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HomeMy WebLinkAboutSHX2010-00003 Replace Dock, Pier - SHX Permit / Conditions - 2/1/2010 STA MASON COUNTY c 'k- DEPARTMENT OF COMMUNITY DEVELOPMENT o A o v� Planning Division o T z P O Box 279, Shelton, WA 98584 o N t o~ (360)427-9670 J � 1864 Exemption from Shoreline Management Act Case No.: SHX2010-00003 Substantial Development Permit Requirement The Proposal By: BUSHNELL GROUP P O BOX 1087 TRACYTON, WA 98393 To undertake the following development: REPLACE BOAT DOCK, GANG WAY, AND PIER MODIFICATION AT CAMP ST. ALBANS NORTH OF ALLYN WA. Within LAKE DEVEREAUX 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 al-LAN bORDEN at ext 365 if you have any questions. Issued: 2/1/2010 Expires: 2/1/2012 Authorized Local Government Official cc: APPLICANT WDFW USACOE WDOE TRIBAL COUNCIL -------------------- 00 ,, AGENCY USE ONLY o i � US Army Corps ; Date received: WASHINGTON STATE Seattle pls ctr$ Joint Aquatic Resources Permit Application (DARPA) Form hel Agency reference#: USE BLACK OR BLUE INK TO ENTER ANSWERS IN WHITE SPACES BELOW. Tax Parcel#(s): Part 1—Project Identification ; Unique project information that makes it easy to identify. hf eM -------------------------------------- 1 a. Unique Project Identifier Number(UPI #) hel • Don't have one yet?Get one at http://www,el)ermitting.wa.gov or call the Washington Governor's Office of Regulatory Assistance at(800)917-0043. 1 b. Project Name (Examples:Smith's Dock or Seabrook Lane Development) h[ elpl CAw1 p ST' Part 2—Applicant The person or organization legally responsible for the project. hel 2a. Name (Last, First, Middle)and Organization (if applicable) AA l U.r-1 JQS� lt- av�t' NCI 21b. Mailing Address (Street or PO Box) 2c. City, State, Zip 2d. Phone(1) 2e. Phone(2) 2f. Fax 2 . E-mail 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.) hel 3a. Name (Last, First, Middle)and Organization (if applicable) d5l f� 1�A VJ- 3b. Mailing Address (Street or PO Box) Id 87 3c. City, State, Zip Ao WA 3d. Phone(1) 3e. Phone(2) 3f. Fax 3 E-mail (3v0) fv92-2�1 Sl�L1k@ JARPA 2009 Page 1 of 11 1 Part 4—Property Owner(s) MU Contact information for people or organizations owning the property(ies)where the project will occur. [heV ASame as applicant. (Skip to Part 5.) ❑ Repair or maintenance activities on existing rights-of-way or easements. (Skip to Part 5.) ❑ There are multiple property owners. Complete the section below and use JARPA Attachment A for each additional property owner. 4a. Name (Last, First,Middle)and Organization (if applicable) 4b. Mailing Address (street or PO Box) 4c. City, State, Zip 4d. Phone(1) 4e. Phone(2) 4f. Fax 4 E-mail Part 5—Project Location(s) Identifying information about the property or properties where the project will occur. heM ❑ There are multiple properties or project locations (e.g., linear projects). Complete the section below and use JARPA Attachment B for each additional property. 5a. Street Address (Cannot be a PO Box. If there is no address, provide other location information in 5n.) hel 051 . 5b. City, State, Zip(If the project is not in a city or town,provide the name of the nearest city or town.) 5c. County Lh2l IMA.ISC>K1 5d. Provide the section, township, and range for the project location. h[ gm '/. Section Section Township Range 5e. Provide the latitude and longitude of the project location. h[ eM • Example:47.03922 N lat./-122.89142 W long 5f. List the tax parcel number(s)for the project location. hel • The local county assessor's office can provide this information. l 2Zo'14p (o 000© 5g. Indicate the type of ownership of the property. (Check all that apply.) heel ❑ State Owned Aquatic Land ❑Tribal APrivate ❑ Other publicly owned (federal,state,county,city,special districts like schools, ports,etc.) JARPA 2009 Page 2 of 11 5h. Contact information for all adjoining property owners, lessees, etc. (If you need more space,use JARPA Attachment 0 hf m Name Mailing Address Tax Parcel # (if known) S4me Aw-, sO:C4 C.4*41 5i. Is any part of the project area within a 100-year flood plain? h[ eM ❑ Yes No ❑ Don't know 5j. Briefly describe the vegetation and habitat conditions on the property. hf eM F14z- I C I I Sfle-M CA61 t AYH L c>C1L• I W144:2't�F_ / r;> 5k. Describe how the property is currently used. heI 51. Describe how the adjacent properties are currently used. h[ ejI 1�:.Tr JARPA 2009 Page 3 of 11 5m. Describe the structures (above and below ground)on the property, including their purpose(s). hl elpl M 'C-1-W t AK�.4S A#*-1457 e-a-t_. L4p4 VTiP-N GTpt 2-ES ���L��LC-� I'`� T'�Ica.L W�p �f�✓►1� S'7�K�T�F?Tc 5n. Provide driving directions from the closest highway to the project location, and attach a map. LtLeV 1-1c�M4 O►-4 5--. STX-V�- �� IfoL4T4-=; 3 Part 6—Project Description 6a. Summarize the overall project. You can provide more detail in 6d. hei mar ��C �,��� �� w►r�- ��.oe�-rr� �.a-r �-x- ��FLOATS P£KACI,^J,�t Vjjp p CAA4 ►1*Y Ml-h4 41,UWAW N7 4^/6WA-Y 4WN> l gAosn G 6b. Indicate the project category. (check all that apply.) hel ❑ Commercial ❑ Residential ,& Institutional ❑ Transportation Recreational ,Maintenance ❑ Environmental Enhancement 6c. Indicate the major elements of your project. (check all that apply.) hf e ❑ Aquaculture ❑ Culvert Float ❑ Road ❑ Bank Stabilization ❑ Dam /Weir ❑ Geotechnical Survey ❑ Scientific Measurement ❑ Boat House ❑ Dike/ Levee/Jetty ❑ Land Clearing Device ❑ Boat Launch ❑ Ditch Z Marina / Moorage ❑ Stairs ❑ Boat Lift PO Dock/ Pier ❑ Mining ❑ Stormwater facility ❑ Bridge ❑ Dredging ❑ Outfall Structure ❑ Swimming Pool ❑ Bulkhead ❑ Fence ❑ Piling ❑ Utility Line ❑ Buoy ❑ Ferry Terminal ❑ Retaining Wall (upland) ❑ Channel Modification ❑ Fishway ❑ Other: JARPA 2009 Page 4 of 11 1 6d. Describe how you plan to construct each project element checked in 6c. Include specific construction methods and equipment to be used. [hel • Identify where each element will occur in relation to the nearest waterbody. • Indicate which activities are within the 100-year flood plain. F� L-"15 AND 4"CdB93V7:;:' TES EiCISTiW`4- S 0--$1A1d1 IMi w, To Agiin 'tNt, .4-i-- SITS . 6e. What are the start and end dates for project construction? (month/year) hel • If the project will be constructed in phases or stages,use JARPA Attachment D to list the start and end dates of each phase or stage. Start date: rV!!> 4,Sniu_ End date: f"$ 2S'sol D ❑ See JARPA Attachment D 6f. Describe the purpose of the work and why you want or need to perform it. h[ eM 6g. Fair market value of the project, including materials, labor, machine rentals, etc. hf eM 14 p- ImAm7LL� -�- U,il j OVV. 6h. Will any portion of the project receive federal funding? hel • If yes, list each agency providing funds. ❑ Yes A No ❑ Don't know Part 7—Wetlands: Impacts and Mitigation ❑ Check here if there are wetlands or wetland buffers on or adjacent to the project area. (If there are none, skip to Part 8.) 7a. Describe how the project has been designed to avoid and minimize adverse impacts to wetlands. hel Not applicable JARPA 2009 Page 5 of 11 7b. Will the project impact wetlands? hl elp] ❑ Yes ❑ No ❑ Don't know 7c. Will the project impact wetland buffers? he(�]I ❑ Yes ❑ No ❑ Don't know 7d. Has a wetland delineation report been prepared? hel • 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? hel • 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? hel • If yes,submit the plan with the JARPA package. ❑ Yes ❑ No ❑ Not applicable 7g. Use the table below to list the type and rating of each wetland that will be impacted; the extent and duration of the impact; and the type and amount of compensatory mitigation proposed. If you are submitting a compensatory mitigation plan with a similar table, you may simply state (below)where we can find this information in the mitigation plan. Lbpjo Activity causing Wetland type Impact area Duration Proposed Wetland impact (fill, and rating (sq. ft. or acres) of impact2 mitigation mitigation area drain, excavate, category' type' (sq. ft. or acres) flood, etc. Ecology wetland category based on current Western Washington or Eastern Washington Wetland Rating System. Provide the wetland rating forms with the JARPA package. 2 Indicate the time(in months or years, as appropriate)the wetland will be measurably impacted by the activity. Enter"permanent"if applicable. 3 Creation(C), Re-establishment/Rehabilitation(R),Enhancement(E), Preservation(P), Mitigation Bank/In-lieu fee(B) Page number(s)for similar information in the mitigation plan, if available: 7h. For all filling activities identified in 7g., describe the source and nature of the fill material, the amount in cubic yards that will be used, and how and where it will be placed into the wetland. h( elpl 7i. For all excavating activities identified in 7g., describe the excavation method, type and amount of material in cubic yards you will remove, and where the material will be disposed. bpipj JARPA 2009 Page 6 of 11 J. Summarize what the compensatory mitigation plan is meant to accomplish, and describe how a watershed approach was used to design the plan. h( eM 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.) LLgm NJ 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 ?L.4S7'1G S %r�vfg7s" fj.. J-S J 4X-17 A KC5 FL-A f-Z-J/J 4 AF�T. FZe1VUC-I,NJr4 GTIi -SITS 8b. Will your project impact a waterbody or the area around a waterbody? hel ❑Yes No 8c. Summarize impact(s)to each waterbody in the table below. hel Activity causing Waterbody Impact Duration Amount of material Area (sq. ft. or impact (clear, name location' of impact2 to be placed in or linear ft.) of dredge, fill, pile removed from waterbody drive, etc.) waterbody directly affected Indicate whether the impact will occur in or adjacent to the waterbody. If adjacent, provide the distance between the impact and the waterbody and indicate whether the impact will occur within the 100-year flood plain. z Indicate the time(in months or years,as appropriate)the waterbody will be measurably impacted by the work. Enter"permanent'if applicable. 8d. Have you prepared a mitigation plan to compensate for the project's adverse impacts to non-wetland waterbodies? h[ eM • If yes,submit the plan with the JARPA package. ❑ Yes ❑ No ;,Not applicable 8e. Summarize what the compensatory mitigation plan is meant to accomplish. Describe how a watershed approach was used to design the plan. • If you already completed 7j., you do not need to restate your answer here. h( el p JARPA 2009 Page 7 of 11 . I 8f. For all activities identified in 8c., describe the source and nature of the fill material, amount(in cubic yards) you will use, and how and where it will be placed into the waterbody. h[ eM 8g. For all excavating or dredging activities identified in 8c., describe the method for excavating or dredging, type and amount of material you will remove, and where the material will be disposed. h[ eeMi Part 9—Additional Information Any additional information you can provide helps the reviewer(s) understand your project. 9a. If you have already worked with any government agencies on this project, list them below. hei Agency Name Contact Name Phone Most Recent Date of Contact 9b. Are any of the wetlands or waterbodies identified in Part 7 or Part 8 on the Washington Department of Ecology's 303(d) List? hel • If yes,list the parameter(s)below. • If you don't know, use Washington Department of Ecology's Water Quality Assessment tools at: htti)://www.ecy.wa.gov/programs/wa/303d/. ❑ Yes ;K No 9c. What U.S. Geological Survey Hydrological Unit Code (HUC) is the project in? Lpipi • Go to http://cfi)ub.epa.gov/surf/locate/index.cfm to help identify the HUC. Onl'!A/b'WV 9d. What Water Resource Inventory Area Number(WRIA#) is the project in? hi eM • Go to http://www.ecy.wa.gov/services/gis/maps/wria/wria.htm to find the WRIA#. u�V 94 � JARPA 2009 Page 8 of 11 9e. Will the in-water construction work comply with the State of Washington water quality standards for turbidity? hel • Go to http://www.ecy.wa.gov/programs/wQ/swas/criteria.htmi 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? h[ elp] • If you don't know,contact the local planning department. • For more information,go to: http://www.ecy.wa.gov/programs/sea/sma/laws rules/173-26/211 designations.html. Rural ❑ Urban ❑ Natural ❑ Aquatic ❑ Conservancy ❑ Other 9g. What is the Washington Department of Natural Resources Water Type? hf eM • Go to http://www.dnr.wa.gov/BusinessPermits/Topics/ForestPracticesApplications/Pages/fp watertyping.aspx for the Forest Practices Water Typing System. El ❑ F ❑ Np ❑ Ns 9h. Will this project be designed to meet the Washington Department of Ecology's most current stormwater manual? LLLeM • If no, provide the name of the manual your project is designed to meet. 8.1 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? bpjpj • If yes,attach it to your JARPA package. ❑ Yes ❑ 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. [tpjpj 91. Name each species or habitat on the Washington Department of Fish and Wildlife's Priority Habitats and Species List that might be affected by the proposed work. hel JARPA 2009 Page 9 of 11 Part 10—Identify the Permits You Are Applying For Use the resources and checklist below to identify the permits you are applying for. • Online Project Questionnaire at http://apps.ecy.wa.gov/opas/. • Governor's Office of Regulatory Assistance at (800) 917-0043 or help(a-)ora.wa.gov. 10a. Compliance with the State Environmental Policy Act (SEPA). (Check all that apply.) [LPjPJ • For more information about SEPA,go to www.ecy.wa.gov/programs/sea/sepa/e-review.html. ,N A copy of the SEPA determination or letter of exemption is included with this application. ❑ A SEPA determination is pending with (lead agency). The expected decision date is ❑ I am applying for a Fish Habitat Enhancement Exemption. (Check the box below in 10b.) • Submit the Fish Habitat Enhancement Project form with this application. The form can be found at http://www.epermitting.wa.gov/Portals/ JarpaResourceCenter/images/default/fishenhancement.doc ❑ 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. hf elpl 101b. Indicate the permits you are applying for. (Check all that apply.) hf elpl LOCAL GOVERNMENT Local Government Shoreline permits: ❑ Substantial Development ❑ Conditional Use ❑ Variance Shoreline Exemption Type (explain): Other city/county permits: ❑ Floodplain Development Permit ❑ Critical Areas Ordinance STATE GOVERNMENT Washington Department of Fish and Wildlife: ❑ Hydraulic Project Approval (HPA) ❑ Fish Habitat Enhancement Exemption Washington Department of Ecology: ❑ Section 401 Water Quality Certification Washington Department of Natural Resources: ❑ Aquatic Resources Use Authorization FEDERAL GOVERNMENT United States Department of the Army permits (U.S. Army Corps of Engineers): ❑ Section 404 (discharges into waters of the U.S.) ❑ Section 10 (work in navigable waters) United States Coast Guard permits: ❑ General Bridge Act Permit ❑ Private Aids to Navigation (for non-bridge projects) JARPA 2009 Page 10 of 11 Part 11—Authorizing Signatures Signatures required before submitting the JARPA package. 11 a. Applicant Signature (required) i el 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 aut or' the agent named in Part 3 of this application to act on my behalf in matters related to this applicatio (initial) By initialin ere, I state that I have the authority to grant access to the property. I also give my consent to the permitting agencies t r' the property where the project is located to inspect the project site or any work related to the proje (initial) Appli nt Q Date 11 b. Authorized Agent Signature hel 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 necessa rmits have been issued. b C919 40 Au orized Agent Date 11 C. Property Owner Signature (if not applicant) h( elp] 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 Own r` Date 18 U.S. §1 1 provides that:Whoever, in any manner within the jurisdiction of any department or agency of the United States knowingly falsifies,c teals,or covers up by any trick,scheme,or device a material fact or makes any false,fictitious,or fraudulent statements or represen ations or makes or uses any false writing or document knowing same to contain any false,fictitious,or fraudulent statement or entry, shall be fined not more than$10,000 or imprisoned not more than 5 years or both. If you require this document in another format, contact The Governor's Office of Regulatory Assistance(ORA). People with hearing loss can call 711 for Washington Relay Service. People with a speech disability can call(877)833-6341. ORA publication number: ENV-019-09 JARPA 2009 Page 11 of 11