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HomeMy WebLinkAboutSHX2023-00052 Bulkhead JARPA - SHX Application - 12/11/2023 RECEIVED RECEIVED: MASON COUNTY DEC 11 2023 COMMUNITY SERVICES 615 W. Alder Street Building,Planning,Environmental Health,Community Health 615 W.Alder St.—Bldg.8,Shelton,Wa 98584 Phone:(360)427-9670 ext.352 ♦ Fax:(360)427-7798 PERMIT NO.:or,1,A 013- CM5*;- SHORELINE PERMIT APPLICATION SHORELINE PERMITS CONDITIONAL USE* SUBSTANTIAL DEVELOPMENT ❑ VARIANCE* ❑ EXEMPTION R ACCESSORY DWELLING UNIT* ❑ The Washington State Shoreline Management Act (RCW 90.58) requires that substantial developments within designated shorelines of the state comply with its administrative procedures (WAC 173-14) and the provisions of the Mason County Shoreline Management Master Program. The purpose of this Act and local program is to protect the state's shoreline resources. The program requires that substantial development (any development of which the total cost or fair market value exceeds $7,047.00 or materially interferes with the normal public use of the water or shorelines of the State be reviewed with the goals, polices, and performance standards established in the Master Program. Answer all questions completely. Attach any additional information that may further describe the proposed development. Incomplete applications will be returned. *Shoreline Variances and Conditional uses require public hearings and have additional pages that shall be attached to this application. APPLICANT: Shelly Knuth ADDRESS: 81 Grape Dr (street) Grapeview, WA 98546 (city) (state) (zip) TELEPHONE: 360-802-5350(Mark-caregiver) (home) (business) AUTHORIZED REPRESENTATIVE: Terri Schultz/Permit Granted LLC ADDRESS: 4810 Pt Fosdick Dr NW#156 (street) Gig Harbor, WA. 98335 (city) (state) (zip) TELEPHONE: 253-377-3713 cell 253-313-5194 office PROPERTY DESCRIPTION: General location (include property address, water body and associated wetlands—identify the name of the shoreline): Rev. Nov. 30, 2021 Include all parcel numbers: Projects located in open water areas, away from land shall provide latitude/longitude. PN: 01 21 08-51-01 01 3 located at 81 Grape Dr, Grapeview, WA 98546. A residential shoreline designated property located on marine shoreline of Puget Sound, Case Inlet. Completed project location is at shoreline edge, along the SE portion of existing bulkhead. A 15' section of bulkhead has been replaced with new rock bulkhead due to collapse. OWNERSHIP: pp � Contract (Identify) Applicant Owner Lessee Purchaser Other Owner:Shelly Knuth 81 Grape Dr, Grapeview, WA 98546 (street) (city) (state) (zip) DEVELOPMENT DESCRIPTON: Development proposal (identify and describe the proposed project, including the type of materials to be used, construction methods, principle dimensions, and other pertinent information): Replaced 15 linear ft of existing collapsed 6' high concrete bulkhead with new rock bulkhead at shoreline edge, constructed from barge using heavy excavator. Existing Use (identify current use of property with exist improvements): Residential Reason for requesting development: The project was completed in Feburary under expedited WDFW HPA Application 30812. The neighbor to the East bulkhead was falling over and taking this 15' portion of the Knuth bulkhead along with it. The work was performed when the neighbors emergency bulkhead repair was done to mimimize environmental construction impacts. An additional bulkhead was also repaird/replaced at that time on parcel 12108-51-01011 (Cederstrom). Separate applications have been submitted for those associated parcels. Art�r� 2 I oq -4 1 -U ( D 14 f- (1( a-4,- $15,000 Estimated Fair Market Value of Project to Closest$1,000: The Applicant shall provide, at a minimum, the following information: a. SITE PLAN -drawn to scale and including: i. The boundary of the parcel(s) of land upon which the development is proposed; ii. The ordinary high water mark (OHWM). This may be an approximate location provided, that for any development where a determination of consistency with the applicable regulations requires a precise location of the OHWM the mark shall be located precisely and the biological and hydrological basis for the location as indicated on the plans shall be included in the development plan. Where the OHWM is neither adjacent to or within the boundary of the project, the plan shall indicate the distance and direction to the nearest OHWM of a shoreline; iii. Where appropriate, the proposed land contours using five-foot intervals in water area and ten-foot intervals on areas landward of OHWM, if development involves grading, cutting, filling, or other alteration of land contours; iv. The dimensions and location of existing structures which will be maintained; v. The dimensions and locations of proposed structures; parking and landscaping; vi. The location of proposed utilities, such as sewer, septic tanks and drain fields, water, gas and electricity, vii.The location, source, composition, and volume of fill material; viii. The location, composition and volume of any extracted materials, and proposed disposal area; b. CROSS SECTION, drawn to scale including: i. The existing ground elevations; ii. The proposed ground elevations; iii. The location and height of existing structures; iv. The location and height of proposed structures; V. The OHWM. c. VICINITY MAP, including: i. The location of subject parcel using natural points of reference (roads, state highways, prominent landmarks, etc.). ii. If the development involves the removal of any soils by dredging or otherwise, identify the proposed disposal site on the map. If disposal site is beyond the confines of the vicinity map, provide another vicinity map showing the precise location of the disposal site and its distance to nearest city or town. iii. On the map, or separately, give a brief narrative description of the vicinity of the proposed project including identification of the adjacent uses, structures and improvements, intensity of development and physical characteristics. d. ADJACENT LANDOWNERS. Provide names and mailing addresses of all real property owners within 300 feet of property line boundaries where development is proposed as mailing labels or pre-addressed envelopes. ACKOWLEDGEMENT: I hereby declare, to the best of my knowledge and belief, the forgoing information and all attached information is true and correct. October 25, 2023 ( plicant or Authoriz &presentative) (date) Publication Cost Agreement Publication cost is the responsibility of the applicant. Final permit processing will not occur until advertising fees have been paid to the newspaper by the applicant. The Shelton-Mason County Journal will bill the applicant directly. Billing Address: Email: l�l�/ -3 Phone: ( � 3) _3 77 I / WE understand tha WE must sign and date the attached acknowledgment indicating and that I / WE understand that is MY / OUR responsibility. I / WE must submit the signed page as part of application in order for it to be considered as complete. Signature of Property Owner Date Print Name OR Signature pplicant Date Print Name 81 East Grape Drive,Grapeview,WA C, )( f1l Restaurants WI Hotels [2 Things to do ® Transit P Parking d Pharmacies ©ATMs ••• 302 — A ark© z 3 F i' Mason County VaughnYMCA Camp Seym Fire-EMS 1 3 KEYCENTER Knuth - Project Location:Shoreline ( Fair Harbor Marine Stretch Point State Park- 81 E Grape Dr ;/ C / Marine My Haunted Forest Q �� i ) access only w BuildingGrapevie Grapeview WA98546 // % Grapeview / �.�(r� 3 O O Stretch Island Directions Save Nearby Sendto Share / x phone _.. v Master Pa Blaster's Q j intball Park a - 3 F Q 81 E Grape Dr,Grapeview,WA 98546 f Suggest an edit on 81 E Grape Dr 0+ Add a missing place Harstene Pointe North Beach Key Peninsula a L6ttheran Church Add your business Haley 9 Hollow P State Park Label Knuth-Project Location:Shoreline / Q Harstene Point Clubhouse'' Jyell Cove State Park JUSTICE LLB d �, Clearing-L a ing / Home Park© Herron Island Ferry Dock m Home l/ + A O n j ♦ D n � o" r yc Z er - is _ Map data 02023Google United Steles Terms Privacy Send Product Feedback 2000 H• t ----------- -------- . Rao STATD ; ^REl V E D ��I WASHINGTON STATE Army Corps Date received: of a of Engineers i SeattleDtnc� DEC I 1 2023 Joint Aquatic Resources Permit Agency referee Application (JARPA) Form',' i L USE BLACK OR BLUE INK TO ENTER ANSWERS IN THE WHITE SPACES BELOW. Tax Parcel#(s): ------------------------------ Part 1—Project Identification 1. Project Name (A name for your project that you create. Examples: Smith's Dock or Seabrook Lane Development) hel Knuth Shoreline Exemption for Bulkhead repair Part 2—Applicant The person and/or organization responsible for the project. [help] 2a. Name (Last, First, Middle) Knuth, Shelly 2b. Organization (If applicable) 2c. Mailing Address (Street or Po Box) 81 E Grape Dr 2d. City, State, Zip Grapeview, WA, 98546 2e. Phone(1) 2f. Phone(2) 2g. Fax 2h. E-mail 360-802-5350 markknauss@hotmail.com (Mark) 'Additional forms may be required for the following permits: . If your project may qualify for Department of the Army authorization through a Regional General Permit(RGP),contact the U.S.Army Corps of Engineers for application information(206)764-3495. • Not all cities and counties accept the JARPA for their local Shoreline permits. If you need a Shoreline permit,contact the appropriate city or county government to make sure they accept the JARPA. 2To access an online JARPA form with[help]screens,go to http://www.epermitting.wa.gov/site/alias resourcecenter/iarpa iarpa form/9984/iarpa form.aspx. For other help,contact the Governor's Office for Regulatory Innovation and Assistance at(800)917-0043 or help(a_)oria.wa.goy. ORIA-revised 07/2022 Page 1 of 12 Part 3-Authorized Agent or Contact Person authorized to represent the applicant about the project. (Note: Authorized agent(s) must sign 11 b of this application.) hel 3a. Name (Last, First, Middle) Schultz, Terri 3b. Organization (If applicable) Permit Granted, LLC 3c. Mailing Address (street or PO Box) 4810 Pt. Fosdick Dr NW Suite #156 3d. City, State, Zip Gig Harbor, WA, 98335 3e. Phone (i) 3f. Phone(2) 3g. Fax 3h. E-mail 253-313-5194 253-377-3713 info@permitgranted.com Part 4-Property Owner(s) Contact information for people or organizations owning the property(ies) where the project will occur. Consider both upland and aquatic ownership because the upland owners may not own the adjacent aquatic land. hLe ® Same as applicant. (Skip to Part 5.) ❑ Repair or maintenance activities on existing rights-of-way or easements. (Skip to Part 5.) ❑ There are multiple upland property owners. Complete the section below and fill out JARPA Attachment A for each additional property owner. ❑ Your project is on Department of Natural Resources (DNR)-managed aquatic lands. If you don't know, contact the DNR at (360) 902-1100 to determine aquatic land ownership. If yes, complete JARPA Attachment E to apply for the Aquatic Use Authorization. 4a. Name (Last, First, Middle) 4b. Organization (If applicable) 4c. Mailing Address (Street or Po Box) 4d. City, State, Zip 4e. Phone(1) 4f. Phone(2) 4g. Fax 4h. E-mail ORIA-revised 0712022 Page 2 of 12 Part 5—Project Location(s) Identifying information about the property or properties where the project will occur. hf eM ❑ There are multiple project locations (e.g. linear projects). Complete the section below and use JARPA Attachment B for each additional project location. 5a. Indicate the type of ownership of the property. (Check all that apply.) neI Z Private ❑ Federal ❑ Publicly owned (state, county, city, special districts like schools, ports, etc.) ❑ Tribal ❑ Department of Natural Resources (DNR)— managed aquatic lands (Complete JARPA Attachment E) 5b. Street Address (Cannot be a PO Box. If there is no address, provide other location information in 5p.) heI 81 E Grape Dr NW 5c. City, State, Zip (If the project is not in a city or town, provide the name of the nearest city or town.) heI Grapeview, WA, 98546 5d. County heI Mason 5e. Provide the section, township, and range for the project location. LLLeM 1/4 Section Section Township Range 17 21N 1W 5f. Provide the latitude and longitude of the project location. heI • Example: 47.03922 N lat./-122.89142 W long. (Use decimal degrees- NAD 83) 47.31594 N lat. / -122.832236 W long. 5g. List the tax parcel number(s) for the project location. heI • The local county assessor's office can provide this information. 121085101013 5h. Contact information for all adjoining property owners. (If you need more space, use JARPA Attachment C.) heI Name Mailing Address Tax Parcel # (if known) Brian and Lynita Scott 158 Prospect Ave N Seattle WA 98109 121085101012 Dillard Family Trust PO Box 690 Grape Dr Grapeview WA 98546 .__.........._......__._.........................._....._---....._.......----_._---...__..---...._-.___ 121085101014 ORIA-revised 0712022 Page 3 of 12 5i. List all wetlands on or adjacent to the project location. nei None 5j. List all waterbodies (other than wetlands) on or adjacent to the project location. nei Puget Sound, Case Inlet 5k. Is any part of the project area within a 100-year floodplain? of eM © Yes ❑ No ❑ Don't know. ***Coastal Flood Hazard Area 51. Briefly describe the vegetation and habitat conditions on the property. [tpipj The property exhibits residential landscaping. The high bank down to the shoreline is covered in ivy & Himalayan blackberry. 5m. Describe how the property is currently used. n( eV Residential 5n. Describe how the adjacent properties are currently used. nei Residential 5o. Describe the structures (above and below ground) on the property, including their purpose(s) and current condition. nei Single Family residence Detached garage 80 linear ft of 6' high rock bulkhead (15 ft collapsed) 5p. Provide driving directions from the closest highway to the project location, and attach a map. of eM From Mason County Community Services: Take W Alder to Wa-3 N/E Pine St, Turn L onto Wa-3/E Pine. Continue to follow Wa-3 for 15 miles. Turn R onto E Grapeview Loop. Continue onto E Eckert Rd. Turn R onto E Stretch Island Rd. Continue onto E Grape Drive. Destination will be on the Left. ORIA-revised 0712022 Page 4 of 12 Skokomish 4 Gra eview 101 East Grape Drive 101...... r r 27 min 18 miles Home v P �y Grant Lakeb, Ba ore MOUNTAIN - Harstine Island VIEW nd 615 West Alder Street Agate Longbr< Arcadia Part 6—Project Description 6a. Briefly summarize the overall project. You can provide more detail in 6b. Lj i -Work completed under Expedited WDFW-HPA Application 30812 -Replaced collapsed 15 linear ft of 80' long, 6' high rock bulkhead. 6b. Describe the purpose of the project and why you want or need to perform it. of eM A portion of the existing bulkhead collapsed during the December 2022 king tide/storm surge. The collapsed portion of bulkhead was adjacent to neighbor bulkhead (Dillard), which also failed. Bulkhead is needed to protect this property and the neighbor's property from shoreline erosion. 6c. Indicate the project category. (Check all that apply) hel ❑ Commercial ® Residential ❑ Institutional ❑ Transportation ❑ Recreational ❑ Maintenance ❑ Environmental Enhancement 6d. Indicate the major elements of your project. (Check all that apply) [help] ❑ Aquaculture ❑ Culvert ❑ Float ❑ Retaining Wall ❑ Bank Stabilization ❑ Dam /Weir ❑ Floating Home (upland) ❑ Boat House ❑ Dike/ Levee / Jetty ❑ Geotechnical Survey ❑ Road ❑ Boat Launch ❑ Ditch ❑ Land Clearing ❑ Scientific Measurement Device ❑ Boat Lift ❑ Dock / Pier ❑ Marina / Moorage ❑ Stairs ❑ Bridge ❑ Dredging ❑ Mining ❑ Stormwater facility ® Bulkhead ❑ Fence ❑ Outfall Structure ❑ Swimming Pool ❑ Buoy ❑ Ferry Terminal ❑ Piling/Dolphin ❑ Utility Line ❑ Channel Modification ❑ Fishway ❑ Raft ORIA-revised 07/2022 Page 5 of 12 ❑ Other: 6e. Describe how you plan to construct each project element checked in 6d. Include specific construction methods and equipment to be used. hel • Identify where each element will occur in relation to the nearest waterbody. • Indicate which activities are within the 100-year floodplain. A barge with ramp was brought in. The failed portion of bulkhead was removed from the site and new rock bulkhead constructed using heavy excavation equipment and large granite rock. 6f. What are the anticipated start and end dates for project construction? (Month/Year) hel • If the project will be constructed in phases or stages, use JARPA Attachment D to list the start and end dates of each phase or stage. Start Date: Feb 15, 2023 End Date: April 7, 2023 ❑ See JARPA Attachment D 6g. Fair market value of the project, including materials, labor, machine rentals, etc. hel $20,000 6h. Will any portion of the project receive federal funding? hf elpl • If yes, list each agency providing funds. Yes ® No ❑ Don't know Part 7—Wetlands: Impacts and Mitigation ❑ Check here if there are wetlands or wetland buffers on or adjacent to the project area. (If there are none, skip to Part 8.) hel 7a. Describe how the project has been designed to avoid and minimize adverse impacts to wetlands. h( eM ❑ Not applicable 7b. Will the project impact wetlands? hel ❑ Yes ❑ No ❑ Don't know 7c. Will the project impact wetland buffers? hel ❑ Yes ❑ No ❑ Don't know 7d. Has a wetland delineation report been prepared? hel • If Yes, submit the report, including data sheets,with the JARPA package. ❑ Yes ❑ No 7e. Have the wetlands been rated using the Western Washington or Eastern Washington Wetland Rating System? hel • If Yes, submit the wetland rating forms and figures with the JARPA package. ❑ Yes ❑ No ❑ Don't know 7f. Have you prepared a mitigation plan to compensate for any adverse impacts to wetlands? h[ gip] • If Yes, submit the plan with the JARPA package and answer 7g. • If No,or Not applicable, explain below why a mitigation plan should not be required. ORIA-revised 0712022 Page 6 of 12 ❑ Yes ❑ No ❑ Don't know 7g. Summarize what the mitigation plan is meant to accomplish, and describe how a watershed approach was used to design the plan. LLeM 71h. Use the table below to list the type and rating of each wetland impacted, the extent and duration of the impact, and the type and amount of mitigation proposed. Or if you are submitting a mitigation plan with a similar table, you can state (below) where we can find this information in the plan. hL eiN Activity (fill, Wetland Wetland Impact Duration Proposed Wetland drain, excavate, Name' type and area (sq. of impact3 mitigation mitigation area flood, etc.) rating ft. or type' (sq. ft. or category' Acres) acres If no official name for the wetland exists,create a unique name(such as"Wetland 1"). The name should be consistent with other project documents, such as a wetland delineation report. z Ecology wetland category based on current Western Washington or Eastern Washington Wetland Rating System.Provide the wetland rating forms with the JARPA package. 3Indicate the days,months or years the wetland will be measurably impacted by the activity. Enter"permanent"if applicable. °Creation C , Re-establishment/Rehabilitation R , Enhancement E , Preservation P , Mitigation Bank/In-lieu fee B Page number(s) for similar information in the mitigation plan, if available: 7i. For all filling activities identified in 7h, describe the source and nature of the fill material, the amount in cubic yards that will be used, and how and where it will be placed into the wetland. LLLeM 7j. For all excavating activities identified in 7h, describe the excavation method, type and amount of material in cubic yards you will remove, and where the material will be disposed. LLeip Part 8—Waterbodies (other than wetlands): Impacts and Mitigation In Part 8, "waterbodies" refers to non-wetland waterbodies. (See Part 7 for information related to wetlands.) hei ® Check here if there are waterbodies on or adjacent to the project area. (If there are none, skip to Part 9.) 8a. Describe how the project is designed to avoid and minimize adverse impacts to the aquatic environment. heI ❑ Not applicable -New bulkhead was constructed slightly landward of existing bulkhead to ensure no beach encroachment. -All debris was removed from the site via barge and disposed of at off-site waste facility -A BMP's & HPA requirements were strictly followed throughout construction 8b. Will your project impact a waterbody or the area around a waterbody? heI ORIA-revised 07/2022 Page 7 of 12 ® Yes ❑ No 8c. Have you prepared a mitigation plan to compensate for the project's adverse impacts to non-wetland waterbodies? heI • If Yes, submit the plan with the JARPA package and answer 8d. • If No,or Not applicable, explain below why a mitigation plan should not be required. ❑ Yes ® No ❑ Don't know The impact was temporary 8d. Summarize what the mitigation plan is meant to accomplish. Describe how a watershed approach was used to design the plan. • If you already completed 7g you do not need to restate your answer here. heI No net loss of habitat or ecological function. 8e. Summarize impact(s) to each waterbody in the table below. heI Activity (clear, Waterbody Impact Duration Amount of material Area (sq. ft. or dredge, fill, pile name' location of impact3 (cubic yards) to be linear ft.) of drive, etc.) placed in or removed waterbody from waterbody directly affected Demolish Puget Sound collapsed Case Inlet Shoreline Temporary 25 linear feet bulkhead Construct new Puget Sound Shoreline Permanent 25 linear feet Rock bulkhead Case Inlet If no official name for the waterbody exists,create a unique name(such as"Stream 1")The name should be consistent with other documents provided. 2 Indicate whether the impact will occur in or adjacent to the waterbody. If adjacent, provide the distance between the impact and the waterbody and indicate whether the impact will occur within the 100-year flood plain. 3Indicate the days, months or years the waterbody will be measurably impacted by the work. Enter"permanent"if applicable. 8f. For all activities identified in 8e, describe the source and nature of the fill material, amount (in cubic yards) you will use, and how and where it will be placed into the waterbody. [Leipj No fill was placed in waterbody 8g. For all excavating or dredging activities identified in 8e, describe the method for excavating or dredging, type and amount of material you will remove, and where the material will be disposed. hf elr�l No excavation or dredging was performed in waterbody Part 9-Additional Information Any additional information you can provide helps the reviewer(s) understand your project. Complete as much of this section as you can. It is ok if you cannot answer a question. 9a. If you have already worked with any government agencies on this project, list them below. heI Agency Name Contact Name Phone Most Recent Date of Contact ORIA-revised 0712022 Page 8 of 12 WDFW Noll Steinweg 360-628-2173 February 2022 I 9b. Are any of the wetlands or waterbodies identified in Part 7 or Part 8 of this JARPA on the Washington Department of Ecology's 303(d) List? Lt2eM • If Yes, list the parameter(s)below. • If you don't know, use Washington Department of Ecology's Water Quality Assessment tools at: https://ecology.wa.gov/Water- Shorelines/Water-quality/Water-improvement/Assessment-of-state-waters-303d. ❑ Yes ® No 9c. What U.S. Geological Survey Hydrological Unit Code (HUC) is the project in? hf eM • Go to http://cfpub.epa.gov/surf/locate/index.cfm to help identify the HUC. Jones Creek-Frontal Case Inlet (171100190608) 9d. What Water Resource Inventory Area Number (WRIA#) is the project in? LLLeM • Go to https://ecologV.wa.gov/Water-Shorelines/Water-supply/Water-availabilitvfWatershed-look-up to find the WRIA#. Kennedy - Goldsborough watershed -Water Resource Inventory Area (WRIA) 14. 9e. Will the in-water construction work comply with the State of Washington water quality standards for turbidity? hel • Go to https://ecology.wa.gov/Water-Shorelines/Water-quality/Freshwater/Surface-water-quality-standards/Criteria for the standards. ❑ Yes ❑ No ® Not applicable 9f. If the project is within the jurisdiction of the Shoreline Management Act, what is the local shoreline environment designation? hel • If you don't know, contact the local planning department. • For more information, go to: https:Hecology.wa.govfWater-Shorelines/Shoreline-coastal-management/Shoreline-coastal- planning/Shoreline-laws-rules-and-cases. ❑ Urban ❑ Natural ® Aquatic ❑ Conservancy ® Other: Residential 9g. What is the Washington Department of Natural Resources Water Type? heI • Go to http://www.dnr.wa.gov/forest-practices-water-typing for the Forest Practices Water Typing System. ® Shoreline ❑ Fish ❑ Non-Fish Perennial ❑ Non-Fish Seasonal 9h. Will this project be designed to meet the Washington Department of Ecology's most current stormwater manual? [tgjpj • If No, provide the name of the manual your project is designed to meet. ® Yes ❑ No Name of manual: 9i. Does the project site have known contaminated sediment? hf eM • If Yes, please describe below. ❑ Yes © No ORiA-revised 07/2022 Page 9 of 12 9j. If you know what the property was used for in the past, describe below. of el!d Residential since 1989 9k. Has a cultural resource (archaeological) survey been performed on the project area? Lejpj • If Yes, attach it to your JARPA package. ❑ Yes `R' No 91. Name each species listed under the federal Endangered Species Act that occurs in the vicinity of the project area or might be affected by the proposed work. hel None affected Puget Sound Chinook Salmon (Oncorhynchus tshawytscha), Puget Sound Steelhead Trout (Oncorhynchus mykiss), Puget Sound Coho Salmon (Oncorhynchus kisutch), Killer Whale (Orcinus orca), Bull trout (Salvelinus conf/uentus), Marbled murrelet (Brachyramphus marmoratus), and Leatherback sea turtle (Dermochelys coriacea). 9m. Name each species or habitat on the Washington Department of Fish and Wildlife's Priority Habitats and pecies List that might be affected by the proposed work. hel None were affected Part 10—SEPA Compliance and Permits Use the resources and checklist below to identify the permits you are applying for. • Online Project Questionnaire at http://apps.oria.wa.gov/opas/. • Governor's Office for Regulatory Innovation and Assistance at (800) 917-0043 or.help(@oria.wa.gov. • For a list of addresses to send your JARPA to, click on agency addresses for completed JARPA. 10a. Compliance with the State Environmental Policy Act (SEPA). (Check all that apply.) nel • For more information about SEPA, go to https://ecologV.wa.gov/regulations-permits/SEPA-environmental-review. ❑ A copy of the SEPA determination or letter of exemption is included with this application. ® A SEPA determination is pending with Thurston County (lead agency). The expected decision date is ❑ I am applying for a Fish Habitat Enhancement Exemption. (Check the box below in yob.) hf elpl ❑ This project is exempt (choose type of exemption below). ❑ Categorical Exemption. Under what section of the SEPA administrative code (WAC) is it exempt? ❑ Other: ❑ SEPA is pre-empted by federal law. 10b. Indicate the permits you are applying for. (check all that apply.) nel ORIA-revised 07/2022 Page 10 of 12 LOCAL GOVERNMENT Local Government Shoreline permits: ❑ Substantial Development ❑ Conditional Use ❑ Variance N Shoreline Exemption Type (explain): WAC 173-27-040 (2) b Maintenance/Repair of existing structure Other City/County permits: ❑ Floodplain Development Permit ❑ Critical Areas Ordinance STATE GOVERNMENT Washington Department of Fish and Wildlife: EXPEDITED HPA ISSUED 30812 N Hydraulic Project Approval (HPA) ❑ Fish Habitat Enhancement Exemption —Attach Exemption Form Washington Department of Natural Resources: ❑ Aquatic Use Authorization Complete JARPA Attachment E and submit a check for$25 payable to the Washington Department of Natural Resources. Do not send cash. Washington Department of Ecology: ❑ Section 401 Water Quality Certification ❑ Authorization to impact waters of the state, including wetlands (Check this box if the proposed impacts are to waters not subject to the federal Clean Water Act FEDERAL AND TRIBAL GOVERNMENT United States Department of the Army (U.S. Army Corps of Engineers): ❑ Section 404 (discharges into waters of the U.S.) ❑ Section 10 (work in navigable waters) United States Coast Guard: For projects or bridges over waters of the United States, contact the U.S. Coast Guard at: ❑ Bridge Permit: D13-SMB-D13-BRIDGES@uscg.mil ❑ Private Aids to Navigation (or other non-bridge permits): D13-SMB-D13-PATON@uscg.mil United States Environmental Protection Agency: ❑ Section 401 Water Quality Certification (discharges into waters of the U.S.) on tribal lands where tribes do not have treatment as a state (TAS) Tribal Permits: (Check with the tribe to see if there are other tribal permits, e.g., Tribal Environmental Protection Act, Shoreline Permits, Hydraulic Project Permits,or other in addition to CWA Section 401 WOC) ❑ Section 401 Water Quality Certification (discharges into waters of the U.S.) where the tribe has treatment as a state (TAS). ORIA-revised 07/2022 Page 11 of 12 Part 11—Authorizing Signatures Signatures are required before submitting the JARPA package. The JARPA package includes the JARPA form, project plans, photos, etc. hel 11 a. Applicant Signature (required) net] I certify that to the best of my knowledge and belief, the information provided in this application is true, complete, and accurate. I also certify that I have the authority to carry out the proposed activities, and I agree to start work only after I have received all necessary permits. I hereby authorize t e agent named in Part 3 of this application to act on my behalf in matters related to this application. ; (initial) By initialing here, I state that I have the authority to grant access to the property. I also give my consent to the permitting agencies enterjn the property where the project is located to inspect the project site or any work related to the project. (initial) 5AO Applicant Printed ame App cant SiginKure Dat 11 b. Authorized Agent Signature L-_-i j I certify that to the best of my knowledge and belief, the information provided in this application is true, complete, and accurate. I also certify that I have the authority to carry out the proposed activities and I agree to start work only after all necessary permits have been issued. j� . .3L 3 Authorized Agent Printed Name Authorized A n Signature Date 11 c. Property Owner Signature (if not applicant) [i- Not required if project is on existing rights-of-way or easements (provide copy of easement with JARPA). I consent to the permitting agencies entering the property where the project is located to inspect the project site or any work. These inspections shall occur at reasonable times and, if practical, with prior notice to the landowner. Property Owner Printed Name Property Owner Signature Date 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. If you require this document in another format. contact the Governor's Office for Regulatory Innovation and Assistance(ORIA) at(800) 917-0043. People with hearing loss can call 711 for Washington Relay Service. People with a speech disability can call (877)833- 6341. ORIA publication number: ORIA-16-011 rev. 09/2018 ORIA-revised 07/2022 Page 14 of 14