HomeMy WebLinkAboutSHX2008-00026 JARPA - SHX Inspections - 4/15/2008 �0N_STATED MASON COUNTY
P c DEPARTMENT OF COMMUNITY DEVELOPMENT
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o A o 1 Planning Division
o T z P O Box 279, Shelton,WA 98584
o N Y o~ (360)427-9670
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1864
Exemption from Shoreline Management Act
Case No.: SHX2008-00026 Substantial Development Permit Requirement
The Proposal By: DERK B.ADAMS
KAREN E ADAMS
2402 OLD BELFAIR HWY TO BE KEPT IN THE
BELFAIR, WA 98528 PARCEL FILE
To undertake the following development:
Emergency replacement of storm damaged bridge in same footprint. Removal of existing bridge
from site install 2 concrete abutments Tx 18'x 12' and install 18"x 12'x91' steel bridge on project
site (30'x120').
Within UNION RIVER and/or its associated wetlands is exempt from the requirement of substantial development
because the development is categorized under WAC 173-27-040(2)as being category
D-emergency construction
Please contact James Scholz at ext 294 if you have any questions.
Issued: 4/15/2008 � ��7"1
Expires: 4/15/2010 Authorized Local Government Official
cc: APPLICANT WDFW USACOE WDOE TRIBAL COUNCILS/�
/
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AGENCY USE ONLY
Agency Referedce#:
D"ate Receivsd: ,
,ogc�t gout.0-a,'gency). : ,
JOINT AQUATIC RESOURCES PERMIT APPLICATION FORM (JARPA)
(for use in Washington State)
PLEASE TYPE OR PRINT IN BLACK INK.
TO FILL IN ELECTRONICALLY, USE F11 TO MOVE THROUGH THE FORM
❑ Application for a Fish Habitat Enhancement Project per requirements of RCW 77.55.290. You must submit a copy of this
completed JARPA application form and the (Fish Habitat Enhancement JARPA Addition)to your local Government
Planning Department and Washington Department of Fish &Wildlife Area Habitat Biologist on the same day.
NOTE: LOCAL GOVERNMENTS—You must submit any comments on these projects to WDFW within 15 working days.
Based on the instructions provided, I am sending copies of this application to the following: (check all that apply)
❑ Local Government for shoreline: ❑Substantial Development []Conditional Use []Variance [aE/xemption ❑Revision
❑Floodplain Management FICritical Areas Ordinance
KWashington Department of Fish and Wildlife for HP (Submit 3 copies to WDFW Region)
Washington Department of Ecology for 401 Water Qu ice-Federal Permit Unit)
iK Washington Department of Natural Resources for Aquatic Resources Use Authorization Notification
Corps of Engineers for. ❑ Section 404 ❑ Section 10 permit
❑ Coast Guard for: General-Bridg *0 Permtt-- ❑ Private 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
SECTION A-Use for all permits covered by this application. Be sure to ALSO complete Section C(Signature Block)for all
permit applications.
1.APPLICANT
AILJNG
MES
M02,DR^ ' Fes. l" �W ¢,(� 1 R -
C/ l ti � � 10&5—2 8
WORK PHONE E-MAIL ADDRESS HOME PHONE FAX#
If an agent is acting for the applicant during the permitprocess, complete#2. Be sure agent signs Section C(Signature Block)
for all permit applications
2.AUTHORIZED GENT
141 M'l V
MA.LING AQDR S /11 J _/4< -l S�
ORK PHONE E-MAIL A DRESS Vv HOME P ONE FAX#
360 z.?� q 00) 1360 3 ya &oZ y
3. Relationship of applicant to property: OJ OWNER ❑ PURCHASER ❑ LESSEE ❑
4. Name, address and phone number of property owner(s)if other than applicant:
5 q��i� (st��etaddress,fincludingity,coun��a�i zips odZ wJere prQp�o 2 tivity exists or will occur)
Local govemment with jurisdiction(cityor county) /` 4 N `j 0A)T
Waterbody you are working in UN;arl (Z;iJ0___ Tributary of WRIA#
Is this waterbody on the 303(d)List" YES NO
If YES,what parameter(s)?
"For 303d List, Shoreline designation 1"tUV-'eJ_
hftp://www.ecy.wa._qov/programs/Wq/303d/index.html p _
Zoning designation I`
'/.Section I Secfion Township I Range Government Lot
P/N, , 1 (a 2-3 A) 23f 6L3 J 0p00 DNR stream type if known
Latitude and Longitude: Fax Parcel Number I L 3 1 b 131 0000
ECY 070-15(Rev. 11/04) JARPA Contact the State of Washington Office of Regulatory Assistance for latest version or call 360/407-7037 or 800/917-0043
1
6. Describe the current use of the property,and skuctures existing on the property. Have you completed any portion of the proposed
activity on this property? ❑ YES 0 NO
nFor any portion of the(�proposed activi already completed on this property, indicate onth and year of com/pletion.
IZe.S,dlt�,,,Cl^� UpcAIk/A e Jr1S-t AJJ - AIJA 6a.;S�'i"I t)C4M4
Fp r N��GaS ,� E y r,4S✓ 70 6LJ re-p 1&" /
Is the property agricultural land? ❑ YES �J NO 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 marls. 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.
Move, FkiSy)'J p grl Qii3 SJPPdXTS., Ik)ST4U 2 CO-J rLl`(— ,t�v-r
o,f iTees- r'4C 01 P;Ju- 4 tNSTat( SY"L- Q w7 t., A LUr0SS r4'
l ON)
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 MAY BE REQUIRED BY OTHER AGENCIES.
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. -TIv, p V rDOs Zi is TOro v I ct(, 4 6C- SS T O
aa;cY(AQ — r®/ Zyo 2- OiA gttrwr- yt� aelF-4r C A. q Y72-J?
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 t (Jotuul i't` p lM .cts :S S'Jft �hM CdrN4-Ti.0 A✓i iJL- p, l( V'a S It
F,¢,)L� Oal`Ouv Nit Ara,, / d F Debllvr'l't S 0f t-, /�UOrI� To I, �►e.�orn"c.� �
P) StAJd-/ 411 R(Mo0el tvIK�n)al1 OF ev;s-t%'J 1Si`;Ot milt � r&-/',,+ Got 7/'O'-4
S ilk, APoy CitiPt-cCoV of NWS 11,V 'trvAX'- �;S-ru b�Arms Ws 6e,
l`e p tH.jrcd W►A yr,.ss 1 or gj\ . tk od go.AA A/w oN� )
7d. For in water construction wo ,will your project be in compliance with the State of Washington water quality standards for turbidity
WAC 173.201A-110? YES NO (See USEFUL DEFINITIONS AND INSTRUCTIONS)
8. Will the project be constructed in stages? YES g NO ❑
Proposed starting date: AS ,SpOnJ AS PoSSccb(A—
Estimated duration of activity: I ('10,dY4
9. Check if any temporary or permanent structures will be placed: }-
❑ Waterward of the ordinary high water mark or line for fresh or tidal waters AND/OR br IrAV r)
❑ Waterward of the mean higher high water for tidal waters?
10.Will fill material(rock,fill,bulkhead,or other material)be placed:
❑ 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)
ECY 070-15(Rev. 11/04) JARPA Contact the State of Washington Office of Regulatory Assistance for latest version or call 360/407-7037 or 800/917-0043
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11. Will material be placed in wetlands? ❑ YES NO
If YES:
A. Impacted area in acres:
B. Has a delineation been completed? If YES,please submit with application. ❑ YES (� NO
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.) O'NveL
E. Material source: PW t.)A4, TOP S of L
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).
G. WILL PROPOSED ACTIVITY CAUSE FLOODING OR DRAINING OF WETLANDS? ❑ YES (� NO
If YES, IMPACTED AREA IS ACRES OF DRAINED WETLANDS.
NOTE:If your project will impact greater than%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 will be required from Ecology in addition to an approved mitigation plan if your project impacts wetlands that are: a)greater than Y,acre in size,
or b)tidal wetlands or wetlands adjacent to tidal water. Please submit the DARPA form and mitigation plan to Ecology for an individual 401 certification if a)or b)applies.
12. Stormwater Compliance for Nationwide Permits Only: 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?
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)
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:
14. Has the State Environmental Policy Act(SEPA)been completed ❑ YES NO
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
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.
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:
ECY 070-15(Rev. 11/04) JARPA Contact the State of Washington Office of Regulatory Assistance for latest version or call 360/407-7037 or 800/917-0043
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SECTION B - Use for Shoreline and Corps of Engineers permits only:
17a. Total cost of project. This means the fair market value of the project, including materials, labor, machine rentals, etc.
A � D 0
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. See instructions for information on ESA.'
FEDERAL FUNDING YES NO If YES, please list the federal agency.
18. Local government with jurisdiction: �!} 4.✓ '/c ..
19. For Corps, Coast Guard and DNR permits, 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
SECTION C- This section MUST be completed for any permit covered by this application
0. 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
this application is made,the right to enter the above-described location to inspect the proposed,in-progress or completed work. I
agree to start work ONLY after all necessary permits have been received.
DATE
SIGNATURE OF APPLICANT 2— -U 8'
DATE
SIGNATURE 07AUTHORIZED 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.
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. (Desp01 Ay,'pe 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
ECY 070-15(Rev. 11/04) JARPA Contact the State of Washington Office of Regulatory Assistance for latest version or call 360/407-7037 or 800/917-0043
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