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SEP2019-00025 DRV2019-00005 FPA Moratorium Waiver - SEP Determinations - 5/24/2019
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 June 7, 2019 Michael MacSems, SEPA Responsible Official Mason County Department of Community Services Planning Division PO Box 279 Shelton, WA 98584 Dear Michael MacSems: Thank you for the opportunity to comment on the determination of nonsignificance for the Jernigan 2-acre Development Moratorium Waiver Project(SEP2019-00025)as proposed by Rhonda Jernigan. The Department of Ecology(Ecology)reviewed the environmental checklist and has the following comment(s): WATER QUALITY/WATERSHED RESOURCES UNIT: Chris Montague-Breakwell(360)407-6364 Erosion control measures must be in place prior to any clearing, grading, or construction. These control measures must be effective to prevent stormwater runoff from carrying soil and other pollutants into surface water or stormdrains that lead to waters of the state. Sand, silt, clay particles, and soil will damage aquatic habitat and are considered to be pollutants. Any discharge of sediment-laden runoff or other pollutants to waters of the state is in violation of Chapter 90.48 RCW, Water Pollution Control, and WAC 173-201A, Water Quality Standards for Surface Waters of the State of Washington, and is subject to enforcement action. Construction Stormwater General Permit: The following construction activities require coverage under the Construction Stormwater General Permit: 1. Clearing, grading and/or excavation that results in the disturbance of one or more acres and discharges stormwater to surface waters of the State; and 2. Clearing, grading and/or excavation on sites smaller than one acre that are part of a larger common plan of development or sale, if the common plan of development or Michael MacSems June 7, 2019 Page 2 sale will ultimately disturb one acre or more and discharge stormwater to surface waters of the State. a) This includes forest practices(including,but not limited to,class IV conversions) that are part of a construction activity that will result in the disturbance of one or more acres, and discharge to surface waters of the State; and 3. Any size construction activity discharging stormwater to waters of the State that Ecology: a) Determines to be a significant contributor of pollutants to waters of the State of Washington. b) Reasonably expects to cause a violation of any water quality standard. If there are known soil/ground water contaminants present on-site, additional information (including,but not limited to:temporary erosion and sediment control plans; stormwater pollution prevention plan; list of known contaminants with concentrations and depths found; a site map depicting the sample location(s); and additional studies/reports regarding contaminant(s))will be required to be submitted. You may apply online or obtain an application from Ecology's website at: http://www.ecy.wa.gov/prograrns/wq/stonnwater/construction/-Application. Construction site operators must apply for a permit at least 60 days prior to discharging stormwater from construction activities and must submit it on or before the date of the first public notice. 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 (MLD:201902935) cc: Chris Montague-Breakwell,WQ Rhonda Jernigan(Proponent) MASON COUNTY DEPARTMENT OF COMMUNITY SERVICES DETERMINATION OF NONSIGNIFICANCE (WAC 197-11-340) SEP2019-00025 Description of This SEPA is associated with an application to waive 2- Proposal: acres of a roughly 30-acre site consisting of three parcels from a 6-year development moratorium,which was the normal consequence of Class II FPA#2419543. The waiver envelope overlaps two parcels and sits on a high bench.The waiver envelope includes slopes of 30+%.A geological assessment was prepared for this site by Tahja Engineering in 2008 and was found to be complete at that time by the County as part of a short subdivision review.The overall site contains a F-stream, and a Ns stream, but the waiver envelope meets or exceeds minimum required setbacks.The waiver envelope has not been stumped and shows no signs of erosion problems.The purpose of the waiver is to allow residential development within the waiver envelope. The balance of the property will remain under the moratorium until 8/14/2023.The site has been replanted. Proponent: Rhonda Jernigan Location of Proposal: Sec. 14,Twp. 19N., Rng. 5W., W.M. Parcel Number: 51914-41-90030&90040 Legal Description: Lots 3 and 4 of SP 3040, portion of NE%, SE%, Sec 14,Twp. 19N., Rng 5W., W.M. Directions to Site: From W Cloquallum Rd, to Bulb Farm Rd, Right at "T" to second driveway(gated) The Lead Agency for this proposal has determined that it does not have a probably 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 Michael MacSems at ext.571,or mms@co.mason.wa.us 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, 615 W Alder St, Shelton WA 98584 by 6/7/2019. 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. Date: 5/24/2019 David Windom,Director,Dept of Community Services SEPA Environmental Checklist Mason County Permit Center Use: ?� G ❑ Single Family DNS: $600.00 SEP -0MA 5.,,f G ❑ Other DNS: 0 to 9.99 acres: $730 Parcel#:�y��� 1Z4—A 1 I- I'00'j 10 to 20 acres: $880 Date Rcvd:S l(1 ly - L-b 1 —�I 00L14 Over 20 acres: $1100 ❑ DS/EIS: $5000 + $90 per hour APR 18 2019 615 W. Alder Sbvet 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: Jtg_!pJ 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 information reasonably related to determining if there may be significant adverse impact. Instructions for Lead Agencies: Please adjust the format of this template 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 n( elpl 1. Name of proposed project, if applicable: 1neM 2. Name of applicant: of em R�,nd , _3 � -;I 4:t,� 3. Address and phone number of applicant and contact person: Jnei 36o-Tg q -579Z l SEPA Environmental checklist(WAC 197-11-960)(MC version-non project portion omitted): 2016 Page 1 of 11 4. Date checklist prepared: Lgipi A pp.l 1(-4,1- ZOI J , 5. Agency requesting checklist: 1nei 6. Proposed timing or sc edule (including pha4ing, if applicable): of em A�40 7. Do you have any plans for future additions, expansion, or further activity related to or connected with this �� proposal? If yes, explain. nip] No 8. List any environmental information you know about that has been prepared, or will be prepared, directly related to this proposal. hLee1 C-7e"-%C--A, oA. c� 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. of elpl VC 10. List any government approvals or permits that will be needed for your proposal, if known. LneM Pof) e--, 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 specifip information on project description.) n[ etm U - 9003 o et- .716 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. of eM Parcel#(s): 51 R(q q( ^ qo:�),3o Address: Legal Description: Twp/Range/Section and/or GPS location: SEPA Environmental checklist(WAC 197-11-960)(MC version-non project portion omitted): 2016 Page 2 Of 11 B. ENVIRONMENTAL ELEMENTS 1net 1. Earth a. General description 9LIhesite nLe (circle one): Flat, rolling, hilly, steep slopes, mountainous, other: b. What is the steepest slope on the site (approximate percent slope)? nei 31 V Leo t- , pc,. ak,cu►wun4— 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. hf eM � � I /1) tV" "�j�jCL4SY1 1Y 00k14,_iY% SG�.J d. Are there surface indications or history of unstable soils in the immediate vicinity? If so, describe. 1neM N 0 � �� - 2c.'k .� 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. rel f. Could erosion occur as a result of clearing, construction, or use? If so, generally describe. n( elplj- Nd g. About what percent of the site will be covered with impervious surfaces after project , construction (for example, asphalt or buildings)? of elpl V1F h. Proposed measures to reduce or control erosion, or other impacts to the earth, if any: nl eM ,k 'oo / UAA 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. of eM b. Are there any off-site sources of emissions or odor that may affect your proposal? If so, generally describe. nL ey Na c. Proposed measures to reduce or control emissions or other impacts to air, if any: n[ eM u1A SEPA Environmental checklist(WAC 197-11-960)(MC version-non project portion omitted): 2016 Page 3 of 11 3. Water a. Surface Water: I) 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. LneL 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. '�) 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. 4) Will the proposal require surface water withdrawals or diversions? Give general description, purpose, and approximate quantities if known. )) 0 5) Does the proposal lie within a 100-year floodplain? If so, note location on the site plan. 0�3 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. nei 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. [help.] J 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. �I'3/1 C_' 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. tnLei SEPA Environmental checklist(WAC 197-11-960)(MC version-non project portion omitted): 2016 Page 4 of 11 2) Could waste materials enter ground or surface waters? If so, generally describe. JnLeM 3) Does the proposal alter or otherwise affect drainage patterns in the vicinity of the site? If so, describe. �t r� d. Proposed measures to reduce or control surface, ground, and runoff water, and drainage pattern impacts, if any: 4. Plants a. Check the types of vegetation found on the site: 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 /� I b. What kind and amount of vegetation will be removed or altered? 'h, e� c. List threatened and endangered species known to be on or near the site. d. Proposed landscaping, use of native plants, or other measures to preserve or enhance vegetation on the site, if any: P M 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: L�elpi birds: hawk, heron, eagle, Co6ngbird)s other: mammals: Q bear, elk, beaver, other: fish: bass, salmon, trout, herring, shellfish, other: SEPA Environmental checklist(WAC 197-11-960)(MC version-non project portion omitted): 2016 Page 5 of 11 b. List any threatened and endangered species known to be on or near the site. r,ei �Jane�" c. Is the site part of a migration route? If so, explain. nL gm N <3 d. Proposed measures to preserve or enhance wildlife, if any: n JA e. List any invasive animal species known to be on or near the site. V)or► e, 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. Jnel f ,6P b. Would your project affect the potential use of solar energy by adjacent properties? If so, generally describe. jteM P tJ 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: jneM P dn-e� 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. LtLeM g 0 1) Describe any known or possible contamination at the site from present or past uses. A)do-) e-,- 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. V 1730 R-1- 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. k) 0 P 4) Describe special emergency services that might be required. �) 0P e__- SEPA Environmental checklist(WAC 197-11-960)(MC version-non project portion omitted): 2016 Page 6 of 11 5) Proposed me sures to reduce or control environmental health hazards, if any: b. Noise 1) What types of noise exist in the area which may affect your project (for example: traffic, equipment, operation, other)? n( e 0(t)rVe_/ 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. ILeM �30n k--- 3) Proposed measures to reduce or control noise impacts, if any: r,I el V /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. jjaei L 5 i o� & ►-c,ei b. Has the project site been used as working farmlands or working forest lands? If so, describe. 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? Z Ac Re<s 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? 1beM pCiee�s 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: kro c. Describe any structures on the site. bLeM <5 nt.J d. Will any structures be demolished? If so, what?ILeM P/,Q z� �� �0 CQ,"� e. What is the current zoning classification of the site? bf eM pR� f. What is the current comprehensive plan designation of the site? ni eM (%)�w SEPA Environmental checklist(WAC 197-11-960)(MC version-non project portion omitted): 2016 Page 7 of 11 g. If applicable, what is the current shoreline master program designation of the site? K)3)1)> h. Has any part of the site been classified as a critical area by the city or county? If so, specify. 004- 4Wi) hel Ve � 5dP0e-4 /►`)et, i. Approximately how many peopld wouldreside or work in the completed project? ItLey 2 ire S / 09 j. Approximately how many people would the completed project displace?JLgm k. Proposed measures to avoid or reduce displacement impacts, if any: ltgeM k"; f'0 L. Proposed measures to ensure the proposal is compatible with existing and projected land uses and plans, if any: k" 114 m. Proposed measures to ensure the proposal is compatible with nearby agricultural and forest lands of long-term commercial significance, if any: 9. Housing a. Approximately how many units would be provided, if any? Indicate whether high, middle, or low- income housing. F b. Approximately how many units, if any, would be eliminated? Indicate whether high, middle, or low-income housing. Me c. Proposed measures to reduce or control housing impacts, if any: l-J 14 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? K0/7 C_, b. What views in the immediate vicinity would be altered or obstructed?ItLeM ti d w_ c. Proposed measures to reduce or control aesthetic impacts, if any: ItLeM )kl-,` 11. Light and glare a. What type of light or glare will the proposal produce? What time of day would it mainly occur? 1';�0 C; b. Could light or glare from the finished project be a safety hazard or interfere with views? Lei PO A t_ SEPA Environmental checklist(WAC 197-11-960)(MC version-non project portion omitted). 2016 Page 8 of 11 c. What existing off-site sources of light or glare may affect your proposal? of el f)Q/)e--, d. Proposed measures to reduce or control light and glare impacts, if any: [help] NJ 12. Recreation a. What designated and informal recreational opportunities are in the immediate vicinity? hI e ,k,)4n4-- b. Would the proposed project displace any existing recreational uses? If so, describe. hf eM c. Proposed measures to reduce or control impacts on recreation, including recreation opportunities to be provided by the project or applicant, if any: ItgiL 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. hf el N(3 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. 1heM /` )d 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. hf em P 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. �Ja71 C/ tNc-,K c l yeCic/ O(CAP—, 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. hf M k)d'/-e/ SEPA Environmental checklist(WAC 197-11-960)(MC version-non project portion omitted): 2016 Page 9 of 11 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? Ju /IQ c. How many additional parking spaces would the completed project or non-project proposal have? How many would the project or proposal eliminate? N14 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). hf el Ala e. Will the project or proposal use (or occur in the immediate vicinity of)water, rail, or air transportation? If so, generally describe. .__ V �J 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? 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. P rD h. Proposed measures to reduce or control transportation impacts, if any: qgi 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. hf elpl � J b. Proposed measures to reduce or control direct impacts on public services, if any. nei 16. Utilities a. Circle utilities currently available at the site: electrE natural gas, water, refuse service, telephone, sanitary sewer, septic system, other SEPA Environmental checklist(WAC 197-11-960)(MC version-non project portion omitted): 2016 Page 10 of 11 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. (hell N<t)Y'V� C. SIGNATURE 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: Date Signed: - 1 Print Name of Signee: C OY1 do, lei V\ \ If applicable, Position and Agency/Organization.- Date Submitted: 4/ / 1 Y //q SEPA Environmental checklist(WAC 197-11-960)(MC version-non project portion omitted): 2016 Page 11 of 11 r FINDING OF FACT WAIVER OF FOREST MORATORIUM # DRV 2019-00005 APPLICANT: Rhonda Jernigan APPLICATION DATE: 4/18/19 Mason County has reviewed the above referenced application for a 2-acre waiver of the six-year moratorium resulting from a permitted Class II forest practice activity(2419543) and finds it in conformance with all applicable County land use regulations in effect at the time of application. FINDINGS The proposed waiver of six-year moratorium is compliant with the following conditions: The applicant has paid the prescribed fees. The applicant has filed a complete application. This six-year moratorium waiver is in conformance with the following Mason County ordinances: Forest Practice Moratorium Ordinance 11.04 1. The development area is no larger than two (2) acres in size. See attached site map. 2. The harvest and reforestation of the property shall be completed as specified in the approved forest practices application/notice. All obligations have been met per DNR e-mail of 5128119. 3. There shall be no damage to a critical area or its associated vegetation area nor to the shoreline area(if any) or any damage to those areas is repairable with restoration. No damage has occurred(within the waiver boundaries). 4. The proposed development is consistent with the Mason County Comprehensive Plan and Development Regulations. 1 The proposed development is limited to residential use per the criteria of the waiver process. The location is zoned Inholding Land, Mixed Use which is consistent with residential development. 5. If necessary,mitigation shall be required for impacts to critical areas, stormwater, and shorelines. Other mitigation may be required to prevent adverse environmental impacts, pursuant to Mason County Ordinance#55-97,the Environmental Policy Ordinance. No mitigation required. Title 15 Mason Development Code This application for a waiver from the six-year moratorium has been processed as a Type II permit with appropriate,notices. Comprehensive Plan and Development Regulations The activity proposed for the site affected by this waiver from a six-year moratorium is compatible with the Mason County Comprehensive Plan and Development Regulations. The site is zoned Inholding Land. Shoreline Master Program This property does not contain land that falls within the jurisdiction of the Mason County Shoreline Master Program. Designation: X. Any activity in those portions of this site shall be consistent with the requirements of the Shoreline Master Program. N/A Mason County Critical Areas Ordinance Site contains_X_slopes. A geological assessment was prepared for the site by Tahja Engineering in 2008 and the checklist approved as complete by county staff. State Environmental Policy Act This application for waiver from the six-year moratorium#DRV 2019-00005 has been reviewed for SEPA compliance under case # SEP 2019-00025, and a determination of non-significance has been made. CONCLUSIONS 2 In conclusion,this application for a waiver from the six-year moratorium associated with FPA 2419543 is consistent with the above criteria. The following types of permits may be issued prior to 8/14/23 under this waiver. 1. Building permits for a single-family residence and/or for a residential outbuilding. 2. Single-family on-site septic permit. 3. Road access permit. 4. Earth modification permits. 5. Shoreline Master Program approvals. 6. Well and potable water permits. 7. Other approvals necessary to the development of a single-family residence and outbuildings. Any permit issued under this waiver shall be conditioned, as necessary, to limit the approval to only that development consistent with the intent of section 11.04.340 of the Mason County Forest Practice Ordinance# 11.04. RECOMMENDATIONS 1, being a duly appointed designee of the Mason County Community Services Department, hereby attest to and certify that appropriate provisions have been made for this six-year moratorium waiver and hereby recommend approval. Dave Windom, Director Community Services Sept. Date Michael MacSems, Forest Practices Revi wer Date 3 D c A a I ro ; o SHORT SUBDIVISION 30L 0 II s eele_N'F CD - _ nla7s- WARNING a N m -- ..� I) RESPONSIBILITY AND EXPENSE FOR N b• �l BUILDING, IMPR06EWENT5 OR MAINTENANCE OF 00 p RI Palr etAlE7. 1 D, R EASEMEN iS AND PRIVATE ROADS LENDING TO FARMSr T A L OR SERVING LOTS WRON THIS SHORT SUB- `S•• DINSfON(UNLESS SUCH ROADS NAVE BEEN N ACCEPTED INTO THE COLIN 5 ROAD SYSTEM) SHALL REST%TM THE LOT ONNERS. D 0 1 p I CLQQUALLUM 4/; ® lip 2) ANY FURTHER.-ON OF LOTS HITHIH D (L TKS SHORT SUBDIOS10H SHALL 6E SUB.,ECT w <-- I�-^ TO THE REQUIREMENTS OF CHAPTER 15.36 OF tc f� -+ '�'r H71m 4 9 enl'es•t [s]f.ea < < <`• — '- �• ' MASON COUNTY CODE r'' /s II 1,lots' [ 1a71,ee Q PORT BLWELY - 4031, �LF)t - - ^��r la�- J) DECLARATION OF SHORT SUBDIVISION a SCALE: 1'-150 FEET DOES PAAMs 1 c, r 5—__ atON -_ ara 14 _�� A1)UOI70R'S FILE/iD LOCATION l 2 N c 1 PER AUOf='S _ FOtAO r In' 1) THE PROPOSED tRCA RON OF SEPAL 0 73 30E 1 rar ND.2579[e L7 -.-- ''-- LRO,,'PE YSIEMS ARE ADVISORY ONLY. DELLSlfE m (OE SMP[F) II -_. _--cn•T---'T'- APPLICATION AND SEP77C SITE INSPECTION MUST BASIS O-BEAMO I `,,`© ©�•, i BE APPLIED FOR PRIOR TO BUAOWG PERWT. 'D ASswm IMTH 0l0929'rAST ALONG ME EILSF UNE Of W SUMEAST �-l�° aMR Es - mARTm IT SWAN 14.TT➢L;R51r, 1`'�� � � S 1,\ [FR c] �w DIRECTOR'S APPROVAL ^)j WM POP*Ei1WOS 1.7 AND A C ) 1IXlsN/0 2 i [ NNONIA Tom` gFFrarN rs "12.44 AC. 1 1v0 ! a arINSIEN J, APPROVED FOR RECORDING PURSUANT TO �'-- I) IYIIUME 14 iF SUIIIEYS PACE IJ 1 qqI / a COUNTY ARE f 16 21 fOIVMC 17 CY 5]IALMr�PALM 137 I "a 41 / s an1,05,E x 3) W(MMC I➢OF SIAI£YS PAGE 175 50 11,' �' q wctwr 73 a 3tAv1EYs.PACE 276. \ `�""_---- '1�_ DIRE TOR OF COUMUMTY OEVELCPIR'N7 y ® q `� �g DA7E APPROVED LEGAL,OESCAIPPPV \�'�' �`<s \� I- 5077r'Oa'E nM AIORD[AST.SNIP 1 9 WA E II ?i ;y;L. 1'y ' •F • LR14 SOUMtASTOUAAIOtFSCN /. I A70ms� AUDITOR'S CERTIFICATE NONM AroB[ ,MAE y [ Fu,ru MASON CWHTY.11AHOION.70N /» ExCaliNG WMERD1A Pit NLRIN 430 I FILED FOR RECORD THIS 2,q DAY OF�,2008 FEET Cr VOL rAST"t PEEr TUDWCI; '•. 11 rr n�qq/� rxr]PnNe nrmFFRoU rw 11Esr3a7 I W V 1 �-r AJ' A rN ~� ^© AT f�' IN VOL7J OF SHOAT PLATS PG 36,tp FM OF Of EAST 11II0 MT cr THE I NOIM la Auss PErEoq Exnrux0 I �' I ; n „s LI, r✓ µA " AT THE REClAEST OF STONEY G BECHA117,R. MLAL7ROu.A 30-FOOT STRIP OF LAND TLC: ry v``'' - CONW 0 io POIT I➢AN[LY MILL I 0� 17 rTEA4 `�`'•`. ''7 3 1 !y�o1•�^— u aA cud°AYs R I.�£77maoED I I \\ •'•,\ 12 8 --.... � AUDITORS FILE N0. Y CWfITY AUDIT • ALSQ IXO[P7u,S AIOD7RlM4 THE [PORT runs] R ^ Fa ixx➢FARM AGATE LAND SURVEYING, PLLC I JI t w `,a y 17.74 1 1v W c t, D PROFESSIONAL LAND SURVEYOR g',LtER aM�,15 rJ�naN<TAT>`uF!4I o- Ls145 2690E AGATE AD.-P.O.BOX 246 - wATIN WT/rIRA ss THEM ANY AND Ail vmvpr"US I l A 1 ` C,`j� s De015] E N ) APPLY)o PARtns uu1r0 rRa+neE oeaNA(tor, p SHEL 71Nl,WA 9BSOf-(J60 42a-1172 519t4-el-000OA AND APE ISYTFD M Aa00 aulm9 4 \ +' g PEA DAY TOTAL NAL VOLUME O A NA TER ,E'E 4x3TANED I '': 4.99 AC. 2 �© -= TLS,B BY: DATE J01 ND. SHEET Sol CN A DOEAVLNTOFEATR AT Mat S,Om §I O� r- 4 /� �\ �p R.S,BECK D7/23/09 3102 DALLDNS DOE AYOtWr o is sP VAT OAN m i l 1 OF i wMpIADN/ROM fACI lOr 1S SPECYIFD 9ELOM O ) �.- _____ I 1 10.41 AC. � � CHECKED BY,• SCALE FILE NO. LOT I: I6[II./ GALLONS PER DAY sl \�/ !� F O ' SCB 1'=150' 3ID2_SS.DwG. 1DT2 a13 J31'JltWS PEA DAY I /�-�` `\ YL19 ( I ev for x ass.v➢Naas PLn DAY i i� \\ \) �\ � ` ,•' � Tg [T"af011i SURVEYORS CERTIFICATE loT I: 16ee.II7 OAUQYS PER DAY , ^ _ / N+� 1 2 / N\i 1 •G MIS MAP CORRECTLY REPRESENTS A SURVEY NO BEAtwO DIsrANS I 6,09 AC.! VI MADE BY ME OR UNOER MY DIREC770H IN / { I ®Fro=-1 CONFORMANCE WITH THE REQUIREMENTS OF THE t it o01 33 E 3a7c I I\\ �/ !O J - I\ SLIMY RECORDING ACT AT THE REOVEST DF n 12 NDOD/'37 [ I[tB7 � RHONDA„ERWOAQN IN JUN 220M 3 N a/11 m ODDS I_'/------•--- *"- 17 OF-•'- - _--"'-- __ 9 ,ar• S L. 11 N 70De'8 E 91.71 s a7T1919'E 13U.43 3>OM --' J 0 I s II71M'I II'F I317,147x e 0 ---- ` U tB N w 9 SIDNEY BFCHiQLT,R.P.L.S. /201J7 tD N54 DI'm f e➢10 4 L7 N 707D]I t 72.94 I'-' POND IX.ANOY La M 04110E E 1 93 LMFF rARMs] ¢ 1d O.BEChr Q 3 LII N/091J1 E TOL I- H �rt'nvuao,] ro NDa S E m31 q�• O Lit a 5a7l, E 74.81 4 �� I-BUlftlKT yfa U V L17 N 2111TM'r 31.11 w O L13 S 311C E 3114 1 27 o �.® LII 9 T77/'ID'C Tots S B7DT.U'E 2B2a.00 us ]31ry t l[ m LEGEND z3 21 °ol-91, 11 OF^ uII sT37e4[ E 373E 'OLaiA>p JIB m u) s 7]74'71 f nafI p /iM➢D]/1'ADN AP[l9 PNIS O.,10,0E SOOT HIrVAIF EA "ENTTOY ¢^ WpER((:MESS ANO U11UaCs �•$ 11II s 1D79'N-[ e3 T TO"1'INCHPA[WIN)IIAYM L ,� ;® 1➢ s sonTr r Sala W Ls nII91e 0.fNrorEcrnt smFAM➢uFTm Tar aooveuuu t77[FX(rYi'E w) LTD 9 2am'ao [ 7e 00 SET rtEDIroLT 5/a'ROAR ANO PARCEL SUBDI W S0N 000 oil LT N mD2 D F— 161r0 P As M RAP PLO Pm37 ©'2a0o roor srDRMwArOv IXx ma aWFEa-nPrcu SHURi SUBOMSlON FOR W ~' A L ® Ult7Mim PD9nU,PCA VOL N O-25.00 SCUT(115 lEET EAOr SIDE Or tar UNO srcftwxrm oovmn eWrm-rrwex sHmr neaiLsa rue RHONDA JERNIGAN LL QC� NO DELTA NADOUS U7NTN OF SVN PAW a/ ©.4 w rEOr"irO;DNY,V-cli-0 suFFEIt RNOIOA MIFIGAN IN �ger�TN Cl1297'II' 1a7.11 JO0/ fls Easnxl:ROL O vOODILT0•LAw isOH4noAo NE 1/4. SE 1/4 23' -1 F -750E FODr r\YE NS SMAW O 'FER O.G7EOLVfr➢N[TANE+'FLAccm ® sM IOCs O-PRMECrnE srRUM BUFFER Fat TOPE F smEAM (NO)4D]-3➢I3 SEC 14, 11 9N, R5W W.M, C DY'ME%EA.WE CORPS' v 5 a r �'� 'C" $-�j,�c.. .�,,�, may,,, .�,.- x 2-`�'Y• w t�t r :4 ZIN /�- �4 d4 a ,r d ;,' .,.. ���.. :+•.. � �� i� y � .��' t� } �. .`a4�` i''` — �—_ P. �� ' ` •� _ �� .. c' .• �� F } {9 �.. � ' Via,.,,, R � ,�f..a ai.i...+.-�y�''►w'�.'i°`-.'"\wr.'+�wsr�wg+l�y � i�� 1. d,��y, '. Y, } �4 � � x- �'� ,� ter• r `� + ��8 � _ , 0)Zv 1 � - O y: � :. .� �. �. : -_.4 .. • 6 —y .. .. - y. ��+ti �:: t' �✓' .�;�, ,;; ,,- � y �.. <� ,. �� � �,'+� . - r'- , - - .. �, ,;� � � .. '...,.. l.. ,�. .-.� t e .-, �,,, � ,, .� � � � - rt.J, b N rt 4 F 0 aa P 1 yr 4 �ft { �n I ♦: w m a � w a x " ti IL iw ,pwrt; ,r .. ;,= ai". « a• ..;' m� °t+ aQ`1 '� �. "iF`+ :'S, ;w „�,s;"." r w w s A at 1 i �" if ,�, � ,' R.;� .sue a";�. x :'4 ' },.S},r� �^ � ��►f" ,�' �s.+r'-,. ;a",�� .�.�-►�.; 1�, - �..-� ��w`L as., .� ��. .m'JAdlq� -•? � t`� �. �_' ..�'����;`.:/f ^.� - Cam, �'^ �� � ` .w;.�w v + A w W���.v a� t �:_.�,+�,`��#'"'�,�. �R� '��, ��ty ��� µ�+ ��" �+, �1 ,w� '�':• � Nip.. �'�" 4� � �i� �l f^ f s le —14 r., *,� j.! •7 t0" � j .s ." JT^r�t ( .� ,.. _.q � a'!.a F` � r„�' - .. � F .,19•. S _ �`' a >. �A ig�e `� rJ. `• rM x w �4Y,�y jay � .'�' + .y 4�• � � +1� k •� h ;}raj .c",y�•����'�'" vti 7 � _w sr vv a. l k AZ of s . zz a I a n e, a Ili. Mr. mi 46, '�•o.�f #� w v ,� ` z+xS ,�mY�`4a�r �''rib �"g � �� ool N, k t �wim 0,1+ ^."pw"Y}.,i'Sf>,�►' tr '�. � lfe �'' �l i'�+t' " ,af F�'�v. `'"� ,3y,s,� 'ter fit ! Yi+il3s � t4at�• ����"`fix i#9�'d r,.. ors�'yr+ �l� ._ y_Y' 6 Ta r� $\ i1: • 44 Y F.'. P '. .T 5,�. 6 t 4 �`� fie+, � .y J}l� f '\ �.� A4#���° a.,sYy, w..4�^ '•n' �., a � - S �4'. 3 yfi��-'R�Nt iY Yt N -low nk 71 'f Aki ; r ' i ~ s yam, 44� t It . g �F ter'y�,r J T "^tad •,"! ` 1*4 i 11i•f i,` Lt� ,. m.. a �,_. _ :;� v_ - TAHJA ENGINEERING, Inc. PO Box 235,Hoodsport, WA 98548 (360) 877-9512 Mason County DCD PO Box 279 Shelton, WA 98584 Rhonda Jernigan 440 W Bulb Farm Road Shelton,WA 98584 (360)482-2615 RE: Geotechnical Assessment Bulb Farm Road Large Lot Subdivision Mason Co. Prcl No. 51914-41-00000 Mason Co. Case No.s PAR2007-00038 SEP2007-00098 LRG2007-00004 INTRODUCTION Sidney Bechtolt,Jr., PLS of AGATE LAND SURVEYING contacted me late last year and requested my assistance in developing a geotechnical assessment or report to address landslide stability issues relating to the plat development of the Rhonda Jernigan property located off of the Bulb Farm Road either as a short plat or a large lot subdivision. Slopes on the property were investigated and the thirty four± acre parcel was found to be located in an area that may be described as hilly,with slopes measured between 15% and 39% over a majority of the property. The northerly half of the property is generally flat and may be described as pastures and orchards. The southerly half of the property contains most of the slopes exceeding 15%, with the steepest slopes found on the property to be 39%or less located in the southwesterly portion of the property. Aside from slopes measured up to 39% or less,no instability indicators were observed or found on the property that would require investigation of the property under the requirements of a geotechnical report. Mason County's Resource Ordinance (MCRO)requires geotechnical investigation of any properties with slopes exceeding 15%and more than 10 feet of vertical relief. Property improvements and ground disturbing-activities within 300 feet of slopes exceeding 40%, or within 300 feet of slopes exhibiting instability are required to have a geotechnical report level document prepared to determine where the property may safely be developed, and/or what mitigation measures may be needed or required to safely develop property either within an area classified as a landslide hazard area, or within the hazard areas' buffer(s).No indications of a geotechnical report were found, so it is my opinion that the property should be investigated under the requirements of a geotechnical assessment. File:C.1ProjectsllernigaMGeo-Assmnt 1 of 5 8/7/2008 TAHJA ENGINEERING, Inc. PO Box 235, Hoodsport, WA 98548 (360) 877-9512 The following nine elements are required to be addressed in geotechnical assessments prepared to meet Mason County's geotechnical assessment requirements. 1. SURFACE AND GEOLOGIC CONDITIONS: The site is located in an area identified below on the Geologic Map of Shelton 1:100,000 Quadrangle, Washington' as the Lost Prairie area approximately 10 miles east and south of Shelton, Washington. The site is accessed off of the Bulb Farm Road,a public County road, and is comprised of approximately 34t acres as shown on the attached site plan. Most of the site is gently sloping with slopes ranging between 0 and 35 percent. Eve f j 90 Jernigan +; Project Location The map reveals that the soils on and surrounding the Jernigan property are classified as Continental Glacial Deposits of the Fraser Glaciation,Vashon Stade (Qgo &Qgt). These soils are further described on the next page of this report. The southerly extent of the late Wisconsinan Cordilleran ice sheet is indicated near the southerly boundary of the Jernigan property, and a contact running north and south is located to the west of the Jernigan property,but doesn't express itself at this site. Inspection of the Soil Survey Map of Mason County found the soil listed as a Grove, gravelly sandy loam which is not identified as an erodible soil in the County's Critical Resource Ordinance. Inspection of the Coastal Atlas, landslide hazard section, did not find a designation for this location, and it is presumed stable. 'DNR OFR2003-15 Geologic Map of Shelton 1:100,000 Quadrangle,Washington File: C:I Projects Uernigan lGeo-Assmnt 2 of 5 8/7/2008 TAHJA ENGINEERING, Inc. PO Box 235,Hoodsport, WA 98548 (360) 877-9512 The geological soils descriptions of the site's soils are as follows; Qgo Proglacial and recessional outwash, late Wisconsinan (Pleisto- cene)—Typically poorly to moderately sorted,rounded gravel and sand with localized coarser- and finer-grained constituents; lithologi- cally varied mixture of mostly northern-provenance clasts, especially containing granitic and metamorphic rocks that identify the unit as being deposited by the Puget lobe of the Cordilleran glacier; also con- tains varying amounts of locally derived Crescent Formation basalt, and in the Mox Chehalis Creek valley, central Cascade Range— derived andesitic clasts; typically shades of gray where fresh or brown where stained especially in proglacial and morainal areas; buff staining near the ground surface; fine sand, silt, and clay constitute local overbank sediments having relatively poor permeability or del- taic foreset bedding along north sides of valleys with higher permea- bility; porous and permeable enough to yield small to moderate quan- tities of groundwater; very poorly consolidated to loose; moderately to well-rounded clasts; mostly unweathered with rare weathered reworked clasts; thickness varies and is not well known; most com- monly occupies outwash channels scoured into or through till. � TM Till, late Wisconsinan (Pleistocene)—Unsorted, unstratified, highly compacted mixture of clay, silt, sand, gravel, and boulders deposited by glacial ice of the Puget lobe; gray; may contain interbedded strati- fied sand, silt, and gravel; sand-size fraction is very angular and con- tains abundant polycrystalline quartz, which distinguishes this unit from alpine till; cobbles and boulders are commonly striated and (or) faceted; although unweathered almost everywhere, may contain cob- bles or small boulders of deeply weathered granitic rock.. 2. Discussion of groundwater conditions at the site: The general slope of the property helps keep the southerly half of the property fairly well drained and dry. The northerly half of the property was observed to have groundwater within approximately 5-feet of the surrounding ground's surface. Two streams issue through the Jernigan property and are shown on the attached site plan. In the southerly portion of the property,these streams are likely to both receive surface runoff, and disperse a portion of their channel flows into the surrounding ground. The permeable soil depth in the southerly portion of the property was found to typically be 5-feet or less,which typically may be File:C:IProjectsVernigan1Geo-Assmnt 3 of 5 8n12008 TAHJA ENGINEERING, Inc. PO Box 235,Hoodsport, WA 98548 (360) 877-9512 considered the depth to perched/surface water residing above the glacial till layer(s) found beneath the site. The deeper water table in the neighborhood likely coincides with the elevation of Gosnel Creek which generally parallel's the property's northerly boundary. C t Vac,(4 CO i cn Vn A Stormwater Site Plan/Stormwater Management Plan is attached as an appendix to this assessment report. The residential build-out and potential stormwater impacts associated with the subdivided property is addressed in the SSP along with stream crossing features. The Jernigan is traversed by two creeks identified on the AGATE LAND SURVEYING mapping as Type"F" streams,both of which will be crossed with driveways serving the properties being created in the subdivision process. 3. Approximate depth to hard or competent soil:As indicated above, observation of the septic system soil log holes found glacial till at an approximate 5-foot depth over most of the site,both level areas and sloping areas. The semi-dense surface soil horizon generally mimicks the glacial till layer beneath it. The Geologic Map of Shelton 1:100,000 Quadrangle Map indicates the presence of a glacial till beneath the site at a shallow depth(usually less than 5-feet). The loamy sand residing above the till layer is moderately dense, and should provide adequate bearing for standard residential footings. 4. Discussion of geomorphic expression of past slope instability: The Jernigan property and properties surrounding the site display no evidence of recent slope instability or earth movement. The Geologic Map of Shelton 1:100,000 Quadrangle Map indicates the presence of a concealed contact approximately two miles west of the Jernigan site, but it doesn't express itself at the Jernigan property. The Washington State Department of Ecology Coastal Atlas indicates that the Jernigan site is located in a stable area. 5. Discussion of the history of landslide activity in the vicinity: Inspection of the Coastal Zone Atlas covering this area found the Jernigan property and surrounding area to be characterized as stable. No documented history of instability was found in the project area. 6. An opinion on whether the proposed development is within the landslide hazard area or its associated buffer or setback. The Jernigan property, in my opinion is not in a landslide hazard area. Literature references and my personal site inspection all support my opinion that this property is not on or near a landslide hazard area. 7. A recommendation by the preparer whether a Geotechnical Report should be required to further evaluate site conditions and the proposed development of the subject property: A geotechnical report level investigation of the property does not appear warranted from the observations and findings already made. 8. If the presence of a hazard is determined within 300 feet of the proposed development, then the area of the proposed development, boundaries of the hazard, and associated buffers and setbacks shall be delineated(top, both sides, and toe) on a geologic map/site map. No landslide hazard areas have been found either on or near the Jernigan property. File:CAProjectsVerniganlGeo-Assmnt 4 of 5 8/7/2008 TAHJA ENGINEERING, Inc. PO Box 235,Hoodsport, WA 98548 (360) 877-9512 9. A site map drawn to scale showing the property boundaries, scale, north arrow, and the location and nature of existing and proposed development on the site: This report includes a site plan which contains the required information. Geologic Checklist Issues: (2)(c)A discussion of quantity of surface seepage; Minor surface seepage occurs along the shallow banks and slopes inside the main stream indicated on the site plans. No activities or development is proposed within the stream buffers except for the creek crossing(s)which will not be effected by these seeps. (2)(d)A discussion of location of upland waterbodies and wetlands.; The two streams coursing through the property are identified on the attached plan sheet 1, as is a wetland identified by AGATE SURVEYING on the plat map prepared for the plat process. 6esrrc+l Creek is located along the Jernigan property's northerly boundary. No other wetlands or waterbodies were observed on or around the site. Summary, This concludes my assessment of the Rhonda Jernigan property located in the Lost Prairie area of Mason County, Washington. In brief,it is my opinion that the property and proposed improvements are not in jeopardy from instability or earth movements, and should be allowed to proceed without additional landslide stability investigation or reporting. Please feel free to contact me if there are any additional concerns or issues required to be addressed by Mason County's Resource Ordinance 17.01.100— 104. Sincerely, Alan A. Tahja, P.E. v�� A T 07 wr Attached: Topographic Plan Sheets& Stream Crossing Alternative Structures Stormwater Site Plan Narrative ��'o 4 30784 w4 ECISTV?� SSI�NAL VS0 EMMS File:C.1ProjectsUernigaMGeo4ssmnt 5 of 5 8/7/2008 TAHJA ENGINEERING, Inc. PO Box 235,Hoodsport, WA 98548 (360) 877-9512 Mason County DCD PO Box 279 Shelton, WA 98584 Rhonda Jernigan 440 W Bulb Farm Road Shelton, WA 98584 (360)482-2615 RE: Property Plat Development Stormwater Management/Stormwater Site Plan(SSP) Bulb Farm Road Short Subdivision Mason Co. Prcl No. 5191441-00000 Mason Co. Case No.s PAR2007-00038 SEP2007-00098 LRG2007-00004 INTRODUCTION The Rhonda Jernigan property located on the Bulb Farm Road in Mason County Washington is being developed into four property parcels in the process of a short plat subdivision process. Agate Land Surveying, PLLC is performing the survey work pertaining to the property subdivision. A Stormwater Site Plan(SSP)was requested at an early stage in project development by Mason County Public Works. A Geotechnical Assessment or Report has also been required to be prepared for the property. The property itself contains no slopes steeper than 40% and no instability indicators have been found on or near the site, so a geotechnical assessment has been prepared to address geotechnical issues relating to the property development through the development of individual home sites in the parcels created by the short plat subdivision process. A copy of this report will accompany the Geotechnical Assessment prepared for this property,though both reports are stand alone documents. Two creeks have been identified on the property and have been classified as Stream Types"F". The access driveway to the southerly three parcels will cross one or both of these streams,requiring Washington Department of Fish and Wildlife(WDF&W)approval in the form of stream crossing hydraulic permits. STORMWATER MANAGEMENT FOR PLATTED PARCELS The smallest parcel being developed in the short plat process encompasses approximately 4.69 acres, and the other three parcels each contains in excess of five acres. The plat is being created with stormwater management buffers along all property lines existing or being created in the plat process. The stormwater management/mitigation buffers are proposed to be 25-feet in width along lot lines File:C:IProjectsVernfgaMSSP 1 of 4 8/7/2008 TAHJA ENGINEERING,Inc. PO Box 235,Hoodsport, WA 98548 (360) 877-9512 except in areas where stream setback buffers are required and provide a greater buffer width.No concentrated stormwater discharges should be released on the property line side of these buffers. Concentrated flows may discharge towards these buffers provided the discharge has been released from a level gravel filled trench which effectively converts a pipe's discharge back into a shallow sheet flow. A typical level spreader would be a 3-foot deep x 3-foot wide x 20-foot long level trench filled with drain gravel. A pipe discharge into vegetation located more than 10-feet away from the edge of a stormwater buffer would not require a dispersion feature. STORMWATER MANAGEMENT FOR EASEMENT DRIVEWAY The easement/driveway should be constructed with 2-foot deep ditches where needed(through cut banks), but should be constructed to disperse collected stormwater at as many locations as present themselves, such as fill locations or minor ravine crossings. The front slope of the ditches(road side of the ditch) should be constructed at a 3:1 slope or shallower with a 1 V2:1 (H:V)or shallower backslope. Any ditches constructed to serve the driveway should be armored with light loose riprap or quarry spalls in any areas where the ditch gradient exceeds 3%,and within 50-feet of either of the two stream crossing on the property. The quarry spalls are intended to serve the duel purpose of providing erosion resistance to the ditches when storm events occur,and to provide a coarse discharge path to provide filtering treatment during any low flow conditions. STREAM CROSSINGS The original Jernigan property receives stormwater runoff from upland properties at two distinct locations. The larger of the two streams enters the Jernigan property at its easterly property boundary at the location indicated on the accompanying site plan. This stream has been delineated and its collection basin has been estimated to encompass approximately 52%acres,which includes the basin area of the smaller of the two streams which enters the Jernigan property from the south. The smaller stream basin has been estimated to encompass approximately 6.3 acres. A stream regression analysis following WDF&W methodology of the larger basin(which includes the smaller stream's basin)indicated relatively small low and high flow condition flows. During the month of May when low flow conditions are expected,both streams identified on the attached site plan were dry,though the regression analysis indicated a predicted flow as high as 0.8 cfs (—6 gallons per second) in the larger(combined)basin. Investigation of this stream in the area northwesterly(Port Blakely property)of the Jernigan property discovered an existing aluminum corrugated squashed arch culvert measuring 6-foot in width with an inside height of 4-feet. This culvert had approximately 8 to 12 inches of natural streambed material/gravel in its bottom and appears to conform to WDF&W's stream simulation sizing criteria which takes the average stream's width,adds 2 feet to the average width, and then is increase 120%. The natural stream varies in width but its average is approximately 3-feet wide over much of its course. Adding 2-feet to the 3-foot average width results in 5-feet. Taking 120%of 5-feet results in a File:C:IProjectsUerniganlSSP 2 of 4 8/7/2008 TAHJA ENGINEERING, Inc. PO Box 235, Hoodsport, WA 98548 (360) 877-9512 6-foot culvert width requirement. The proposed Jernigan creek crossing is approximately 150 feet upstream from the existing Port Blakeley culvert, so there is little hydraulic change in the creek between these two crossing areas. Typically a smaller capacity structure is not installed upstream of an existing structure, so a 20-foot long by 4-foot tall by 6-foot wide aluminum squashed arch culvert installed level is promoted as one possible crossing structure. A second alternative under consideration is the installation of a railroad car bridge installed on a poured in place or ecology block abutment foundation. The second creek crossing on the smaller stream is very near the stream's headwater, and serves an approximate 6.3 acre area. This stream is tributary to the larger stream,with most of the basin area located in undeveloped forest land located south of the Jernigan property. As with the larger stream, flow analysis indicates very insignificant flows. This stream has a narrow scoured channel north (downstream)of the Jernigan driveway crossing,but is not well defined in the flatter area south (upstream) of the Jernigan property and crossing location. A 30-foot long by 18-inch diameter round corrugated metal or plastic culvert pipe installed generally along the ground's natural grade should provide adequate hydraulic capacity for this driveway crossing. The outfall from this culvert should have a scour resistant dispersion pad or blanket installed to disperse flow velocity and energy during significant storm events. EROSION AND SEDIMENT CONTROL The plat process will involve little land disturbing activities other than the construction of the driveway serving lots 2, 3 &4. The majority of the road construction will occur well inside the Jernigan property boundaries and will have ample natural vegetation to provide filtering of construction borne stormwater contamination. The installation of the bridging structure or arch culvert in the northwest corner of the Jernigan property should be contained with the installation of silt fencing installed downgradient of the construction area and upgradient Aeerwi Creek. Hay Bale check dams should also be installed to provide stilling areas in ditch sections where silt and turbidity can be filtered out and removed from stormwater discharges. Bare soils should be stabilized within 2 days during the wet season(Oct 1 to April 30) and within 7 days during the dry season (May 1 to Sept 30), and maintained until they are no longer needed. Temporary stabilization measures can include compacting unworked soil and covering bare soils with a 3 inch thick layer of straw or hay. Permanent stabilization is expected to be accomplished with sewn grass and natural vegetation. Temporary measures should be maintained until permanent stabilization has been achieved. �Cle�aal�k«� ci'k07- SUMMARY The proposed development of the Rhonda Jernigan property through a short subdivision plat process and build-out with four(3 new, 1 existing)individual Single Family Residences(SFRs) can be mitigated with fairly simple stormwater management features in the form of large property parcels, limiting discharges from developed areas near property boundaries, installing erosion resistant armoring in scour susceptible driveway ditch sections, and installing fish passable culvert structures at stream crossings. File:C.WrojeasUerniganlSSP 3 of 4 8/7/2008 TAHJA ENGINEERING, Inc. PO Box 235, Hoodsport, WA 98548 (360) 877-9512 The subgrade beneath most of the Jernigan property is typically a dense compacted glacial till in the moderately sloping and level areas of the property. During the wet months of the year,the water table typically rests on top of the glacial till layer in the flatter areas of the property, generally making infiltration of impervious surface runoff into the ground impractical and not likely to provide any substantial benefit. I hope this report satisfies Mason County Stormwater Site Plan requirements for the proposed development and activities. Please feel free to contact me if there are any questions regarding this report. Sincerely, Alan A. Tahja, P.E. Attached: Geotechnical Assessment Plan Sheets Including Stream Crossing Alternatives `� A T WA SS'IONAL E��1 S --M File:C:WrojectsUerniganlSSP 4 of 4 8/7/2008 �N SCALE: 1"=200' ��ll4Arl ✓. '� ` � b o so 100 200 Creek 4F/�4�q► < 1 Crk: w E Pro Line(PL)403.84' uffer, c PL 121.60' - z b Existing Road- A Stream Crossing n��Exist.Gravel Road I � ` b' 4'x6'Alu ' I Y�0' j o. Hay Bale 1 -L e Check Dams T ical .100' `S i Well Radius c Silt Fe ce Road-Stream / 410784 p sing No. 1 � � � � PL-3 � 30.14' ati° ' ��ISTER�9 r�' n�o b -� 460 --- - T cal_ _ �`s`4l0NAL E��l Soil i; w xb�yy sO I S of ® o f maps , _ o I 'WetC ,C�`tr i L ' 14 bC1 l.cri ; 1 a L--- ---- --- ---- by v r/ 42a / LL. �_�i TyP a125'Wide a 484, v Stormw, 1 490 p I :, - �� �� �� 4s6 � Mitigation - p DAB 1 o Buffer ` 70 I I W Elk �] asp t4 A 2 1 480 V- a N - �•�� I Op S�. Sao y/ ��.`V r Fj' 480 I L 1 i �0 �_-- - Sao : i i ` `\ R, ad-Streafn 1 C} ssin o.2 i £�o - _-', --- -- - M9_+itbi2isper Pad I 4, o� roP ty Li e 131 47! 1 - I hS1n Rev# Description Date TAHJA ENGINEERING,INC. STREAM BASINS ft A'' Alan Tahja,P.E. Rhonda Jernigan Jernigan PO Box 235 440 W Bulb Farm Road HoodspoA WA 98548 Shelton, WA 98584-9154 2 of 4 Mason Co.Prcl No.: 51914-41-00000 (360)877-9512 (360) 482-2615 � ���� C ra E a $ U b3w� o o 6't O�wW] o I z In .b Jl 61 01 � N,-. ,, ✓ ,�," 1 N 1 + 'tz O / 1 � a I I # . W l M c U 11 Cd E Cd� LV o E A. x Cb Creek Crossing 1 WAstl Longitudinal SCALE: 1"=5' v r e Materials and Specifications shall conform to Arch Culvert Pipe o 1 z 3 a s Washington State Department of Transportation Centerline Standard Plans and Specification for Road,Bridge u�! and Municipal Construction,2002 or later. ° b ,k30784 2. OA GIST?- 3"+Crushed Gravel S'IONALE�� a Driving Surface — EXPERPS 0 Q .° ° ° a. 0 A o, 0 n d ° d o • e ' n 4-7 00 0 SCALE: 1"=5' FLOW DIRECTION 0 1 2 3 4 5 DO o � 20 Armor potential Downstream �r:b 12'Driving Width Scour Pool Area with Heav a � y � Armor Upstream Invert tv tb Loose Riprap&Quarry Spall Cr� b with Heavy Loose Riprap a ° Rock-Min. 1'Thick �1°q Rock(2 to 3 Man Rock) �, 2r�Vliriimum•Pipe- ver.Q �n • �^ C� on 20'x 4'-7"x 6'-1"Squashed Arch Aluminum Culvert 8 to 12" Streambed Gravel Creek Crossing 1 Longitudinal SCALE: P=5' 4k Railroad Car o 1 2 s 4 5 c Centerline c 40 to 60'Length as Available p• 4"x 6"Treated Wood g Driving Surface as a o Full b 14 00 o Y 40' x 14' Railroad Car Bridge with Ecology Block Abutments FLOW DIRECTION ti w Elllt 20' SCALE: 1"=5' N o 1 2 s 4 s �— 12 to 14' Driving Width V✓ �. •pow GIST Eg S'IONAL E�G� e • Ecology Block Abutment EXPIRES — �C Mason County Department of Community Development Submittal Checklist For a Geotechnical Assessment Instructions: This checklist must be submitted with a Geotechnical Report and completed, signed, and stamped by the licensed professional(s)who prepared the Geotechnical Assessment for review by Mason County pursuant to the Mason County Resource Ordinance. If an item found to be not applicable, the report should explain the basis for the conclusion. Applicant/Owner_Rhonda Jernigan Parcel# 5 1 9 1 4-4 1-00000 Site Address 440 W Bulb Farm Road, Shelton,Washington 98584 (1) A discussion of general geologic conditions in the general vicinity of the proposed development, with geologic unit designation based on reference maps. Located on page(s) Pgs 1 thru 3 (2) (a) A discussion of the groundwater conditions at the site, Located on page(s) Pas 3-4 (b) A discussion of the estimated depth to water Located on page(s) Pgs 3-4 (c) A discussion of the quantity of surface seepage Located on page(s) Pg 5 (d) A discussion of the upslope geomorphology Located on page(s) Pas 1-3 (e) A discussion of location of upland waterbodies and wetlands. Located on page(s) Pg 5 (3) The approximate depth to hard or competent soil, e.g. glacial till or outwash sand. Located on Map(s) Pg 4 (4) A discussion of any geomorphic expression of past slope instability (presence of hammocky ground or ground cracks, terraced topography indicative of landslide block movement, bowed or arched trees indicating downslope movement, etc.). Located on Map(s) Pg 4 (5) A discussion of the history of landslide activity, as available in the referenced maps and records. Located on Map(s) Pg 4 (6) An opinion on whether the proposed development is within the landslide hazard area or Its associated buffer or setback and the potential for landslide activity at the site in light of The proposed development. Located on Map(s) P)z 4 Disclaimer: Mason County does not certify the quality of the work done in this Geotechnical Assessment. Page 1 of 2 Form Effective June 2008 (7) A recommendation by the preparer whether a Geotechnical Report should be required to further evaluate site conditions and the proposed development of the subject property. Located on page(s) _ Pg 4 (8) If the presence of a hazard is determined within 300 feet of the proposed development, then the following are delineated on a geologic map/site map: (a)the area of the proposed development Located on Maps None Found or Observed (b)the boundaries of the landslide hazard area (top, both sides, and toe), Located on Map(s) None Found or Observed (c)the associated buffers (top, both sides, and toe). Located on Map(s) None Found or Observed (d) building or other setbacks(top,both sides, and toe). Located on Map(s) Plan Shts 1 &2 (9) A site map drawn to scale showing the property boundaries, scale, north arrow, and the Location and nature of existing and proposed development on the site. Located on Maps Plan Sheets 1 through 4 I, Alan A. Tahja, P.E. hereby certify under penalty of perjury that I am a civil engineer licensed in the State of Washington with specialized knowledge of geotechnical/geological engineering or a geologist or engineering geologist licensed in the State of Washington with special knowledge of the local conditions. I also certify that the Geotechnical Assessment, dated 8/7/08 and entitled Rhonda Jernigan Geotechnical Assessment meets all the requirements of the Mason County Resource Ordinance, Landslide Hazard Section, is complete and true, that the assessment demonstrates conclusively that the risks posed by the landslide hazard can be mitigated through the included geotechnical design recommendations, and that all hazards are mitigated in such a manner as to prevent harm to property and public health and safety. (Signature and Stamp) A T rA0 +Q 30784 9 w� STER�' s`sjONAL E��l E!0?TF{ES .r Disclaimer: Mason County does not certify the quality of the work done in this Gebtechnical Assessment. Page 2 of 2 Form Effective June 2008 n�izuud) Michael MacSems -Geological Assessment Review Checklist 6-08.doc Mason County Review Checklist For a Geological Assessment Instructions: This checklist is intended to assist Staff in the review of a Geological Assessment. The Assessment is reviewed for completeness with respect to the Resource Ordinance. If an item is found to be not applicable,the report should explain the basis for the conclusion.The Assessment is also reviewed for clarity and consistency. If the drawings,discussion,or recommendations are not understandable,they should be clarified. If they do not appear internally consistent or consistent with the application or observations on site,this needs to be corrected or explained. If resolution is not achieved with the author,staff should refer the case to the Planning Manager or Director. Applicant's Name: �I'( 1(��� �t�.f�(►tq�� Permit# 50L 2Ccr$ - Ocv Iq Parcel# S)g/ 4/ — O'Ooop Date(s)of the Document(s)reviewed: Gec, A5 S cwu."L- t13, ix- (1) A discussion of geologic conditions in the general vicinity of the proposed development,with geologic unit designation based on referen ed maps. OK? Comment: (2) (a)A discu sion of the ground water conditions at the site, OK?V Comment: (b) A discussion of the estimated depth to water OK? 1! Comment: (c) A dis_cpssion of the quantity of surface seepage OK? ,V Comment: (d) A discussion of the upslope geomorphology OK?_ / Comment: Uy\ I C-y3to M c,,y SCULL. 1 (e) A disc sion of location of upland waterbodies and wetlands. OK? Comment: (3) The approximate depth to hard or dense competent soil,e.g.glacial till or outwash sand. OK? L Comment: (4) A discussion of any geomorphic expression of past slope instability(presence of hummocky ground or ground cracks,terraced topography indicative of landslide block movemen bowed or arched trees indicating downslope movement, etc.). OK? Comment: (5) A discussion of the history of landslide activity in the vicinity,as available in the referenced maps a records. OK? Vd Comment: (6) An opinion on whether the proposed development is within the landslide hazard area or its associated buffer or setback and the potential for landslide activity at the site in light of the proposed development. OK? ✓ Comment: Smo�I As< 3CiU , -A", (7) A recommendation by the preparer whether a Oeotechnical Report should be required to further ev luate site conditions and the proposed development of the subject property. OK? Comment: (8) If the presence of a hazard is determined within 300 feet of the proposed development, then the following are delineated on a geologic map/site map: (a) the area- re of the proposed development, OK?Comment: (b) the boundaries of the landslide hazard area (top, both sides,and toe), Page 1 of 2 Form Effective June 2008 piO2008)Michael Ma cSems - Geological Assessment Review Checklist 6-08.doc Page 2 OK? G� Comment: (c) theapsociated buffers(top, both sides,and toe) OK? Comment: (d) building or other setbacks(top, both sides, and toe). OK? Comment: (9) A site map drawn to scale showing the property boundaries,scale,north arrow,and the location�pd nature of existing and proposed development on the site. OK? k Comment: Are the Document(s)signed and stamped? Type and#of License: q`{ G'f P fi.�i r v�cy f ��f�1 C3,{ Y,,�v 6764- If not approved,what is the next action/recommendation for further action? Reviewed by YAVYU ,on Time spent in review: 1 kt a— SECOND REVIEW/UPDATE: Reviewed by on Time spent in second review: THIRD REVIEW/UPDATE: Reviewed by on Time spent in third review: Disclaimer: Mason County does not certify the quality of the work done in this Geological Assessment Page 2 of 2 Form Effective June 2008 4/8/2019 Mail-Curt Christopherson-Outlook Re: Fw: Moratorium Waiver Application Short Plat #3040 Michael MacSems <mms@co.mason.wa.us> Mon 4/8/2019 2:24 PM To:Curt Christopherson <seaportrealty@outlook.com> Curt, Go ahead and have your customer make application without Rhonda's signature,but I'll need it before the Waiver can be issued. Conformation on the $1,460 payable to the Mason County Treasurer. Sounds like they will need an extension on the purchase agreement. Michael t >>> Curt Christopherson<seaportrealty@outlook.com>4/8/2019 1:05 PM>>> stumps are in the ground, house I know about on lot 3 is going be around 1200 sq ft. 2 BR 26A it sounds like. I don't see any issues with the questions you've ask. Rhonda the owner is in Hawaii I will email her the checklist to complete and she will sign and notarize the waiver application. To confirm the fee is $1460 check made of to Mason County?4- 8 weeks to get an answer to confirm. Our closing is in 2 weeks the buyer wants to make sure this waiver gets approved before closing we will do an extension. Curt Christopherson Sea-Port Realty 253 640 2121 From: Michael MacSems<mms@co.mason.wa.us> Sent: Monday, April 8, 2019 12:42 PM To:Curt Christopherson Subject: Re: Fw: Moratorium Waiver Application Short Plat#3040 Hi Curt, Thanks for checking in. If this happens before the sale,Rhonda needs to sign the application as the owner(notarized). The waiver review is subject to review under SEPA, to a complete checklist needs to be submitted (no additional fee). http://www.co.mason.wa.us/forms/Community Dev/environmental checklist.pdf Are the stumps still in the ground? Provided that the amount of ground disturbance is under .75 acres and the amount of new impervious surfaces (within the waiver boundary) does not exceed 5,000 sq ft, an engineered stormwater and erosion control plan is not required, but documentation that the site meets minimum stormwater and erosion requirements is required (see attachment). As we already discussed, the geo-review is already covered. https://outlook.live.com/mail/inbox/id/AQMkADAwATIwMTAwACOwMmQzLTQl YmQtM DACLTAwCgBGAAADKWcxo5mUrEgfivh7atRuRgcARNzDghm... 1/3 FPA/N#: c? ` C ` J + 3 �pgNlNpro 4, e Received Date: -2` 2 9- 1 -7 a WDFW Concurrence Due Date: a ' WDFW Concurrence Review 'ice of NATUSL Completed: ~� 8"�'- Forest Practices Application/Notification Comments Due Date: �- ] - Z 3 - l7 Office Checklist Page 1 Decision Due Date: South Puget Sound Region FP Forester: [V16 - 3 I a-7 Shutdown Zone: _ O//�jf(� RMAP#: tT`TI t 7 FPA/N CLASSIFICATION: ❑11 PkIll ❑IVG ❑IVS ❑ Biomass ❑ FFFPP ❑20/ac Exempt ❑ Aerial Spray Landowner / V Project Name: y�j �G't/ c (/(_ Name: WRIA: u,,w Cl f WAU: G i0&L) E-L-L-G''✓yn -- WRIA: WAU: WRIA: ' / __ WAU: rnn ,, Legal: I`"1: " I R- S � ��J r�•--,� County:_ U r �-`��� Activity Type(s): Harvest ;-0 ac Spray ac Crossing(s) # Rock Pit ac Spoils py Construction e(DC) ft Abandonment ft ALTERNATIVE PRESCRIPTIONS Alternate Plan ❑ Habitat Conservation Plan ❑Ten-Year Forest Management Plan ❑ Landowner Option Plan for Northern Spotted Owl ❑ ;r':.;: RI,- ,_,r„sac; Narvna! Scenic Area ❑ Cooperative Habitat Enhancement Agreement ❑Watershed Analysis: RESOURCE REVIEW ❑ Potentially Unstable Slopes❑ 011 ❑ 012 ❑ Bull Trout Overlay❑ HCP Bull Trout Population ❑Soils Map ❑ Highly Erodible❑ Highly Unstable ❑ Arsenic Plume 40.1+❑ WANHP Rare Species nSLPSTAB ❑ Bald Eagle nest or roost within 660 feet LHZ❑ High/Very High❑ Moderate❑ Low ❑Group A or B Water Supply ❑ Landslide Inventory Polygon ❑ Hatchery I Name:__ ❑ Rain-on-Snow ❑Outside Approved WA ❑ Even-Aged Harvest greater than 120 Acres ❑ Hydric Soils ❑ Ground-based Equipment on Slopes greater than 40% ❑ Wetland ❑ Forested❑ A❑ B ❑ Road Construction on Slopes greater than 65% ❑ In WMZ of❑ A❑ B Wetland ❑ Saltwater Islands X In RMZ/ELZ of Type❑S[X F❑ Np ❑ In or Over Typed Water❑S❑ F❑ Np❑ Ns ❑Water Verification ❑Volt ime greater than 5 mhf pi- ASSOCIATED NON-SCANNED DOCUMENTS-On file with the FPA/N at the Region office. ❑ SEPA Checklist/Documents ❑ Large Landowner RMAP ASSOCIATED SCANNED DOCUMENTS ❑ Conversion Option Harvest Plan F1 Hardwood Conversion Form ❑ FPHP Plans& Specifications ❑Wetland Mitigation Plan ❑ Qualified Expert Report I Type: ❑Water Protocol Surveys r] Natural Regeneration Plan ❑ Modification Form# ❑ Shoreline Permit Water Classification Worksheet ❑ Marbled Murrelet Form �Shade Documentation (Stream Shade Assessment Worksheet) 4 FPBM Appendix(s) ❑Watershed Analysis Worksheet SFLO RMAP Checklist ❑ DFC Printout CMZ Assessment Form ❑ Slope Stability Informational Form EARR Tax Credit( Yes❑ No ADDITIONAL COMMENTS: ❑ ICN ❑ SWO❑ NTC#_ ❑ Previous FPA#__ Form completed by� October,2016 Version �'SHINGipAV r For DNR Region Office Use Only o NATUOL P� - Region: Forest Practices Application/Notification Received Date: `7_7—�—� 1 -7 Western Washington PLEASE USE THE INSTRUCTIONS TO COMPLETE THIS APPLICATION. TYPE OR PRINT IN INK, 1. Landowner, Timber Owner and Operator Legal Name of LANDOWNER Legal Name of TIMBER OWNER Legal Name of OPERATOR (if different than Landowner) (if different than Landowner) Rhonda Jernigan RJ Borden, Inc Mailing Address: Mailing Address. Mailing Address: 440 W Bulb Farm RD 505 E Satsop Rd City, State, Zip City, State; Zip City, State, Zip Shelton, WA 98584-9154 Elma, WA 98541 Phone(360 )789-5821 Phone( } Phone(360 )561-4269 Email Email: Email: rjborden@earthlink.net 2. Contact Person Contact Person: Phone(360 )561-4269 Bob Borden Email: rjborden@earthlink.net 3. Landownership information: See instructions a. [:]No X❑Yes Are you a small forest landowner per RCW 76.09.450? If yes, continue to b. b. ❑No DYes Is your entire proposed harvest area on a single contiguous ownership consisting of one or more parcel? 4. If you are harvesting timber, enter the Forest Tax Reporting Account Number of the Timber Owner: 800 081 158 For tax reporting information or to receive a tax number, call the Department of Revenue at 1-800-548-6829. 5. Are you substituting prescriptions from an approved state or federal conservation agreement or watershed analysis? ❑x No []Yes Write 'HCP'or'Using Prescriptions' in tables that apply. Attach or reference prescriptions and/or crosswalks on file at the Region office. 6/1/2016 Page 1 of 8 Western Washington 6. What is the legal description of your forest practices? Section Township Range E/W Tax Parcel Number County 14 19 5 W 51914-41-90010 Mason i I 7. When are you planning to begin work on the proposed activity? August 2017 8. Is the taxpayer eligible for the EARR Tax Credit? [] No x❑Yes 9. Have you reviewed this forest practices activity area to determine whether It may involve historic sites and/or Native American cultural resources? Read the instructions before answering this question. ❑ No 0 Yes 10. Do you have a DNR approved Road Maintenance and Abandonment Plan (RMAP)? a. No ❑ Yes List the RMAP number: If no, continue to b. b. ❑ No Q Yes Is a Checklist RMAP required (see instructions)? 11. Are there potentially unstable slopes or landforms in the area of your forest practices activity? ❑X No ❑ Yes—attach Slope Stability Informational Form. If applicable, attach geotechnical report, the SEPA Environmental Checklist, HCP, or Watershed Analysis prescriptions 12. Are there potentially unstable slopes or landforms around the area of your forest practices activity? ❑X No ❑ Yes—attach Slope Stability Informational Form. If applicable, attach geotechnical report, HCP, or Watershed Analysis prescriptions. 13. Is this forest practice application/notification (answer every question): a. ❑X No ❑Yes Within city limits or inside an urban growth area? If yes, see instructions for additional required documents. b. ❑X No ❑ Yes For road work that is included in an approved Road Maintenance and Abandonment Plan (RMAP)? c. ❑X No ❑ Yes Within a public park? If yes, include SEPA Environmental Checklist or SEPA Determination -except for harvestlsalvage of less than 5,000 board feet within a developed public park. d. ❑X No ❑ Yes Within 500 feet of a public park? Park name: e. X❑ No [] Yes in an approved Conversion Option Harvest Plan (COHP) from the local government?If yes, include a copy.This only applies to proposals within urban growth areas. f. Q No ❑ Yes Within 200' of the Ordinary High Water Mark (OHWM) or floodway of Type S water? If yes, check with the county or city to determine whether a substantial development permit is required under the local shorelines master plan. g. d No ❑Yes A request for a multi-year permit? If yes, length requested: ❑4 years or❑ 5 years. Not everyone qualifies for a multi-year permit. See instructions for details. 6/1/2016 Page 2 of 8 Western Washington h. ❑ No [x1 Yes An Alternate Plan? If yes, include a copy. I. Q No ❑Yes Within 50 miles of saltwater and do you own more than 500 acres of forest land in Washington State? If yes, include Marbled Murrelet Form or attach/reference HCP prescriptions. J. 0 No ❑Yes In or directly adjacent to a potential Channel Migration Zone (CMZ)? If yes, include CMZ Assessment Form. Attach/reference applicable HCP and/or Watershed Analysis prescriptions. ***** If not working in or over typed waters, skip to Question 18 You are required to verify Type Np and Ns water types within 200 feet of your proposed forest practices activities prior to submitting a Forest Practices Application/Notification Use the Additional Information section, additional pages, the Water Type Classification Worksheet, and/or a Water Type Modification form to explain how you verified water types. See Water Typing Requirements in the instructions. Prior to answering Questions 14-17 in this section please refer to the Forest Practices Application Instructions and Forest Practices Board Manual Section 5. 14. Are you proposing any of the following projects NOT permitted by current HPAs from WDFW? a. QX No ❑ Yes Installing, replacing, or repairing a culvert at or below the bankfull width of Type S or F water(s)that exceeds a five percent gradient? b. Nx No ❑Yes Constructing, replacing, or repairing a bridge at or below the bankfull width of unconfined streams in Type S or F water(s)? c. ❑x No ❑ Yes Placing fill material within the 100-year flood level of unconfined streams in Type S or F water(s)? 15. Have you consulted with DNR and/or WDFW about the proposed hydraulic project(s) In or over Type S or F water? xQ No ❑Yes 16. If installing, replacing, removing, or maintaining structures in or over any typed water,complete the table below. Type S and F waters require detailed plan information. Provide plan details in Question 31 or attach plan to the FPA/N. Provide crossing locations and identifiers on your Activity Map. A detailed plan with profiles may also be required for more complex hydraulic projects in Type N Waters per WAC 222-24-042(2). & o .O 4) > E �o c c m E w y E 2 -2 u N ro E Z E c I do n 5c) c Ua` L yp ` a m ruL >o vCD ocn v� Ti �o O c e c x ,� :Z W E a` Z` n.a w . r o c rZ � m dQN L, !^ n- Q a > o Co o Iaalyo Zoo XM M Eca >Z f ) o �U x a LLr L ` i i 'Existing HPAs issued by WDFW will be complied and enforced by WDFW until expiration. Plan details are not required for hydraulic projects permitted with an existing HPA(see instructions). *' Fords and equipment crossings on Type S and F Waters may result in an unauthorized incidental take of certain endangered or threatened fish species. For more information, see'Background for the State's Incidental Take Permits for certain endangered and threatened fish species'following Question 24 of the FPA/N Instructions. 6/1/2016 Page 3 of 8 Western Washington 17. If conducting any of the following activities in or over typed water, complete the table below. Some activities will require identifiers on the Activity map and/or more information in Question 31. See instructions. *Activity Type S Water Type F Water Type Np Water Type Ns Water Equipment Crossing` Suspending Cables I Cable Yarding LWD Placement/Removal Beaver Dam Removal Felling and Bucking Other(describe in Question 31) `Existing HPAs issued by WDFW will be complied and enforced by WDFW until expiration. Plan details are not required for hydraulic projects permitted with an existing HPA (see instructions). ** Fords and equipment crossings on Type S and F Waters may result in an unauthorized incidental take of certain endangered or threatened fish species. For more information, see 'Background for the State's Incidental Take Permits for certain endangered and threatened fish species'following Question 24 of the FPA/N Instructions. 18. If constructing or abandoning forest roads,complete the table below. Show the road locations and identifiers on the Activity Map. Include abandonment plans for temporary roads and abandonment projects. Road Construction Road Abandonment Road Identifier (name, number) Length(feet) Steepesto Length(feet) Abandonment Date Side-slope (/o) New Rd 800, 1% 19. If depositing spoils and/or expanding or developing a rock pit for forestry use,complete the table below. Show locations and identifiers on the Activity Map. Amount of Spoils Rock Pit Identifier Acres of New Rock Acres of Existing Spoil Area Identifier 9 (letter,number) Deposited (name, number or Pit Developed Rock Pit Expanded (cubic yards) letter) i 20. If operating in or within 200 feet of a wetland, complete the table below. Show the boundaries of each wetland,along with its identifier, and WMZ on the Activity Map. See instructions for information. Wetland Planned Identifier Wetland Type Planned Activities in Total Wetland How many How many (A, B,or Activities in Area acres will be acres will be (number, Forested) Wetland Maximum (acres) drained? filled? letter) Width WMZ I * * *** If not harvesting or salvaging timber, skip to Question 29 611,12016 Page 4 of 8 Western Washington i 21. If harvesting or salvaging timber, complete the table below. Show all harvest areas and unit numbers on the Activity Map. For even-aged harvest units, also show surrounding stand information on the Activity Map. Harvest Method _ (Rubber Tired Skidder, 03 Z Tracked Skidder, Dozer, v v n .0 a Cc .0 Harvest Type M -0 �; E o 0 c o o E _ ^ Shovel, Full Suspension o (Even-aged, z �- y O a a) ° a) a � Cable, Lead-end H u, E Uneven-aged, Salvage, M Suspension Cable, E' R a u, Right-of-Way) E Helicopter,Animal, Q = E °' o = o o ca y mChipper-forwarder, Slash > _ 7 _ Bundler Even Aged N Shovel 18 250 100% 25% 2 Even Aged N Shovel 2 50 100% 2% 22. Reforestation. Check the appropriate box(es). ❑X Planting. Tree Species Douglas Fir ❑ Natural. Include a Natural Regeneration Plan ❑ Not required because of one or more of the following: ❑ I am converting some or all of this land to non-forest land in the next 3 years or lands are exempted under WAC 222-34-050. ❑ Individual dead, dying, down, or wind-thrown trees will be salvaged. ❑Trees are removed under a thinning program reasonably expected to maximize the long-term productivity of commercial timber. ❑ I am leaving at least 100 vigorous, undamaged, and well-distributed saplings or merchantable trees per acre. ❑ An average of 190 tree seedlings per acre are established on the harvest area and my harvest will not damage it. ❑ Road right-of-way or rock pit development harvest only. **** If you own MORE than 80 forested acres in Washington, skip to Question 27 23. Are you using the exempt 20-acre parcel riparian management zone(RMZ) rule on type S, F,or Np waters? ❑X No If no, continue to Question 27. ❑ Yes If yes, continue to Question 24. See instructions for qualifications and information. 24. Choose the answer below that best fits your situation. Show all RMZs on the Activity Map. ❑ a. ALL of the fallowing apply to me and my land: (if no, answer b.) - Between June 5, 2006 and today's date I have always owned less than 80 acres of forestland in Washington - Between June 5, 2006 and today's date this parcel has always been 20 acres or less of contiguous ownership. See RCW 76.09.020 for definition of'contiguous'. - Between June 5, 2006 and today's date this parcel has always been owned by me or someone else that has owned less than 80 acres of forestland in Washington. 6/1/2016 Page 5 of 8 Western Washington b. ONE OR MORE of the following apply to me and/or my land(check all that apply): ❑ I currently own more than 80 acres of forestland in Washington. ❑ Between June 5, 2006 and today's date I have owned more than 80 acres of forestland in Washington. ❑ Between June 5, 2006 and today's date this parcel has been a part of more than 20 acres of contiguous ownership. See RCW 76.09,020 for definition of`contiguous'. ❑ Between June 5, 2006 and today's date this parcel has been owned by someone that has owned more than 80 forested acres in Washington. If any of_the statements in (b) above apply AND you use the 20-acre exempt RMZ rule, you are NOT authorized under the States Incidental Take Permits (see explanation in FPA instructions under Questions 24). 25. If harvesting within 115 feet of a Type S or F water on an exempt 20-acre parcel, complete the table below. Show RMZs and stream segment Identifiers on the Activity Map. If you are harvesting within 75 feet or within the maximum RMZ (whichever is less), stream shade must be assessed and met following harvest. Describe how stream shade was determined to be met, using the `Stream Shade Assessment Worksheet' if necessary. Are you Stream Segment Water Type Segment Length Bankfull Width Maximum RMZ harvesting within Identifier` (S, F) (feet) (feet) Width the maximum (letter) (feet) RMZ? (Y or N) I i I 26. Are you harvesting within 29 feet of a Type Np water on a 20-acre exempt parcel? ❑ No Continue to Question 29. ❑Yes See instructions and describe leave tree strategy in Question 31. Then continue to Question 29. 27. If harvesting within 200 feet of any of Type S or F water, complete the table below. Include DFC for all inner zone harvests unless you have an HCP prescription. Show RMZs,CMZs,and stream segment identifiers on the Activity Map. If you are harvesting within 75 feet or within the maximum RMZ(whichever is less), stream shade must be assessed and met following harvest. Describe how stream shade was determined to be met, using the'Stream Shade Assessment Worksheet' if necessary. Stream RMZ Stream Is there a Harvest Total width Segment Water Type Site Class Width CMZ? Code(s) DFC Run of RMZ Identifier (S or F) (I-V) Number (letter) (feet) (Y/N) (see (feet) instructions) A F II 6' N A 118, B F II 3' N A 118, 6/1/2016 Page 6 of 8 Western Washington 28. If harvesting within 50 feet of Type Np water,complete the table(s) below. Show RMZs and stream segment Identifiers on the Activity Map. Stream Total Length of No-Harvest, Stream Total Stream Length of No-Harvest, Segment Stre50-foot Buffers in Segment 50-foot Buffers in Identifier Length in Harvest Unit Identifier Length in Harvest Unit (letter) Harvest Unit (feet) (letter) Harvest Unit (feet) (feet) (feet) 29. How are the following marked on the ground? (Flagging,paint, road, fence, etc.) Harvest Boundaries. Pink Ribbon Clumped Wildlife Reserve Trees/Green Recruitment Trees: In RMZ Right-of-way limits/road centerlines: NA Stream Crossing Work: NA Riparian Management Zone Boundaries and Leavefrake Trees: Pink Ribbon for RMZ boundary Channel Migration Zone: NA Wetland Management Zone Boundaries and Leavelrake Trees: NA 30. Are you converting the land to non-forestry use within 3 years of harvest? ©No ❑Yes If yes, include your SEPA Determination and/or SEPA checklist. 31. Additional Information (attach additional pages if necessary): For hydraulic projects in or over Type S. F. or complex N water(s) see instructions for required plan information. 6/1/2016 Page 7 of 8 Western Washington i 32. We acknowledge the following: The information on this application/notification is true. We understand this proposed forest practice is subject to: o The Forest Practices Act and Rules AND o All other federal, state or local regulations. Compliance with the Forest Practices Act and Rules does not ensure compliance with the Endangered Species Act or other federal, state or local laws. If we said that we would not convert the land to non-forestry use, the county or city may deny development permits on this parcel for the next 6 years. The following may result in an unauthorized incidental take of certain endangered or threatened fish species: o Conversion of land to non-forestry use. o Harvesting within the maximum RMZ on a 20-acre exempt parcel that was acquired after June 5, 2006. o Equipment Crossings/Fords in or over Type S and F Waters. Inadvertent Discovery—Chapters 27.44, 27.53, 68.50 and 68.60 RCW o If you find or suspect you have found an archaeological object or Native American cairn, grave, or glyptic record, immediately cease disturbance activity, protect the area and promptly contact the Department of Archaeology and Historic Preservation at 360 586-3077. o If you find or suspect you have found human skeletal remains, immediately cease disturbance activity, protect the area, and contact the County Coroner or Medical Examiner and local law enforcement as soon as possible. Failure to report human remains is a misdemeanor. The landowner understands that by signing and submitting this FPA, he/she is authorizing the Department of Natural Resources to enter the property in order to review the proposal, inspect harvest operations, and monitor compliance for up to three years after its expiration date. RCW 76.09.150 n ture of LANDOWNER Signature of TIMBER OWNER* Signature of OPERATOR (If different than landowner) (If VBrent th n landowner) Pr�in_t Nafine. /� Print Name: Print Name: 1� CZ 0't� Date: l s' Date: Date: 7 /r 17 *NOTE: If you are a "Perpetual Timber Rights Owner,"and are submitting this without the Landowner's Signature, provide written evidence the landowner has been notified. Please make a copy of this FPA/N for your records. If this FPA/N contains a hydraulic project requiring WDFW concurrence review,it will not be available online for public review until after the WDFW concurrence review period. 6/1/2016 Page 8 of 8 Western Washington FOREST PRACTICE ACTIVITY MAP TOWNSHIP 19 NORTH HALF 0, RANGE 05 WEST(/W.M.)'hMLr- 0,SECTION 14 Application N N/ 10 11 12 — 7428 U6 +697520 +6975 r rG r �U V Cloqu ofn Cr7 +697408 Cloquallum C +69750 -h. 7500 oquallum Cree F. S l`Fi IF F• 15 14 S S�'S E Vf; 1 3 V-r- 5 s e u- 6488 69658 S S 2 S—+5 z t�' NOT u. IF 0 / B Sir ' F-�/ �T 96468 = 696560 696552 + Z + 22 z 3 2 2 24- N Z 1 N� Fee Please use the legend from the FPA Instruction or provide a list of symbols used. , UUU - 7� -- 'YX'41" ,===:T � '-S/i Ls A D..:6/1712017 Time:8:58:22 AM �X"4Dq&,51'1 eS� NAD 83 q Contour interval:40 Feet �� Sf re 2wt. n t`�2Y�Z.�s �-�'-►�c.' s's I �rS►+i NOTo� WASHINGTON STATE DEPT OF nA T U R A L For DNR Region Office Use Only RESOURCES FPA#: ��f(4s�3 of • gP� Region: S1,5 Nara Alternate Plan for Western Washington Fixed Width Riparian Management Zones Template for Types S and F Waters, for Small Forest Landowners This fixed width Riparian Management Zone(RMZ)alternate plan template replaces the following Forest Practices Rules: Western Washington Riparian Management Zones for Type S and F waters: WAC 222-30- 021(1)(h)and(c) This form must be submitted with a Forest Practices Application. For more detail about which forests are eligible for this alternative, and the information necessary for this form, please refer to Forest Practices hoard Manual Section 21, or call your nearest DNR region office. 1. Eligibility In order for a stand to be eligible for the Fixed Width RMZ Template, it must meet the following criteria: a) Landowner must be a Small Forest Landowner as defined in WAC 222-21-010 (13), b) Timber harvest is proposed in a riparian management zone adjacent to Type S or F water. 2. Implementation Schedule List the seasons and the years during which harvest activities will take place as part of this alternate plan. Schedule Example Spring 2010. 2011 Spring 2017,2018,2019 Summer 2010, 2011 Summer Fall 2011 Fall Winter 2010, 201 i Winter 3. Prescriptions When harvesting trees adjacent to Type S or F water, a 'No Harvest Riparian Management Zone' must be left. The width begins at bank full width or outer edge of a channel migration zone and extends to the width determined by the site class. The following widths must be used when using this Fixed Width RMZ template: Fixed Width, No Harvest Buffer Widths by Site Class Site Class No Harvest Zone width(measured from outer edge of BFW or outer edge of CW) 1 145 feet II 118 feet III 101 feet IV 82 feet V 75 feet Washington State Department of Natural Resources•Forest Practices Page 1 of 2 Fixed Width Riparian Management Zones Template for Types S and F Waters for Small Forest Landowners•For Western Washington•12-30-2013 Using the table above and a Site Class Map; please fill out the following table for your alternate plan. If the Site Class changes on a stream segment select one of the following: • Use the widest width for the entire segment, OR ■ Identify separate segments for each site class Segment Stream Type Site Class Fixed Width Length A F I I 118' 1000, B F 11 118, 600' If the stand is located within 200 feet of Type S water, a landowner must contact the county, which will determine if a substantial development permit is required. Attach a map showing the location of each stream segment listed above. Map scale should be 1 inch = 400 feet. 4. Riparian Functions associated with Type S and F waters The fixed width riparian buffer establishes a riparian area equal, on average, to the riparian buffer widths occurring when the Desired Future Condition Model is applied on S and F waters in Western Washington. Once adjacent timber is harvested, the growth of the trees will remain on the same trajectory to achieve the desired future condition targets for future riparian function required by the state Forest Practices Rules. The objective is to improve riparian function over the long-term while reducing the complexity of the Forest Practices Rules. Riparian function includes the following: Bank Stability: Retaining trees within a Fixed Width Riparian Management Zone provides the root mass necessary to stabilize a stream bank. Although roots can extend beyond the drip-line of a tree's crown,the bulk of the root mass is contained within this area. Where a channel migration zone (CMZ) exists, the Fixed Width Riparian Management Zone begins at the edge of the CMZ. Woody Debris: Periodic large woody debris input is vital to properly functioning riparian and aquatic systems. Harvest near a stream in the short term may reduce the potential source of woody debris. If no harvest occurs, the woody debris that falls into the stream is that immediately adjacent to the bank.A fixed width buffer leaves all trees available until random, natural recruitment begins. Leaf Litter/ Nutrients: Needles and leaf litter are an essential component of the nutrient cycle of a stream by serving as food sources for insects and fish.An edge effect will result from a fixed width buffer that may result in increased growth and diversity of understory vegetation, further improving nutrient cycling in the riparian area and duff development on the forest floor. Sediment Filtering: Depending on the slope of the site,there may be a risk of overland runoff due to decreased interception of rainfall through a canopy. Management practices such as leaving ground vegetation undisturbed and distributing of slash will minimize the risk of sediment delivery until groundcover is reestablished. Shade: The canopy will remain in the same condition as exist. Trees retained within the fixed width RMZ will continue to provide shade within a minimum of 75 feet from the stream. Other Riparian Features: Microclimate features such as ambient air temperature may be affected, depending on the extent of upland management activities. Temporary soil temperature increases in the forest stands may result, which can affect groundwater and instream water temperatures. However, as understory vegetation fills in and as the adjacent canopy of the new stand recovers, temperature fluctuations will be reduced, resulting in a low likelihood of impact to groundwater or instream temperatures. Washington State Department of Natural Resources • Forest Practices Page 2 of 2 Fixed Width Riparian Management Zones Template for Types S and F Waters for Small Forest Landowners-For Western Washington•12-30-2013 p�° I ' I -� . . • � � 1 .. � � !� Appendix A. Western Washington Water Type Classification Worksheet Stream/Segment ID: A Stream/Segment ID: B Stream/Segment ID:C Date Observed: 7/5/17 Date Observed: 715117 Date Observed: 7/5/17 1. Do you have a protocol survey? (See the Board Manual Section 13) Or,does the stream have waiver characteristics? (See WAC 222-16-031(3)(b)(ii)) [x]No. Continue. [x] No. Continue. [x] No. Continue. [ ]Yes.Attach documentation or [ ]Yes.Attach documentation or [ ]Yes.Attach documentation or approved WTMF number: approved WTMF number: approved WTMF number: [ ]Fish found. Stop. [ ]Fish found. Stop. [ ]Fish found. Stop. [ ]No fish found. Go to 6. [ J No fish found. Go to 6. [ ]No fish found. Go to 6. 2. Were fish observed or are fish known to use the stream anytime of the year? [ ]Yes. Type F water. Stop. [ ]Yes. Type F water. Stop. [ ]Yes. Type F water. Stop. [x]No. Continue. [x]No. Continue. [x] No. Continue. 3. Is there an impoundment(ponded water)upstream of the assessed segment,that is greater than.5 acres? [ ]Yes. Type F water. Stop. [ ]Yes. Type F water.Stop. [ ]Yes. Type F water, Stop. [x]No. Continue. [x]No.Continue. [x] No.Continue. 4. Are there segments within or above the assessed portion of the stream where the average BFW is two feet or greater? AND the average stream gradient is less than or equal to 16%? [x]Yes. Type F water. Stop. X Yes, Type F water.Stop. [ ]Yes. Type F water. Stop. [ ]No. Continue. [ ]No. Continue. [x] No. Continue. 5. Are there segments within or above the assessed portion of the stream where the average BFW is two feet or greater? AND the average stream gradient is between 16%and 20%? AND,the contributing basin to the stream is greater than 50 acres? [ ]Yes. Type F water. Stop. [ ]Yes. Type F water.Stop. [ ]Yes. Type F water. Stop. [ ]No. Continue. [ J No. Continue. [x] No.Continue. 6. Does the stream segment contain water at all times during a normal rainfall year? [ ]Yes. Type Np water. Go to 9. [ ]Yes. Type Np water.Go to 9. [ ]Yes. Type Np water. Go to 9. [ ]No. Continue. [ ] No. Continue. [x] No. Continue. 7. Is the stream segment downstream of a perennial source of water? [ ]Yes.Type Np water. Go to 9. ( ]Yes. Type Np water.Go to 9. [ ]Yes.Type Np water. Go to 9. [ ]No.Continue. [ ] No.Continue. [x]No. Continue. 8. Is the stream physically connected by an above-ground channel to Type S,F,or Np water? [ ]Yes, Type Ns water. Stop. [ j Yes,Type Ns water.Stop. [x]Yes, Type Ns water. Stop. [ j No, non-typed water. [ ]No, non-typed water. [ ]No, non-typed water. 9. Describe how you determined the uppermost point of perennial flow.Include a description of its location and show the point on a map(Use a separate piece of paper if necessary). Stream/Segment ID Description: 6/1/2016 � �f,SNINGlp� o WASHINGTON STATE DEPT OF s d n A T U R A L For DNR Use Only RESOURCES Checklist#: °f tipTUaP� SMALL FOREST LANDOWNER CHECKLIST RMAP WHEN TO SUBMIT A CHECKLIST RMAP Submit this checklist with your Forest Practices Application/Notification (FPA/N)for harvest or salvage. If you have already submitted a Checklist for these roads, please contact the DNR region office.The Checklist is for existing roads on your forest land that have been used by anyone for a forest practice since 1974. Do not include haul roads on your neighbor's property. Do not include skid trails. THIS CHECKLIST APPLIES TO(Check one) ® The forest roads on my forest land that I will use for this FPA/N. Minimum Required ❑ I assessed all the forest roads on my forest land.Assessing all your forest roads is optional. If you choose this, you will not be required to submit additional checklists with future FPA/N's. If you check this box,include a DNR Activity Map(s)that shows all your forest roads. Maps are available at DNR region offices and on the DNR website at: http://www.dnr wa gov/BusinessPemlits/Topics/ForestPracticesApplications/Pages/fp fpars.aspx.You need to know the legal description(section,township,and range)of your roads in order to request a map. The approximate total number of miles of forest road assessed in this Checklist is: '4 This information will be used for statewide statistics. FOREST ROAD ASSESSMENT Please complete this section after you have assessed your forest roads. ❑ I need help with this section.(If you check this box, you may leave the rest of the boxes in this section blank. DNR will contact you) The following boxes describe common sediment and road issues. Check all that apply. ❑ Water from the road or ditch runs ❑ The road has sinkholes. (Not a pothole—but a hole that you directly into typed water. can't drive over) ❑ Dirt from the uphill side of the road keeps falling into the • Water flows under, over,or around ditch-line before regularly scheduled maintenance. the culvert. ❑ Dirt from the cut-slope keeps falling downhill into or near a ❑ The culvert keeps filling with dirt. stream, pond,or wetland. ❑ The road has large cracks or ruts. ❑ There are indications of past surface erosion The road crosses typed water(a culvert, bridge,or ford exists). (X] I have assessed my forest roads and they do not have any of the above issues. FAMILY FOREST FISH PASSAGE PROGRAM This is a program to fix fish passage barriers,such as culverts. Not all culverts are fish passage barriers. For an evaluation of your potential fish passage barrier please contact the DNR's Small Forest Landowner Office in Olympia at(360)902-1404 or go to www.dnr.wa.gov\fffpp for more information. 09-26-2014 Checklist RMAP Page 1 of 2 Check one of these boxes ❑ 1 choose to enroll in the Family Forest Fish Passage Program and would like to have my potential barrier evaluated for eligibility. I understand that by checking this box I may be required to provide cost-share associated with the barrier removal or replacement. CK I choose not to enroll in the Family Forest Fish Passage Program and accept responsibility for removing or repairing any artificial fish barrier on my forest roads at my own expense. ❑ This barrier is already enrolled in the Family Fish Passage Program. ORPHANED ROADS State law requires DNR to keep an inventory of orphaned roads that pose a risk to public safety or to public resources.Your help with this inventory is requested. Orphaned roads am: Roads on your forest land that have not been used for forest activities since 1974. Forest Practices activities include timber cutting,timber hauling,tree planting,brush control, precommercial thinning,timber salvage, etc. Check one of these boxes ❑X 1 do not have orphaned roads that I think pose a risk to public resources or public safety—such as houses, highways,county roads, streams, ponds,or wetlands. ❑ I have orphaned roads that I think may pose a risk to public resources or public safety--such as houses, highways,county roads,streams, ponds or wetlands. (Please show the locations of all these orphaned roads on a separate DNR Activity Map. This is not the same map that shows your harvest) ❑ I need help identifying orphaned roads. ROAD MAINTENANCE OBLIGATIONS All forest landowners have a legal obligation to maintain all their forest roads on all their forest land to the extent necessary to prevent damage to public resources.This includes forest roads not shown on this Checklist. Maintenance rules are in WAC 222-24-052. Best Management Practices(BMP's)for road maintenance are in the Forest Practices Board Manual Section 3. Both are in the forest practices rule book or on the DNR website at:http:/;Www.dnr.wa.gov/BusinessPermits/Topics/ForestPracticesRules/Pages/Home.aspx Road maintenance includes: • Inspecting forest roads and fixing damage before,during,and after hauling timber and/or rock • Keeping drainage structures(relief culverts,ditches,water bars,dips, etc.)and water crossings functional • Making sure water from roads and ditches do not flow directly into streams,ponds, or wetlands ❑X My road(s)are maintained to Forest Practices standards. LANDOWNER INFORMATION I certify that at the time l submit this FPA/N I am a small forest landowner because: I have an average annual timber harvest level of two million board feet or less from my own forest land in Washington State;and I have not exceeded this average annual harvest level in the last three years;and 1 will not exceed this average annual harvest level for the next ten years. Printed Name of Landowner: lk` V1 1 Landowner Signature(s): Complete this s tion onl -f you are a W submitting an FPA/N Mailing Address: — City: State: Zip Code: E-Mail Address(optional). Phone Number. Printed Name of Contact Person(If different from landowner): E-Mail Address(optional): Phone Number: 09-26-2014 Checklist RMAP Page 2 of 2 �PSHIN(itp� o FPAIN No: 2419543 A Effective Date: 811412017 3 a p Expiration Date: 8/14/2020 G�NATUA'� Shut Down Zone: 655 Forest Practices Application/Notification EARR Tax Credit: ® Eligible ❑ Non-eligible Notice of Decision Reference: 14-19-05W Decision ® Notification Operations shall not begin before the effective date. ® Approved This Forest Practices Application is subject to the conditions listed below. ❑ Disapproved This Forest Practices Application is disapproved for the reasons listed below. ❑ Closed Applicant has withdrawn FPAIN. FPAIN Classification Number of Years Granted on Multi-Year ReULlest ❑ Class II ® Class III ❑ Class IVG ❑ Class IVS ❑ 4 years ❑ 5 years Conditions on Aonroval I Reasons for Disaooroval Issued By: Matt Brady Region: South Puget Sound Title: Resource Protection Forester Date: 811412017 Copies to: ® Landowner,Timber Owner and Operator. Issued in person: ❑ Landowner❑Timber Owner❑ Operator By: Washington State Department of Natural Resources•Notice of Decision•August 5,2013 Page i Appeal Information You have thirty (30) days to appeal this Decision and any related State Environmental Policy Act determinations to the Pollution Control Hearings Board in writing at the following addresses:/ Physical address: 1111 Israel Rd. SW, Ste 301, Tumwater,WA 98501 Mailing address: P.O. BOX 40903, OLYMPIA,WA 98504-0903 Information regarding the Pollution Control Hearings Board can be found at: http:l/www.eluho.wa.gov/ At the same time you file an appeal with the Pollution Control Hearings Board, also send a copy of the appeal to the Department of Natural Resources' region office and the Office of the Attorney General at the following addresses: Office of the Attorney General Department Of Natural Resources Natural Resources Division South Puget Sound Region 1125 Washington Street SE And 950 Farman Ave N PO Box 40100 Enumclaw,WA 98022 Olympia, WA 98504-0100 Other Applicable Laws Operating as described in this application/notification does not ensure compliance with the Endangered Species Act, or other federal, state, or local laws. Transfer of Forest Practices Ann fca io /Notification (WAC 222-20-010) Use the "Notice of Transfer of Approved Forest Practices Application/Notification" form. This form is available at region offices and on the Forest Practices website: httg:llwww.dnr.wa.govlbusinessl2ermits/forestgractices. Notify DNR of new Operators within 48 hours. Continuing Forest Land Obligations(RCW 76.09.060. RCW 76-QS.070. RCW 76,02.390.and WAG 222-20-0551 Obligations include reforestation, road maintenance and abandonment plans, conversions of forest land to non- forestry use and/or harvest strategies on perennial non-fish habitat(Type Np)waters in Eastern Washington. Before the sale or transfer of land or perpetual timber rights subject to continuing forest land obligations, the seller must notify the buyer of such an obligation on a form titled "Notice of Continuing Forest Land Obligation". The seller and buyer must both sign the"Notice of Continuing Forest Land Obligation"form and send it to the DNR Region Office for retention. This form is available at DNR region offices. If the seller fails to notify the buyer about the continuing forest land obligation, the seller must pay the buyer's costs related to continuing forest land obligations, including all legal costs and reasonable attorneys' fees incurred by the buyer in enforcing the continuing forest land obligation against the seller. Failure by the seller to send the required notice to the DNR at the time of sale will be prima facie evidence in an action by the buyer against the seller for costs related to the continuing forest land obligation prior to sale. DNR affidavit of mailing: On this day 8/14/2017 1 placed in the United States mail at Enumclaw WA, (date) (post office location) postage paid, a true and accurate copy of this do De ion FPA#2419543 Meredith Desserts (Printed name) (Signature Washington State Department of Natural Resources•Notice of Decision-August 5,2013 Page 2 ApR 18 MASON COUNTY DEPARTMENT OF C�1VIIV>"IINITY SAlder EA CES Mason County Bldg.8,615 W.Alder Street, Shelton,98584 (360)427-9670 Belfair(360)275-4467 Elma(360)482-5269 rasi W-*vw.eo.mason.wa.us FOREST MORATORIUM WAIVER/RELEASE APPLICATION This application is to be used to waiver a portion of a parcel for development pennits or to release the entire tract from the six year moratorium for development permits.This process was created under the guidance of RCW 76.09.060.This application needs to be filled out completely,so that we have all the information to process this in an expedient manner. Which are your uesting.fro the Moratorium?,Waiver El Release Applicant's Name: �CV)r1 1 Operator's Name: _ Applicant's Address:© M _ Operator's Address: ioij Ct< q Applicant's E-mail: f7AC. C4C4 rr-\— Applicant's Phone number: 3(c<3" T$9 5 Effected Parcel Number i -�� _ q Parcel size(in acres): y, cr y l° ,- Identify what type of tim'Ser was removed ie:Douglas ir,Western Red Cedar,Alder,Maple,etc: Was the timber harvest done under an approved forest practice application: M Yes ❑No Was there an enforcement action taken by the Department of Natural Resources(DNR): ❑Yes [ No Forest Practice Application Number2 9 I 1 S 7'3 Forest Practice Application date of approval: What is your intention to do with the effected parcel:S , y,;k ,N U e 7 ec r y ey— QT e CL-. Have you attached a site plan to show the area of the requested waiver or release: Yes M No Are there any critical areas on your site?ie:wetlands,streams,creeks,steep slopes,etc.: Yes No If yes,identify the type of critical area(s): LAC �l�x Py_ p Q w N rorn W A/V tr Area, Please list conditions of approvals by DNR for your forest practice application: n nno sr� PA gi q5 3 Were any of the buffer areas effected by the timber harvest?: 0 Yes No / Identify if you harvested any timber in the critical areas on your site: ❑Yes No `'1 Did you replant per DNR standards: Yes ❑No Wk/- , f Application Signature 1) I certify that I am the forest land owner,as that term is defined in RCW 76.09.020 and WAC 222-16-010, and that I am familiar with the requirements of the Forest Practices Act, RCW 76.09 and the forest practice rules,WAC Title 222.I am specifically familiar with RCW 76.09.460(c)and its effects. 2) I certify and declare under penalty of perjury under the laws of the state of Washington that the foregoing is true and correct. Signed this _-/- __day of �,20 at (Month) - lAnoAd k , aka c 1 _ (City) (State) L (Sign at STATE OF WASHINGTON) h bnd Ct J t'n 19 )SS COUNTY OF MASON ) On this day of ,20_, before me,the undersigned, a Notary Public in and for the State of Washington,duly commissioned and sworn, personally appeared to me known to be the individual described in and who executed the within and foregoing instrument, and acknowledged that signed the same as free and voluntary act and deed,for the uses and purposes therein mentioned. GIVEN under my hand and official seal this day of , 20 NOTARY PUBLIC in and for the State of Washington residing at See Attached For Notarial Acknowledgement or Jurat Certificate E STATE OF HAWAI'I CITY AND COUNTY OF HONOLULU SS. Acknowledgement Certificate for a Corporation, Partnership, Estate or Trust On this 10+� day of Apr;I , 20�, before me personally appeared R1,J,, 0. ,-n; ,ch who, being by me duly sworn, did say that/ h�AheyQ/ve the ovncr of /Cli , and that the instrument was signed on behalf of the corporation , partnership, estate, or trust, by au- "' " ",1 thority of its board of directors, partners or trustees, and sh /may ........ °SF acknowledged the instrument to be the free act and deed of the corpora- ; NOTARY _ tion, partnership, estate, or trust. PUBLIC Comm.No. 18-422 \� Coy .M. Hirose, Notary Public, State of Hawaii My commission expires: July 22, 2022 NOTARY CERTIFICATION Document Description: NOTARY = - PUBLIC -_ ----— Comm.No. 18422 Date of Document: ogiio/l4 No. of Pages: 1 ' sT ''•. ..... Pam : Cody .M. Hirose, Notary Public, State of Hawai'i Date First Circuit