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HomeMy WebLinkAboutFPA No. 2418399 - FPA Permit / Conditions - 2/17/2016 'r FPA/N No: 2418399 WASHINGTON STATE DEPARTMENT OF Effective Date: 2/17/2016 ®® Natural Resources v PeterGoldmark-Commissioner of Public Lands Expiration Date: 2/17/2019 Shut Down Zone: 654 Forest Practices Application/Notification EARR Tax Credit: ® Eligible ❑ Non-eligible Notice of Decision Reference: Decision ❑ Notification Operations shall not begin before the effective date. ® Approved This Forest Practices Application is subject to the conditions listed below. ❑ Disapproved This Forest Practices Application is disapproved for the reasons listed below. ❑ Closed Applicant has withdrawn approved FPA/N FPA/N Classification Number of Years Granted on Multi-Year Request ❑ Class II ® Class III ❑ Class IVG ❑ Class IVS ❑ 4 yrs ❑ 5 yrs Conditions on Approval/ Reasons for Disapproval Note: Contact Forest Practices Forester at (360)490-6260 once reforestation obligations have been met. Please provide application number, species plated,stock type, and number of trees per acre planted. Issued By: Jason Sharp Region: South Puget Sound Title: Resource Protection Forester Date: 2/17/2016 Copies to: ® Landowner,Timber Owner and Operator. Issued in person: ❑ Landowner❑Timber Owner❑ Operator By: Washington State Department of Natural Resources-Notice of Decision•July 10,2012 Page 1 of 2 Aooeal Information You have thirty(30)days to appeal this Decision and any related State Environmental Policy Act determinations to the Pollution Control Hearings Board in writing at the following addresses: Physical address: 1111 Israel Rd. SW, Ste 301,Tumwater,WA 98501 Mailing address: P.O. BOX 40903, OLYMPIA,WA 98504-0903 Information regarding the Pollution Control Hearings Board can be found at: http://www.eho.wa.gov/ At the same time you file an appeal with the Pollution Control Hearings Board,also send a copy of the appeal to the Department of Natural Resources' region office and the Office of the Attorney General at the following addresses: Office of the Attorney General Department Of Natural Resources Natural Resources Division South Puget Sound Region 1125 Washington Street SE And 950 Farman Ave. N PO Box 40100 Enumclaw,WA 98022 Olympia,WA 98504-0100 Other Aoolicable Laws Operating as described in this application/notification does not ensure compliance with the Endangered Species Act, or other federal, state,or local laws. Hydraulic Project Anoroval(HPA)(Chanter 77.55RCW and WAG 222-50-020(211 The Department of Fish and Wildlife (WDFW), as the jurisdictional agency issuing HPAs, has final authority for approving water crossing structures in Type S and F waters.W DFW continues to have authority on Type N waters and may exercise that authority on some Type N waters. Notice:The HPA water crossing requirements supersede what is indicated on the FPA. Landowners are required by law to follow the provisions as directed on the HPA. Transfer of Forest Practices Aoolication/Notification fWAC 222-20-0101 Use the"Notice of Transfer of Approved Forest Practices Application/Notification"form. This form is available at region offices and on the Forest Practices website: http://www.dnr.wa.gov/businessoermitsfforesti2ractices. Notify DNR of new Operators within 48 hours. Continuing Forest Land Obligations(RCW 76.09.060. RCW 76,09.070.RCW 76,09,390,and WAC 222-20-055) Obligations include reforestation, road maintenance and abandonment plans,conversions of forest land to non- forestry use and/or harvest strategies on perennial non-fish habitat(Type Np)waters in Eastern Washington. Before the sale or transfer of land or perpetual timber rights subject to continuing forest land obligations,the seller must notify the buyer of such an obligation on a form titled"Notice of Continuing Forest Land Obligation".The seller and buyer must both sign the"Notice of Continuing Forest Land Obligation"form and send it to the DNR Region Office for retention.This form is available at DNR region offices. If the seller fails to notify the buyer about the continuing forest land obligation, the seller must pay the buyer's costs related to continuing forest land obligations, including all legal costs and reasonable attorneys'fees incurred by the buyer in enforcing the continuing forest land obligation against the seller. Failure by the seller to send the required notice to the DNR at the time of sale will be prima facie evidence in an action by the buyer against the seller for costs related to the continuing forest land obligation prior to sale. DNR affidavit of mailing: On this day 2/17/2016 1 placed in the United States mail at Enumclaw ,WA, (date mm/dd/yyyy) (post office location) postage paid, a true and accurate copy of this docu9iept. Notice, f eci FPA#2418399 Sharon Koehn 1l/ (Printed name) (Signature) Wastungton State Department of Natural Resources-Notice of Decision-July 10,2012 Page 2 of 2 _ .............. _..._ _ ,Z........... �.. 'p FPA/N#: 1A� .. 7MWASHINGTON STATE DEPARTMENTOF i� I Natural Resources Received Date: WDFW Concurrence Due Date: WDFW Concurrence Review Forest Practices Application/Notification Completed: Office Checklist Page 1 Comments Due Date: South Puget Sound Region Decision Due Date: FP Forester: lJ Shutdown Zone: % RMAP#: FPA/N CLASSIFICATION: { J 11 Alll [ )IVG [ )IVS RMAP Exempt:[ J 80/20 [ )No Forest Roads ( ]Ag [ )LLO Landowner W, ti �l` �L tj rl>t roject Name: Name: — v WRIA: 1:`1 �( WAU: it lA t wlyula' ......... WRIA: WAU: Legal Description: ° V' �I 't Activity Type: Harvest ac Spray ac Stream Crossing(s) Road Construction ` � .� _ft Road Abandonment It Rock Pit ac ALTERNATIVE PRESCRIPTIONS ( J Aftemate Plan [ ] Habitat Conservation Plan [ ) Ten-Year Forest Management Plan [ ] Landowner Option Plan for Northern Spotted Owl [ ] Columbia River Gorge National Scenic Area [ j Cooperative Habitat Enhancement Agreement [ ) Watershed Analysis: RESOURCE REVIEW Unstable Slopes(Risk: Highway,Water; ) [ ] Bull Trout Overlay [ j Soils Map(Highly Erodible&Very Unstable) [ ] HCP Bull Trout Population SLPSTAB [ ] Bald Eagle nest or roost within 660 feet ( ] Landslide Hazard Zonation ( ) Group A or B Water Supply(TRAX code DM or MU) [ ] Landslide Polygon [ ] Hatchery(TRAX code S)(Name: ) [ ] Rain-on-Snow and Outside Approved WA [ ] Even-Aged Harvest greater than 120 Acres [ ] Hydric Soils [ ) Ground-based Equipment on Slopes greater than 40% [ ]Wetland[ j Forested,[ j A, ( ] B [ ] Road Construction on Slopes greater than 65% [ ] In WMZ of[ j A,or[ j B Wetland [ j Saltwater Islands(Name: ) [,J-,In RMZ/ELZ of Type( ]S,NF, [ ) N water [ ] Water Verification ASSOCIATED NON-SCANNED DOCUMENTS—On file with the FPA/N at the region office. [ ) SEPA Checklist/Documents [ ]Large Landowner Road Maintenance and Abandonment Plan ASSOCIATED SCANNED DOCUMENTS [ ] Conversion Option Harvest Plan ( ] Hardwood Conversion Form [ ] FPHP Plans 8 Specifications [ J Wetland Mitigation Plan [ ] Qualified Expert Report [ j Water Protocol Surveys[ ]Modification ( ] Natural Regeneration Plan Form# ( ] Shoreline Permit ] Water Classification Worksheet [ ) Marbled Murrelet Form [ j Shade Documentation (Stream Shade Assessment Worksheet) [ ] FPBM Appendix(s) _ [ ] Watershed Analysis Worksheet ( ]Small Landowner RMAP Checklist [ ] DFC Printout [ J CMZ Assessment Form [ ] Slope Stability Informational Form EARR Tax Credit( ] Yes[ j No Form completed by ADDITIONAL tyOMMENTS For DNR Region Office Use Only �t 3CCTIr Vrim:. t' T � r AIT:-:r '..:.S ttllr l.:Tal t7 = Natural Resources FPAIN #: 1 Region: ' Forest Practices Application/Notification Received Date: - - f, Western Washington PLEASE USE THE INSTRUCTIONS TO COMPLETE THIS APPLICATION. TYPE OR PRINT IN INK. 1. Landowner,Timber Owner and Operator !Legal Name of LANDOWNER Legal Name of TIMBER OWNER iLegal Name of OPERATOR ' (if different than Landowner) (if different than Landowner) Cedarland Forest Resources Cedarland Purest RzsOUrres Cedarland Forest Re-sources Mailing Address: Mailing Address: Mailing Address: PO Box 2264 PO Box 2264 PO Box 2264 City, State, Zip City, State, Zip City, State, Zip Gig I Iarbor,WA 98 Gig Harbor,WA 98 Gig Harbor.WA 98 i Phone ( 253 ) 208-8136 Phone ( 253 ) 208-51 36 Phone ( 253 ) 208-8136 hemu'cedarlandforestre,ources.com hen it cedariandforestresource..coin ben,u;cedarlandf rre tresources.corn Email: Email: Email 2. Contact Person Contact Person: Phone( 253 ) 208-7686 I3en Cedarland hzn:rcedarl andforestresources.com !Email: NOTE: You are required to verify Type Np, and Ns water types within 200 feet of your proposed forest practices activities prior to submitting a Forest Practices Application / Notification. Use the Additional Information section, additional pages, the Water Type Classification Worksheet, and/or a Water Type Modification form to explain how you verified water types. See Water Typing Requirements in the instructions. 3. Landownership information: See instructions a. ONo ✓QYes Are you a small forest landowner per RCW 76.09.450? If Yes, go to b. b. FjNo ✓/Yes Is your entire proposed harvest area on a single contiguous ownership consisting of one or more parcel 4. If you are harvesting timber, enter the Forest Tax Reporting Account Number of the Timber Owner: 810-059-7 7-2 For tax reporting information or to receive a tax number, call the Department of Revenue at 1-800-548-8829. 5. Are you substituting prescriptions from an approved state or federal conservation agreement or watershed analysis? QNo ❑Yes Write"HCP" or"Using Prescriptions" in tables that apply. Attach or reference on file prescriptions and/or crosswalks. 5/9/2014 _ Page 1 of 7 Western Washington 6. What is the legal description of your forest practice? Section Township Range E/W Tax Parcel Number County 16 22 01 W 1 22 1 6-2=3-00WO Mason 3 ' 1 U[N)n approval of FRA, 7. When are you planning to begin work on the proposed activity? ; 8. Is the taxpayer eligible for the EARR Tax Credit? F-1No Q✓ Yes 9. Have you reviewed this forest practices activity area to determine whether it may involve historic sites and/or Native American cultural resources? Read the instructions before answering this question. No Q✓ Yes 10. Do you have a DNR approved Road Maintenance and Abandonment Plan (RMAP)? a. 0 No F]Yes List the RMAP number: If no, go to b. b. F] No R Yes Is a Checklist RMAP required?(see instructions) 11. Are there potentially unstable slopes or landforms within the boundaries of your forest practices activity area? Q No ❑ Yes—attach geotechnical report and"Slope Stability Informational Form." If applicable, attach the SEPA checklist, HCP or Watershed Analysis prescriptions. 12. Are there potentially unstable slopes or landforms adjacent to your forest practices activity area? ©No R Yes—complete and attach the"Slope Stability Informational Form." If applicable, attach geotechnical report. HCP or Watershed Analysis prescriptions. 13. Is this forest practice application/notification: (Answer every question) a. ✓0 No []Yes Within city limits or inside an urban growth area? (IF YES SEE INSTRUCTIONS FOR ADDITIONAL REQUIRED DOCUMENTS.) b. [✓ No Yes For road work that is included in an approved Road Maintenance and Abandonment Plan (RMAP)? c. No ❑Yes Within a public park? If Yes, include SEPA Environmental Checklist or SEPA Determination -except for harvesting/salvaging less than 5,000 board feet within a developed public park. d. Q✓ No R Yes Within 500 feet of a public park? Park name: e. Q No Yes In an approved Conversion Option Harvest Plan (COHP)from the local government? If yes, include a copy. This only applies to proposals within urban growth areas. f. Q No ❑Yes Within 200' of the Ordinary High Water Mark (OHWM)or floodway of Type S water? If yes, check with the county or city to determine whether a substantial development permit is required under the local shorelines master plan. 519/2014 Page 2 of 7 Western Washington i g. © No Yes A request for a multi-year permit? If yes, length requested:Q 4 years or Q 5 years. Not everyone qualifies for a multi-year permit. See instructions for details. h. Q✓ No ❑Yes An Alternate Plan? If yes, include a copy. L Q✓ No ❑ Yes Within 50 miles of saltwater and do you own more than 500 acres of forest land in Washington State? If Yes - include the"Marbled Murrelet Form"or attach/reference HCP prescriptions. j. FV No ❑Yes In or directly adjacent to a potential Channel Migration Zone (CMZ)? If Yes—include the "CMZ Assessment Form."Attach/reference applicable HCP and/or Watershed Analysis prescriptions. * * * * * If not working in or over typed waters, skip to number 18 Prior to answering number 14-17 in this section please refer to the Forest Practices Application Instructions and Forest Practices Board Manual Section 5 (BM 5). 14. Are you proposing any of the following projects NOT permitted by current HPAs from WDFW? a. © No Yes Installing, replacing or repairing a culvert at or below the bankfull width of Type S or F Water(s) that exceeds a five percent gradient? b. 2 No ❑Yes Constructing, replacing, or repairing a bridge at or below the bankfull width of unconfined streams in Type S or F water(s)? c. FV No F Yes Placing fill material within the 100-year flood level of unconfined streams in Type S or F water(s)? 15. Have you consulted with DNR and/or WDFW about the proposed hydraulic project(s) in or over Type S or F water? Q✓ No Yes 16. If installing, replacing, removing or maintaining structures in or over any typed water,complete the table below. Type S and F waters require detailed plan information. Provide plan details in number 31 or attach plan to the FPA/N. Provide crossing locations and identifiers on your Activity Map. (A detailed plan with profiles may also be required for more complex hydraulic projects in Type N Waters per WAC 222-24-042(2)). d y 3 Q) O E io O t N U y -y •� a I I .tea) .. — O O>= z E a_ � C 7 p > > I N H a> .+ U o Z! = y ` m n -o m voi y0p c Col c p I O a n Q a = m n = o 0 0 a. CL Zma c> ) i pi� mc c r qap OZ IL o I ' I i i ' i I i i I i i "Existing HPAs issued by WDFW will be complied and enforced by WDFW until expiration. Plan details are not required for hydraulic projects permitted with an existing HPA(see instructions). "' Fords and equipment crossings on Type S and F Waters may result in an unauthorized incidental take of certain endangered or threatened fish species. For more information, see"Background for the state's Incidental Take Permits for certain endangered and threatened fish species"following number 24 of the FPA/N Instructions, 5/9/2014 Page 3 of 7 Western Washington 17. If conducting any of the following activities in or over typed water, complete the table below. Some activities will require identifiers on your Activity map and/or more information in number 31, Additional Information. See instructions. *Activity Type S Water Type F Water Type Np Water Type Ns Water Equipment Crossing*" Suspending Cables Cable Yarding LWD Placement/Removal Beaver Dam Removal Felling and Bucking _ Other(describe in number 31) *Existing HPAs issued by WDFW will be complied and enforced by WDFW until expiration. Plan details are not required for hydraulic projects permitted with an existing HPA(see instructions). `* Fords and equipment crossings on Type S and F Waters may result in an unauthorized incidental take of certain endangered or threatened fish species. For more information, see"Background for the state's Incidental Take Permits for certain endangered and threatened fish species"following number 24 of the FPA/N Instructions. 18. If constructing or abandoning forest roads complete the table below. Show the road locations and identifiers on your Activity Map. Include abandonment plans for temporary roads and abandonment projects. Road Construction Road Abandonment Road Identifier — -- (name, number) Length (feet) Steepest Length (feet) Abandonment Date Side-slope(%) Road I 10 ...._._..... 19. If depositing spoils and/or expanding or developing a rock pit for forestry use, complete the table below. Show locations and identifiers on your Activity Map. Amount of Spoils Rock Pit Identifier �— Spoil Area Identifier Deposited (name, number or Acres of New Rock Acres of Existing (letter. number) (cubic yards) letter) Pit Developed Rock Pit Expanded � ' I i 20. If operating in or within 200 feet of a wetland, complete the table below. Show the boundaries of each wetland, along with its identifier, and WMZ on your Activity Map. See instructions for information. Wetland Planned Wetland Type Planned Total Wetland How many How many Identifier (A, B,or [Activities in Activities in Area acres are you acres are you (number, Forested) Wetland Maximum (acres) draining? filling? letter) Width WMZ * * * * * If not harvesting or salvaging timber, skin to number 29 5/9/2014 Page 4 of 7 Western Washington 1 21. If harvesting or salvaging timber, complete the table below. Show all harvest areas and unit numbers on your Activity Map. For even-aged harvest units also show surrounding stand information on your Activity Map. Harvest Method c v (Rubber Tired Skidder, m o Harvest Type Tracked Skidder, Dozer, d E ' �' �' o o ea y s► Its c ) .. a (Even-aged, = Shovel, Full Suspension .a zs o a o a ° 010 EF Uneven-aged, Salvage, Cable. Lead end Suspension o 2 d 2 �, .� m « m Z Right-of-Way) `� Cable, Helicopter,Animal, U) 0 C E W E ai E cc E d a m "= ? a Z Chipper-forwarder, Slash °-' j PP ea o o m � `o° it m 2 M .. ea D m � Bundler) Qx > x > = v > x tnx i E\en-abed N tihrn el.$kidder �.-5 55 I(() I j Even-aced \ Sfiovel.Skidder l.? 2+ I IS 22. Reforestation. Check the appropriate box(es). Planting. Tree Species. -[ir-Knit I ❑✓ : ` ❑Natural. Include a Natural Regeneration Plan ❑Not required because of one or more of the following: ❑I am converting some or all of this land to non-forest land in the next 3 years or lands are exempted under WAC 222-34-050. ❑Individual dead, dying, down, or wind-thrown trees will be salvaged. ❑Trees are removed under a thinning program reasonably expected to maximize the long-term productivity of commercial timber. ❑I am leaving at least 100 vigorous, undamaged; and well-distributed saplings or merchantable trees per acre. ❑An average of 190 tree seedlings per acre are established on the harvest area and my harvest will not damage it. ❑ Road right-of-way or rock pit development harvest only. If you own MORE than 80 forested acres in Washington, skip to number 27 *" j 23. Are you using the exempt 20-acre parcel riparian management zone (RMZ) rule on type S, F, or Np waters? ❑ No If no, continue to number 27. ❑✓ Yes If yes, continue to number 24. See instructions for qualifications and information. 24. Choose the answer below that best fits your situation. Show all RMZs on your Activity Map. ❑✓ a. ALL of the following apply to me and my land. (If no, answer b.) • Between June 5, 2006 and today's date I have always owned less than 80 acres of forestland in Washington. • Between June 5, 2006 and today's date this parcel has always been 20 acres or less of contiguous ownership. - Between June 5, 2006 and today's date this parcel has always been owned by me or someone else that has owned less than 80 acres of forestland in Washington. __.........._._.. 5/9/2014 Page 5 of 7 Western Washington b. ONE OR MORE of the following apply to me and/or my land (check all that apply): I currently own more than 80 acres of forestland in Washington. Between June 5, 2006 and today's date I have owned more than 80 acres of forestland in Washington. Between June 5. 2006 and today's date this parcel has been more than 20 acres of contiguous ownership. Between June 5.. 2006 and today's date this parcel has been owned by someone that has owned more than 80 forested acres in Washington. 25. If harvesting within 115 feet of a Type S or F water on an exempt 20-acre parcel, complete the table below. Show RMZs and stream segment identifiers on your Activity Map. (Include stream shade assessment methodology if you are harvesting within 75 feet, or the maximum RMZ, whichever is LESS. If using BM1 to evaluate shade, you may use the"Stream Shade Assessment Worksheet"). Are you Stream Segment Water Type Segment Length Bankfull Width Maximum RMZ harvesting within Identifier I Width the maximum (letter) (S,F) (feet) (feet) {feet} RMZ? (Y or N) A f= ?;i i 58 N I 26. Are you harvesting within 29 feet of a Type Np water on a 20-acre exempt parcel? []✓ No Continue to number 29. ❑Yes See instructions and describe leave tree strategy in number 31. Then continue to number 29. 27. If harvesting within 200 feet of any of Type S or F waters, complete the table below. Include DFC for all inner zone harvests unless you have an HCP prescription. Show RMZs, CMZs, and stream segment identifiers on your Activity Map. (Include stream shade assessment methodology if you are harvesting within 75 feet of S or F waters. If using BM1 to evaluate shade, you may use the"Stream Shade Assessment Worksheet"). Stream RMZ Stream Is there a Harvest Total width Segment Water Type Site Class DFC Run Width CMZ? Code(s) of RMZ Identifier (S or F) (I-V) (feet) (Y/hl) {see Number ( (feet) (letter} i instructions} 28. If harvesting within 50 feet of Type Np water, complete the table(s) below. Show RMZs and stream segment identifiers on your Activity Map. �j Stream Total Length of No-Harvest, I Stream Total Length of No-Harvest, Segment Stream 50-foot Buffers in Segment Stream 1 50-foot Buffers in Length in I Length in Identifier Harvest Unit I Identifier Harvest Unit (letter) ! Harvest Unit (feet) {letter) Harvest Unit (feet) (feet) (feet) I 5/9/2014 Page 6 of 7 Western Washington 29. How are the following marked on the ground? (Flagging; paint, road, fence. etc.) Harvest Boundaries: Pink "Timber Har\est Boundar\"f"THB"1 Ribtxm Clumped Wildlife Reserve Trees/Green Recruitment Trees: ('(umred in RM7_of Streams A Right-of-way limits/road centerlines: of marked-hest fit centered on I hlit 2 frorn SR 302 as per State[X)T I rmit. Stream Crossing Work: Riparian Management Zone Boundaries and Leave/Take Trees: Pink"I'lIB"Ribhon at S8',"THB"around lease trees Channel Migration Zone: Wetland Management Zone Boundaries and Leave/Take Trees: h-,A 30. Are you converting the land to non-forestry use within 3 years of harvest? ✓0 No F1 Yes If yes, include your SEPA Determination and/or SEPA checklist. 31. Additional information (attach additional pages if necessary): For hydraulic projects in or over S or F water(s) see instructions for required plan information. iK buffer installed with pink "Timber Harvest BOUDdary"11aggin or, 'wide cohhle-"gr:i:cl substrate creek. 22 requisite leave trees required within buffer(hoth sides)flagged with pink""I imher Harvest Boundary"flagging around trees. 32. We acknowledge the following: • The information on this application/notification is true. We understand this proposed forest practice is subject to: The Forest Practices Act and Rules AND All other federal, state or local regulations. Compliance with the Forest Practices Act and Rules does not ensure compliance with the Endangered Species Act or other federal, state or local laws. If we said that we would not convert the land to non-forestry use, the county or city may deny development permits on this parcel for the next 6 years. • The following may result in an unauthorized incidental take of certain endangered or threatened fish species: Conversion of land to non-forestry use. Harvesting within the maximum RMZ on a 20-acre exempt parcel that was acquired after June 5, 2006. Equipment Crossings/Fords in or over Type S and F Waters. Signat of LAND Signature of TIMBER OWNER' Signature of OPERATOR (if different than landowner) (If different than landowner) Print ame- en c_cdarlanc Print Name: Print Name: 01/11/2016 Date: Date: Date: NOTE: If you are a "Perpetual Timber Rights Owner,"and are submitting this without the Landowner's Signature, provide written evidence the landowner has been notified. Please make a copy of this FPAIN for your records. If this FPA/N contains a hydraulic project requiring WDFW concurrence review, it will not be available online for public review until after the WDFW concurrence review period. 5/9/2014 Page 7 of 7 Western Washington Exhibit A. Gedarland Allyn Parcel Harvest 4acres i' A' t' < 170672 FH_._.- 1706628 r� s' J SR 302 I' Str.A Unit 1 i Type F l ' s1 s1 - T22ON R1-0 2 1 West �t Parcel +ff, s 12216-24-00000 ego ,) i r 17 700 1706608 * Ef Legend IF r MASTER2000_Tlc Harvest Unit Boundary trans(existing roads) Forest Management •=—,wchydro(strearns) RMZ Solutions LLC TN_contour40 county for O VVA Legal Descriptions XX"X Stream not present Cedarland Forest Resources Parcels /� NAD 1983 UTM 10 0 125 250 500 750 1.000 1 inch =400 feet Feet i I Western Washington dilater Type Classification; Worksheet S*ream!Segment iD.,_! StreanVSegment ID Stream/Segment ID: Nate Observea _l �1—i( date Oaserved: Date Observed. 1. Do you have a protocol survey? (See the Board Manual Section 13) Or.does the stream have waiver characteri s? (See WAC 222-16-031(3)(b)(ii)) No. Continue. F L j No. Continue ❑No. Continue. Yes.Attach documentation or r Yes.Anacn documentation or ❑ yes.Attach documentation or approved 1NTMF number: approved,"At-MF riurnber approvec WTUF number. Di Fish found.Stop. Fish.found Stor. E-'Fish found Stop. No frSri found. S3O to G; a No fish fond.Go to 6 No ash found Go to 6. Wers fish observed or are fish known io use the stream any time of the year'? es.Typ=F water. Stac - 'res.Type=;water Stop Yes. Type F water. Stop. No Continue. ! No Continue. r, i f No. Confinue, 3. Is there an impoundment(ponded water)upstream of the assessed segment,that is greater than,.5 acres? Yes Ype F water Stop Yes.Type F water.Stop Yes. Ype F water S;::l: r-No. Continue No Continue, 7 Na. Co.^.tinue. 4, Are there segments within or above the assessed portion of the stream where the average BFW is two feet or greater? AND the average stream gradient is less than or equal to 16%? "es. T vpe F water. Siop. L. Yes.Type F water. Stop. i"es. Type F water.Stop r No Continue Lj No. Continue. LD No.Continue 5. Are there segments within or above the assessed portion of the stream where the average BFW is two feet or greater? AND the average stream gradient is between 16%and 20%? AND,the contributing basin to the stream is greater than 59 acres? Yes_Type F water. Stop. Yes.Type F water. Stop. J Yes.Type F water Stop_ No.. von t;nifc. �+o "Cont ue - No.Cont" Does the stream segment contain water at all times during a normal rainfall year? ti"es —ype Np water. Go to 9 veS Type;vp water. Go to 9. Yes.Type NP wafer. CsG to y No. Continue. No. Conti^ue. 7_._ No Continue. 'r. Is the stream segment downstream of a perennial source of water? Yes -jape No water tie tc 9. Yes.-yt;¢?N,:water Go to 2. LED Yes.-i yaa N p water. :v a G. = No C.ortinue i o Continue No. Continue. 3. is the stream physically connected by an above-ground channel to Type S, !_,or hop water? ;; Yes. Type vs water.Step (_ :`es.Type Ns water. Stop, Yes, Type Ns water. Stop. itiC. ...o.j-typed wpte" No non'ypea water. No, non•rypeowater. 9. Describe how you determined the uppermost point of perennial glow. Include a description of its location and show the point on a map(Use a separate Piece of paper if necessan,). StreamlSegment ID Description, wTCw revised 08!15/2013 �.) "rest•�ri Y,lashsiq:pn FOREST PRACTICE ACTIVITY MAP TOWNSHIP 22 NORTH HALF 0,RANGE 01 WEST{W.M.)HALF 0,SECTION 16 Application#:. �F IF h \ I 1 I 1706646 1706648 1706740 1 + * } I 1 l � k j y X I 1706626 78 1706720 + 4l r <c � \ I 1 I 17066M S P Sound 1706608 t1706700' Puget + r. X l J I' S Puget Sound f J l l u U. 1 U (J 1 t j, 1705686 _. -,.=0568a_.__.._ 17057 44th St KPN I: l I. r, I 4 1' t I Feet Please use the legend from;he FPA[nstructim or p+ovide a list of symbrr[s usfi 1,000 Date:1l1112016 Time:4:07:52PM NAD 83 Contour interval.40 Fee: _ :� - ir^ �£ r� ��` °� „'� �`'X.ax�'�la: �r '! r�.* '•'i�K.�r+�y'�i ��. fig" a�".3t'`,�. ��, , per &.:s� ,y, .. � '�• #, '^�• 7ia:-,�` �,.:c:'+a�-. '+ i• `r�d�;� ���'.'��'�'7 ••,k���3".,-�.�� x*�x. a ):+))1'4"'t� A ' '��`' i, R, a "° �.'r• .a+�. M tY�.ti '*^�/� 5`J.."t bail .. b. r tk ' �> . k• . ti a ..�� .A a 4 Y ALol'�' £"'fva Ylx� k d x'e'� i F' ^�^nY .€. !C. Y �5{ A^x �� • J r y� 41'y' L s .,ram fir. � .��, ., ��,• .ti. �i ' n 7 � S l M Revisions to FPA/N 2418399 DATE DOCUMENT DESCRIPTION 2/09/2016 #31 Revised Information 29. Now are the following marked on the ground? (Flagging. paint road. fence. etc) lint, 'i I1OX-r Hart i,!14,;un+lan' 'i I Ili")K,ittw sn Harvest Boundaries --- Clumped Wildlife Reserve Trees/Green Recruitment Trees. i•tuml><.1,n Kit%A ]u'ran!,1 \,d w.irkt-d tx•.i itt.• iiiered Right-of-way limitsiroad centerlines Stream Crossing Work. r Riparian Management Zone Boundaries and LeaveiTake Trees VA Channel Migration Zone Wetland Management Zone Boundaries and Leave/Take Trees 30. Are you converting the land to non-forestry use within 3 yean3 of harvest? 0 No ❑Yes If yes. include your SEPA Determination andfor SEPA checklist. 31. Additional Information(attach additional pages if necessary): For hydraulic proiects in or over S or F waterts?see instructions for required plan information is •„fir, vt>t.JtcJ++rth inn1, "lunit^ td:u,c.l l;.u+n.ktr'+"Il,,__nr,ai "+++ai�uhi,ic_ratil :ul+�lr:drin•rk 32. We acknowledge the following: The information on this applicationmotificat!on is true. • We understand this proposed forest practice is subject to Tne Forest Practices Act and Rules AND All other federal, state or local regulations • Compliance with the Forest Practices Act and Rules does not ensure compliance with the Endangered Species Act or other federal, state or focal laws. • if we said that we would not convert the land to non-forestry use, the county or city may deny development permits on this parcel for the next 6 years The following may result in an unauthorized incidental take of certain endangered or threatened fish species Conversion of land to non-forestry use Harvesting within the maximum RMZ on a 20-acre exempt parcel that was acquired after June 5 2006 Equipment Crossings/Fords in or over Type S and F Waters. Signat of LAN Signature of TIMBER OWNER' Signat a of OPERATOR (If different than landowner) XdiePrint me .tr c iJ.arliu',if Print Name. All i Date "i i i _'air, Date Date 2 S v� Z to NOTE 1f you are a -Perpetual Timber Rights Owner...and are submitting this without the Landowner s Signature provide written evidence the landowner has been notified Please make a copy of this FPA/N for your records. if this FPA/N contains a hydraulic project requiring WDFW concurrence review, if will not be available online for public review until after the WDFW concurrence review period. 519/2014 Page 7�.f 7 western Washington