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HomeMy WebLinkAboutSHX2024-00020 Replace Float - SHX Application - 5/15/2024 RECE"RECEIVED VER ECE IVED �� , MASON COUNTY �'[ MAY 1 5 2024 kiW COMMUNITY SERVICES \ Building,Planning,Environmental Health,Community Health 6�`5 W. Mar S 615 W.Alder St.—Bldg.8,Shelton,Wa 98584 Phone:(360)427-9670 ext.352 ♦ Fax:(360)427-7798 PERMIT NO.: V�X gD�`'f SHORELINE PERMIT APPLICATION SHORELINE PERMITS CONDITIONAL USE* SUBSTANTIAL DEVELOPMENT VARIANCE* EXEMPTION ACCESSORY DWELLING UNIT* The Washington State Shoreline Management Act(RCW 90.58) requires that substantial developments within designated shorelines of the state comply with its administrative procedures (WAC 173-14) and the provisions of the Mason County Shoreline Management Master Program. The purpose of this Act and local program is to protect the state's shoreline resources. The program requires that substantial development (any development of which the total cost or fair market value exceeds $7,047.00 or materially interferes with the normal public use of the water or shorelines of the State be reviewed with the goals, polices, and performance standards established in the Master Program. Answer all questions completely. Attach any additional information that may further describe the proposed development. Incomplete applications will be returned. "Shoreline Variances and Conditional uses require public hearings and have additional pages that shall be attached to this application. APPLICANT: North Forty Lodging,LLC(DBA:Alderbrook Resort and Spa)Go Shaun Tucker ADDRESS: 10 E.Alderbrook Drive (street) Union WA 98592 (city) (state) (zip) TELEPHONE: 360-898-2252 (home) (business) AUTHORIZED REPRESENTATIVE: Raquel Corniuk(Marine Surveys&Assessments) ADDRESS: 2601 Washington Street (street) Port Townsend WA 98368 (city) (state) (zip) TELEPHONE: 360-385-4073 PROPERTY DESCRIPTION.- General location (include property address, water body and associated wetlands—identify the name of the shoreline): Rev. Nov. 30, 2021 The Alderbrook Resort is located at 10 E. Alderbrook Drive, Union, WA 98592 within the lower Hood Canal. The National Wetlands Inventory shows the shoreline to be listed as Estuarine and Marine Wetland (E2AB/USN). Waterward along the project site is Estuarine and Marine Deepwater (E1 UBL). Include all parcel numbers: Projects located in open water areas, away from land shall provide latitude/longitude. The parcel number is 322335100023 and the open water work would occur at 47.349431 N lat/ -123.068036 W long. OWNERSHIP: Contract fy) Applicant � Owner Lessee T (identify) Other Owner: Same as above. The project is on Department of Natural Resources (DNR) managed aquatic lands. Lease # is 20-009885. (street) (city) (state) (zip) DEVELOPMENT DESCRIPTON: Development proposal (identify and describe the proposed project, including the type of materials to be used, construction methods, principle dimensions, and other pertinent information): The proposed project is to replace an existing solid 8'x 24'float in the same footprint with a grated 8'x 24'float on the west side of the walkway. An existing 18'x 24'existing solid float on the west side of the walkway will also be replaced in the same footprint with a grated float measuring 18' x 32'.To offset the increase in the replacement float's size,a 8'x 24'solid float will be permanently removed from the east side of the walkway. No other floats will be replaced.There will be no pile work. Existing Use (identify current use of property with exist improvements): The Alderbrook Resort and Spa contains the main property building and 16 cottages that are in good condition. There is an existing walkway "T-shape" float that extends over the tidelands into the Hood Canal. Along the east and west sides of the walkway float there are seven floats utilized for recreational activities and the remaining portions of the float are utilized for docking marine vessels. Reason for requesting development: The purpose of this project is to replace old components in order to keep the facility safe and usable for its patrons to enjoy recreational, water dependent activities and to bring these floats into compliance with current design standards. Estimated Fair Market Value of Project to Closest$1,000: $63,000 The Applicant shall provide, at a minimum, the following information: a. SITE PLAN -drawn to scale and including: i. The boundary of the parcel(s)of land upon which the development is proposed; ii. The ordinary high water mark (OHWM). This may be an approximate location provided, that for any development where a determination of consistency with the applicable regulations requires a precise location of the OHWM the mark shall be located precisely and the biological and hydrological basis for the location as indicated on the plans shall be included in the development plan.Where the OHWM is neither adjacent to or within the boundary of the project, the plan shall indicate the distance and direction to the nearest OHWM of a shoreline; iii. Where appropriate, the proposed land contours using five-foot intervals in water area and ten-foot intervals on areas landward of OHWM, if development involves grading, cutting, filling, or other alteration of land contours; iv. The dimensions and location of existing structures which will be maintained; v. The dimensions and locations of proposed structures; parking and landscaping; vi. The location of proposed utilities, such as sewer, septic tanks and drain fields, water, gas and electricity; vii.The location, source, composition, and volume of fill material; viii. The location, composition and volume of any extracted materials, and proposed disposal area; b. CROSS SECTION, drawn to scale including: i. The existing ground elevations; ii. The proposed ground elevations; iii. The location and height of existing structures; iv. The location and height of proposed structures; V. The OHWM. c. VICINITY MAP, including: i. The location of subject parcel using natural points of reference(roads, state highways, prominent landmarks, etc.). ii. If the development involves the removal of any soils by dredging or otherwise, identify the proposed disposal site on the map. If disposal site is beyond the confines of the vicinity map, provide another vicinity map showing the precise location of the disposal site and its distance to nearest city or town. iii. On the map, or separately, give a brief narrative description of the vicinity of the proposed project including identification of the adjacent uses, structures and improvements, intensity of development and physical characteristics. d. ADJACENT LANDOWNERS. Provide names and mailing addresses of all real property owners within 300 feet of property line boundaries where development is proposed as mailing labels or pre-addressed envelopes. ACKOWLEDGEMENT: I hereby declare, to the best of my knowledge and belief, the forgoing information and all attached information is true and correct. Digaslly signed by:Raquel Comiuk Raquel Corniuk DN CN=Raquel Cormuk email=mquel@msaenirmn mal.comC=AD 4/26/2024 Data 2024.04.26 12.13-.56-08'00' (Applicant or Authorized Representative) (date) Publication Cost Agreement Publication cost is the responsibility of the applicant. Final permit processing will not occur until advertising fees have been paid to the newspaper by the applicant. The Shelton-Mason County Journal will bill the applicant directly. Billing Address: North Forty Lodging LLC dba Alderbrook Resort&Spa Email: accounting@alderbrookresort.com PO Box 609 Union,WA 98592 Phone: 360-898-5506 1 / WE understand that I / WE must sign and date the attached acknowledgment indicating and that I / WE understand that is MY / OUR responsibility. I / WE must submit the signed page as part of application in order for it to be considered as complete. ti i� 5-7-24 Shaun Tucker, Authorized Agent Signature of Property Owner Date Print Name OR Signature of Applicant Date Print Name • RECEIVED Q ; AGENCY USE O M ; �Y 15 2024 WASHINGTON STATE oUS fEn�ers Date received: '°� yn� 615 W. Alder Stle4t Joint Aquatic Resources Permit ; Agency reference#: 5t1XaDa�}-Oo�a© Application (DARPA) Form'�2 � ' I I 1 1 USE BLACK OR BLUE INK TO ENTER ANSWERS IN THE WHITE SPACES BELOW. Tax Parcel#(s): 3,;L a 33-51 -0 00,),3 1 1 1 1 1 1 I ' -------------' Part 1—Project Identification 1. Project Name (A name for your project that you create. Examples: Smith's Dock or Seabrook Lane Development) h[ elm Alderbrook Float Replacement Part 2—Applicant The person and/or organization responsible for the project. [help] 2a. Name(Last, First, Middle) Tucker, Shaun 21b. Organization (If applicable) North Forty Lodging, LLC (DBA: Alderbrook Resort and Spa) 2c. Mailing Address (Street or PO Box) 10 East Alderbrook Drive 2d. City, State, Zip Union, WA 98592 2e. Phone(1) 2f. Phone(2) 2g. Fax 2h. E-mail 360-898-2252 Shaun.tucker@alderbrookresort.com 'Additional forms may be required for the following permits: • If your project may qualify for Department of the Army authorization through a Regional General Permit(RGP),contact the U.S.Army Corps of Engineers for application information(206)764-3495. • Not all cities and counties accept the JARPA for their local Shoreline permits.If you need a Shoreline permit,contact the appropriate city or county government to make sure they accept the JARPA. 2To access an online JARPA form with[help]screens,go to http://www.epermifting.wa.gov/site/alias resourcecenter/lama iarpa form/9984/iarpa form.aspx. For other help,contact the Governor's Office for Regulatory Innovation and Assistance at(800)917-0043 or help(a.oria.wa.gov. ORIA-revised 11/2023 Page 1 of 13 Part 3—Authorized Agent or Contact Person authorized to represent the applicant about the project. (Note: Authorized agent(s) must sign 11 b of this application.) [help] 3a. Name (Last, First, Middle) Corniuk, Raquel 3b. Organization (If applicable) Marine Surveys &Assessments 3c. Mailing Address (Street or PO Box) 2601 Washington Street 3d. City, State, Zip Port Townsend, WA 98368 3e. Phone(1) 3f. Phone(2) 3g. Fax 3h. E-mail 360-385-4073 raquel@msaenvironmental.com Part 4—Property Owner(s) Contact information for people or organizations owning the property(ies) where the project will occur. Consider both upland and aquatic ownership because the upland owners may not own the adjacent aquatic land. of eld x Same as applicant. (Skip to Part 5.) ❑ Repair or maintenance activities on existing rights-of-way or easements. (Skip to Part 5.) ❑ There are multiple upland property owners. Complete the section below and fill out JARPA Attachment A for each additional property owner. x Your project is on Department of Natural Resources (DNR)-managed aquatic lands. If you don't know, contact the DNR at (360) 902-1100 to determine aquatic land ownership. If yes, complete JARPA Attachment E to apply for the Aquatic Use Authorization. 4a. Name(Last, First, Middle) 4b. Organization (If applicable) 4c. Mailing Address (Street or PO Box) 4d. City, State, Zip 4e. Phone(1) 4f. Phone(2) 4g. Fax 41h. E-mail ORIA-revised 1112023 Page 2 of 13 Part 5—Project Location(s) Identifying information about the property or properties where the project will occur. hel ❑ There are multiple project locations (e.g. linear projects). Complete the section below and use JARPA Attachment B for each additional project location. 5a. Indicate the type of ownership of the property. (Check all that apply.) h� e x Private ❑ Federal ❑ Publicly owned (state,county, city,special districts like schools, ports,etc.) ❑ Tribal x Department of Natural Resources (DNR)—managed aquatic lands (Complete JARPA Attachment E) DNR lease#: 20-CO9885 51b. Street Address (Cannot be a PO Box. If there is no address,provide other location information in 5p.) [help] 10 East Alderbrook Drive 5c. City, State, Zip(If the project is not in a city or town,provide the name of the nearest city or town.) hf elpl Union, WA 98592 5d. County hf eM Mason 5e. Provide the section, township, and range for the project location. hf elpl 1/4 Section Section Township Range 33 22N 3W 5f. Provide the latitude and longitude of the project location. hf gipl • Example:47.03922 N lat./-122.89142 W long. (Use decimal degrees-NAD 83) 47.349431 N lat. /-123.068036 W long. 5g. List the tax parcel number(s)for the project location. hel • The local county assessor's office can provide this information. 322335100023 5h. Contact information for all adjoining property owners. (if you need more space, use JARPA Attachment C.) he( ei ) Name Mailing Address Tax Parcel#(if known) Raikes, Jeffery S & Patricia 7201 E State Route 106 McGinnis 322335000015 Union, WA 98592 Watermark Estate Management 6999 E State Route 106 Site M Services LLC -- 322335000012 Union, WA 98592 North Forty Lodging, LLC P.O. Box 609 ------- ------ 322335000014 Union, WA 98592 ORIA-revised 1112023 Page 3 of 13 5i. List all wetlands on or adjacent to the project location. h( eV The National Wetlands Inventory shows the area along the shoreline to be listed as Estuarine and Marine Wetland (E2AB/USN). Waterward in the area of the proposed float replacement is Estuarine and Marine Deepwater (E1 UBL). �g WE,� . � 71 5j. List all waterbodies (other than wetlands) on or adjacent to the project location. Lbpjpj lower Hood Canal 5k. Is any part of the project area within a 100-year floodplain? hel x Yes ❑ No ❑ Don't know Zone AE (EL 14 ft) 51. Briefly describe the vegetation and habitat conditions on the property. LtLeV The Department of Natural Resources (DNR) has not surveyed the project area as a part of their Submerged Vegetation Monitoring Program. The nearest eelgrass (Zostera marina) presence documented by the WDNR Submerged Vegetation Monitoring Program is located approximately 1.7 miles northeast of the project site, along the shoreline of NE North Shore Rd in the Hood Canal, outside of the action area. In September 2020, Marine Surveys &Assessments completed dive surveys around the two docks immediately west and transects that covered the area waterward of the west end of the Alderbrook floating docks showed no eelgrass, kelp, or any other submerged aquatic vegetation. Patchy areas of Zostera marina eelgrass were documented further west approximately 400-500 ft from shore. 5m. Describe how the property is currently used. he► The Alderbrook Resort and Spa is utilized as a luxury hotel that contains 77 rooms and 16 separate cottages east of the main building. 5n. Describe how the adjacent properties are currently used. !eI The adjacent properties are residential parcels. ORIA-revised 1112023 Page 4 of 13 5o. Describe the structures (above and below ground) on the property, including their purpose(s) and current condition. [help] The Alderbrook Resort and Spa contains the main property and 16 cottages that are in good condition. There is an existing walkway T-shape floating walkway that extends over the tidelands into the Hood Canal. Along the east and west sides of the walkway float there are seven floats utilized for recreational activities and the remaining portions of the float are utilized for docking marine vessels. 5p. Provide driving directions from the closest highway to the project location, and attach a map. hip] Heading south on US-101 S, turn left onto WA-106 E, turn right onto E McReavy Rd, turn left onto E Dalby Rd, turn right onto WA-106E, then in 331 ft turn left and your designation will be on your right. Union . iF w . Alderbrook Resort Spa �k�kc, i I€iitt"rC' -- ,nzmur enter �i 13 min 1030 North servation Road IR� k�ornish t' J '_ ,, f -$ 0£'tt`:^its' _ _ 1� Part 6-Project Description 6a. Briefly summarize the overall project. You can provide more detail in 6b. [help] The proposed project is to replace an existing solid 8' x 24' float in the same footprint with a grated 8' x 24' float on the west side of the walkway. An existing 18' x 24' existing solid float on the west side of the walkway will also be replaced in the same footprint with a grated float measuring 18' x 32'. To offset the increase in the replacement float's size, a 8' x 24' solid float will be permanently removed from the east side of the walkway. No other floats will be replaced. There will be no pile work. 6b. Describe the purpose of the project and why you want or need to perform it. hf elpl The purpose of this project is to replace old components in order to keep the facility safe and usable for its patrons to enjoy recreational, water dependent activities and to bring these floats into compliance with current design standards. ORIA-revised 11/2023 Page 5 of 13 6c. Indicate the project category. (check all that apply) [tpjPJ x Commercial ❑ Residential ❑ Institutional ❑ Transportation x Recreational x Maintenance ❑ Environmental Enhancement 6d. Indicate the major elements of your project. (Check all that apply) [help] ❑ Aquaculture ❑ Culvert x Float ❑ Retaining Wall ❑ Bank Stabilization ❑ Dam /Weir ❑ Floating Home (upland) ❑ Boat House ❑ Dike/ Levee/Jetty ❑ Geotechnical Survey ❑ Road ❑ Boat Launch ❑ Ditch ❑ Land Clearing ❑ Scientific Measurement Device ❑ Boat Lift ❑ Dock/Pier ❑ Marina/ Moorage ❑ Stairs ❑ Bridge ❑ Dredging ❑ Mining ❑ Stormwater facility ❑ Bulkhead ❑ Fence ❑ Outfall Structure ❑ Swimming Pool ❑ Buoy ❑ Ferry Terminal ❑ Piling/Dolphin ❑ Utility Line ❑ Channel Modification ❑ Fishway ❑ Raft ❑ Other: 6e. Describe how you plan to construct each project element checked in 6d. Include specific construction methods and equipment to be used. h( eM • Identify where each element will occur in relation to the nearest waterbody. • Indicate which activities are within the 100-year floodplain. A barge will be used to access the site where the existing floats will be disconnected and removed. The replacement floats will be floated into place and securely connected using hand tools. The removed floats will be towed back to the contractor's site via barge to be disposed of at an approved upland facility. 6f. What are the anticipated start and end dates for project construction? (MonthNear) hf e!M • If the project will be constructed in phases or stages, use JARPA Attachment D to list the start and end dates of each phase or stage. Start Date: summer of 2024 End Date: winter of 2029 ❑ See JARPA Attachment D 6g. Fair market value of the project, including materials, labor, machine rentals, etc. hf eM $62,626 61h. Will any portion of the project receive federal funding? hl eM • If yes, list each agency providing funds. ❑ Yes x No ❑ Don't know Part 7—Wetlands: Impacts and Mitigation ❑ Check here if there are wetlands or wetland buffers on or adjacent to the project area. (If there are none, skip to Part 8.) hel 7a. Describe how the project has been designed to avoid and minimize adverse impacts to wetlands. hLeM ❑ Not applicable ORIA-revised 11/2023 Page 6 of 13 7b. Will the project impact wetlands? hI eM ❑ Yes ❑ No ❑ Don't know 7c. Will the project impact wetland buffers? LLeip ❑ Yes ❑ No ❑ Don't know 7d. Has a wetland delineation report been prepared? hl eM • If Yes,submit the report, including data sheets,with the JARPA package. ❑ Yes ❑ No 7e. Have the wetlands been rated using the Western Washington or Eastern Washington Wetland Rating System? h(�el ] • If Yes,submit the wetland rating forms and figures with the JARPA package. ❑ Yes ❑ No ❑ Don't know 7f. Have you prepared a mitigation plan to compensate for any adverse impacts to wetlands? h( eM • If Yes, submit the plan with the JARPA package and answer 7g. • If No,or Not applicable,explain below why a mitigation plan should not be required. ❑ Yes ❑ No ❑ Don't know 7g. Summarize what the mitigation plan is meant to accomplish, and describe how a watershed approach was used to design the plan. hel 7h. Use the table below to list the type and rating of each wetland impacted, the extent and duration of the impact, and the type and amount of mitigation proposed. Or if you are submitting a mitigation plan with a similar table, you can state (below)where we can find this information in the plan. h[ eM Activity (fill, Wetland Wetland Impact Duration Proposed Wetland drain, excavate, Name' type and area (sq. of impact' mitigation mitigation area flood, etc.) rating ft. or type' (sq. ft. or category2 Acres) acres) If no official name for the wetland exists,create a unique name(such as"Wetland 1' . The name should be consistent with other project documents, such as a wetland delineation report. 2 Ecology wetland category based on current Western Washington or Eastern Washington Wetland Rating System.Provide the wetland rating forms with the JARPA package. 3 Indicate the days,months or years the wetland will be measurably impacted by the activity.Enter"permanent"if applicable. `Creation C ,Re-establishment/Rehabilitation R ,Enhancement E, Preservation P,Mitigation Bank/In-lieu fee B Page number(s) for similar information in the mitigation plan, if available: 7i. For all filling activities identified in 7h, describe the source and nature of the fill material, the amount in cubic yards that will be used, and how and where it will be placed into the wetland. hf elpl ORIA-revised 1112023 Page 7 of 13 7j. For all excavating activities identified in 7h, describe the excavation method, type and amount of material in cubic yards you will remove, and where the material will be disposed. heel I Part 8—Waterbodies (other than wetlands): Impacts and Mitigation In Part 8, "waterbodies" refers to non-wetland waterbodies. (See Part 7 for information related to wetlands.) Ltpipj x Check here if there are waterbodies on or adjacent to the project area. (If there are none, skip to Part 9.) 8a. Describe how the project is designed to avoid and minimize adverse impacts to the aquatic environment. ht tM ❑ Not applicable The replacement floats will be at least 50% grated and the grating will have a minimum of 60% open area. In-water work windows will be followed. The barge will not ground out at any time. The overall float area will be reduced by 48 sq ft by permanently removing a solid 8' x 24' float to offset the 18' x 32' replacement float. 8b. Will your project impact a waterbody or the area around a waterbody? k x Yes ❑ No 8c. Have you prepared a mitigation plan to compensate for the project's adverse impacts to non-wetland waterbodies? LkU • If Yes,submit the plan with the JARPA package and answer 8d. • If No,or Not applicable,explain below why a mitigation plan should not be required. ❑ Yes x No ❑ Don't know Since this project is maintenance in the same footprint without an overall increase in footprint, no mitigation is proposed at this time. The overall float area will actually be reduced by 48 sq ft by permanently removing a solid 8' x 24' float to offset the 18' x 32' replacement float 8d. Summarize what the mitigation plan is meant to accomplish. Describe how a watershed approach was used to design the plan. • If you already completed 7g you do not need to restate your answer here. hel N/A 8e. Summarize impact(s) to each waterbody in the table below. hf m Activity (clear, Waterbody Impact Duration Amount of material Area (sq. ft. or dredge, fill, pile name' location of impact3 (cubic yards) to be linear ft.) of drive, etc.) placed in or removed waterbody from waterbody directly affected Below Remove West Hood Canal OHWM, in permanent 8' x 24' 192 sq ft Float LSZ overwater Install Below 192 sq ft Replacement Hood Canal OHWM, in permanent 8' x 24' overwater West Float LSZ ORIA-revised 11/2023 Page 8 of 13 Remove West Below Hood Canal OHWM, in permanent 18' x 24' 432 ft Float LSZ overwater Install Below 576 sq ft Replacement Hood Canal OHWM, in permanent 18' x 32' overwater West Float LSZ Below Remove East Hood Canal OHWM, in permanent 8' x 24' overwater Float LSZ 'If no official name for the waterbody exists,create a unique name(such as"Stream 1")The name should be consistent with other documents provided. z Indicate whether the impact will occur in or adjacent to the waterbody. If adjacent,provide the distance between the impact and the waterbody and indicate whether the impact will occur within the 100-year flood plain. 3 Indicate the days,months or years the waterbody will be measurably impacted by the work. Enter"permanent"if applicable 8f. For all activities identified in 8e, describe the source and nature of the fill material, amount (in cubic yards) you will use, and how and where it will be placed into the waterbody. hl elat N/A 8g. For all excavating or dredging activities identified in 8e, describe the method for excavating or dredging, type and amount of material you will remove, and where the material will be disposed. h(�el ] N/A 8h. Have you prepared a Water Quality Monitoring Plan (WQMP)for all in-water work (below ordinary high water), over water work or discharges to waters of the state? ❑ Yes x No If NO describe the monitoring that you will be conducting including parameters, equipment and locations, or explain why monitoring will not be necessary. [help] No water quality issues are anticipated since there will be no pile driving and the barge will operate at a high tide to reduce turbidity. Part 9—Additional Information Any additional information you can provide helps the reviewer(s) understand your project. Complete as much of this section as you can. It is ok if you cannot answer a question. 9a. If you have already worked with any government agencies on this project, list them below. hl elpl Agency Name Contact Name Phone Most Recent Date of Contact 9b. Are any of the wetlands or waterbodies identified in Part 7 or Part 8 of this JARPA on the Washington Department of Ecology's 303(d) List? fheipi • If Yes,list the parameter(s)below. • If you don't know, use Washington Department of Ecology's Water Quality Assessment tools at:https://ecology.wa.gov=ater- Shorel i nes/Water-qua I itv/Water-i m provem ent/Assessme nt-of-state-waters-303d. ❑ Yes x No ORIA-revised 1112023 Page 9 of 13 9c. What U.S. Geological Survey Hydrological Unit Code (HUC) is the project in? hheeli)] • Go to http://cfpub.epa.gov/surf/locate/index.cfm to help identify the HUC. 17110018— Hood Canal 9d. What Water Resource Inventory Area Number (WRIA#) is the project in? h[�el j • Go to https://ecology.wa,gov/Water-Shorelines/Water-supply/Water-availabilityMatershed-look-up to find the WRIA#. WRIA 14— Kennedy/Goldsborough 9e. Will the in-water construction work comply with the State of Washington water quality standards for turbidity? hf elpl • Go to https://ecology.wa.gov/Water-Shorelines/Water-quality/Freshwater/Surface-water-quality-standards/Criteria for the standards. x Yes ❑ No ❑ Not applicable 9f. If the project is within the jurisdiction of the Shoreline Management Act, what is the local shoreline environment designation? hf pM • If you don't know,contact the local planning department. • For more information,go to:https://ecology.wa.gov/Water-Shorelines/Shoreline-coastal-management/Shoreline-coastal- planning/Shoreline-laws-rules-and-cases. ❑ Urban ❑ Natural ❑ Aquatic ❑ Conservancy x Other: Residential 9g. What is the Washington Department of Natural Resources Water Type? hl m • Go to http://www.dnr.wa.gov/forest-practices-water-typing for the Forest Practices Water Typing System. x Shoreline ❑ Fish ❑ Non-Fish Perennial ❑ Non-Fish Seasonal 9h. Will this project be designed to meet the Washington Department of Ecology's most current stormwater manual? LtLel • If No, provide the name of the manual your project is designed to meet. ❑ Yes ❑ No x N/A Name of manual: 9i. Does the project site have known contaminated sediment? heel • If Yes,please describe below. ❑ Yes x No 9j. If you know what the property was used for in the past, describe below. h[ eip] Unknown. ORIA-revised 1112023 Page 10 of 13 9k. Is the project located in or adjacent to a designated state or federal contaminated site or clean-up site. (e.g. MTCA or CERCLA)? [help] • If Yes, provide any additional details below. ❑ Yes x No The nearest cleanup site is the Hood Canal Marina Corp approximately 1.61 miles northeast of the project site. 91. Has a cultural resource (archaeological) survey been performed on the project area? LtLeM • If Yes,attach it to your JARPA package. ❑ Yes x No 9m. Name each species listed under the federal Endangered Species Act that occurs in the vicinity of the project area or might be affected by the proposed work. h( eio Bocaccio Rockfish, Hood Canal Summer-run Chum, Bull Trout, Puget Sound Steelhead, Puget Sound Chinook 9n. Name each species or habitat on the Washington Department of Fish and Wildlife's Priority Habitats and Species List that might be affected by the proposed work. h( elp] Surf smelt spawning habitat, Estuarine and Marine Wetland, and oyster beds along the shoreline. Dungeness crab presence and a purple martin breeding area are in the vicinity of the floating structure. Streams in the project's vicinity are utilized by winter steelhead, fall chum, coho, and resident coastal cutthroat. Part 10—SEPA Compliance and Permits Use the resources and checklist below to identify the permits you are applying for. • Online Project Questionnaire at http://apps.oria.wa.gov/opas/. • Governor's Office for Regulatory Innovation and Assistance at (800) 917-0043 or help(cD_oria.wa.gov. • For a list of addresses to send your JARPA to, click on agency addresses for completed JARPA. 10a. Compliance with the State Environmental Policy Act (SEPA). (Check all that apply.) hl elp] • For more information about SEPA,go to https://ecology.wa.gov/regulations-permits/SEPA-environmental-review. ❑ A copy of the SEPA determination or letter of exemption is included with this application. ❑ A SEPA determination is pending with (lead agency). The expected decision date is ❑ I am applying for a Fish Habitat Enhancement Exemption. (check the box below in 10b.) hel p] X This project is exempt (choose type of exemption below). x Categorical Exemption. Under what section of the SEPA administrative code (WAC) is it exempt? WAC 197-11-800(3) repair, remodeling, and maintenance activities ❑ Other: ❑ SEPA is pre-empted by federal law. 10b. Indicate the permits you are applying for. (Check all that apply.) [tpjpJ LOCAL GOVERNMENT ORIA-revised 11/2023 Page 11 of 13 Local Government Shoreline permits: ❑ Substantial Development ❑ Conditional Use ❑ Variance x Shoreline Exemption Type (explain): MCC 17.50.400 (b) "normal maintenance or repair of existing structure..." Other City/County permits: ❑ Floodplain Development Permit ❑ Critical Areas Ordinance STATE GOVERNMENT Washington Department of Fish and Wildlife: x Hydraulic Project Approval (HPA) ❑ Fish Habitat Enhancement Exemption —Attach Exemption Form Washington Department of Natural Resources: x Aquatic Use Authorization Complete JARPA Attachment E and submit a check for$25 payable to the Washington Department of Natural Resources. Do not send cash. Washington Department of Ecology: x Section 401 Water Quality Certification ❑ Authorization to impact waters of the state, including wetlands (Check this box if the proposed impacts are to waters not subject to the federal Clean Water Act FEDERAL AND TRIBAL GOVERNMENT United States Department of the Army (U.S. Army Corps of Engineers): ❑ Section 404 (discharges into waters of the U.S.) x Section 10 (work in navigable waters) United States Coast Guard: For projects or bridges over waters of the United States,contact the U.S. Coast Guard at: ❑ Bridge Permit: D13-SMB-D13-BRIDGES@uscg.mil ❑ Private Aids to Navigation (or other non-bridge permits): D13-SMB-Dl3-PATON@uscg.mil United States Environmental Protection Agency: ❑ Section 401 Water Quality Certification (discharges into waters of the U.S.) on tribal lands where tribes do not have treatment as a state (TAS) Tribal Permits: (Check with the tribe to see if there are other tribal permits, e.g.,Tribal Environmental Protection Act, Shoreline Permits, Hydraulic Project Permits,or other in addition to CWA Section 401 WQC) ❑ Section 401 Water Quality Certification (discharges into waters of the U.S.) where the tribe has treatment as a state (TAS). ORIA-revised 11/2023 Page 12 of 13 Part 11—Authorizing Signatures Signatures are required before submitting the JARPA package. The JARPA package includes the JARPA form, project plans, photos, etc. (helpl 11a.Applicant Signature (required) h[ el I certify that to the best of my knowledge and belief,the information provided in this application is true, complete, and accurate. I also certify that I have the authority to carry out the proposed activities, and 1 agree to start work only after I have received all necessary permits. hereby authorize the agent named in Part 3 of this application to act on my behalf in matters related to this application. fS4 (initial) By initialing here, I state that I have the authority to grant access to the property. I also give my consent to the permitting agencies entering the property where the project is located to inspect the project site or any work related to the project. 7.(-i-1- (initial) Shaun Tucker, General Manager �jL(� 3-15-24 Applicant Printed Name Applicant Signature Date 11 b.Authorized Agent Signature rhelpl I certify that to the best of my knowledge and belief,the information provided in this application is true, complete, and accurate. I also certify that 1 have the authority to carry out the proposed activities and I agree to start work only after all necessary permits have been issued. Raquel Comiuk(MSA) y ~q-, 2 OLD{ Authorized Agent Printed Name Authorizp Agent Signature Date 11 c. Property Owner Signature (if not applicant) Leio Not required if project is on existing rights-of-way or easements (provide copy of easement with JARPA). I consent to the permitting agencies entering the property where the project is located to inspect the project site or any work. These inspections shall occur at reasonable times and, if practical, with prior notice to the landowner. Shaun Tucker,Authorized Agent 3 15-24 Property Owner Printed Name Property Owner Signature Date 18 U_S.0§1001 provides than Whoever,in any manner within the jurisdiction of any department or agency of the United States knowingly falsifies,conceals,or covers up by any trick,scheme,or device a material fact or makes any false,fictitious,or fraudulent statements or representations or makes or uses any false writing or document knowing same to contain any false,fictitious,or fraudulent statement or entry,shall be fined not more than$10,000,or imprisoned not more than 5 years or both. If you require this document in another format,contact the Governor's Office for Regulatory Innovation and Assistance(ORIA)at(800) 917-0043. People with hearing loss can call 711 for Washington Relay Service.People with a speech disability can call(877)833- 6341. ORIA publication number: ORIA-16-011 rev. 09/2018 ORIA-revised 1112023 Page 13 of 13 ----------------------------------------- Sl AG CYUSEO Y }fir 17 t US Army Corps , Date received: ; ❑ Town C WASHINGTON STATE Sof oatWineers• i oattle Distriq ❑ Application Fee Received; ❑ Fee N/A , Joint Aquatic Resources Permit ❑ New Application; ❑ Renewal Application hel ] Typemrefix#: ;Nature Use Code: Application (JARPA) ; LNI Initials&BP#: RE Assets Finance BP#: ; Attachment E. New Application Number: Trust(s): ;County: , Aquatic Use Authorization on AQR Plate#(s): , t Department of Natural Resources Gov Lot#(S): (DNR)-managed aquatic lands [h.,,] Tax Parcel#(s): =---------------------------------------- Complete this attachment and submit it with the completed JARPA form only if you are applying for an Aquatic Use Authorization with DNR. Call (360) 902-1100 or visit http://www.dnr.wa.gov/programs-and- services/aquatics/leasing-and-land-transactions for more information. • DNR recommends you discuss your proposal with a DNR land manager before applying for regulatory permits. Contact your regional land manager for more information on potential permit and survey requirements. You can find your regional land manager by calling (360) 902-1100 or going to http://www.dnr.wa.gov/programs-and-services/aquatics/ag uatic-districts-and-land-managers-map. [ham] • The applicant may not begin work on DNR-managed aquatic lands until DNR grants an Aquatic Use Authorization. • Include a $25 non-refundable application processing fee, payable to the"Washington Department of Natural Resources." (Contact your Land Manager to determine if and when you are required to pay this fee.) hel DNR may reject the application at any time prior to issuing the applicant an Aquatic Use Authorization. n[hel ] Use black or blue ink to enter answers in whites aces below. 1. Applicant Name (Last, First, Middle) North Forty Lodging LLC (dba: Alderbrook Resort & Spa) 2. Project Name (A name for your project that you create. Examples: Smith's Dock or Seabrook Lane Development)[help] Alderbrook Float Replacement 3. Phone Number and Email eric.sund@alderbrookresort.com, 360-898-2252 4. Which of the following applies to Applicant? Check one and, if applicable,attach the written authority—bylaws, power of attorney,etc.[hel ❑ Corporation ❑ Individual ❑ Limited Partnership ❑ Marital Community (Identify spouse): ❑ General Partnership ® Limited Liability Company ❑ Government Agency Home State of Registration: ❑ Other (Please Explain): Washington JARPA Attachment E Rev. 10/2016 Page 1 of 2 5. Washington UBI (Unified Business Identifier) number, if applicable: [nel 602-145-156 6. Are you aware of any existing or previously expired Aquatic Use Authorizations at the project location? ® Yes ❑ No ❑ Don't know If Yes, Authorization number(s): DNR lease#: 20-CO9885 7. Do you intend to sublease the property to someone else? ❑ Yes ® No If Yes, contact your Land Manager to discuss subleasing. 8. If fill material was used previously on DNR-managed aquatic lands, describe below the type of fill material and the purpose for using it. i,e—i N/A To be completed by DNR and a copy returned to the applicant. Signature for projects on DNR-managed aquatic lands: Applicant must obtain the signature of DNR Aquatics District Manager OR Assistant Division Manager if the project is located on DNR-managed aquatic lands. I, a designated representative of the Dept. of Natural Resources, am aware that the project is being proposed on Dept. of Natural Resources-managed aquatic lands and agree that the applicant or his/her representative may pursue the necessary regulatory permits. My signature does not authorize the use of DNR-managed aquatic lands for this project. Cailan Nealer 4/23/2024 Printed Name Signature Date Dept. of Natural Resources Dept. of Natural Resources District Manager or Assistant Division Manager District Manager or Assistant Division Manager If you require this document in another format, contact the Governor's Office for Regulatory Innovation and Assistance (ORIA) at(800) 917-0043. People with hearing loss can call 711 for Washington Relay Service. People with a speech disability can call 877 833-6341. ORIA Publication ORIA-16-016 rev. 10/2016 JARPA Attachment E Rev. 10/2016 Page 2 of 2