 98548 5d. County ,[hl Mason 5e. Provide the section, township, and range for the proje t location. [hpjpj 1/4 Section Section Township - - Range 07 23N 4W 5f. Provide the latitude and longitude of the project location. [helpi Example;47.03922 N lat./-122.89142 W long. (Use decimal egrees-NAD 83) 47.49317 N -123.24995 W 5g. List the tax parcel number(s)for the project location. hel The local county'assessor's office can provide this information. 42307-50-00026 5h. Contact information for all adjoining property owners.'pf you need more space, use JARPA Attachment G.) [held Name Mailing Address Tax Parcel #(if known) Gallimore, David &Gallimore- PO Box 1707, Mercer Island Wa, 98040 42307-50-00025 Wong, Pamela 826 Fairmount Ave, Shelton Wa, 98548 42307-50-00027 ----------------------------------------------------------------------------------------------------------------------------------------- Joan M. Manke Family LLC -----------------------------_-------------------...------------------------------------------------------------ ----------------- Page 3 of 12 JARPA Revision 2012.1 5i. List all wetlands on or adjacent to the project location. [help No wetlands on or adjacent to the project location. 5j. List all waterbodies (other than wetlands) on or adjacent to the project location. hei Lake Cushman. 5k. is any part of the project area within a 100-year floodplain? [help] ® Yes ❑ No ❑ Don't know 51. Briefly describe the vegetation and habitat conditions on the property.- [htid Site moderatly vegetated with native vegetation. 5m. Describe how the property is,currently used. hei Recreational and residential. 5n. Describe how the adjacent properties are currently used. [hep] Recreational and residential. 5o. Describe the structures (above and below ground)on the property, including their purpose(s) and current condition. [ham] There is a single family residence and the following existing shoreline appurtenances: an approx. seventy-seven-foot(77') concrete bulkhead with lakebed access steps, a twenty-eight by twelve-foot(28' x 12')failing pier, a twenty by twelve-foot(20' x 12')failing float with a seven by five-foot(7' x 5')jet ski ramp, a vertical metal ladder between the pier and float, a concrete paver fire pit, and an approx. fifteen by two-foot(15, x 2') concrete walkway on the lakebed. 5p. Provide driving directions from the closest highway to the project location, and attach'a map. [h_"i j From SR 119 going North, turn right onto N Mount Church Drive, then turn right when N Mount Church Drive turns into N Potlatch Drive North and follow addresses to the site. The property is on the left. JARPA Revision 2012.1 Page 4 of 12 Part 6—Project Description 6a. Briefly summarize the overall project. You can provide more detail in 6b. [hep]''' Minor repair activity to extend the life of the shoreline structures for another season until the structures can be rebuilt 6b. Describe the purpose of the,project and why you want r need to perform it. [help] The applicant's existing pier and float are old and in need of repair. There is an existing application in place to replace the entire structure, however the permits will not be received in time for the summer months. The applicant wishes to use the dock during the summer months and ensure that it is structurally sound to make it through another season until it can be rebuilt. This will make the overwater structures safer for both humans and the environment. Therefore, the project objective is to repair the existing shoreline appurtenances while avoiding or minimizing impacts to ESA-listed species and improving shoreline habitat at the site. 6c. Indicate the project category. (Check all that apply) [hel ❑ Commercial ® Residential ❑ Institutional ❑ Transportation ❑ Recreational ❑ Maintenance ❑ Environmental Enhancement 6d. Indicate the major elements of your project. (Check all t t apply) [help] ❑ Aquaculture ❑ Culvert ® Float ❑ Retaining Wall (upland) ❑ Bank Stabilization ❑ Dam/Weir ElFloating Home ❑ Road ❑ Boat House ❑ Dike/Levee/Jetty ElGeotechnical Survey Land Clearing ❑ ❑ Boat Launch ❑ Ditch ❑ g ScientificMeasurement Device ❑ Boat Lift ® Dock/ Pier ❑ Marina/ Moorage ❑ Stairs ❑ Bridge ❑ Dredging ❑ Mining ❑ Stormwater facility ❑ Bulkhead ❑ Fence ❑ Outfall Structure ❑ Swimming Pool ❑ Buoy ❑ Ferry Terminal ❑ Piling/Dolphin ❑ Utility Line ❑ Channel Modification ❑ Fishway ❑ Raft ❑ Other: 6e. Describe how you plan to construct each project elerr ent checked in 6d. Include specific construction methods and equipment to be used. ihepl • identify where each element will occur in relation to the neare t waterbody,. • Indicate which activities are within the 100-year floodplain. 1. Repair of existing pier and dock, as follows: - Sister to existing, split column to improve structural stability (see pic 1) - Install blocking under existing mooring whips and cleats - Demo, remove, and dispose of existing ramp on water-side of floating dock(see pic 2) - Inspect underneath pier and reinforce weak areas,where detected - Inspect floating dock for issues of weakness and repair or reinforce, where necessary; secure floats if loose Replace up to 10 rotted or broken deck-boards 2. All debris will be disposed of in a state-licensed landfill Page 5 of 12 JARPA Revision 2012.1 6f. t e the anticipated start and end dates for project construction? (MonthNear) [ig]pJ project will be constructed in phases or stages, use JARPA Attachment D to list the start and end dates of each phase or . Start date: Feb 2018 End date: Feb 2018 ❑ See JARPA Attachment D 6g. Fair market value of the project, including materials, labor, machine rentals, etc. [h.elp.I $800 61h. Will any portion of the project receive federal funding? [hel4] • 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.)[help] 7a. Describe how the project has been designed to avoid and minimize adverse impacts to wetlands._ [help] ® Not applicable 7b. Will the project impact wetlands? [ju, ❑ Yes ❑ No ❑ Don't know 7c. Will the project impact wetland buffers? [he_Ip] ❑ Yes ❑ No ❑ Don't know 7d. Has a wetland delineation report been prepared? [help] • 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? [help] • If Yes, submit the wetland rating forms and figures with the JARPA package. ❑ Yes ❑ No ❑ Don't know 7f. Have you prepared a mitigation plan to compensate for any adverse impacts to wetlands? [help] • If Yes,submit the plan with the JARPA package and answer 7g. • If No,or Not applicable,explain below why a mitigation plan should not be required. ❑ Yes ❑ No ❑ Not applicable 7g. Summarize what the mitigation plan is meant to accomplish, and describe how a watershed approach was used to design the plan. [h,,- 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. [hip] JARPA Revision 2012.1 Page 6 of 12 Activity (fill, Wetland Wetland Impact Duration Proposed Wetland drain, excavate, Name' type and area(sq. of impact' mitigation mitigation area flood, etc.) rating ft. or type 4 (sq. ft. or category' Acres) acres) 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),Preservatign(P),Mitigation Bank/In-lieu fee(B) Page number(s) for similar information in the mitigation plan, if available: 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 laced into the wetland. [help] 7j. For all excavating activities identified in 7h,'describe th excavation method, type and amount of material in cubic yards you will remove, and where the material will be disposed. [hei,31 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.) [b—elpj ® 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. [hel ❑ Not applicable 1. No construction to occur unless Lake Cushman's waters are low. 2. No pressure treated lumber will be used in this project. Sustainably harvested Alaska yellow cedar, which is insect and decay resistant, will be utilized for all wood members of the pier and float. 3. Construction to take place as per the HPA provisions from the Washington Department of Fish and Wildlife. 8b. Will your project impact a waterbody,or the area around a waterbody? [h-e-lpj ® Yes❑ No 8c. Have you prepared a mitigation plan to compensate for the project's adverse impacts to non-wetland waterbodies? [hel • If Yes,submit the plan with the JARPA package and answer 8d. • If No,or Not applicable,explain below why a mitigation plan should not be required. ❑ Yes ® No ❑ Not applicable Page 7 of 12 JARPA Revision 2012.1 8d.:used mmarize what the mitigation plan is meant to accomplish._Describe'how a watershed approach was to design the plan. fyou already completed 7g you do not need to restate your answer here. [help] 8e. Summarize impact(s) to each waterbody in the table below. [hey Activity (clear, Waterbody Impact Duration Amount of material Area (sq. ft. or dredge, fill, pile name' location2 of impact3 (cubic yards) to be linear ft.) of drive, etc.) placed in or waterbody removed from directly affected waterbod Repair Lake Shoreline 1 cubic yards of 300 sq ft Cushman Alaskan yellow cedar installed on existing shoreline structure m Deo Lake Shoreline .5 cubic yards of wood 30 sq ft Cushman ramp to be removed from existing shoreline structure 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. 2lndicate 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. 3 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. [hem None 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. h[ ems) None 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. het Agency Name Contact Name Phone Most Recent Date of Contact' JARPA Revision 2012.1 Page 8 of 12 T�_ 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? [ham] i • If Yes,list the parameter(s)below. • If you don't know,use Washington Department of Ecology's Wager Quality Assessment tools at: http�//www.ecy.w_a-9 ❑ Yes ® No 9c. What U.S.Geological Survey Hydrological;,Unit Code (j UC) is the project in? [helpi • 'Go to http//cfpub epa qov/surf/locate/index.cfm,,to help identify he HUC. 17110018 9d. What Water Resource Inventory Area Number(WRIA )=is the project in? [her • Go to http//www.ecy.wa.gov/services/qis/ )Ps/wria�/W ,Lia.htm to find the'WRIA#. WRIA 16 9e. Will the in-water construction work comply with the State of Washington water quality standards for turbidity? [b-e-lpj • Go to http//w L,( ecy_wa ctov/programs/wq/swgs/criteria htrnl for the standards. ® Yes ❑ No ❑ Not applicable 9f. If the project is within the jurisdiction of the Shoreline Management Act,what is the local shoreline environment designation? [heI • If you don't know,contact the local planning department. • For more information,go to:h1!2://www.ecy.wa.gov/programs/sea/sma/laws rules/173-26/211 designations.html. ❑ Rural ❑ Urban ❑ Natural ❑ Aquatic ❑ Conservancy ® Other Urban Residential 9g. What is the Washington Department of Natural Resources Water Type? [help] •' Go to htto�//www dnr wa gov/BusinessPermits/Topics/ForestPracticesApplications/Pages/fp watertyping aspx for the Forest Practices Water Typing System.'' ® Shoreline ❑ Fish ❑ Non-Fish Perennial ❑ Non-Fish Seasonal 9h. Will this project be designed to meet the Wash i ngtonj Department of Ecology's most current stormwater' manual? [heI • If No, provide the name of the manual your project is designed to meet. ® Yes ❑ No Name of manual: Stormwater Management Manual for Western Washington. 9L Does the project site have known contaminated sediment? [helps •' If Yes,please describe below: Page 9 of 12 JARPA Revision 2012.1 EYesE property was used for in the past, describe'below. [nftipj it was a forest. 9k. Has a cultural resource (archaeological) survey been performed on the project area? [help] • If Yes, attach it to your JARPA package. - ® Yes ❑ No 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. [help] The Chinook salmon, the bull trout, the Puget Sound steelhead, the marbled murrelet, streaked horned lark, yellow-billed cuckoo, and the spotted owl are the ESA listed threatened or endangered species in the area. 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. [hem See above, plus cutthroat trout, Kokanee, and fisher. Part 10—SEPA Compliance and Permits Use the resources and checklist below to identify the permits you are applying for. • Online Project Questionnaire at http://apps.ecy.wa.gov/opas/. • Governor's Office of Regulatory Assistance at(800) 917-0043 or helpCa-)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.) [help] • For more information about SEPA,go to www,ecy.wa.gov/programs/sea/Sepa/e-review.html. ❑ A copy of the SEPA determination or letter of exemption is included with this application. ®A SEPA determination is pending with_Mason County_(lead agency). The expected decision date is ❑ 1 am applying for a Fish Habitat Enhancement Exemption. (Check the box below in 1 ob.)[help] ❑ This project is exempt (choose type of exemption below). ❑ Categorical Exemption. Under what section of the SEPA administrative code (WAC) is it exempt? ❑ Other: JARPA Revision 2012.1 Page 10 of 12 t ,sling here, I state that i have the authority to grant access to the property. I also give my consent to the „fling agencies entering property where the project is located to inspect the project site or any work ,,led to the project. (initial) D A�Q�__ k o vim. Q�•�ds� j�z 7/j 9 Applicant Panted Name Applicant Signature Date 11 b. Authorized Agent Signature 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. Caral n M.Valdeman 01/29/2018 Aufort odA9W Rkftd Nwo Authorized Agent Signature Date i 11a. Property Owner Signature(if not applicant), ► i 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. IIt you require this document in another format,contact the Govemor's Office of Regulatory Assistance(ORA)at(800)917-0043. People with hearing loss can wX 711 for Washington Relay Service.People with a speech disability can call(877)$33�1341. ORApublicMionnumber, ENV-019-09 rev.06-12 JARPA Revision 2012 1 Page 1 of 12 yf,arellrie Lxernpt'On t ypu texpiavq 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—Attach Exe!np_=Form ffective July 10. 2012, you must submit a check for$150 to Washington Department of Fish and Wildlife, unless ur project qualifies for an exemption or alternative payment method below. Do not send cash. ck th apprrqpriatg boxes- $150 check enclosed. (check#_Will be paid online via APPS__) Attach check made payable to Washington Department of Fish and VVIdlife. Charge to billing account under agreement with WDFW. (Agreement# ). My project is exempt from the application fee. (check appropriate exemption) HPA processing is conducted by applicant-funded WDFW staff. (Agreement # ), Mineral prospecting and mining. Project occurs on farm and agricultural land, (Attach a copy of current land use classification recorded with the county auditor,or other proof of current land use.) Project is a modification of an existing HPA originally applied for, prior to July 10, 2012. (HPA# )_ Washington Department of Natural Resources: Aquatic Use Authorization Complete JARPA Attachment E and submit a check for$25 payable to the Washington Department of Natural Resources. Do not send cash. Washington Department of Ecology: Section 401 Water Quality Certification FEDERAL GOVERNMENT United States Department of the 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-b(dge projects) SEPA is pre-empted by federal law. Part 11 Authorizing Signatures Signatures are required before submitting the JARPA package. The JARPA package includes the JARPA form, project plans, photos, etc. het 11a. Applicant Signature(required) hei I certify that to the best of my knowledge and belief, the information provided in this application is true, complete, and accurate. I also certify that I have the authority to carry out the proposed activities, and I agree to start work only after I have received all necessary permits. I hereby auth ' agent named in Part 3 of this application to act on my behalf in matters related to this application. (initial}