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DNR SEPA Surface Mining - SEP Determinations - 11/1/2004
WASHINGTON STATE DEPARTMENTOF �-3 f� _ 1�y,r,�O DOUG SUTHERLAND Natural Resources I C6 Commissioner of Public Lands v 1 November 2004 TO BE KEPTi RECEIVED RICHARD MEDEIROS �N T,-iL NOY 0 3 2004 NE2481 OLD BELFAIR HIGHWAY PA RG EL r-ILL c BELFAIR, WA 98528 MCCD - PLANNING RE: SEPA FOR SURFACE MINE RECLAMATION PERMIT #70-012066 (BELFAIR SAND & GRAVEL) Dear Mr. Medeiros: Thank you for the letters regarding the reclamation at the Department of Natural Resources (DNR) Surface Mine Reclamation Permit mentioned above located in a portion of Section 17, Township 23 North, Range 1 West, W.M., Mason County, Washington. The permit holder for Belfair Sand and Gravel is currently working on reclaiming their site. The DNR will ensure that the old tank and stockpile of tires will be removed from the site before terminating the permit. If you have any questions regarding this letter, please contact me in the Geology and Earth Resources Office at (360) 902-2133. Sincerely, G64' j- -- S- j Carol Serdar Surface Mine Reclamation Specialist Enclosure: Letter from RMedeiros to DNR dated 21 October 2004 c: Jeff Hartman, permit holder Bill Leber, Site Manager, Allen Shearer Trucking Rick Mraz,Mason County Community Development Scott Morrison, DOE File#12066 rf GEOLOGY AND EARTH RESOURCES DIVISION 1 1111 WASHINGTON ST SE 1 PO BOX 47007 1 OLYMPIA,WA 98504-7007 TEL:(360)902-1450 1 FAX.(360)902-1785 1 TTY.(360)902-1125 }� Equal Opportunity/Affirmative Action Employer RECYCLED PAPER iN11 Gct 21 ,04 10: 24a Richard Medeiros (3G0) 275-2110 p. 1 October 21, 2004 Richard Medeiros NE2481 Old Belfair Highway Belfair, Washington 98528 Carol Serdar Department of Natural Resources 1111 Washington St SE MS 47007 Olympia, Washington 98504-7007 Fax: (360) 9021785 Re: Reclamation Plan Dear Carol This is a follow up letter. In the past letters I viewed my concerns about the Belfair Sand and Gravel, Inc. reclamation plan. The reclamation plan concerns me, because, I am affected by the results. Because of the past and continuous operation, I am losing my home and property because of the mine operations continuous water run-off onto my property. What I have observed in the past several weeks, is an attempt to comply with the Department of Ecology order. Many items need to be addressed to complete the reclamation scheme, and none of them have begun, for example: Removal of the 10, 000 gallon tank, reclaim the south mid-level of the mine property that has deposited hundreds and hundreds of material from erosion, reconstruct the lower settling pond because it encroaches some 35 feet onto the adjacent property, remove all tires, remove superfund waste, remove all woodwaste, and most of all reclaim the mine property to the current reclamation plan dated 1988, as required by law. Please advise on your intentions of the above matter. Hard copy to follow. S ' r y Richard Me eiro'� cc: Randy Loun cc: D.O.E. cc: M.C.D.C.D. KEE..E[ii'EDA IPA � WASHINGTON STATE DEPAfiTMENTOF JUL 20 �Q. "1 i1 a Natural Resources °e� -�W Geolo and E APPLICATOR RECL T70cv Geology arty �(r FORM SM-8ACheck appropriate box(es): ❑ new permit evision of existing permit ❑ transfer of permit ❑ expansionNOTE: Do not attempt to complete this form until you have carefully read the accompanying instruction document (SM8AINST.PDF). Do not attempt to use this form as an MS Word Template unless you are familiar with the use of templates in MS Word. 1. NAME OF APPLICANT/PERMrr HOLDER(S) 12. Are all of these mines now in compliance with RCW 78.",WAC 332-18,and conditions of the permits? ❑ yes ❑ HOOD CANAL LAND AND GRAVEL, LP no 13. Have you ever had a surface mine operating or 2 MAILING ADDRESS reclamation permit revoked? El yes A� no I P.O. Box 789 Be l f a i r, WA 98528 Have you ever had a reclamation security forfeited? ❑ yes � no If you answered yes to either of the above,list the permit number(s): 3. Telephone 14. Type of proposed or existing mine: pit quarry IISI No (3 6 0) 2 7 5-3 4 6 5 Materials to be mined: sand and gravel ( ) ❑ gra ❑ rock or scone ❑ clay ❑ metal ❑ limestone ❑ silica 4. NAME OF MINE ❑ other OLD BELFAIR PIT Deposit type: )m glacial El river floodplain(alluvial) S. Street address and milepost of surface mine _ ❑ river channel deposits ❑ talus ❑ bedrock ❑ lode ❑ unknown NE 2493 Old Belfair Highway ❑ other IS. Total Acreage and Depth of Permit Area: B e l f a i r, WA 98528 (Include all acreage to be disturbed by mining,setbacks,buffers,and associated activities during the life of the mine.) (See Form SM-6.) 40 CY 34 . 46 / X 00000 Total area disturbed will be acres. 11-13 Area to be disturbed in next 36 months will be acres. 3 G aximum vertical depth below re-minin hie de i feet. B E KEPT IN TF4A\-P� Maximum d th of ex avated mine floor i t relative to mean sea level 16. Expected start date of reining 17. ti ears 6. Distance (miles) 7. Direction from 8. Nearest community 18.Total quantity to be mined over life of 19.Estimated annual production: . mine(estimated): ❑tons,or v i >L �� ❑ tons,or ❑cu yds 9. COUNTY MASON 20. Subsequent land use: industrial commercial residential tr� No attachments will be accepted. Legal Description of permit area: ❑ agricultu stry ❑ wetlands and lakes 1/4 114 Section TownshipOther Range ��QQ 3❑ } 2 Reclaimed elevation of floor of mine: feet relative to n sea level �� ` s Reclaimed elevation is shown on cross sections?J ❑ yes ❑ no Subsequent land use is compatible with 10. TOTAL ACREAGE OF PERMIT AREA APPLIED FOR County or Municipal comprehensive plan? ® yes El no - (include all acreage to be disturbed by ales,buffers,and associated t 1 County or Municipality Approval for activities during the life of the mine Surface Mining(Form SM-6)attached? P9 Yes ❑ no acres 11. Do you or any person,partnership,or corporation associated with you now SEPA Checklist required.? ❑ yes ❑ no hold,or have you held,a surface mining operating or reclamation permit? ❑ yes ❑ no The site has a county vt If any answers are no,explain: ` If you answered yes to the above,pleaselist: designation of mural Single Family _ Permit Number Active Reclamation 1DU/5AC . The reclaimed site will be Operation? current/com lete. Yes No Yes No subdivided into 8 single-family lots . ❑ ❑ The owner intends to explore a rezon 1 ❑ Licht Industrial Land Use. ❑ ❑ 1 ❑ 1 ❑ 21. Application fee for a new reclamation permit is herewith attached? ❑ 0 1 ❑ 1 ❑ ❑ yes ❑ no Form SM-8A(MS Word 2000 Template version) Revised 12101 Paae 1 of 1 Reclamation Permit/App No. 7 0-0 1 2 0 6 6 CHECKLIST OF RECLAMATION STANDARDS Permit area has been divided into segments for mining and a mining schedule has been developed? yes U no If no,explain: Continuous mining will occur, Over burden of one unit is removed annually and utilized to reclaim the completed mine unit behind activelX mined unit. Permit area has been divided into segments for reclamation and a reclamation schedule has been developed? yes U no �✓ If no,explain: �n� � ,� 23A. Perrint and D>tsturbe_a,Area$oundatieS Boundary of the permit area has been marked on the ground with permanent boundary markers? yes no Explain boundary markers: S X -�,� q/l C-� S Dc. - tlhS 23B. Savin '10 so>11 Subsoil,and Overburden-for Reclamation = 7 Thickness of topsoil is 2 ' ±`feet �Aa Thickness of subsoil is link feet �� Depth to bedrock is Tin feet Total volume of topsoil is cubic yards 3 2;2 6 6 Total volume of subsoil is cubic yards 9 0,3 4 7 Volume of stored topsoil/subsoil is * cubic yards and will re 1 5 acres fof storage. *3 3 0 v 0 Storage areas are shown on maps and have been marked on the ground with perhmurmthouild'ary markers9 0 yes LJ no Topsoil will be salvaged? RX yes LJ no If no,explain: Topsoil and overburden will be moved to reclaim an adjacent depleted segment? U yes 0 no If no,explain: Before materials are moved,vegetation will be cleared and drainage planned for soil storage eas? U yes LJ no If no,explain: V� b t L 3 n Soil storage areas will be stabilized with vegetation to prevent erosion if materials will be stored for more than one season? yes ❑ no If no,explain: 23C. Setbacks and Screens Maximum depth of the mine will be 9 5 feet frod et(highest)t eet(lowest)elevation relative to mean sea level.. 4� f 6r The setback for this site will be 3 0 feet wide. Is a permanent,undisturbed buffer planned for this site? yes L1 no If no,explain: Setbacks are shown on maps and have been marked on the ground with permanent boundary markers? U yes LJ(� no If no,explain: C 6�(,�L �C-, 1 j,�6�( � �� •F-Q- Application for Reciamation Permit(Form SM-8A) Revised 12101 Page 2 of 2 Reclamation Permit/App No. 7 0—01 2 0 6 6 IST OF RECLAMATION STANDARDS roes this site have backfill ng pl at addresses the protection of adjacent property and how the final,stable lopes are to be achieve `7 U yes El no i no,explain: t� S �'{ Lp-� ' �QC-� 6 31D. Buffers to-ProWet streams:and Oood Plains ryes,see "Additional Information Re uirements or Flood Plain Mines." This document is included in the stream buffer of at least 200 feet has been marked on the ground with permanent boundary markers? yes LA no buffer of at least 200 feet from the 100-year flood plain has been marked on the ground with permanent oundary markers? ❑C yes ❑X no f no,explain: ' S a� 7 G> e"S S `� ;opy of Shoreline Permit from local government or the Dept of Ecology is attached? U yesJJXJ no i draulic Project Approval from the Department of Fish and Wildlife is attached? I U yes EJ no W. Conservation Buffers ;onservation buffers will be established for the following purpose(s): (Check all that apply) ❑ unstable slopes ❑ wildlife habitat � water quality ❑ other )e nature and configuration of the conservatio ffer 65 ' stream buffer setback is equired by Mason County , from the Class III am along the West side of the proper y. :onservation setbacks are shown on maps and have been marked on the ground with permanent boundary ❑ oarkers? es ❑ no 3F. Ground W. Otter - ligh water table depth is feet relative to mean sea level, LJ below original surface,or unknown. .ow water table depth is feet❑relative to mean sea level,❑below original surface,or unknown. lnnual fluctuation of water table is from feet on to feet on Xrection of groundwater flow: Assumed SE kre well logs attached? 10 yes no s the aquiferperched? yes Uno s the shallowest aquifer: LJ confined LJ unconfined fhe site will be mined: U wet U dry both 4 uti VP1 w� - )escribe mining method: �- Static groundwater elevation unknown. ['he site is in a: ] critical aquifer recharge area ❑ sole source aquifer ❑ public water supply watershed ] wellhead protection area ❑ special protection area ❑ designated aquifer protection area around water study attached? LJ yes U no f yes, see "Additional Information Requirements for Hydrologically Sensitive Areas." This document is ncluded in the SM8AINST.PDF file. f no,explain: !3G. Archeology kre archeological/cultural resource sites present? t �- yes no f yes, describe how you will protect these resources: .v �' F` ..UL i kpplication for Reclamation Permit(Form SM-8A) Revised 12101 Page 3 of 3. Reclamation Permit/App No. 70-01 2066 CHECKLIST OF RECLAMATION STANDARDS 1VG�RATCTO � BM'I� T ,R � `IO Ili.. Soil Replacement opsoil will be saved? yes LJ no no,explain: �p to 4 feet of topsoil and(or)subsoil will be restored? yes Ej no no,explain: 'opsoil will be restored and seedbeds prepared as necessary to promote effective revegetation and to stabilize .opes and mine floor? ® yam ❑ °O ""yes"give details,if"no",explain: Mining will be continuous and overburden and reclama- tion of a unit will be done on an annual basis. ubsoil will be replaced to an approximate depth of feet on the pit floor and a depth of feet on slopes. S � � 0. 5-1 0 .5-1 'o soil will be replaced to an approximate depth of feet on the pit floor and a depth of feet on slopes , 'opsoil will be distributed evenly over the site? yes no no,explain: 'topsoil is in short supply,it will be strategically placed in depressions and low areas in ade s to ^—� onserve moisture and promote revegetation? El Y& ❑ no 'no,explain: Unlikely to be short of material as wood waste recyc materials are available to augment restoration of these beds. No opsoi from the Co site will be exported. 'opsoil will be moved when conditions are not overly wet or dry? Ej yes no `no,explain: 'opsoil will be imported? yes no f yes,describe source. If no,explain: ynthetic topsoil made from compost,biosolids,or other amendments will be used and(or)ma to upplement existing topsoil? 0 yes El no ryes,explain: Unlikely to be short of material G wnnr� waste recyple terials are available to augment restoration of these beds. No topsoi om the site will be exported. daterials such as till, loess,and m (or i11 4e available on site that could be used to supplement topsoil for J,r :claation. �` f yes,explain: Materials a not available on site. yes )IN no �(yy fr settling ponds or a filter press will be used for reclamation? yes no explain: ,pplication for Redarnation Permit(Form SM-8A) Revised 12/01 Page 4 of 4 Reclamation Permit/App No. 7 0-0 1 2 0 6 6 • CHECKLIST OF RECLAMATION STANDARD Settling pond clay slurries will be pumped or hauled to other segments for reclamation? ` \.r yes no If yes,explain: Topsoil will be replaced with equipment that will minimize compaction,or it will be plowed,disked,or ripped following placement? ® yes ❑ no ; If no,explain: Topsoil will be immediately stabilized with grasses and legumes to prevent loss by erosion, slumping, or El yes El no V) If no,explain: I , Topsoil stockpile areas are o on maps d will be marked on the ground with permanent boundary markers to protect from loss? t-k X❑ yes ❑ no If no,explain: ( �" Segmental topsoil removal and replacement is shown on maps? U yes Lj no If no,explain: Lc �� ✓ c v Topsoil salvage and replacement plan included? yes no ! If no,explain: 5 t,—C' t ck Vi-Q- S .24B. Removal of Vegetation Vegetation will be removed sequentially from areas to be mined to prevent unnecessary erosion? fi yes Ljno If no,explain: c;✓ Small trees and other transplantable vegetation will be salvaged for use in v e t oTr�'se gryrepfs. ��� yes no If yes,give details. If no,explain: (FM/ C Three patches of forest located on the site — they will be logged; marketable timber removed. The remainder cut for firewood and the slash and stumps re— ood and other organic debris will be: ❑ recycled ❑ removed from site ❑ chipped ❑ bumed ❑ buried ❑ used to syl%kes.ize topsoil or mulch ❑ other(explain) Solid waste disposal,burning,and land use permits are attached? ❑ yes U no Some coarse wood(logs,stumps)and other large debris will be salvaged for fish and wildlife habitat 71 yes X no If yes,give details. If no, explain: 24C. Erosion control for Reclamation Pit floor will slope at gentle angles toward highwall, sediment retention pond, or proper drainage? yes 1i no If yes, give details. If no, explain: I Application for Reclamation Permit(Form SM-8A) Revised 12101 Page 5 of 5 Reclamation Permit/App No. 7 O-0 1 2 C 6 E CHECKLIST OF RECLAMATION STANDARDS evegetation,sheeting,and(or)matting will be used to protect areas susceptible to yes LJ no yes,give details. If no,explain: Topsoil replacement 3 cycled wood waste an revegetation using fir and cedar trees and nature planting on d slope Futu e building pads to be seeded with grass. 6yr Tater control systems used for erosion control during segmental reclamation will: Divert clean water around pit? U yes ❑ no Trap sediment-laden runoff before it enters a stream? fi yes El no Result in essentially natural conditions of volume,velocity,and turbidity? yes ❑ no Handle a 25-year,24-hour peak event? yes no (Have you attached calculation?) ❑ yes no Be remo d? J2 yes anyans Till any water control systems be removed upon final reclamation? yes LJ no 'yes, explain: Tater control measure will be established to prevent erosion of setbacks and neighboring properties? 12 yes 0 no 'yes, give details. Ifno,explain: Armored channels will be provided along the south and east-setback to contain and route water to the stormwater facilities and protect downstream properties . torm-water conveyance ditches and channels will be lined with vegetation or riprap? yes no yes,give details. If no,explain: L atural and other drainage channels will be k t free o�equipmentAwl tes, stockpiles,and overburden? x yes no no,explain: The mine will b set rom the Class III intermittant stream along .the West pro_ ainage from the mine will be directed away from this stream and to the stormwater facilities in place. final slopes will be created using the cut-and-fill method? ��, �� yes LJ no xplain procedure to be used: �` � � - .� t � ✓-�� � �� lopes will be created by mining to the final slope using the cut method? (t 7c, 0 yes LJ no xplain procedure to be used: lopes will vary in steepness? yes In no no,explain: The majority of slopes will be 3 : 1 topography with some at 2 : 1 . They will tie into the adjacent buffers . y-( 1, '�( V 2 j Y r lopes will have a sinuous appearance in both profile and plan view? V yes no no, explain: Final slopes will undulate between 2 : 1 and 3 : 1 with terraces for future streets and building sites . �` `�; t rivkd' l C_ tA^"*-+�''� 70-012066 pplication for Reclamation Permit(Form SM-8A) Revised 12/01 Page 6 of 6 Reclamation Perthit/App No. CHECKLIST OF RECLAMATION STANDARDS arge rectilinear(that is,right angle, or straight,planar)areas will be eliminated? yes no no,explain: there reasonable,tracks of the final equipment pass will be preserved and oriented to trap moisture,soil,and :eds,and to inhibit erosion? ) yes ❑ no Cno,explain: SB, .Slo, a Re, uirements for Pits:and Overburden/Waste Rock bums non-saieable products) f the mine is a quarry or in hard rock,skip to Quarry section(25C). lopes will vary between 2 and 3 feet horizontal to l foot vertical or flatter, except in limited areas where teeper slopes are necessary to create sinuous topography and control drainage? yes ❑ no f no,explain: 'or pits,slopes will not exceed 2 feet horizontal to l foot vertical except as necessary to blend with adjacent yes no iatural slopes? five details: The majority of the site will have 3 : 1 to. 2 : 1 slopes. Steeper slopes are not anticipated. lope stability analysis required? 0 yes no ryes,see "Additional Information Requirements for Mines with Potentially Unstable or Steep Slopes." This !ocument is included in the SMBAINST.PDF file. ;lope stability analysis provided b 'SC ';Slo a]Fie u rements for Quarries and Hardrock Metal Mines mine is a it in unconsolidated materials covered by Section 25B,go to Section 25D ;heck the appropriate box(es) ] Slopes will not exceed 2 feet horizontal to 1 foot vertical. ] Slopes steeper than l foot horizontal to l foot vertical are an acceptable subsequent land use as confirmed on Form SM-6. ] Hazardous slopes or cliffs are indigenous to the immediate area and already present a potential threat to human life. Photo and naps attached to document presence of cliffs. ] Geologic or topographic characteristics of the site preclude slopes being reclaimed at a flatter angle and are an acceptable vbse vent land use as confirmed on Form SM-6. Dope stability analysis required? El yes 11 no Eyes,see "Additional Information Requirements for Mines with Potentially Unstable or Steep Slopes." This locument is included in the SM8AINST.PDF file. Dope stability analysis provided b Measures will be taken to limit access to the top and bottom of hazardous slopes? yes no describe measures, or if no,explain: selective blasting will be used to remove benches and walls and to create chutes,buttresses,spurs, scree slopes, ind rough cliff faces that appear natural? ❑ yes ❑ no )escribe procedures, or if no, explain: 2eclamation blasting will be used to reduce the entire highwall to a scree or rubble slope less than 2 feet rorizontal to l foot vertical? NSA ❑ yes ❑ no 31asting plan is attached? ❑ yes ❑ no f no,explain: %pplication for Reclamation Permit(Form SM-8A) Revised 12/01 Paae 7 of 7 Reclamation Permit/App No. 7 O—O 1 2 O 6 6 CHECKLIST OF RECLAMATION STANDARDS ccess to benches will be maintained for reclamation blasting? 0 yes U no no,explain: mall portions of benches will be left to provide habitat for raptors and other cliff-dwelling birds? yes no 5�. $0074lin lopes will require backfrlling? yesEl no Depth of backfilling is feet. Slope stability compaction analysis required? N. �A ❑ yes ❑ no Compaction analysis provided by e �ackfrlling plan and(or)permits are attached? yes no f no,explain: CSC '�ackfrlling will be done with overburden material after topsoil has"been separated? L c �(/ yes no Fno,describe composition and source of backfrll material: J r X c 6j L/ ixplain method of placement of fill: ��D ,ocations of stockpiles are shown on maps and will be marked on the ground with permanent boun ` ki 3arkers? ❑ yes ❑ no Vill backfrll be imported? U yes Lj no f yes,give volumes needed to meet reclamation plan: 9-/ �- �reas to be backfrlled are shown on maps? �\ yes no t f no,explain: � ( � k11 grading/backfrlling will be done with clean,inert, non-organic solids? �� yes no f yes,give details. if no,explain: 3ackfrlled slopes will be compacted? U yes El no f yes,give details. If no,explain: Will you be backfrlling into water? El yes no f yes,is slope stability analysis attached? ❑ yes ❑ no f yes,describe method: 15E. Mine Floors -lat areas will be formed into gently rolling mounds? yes no fyes,give details. Ifno,Explain: Mine is on hillside. Benches will be created for terraced effect. The benched areas will provide building sites and street right-of-ways for future use . The benches will be back sloped to route water to the street and drain system and away from the down hill slope face. application for Reclamation Permit(Form SM-8A) Revised 12/01 Page 8 of 8 Reclamation Permit/App No. 7 O—01 2 O 6 6 CHECKLIST OF RECLAMATION STANDARDS tine floor will be gently graded into sinuous drainage channels to preclude sheetwash erosion during intense recipitation? ❑ yes ® no 'yes,give details. If no,explain: The mine will be graded to provide drainage consistent with the future development layout. line floor and other compacted areas will be bulldozed,plowed,ripped,or blasted to foster revegetation? El yes 0.no Eyes,give details. If no,explain: The mine will be graded to provide drainage consistent with the future development layout. SF. Lakes,Ponds,and wetlands s water currently present in the area or will the mining penetrate the water table? U yes Un f no,go to Section 25G. reclaimed areas below the permanent low water table in soil,sand,gravel,and other unconsolidated material MI have a slope no steeper than 1.5 feet horizontal to l foot vertical? Rk yes ❑ no f yes,give details. If no,explain: I f not already present,soils,silts,and clay-bearing material will be placed below water level to enhance - evegetation? yes El no fyes,give details. If no,explain: The final detention pond will be a two -cel wet pond-0 v '` which will be planted with emergent and submergent vege r�-c,� s iome parts of pond and lake banks will be shaped so that a person can escape from the water? yes Cy no fyes,give details. If no,explain: Constructed at-slopes-of 3 : 1 or flatter. Armored spillways or other measures to prevent undesirable overflow or seepage will be provided to stabilize Bodies of water and adjacent slopes? 93 yes ❑ no If yes,give details. If no,explain: An armored spillway will be provided on final pond for overflow in extreme runoff events . Wildlife habitat will be developed,incorporating such measures as: Sinuous and irregular shorelines? yes ❑ no Varied water depths? yes ❑ no Shallow areas less than 18 inches deep? U yes ❑ no Islands and peninsulas? ❑ yes ❑ no Give details: Wet pond size will be sized for the design storm. Two cells with common isthmus. 7 r Ponds or basins will: Be located in stable areas? U yes ❑ no Have sufficient volume for expected runoff? U yes ❑ no Have an emergency overflow spillway? U yes ❑ no Spillways and outfalls will be protected (for example,rock armor)to prevent failure and erosion? tN yes ❑ no If any answers are no, explain: Application for Reclamation Permit(Form SM-8A) Revised 12/01 Page 9 of 9 Reclamation Permit/App No. 7 O—O 1 2 O 6 6 CHECKLIST OF RECLAMATION STANDARDS 'roper measures will be taken to prevent seepage from water impoundments that could cause flooding outside be permitted area or adversely affect the stability of impoundment dams or adjacent slopes? ❑ yes ❑ no f yesi give details. If no,explain: The pond provided is in the sump condition. e�� �^^� JVritten approval from other agencies with jurisdiction to regulate impoundment of water is attached? yes no .f no,explain: N/A !3G. FINAL DRAINAGE CON I!GUItAT1 N ?rainage will be capable of carrying the peak flow of the 25-year,24-hour precipitation event(Data are mailable at DNR Region offices) f yes,are calculations attached? ❑ yes no .f yes,give details. Ifno,explain: For the reclaimed site the storm water facilities wi exceed the 25-year, 24-hour event. During the active mining of the site, the stormwater facilities will meet this standard. drainages will be constructed on ch reclaimed segment o control surface water,erosion,and siltation? yes 0 no lean runoff is directed to a safe outlet. ❑ yes El no :f either yes,give details. Ifno,explain: Interim` storm water facilities will be installed and maintained during the ive life of the mine. ire these shown on maps? the grade of ditches and channels will be constructed to limit erosion and siltation? o Syes,give details. If no,explain: Natural-appearing drainage channels will be established upon reclamation? yes o [f yes,give details. if no,explain: 2 .; aflP 'ARATI4 'flR� VL' AT7� a 26_A.Dealing with Hazardous lVl iiefials Hazardous-rnatcr' sent at the mine site? tiN ti es no no, o to Section e ma ground surface drains away om us natural materials? Y� no If yes,give details. If no,explain: Plan for handling hazardous mineral wastes indigenous to the site is attached? El yes no If no,written approval from all appropriate solid waste regulatory agencies attached? LJ yes kA no 26B. Removal of Debris All debris (garbage, `bone piles', treated wood,old mining equipment,etc.) will be removed from the mine site? yes In no All sheds, scale houses,and other structures will be removed from the site? B yes ❑ no If either answer is yes,give details. If no,explain: Upon completion of the site , offices , hatch plant, wash rack, stormwater, pump stations , sheds , maintenance buildings , peripheral equipment, bone piles , etc . will be removed from the site and her s Ivagedosed in an ppr oat The mine site is in: F1 eastern Washington western Washington The mine site is: ❑ wet ® dry? Application for Reclamation Permit(Form SM-8A) Revised 12/01 Page 10 of 10 Reclamation Permit/App No. 0 1 6 6 CHECKLIST OF RECLAMATION STANDARDS The average precipitation is 6 0/(per year. Revegetation will start during the first proper growing season{fall for grasses and legumes,fall or late winter For trees and shrubs)following restoration of slopes? ® yes ❑ no if yes,give details. If no,explain: Temporary seeding of inactive portions of the mine. Whe opening a unit (annually) topsoil removed, salvaged, and overburden will im- mediately be placed as fill and topsoil utilized on the unit being reclaimed to the desired grades on the site plan. The unit will then be RjaAted wi th* Test plots will be used to determine optimum vegetationplans? I U Yes 0 no The site will not be revegetated because: ❑ It is a rural area with a rainfall exceeding 30 inches annually and erosion will not be a problem(requires approval of DNR). ❑ Demonstration plots and areas will be used to show that active revegetation is not necessary. ❑ Revegetation is inappropriate for the approved subsequent use of this surface mine. Explain: Documentation is attached? ❑ yes ❑ no 27A. Recommended Pioneer Species In the Sections below,check the species that will be planted at your mine site: *indicates nitrogen-fixing species Western Washington Dry Areas ❑ alfalfa* ® Lupine* 30 lbs.® clover* 5 lbs . orchard grass 25 lbs. 13 cereal rye 5 lbs. ❑X perennial rye 15 lb® colonial bent grass 5 ❑ ponderosa pine 18 creeping red fescue.3 CO red alder* ® Douglas fir ❑ shore pine ❑ ground cover ® shrubs ® other 300 trees/acre. Mixed trees on slopes , grasses on terraces. Western Washington Wet Areas ❑ birdsfoot trefoil ❑X sedges cedar ❑ tubers ❑ cottonwood © wetland grasses ❑ creeping red fescue ❑ willow U red alder* ❑ other Eastern Washington Dry Areas ❑ alder* ❑ grasses ❑ alfalfa* ❑ juniper ❑ black locust ❑ lodgepole pine ❑ clover ❑ lupine* ❑ deciduous trees ❑ ponderosa pine ❑ shrubs ❑ deep-rooted ground cover ❑ diverse evergreens ❑ other Eastern Washington Wet Areas ❑ alder* ❑ cottonwood ❑ poplar ❑ sedges ❑ serviceberry ❑ tubers ❑ willow ❑ other Give planting details (stems/acres of trees and shrubs,see Forest Practices manual;lbs/acre of grass,legume,or forb mixture): *mix specified above. Monitoring and replacement will be conducted on an annual basis. Reclamation will be progressive . Describe weed control plan: 27B. Planting Techniques Application for Reclamation Permit(Form SM-8A) Revised 12/01 Page 1 t of 1 1 Reclamation Permit/App No. 7 0—01 2 0 6 6 i CHECKLIST OF RECLAMATION STANDARDS yes no cvegetation at this site will require: Ripping and tilling? C Blasting to create permeability? S / (r� El yes ® no ® Yes ❑ no Mulching? Irrigation? � [I yes a] no Fertilization? \�!` X❑ Yes El no Importation of clay-or humus-bearing soils? ❑ yes El no Other soil conditioners or amendments? ° Give details: Utilizing salvaged topsoil augmented with r ycled w�ood �was Quantities are sufficient to cover the site. Seed, fertilizer, mulch and restoration Planting is all that is re red. Tees and shrubs will be planted in topsoil or in subsoil amend en&ous amounts of organic matter? yes no Eyes,give details. Ifno,explain: The slopes an poin b 'rder will be planted with trees . Source is the WDNR Nursery in 01 pia 4ulch will be piled around the base of trees and shrubs? Ek yes EJ no ligh quality stock will be used? a yes ❑ no 'rees and shrubs will be planted while they are dormant? EX yes ❑ no -tock will be properly handled,kept cool and moist,and planted as soon as possible? a yes ❑ no seeds will be covered with topsoil or mulch no deeper than one-half inch? Ek yes ❑ no f any answers are no,explain: OWN 01 required maps are attached(See Instructions or detailed requirements)? es no 01 required cross-sections are attached(See Instructions or detailed requirements)? es no 3eolo is ma attached(if required)? es no k11 documents submitted have the date,the name and address of the permit holder,and the application number m every page of the material? ❑ yes ❑ no 'he plan contains predominantly relevant information? yes no iave you completed the SM-6 and has it been signed by the local jurisdiction? yes no iave ou provided the SEPA checklist? yes no iave ou Provided a copy of the SEPA Determination(DNS,MDNS,or DS)? yes LJ no iave you attached photographs? I LJ yes 0 no ire additional supplemental studies included? F1 yes n no f yes,check the appropriate box(es)below: ] Archeological ❑ Geohydrologic ❑ Backfill ❑ Slope stability ] Topsoil ❑ Flood plain ❑ Conservational ❑ Vegetation ] Other 3ther permits required? yes no f yes, check the appropriate box(es)below: ] Shoreline permit ❑ Water Discharge Permit ❑ Solid Waste Permit ] Air Quality Permit ❑ NPDS or General Discharge Permit ❑ Hydraulic Project Approval ] Special or Conditional Use Permit ❑ Other 4pplication for Reclamation Permit(Form SM-8A) Revised 12/01 Page 12 of 12 Reclamation Permit/App No. 7 0—01 2 0 6 6 CHECKLIST OF RECLAMATION STANDARDS When signed by the applicant and approved by the Department of Natural Resources, this document and the associated maps, cross sections, reclamation narrative, and other attachments will be the approved reclamation plan for this permit that the permit holder must follow. Significant variations from the approved reclamation plan may require that a new plan be submitted to the Department for approval The applicant shall be considered as the permit holder for this surface mine and shall be responsible for compliance with Chapter 78.44 RCW,Chapter 332-18 WAC,the approved reclamation plan and attachments, and the conditions of the permit if issued by the Department of Natural Resources. I hereby agree to comply with this plan. Name and Title of Company Representative Date s' ed Signature of applicant or company representat've (Please print) EFFREY A. HARTMAN , Manager SURFACE OWNS SH OWERSHFP OF RIGHTS TO REMOVE MINERALS BY Fb names,address an tur fall individuals with possessory SURFACE MINING For`-Mt 4- GiveYS `� interest in land. Give names,addresses,and signatures of a i ividuals with rights (attach5igned copies o this page if more than one) (attach signed copies of this page if more than on I yeiify that the applicant has my permission to mine from my land. I verify that the applicant has my permission to mine is land. ,,Signature of landowner(s) Date Signed Signature of rights owner(s) Date Signet �� `I,hereby verify that I have seen and approved this plan. I hereby verify that I have seen and approved this plan. Signature of landowner(s) Date Signed Signature of rights owner(s) Date Signed FOR DEPARTMENTAL USE ONLY Date accepted Accepted by: Title: Reclamation Permit No. Comments by Departrment: CF' � ,4 V 4pplication for Reclamation Permit(Form SM-8A) Revised 12/01 Page 13 of 13 Reclamation Permit/App No. 7 0-01 2 0 66 ` R r C E r V EREQUEST FOR TRANSFER '• WASHING ON STATE DEPARTMETP� a.a 2004 OF SURFACE MINE WN Natural Resources RECLAMATION PERMIT 11�� and Earth (Form SM-213) I(We), BELFAIR SAND AND GRAVEL,INC. ,the current permit holder(s),hereby consent to the transfer of my(our)rights,privileges,and obligations under Reclamation Permit No. 70-012066 located in Section(s) 17 ,Township(s) 23 North,Range(s) of MASON County,Washington. 1. 1 (We) acknowledge that 1 (we) will continue to be responsible for all reclamation responsibilities for Reclamation Permit No. 70-012066 , and for all obligations under the Surface Mining Reclamation Act as permittee(s),until final approval of this transfer by the Department of Natural Resources(DNR)as evi- denced by the authorized signature below. I understand that DNR may not accept the transfer of the Permit until the Proposed transferee(s)submit(s)acceptable documents required by the Surface Mine Reclamation Act and rules,especially WAC 332-18-150.The proposed transferees)may be required to submit the following documents,in complete and accept- able form,prior to approval by DNR: (1)SM-8A; (2)revised reclamation plan; (3)written approval of all parties having a possessory interest in the land; (4) revised SM-6; (5) SEPA checklist; and (6) adequate performance security. Prior to transfer,the permit must be in good standing and order. NEW PERMIT HOLDER AND/OR LANDOWNER/MINERAL RIGHTS HOLDER INFORMATION New Permit Holder Landowner/Mineral Rights Holder (attach signed copies if more than one) HOOD CANAL LAND AND GRAVEL,LP HOOD CANAL LAND AND GRAVEL,LP Address Address P.O.BOX 789 P.O.BOX 789 UBI No. City,State,Zip City,State,Zip BELFAM WA 98528 BELFAIR,WA 98528 Phone Phone 360/275-3465 360/275-3465 11. 1 (We) agree to comply with all of the terms and conditions of the current approved Permit, the Surface Mine Reclamation Act,and rules. I(We)acknowledge that I(we)may be required to submit any or all of the documents listed in Section I above prior to approval of the transfer by DNR. New Permit Holder Signature Landowner/Mineral Rights Holder Signature y: BERT W. LEBER, JR. , Gen. Part. By : ALBERT W. LEBER, JR. Gen Part Ill. With this signature, 1 (we) hereby relinquish all interest in Surface Mining Permit No. 70-012666 subject to the approval of this transfer request by the Department of Natural Resources. Current Permit Holder BELFAIR SAND & GRAVEL, DaIeNC . President IV. This transfer has been approved by the Department of Natural Resources. DNR Surface Mining Approved Signature Date Request for Transfer of Surface Mine Reclamation Permit(SM-21B) Revised 1/01 ' RECEIVED JUL 0 a 2004 ENVIRONMENTAL CHECKLIST Geology and Earth Purpose of Checklist: The State Environmental Policy Act(SEPA),Chapter 43.21 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,if it can be done)and to help the agency decide whether an EIS is required. Instructions for Applicants: This environmental checklist asks you to describe some basic information about your proposal. Governmental agencies use this checklist to determine whether the environmental impacts of your proposal are significant,requiring the 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 question 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 the your proposal or its environmental effects. The agency to which you submit this checklist may ask you to explain your answers or to provide additional information reasonably related to determining if there may be significant adverse impact. Use of checklist for nonproject proposals: Complete this checklist for nouproject proposals,even though questions may be answered"does not apply." IN ADDITION,complete the SUPPLEMENTAL SHEET FOR NONPROJECT ACTIONS(Part D). For nonproject actions,the references in the checklist to the words"project," "applicant,"and"property or site" should be read as "proposal," "proposer," and "affected geographic area," respectively. A. BACKGROUND 1. Name of proposed project, if applicable: 2. Name of applicant: HOOD CANAL LAND AND GRAVEL , LP 3. Address and phone number of applicant and contact person: BILL LEBER (3 6 0) 2 7 5—7110 P.O. Box 1880 , NE 2493 Old Belfair Hwy . , Belfair, WA 98528 4. Date checklist prepared: December 2003 5_ Agency requesting checklist.- Department of Natural Resources 6. Proposed timing or schedule(including phasing, if applicable): N/A 7. Do you have any plans for future additions,expansion,or further activity related to or connected with this proposal? If yes,explain. No 8. List any environmental information you know about that has been prepared,or will be prepared,directly related to 1 this proposal. N/A ? < 9. Do you know whether applications are pending for governmental a royals of other proposals directly affecting the property covered by your proposal?If yes,explain. 41 0 10. List any government approvals or permits that will be needed for your proposal, if known. Reclamation Permit IL Give brief,complete description of your proposal,including the proposed uses and the size of the project and site. There are several questions later in this checklist that ask you to Aescribe certain aspects of your proposal. You do not need to repeat those answers on this page. (Lead agency may modify this form to include additional specific �C- information on project description.) A <9 — Sand and Gravel Reclamation !� 12. Location of 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 topographical 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 applications related to this checklist. NE 2493 Old Belfair Hwy. , Belfair, Washington B. ENVIRONMENTAL ELEMENTS 1. Earth a. General description of the site(circle one):Flat,rolling, ill steep slopes,mountains,other b. What is the steepest slope on the site(approximate percent slope)? 1 to 1 �"►'u, s CA/ s l c. What general types of soils (for example, clay, sand, gravel, peat, muck)? if you know the classification of agricultural soils,specify them and note any prime farmland. Sand and Gravel d. Are there surface indications or history of unstable soils in the immediate vicinity? If so,describe. No e. Describe the purpose,type,and approximate quantities of any filling or grading proposed. lndicat ource of fill. Slope restoration on NW slope approx. 12 ,000 yds grave y hard pan and* f. Could erosion occur as a result of clearing,construction, or use? If so,generally describe. eject sand mi Yes. Runoff of exposed minerals . all SA g. About what percent off covered with impervious surfaces after project construction(for example, ca� asphalt or buildings)? 7 5 )j � L lam"- j fill h. Proposed measures to reduce or control erosion,or other impacts to the earth, if a : Erosion/Sedimentation Control Plan approved by Dept of Ecology. 2. Air a. What types of emissions to the air would result from this 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. Dust b. Are there any off-site sources of emissions or odor that may affect your proposal? if so,generally describe. No c. Proposed measures to reduce or control emissions or other impacts to air, if any: Water Truck 3. Water a. Surface: 2 r 1 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 w at stream or river it flows into. yy� Class 3 Stream to Union River r,V � 14\ 2) Will the project require any work over,in,or adjacent to(within 200 feet)the described waters? Ifyesjgewe (� describe and attach available plans. Yes. Within 65 feet of Stream by Permit r 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 the fill material. N/A 4) Will the proposal require surface water withdrawals or diversions? Give general description, purpose, and approximate quantities if known. Surface water will be diverted to wash pond for treatment and discharge into rock—lined ditch, quantities depend on* 5) Does the proposal lie within a 100 year floodplain? If so,note location on the site plan. *rainfall . No 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. Silt. ` Regulated by Dept of Ecology ` b. Ground: 1) Will groundwater be withdrawn, or will water be rscharged to groundwate ve general description, purpose,and approximate quantities if known. Well Water 2) Describe waste material that will be discharged into the ground from septic tanks or other sources,if any(for IfCA sµ,� example: Domestic sewage; industrial,containing the following chemicals . . .; agricultural; etc.). Describe the �Cy^ general size of the system,the number such systems, the number of houses to be served ( if applicable), or the V-C Q, number animals or humans the system(s)are expected to serve. N/A 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 w? Will this water flow into other waters? If so,describe. Storm Water. enerall eld on site. d 2) Could waste material enter grown or surface waters? If so,generally describe. No d. Propo a res to re uc _ar co_ surface,ground,and runoff water impacts, if any: See Operations Repo d Storm Water Plan submitted and accepted Dept.. o ogy S 7 4. Plan T a. Check or circle types of vegetation found on the site: X deciduous tree: alder,maple, aspen,other evergreen tree: fir,ceder, pine,other X shrubs X grass _pasture _crop or grain wet soil plants: cattail, buttercup,bulrush, skunk cabbage,other �L(� _water plants: water lily,eelgrass, milfoil,other _other types of vegetation b. What kind and amount of vegetation will be removed or altered? s- C� 80% of Property c. List threatened or endangered species known to be on or near the site. N/A 3 d. ProposeA landscapepg,u e of native plants,or other measures to preserve or enhance vegetation on the site,if any: Reclama ' on Plan 1 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, agle songbirds other: mammals deer bear elk,beaver,other: ; fish:bass,salmon,trout,herring,shellfish,other: �S--p' b. List any threatened or endangered species known to be on or near the site. l N/A c. Is the site part of a migration route?If so,explain. N/A d. Proposed measures to preserve or enhance wildlife, if any: N/A 6. Energy and Natural Resources a. What kinds of energy(electrical,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. Electrical Energy. Manufacture of Sand and Gravel b. Would your project affect the potential use of solar energy by adjacent properties? If so,generally describe. No 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: N/A 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. No 1) Describe any emergency services that might be required. 2) Propose measures to reduce or control environmental health hazards, if any: b. Noise 1) What types of noise exist in the area which may affect your project(for example:traffic,equipment,operation, other)? Rock Crusher/Wash Plant 2) What types and levels of noise would be created by or associated with the project on a short-term basis(for example:traffic,construction, operation, other)? Indicate what hours noise would come from the site. 9 : 00 am — 4 : 00 pm in Winter / 7 : 00 am — 7 : 00 pm in Summer 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? Residential/Forestry b. Has the site been used for agriculture? If so,describe. No c. Describe any structures on the site. Office Trailer d. Will any structures be demolished? if so, what? No 4 4 I II I e. What is the current zoning classification of the site? Mine f. What is the current comprehensive plan designation of the site? Mine g. If applicable,what is the current shoreline master program designation of the site? N/A h. Has any part of the site been classified as an "environmentally sensitive"area? If so,specify. N/A i. Approximately how many people would reside or work in the completed project? 4 — 5 people will work j. Approximately how many people would the completed project displace? None k. Proposed measures to avoid or reduce displacement impacts, if any: N/A 1. Proposed measures to ensure the proposal is compatible with existing and projected land uses and plans, if any: N/A 9.Housin a. Approximately how many units would be provided,if any? Indicate whether high,middle or low-income housing. N/A b. Approximately how many units, if any, would be eliminated? Indicate whether high, middle, or low-income housing. N/A c. Proposed measures to reduce or control housing impacts,if any: N/A 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? 10 ft. Office Trailer b. What views in the immediate vicinity would be altered or obstructed? No c. Proposed measures to reduce or control aesthetic impacts, if any: N/A 11. Light and Glare a. What kind of light or glare will the proposal produce? What time of day would it mainly occur? None b. Could light or glare from the finished project be a safety hazard or interfere with views? None c. What existing off-site sources of light or glare may affect your proposal? None d. Proposed measures to reduce or control light and glare impacts, if any: None 12. Recreation a. What designated and informal recreation opportunities are in the immediate vicinity? None b. Would the proposed project displace any existing recreational uses? If so,describe. None c. Proposed measures to reduce or control impacts on recreation,including recreational opportunities to be provided by the project or applicant, if any: None 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. No b. Generally describe any landmarks or evidence of historic,archeological,scientific,or cultural importance known to . be on or next to the site? If so,generally describe. N/A r c. Proposed measures to reduce or control impacts,if any: N/A 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. Belfair Highway / Easement Road b. Is the site currently served by public transit? If not,what is the approximate distance to the nearest transit stop? Belfair Highway c. How many parking spaces would the completed project have? How many would the project eliminate? N/A 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). No e. Will the project use (or occur in the immediate vicinity of) water, rail, or air transportation? If so, generally describe. No f How many vehicular trips per day would be generated by the completed project? If known,indicate when peak volumes would occur. Truck Traffic during Daylight hours g. Proposed measures to reduce or control transportation impacts,if any: None 15. Public Services a. Would the project result in an increased need for public services(for example: fire protection,police protection, health care,schools,other)? If so,generally describe. No b. Proposed measures to reduce or control direct impacts on public services, if any. None 16. Utilities a. Circle utilities currently available at the site:6lectricity natural gas,water,refuse service telephone, 'terry 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 which might be needed. None / Installed C. SIGNATURE The above answers are true and complete to e best of my knowledge. I understand that the lead agency is relying on them to ,a4 its decision. Signature: Review by: / JUL 0 6 �Gc)loav'and Laflh Title: Manager Date: D. SUPPLEMENTAL SHEET FOR NONPROJECT ACTIONS (Do not use this sheet for project action) Because these questions are vey general, it may be helpful to read them in conjunction with the list of the elements of the environment. When answering these questions, be aware of the extent the proposal,or the types of activities likely to result from the proposal,would affect the item at a greater intensity or at a faster rate than if the proposal were not implemented. Respond briefly and in general terms. 1. How would the proposal be likely to increase discharge to water;emissions to air;production,storage,or release of toxic or hazardous substances; or production of noise? Proposed measures to avoid or reduce such increases are: 2. How would the proposal be likely to affect plants,animals, fish or marine life? Proposed measures to protect or conserve plants, animals,fish,or marine life are: 3. How would the proposal be likely to deplete energy or natural resources? Proposed measures to protect or conserve energy and natural resources are: 4. How would the proposal be likely to use or affect environmentally sensitive areas or areas designed(or eligible or under study)for governmental protection: such as parks,wilderness,wild and scenic rivers,threatened or endangered species habitat, historic or cultural sites,wetlands,floodplains,or prime farmlands? Proposed measures to protect such resources or to avoid or reduce impacts are: 5. How would the proposal be likely to affect land and shoreline use, including whether it would allow or encourage land or shoreline uses incompatible with existing plans? Proposed measures to avoid or reduce shoreline and land use impacts are: 6. How would the proposal be likely to increase demands on transportation or public services and utilities? Proposed measures to reduce or respond to such demand(s)are: 7. Identify, if possible,whether the proposal my conflict with local, state,or federal laws or requirements for the protection of the environment. Jq 'C1F- C, a:lcheklist&supp 1/26199 7 0 2004 ;ieoiogy and Earth REQUEST FOR TRANSFER WASHINGTON STATE DEPARTMENTOF OF SURFACE MINE Natural Resources RECLAMATION PERMIT i� (Form SM-213) l(We),BELFAIR SAND AND GRAVEL, INC. the current permit holder(s),hereby consent to the transfer of my(our)rights,privileges,and obligations under Reclamation Permit No. 7 0-012 0 6 6 ,located in Sections) 17 ,Township(s) 23 North,Range(s) 1 8/W, of MASON County,Washington, I. 1 (We) acknowledge that 1 (we) will continue to be responsible for all reclamation responsibilities for Reclamation Permit No. 70-012066 , and for all obligations under the Surface Mining Reclamation Act as permittee(s), until final approval of this transfer by the Department of Natural Resources (DNR)as evi- denced by the authorized signature below. I understand that DNR may not accept the transfer of the Permit until the proposed transferee(s)submit(s)acceptable documents required by the Surface Mine Reclamation Act and rules,especially WAC 332-18-150.The proposed transferee(s)may be required to submit the following documents,in complete and accept- able form,prior to approval by DNR: (1)SM-8A; (2)revised reclamation plan; (3)written approval of all parties having a possessory interest in the land; (4) revised SM-6; (5) SEPA checklist; and (6) adequate performance security. Prior to transfer, the permit must be in good standing and order. NEW PERMIT HOLDER AND/OR LANDOWNER/MINERAL RIGHTS HOLDER INFORMATION New Permit Holder Landowner/Mineral Rights Holder(attach signed topics If more thon one) ALLEN SHEARER SAND & GRAVEL LLC HARTMAN FAMILY TRUST, ' dated November 1 , 1990 Address Address P.O. BOX 789 3300 Irvine Ave. , Suite 103 USI No. 601 916 325 City,State,Zip City,State,Zip Belfair, WA 98528 Newport Beach, CA 92660 Phone Phone 360/275-3465 949/252-8111 11. 1 (We) agree to comply with all of the terms and conditions of the current approved Permit,the Surface Mine Reclamation Act, and rules. I(We)acknowledge that I(we)may be required to submit any or all of the documents listed in Section I above prior to approval of the transfer by DNR. New Permit Hol Si3nature � Lan wn ral Rights Holde ign AL EN M. SHEAf1 rlember JEF R�ZUAARTMAN Trustee Ill. With this signature, I (we) hereby relinquish all interes#-ih Surface Mining Permit No. 70-012066 subject to the approval of this transfer request by the Department of Natural Resources. Ct \Permit Holder Date RECEIVED \\ JEF'F HARTI N President C i, IV. 0This transfer has been approved by the Department of Natural Resources. Geology and Earth DNR Surface Mining Approved Signature Date (� \1 G'wt_ 5 Request for 7rensfer of Surface Mine Reclamation Permlt(SM-26) Revised 1I01 \