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HomeMy WebLinkAboutSHX2012-00004 Replace Bulkhead, Stairs - SHX Permit / Conditions - 2/21/2012 TA7g ,COS c Gf. 4 r. b�rgFe� STATE OF WASHINGTON DEPARTMENT OF ECOLOGY PO Box 47775 -Olympia, Washington 98504-7775 -(360)407-6300 711 for Washington Relay Service •Persons with a speech disability can call 877-833-6341 March 6, 2012 Mr.Allan Borden Your address Mason County = is in the Department of Community Development t Kennedy- Planning Division t, Goldsborough PO Box 279 ;;,_; watershed Shelton, WA 98584 Dear Mr. Borden: Thank you for the opportunity to comment on the determination of nonsignificance for the Geloneck-Bulkhead Replacement project(SEP2012-00005) located at 265 East Stretch Island Road North in Grapeview as proposed by William Geloneck. The Department of Ecology (Ecology)reviewed the environmental checklist and has the following comment(s): FLOODPLAINS MANAGEMENT: Donovan Gray(360)407-7273 It appears the project is in the 100yr floodplain and will require a floodplain development permit. If not already done, a habitat assessment should be conducted to determine impact to ESA listed species. SEPA REVIEWER: Sonia Mendoza WATER QUALITY CONTACT: Stephanie Jackson (360)407-6294 Erosion control measures must be in place prior to any clearing, grading, or construction. These control measures must be effective to prevent soil from being carried into surface water by stormwater runoff. Sand, silt, clay particles, and soil will damage aquatic habitat and are considered pollutants when discharged to waters of the state. Any discharge of sediment-laden runoff or other pollutants to waters of the state is in violation of Chapter 90.48, Water Pollution Control, and WAC 173-201A, Water Quality Standards for Surface Waters of the State of Washington,and is subject to enforcement action. During construction,all releases of oils,hydraulic fluids, fuels, other petroleum products, paints, solvents,and other deleterious materials must be contained and removed in a manner that will prevent their discharge to waters and soils of the state. The cleanup of spills should take precedence over all other work on the site. Proper disposal of construction debris must be on land in such a manner that debris cannot enter Case Inlet or cause water quality degradation of state waters. March 6,2012 Page 2 All trenches, depressions,or holes created in the intertidal area shall be backfilled prior to inundation by tidal waters. All stormwater discharges must be constructed in a manner that will not cause scouring on the beach. Fresh uncured concrete in direct contact with the water is toxic to aquatic life. All concrete shall be poured in the dry and allowed to cure a minimum of seven(7)days before contact with water. Shoreline armoring(e.g., hardening with rock) can result in adverse impacts to the natural character of the shoreline,but can be avoided. Ecology recommends the applicant use appropriate plantings of native vegetation to stabilize shorelines,rather than hardening them with rock or concrete. Ecology can provide further information on request. Applicants should consider that placement of a bulkhead may in some cases accelerate erosion of the beach. Bulkheads are not truly permanent, and may require expensive maintenance, especially after storm events. Per Chapter 90.58 RCW(WA State Shoreline Management Act), local governments must also consider the cumulative impacts of armoring large stretches of currently natural shoreline. Ecology's comments are based upon information provided by the lead agency. As such,they may not constitute an exhaustive list of the various authorizations that must be obtained or legal requirements that must be fulfilled in order to carry out the proposed action. If you have any questions or would like to respond to these comments, please contact the appropriate reviewing staff listed above. Department of Ecology Southwest Regional Office (SM:12-0797) cc: Donovan Gray, SEA Stephanie Jackson, WQ William Geloneck(Proponent) Steve Merrill,Jesfield Construction(Agent) PC701%-STgTFO MASON COUNTY C DEPARTMENT OF COMMUNITY DEVELOPMENT o A o ��, Planning Division Y o N z P O Box 279, Shelton, WA 98584 T • I N Y y (360)427-9670 OJ �O 1864 Exemption from Shoreline Management Act Case No.: SHX2012-00004 Substantial Development Permit Requirement The Proposal By: JESFIELD CONSTRUCTION *1111AW P.O. BOX 1590 vV (r ALLYN,WA 98524 ��'�✓ To undertake the following development: PN Replace existing wooden bulkhead (long failing) with concrete bulkhead along current alignment; wall to be 116 ft. long and 8 ft. high, with a 6 ft. wide inset stairs. Within CASE INLET 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 C-normal protective bulkhead Please contact Allan Borden at ext 365 if you have any questions. Issued: 2/21/2012 *A Expires: 2/21/2014 Authorized Local Government Official cc: APPLICANT WDFW USACOE WDOE TRIBAL COUNCIL i I, 4 r ,« , '. •� �. 4'; aedo ems. to Y. P a_ 7 �t GASH TNLEr ►30Ll<HCA0 12,1-:F EN.�' ^------� W)W-I A►^1 K. G-E L o AJCC K AD E. 26S 5T2t 7—CH ,r"SLAtA) EX►st- Fi4rW�G �o(r LKy H G-12APC—JIC-LJ WA 9$S-4-6 � v 12 luc6- -75'-9 oo'L+ REC'EIVEI Sy r3' 746t Con cC6Y6 r��KHE�t`�.J FEB 0 2 2012 L f Corlc�tr'7E SrA�25 v l > :EUAR ST X1ST EXIST. ACrAn/�w4 � sq �_ ?� • 5( E PTIc \ V � L.OT � S06 1 l 20' ------------------ --------------- -- RECENED - • 2010 ' "�" Date received: US Army Corps : FEB 0 2 2012 ; WASHINGTON STATE WE�"gn,"�'s Joint Aquatic Resources Permit Agency reference Application (JARPA) Form' Tax Parcel#(s): 121�-'lS-�i<b]�I USE BLACK OR BLUE INK TO ENTER ANSWERS IN 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) hel Rf & -L.>1✓rr C IC 2�0 K H /}v IZ t1?LA(_t.V 1 t=n/t Part 2—Applicant The person or organization responsible for the project. [heir] 2a. Name (Last, First, Middle)and Organization(if applicable) // 2b. Mailing Address (Street or PO Box) !Vv x;x 4-7t 2c. (/Citity,,AState, Zip c`_) ��/p /V'��/- / ,`-- V P— 'P& Y #1.V� vV A { Vt 4-V _ V T / 5- 2d. Phone(1) 2e. Phone(2) 2f. Fax 29. E-mail Part 3—Authorized Agent or Contact Person authorized to represent the applicant about the project. (Note: Authorized agent(s) must sign 11b. of this application.) nei 3a. Name (Last, First, Middle) and Organization (if applicable) 3b. Mailing Address (Street or PO Box) &);< 1 5 610 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 rill out a Specific Project Information Form(SPIF)or prepare a Biological Evaluation. Forms can be found at http://Www.nws.usace.at ii�y.mil/Publi, ;enarne=r • If you are applying for an Aquatic Resources Use Authorization you will need to fill out and submit an Application for Authorization to Use State- Owned Aquatic Lands form to DNR.which can be found at ra.gov/Publicationsiagr_use_auth_app.doc • Not all cities and counties accept the JARPA for their local Shoreline permits.If you think you will need a Shoreline permit,contact the appropriate city or county government to make sure they will accept the JARPA. ZTo access an online JARPA form with[help]screens,go to http: ::a, a c;rr,;r;;r; .; ,,site;ail as resourcecenterijarpaJarpa_form/9984l arpa_form.aspx. For other help,contact the Governor's Office of Regulatory Assistance at 1-800-917-0043 or help@ora.wa gov. City, State, Zip wA cis Z zr 3d. Phone(1) 3e. Phone(2) X Fax 3 . E-mail -2 l Sv- e_ L-L.... 0 �- CTr-. r�,.-t Part 4-Property Owner(s) Contact information for people or organizations owning the property(ies) where the project will occur. [held) 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 fill out -f ARPA Attachment t 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 4g. E-mail Part 5-Project Location(s) Identifying information about the property or properties where the project will occur. [_ ❑ There are multiple project locations (e.g., linear projects). Complete the section below and use Attachment R for each additional project location. 5a. Indicate the type of ownership of the property. (Check all that apply.) [het ❑ State Owned Aquatic Land (If yes or maybe, contact the Department of Natural Resources (DNR) at(360)902-1100) ❑ Federal ❑ Other publicly owned (state, county, city, special districts like schools, ports, etc.) ❑ Tribal 'R Private 5b. Street Address (Cannot be a PO Box. If there is no address, provide other location information in 5p.) hel 5C. City, State, Zip(If the project is not in a city or town, provide the name of the nearest city or town.) hel GeA-PEVi EVJ WA C1 r65 Y-6 5d. County hel MAS,—� IIJ e. Provide the section, township, and range for the project location. hel '/4 Section Section Township Range 5f. Provide the latitude and longitude of the project location. hel • Example: 47.03922 N lat./-122.89142 W long. (NAD 83) 47- 3;04.2 N LA;. l —1zz . $7-936 w LowG-. 5g. List the tax parcel number(s) for the project location. hel • The local county assessor's office can provide this information. 12-l016' -- I-S-- 0/0c1 + 5h. Contact information for all adjoining property owners. (if you need more space, use JARPA Attachment C.) hel Name Mailing Address Tax Parcel #(if known) ALt.ort r4, _SA.-vir3 A- KAY E _ 2u2:,n,'A D2 t� &-I&- HAet3�.Q , �,/,A �633t- IZf�S- 7S- gool3 - ;L-L&-s, w Ut-)s t Supim Po &%X 4-2-5r G-,-APFv,Ems, v✓A �14s54-b I Z!o - 76-°10 3 Z 5i. List all wetlands on or adjacent to the project location. Inc 'VO tJ E 5j. List all waterbodies (other than wetlands) on or adjacent to the project location. CA S rC 17iv LET" 5k. Is any part of the project area within a 100-year flood plain? hei ❑ Yes ❑ No Don't know 51. Briefly describe the vegetation and habitat conditions on the property. hel A Iv►N�QivY of -T), lrv7— wAtS c_"-), 2c� D�f2�NG Co�nJSVlvc d� THE Hoos R ruw ` t*(ZS /4Ni� {LEW11�In/S i?'IAT 1,/AY. ' 11 t12F A a..t AZ c*S oe A)ATt,f fc 5112�3 S Some AT Th t �-1J�� OF Th E �✓L:>��YL Z Y. r -- 5m. Describe how the property is currently used. nei 5n. Describe how the adjacent properties are currently used. Lei & 0 G-Lc- FA W 11!y 12-S I D E-v T,A L- 50. Describe the structures (above and below ground) on the property, including their purpose(s). n i S1 6i wl I LY h,}>M E WI r / i.R.2C- PI Lt- TA w A L-t— UH i tj D At'/ 6 TC> o PJt S i b c v F TYt c 5p. Provide driving directions from the closest highway to the project location, and attach a map. nei F120 YA S H CLTL),) TAKE H mi''f 2, AJ w21'H l I' i Cr H 1— 0 ni Flo? ST RI Gk i © r./ CY—��2T f� L A+�v RC�cSS T321►�GL ;o S,2E-rCVJ T5LAaD . Nr �ovTL �a� r�+itvzS�Zrt�,.� OW7-D C- SiTaLTtM Z5zAa/� iLI> A-T TOP 0 r` C IJ ✓V S 17N.9 LT fZ,Rom). Gk�`- Part 6-Project Description 6a. Summarize the overall project. You can provide more detail in 6d. hel IZ L o lr RE.1 le �l4 0L.-,/ T7-1 Nt:w CotJC267F OF �✓-T1 25 "E"✓ &,)LKHL-I'�b W)LL i3r n/o ��Z L gTtYzi,.��tt►� `THAN YKF LxiSrI )C iK14e;)+I> i7a oS ��n1L ;;X . 6b. Indicate the project category. (check all that apply) hel ❑ Commercial Residential ❑ Institutional ❑ Transportation El Recreational ❑ Maintenance ❑ Environmental Enhancement 6c. Indicate the major elements of your project. (check all that apply) [help] ❑ Aquaculture ❑ Culvert ❑ Float ❑ Road ❑ Bank Stabilization ❑ Dam /Weir ❑ Geotechnical Survey El Scientific ❑ Boat House ❑ Dike / Levee / Jetty ❑ Land Clearing Measurement Device ❑ Boat Launch ❑ Ditch ❑ Marina / Moorage Stairs ❑ Boat Lift ❑ Dock/ Pier ❑ Mining ❑ Stormwater facility ❑ Bridge ❑ Dredging ❑ Outfall Structure ❑ Swimming Pool Bulkhead ❑ Fence ❑ Piling El Utility Line ❑ Buoy ❑ Ferry Terminal ❑ Retaining Wall ❑ Channel Modification ❑ Fishway (upland) ❑ Other: 6d. Describe how you plan to construct each project element checked in 6c. Include specific construction methods and equipment to be used. heipj • Identify where each element will occur in relation to the nearest waterbody. • Indicate which activities are within the 100-year flood plain. LA07C fXcAvATO(L WiILL� BE- -FEOV6-HT- /A) DWI LAr-YD",6tus To REi►mo�� iSriA1(,- I-V& f3VLVHCAD ANO EXU VAt-E f-:vt NFw wALL Corr NG foUt�'PJ" WPLL WILL 6F FJRMtb /1V PLACE eVNC le- ErE W ►><.L 6E" �vrr"t'rED �r�JT-D 'r"I-tE FoRW1S �o✓� �AN�I�JAi21�.. S fiA►i25 w r'LL Tt-i t►�.� Cam= �o�wt Ei.� up �.11 LL 13E FL-ACE-0 L-A No WAV?-v QF: N E+.,l t../.4 LL , 6e. What are the start and end dates for project construction? (month/year) [help] • 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: ❑ See JARPA Attachment D 6f. Describe the purpose of the project and why you want or need to perform it. MIA • R� c�c� I=AIS:1nIC \/U,eYi(,A L Lac:- )3i-KHLA0, 711f4-F s SE�'tYt-tZ.I��I D r=T ,iyb-b )A,o,J L-, / nJ D JA n1 GcYZ- of C;,e_LA r>S► 6g. Fair market value of the project, including materials, labor, machine rentals, etc. [help] 6h. Will any portion of the project receive federal funding? [L_o- • If yes, list each agency providing funds. ❑ Yes JK 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.)[ J 7a. Describe how the project has been designed to avoid and minimize adverse impacts to wetlands. hei ❑ Not applicable 7b. Will the project impact wetlands? hei ❑ Yes ❑ No ❑ Don't know 7c. Will the project impact wetland buffers? [help ❑ Yes ❑ No ❑ Don't know 7d. Has a wetland delineation report been prepared? [h_eip • 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? [ -f • 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? [ • 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. [ ] 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. [ Activity (fill, Wetland Wetland Impact Duration Proposed Wetland drain, excavate, Name' type and area (sq. of impact3 mitigation mitigation area flood, etc.) rating ft. or type (sq. ft. or category' Acres) acres) - --- - -- --- - ----- --- 1 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. Z Ecology wetland category based on current Western Washington or Eastern Washington Wetland Rating System. Provide the wetland rating forms with the DARPA package. 3 Indicate the days, months or years the wetland will be measurably impacted by the activity. Enter"permanent'if applicable- 4 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: 7L 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. [ I J. 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. [tje 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.) [heip] 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. ❑ Not applicable MC N'cv✓ Geri(IZ �' GO -II/ H A Q�O UOLL QC PL,,V cc-i> t jo i=v.ZrN ,Z ATCgVAelf 1H/tI� THE C)(IS71N/&( L 0& 13vL.Kt-tE60 . TJt EXL:1 Aro► - V IL- - LSD A Si r &L E Fv(NT" A C C E-SS TD T-IRE- OFA CH V)A Th!!— �v13 tr PRo PF(ZrYT AND utA it woi?-v ON) TiA IF 13EACH Tv ►A 25 Fa0-r SIDE Co)e2-1PQ)e - FILre2 FAkF4ZK- wsLL >;3C-' T-c> OMIT EROSrUN Aj�-sD ►vATFg- 7-k,11261_piTy 6v►vSrgv(-Tiok1 eoNce-tT LL BE AA) VPC,ANP L OZAT-)o tN. 8b. Will your project impact a waterbody or the area around a waterbody? hel DK Yes ❑ No 8c. Have you prepared a mitigation plan to compensate for the project's adverse impacts to non-wetland waterbodies? iieip • 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 `�i�nf►�1�� 13�3i W1A ni AGt�n�1.i i �2e4�71 CE5 �,2 51��.2�� �i w,�2k I,✓It-L 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. [t; ] 8e. Summarize impact(s) to each waterbody in the table below. LtLeid Activity (clear, Waterbody Impact Duration Amount of material Area (sq. ft. or dredge, fill, pile name' location2 of impac(3 to be placed in or linear ft.) of drive, etc.) removed from waterbody waterbody directly affected \f L � li1 f5 F y �♦!.-C � %�I�l:�C C N T {�t�Z.�i.� �qi'r �i ai per"L � 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. 2Indicate 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 a licable. 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. LLeI NJ r-li.L IMA-RL(Z#AL c, IL-1,. & 1Ii 6/ATl16`(Z F-,) IJi`. 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. heI 1:2 PLAcC wiE.\/; vF C�) ,✓C2t TE F00T1��SI 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. [neirl Agency Name Contact Name Phone Most Recent Date of Contact 91b. Are any of the wetlands or waterbodies identified in Part 7 or Part 8 on the Washington Department of Ecology's 303(d) List? L-!_] • If yes, list the parameter(s)below. • If you don't know, use Washington Department of Ecology's Water Quality Assessment tools at: hftp://wv�w-ecy.wa.gov/programs/wq/303d/. ❑ Yes No 9c. What U.S. Geological Survey Hydrological Unit Code (HUC) is the project in? [;_: • Go to hftp://cfpub.epa.gov/surf/locate/index.cfm to help identify the HUC. j ?/Ido /CJ 9d. What Water Resource Inventory Area Number(WRIA#) is the project in? • Go to http://www.ecy.wa.gov/services/gis/maps/wria/wria.htm to find the WRIA#. Wf-IA Zt 9e. Will the in-water construction work comply with the State of Washington water quality standards for turbidity? ;ei. • Go to hftp://www.ecy.wa.gpv/programs/wg/swqs/criteria.html for the standards. Yes ❑ No ❑ Not applicable 9f. If the project is within the jurisdiction of the Shoreline Management Act, what is the local shoreline environment designation? [hem[ • If you don't know, contact the local planning department. • For more information, goto: http://www.ecy.wa.gov/programs/sea/sma/laws rules/173-26/211 designations html ❑ Rural 64 Urban ❑ Natural ❑ Aquatic ❑ Conservancy ❑ Other 9g. What is the Washington Department of Natural Resources Water Type? [hei • Go to http://www.dnr.wa.gov/BusinessPermits/Topics/ForestPracticesApplications/Pageslfp watertyping aspx for the Forest Practices Water Typing System. X Shoreline ❑ Fish ❑ Non-Fish Perennial ❑ Non-Fish Seasonal i 9h Will this project be designed to meet the Washington Department of Ecology's most current stormwater manual? [help] • If no, provide the name of the manual your project is designed to meet. Yes ❑ No Name of manual: 9i. If you know what the property was used for in the past, describe below. [hei 9j. Has a cultural resource (archaeological) survey been performed on the project area? [hel • If yes, attach it to your JARPA package. ❑ Yes X 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. ±.e, ] 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. hei � N� Part 10—SEPA Compliance and Permits Use the resources and checklist below to identify the permits you are applying for. • Online Project Questionnaire at nttp://apps.ecy.wa.gov/opas/. • Governor's Office of Regulatory Assistance at (800) 917-0043 or ,etp�or a.wa.gov. • For a list of agency addresses to send your application, click on the "where to send your completed JARPA" at http://www.epermitting.wa.gov. 10a. Compliance with the State Environmental Policy Act (SEPA). (check all that apply.) hem • For more information about SEPA, go to www.ecv.wa.gov/aro4rams/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 M45,,) (lead agency). The expected decision date is ❑ I am applying for a Fish Habitat Enhancement Exemption. (check the box below in iob.) nel ❑ 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. 10b. Indicate the permits you are applying for. (check all that apply.) hei LOCAL GOVERNMENT Local Government Shoreline permits: ❑ Substantial Development ❑ Conditional Use ❑ Variance X Shoreline Exemption Type (explain): MAin/i�,lgn/c r a Rtti''r� Other city/county permits: ❑ Floodplain Development Permit ❑ Critical Areas Ordinance STATE GOVERNMENT Washington Department of Fish and Wildlife: X 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 0 Private Aids to Navigation (for non-bridge projects) Part I I—Authorizing Signatures Signatures are required before submitting the JARPA package. The JARPA package includes the JARPA form, project plans, photos, etc. [ _:_, 11 a. Applicant Signature (required) [n ji ] 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 authorize the agent named in Part 3 of this application to act on my behalf in matters related to this application. L-�, (initial) By initialing here, I state that I have the authority to grant access to the property. I also give my consent to the permitting agencies entering the property where the project is located to inspect the project site or any work related to the project. (initial) 1 1 Applicant Printed Name Applicant Signature Dat 11b. Authorized Agent Signature [-tp] 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. T��=�tip Co�✓5—r2 t n= C- T i&. Authorized Agent Printed Name Authorized Agent Signature Date 11 c. Property Owner Signature (if not applicant). [:. l 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). 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