HomeMy WebLinkAboutSEP2011-00023 Dock, Ramp, Piles - SEP Determinations - 5/9/2011 ON_STArt MASON COUNTY
BPS M c �� DEPARTMENT OF COMMUNITY DEVELOPMENT
0 AS ° = Planning Division
0 T �? P O Box 279, Shelton, WA 98584
V �,o~ (360)427-9670
1864
DETERMINATION OF NONSIGNIFICANCE
(WAC 197-11-340)
SEP2011-00023
Description of Proposal: New modular floating dock; 4 ft. wide by 6 ft. long ramp attached
to 6.5 ft. deep by 10 ft. wide dock and secured by two pin piles.
Proponent: RICHARD KRIEGBAUM
Location of Proposal: 660 E LAKESHORE DR ALLYN
Parcel Number: 122205400056
Legal Description: LAKELAND VILLAGE 5 TRACT 56
Directions to site: In Allyn from State Route 3 on Lakeland Dr. tand left on
Lakeshore Dr. to 660 address.
Lead Agency: Mason County
The Lead Agency for this proposal has determined that it does not have a probable significant
adverse impact on the environment. An Environmental Impact Statement (EIS) is not required
under RCW 43.21 C.030(2)(c). This decision was made after review of a completed
Environmental Checklist and other information on file with the Lead Agency. This information is
available to the public upon request.
Please contact Allan Borden at ext. 365 with any questions. This DNS is issued under WAC
197-11-340(2). The Lead Agency will not act on this proposal for 14 days from the date shown
below, when the determination is final. Comments must be submitted to Dept. of Community
Development, P.O. Box 279, Shelton WA 98584 by 5/23/2011. Appeal of this determination
must be filed within a 14-day period following this final determination date, per Mason County
Code Chapter 15.11 Appeals.
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Authorized Local Government Official Date
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MASON COUNTY,
SEPA CHECKLIST
$385 - Single Family (Mason County Permit Center Use)
$630 - Non-Single Family 0 to 9.99 Acres SEP BI( -�
$755 -10 to 20 Acres
$945 - Over 20 Acres Date Rcvd: .3
$2,525 + 70/hr- EIS (DS)
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Purpose of Checklist:
The State Environmental Policy Act (SEPA), chapter 43.21 C 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) and to help the agency decide whether an EIS is required.
Instructions for Applicants:
Governmental agencies use this checklist to determine whether the environmental impacts of your proposal are
significant, requiring 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 questions 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 your proposal or its environmental
effects. The agency to which you submit this checklist may ask you to explain your answers or provide additional
information reasonably related to determining if there may be significant adverse impact.
There is a fee required, for the processing of the checklist, see above for the appropriate fee. Please make your check
payable to "Mason County Treasurer".
A. BACKGROUND
1. Name of proposed project: /
2. Name of applicant:
Property owner:
3. Applicant mailing address: d q-
Applicant phone numbers: 3�� oZ� bQ_�.-/
4. Date checklist prepared: _3772If 7_1�_---.__
5. Agency requesting checklist: --
Mason County SEPA Checklist 1
6. PPr/rj�op��osed timing or schedule (including phasing, if applicable):
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7. Do you have any plans for future expansion, or further activity related to or connected with this proposal? If yes,
explain. -/)!eng,"
8. List any environmental information you know about that has been prepared, or will be prepared, directly related to
this proposal.
9. Do you know whether applications are pending for governmental approvals of other proposals directly affecting the
property covered by your proposal? If yes, explain.
10. List any government approvals or permits that will be needed for yo r proposal, if known.
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11. Give a 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 describe certain aspects of your proposal.
You do not need to repeat those answers on this page. (Lead agencies may0m'od�ify this form to include additional
specific information on project description.) 4)e 6/ /LZ O a—! GG l/
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12. What is the location of the 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 topographic 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 permit applications related
to this checklist. P
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Mason County SEPA Checklist 2
B. ENVIRONMENTAL ELEMENTS
1. EARTH:
a. General description of the site (circle one): Flat r lin , hilly, steep slopes, mountainous, other(explain).
b. What is the steepest slope on the site (approximate percent slope)?
c. What general types of soils are found on the site (for example, clay, sand, gravel, peat, muck)? If you know
the classification of agricultural soils, specify them and note any prime farmland. �&n Q,
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d. Are there surface indications or history of unstable soils in the immediate vicinity? If so, describe.
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e. Describe the purpose, type, and approximate quantities of any filling or grading proposed. Indicate source of
fill. /(��n n'x't�-
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f. Could erosion occur as a result of clearing, construction, or use? If so, generally describe.
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g. About what percent of the site will be covered with impervious surfaces after project constructions (for
example, asphalt or buildings)?
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h. Proposed measures to reduce or control erosion, or other impacts to the earth, if any:
2. AIR:
a. What types of emissions to the air would result from the 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.
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b. Are there any off-site sources of emissions or odor that may affect your proposal? If so, generally describe.
Mason County/SIEPP�A Checklist 3
c. Proposed measures to reduce or control emissions or other impacts to air, if any:
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3 WATER:
a. Surface:
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 what stream or river it flows into. CJ6_Z�
2) Will the project require any work over, in, or adjacent to (within 200 feet)the described waters?�If yes,
please describe and attach available plans. ? 72C�{J a'O--eI�¢�
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 fill material.
4) Will the proposal require surface water withdrawals or diversions? Give general description, purpose, and
approximate quantities if known.
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5) Does t�roposal lie within a 100-year floodplain? If so, note location on the site plan.
6) Does the proposal involve any discharges of waste materials to surface waters? If so, describe the type of
waste anticipated volume of discharge.
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b. Ground:
1) Will groundwater be withdrawn, or will water be discharged to groundwater? Give general description,
purpose, and approximate quantities, if known.
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Mason County SEPA Checklist 4
2) Describe waste material that will be discharged into the ground from septic tanks or other sources, if any
(for example; domestic sewage, industrial, containing the following chemicals..., agricultural, etc.).
Describe the general size of the system, the number of such systems, the number of houses to be served
(if applicable), or�the
�number of animals or humans the system(s) are expected to serve.
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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 will this water flow? Will this flow into other waters?
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2) Could waste materials enter ground or surface waters: If so, generally describe.
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d. Proposed measures to reduce or control surface, ground, and runoff water impacts, if any:
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4. PLANTS:
a. Check or circle types of vegetation found on the site:
V_ deciduous tree: alder, maple, aspen, other
evergreen tree ir, cedar pine, other
shrubs
grass
pasture
crop or grain
wet soil plants: cattail, buttercup, bullrush, skunk cabbage, other
water plants: water lily, eelgrass, milfoil, other
other types of vegetation
b. What kind and amount of vegetation will be removed or altered?
Mason County SEPA Checklist 5
c. List threatened or endangered species known to be on or near the site.
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d. Proposed landscaping, use of native plants, or other measures to preserve or enhance vegetation on the site,
if any:
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: haWeer,
eagle, songbirds other _
Mammals: r, elk, beaver, other
Fish: bass, salmon trout herring, shellfish, other
b. List any threatenedor endangered species known to be on or near the site.
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c. Is the site part of a migration route? If so, explain.
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d. Proposed) measures to preserve or enhance, if any:
6. ENERGY AND NATURAL RESOURCES:
a. What kinds of energy (electric, natural gas, oil, wood stove, solar)will be used to meet the completed project's
ener needs? Describe whether it will be used for heating, manufacturing, etc.
b. Would your project affect the potential use of solar energy by adjacent properties: If so, generally describe.
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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:
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Mason County SEPA Checklist 6
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. _
1) Describe special emergency services that might be required.
2) Proposed measures to reduce or control environmental health hazards, if any:
b. Noise.
1) What types of noise exist in the area that may affect your project(for example: traffic, equipment,
operation, other)? 7�owe—,,I
2) What types and levels of noise would be created by or associated with the project on a short-term or a
long-term basis (for example: traffic,�construction, operation, other)? Indicate what hour's noise would
come from the site.
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?
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b. Has the site been used for agriculture? If so, describe.
c. DescWM,V__)
ribe any structures on the site.
d. Will any structures be demolished? If so, what? 770
Mason Countv SEPA Checklist 7
e. What is the current zoning classification of the site?
f. What is the current comprehensive plan designation of the site?
g. If applicable, what is the current Shoreline Master Program designation of the site?
h. Has any part of the site been classified as an "environmentally sensitive" area? If so, specify. 720
i. Approximately how many people would reside or work in the completed project? _ 41` A
j. Approximately how many people would the completed project displace?
k. Proposed measures to avoid or reduce displacement impacts, if any: /V//_�
t. Proposed measures to ensure the proposal is compatible with existing and projected land uses and plans:
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9. HOUSING:
a. Approximately how many units would be provided, if any? Indicate whether high, middle, or low-income
housing. /V//-)t
b. Approximately how many units, if any, would be eliminated? Indicate whether high, middle, or low-income
housing. N/rT
c. Proposed measures to reduce or control housing impacts, if any:
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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?
b. What views in the immediate vicinity would be altered or obstructed?
c. Proposed measures to reduce or control aesthetic impacts, if any:
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Mason County SEPA Checklist 8
11. LIGHT AND GLARE
a. What type of light or glare will the proposal produce? What time of day would it mainly occur?
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b. Could light or glare from the finished project be a safety hazard or interfere with views?
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c. What existing off-site sources of light or glare may affect your proposal:
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d. Proposed measures to reduce or control light and glare impacts, if any:
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12. RECREATION:
a. What designated and informal recreational opportunities are in the immediate vicinity?
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b. Would
ythe
)proposed project displace any existing recreational uses? If so, describe.
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c. Proposed measures to reduce or control impacts on recreation, including recreation opportunities to be
provided by the project or applicant, if any:
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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. '/70
b. Generally describe any landmarks or evidence of historic, archaeological, scientific, or cultural importance
known to be on or next to the site.
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c. Proposed
�/measures to reduce or control impacts, if any:
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Mason County SEPA Checklist 9
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.
b. Is site currently served by public transit? If not, what is the approximate distance to the existing street system?
Show on site plans, if any. W®
c. How many parking spaces would the completed project have? How many would the project eliminate?
IV114�-
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).
e. Will the project use (or occur in the vicinity of)water, rail, or air transportation? If so, generally describe.
e)
i C.
f. How many vehicular trips per day would be generated by the completed project? If known, indicate when
peak volumes would occur. /V/A
g. Proposed measures to reduce or control transportation impacts, if any:
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15. PUBLIC SERVICES:
a. Would the project result in an increased need for public service (for example: fire protection, police protection,
health care, schools, other)? If so, generally describe: / 2D
b. Proposed measures to reduce or control direct impacts on public services, if any:
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16. UTILITIES:
a. Circle utilities currently available at the site: electricity, natural gas water, refuse service telephone,
sanity sewer septic stem, other: �`�
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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 that might be needed.
The above answers are true and complete to the best of my knowledge. I understand that the lead agency is relying
on them to make its decisio
Applicant Signatur Date: e✓%rZ�J/
Mason County SEPA Checklist 10
ESA LISTED SALMONIDS CHECKLIST
This worksheet was designed to help project proponents, and government agencies, identify when a project needs
further analysis regarding adverse effects on ESA (Endangered Species Act) listed salmonids. Salmonids are salmon,
trout and chars, e.g. bull trout. For our purposes, "ESA Listed Salmonids" is defined as fish species listed as
endangered, threatened or being considered for listing.
If ESA listed species are present or ever were present in the watershed where your project will be located, your project
has the potential for affecting them, and you need to comply with the ESA. The questions in this section will help
determine if the ESA listings will impact your project.
The Fish Program Manager at the appropriate Department of Fish and Wildlife (DFW) regional office can
provide information for the following two questions.
1. Are ESA listed salmonids currently present in the watershed in which your project will be located?
YES NO Please describe.
2. Has there ever been an ESA listed salmonid stock present in this watershed?
YES_ NO_/ Uncertain_ Please describe.
If you answered "yes" to either of the above questions, you should complete the
remainder of this checklist.
PROJECT SPECIFICES: The questions in this section are specific to the project and vicinity.
1. Name of watershed:
2. Name of nearest waterbody:
3. What is the distance from this project to the nearest body of water: Often a buffer
between the project and a stream can reduce the chance of a negative impact to fish.
4. What is the current land use between the project and the potentially affected water body (parking lots, farmland,
etc.)?
5. Is the project above a:
natural permanent barrier(waterfall) YES_ NO
natural temporary barrier(beaver pond) YES_ NO
man-made barrier(culvert, dam) YES_ NO_
• other (explain):
6. If yes, are there any resident salmonid populations above the blockage?
YES NO Don't know
7. What percent of the project will be impervious surface (including pavement & roof area)?
Mason County SEPA Checklist 1 I
STgTFO MASON COUNTY
P DEPARTMENT OF COMMUNITY DEVELOPMENT
M C �t
o s o i Planning Division
r O N Z P O Box 279, Shelton, WA 98584
7 N Y Y (360)427-9670
1864
Exemption from Shoreline Management Act
Case No.: SHX201 1-00010 Substantial Development Permit Requirement
The Proposal By: RICHARD KRIEGBAUM
660 E LAKESHORE DR
ALLYN, WA 98524
To undertake the following development:
New modular floating dock; 4 ft. wide by 6 ft. long ramp attached to 6.5 ft. deep by 10 ft. wide
dock and secured by two pin piles.
Within ANDERSON LAKE 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
H-dock
Please contact Allan Borden at ext 365 if you have any ques4��
tions
Issued: 5/9/2011
Expires: 5/9/2013 Authorized Local Government Official
cc: APPLICANT WDFW USACOE WDOE TRIBAL COUNCIL
Q ;1AR ^5 2011
PERMIT NO. 64X 2.DI I— �1 SHORELINE SUBSTANTIAL DEVELOPMENT
DATE RECEIVED 3-o`�S-ZOI SHORELINE VARIANCE WASON COUNTY
SHORELINE CONDITIONAL USE
SHORELINE EXEMPTION
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 $5,000.00 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 my further describe the proposed
development. Incomplete applications will be returned.
APPLICANT: I ,
ADDRESS:
(street)
(city) (state) (zip)
TELEPHONE: 3&� oZ`7,5
(home) (business)
AUTHORIZED REPRESENTATIVE: 0 6&!!!� '
ADDRESS: H9l.g 6V " /1°!✓
(city (state (zip)
TELEPHONE:
PROPERTY DESCRIPTION:
General location(include property address,water body and associated wetlands—identify the name of the
shoreline): ^
Legal description (include section, township, and range to the nearest quarter, quarter section or latitude and
longitude to the nearest minute. Projects located in open water areas away from land shall provide a longitude
location)—include all parcel numbers:
OWNERSHIP:/ Contract
Applicant V Owner Lessee Purchaser (Identify) Other
Owner:
Use(identify current use of property with exist improvements:
Reason for requesting development: _
of
ACKOWLEDGEMENT
I hereby declare,to the best of my knowledge and belief,the forgoing information and all attached information is
true orrect.
(applicant or authorized representative) (date)
...................■a a a...a a a a a a a a a.....a a.a a a.a a■a■■a.a a a a a a a a a....a a a a a a.a a■
TO BE COMPLETED BY LOCAL OFFICIAL
Identify and describe existing features of the site and surrounding area:
If proposed structures will exceed a height of 35 feet above the existing grade level, indicate the location of any
residential units that will have an obstructive view:
If a Conditional Use or Variance is requested,make reference to the appropriate section in the Master Program:
-------------------------------------
AGENCY USE ONLY
2010 M '
Date received:
a
WASHINGTON STATE US Army Corps ;
of Engineers
$eatlle Distract , GG,, '
Agency reference#:✓02-61 1
Joint Aquatic Resources Permit ,
Application (JARPA) Form' Tax Parcel#(s):
USE BLACK OR BLUE INK TO ENTER ANSWERS IN WHITE SPACES BELOW.
,
------------------------------------
Part 1—Project Identification
1. Project Name (A name for your project that you create. Examples: Smith's Dock or Seabrook Lane Development) hel
Kriegbaum Dock
Part 2—Applicant
The person or organization responsible for the project. [hem
2a. Name (Last, First, Middle) and Organization (if applicable)
Richard Kriegbaum
2b. Mailing Address (Street or Po Box)
660 E Lakeshore Dr
2c. City, State, Zip
Allyn WA 98524
2d. Phone(1) 2e. Phone(2) 2f. Fax 2 . E-mail
360 275 6019 :1( ) ( ) mekrieg@msn.com
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.) hI elp]
3a. Name (Last, First, Middle) and Organization (if applicable)
EVANS, BILL Evans Marine Solutions
3b. Mailing Address (Street or Po Box)
F928 Libby Rd NE
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.
• If your project might affect species listed under the Endangered Species Act,you will need to fill out a Specific Project Information Form(SPIF)or
prepare a Biological Evaluation. Forms can be found at
http://www.nws.usace.army.mii/PublicMenu/Menu.cfm?sitename=REG&pagename=mainpage_ESA
• If you are applying for an Aquatic Resources Use Authorization you will need to fill out and submit an Application for Authorization to Use State-
Owned Aquatic Lands form to DNR,which can be found at http://www.dnr.wa.gov/Publications/aq _use_auth_app.doc
• Not all cities and counties accept the JARPA for their local Shoreline permits. If you think you will need a Shoreline permit,contact the appropriate
city or county government to make sure they will accept the JARPA.
ZTo access an online JARPA form with[help]screens,go to
http://www.epermitting.wa.gov/site/alias resoureecenter/jarpa_jarpa_form/9984/J*arpa_fonn.aspx.
For other help,contact the Governor's Office of Regulatory Assistance at 1-800-917-0043 or help@ora.wa.gov.
3c. City, State, Zip
, Olympia WA 98506
3d. Phone(1) 3e. Phone(2) 3f. Fax 3 . E-mail
360 352 3084 ( ) 360 705 8545 :::: evansezdock@yahoo.com
Part 4—Property Owner(s)
Contact information for people or organizations owning the property(ies)where the project will occur. [Leipj
XX 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 property owners. Complete the section below and fill out JARPA Attachment A for each
additional property owner.
4a. Name (Last, First, Middle)and Organization (if applicable)
4b. Mailing Address (Street or PO Box)
4c. City, State, Zip
4d. Phone(1) 4e. Phone(2) 4f. Fax 4 . E-mail
Part 5—Project Location(s)
Identifying information about the property or properties where the project will occur. hf elpl
❑ 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.) hel
❑ State Owned Aquatic Land (If yes or maybe, contact the Department of Natural Resources(DNR)at(360)902-1100)
❑ Federal
❑ Other publicly owned (state, county, city, special districts like schools, ports,etc.)
❑ Tribal
XX Private
5b. Street Address (Cannot be a PO Box. If there is no address,provide other location information in 5p.) hel
660 E Lakeshore Dr
5c. City, State, Zip(If the project is not in a city or town, provide the name of the nearest city or town.) hel
Allyn WA 98524
5d. County hf M
MASON
5e. Provide the section, township, and range for the project location. h[ elpl
'/4 Section Section Township Range
19 & 20 22N 1W
5f. Provide the latitude and longitude of the project location. hf elpl
• Example:47.03922 N lat./-122.89142 W long. (NAD 83)
47.375916 lat / -122.847534 long
5g. List the tax parcel number(s)for the project location. hl elp]
• The local county assessor's office can provide this information.
12220 54 00056
5h. Contact information for all adjoining property owners. (If you need more space, use JARPA Attachment C.) h( ell
Name Mailing Address Tax Parcel #(if known)
5i. List all wetlands on or adjacent to the project location. h[ eip]
N/A
5j. List all waterbodies (other than wetlands) on or adjacent to the project location. hf eM
Lake Anderson
5k. Is any part of the project area within a 100-year flood plain? hl eM
❑ Yes XX No ❑ Don't know
51. Briefly describe the vegetation and habitat conditions on the property. [hel
Grass region around the house. Area between grass and waterfront contains trees (alder,
cedar, fir), and native vegetation.
5m. Describe how the property is currently used. n[ eM
Single family residential
5n. Describe how the adjacent properties are currently used. nei
Single family home on one side and Lakeland Village Community boat storage & launch on
other side.
5o. Describe the structures (above and below ground) on the property, including their purpose(s). hei
Single family, single story home w/garage.
5p. Provide driving directions from the closest highway to the project location, and attach a map. hei
From Shelton city limits proceed N on Hwy 3 approx 18 miles. Turn LEFT on E Lakeland Dr, go .6 miles. Turn
LEFT on E Lakeforest Dr, go .4 miles. Turn LEFT onto E Lakeshore Dr, go .4 miles Oust past E North Bay PI) to
660 E Lakeshore Dr.
Part 6-Project Description
6a. Summarize the overall project. You can provide more detail in 6d. [t-1ejP]
Install floating modular dock w/ poly gangway.
6b. Indicate the project category. (Check all that apply) [hem
❑ Commercial XX Residential ❑ Institutional ❑ Transportation XX Recreational
❑ Maintenance ❑ Environmental Enhancement
6c. Indicate the major elements of your project. (Check all that apply) [help]
❑ Aquaculture ❑ Culvert ❑ Float ❑ Road
❑ Bank Stabilization ❑ Dam /Weir ❑ Geotechnical Survey ❑ Scientific
❑ Boat House ❑ Dike / Levee /Jetty ❑ Land Clearing Measurement Device
❑ Boat Launch ❑ Ditch ❑ Marina / Moorage ❑ Stairs
❑ Boat Lift XX Dock/ Pier ❑ Mining ❑ Stormwater facility
❑ Bridge ❑ Dredging ❑ Outfall Structure ❑ Swimming Pool
❑ Bulkhead ❑ Fence ❑ Piling ❑ Utility Line
❑ Buoy ❑ Ferry Terminal ❑ Retaining Wall
❑ Channel Modification ❑ Fishway (upland)
❑ Other:
6d. Describe how you plan to construct each project element checked in 6c. Include specific construction
methods and equipment to be used. n[�el ]
• Identify where each element will occur in relation to the nearest waterbody.
• Indicate which activities are within the 100-year flood plain.
Dock section & poly gangway will be floated into water from community boat launch next door to site and
secured w/two galv schedule 40 pin piles on each end of dock section.
6e. What are the start and end dates for project construction? (month/year) n[ elp]
• 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: _May 15, 2011 End date: May 15, 2011 ❑ See JARPA Attachment D
6f. Describe the purpose of the project and why you want or need to perform it. hel
To give client opportunity to be able to fish & tie up small boat
6g. Fair market value of the project, including materials, labor, machine rentals, etc. hel
$3356
6h. Will any portion of the project receive federal funding? hel
• If yes, list each agency providing funds.
❑ Yes XX 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. hel
XX Not applicable
7b. Will the project impact wetlands? h� elp]
❑ Yes XX No ❑ Don't know
7c. Will the project impact wetland buffers? hI elpl
❑ Yes XX 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 XX No
7e. Have the wetlands been rated using the Western Washington or Eastern Washington Wetland Rating
System? h[ M
• If yes, submit the wetland rating forms and figures with the JARPA package.
❑ Yes XX No ❑ Don't know
7f. Have you prepared a mitigation plan to compensate for any adverse impacts to wetlands? [km
• 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.
❑ Yes ❑ No XX Not applicable
7g. Summarize what the mitigation plan is meant to accomplish, and describe how a watershed approach was
used to design the plan. hf eld
Not applicable
7h. 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. h[ elal
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
category2 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.
3 Indicate 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
ards that will be used, and how and where it will be placed into the wetland. hf elal
Not applicable
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. hel
Not applicable
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.) hel
XX 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.
hf elp]
❑ Not applicable
No adverse impacts will effect the aquatic environment
8b. Will your project impact a waterbody or the area around a waterbody? hel
XX Yes ❑ No
8c. Have you prepared a mitigation plan to compensate for the project's adverse impacts to non-wetland
waterbodies? h[ eU
• 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 XX Not applicable
Anchoring galv pin piles will be hand driven into substrate. No mitigation plan needed.
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. [be
l
Not applicable
8e. Summarize impact(s) to each waterbody in the table below. hf M
Activity (clear, Waterbody Impact Duration Amount of material Area (sq. ft. or
dredge, fill, pile name' location of impact3 to be placed in or linear ft.) of
drive, etc.) removed from waterbody
waterbody directly affected
Two galv pin Lake Substrate 30 Two gals schedule 40 5 feet
piles inserted by Anderson minutes pin piles
hand
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.
z 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. het
No fill used.
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. het
Not applicable
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. hf @M
Agency Name Contact Name Phone Most Recent
Date of Contact
9b. Are any of the wetlands or waterbodies identified in Part 7 or Part 8 on the Washington Department of
Ecology's 303(d) List? hf elal
• If yes, list the parameter(s)below.
• If you don't know, use Washington Department of Ecology's Water Quality Assessment tools at:
hftp://www.ecy.wa.gov/programs/wq/303d/.
❑ Yes XX No
9c. What U.S. Geological Survey Hydrological Unit Code (HUC) is the project in? Lhei
• Go to http://cfl)ub.epa.gov/surf/locate/index.cfm to help identify the HUC.
17110019
9d. What Water Resource Inventory Area Number (WRIA#) is the project in? hei
• Go to http://www.ecy.wa.gov/services/gis/maps/wria/wria.htm to find the WRIA#.
15
9e. Will the in-water construction work comply with the State of Washington water quality standards for
turbidity? hl eM
• Go to http://www.ecy.wa.gov/programs/wq/swgs/criteria.htm]for the standards.
XX Yes ❑ No ❑ Not applicable
9f. If the project is within the jurisdiction of the Shoreline Management Act, what is the local shoreline
environment designation? [help]
• If you don't know, contact the local planning department.
• For more information, go to: http://www.ecy.wa.gov/programs/sea/sma/laws rules/173-26/211 designations.html.
XX Rural ❑ Urban ❑ Natural ❑ Aquatic ❑ Conservancy ❑ Other
9g. What is the Washington Department of Natural Resources Water Type? hf eM
• Go to http://www.dnr.wa.gov/BusinessPermitsfTopics/ForestPracticesApplications/Pages/fp watertyping.aspx for the Forest
Practices Water Typing System.
XX 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? [t elp]
• If no, provide the name of the manual your project is designed to meet.
XX Yes ❑ No
Name of manual:
9L If you know what the property was used for in the past, describe below. hf elpl
Do not know
9j. Has a cultural resource (archaeological) survey been performed on the project area? hf m
• If yes,attach it to your JARPA package.
❑ Yes XX No
9k. 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. hl eM
Don't know
91. Name each species or habitat on the Washington Department of Fish and Wildlife's Priority Habitats and
Species List that might be affected by the proposed work. [help]
Don't know
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.ecy.wa.gov/opas/.
• Governor's Office of Regulatory Assistance at (800) 917-0043 or help _ora.wa.gov.
• For a list of agency addresses to send your application, click on the "where to send your completed
JARPA" at http://www.epermitting.wa.gov.
10a. Compliance with the State Environmental Policy Act (SEPA). (Check all that apply.) hem
• For more information about SEPA, go to www.egy.wa.gov/programs/sea/sepa/e-review.htmi.
❑ A copy of the SEPA determination or letter of exemption is included with this application.
XX A SEPA determination is pending with _Mason Co (lead agency). The expected decision date is
❑ I am applying for a Fish Habitat Enhancement Exemption. (Check the box below in 1 ob.) hf elpl
XX 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.) hem
LOCAL GOVERNMENT
Local Government Shoreline permits:
❑ Substantial Development ❑ Conditional Use ❑ Variance
XX Shoreline Exemption Type (explain):
Other city/county permits:
❑ Floodplain Development Permit ❑ Critical Areas Ordinance
STATE GOVERNMENT
Washington Department of Fish and Wildlife:
XX Hydraulic Project Approval (HPA) ❑ Fish Habitat Enhancement Exemption
Washington Department of Ecology:
❑ Section 401 Water Quality Certification
Washington Department of Natural Resources:
❑ Aquatic Resources Use Authorization
FEDERAL GOVERNMENT
United States Department of the Army permits (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 permits:
❑ General Bridge Act Permit ❑ Private Aids to Navigation (for non-bridge projects)
Part 11—Authorizing Signatures
Signatures are required before submitting the JARPA package. The JARPA package includes the JARPA form,
project plans, photos, etc. h[ elo
11a. Applicant Signature (required) hf elpl
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 aut e 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 en property where the project is located to inspect the project site or any work
related to the project. (initial)
A CNe9d2h HLftAl hRIC&OAVAL d..Z Z��Afz 20//
Applicant Printed Name plicant Signature Date
11 b. Authorized Agent Signature [bLeilgl
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.
Authorized Agent Printed Name Au orized A ent Signature Dat
11 c. Property Owner Signature (if not applicant). hel
Not required if project is on existing rights-of-way or easements.
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 of Regulatory Assistance (ORA). People with hearing loss
can call 711 for Washington Relay Service. People with a speech disability can call (877)833-6341.
ORA publication number: ENV-019-09