HomeMy WebLinkAboutSEP2012-00016 - SEP Application - 3/2/2012 SEPA CHECKLIST
$385 - Single Family (Mason County Permit Center Use)
$630 - Non-Single Family 0 to 9.99 Acres SEP
$755 -10 to 20 Acres
$945 - Over 20 Acres Date Rcvd:13 Z-� Z-
$2,525 + 70/hr- EIS (DS)
PN:
42D 0 2--00 o®1it)
Purpose of Checklist:
The State Environmental Policy Act(SEPA), chapter 43.21C RCW, requires all governmental agencies to consider the
environmental impacts of a proposal before making decisions. An environmental impact statement (EIS) must be
prepared for all proposals with probable significant adverse impacts on the quality of the environment. The purpose of
this checklist is to provide information to help you and the agency identify impacts from your proposal (and to reduce or
avoid impacts from the proposal)and to help the agency decide whether an EIS is required.
Instructions for Applicants:
Governmental agencies use this checklist to determine whether the environmental impacts of your proposal are
significant, requiring preparation of an EIS. Answer the questions briefly, with the most precise information known, or
give the best description you can.
You must answer each question accurately and carefully, to the best of your knowledge. In most cases, you should be
able to answer the questions from your own observations or project plans without the need to hire experts. If you really
do not know the answer, or if a question does not apply to your proposal, write "do not know" or "does not apply".
Complete answers to the questions now may avoid unnecessary delays later.
Some questions ask about governmental regulations, such as zoning, shoreline, and landmark designations. Answer
these questions if you can. If you have problems, the governmental agencies can assist you.
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.
There is a fee required, for the processing of the checklist, see above for the appropriate fee. Please make your check
payable to"Mason County Treasurer".
A. BACKGROUND
1. Name of proposed project: �4A-Ova A'%ypoe' RA. W0.�^'tv'' Exmhs,loy) PrDiP�t
2. Name of applicant: C i}-� o� sl a ♦on
Property owner: A Soh COti n+q W dtS W1 n't -evi 5i-a e.
3. Applicant mailing address: C0+A !;f. 6�aTan , WA g8584
Applicant phone numbers: ' 5 1 aw 67
4. Date checklist prepared: J 41 %0 2012
5. Agency requesting checklist: measa ► CDU n+j,
Mason County SEPA Checklist 1
r �
6. Proposed timing or schedule(including phasing, if applicable):
1. { 1�J Ct�� ICE �Tr:Cl �►w~ c.L,ed� �G "A" 411 6eg1h (,,ons+wAc+leh
2012 , Cons+v-jk a -i alh ray Sc.M e J k ie 111311 iS (.1Vk V oW h•
7. Do you have any plans for future expansion,or further activity related to or connected with this proposal? If yes,
explain.
Cons4-vac.-l-1on '(9✓ SeV,eAtle "�`� '1S �►�khow/1.
8. List any environmental information you know about that has been prepared, or will be prepared, directly related to
this proposal.
- form W-.+w Po 11tA+;on Preven-+JOVX Mom (SVJ rrr)
INo}ire, 64' I1,%+en+
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.
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10. List any government approvals or permits that will be needed for your proposal, if known.
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11. Give a 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 s�-
specific information on project description.) C2) ,2 e)iJ"� —
ac�l ed u l e "A"' , (�ahS�'r�L} 12 V4a' -e r mi j r\ Bey i hhi I A�)t A'1ne, PA6�5
of Tgrragon Ave . k SV%d+nv► $�r��s Rd. , 4n Steel+-
SYvin�5 Tke.nc2 a 1 ovt US 101 +o '6R,102 ; Tke,nce,alo►VJ,
SR l02 -!� 1�llasl�tng�'dh S}, Pawl $" : Gans1+✓uck IZ'�Wgkevn�c,►n
T✓om WaSb►�n���1 S�'• 1�A++rol J-., '{'1�� "nv Jecar►bv\G Ce►'\3'ev.
12. What is the 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.
Ple46-6 see c<tfa�teed flan Sef.
Mason County SEPA Checklist 2
B. ENVIRONMENTAL ELEMENTS
1. EARTH:
a. General description of the site (circle one): Flat,jrollingi hilly, steep slopes, mountainous, other(explain).
b. What is the steepest slope on the site (approximate percent slope)?
LeSS A-�Av\ °/a
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 prime farmland.
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d. Are there surface indications or history of unstable soils in the immediate vicinity? If so,describe.
fNoY\e— ob5ervM av- Y\oA-e-A nth A 1ne <,oun-t Wel� kvctr
flgZk✓A, M4,0e,+)on Plan I July , 2010 Fu6 e,+'t017.
e. Describe the purpose,type, and approximate quantities of any filling or grading proposed. Indicate source of
fill.
f. Could erosion occur as a result of clearing, construction, or use? If so, generally describe.
Tt �s r) an},tC-1, -��; -}-�,a� N��✓e, w% f1 Ise einj si5n���cGh�4-
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g. About what percent of the site will be covered with impervious surfaces after project constructions(for
example, asphalt or buildings)?
7VI'.6 w*11) no� IrnPexviotAs sUY-ctceS.
h. Proposed measures to reduce or control erosion, or other impacts to the earth, if any:
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2. AIR:
a. What types of emissions to the air would result from the proposal (i.e. dust, automobile, odors, industrial wood
smoke) during construction and when the project is completed? If any, generally describe and give
approximate quantities, if known.
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A rest,, ohs' ��►-t.,eh�vv�. > >t�d'�t� for\ l acLd I>hy o �"ruG K3
prinen Pxl,aus-}-
b. Are there any off-site sources of emissions or odor that may affect your proposal? If so, generally describe.
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Mason County SEPA Checklist 3
c. Proposed measures to reduce or control emissions or other impacts to air, if any.
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3 WATER:
a. Surface:
1) 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.
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S1�e I}o►\ Spri-n9S Ra , Ca r)6+r14c�-i a✓1 w, l) -�-mvL✓Sc.
Tur+le, Lake aveA hefweGn SR lo2 4 W. Sandetrsan Wa� .
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.
Cons+-n4c4-ian w,'O 6*, gd jacen+ fe f-t,e kno,,n LA)eH4nd
Gi1A Tew-He LaKa� rme-A+l&Aed in 'I+-e^ #! albove.
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.
Cons+rke-+;ors w: Ii hof +D(Ac-11 G,}he.v- we+lei,a aY 1L-VOe
LaKL . All wo,/L 'tv\ gYeas W�,1\ occuv' w'+61 y\ A'4.e.
C o un A � or C.+,t+,e. IZ'9 k4 -4- Way .
4) Will the proposal require surface water withdrawals or diversions? Give general description, purpose, and
approximate quantities if known.
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5) Does the proposal lie within a 100-year floodplain. If so, note location on the site plan.
Nv. 1J9+ Acc ova4Y A-o FEtAk flood Nlaf, 53o11rp 6190 �-
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.
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b. Ground:
1) Will ground water be withdrawn, or will water be discharged to ground water? Give general description,
purpose,and approximate quantities, if known.
1�I
Mason County SEPA Checklist 4
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.
1 _I/)',
c. Water runoff(including storm water):
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 flow into other waters?
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Cdlec+eA l'h fie, road s1de. d }�he5 , finis+ �+� Sa�)s Cflns'►sf
1nD-C&1y o� n�ri1�"va}'►vti. v-,q}as da YNV+ prorno-Ire.
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2) Could waste materials enter ground or surface waters: If so, generally describe.
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d. Proposed measures to reduce or control surface, ground, and runoff water impacts, if any:
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4. PLANTS:
a. Check or circle types of vegetation found on the site:
deciduous tree: alder, maple, aspen, other
Y_ evergreen tree: fir, cedar, pine, other
X shrubs
grass
pasture
crop or grain
wet soil plants: cattail, buttercup, bullrush, skunk cabbage, other
water plants: water lily, eelgrass, milfoil, other
other types of vegetation
b. What kind and amount of vegetation will be removed or altered?
-Tree15 � 51r,r�b6 '� g�a5S25
Mason County SEPA Checklist 5
c. List threatened or endangered species known to be on or near the site.
wov,a known
d. Proposed landscaping, use of native plants, or other measures to preserve or enhance vegetation on the site,
if any:
H c Av'o Seed diSk�rb>✓d a�'eas .
5. ANIMALS
a. Circle any birds and animals which have been observed on or near the site or are known to be on or near the
site:
Birds: hawk heron, eagle ongbirds other
Mammals: dee bear, elk, beaver, other
Fish: bass, salmon, trout, herring, shellfish, other
b. List any threatened or endangered species known to be on or near the site.
bA,t2ctv.,,,q, P.e-ke-t e"Phe-'_ (Cgv"d;d_-4_e- T11Ve-QteAed) �- S+,rea�C,✓d
Nary\P.d l-nv-k- (041411Aa+V_, Ehagnrr'ed) r"grP2d
c. Is the site part of a migration route? If so,explain.
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d. Proposed measures to preserve or enhance wildlife, if any:
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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.
67G6oI i n e ov- P1er52J Iv, �-r"clLs 4 excavakors +o
F �ny OX+-ev- coon rIe-4.10Y1 ,
b. Would your project affect the potential use of solar energy by adjacent properties: If so,generally describe.
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:
Mason County SEPA Checklist 6
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.
r rn�,��- Etr � '�hV-\ c h+.
1) Describe special emergency services that might be required.
I,Io 5Pe4 I ew,e_r evw_c� 5erv�ce,5 he�dQd.
2) Proposed measures to reduce or control environmental health hazards, if any:
Cor-}Yar_A-ov` vA',1) Vv)+ L�,e , Flowed -i o �, ,,re q(Ae\ oV, ProjeG{'.
b. Noise.
1) What types of noise exist in the area that may affect your project(for example: traffic, equipment,
operation,nother)?
Noe- 4-Aq to I i1��Vc+ )C •.� .
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)? Indicate what hour's noise would
come from the site.
TeM'P0V-av'r� ec�ina�v',eVI h0 Se, f;I,- +V)C, e0vAS-FrIAC+16Ir
Q th e VA q, -•ev w,cit v,,
3) Proposed measures to reduce or control noise impacts, if any:
8. LAND AND SHORELINE USE:
a. What is the current use of the site and adjacent properties? 1
Cd M m e v Gi c, I i i fZC'_��I c1f�l�I Ct 1
b. Has the site been used for agriculture? If so, describe.
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c. Detscribe any structures on the site. +
rA\J V-nAa r•.IoYeir-,t ,,yvN 4 a6we J✓nle- CkPlItTiLS.
d. Will any structures be demolished? If so,what?
Mason County SEPA Checklist f\l r>, 7
e. What is the current zoning classification of the site? G A . M 20 1 Ra.3 LT G=
f. What is the current comprehensive plan designation of the site? C.i-Ft, tf Shed♦n 1AGA
g. If applicable,what is the current Shoreline Master Program designation of the site? N ovNe-
h. Has any part of the site been classified as an"environmentally sensitive"area? If so, specify.
'1 C-e,YX)dA- , 9
i. Approximately how many people would reside or work in the completed project? _ "I R
j Approximately how many people would the completed project displace? _ N o)Ne _
k. Proposed measures to avoid or reduce displacement impacts, if any:
I. Proposed measures to ensure the proposal is compatible with existing and projected land uses and plans:
WQ�erMa\�n ex�e�nsican �5 In ccc.ordahce- w��h i-�,� C��°y o�
Sl�e.�+a►, Wa��v^ Co+kIP Plan qnd Q�'ov�ae5 �u�able, wad-etr �-o
Co,,n* Se-v-v'�c4.S .
9. HOUSING:
a. Approximately how many units would be provided, if any? Indicate whether high, middle, or low-income
housing.
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b. Approximately how many units, if any, would be eliminated? Indicate whether high, middle, or low-income
housing.
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c. Proposed measures to reduce or control housing impacts, if any:
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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?
1 Y 11"
b. What views in the immediate vicinity would be altered or obstructed?
Wo'nL
c. Proposed measures to reduce or control aesthetic impacts, if any:
Mason County SEPA Checklist 8
11. LIGHT AND GLARE
a. What type of light or glare will the proposal produce? What time of day would it mainly occur?
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b. Could light or glare from the finished project be a safety hazard or interfere with views?
c. What existing off-site sources of light or glare may affect your proposal:
d. Proposed measures to reduce or control light and glare impacts, if any:
i'�lIli ,
12. RECREATION:
a. What designated and informal recreational opportunities are in the immediate vicinity?
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b. Would the pro/posed project displace any existing recreational uses? If so, describe.
1,11 „ ,
c. Proposed measures to reduce or control impacts on recreation, including recreation opportunities to be
provided by the project or applicant, if any:
V\/'I',
13. HISTORIC AND CULTURAL PRESERVATION:
a. Are there any places or objects listed on, or proposed for, national, state, or local preservation registers known
to be`on or next to the site? If so, generally describe.
I '6ne- kewu 1V\,
b. Generally describe any landmarks or evidence of historic, archaeological, scientific, or cultural importance
known to be on ornext to the site.
WC)V\f- KNo/.o�"
c. Proposed measures to reduce or control impacts, if any:
Mason County SEPA Checklist 9
14. TRANSPORTATION:
a. Identify public streets and highways serving the site and describe proposed access to the existing street
system. Show on site plans, if any.
6'ke-N ah SpYi,vis RJ . Us I o SK 102-
b Is site currently served by public transit? If not,what is the approximate distance to the existing street system?
Show on site plans, if any. yes, 5P, col ", 5 R IO2 a,re ��,4.� - 0.- R;ae- (N 0 f3aS f�j-14-4
s ✓S�1
54.e►}e►1 5pr'��ng Ra t s 1"{o,Ae-7 w'i�4, s+vps e%+ 9a5 s+q+'� W,9g i Se-I,�oo) ov eth J
S4 Puce, oA ahe 51 &Roh S5 fle;»g5 Rd, (► io Bas ��el+e�s
c. How many parking spaces would the completed project have? How many would the project eliminate?
i
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d. Will the proposal require any new roads or streets, or improvements to existing roads or streets, not including
driveways? If so, generally describe(indicate whether public or private).
e. Will the project use(or occur in the vicinity of)water, rail, or air transportation? If so, generally describe.
, )
f. How many vehicular trips per day would be generated by the completed project? If known, indicate when
peak volumes would occur.
N/k
g. Proposed measures to reduce or control transportation impacts, if any: L
1e-.Yv\pov,-.q V 4T)r,i"F-C. C 0✓*Y 0 d LA\0- O v\e,+VYA.G'T1 OY1
15. PUBLIC SERVICES: ")
a. Would the project result in an increased need for public service(for example: fire protection, police protection,
health care, schools, other)? If so, generally describe:
Q 0 .
b. Proposed measures to reduce or control direct impacts on public services, if any:
16. UTILITIES:
a. Circle utilities currently available at the site: electricit natural ga (Ovate refuse service, ,telephone
sanitary sewer, septic system, other:
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 that might be needed.
tie C,1-y o-� G1Ne_ 6vn Prof oyes A_o ex�-evna Wakarrna,v\ +Z) WSP A V•o.c.
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.
Applicant Signature: Date: '5AZ'�60a
Mason County SEPA Checkfis 10
ESA LISTED SALMONIDS CHECKLIST
This worksheet was designed to help project proponents, and government agencies, identify when a project needs
further analysis regarding adverse effects on ESA(Endangered Species Act) listed salmonids. Salmonids are salmon,
trout and chars, e.g. bull trout. For our purposes, "ESA Listed Salmonids" is defined as fish species listed as
endangered, threatened or being considered for listing.
If ESA listed species are present or ever were present in the watershed where your project will be located, your project
has the potential for affecting them, and you need to comply with the ESA. The questions in this section will help
determine if the ESA listings will impact your project.
The Fish Program Manager at the appropriate Department of Fish and Wildlife (DFW) regional office can
provide information for the following two questions.
1. Are ESA listed salmonids currently present in the watershed in which your project will be located?
YES X NO— Please describe. Colo
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2. Has there ever been an ESA listed salmonid stock present in this watershed?
YES )! NO— Uncertain_ Please describe.
If you answered "yes" to either of the above questions, you should complete the
remainder of this checklist.
PROJECT SPECIFICES: The questions in this section are specific to the project and vicinity.
1. Name of watershed: WRI - kPr\y\P_c�lw 'l`�01AA�orOu h
S3 , A - a ��v�r ���-�d wye�\o,wds
2. Name of nearest waterbody: 5��,. Ig - Id , Eov I+t /��ids h,,•-ash Gv«k 5 �)I p�lusjv�h
Sc4�, f� - J.1�,v,'s�-r•• ' 3�o00�Ir
3. What is the distance from this project to the nearest body of water: Sr V. 15- G.Gv._ �:300- BRen a�-buffer
between the project and a stream can reduce the chance of a negative impact to fish.
4. What is the current land use between the project and the potentially affected water body (parking lots, farmland,
etc.)? f e�weG✓► SGL�. A Frq' fc t J oV% ;g Cv ee.1_ - east tAndeve f oj�e 1=o��3f1
We+laytd Avea . 6e+wee, 5�1. . fC3 Pv'ojcG4' 4 '7oI barou��► �v ee-I_- r1 ow,+
fv,rPs}- �Gh� , Somme. 1��1i� ihdksfvigl end a�r�nv+- rt _Ili es,
5. Is the project above a:
natural permanent barrier(waterfall) YES NO
• natural temporary barrier(beaver pond) YES_ NO
• man-made barrier(culvert, dam) YES— NO_
• other(explain): �-orA
6. If yes, are there any resident salmonid populations above the blockage?
YES_ NO Don't know — �o�' G�GoYd� +0 PHS rhGQS
7. What percent of the project will be impervious surface(including pavement&roof area)? N ov%e,
Mason County SEPA Checklist I I
FISH MIGRATION: The following questions will help determine if this project could interfere with migration of adult
and juvenile fish. Both increases and decreases in water flows can affect fish migration.
1. Does the project require the withdrawal of:
a. Surface water? YES NO 7<
Amount
Name of surface water body
b. Ground water? YES NO
Amount.
From where
Depth of well
2. Will any water be rerouted: YES_ NO
If yes,will this require a channel change?
3. Will there be retention or detention ponds? YES \ NO
If yes, will this be an infiltration pond or a surface discharge to either a municipal storm water system or a surface
water body? If to a surface waterbody, please give the name of the waterbody.
YES ,`�' NO IF0V\8
4. Will this project require the building of new roads? YES_ NO
Increased road mileage may affect the timing of water reaching a stream and may impact fish habitat.
5. Are culverts proposed as part of this project? YES;C NO
6. Will topography changes affect the duration/direction of runoff flows? YES_ NO
If yes, describe the changes.
7. Will the project involve any reduction of the floodway or floodplain by filling or other partial blockage of flows?
YES_ NO ~'
If yes, how will the loss of flood storage be mitigated by your project?
WATER QUALITY: The following questions will help determine if this project could adversely impact water quality.
Such impacts can cause problems for listed species.
Water quality can be made worse by runoff from impervious surfaces, altering water temperature, discharging
contaminants, etc.
1. Do you know of any problems with water quality, in any of the streams,within this watershed?
YES �X NO _ If yes, describe. 1
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�ly'ert 5 , B tA+ � r,i Wq�rv- Y cL Ili y I M FC4C(-5 cAye V-'0+ 4 C0v1 C eyV►.
Mason County SEPA Checklist 12
2. Will your project either reduce or increase shade along or over a waterbody?
YES_ NO ) If yes, describe.
Removal of shading vegetation or the building of structures such as docks or floats often results in a change in
shade.
3. Will the project increase nutrient loading or have the potential to increase nutrient loading or contaminants
(fertilizers, other waste discharges, or runoff)to the waterbody? If yes, describe.
YES — NO_';_
4. Will turbidity be increased because of construction of the project or during operation of the project?
YES_ NO 1�o n �.�a��e./' Oar lneav'-w0 W o�I< .
In-water or near water work will often increase turbidity.
5. Will your project require long-term maintenance, i.e. bridge cleaning, highway salting, and chemical sprays for
vegetation management, clearing of parking lots?
YES_ NO If yes, please describe.
VEGETATION: The following questions are designed to determine if the project will affect riparian vegetation,
thereby, adversely impacting salmon.
1. Will the project involve the removal of any vegetation from the stream banks:
YES NO "�,
If yes, please describe the existing conditions, and the amount and type of vegetation to be removed.
2. If any vegetation is removed, do you plan to re-plant?
YES NO_ If yes,what types of plants will you use?
I,t et 5 o i 5 uv G c-e w l I I �C, y 4v p s e esl ea
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 Oe
Applicant Signature: Date:
Mason County SEPA Checklist 13
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io
465400 486000 486600 48720C 4878CO 488400 489000 489600 490200
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485400 486000 486600 487200 487800 488400 489000 489600 490200
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N Meters N
0 350 700 1,400 2,100
Feet
0 1,500 3,000 6,000 9,000
Natural Resources Web Soil Survey 5/23/2011
Conservation Service National Cooperative Soil Survey Page 1 of 3
Soil Map—Mason County,Washington
MAP LEGEND MAP INFORMATION
Area of Interest(A01) (,y) Very Stony Spot Map Scale: 1:27,100 if printed on A size(8.5"x 11")sheet.
Area of Interest(AOI) Wet Spot The soil surveys that comprise your AOI were mapped at 1:31,680.
Soils other Please rely on the bar scale on each map sheet for accurate map
Soil Map Units measurements.
Special Line Features
Special Point Features Gully Source of Map: Natural Resources Conservation Service
Blowout Web Soil Survey URL: http://websoilsurvey.nres.usda.gov
® Borrow Pit Short Steep Slope Coordinate System: UTM Zone 1 ON NAD83
X Clay Spot Other This product is generated from the USDA-NRCS certified data as of
Political Features the version date(s)listed below.
Closed Depression Cities
� Soil Survey Area: Mason County,Washington
}; Gravel Pit water Features Survey Area Data: Version 6,Sep 22,2009
Gravelly Spot Oceans Date(s)aerial images were photographed: 7/21/2006
Landfill Streams and Canals The orthophoto or other base map on which the soil lines were
n Lava Flow Transportation compiled and digitized probably differs from the background
imagery displayed on these maps.As a result,some minor shifting
,J& Marsh or swamp +++ Rails of map unit boundaries may be evident.
k Mine or Quarry Interstate Highways
Q Miscellaneous Water US Routes
Q Perennial Water Major Roads
v Rock Outcrop Local Roads
+ Saline Spot
Sandy Spot
Severely Eroded Spot
0 Sinkhole
'y) Slide or Slip
0 Sodic Spot
Spoil Area
Q Stony Spot
USDA Natural Resources Web Soil Survey 5/2 312 0 1 1
� Conservation Service National Cooperative Soil Survey Page 2 of 3
Soil Map-Mason County,Washington
Map Unit Legend
Mason County,Washington(WA645)
Map Unit Symbol Map Unit Name Acres in AOI Percent of AOI
Ca Carslairs gravelly loam,0 to 5 percent 27.5 15.1%
slopes
Ga Gravel pit 0.3 0.2%
Gh Grove gravelly sandy loam,0 to 5 percent 114.3 62.6%
slopes
Gk Grove gravelly sandy loam,5 to 15 percent 9.0 4.9%
slopes
Gm Grove gravelly sandy loam,1510 30 0.3 0.2%
percent slopes
Lb Lystair loamy sand,0 to 5 percent slopes 30.5 16.7%
Sf Shelton gravelly sandy loam,5 to 15 0.4 0.2%
percent slopes
W Water - — 0.2 0.1%
Totals for Area of Intwest 182.5 100.0•/0
Usu� Natural Resources Web Soil Survey 5/23/2011
�� Conservation Service National Cooperative Soil Survey Page 3 of 3
KEY TO MAP
I 500-Year Flood Boundary
ZONE$ APPROXIMATE SCALE IN FEET
100-Year Flood Boundary 1000 0 1000
Zone Designations
I 100-Year Flood Boundary
ZONE.B
30
500-Year Flood Boundary NATIONAL FLOOD INSURANCE PROGRAM
Base Flood Elevation Line 513
With Elevation In Feet"
Base Flood Elevation in Feet (EL 987) �'R�
Where Uniform Within Zone"
Elevation Reference Mark RM7x
FLOOD INSURANCE RATE MAP
Zone D Boundary
I River Mile 4M1.5 MASON COUNTY,
I
*Referenced to the National Geodetic Vertical Datum of 1929 WASHINGTON
(UNINCORPORATED AREAS)
EXPLANATION OF ZONE DESIGNATIONS
I
ZONE EXPLANATION
A Areas of 100-year flood; base flood elevations and PANEL 190 OF 300
flood hazard factors not determined. (SEE MAP INDEX FOR PANELS NOT PRINTED)
AO Areas of 100-year shallow flooding where depths
are between one (1) and three(3)feet;average depths
v� of inundation are shown, but no flood hazard factors
are determined.
AH Areas of 100-year shallow flooding where depths
fare between one (1) and three (3) feet; base flood
elevations are shown, but no flood hazard factors
31 are determined.
i
Al-A30 Areas of 100-year flood; base flood elevations and ZONE R flood hazard factors determined.
i COMMUNITY-PANEL NUMBER
A99 Areas of 100-year flood to be protected by flood 530115 0190 C
protection system under construction; base flood
elevations and flood hazard factors not determined.
B Areas between limits of the 100-year flood and 500- EFFECTIVE OATS:
year flood;or certain areas subject to 100-year flood-
ing with average depths less than one(1)foot or where
the contributing drainage area is less than one square
mile;or areas protected by levees from the base flood.
(Medium shading)
C Areas of minimal flooding.(No shading) Federal Emergency Management Agency
0 Areas of undetermined, but possible, flood hazards.
V Areas of 100-year coastal flood with velocity (wave This Is an official copy of a portion or the above referenced flood map. It
action);base flood elevations and flood hazard factors was extracted using F-MIT On-Una This map does not reflect changes
not determined. or amendments which may haw been made subsequent to the date on the
title Work. For the latest product information about National Flood Insurance
V1-V30 Areas Of 100- ear coastal flood with velocity wave v Program good maps check the FEMA Flood Map Store at-Insafema.gov
_ APPROXIMATE SCALE IN FEET
1000 0 1000
4
NATIONAL FLOOD INSURANCE PROGRAM
FIRM
FLOOD INSURANCE RATE MAP
MASON COUNTY,
WASHINGTON
(UNINCORPORATED AREAS)
PANEL 190 OF 300
G (SEE MAP INDEX FOR PANELS NOT PRINTED)
O�
I
i
COMMUNITY-PANEL NUMBER
530115 0190 C
EFFECTIVE DATE:
MAY 17, 1988
f Federal Emergency Management Agency
"5 ZONE A
Thia le an otfl Jai copy of a portion of the above referenced flood map. It
was extracted using F-MIT On-Une. This map does not reflect changes
or amendments which may have been made subsequent to the date on the
fill dock. For the latest product information about National Flood Insurance
Program flood maps check the FEMA Flood Map Store at www.msc.fema.gov
1
II
(I APPROXIMATE SCALE IN FEET
1000 0 1000
NATIONAL FLOOD INSURANCE PROGRAM
3
FIRM
FLOOD INSURANCE RATE MAP
MASON COUNTY,
WASHINGTON
(UNINCORPORATED AREAS)
PANEL 190 OF 300
(SEE MAP INDEX FOR PANELS NOT PRINTED)
i
COMMUNITY-PANEL NUMBER
530115 0190 C
EFFECTIVE DATE:
MAY 17,1988
ZONE C
i
Federal Emergency Management Agency
This is an official copy of a portion of the aboe referenced flood map. It
was extracted using F-MIT On-line. Ttus map does not reflect changes
or amendments which may have been made subsequent to the date on the
title dock. For the latest product information about National Flood Insurance
10 Program flood maps check the FEMA Flood Map Store at www.msc.fema.gov
ZO N E N1/ \ i
` APPROXIMATE SCALE IN FEET
1000 0 1000
i
NATIONAL FLOOD INSURANCE PROGRAM
ZONE A \
FIRM
a D 2 FLOOD INSURANCE RATE MAP
TURTLE LAKE
MASON COUNTY,
WASHINGTON
(UNINCORPORATED AREAS)
PANEL 190 OF 300
(SEE MAP INDEX FOP PANELS NOT PAINTED)
ZONE C
I
COMMUNITY-PANEL NUMBER
O 530115 0190 C
EFFECTIVE DATE:
O MAY 17,1988
II
S H E LTO N I Federal Emergency Dlanagemen[Agency
AIRPORT This ra d copy of a portion of the atoms¢referenced flood map. ita
was extracteded using F-Mff On-line, This map does not reflect changes
or amendments which may haw been made subsequent to the date on the
title block. For the latest product information about National Flood Insurance
>. Program flood maps check the FEMA Flood Map Store at www.msc.fema.gov
I
LAKE
ZONE C rL�J
APPROXIMATE SCALE IN FEET
j 1000 0 1000
OO NATIONAL FLOOD INSURANCE PROGRAM
0
FIRM
26I1tE=. FLOOD INSURANCE RATE MAP
ON
RT MASON COUNTY,
WASHINGTON
(UNINCORPORATED AREAS)
12 � -
`ZONE a
PANEL 190 OF 300
(SEE MAP INDEX FOR PANELS NOT PRINTED)
— J
ZONE A
COMMUNITY-PANEL NUMBER
530115 0190 C
I
EFFECTIVE DATE:
ZONE MAY 17, 1988
Federal Emergency Management Agency
LLJ
� � J
=amendmenfts
lal copy of a portion of the above referenced flood map. tt
Q using F-MIT On-line. This map does not reflect changes
s which may haae been made subsequent to the date on the
Cit n fr the latest product information about National Flood Insurance
a Y t maps check the FEMA Flood Map Store at w .msatema.gov
Mason County Map Output Page Page 1 of 1
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http://mapniason.co.niason.wa.us/servlet/coni.esri.esi-imap.Esrimap?ServiceName=amason... 5/23/2011
= NOTICE OF INTENT NOI
( ) Check if applicable:
APPLICATION FORM
❑ Change or Update Permit Information
DEPARTMENT OF Construction Stormwater General ❑ Modification of Permit Coverage
ECOLOGY Permit Permit#WAR
State of Washington
Please print or type all sections of this application. All fields are required unless otherwise marked.
I. Operator/Permittee(Party with operational control over plans and specifications or day-to-day operational control of activities
which ensure compliance with Stormwater Pollution Prevention Plan (SWPPP) and permit conditions. Ecology will send
correspondence and permit fee invoices to the permittee on record.
Name: City of Shelton Company: City of Shelton
Business Phone: Ext. Unified Business Identifier(UBI): XXX-XXX-XXX
360 432-5167 (UBI is a nine-digit number used to identify a business entity.
Cell Phone(Optional): Fax(Optional): Write "none"if you do not have a UBI number.)
E-mail:dennis@ci.shelton.wa.us 6D/,2 7 7
Mailing Address: City: State: Zip+4:
525 W Cota St. Shelton � WA 98584-t-
Il. Property Owner(The party listed on the County Assessor's records as owner and taxpayer of the parcel[s]for which permit
coverage is requested. Ecology will not send correspondence and permit fee invoices to the Property Owner. The Property Owner
information will be used for emergency contact ur oses.
Name: XXXXX Company(if applicable):
Business Phone: Ext. Unified Business Identifier(UBI):
Cell Phone (Optional): Fax(Optional): (UBI is a nine-digit number used to identify a business entity.
Write "none"if you do not have a UBI number.)
E-mail:
Mailing Address: City: State: Zip+4:
III. On-site Contact Person (Typically the Certified Erosion & Sediment Control Lead or 0 erator/Permittee
Name: Dennis McDonald, Regional Project Manager Company: City of Shelton
Business Phone: Ext. Mailing Address:
360 432-5167 525 W Cota St.
Cell Phone (Optional) City: TState: Zip+4:
Fax(Optional): Shelton 98584t
E-mail:dennis@ci.shelton.wa.us
IV. WebDMR Electronic Discharge Monitoring Reporting)
You must submit monthly discharge monitoring reports using Ecology's WebDMR system. To sign up for WebDMR, or to
register a new site, go to www.ecy.wa.gov/stormwater, and click on the"Construction Stormwater" link. You will find information on
WebDMR under the"WebDMR and PARIS" link on the right-hand side. If you are unable to submit your DMRs electronically, you
may contact Ecology to request a waiver. Ecology will generally only grant waiver requests to those permittees without internet
access. Only a permittee or representative, designated in writing, may request access to or a waiver from WebDMR. To have the
ability to use the system immediately, you must submit the Electronic Signature Agreement with your application. If you have
questions on this process, contact Ecology's WebDMR staff at WebDMR ec .wa. ov or 360-407-7097.
ECY 020-85(Rev.03/11) 1
r
V. Site Information
Site or Project Name Site Acreage '
Dayton Airport Road Water Expansion Project Total size of your site/project(that you own/control): 38 acres. 44
Street Address or Location Description (If the site lacks a
street address, list its specific location. For example, Total area of soil disturbance(grading and/or excavating)for your
Intersection of Highway 61 and 34.) site/project over the life of the project: 2 acres. (Note: 1 acre=
43,560 W.)
Dayton Airport Road,Shelton Springs Road. US101
Concrete/Engineered Soils
Parcel ID#: (Optional) How many yards of concrete will be poured over the life of the
project? 50 yd3(estimate
Type of Construction Activity(check all that apply):
❑ Residential How many yards of recycled concrete will be used over the life of
❑ Commercial the project? 0 yd3(estimate)
❑ Industrial
❑ Highway or Road (city,county,state) Will any engineered soils be used?(For example:cement treated
® Utilities(specify):Water base,cement kiln dust,etc.)
❑ Other(specify): ❑Yes ® No
City(or nearest city): Shelton Zip Code: Estimated project start-up date(mm/dd/yy):XXXXX
County: Mason 98584 Estimated project completion date(mm/dd/yy):XXXXX
Record the latitude and longitude of the main entrance to the site or the approximate center of site.
Latitude:XXXXX ON Longitude: XXXXX °W
For assistance with latitude and longitude, refer to any of the following websites:www.getiatlon.com or
http://www.woridatlas.com/aatlas/imageg.htm. Please convert all latitude and longitude coordinates into decimal degrees format. For
help with this process, go to:http./lwww.fcc.govlmblaudiolbickel/DDDMMSS-decimal.html.
VI. Existing Site Conditions
1. Are you aware of contaminated soils present on the site? ❑Yes ® No
2. Are you aware of groundwater contamination located within the site boundary? ❑Yes ® No
3. If you answered yes to questions 1 or 2, will any contaminated soils be disturbed or will any contaminated groundwater be
discharged due to the proposed construction activity? ❑Yes ® No
["Contaminated"and "contamination" here mean containing any hazardous substance(as defined in WAC 173-340-200)that does not
occur naturally or occurs at greater than natural background levels.]
If you answered yes to Question 3, please explain below or on a separate paper in detail the locations,contaminants, and
concentrations, and pollution prevention and/or treatment BMPs proposed to control the discharge of soil/groundwater contaminants.
Ecology may request a copy of your SWPPP. N/A
VII. Stormwater Pollution Prevention Plan SWPPP
You must develop a SWPPP prior to starting construction. Do not submit your SWPPP with your application.The exception is that
Ecology may request a copy ofyour SWPPP if you answered yes to the questions in Part VI.
ECY 020-85(Rev.03/11) 2
Vill. Best Management Practices BMPs
You must use the BMPs listed in the Stormwater Management Manual for Western Washington or the Stormwater Management
Manual for Eastern Washington or other manuals approved by Ecology. Alternatively,you may use demonstrably equivalent BMPs ` 4
on the basis of permit condition S9.C.4. If you intend to use a BMP at your site that is not included in these manuals, but that you
believe meets the definition of a demonstrably equivalent BMP,you must notify the appropriate regional office. (See Definitions in the
Construction Stormwater General Permit).*
http://www.ecy.wa.gov/prop rams/wq/stormwater/construction/contacts.htmi
*Note that if you receive permit coverage without indicating the preference for a demonstrably equivalent BMP and later decide to use one,you
must provide Ecology with notice of the selection of an equivalent BMP no less than 60 days before the intended use of the equivalent BMP.
IX. Discharge/Receiving Discharge/Receiving Water Information
Indicate whether your site's stormwater and/or dewatering water could enter surface waters, directly and/or indirectly:
® Water will discharge directly or indirectly(through a storm drain system or roadside ditch)into one or more surface waterbodies
(wetlands,creeks, lakes, and all other surface waters and water courses).
If your discharge is to a storm sewer system, provide the name of the operator of the storm sewer system:
(e.g., City of Tacoma): Goldsborough Creek,Turtle Lake
(NOTE: If your stormwater discharges to a storm sewer system operated by the City of Seattle, King County, Snohomish
County, City of Tacoma, Pierce County,or Clark County,you must also submit a copy of this NOI to the appropriate
jurisdiction.)
❑ Water will discharge to ground with 100%infiltration, with no potential to reach surface waters under any conditions.
If your project includes dewatering, you must include dewatering plans and discharge locations in your site Stormwater Pollution
Prevention Plan.
Location of Discharge into Surface Waterbody
Enter the waterbody name and latitude/longitude of the point(s)where the site has the potential to discharge into a waterbody(enter
all locations).
• Include the names and locations of both direct and indirect discharges to surface waterbodies,even if the risk of discharge is
low or limited to periods of extreme weather.
• Some large construction projects(for example,subdivisions, roads,or pipelines) may discharge into several waterbodies.
• If the creek or tributary is unnamed, use a format such as"unnamed tributary to Deschutes River."
• Attach a separate list if necessary.
Surface Waterbody Name Latitude Longitude
Decimal Degrees Decimal Degrees
Goldsborough Creek XXXXX° N XXXXX°W
Turtle Lake XXXXX° N XXXXX°W
° N °W
° N °W
If your site discharges to a waterbody that is on the impaired waterbodies list(i.e.,303(d]list)for turbidity, fine sediment, high pH,or phosphorus,
Ecology will require additional documentation before issuing permit coverage and these sites will be subject to additional sampling and numeric
effluent limits(per Permit Condition S8). Ecology will notify you if any additional sampling requirements apply.Information on impaired waterbodies is
available online at:http.//www.ecy.wa.gov/programs/wp/stormwater/constructionrimpaired.html.
ECY 020-85(Rev.03/11) 3
X. State Environmental Policy Act(SEPA) '``
This Notice of Intent(NOI) is incomplete and cannot be approved until the applicable SEPA requirements under Chapter 1'97=17V
WAC are met.
Who is the SEPA lead agency on your site?XXXXX 4#5' tJ
Has the SEPA lead agency issued a final decision on your checklist? []No ❑Yes ❑ Exempt*
If No: The NOI is incomplete. Ecology will hold the application until a final SEPA decision is made or the Construction
Stormwater NOI public comment period ends, whichever is later. You must notify Ecology once the lead agency has issued
a determination.
If Yes: Type of SEPA decision issued: ❑ Determination of Non-Significance(DNS) ❑ Mitigated DNS(MDNS) ❑
Determination of Significance(DS) ❑ Final Environmental Impact Statement(EIS) ❑ Other:
• Date of final SEPA decision: XXXXX
• If a supplemental EIS, SEPA addendum, or some other type of additional SEPA review was required, please attach
and submit with this form.
• Date when all SEPA-related comment&appeal periods are exhausted:
*If Exempt: Attach written documentation, check type of exemption below, and proceed to Section VII.
❑ Watershed Restoration & Fish Habitat Enhancement Exemption (RCW 43.21C.0382).
❑ Infill Development Exemption(RCW 43.21 C.229).
❑ Planned Action Exemption (RCW 43.21 C.031).
❑ Categorical Exemption. Under what section of the SEPA Rule(WAC 197-11-800) is it exempt? (for
example, WAC 197-11-800(1) Minor New Construction)
More SEPA information is available at:hftp://www.ecy.wa.gov/programs/sea/sepa/e-review.html.
XI. Public Notice
You must publish a public notice at least once a week for two consecutive weeks with seven days between publications, in at least a
single newspaper of general circulation in the county in which the construction is to take place. Ecology cannot grant permit
coverage sooner than the end of the 30-day public comment period, which begins on the date of the second public notice.
Mail or fax(360-407-6426)the NOI to Ecology on or before the first public notice date. If you fax the public notice to Ecology, you
must also mail a hard copy. Failure to do so may delay the issuance of your permit.
Provide the exact dates(mm/dd/yy)that the first and second public notices will appear in the newspaper(s):
First notice: XX/XX/XXXX
Second notice: XX/XX/XXXX (Begins 30-day public comment period.)
For example: First notice: 01/01/10
Second notice: 01/08/10
Name of the newspaper(s) publishing the notices: Shelton-Mason County Journal
ECY 020-85(Rev.03/11) 4
PUBLIC NOTICE TEMPLATE r ,
Complete this template using project-specific information and submit to a local newspaper with general circulation within the cout{ty
where the project is located. The bold language is required by WAC 173-226-130 and must be included in its entirety. (Either use
the fill-in template below or attach on a separate sheet of paper, if necessary.)
(Note: This section is unprotected so you can delete text in parentheses)
City of Shelton, 525 W Cota Street, Shelton WA 98584 is seeking coverage under the Washington State
Department of Ecology's Construction Stormwater NPDES and State Waste Discharge General Permit.
The proposed project, Dayton-Airport Road Water Expansion is located at Shelton Springs Road, US101, and
Dayton Airport Road near Shelton, in Mason County.
This project involves 2 acres of soil disturbance for watermain construction activities.
Stormwater will be discharged to Goldsborough Creek and Turtle Lake.
Any persons desiring to present their views to the Washington State Department of Ecology regarding this application, or
interested in Ecology's action on this application, may notify Ecology in writing no later than 30 days of the last date of
publication of this notice. Ecology reviews public comments and considers whether discharges from this project would
cause a measurable change in receiving water quality, and, if so, whether the project is necessary and in the overriding
public interest according to Tier II antidegradation requirements under WAC 173.201A-320.
Comments can be submitted to:
Department of Ecology
Attn: Water Quality Program, Construction Stormwater
P.O. Box 47696, Olympia, WA 98504-7696
XII. Certification of Permittees
"1 certify under penalty of law that this document and all attachments were prepared under my direction or supervision in accordance
with a system designed to assure that qualified personnel properly gather and evaluate the information submitted. Based on my
inquiry of the person or persons who manage the system or those directly responsible for gathering the information, the information
submitted is, to the best of my knowledge and belief, true, accurate, and complete. I am aware that there are significant penalties for
submitting false information, including the possibility of fine and imprisonment for knowing violations."
Printed Name/Company(operator/permittee only) Title
Signature of Operator/Permittee Date
* Federal regulations require this application is signed by one of the following:
A. For a corporation: By a principal executive officer of at least the level of vice president.
B. For a partnership or sole proprietorship: By a general partner or the proprietor, respectively.
C. For a municipality, state,federal, or other public facility: By either a principal executive officer or ranking elected official.
Please sign and return this document to the following address:
Washington Department of Ecology- Stormwater
P.O. Box 47696
Olympia, WA 98504-7696
ECY 020-85(Rev.03/11) 5