HomeMy WebLinkAboutJARPA - SHX Application - 12/7/2007 t 1
AGENCY USE ONLY JARPA FORM LAST UPDATED:March 19,2007
Agency Reference#: Date Received:
Circulated by: (local govt.or agency)
Project Tracking Number:
Washington State JOINT AQUATIC RESOURCES PERMIT APPLICATION (JARPA) Form
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Step 1: Get Ready Step 2:Complete Form Step 3: Check Work Step 4:Copy and Send In
Go to�N�k%�.epermittinp_ore Use black ink. Use internet"Help" Use final review See JARPA Contacts at
for correct form and Check correct buttons to answer checklist at %�kk Nk.epermitting.org for
instructions. permit boxes. questions completely. kr«w.epermitting org. correct mailing addresses.
❑ Fish Habitat Enhancement Projects per RCW 77.55.181. You must submit copy of completed JARPA form and Fish Habitat
Enhancement JARPA Addition to your Local Government Planning Dep't and WA Dep't of Fish and Wildlife(WDFW)Area Habitat
Biologist on same day. Note for Local Governments: You must submit comments to WDFW within 15 working days.
Based on instructions at www.epermitting.org, I am sending copies of this application to the following: (check all that apply)
X❑Local Government for Shoreline: nSubstantial Development ❑Conditional Use Flyariance ❑Exemption ❑Revision
nFloodplain Management ❑Critical Areas Ordinance
❑Washington Department of Fish and Wildlife for Hydraulic Proiect Approval(Submit 2 copies to WDFW Region)
❑Washington Department of Ecology for 401 Water Quality Certification (to Regional Office-Federal Permit Unit)
❑Washington Department of Natural Resources for Aquatic Resources Use Authorization Notification
X❑Corps of Engineers for: nSection 404 permit FISection 10 permit
❑Coast Guard for: nGeneral Bridqe Act Permit nPrivate Aids to Navigation(for non-bridge projects)
❑For Department of Transportation projects only: This project will be designed to meet conditions of the most current
Ecology/Department of Transportation Water Quality Implementing Agreement
PROJECT TITLE: Carrougher Well Access Road
PROJECT DESCRIPTION: To place an access road and tum-around area from Highway 106 to our well-head.
SECTION A - Use for all permits covered by this application. Be sure to ALSO complete Section C (Signature Block)
for all permit applications.
m 1.APPLICANT John G and Gretchen Carrougher
MAILING ADDRESS
3516 24a'Avenue Court NW
WORK PHONE E-MAIL ADDRESS HOME PHONE FAX#
206-744-286 grarrougher@_comcast.net 253-851-6067 253-851-7684
If an agent is acting for the applicant during the permit process, complete#2. Be sure agent signs Section C(Signature
Block)for all permit applications
m 2.AUTHORIZED AGENT
MAILING ADDRESS
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WORK PHONE E-MAIL ADDRESS HOME PHONE FAX#
3. Relationship of applicant to property: ® OWNER PURCHASER LESSEE
CM 4. Name,address and phone number of property owner(s)if other than applicant:
CO 5. Location (street address, including city, county and zip code,where proposed activity exists or will occur)
7611 East Highway 106 Union,WA 98592
Local government with jurisdiction (city or county) Mason County
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m Waterbody you are working in Hood Canal CMTributary of NA Im WRIA#
jIs this waterbody on the 303(d) List ® YES ❑ NO
If YES,what parameter(s)?
The property on which the access road is to be placed is south of East ®Shoreline designation
Hwy 106.This highway cuts across our property and the access road
is on the opposite side of the highway from Hood Canal.
Zonin designation Residential
%Section Section ownship Range Government Lot
33 22 3 West 1 IM DNR stream type if known NA
Office of Regulatory Assistance,JARPA JARPA FORM LAST UPDATED:March 19.2007 For help call 800-917-0043 or visit www.epermifing.org 1
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M3 Latitude and Longitude: See attached legal description Tax Parcel Number 32233-44-00010
EM 6. Describe(a)the current use of the property, (b)structures existing on the property, and (c)existing environmental conditions.
Have you completed any portion of the proposed activity on this property? ❑ YES ® NO
For any portion of the proposed activity already completed on this property, indicate month and year of completion.
A. Private residence
B. One singe-family home is located on the property. It is a two-story home, approximately 1610 sq ft that was
built in 1953. One shed adjacent to home exists on the property and it is approximately 220 sq ft. A fence
composed of wood, metal, and brick surround the home's perimeter. Extending into Hood Canal is an
existing dock.
C. The property is bordered to the north by Hood Canal (212 feet north to south, and 115 feet east to west) with
Highway 106 passing through it. The western line of the property parallels a non-fish bearing stream. The
well head (requires access for repairs) is located south of the wetlands near the base of a hillside.
Is the property agricultural land? ❑ YES ® NO m Are you a USDA program participant? ❑ YES ® NO
7a. Describe the proposed work that needs aquatic permits: Complete plans and specifications should be provided for all work
waterward of the ordinary high water mark or line, including types of equipment to be used. If applying for a shoreline permit,
describe all work within and beyond 200 feet of the ordinary high water mark. If you have provided attached materials to describe
your project,you still must summarize the proposed work here. Attach a separate sheet if additional space is needed.
The proposed access and turn-around to our well head is needed in order to make repairs to our existing and
only well. The water is deemed contaminated and non-potable due to well dysfunction. The proposed access
road/area is to accommodate trucks that weigh 14,000 pounds and are top-heavy (see attached letter from
Arcadia Drilling, Inc). They require a turn-around/back-up space in order to bring the necessary equipment to the
well head site. In May 2004, we hired Lee Boad to perform a Habitat Management Plan for our property. He
determined that a portion of our property met the wetland indicators for a Category II Wetland in Mason County.
In his report, he provided a recommended water system access to minimize wetland impact. This access
recommendation was to identify the area of least wetland disturbance but did not specify dimensions needed for
heavy equipment access which we have subsequently obtained.
We have attached a drawing that outlines the specifics of the access/turn-around for repair of our well. This
access will be composed of Typar road fabric, 4' to 8" Gubian rock with a top coat of 1.25 rock. Silt fencing will
be installed around the work area with straw on remaining exposed soils to prevent erosion and siltation of
waters. The total amount of wetlands that will be disturbed is less than 1/10 acre (0.048 acres). We estimate
that only 2,112 sq. feet of wetlands will be disturbed for this project.
PREPARATION OF DRAWINGS: See sample drawings and guidance for completing the drawings. ONE SET OF ORIGINAL OR GOOD QUALITY REPRODUCIBLE
DRAWINGS MUST BE ATTACHED. NOTE. Applicants are encouraged to submit photographs of the project site,but these DO NOT substitute for drawings. THE CORPS
OF ENGINEERS AND COAST GUARD REQUIRE DRAWINGS ON 8.112 X 11 INCH SHEETS. LARGER DRAWINGS MAYBE REQUIRED BY OTHER AGENCIES.
m 7b. Describe the purpose of the proposed work and why you want or need to perform it at the site. Please explain any specific needs
that have influenced the design.
The proposed access to our well head is required for repair of our existing well. Currently, we cannot drink or
use the water other than to flush toilets. We have designed the access using the 2004 Habitat Management
Plan. Specifically, we have used the east side of the property for access from Highway 106 that Mr. Boad
suggested. This side of the property (versus the west side) allows for less disturbance of existing wetlands.
7c. Describe the potential impacts to characteristic uses of the water body. These uses may include fish and aquatic life, water
quality,water supply, recreation and aesthetics. Identify proposed actions to avoid, minimize, and mitigate detrimental impacts
and provide proper protection of fish and aquatic life. Identify which guidance documents you have used. Attach a separate
sheet if additional space is needed.
There is a stream on the western side of our property that flows through the wetlands, and then drains under
Highway 106 through an existing culvert. This stream is perennial and non-fish bearing and is a Type 4 Stream
in Mason County. To minimize any negative impact on this stream, we 1) have chosen to place the access on
the eastern side of our property, 2) will use silt fencing around the work area with straw on remaining exposed
soils to prevent erosion and siltation of waters, and 3) will mitigate using riparian plantings along the bulkhead
using native shrubs and plants. The approximate area of mitigation is 360 sq ft (two separate planting beds).
Office of Regulatory Assistance,JARPA JARPA FORM LAST UPDATED: March 19,2007 For help call 800-917-0043 or visit www.epermitting_org 2
To gain access from Highway 106 to our property, we have asked the WSDOT for access (contact person: Larry
Deemer, #360-874-3050). That permit is pending. In accordance with the WSDOT, we will place a culvert in the
ditch that parallels our property. The size of the culvert is 18 inches in diameter by 30 feet in length. The size of
the culvert was determined by our contractor in communication with Mr. Deemer.
IM 7d. For in-water construction work,will your project be in compliance with the State of Washington water quality standards for
turbidity(WAC 173-201A-410)? ® YES ❑ NO Not Applicable
EM 8. Will the project be constructed in stages? ❑ YES ® NO
Proposed starting date: December 30,2007
Estimated duration of activity: January 30 ,2008
m 9. Check if any temporary or permanent structures will be placed: NONE
❑ Waterward of the ordinary high water mark or line for fresh or tidal waters AND/OR
❑ Waterward of the mean higher high water for tidal waters?
m 10. Will fill material(rock,fill, bulkhead,or other material)be placed: NONE
❑ Waterward of the ordinary high water mark or line for fresh waters?
If YES,VOLUME (cubic yards) /AREA (acres)
❑ Waterward of the mean higher high water for tidal waters?
If YES,VOLUME (cubic yards) /AREA (acres)
m 11. Will material be placed in wetlands? ® YES ❑ NO
If YES:
CM A. Impacted area in acres: Less than 1/10 acre(0.048 acres)
m B. Has a delineation been completed? If YES,please submit with application. ® YES ❑ NO
CM C. Has a wetland report been prepared? If YES, please submit with application ® YES ❑ NO
D.Type and composition of fill material (e.g.,sand,etc.) 4"-8"Gubian rock and 1.25 rock
E. Material source: NA per Ms. Romero
F. List all soil series(type of soil)located at the project site,and indicate if they are on the county's list of hydric soils. Soils
information can be obtained from the natural Resources Conservation Service (NRCS).
According to the Habitat Management Plan (Lee Boad report),the soil in the upland portions of our property is Alderwood Gravelly
Sandy loam—a well-drained upland soil. This soil is not on the list of hydric soils. In the wetlands area,soil was identified as
characteristic of Mukilteo peat.This soil qualifies as hydric soil according to the Washington State Wetland Identification and
Delineation Manual(1997).
m G.WILL PROPOSED ACTIVITY CAUSE FLOODING OR DRAINING OF WETLANDS? ® YES ❑ NO
If YES, IMPACTED AREA IS less than 1/10 ACRES OF DRAINED WETLANDS.
NOTE:If your project will impact greater than 1/10 of an acre of wetland,submit a mitigation plan to the Corps and Ecology for approval along with the JARPA form.
NOTE:A 401 water quality certification may be required from Ecology in addition to an approved mitigation plan if your project wetland impacts are greater than 1/10 acre in size.
Please submit the JARPA form and mitigation plan to Ecology for 401 certification review.
m 12. Stormwater Compliance: This project is (or will be)designed to meet ecology's most current
stormwater manual, or an Ecology approved local stormwater manual. ® YES ❑ NO
If YES—Which manual will your project be designed to meet?The stormwater manual for western Washington.
m If NO—For Clean Water Act Section 401 and 404 permits only—Please submit to Ecology for approval,along with this JARPA
application,documentation that demonstrates the stormwater runoff from your project or activity will comply with the water quality
standards,WAC 173-201 A
m 13. Will excavation or dredging be required in water or wetlands? ❑ YES ® NO
If YES:
A. Volume: (cubic yards) /area (acre)
B. Composition of material to be removed:
C. Disposal site for excavated material:
D. Method of dredging:
MM 14. Has the State Environmental Policy Act(SEPA) been completed YES ® NO Emergency permit with Mason Co.
#MEP 2007-00098 has been submitted (Date received 09/29/2007;approval pending;contact person Ryan Crater,#360-427-9670,ext
#577)
SEPA Lead Agency:
SEPA Decision: DNS,MDNS,EIS,Adoption, Exemption Decision Date(end of comment period)
SUBMIT A COPY OF YOUR SEPA DECISION LETTER TO WDFW AS REQUIRED FOR A COMPLETE APPLICATION
Office of Regulatory Assistance,JARPA DARPA FORM LAST UPDATED: March 19.2007 For help call 800-917-0043 or visit www.eoermitting.org 3
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M3 15. List other Applications,approvals or certifications from other federal,state or local agencies for any structures,construction
discharges or other activities described in the application (i.e. preliminary plat approval,health district approval, building permit,
SEPA review,federal energy regulatory commission license(FERC), Forest practices application, etc.). Also, indicate whether
work has been completed and indicate all existing work on drawings. NOTE:For use with Corps Nationwide Permits, identify
whether your project has or will need an NPDES permit for discharging wastewater and/or stormwater.
TYPE OF APPROVAL ISSUING AGENCY IDENTIFICATION DATE OF APPLICATION DATE APPROVED COMPLETED?
NO
Washington Dept of Transportation WSDOT Pending
Mason Co.Dept of Community Development-MEP Mason Co. 0913 007 9/29/2007 Pending
m 16. Has any agency denied approval for the activity you're applying for or for any activity directly related to the activity described
herein?
❑ YES ® NO
If YES,explain:
SECTION B- Use for Shoreline and Corps of Engineers permits only:
IM 17a. Total cost of project. This means the fair market value of the project, including materials, labor,machine rentals,etc.
Unknown at this time.
IM 17b. If a project or any portion of a project receives funding from a federal agency,that agency is responsible for ESA consultation.
Please indicate if you will receive federal funds and what federal agency is providing those funds.
FEDERAL FUNDING ❑ YES ® NO If YES, please list the federal agency.
CM 18. Local government with jurisdiction: Imason County
19. Provide names,addresses and telephone numbers of adjoining property owners, lessees,etc. Please note: Shoreline
Management Compliance may require additional notice— consult your local government.
NAME ADDRESS PHONE NUMBER
Nick Klose Pack Regent#1206 919 1 Oe NE Bellevue,WA 98004 425-646-6051
Jeanne Moore 7556 E.Hwy 106 Union,WA 98592 360-898-2474
Tom Elberson PO Box 96 Union,WA 98592 360-898-1314
SECTION C - This section MUST be completed for any permit covered by this application
m 20. Application is hereby made for a permit or permits to authorize the activities described herein. I certify that I am familiar with the
information contained in this application,and that to the best of my knowledge and belief,such information is true,complete,
and accurate. I further certify that I possess the authority to undertake the proposed activities. I hereby grant to the agencies to
which t application is made,the right to enter the above-described location to inspect the proposed,in-progress or completed
wo a ree to start work ONLY after all necessary permits have been received.
DATE �]
SIG TUR P ICANT �(�) ��I, I /
DATE
SIGNATURE OF AUTHORIZED AGENT
I HEREBY DESIGNATE TO ACT AS MY AGENT IN MATTERS RELATED TO THIS APPLICATION FOR
PERMIT(S). I UNDERSTAND THAT IF A FEDERAL PERMIT IS ISSUED, I MUST SIGN THE PERMIT.
Office of Regulatory Assistance,JARPA ,DARPA FORM LAST UPDATED: March 19,2007 For help call 800-917-0043 or visit www.epermitting_org 4
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SIGNATURE OF APPLICANT DATE
SIGNATURE OF LANDOWNER (EXCEPT PUBLIC ENTITY LANDOWNERS, E.G. DNR)
THIS APPLICATION MUST BE SIGNED BY THE APPLICANT AND THE AGENT, IF AN AUTHORIZED AGENT IS DESIGNATED.
18 U.S.0 §1001 provides that: Whoever, in any manner within the jurisdiction of any department or agency of the United States knowingly
falsifies, conceals,or covers up by any trick, scheme,or device a material fact or makes any false,fictitious, or fraudulent statements or
representations or makes or uses any false writing or document knowing same to contain any false,fictitious, or fraudulent statement or
entry, shall be fined not more than $10,000 or imprisoned not more than 5 years or both.
COMPLETED BY LOCAL OFFICIAL
A. Nature of the existing shoreline. (Describe type of shoreline,such as marine, stream, lake, lagoon, marsh, bog, swamp,flood
plain,floodway,delta;type of beach, such as accretion, erosion, high bank, low bank,or dike; material such as sand,gravel, mud,clay,
rock, riprap; and extent and type of bulkheading, if any)
B. In the event that any of the proposed buildings or structures will exceed a height of thirty-five feet above the average grade level,
indicate the approximate location of and number of residential units,existing and potential,that will have an obstructed view:
C. If the application involves a conditional use or variance, set forth in full that portion of the master program which provides that the
proposed use may be a conditional use,or, in the case of a variance,from which the variance is being sought:
These Agencies are Equal Opportunity and Affirmative Action employers.
For special accommodation needs, please contact the appropriate agency in the instructions
Office of Regulatory Assistance,DARPA JARPA FORM LAST UPDATED: March 19,2007 For help call 800-917-0043 or visit www.epermitting.org 5
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