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HomeMy WebLinkAboutSHX2009-00042 JARPA - SHX Permit / Conditions - 9/21/2009 STgTFO MASON COUNTY �P c DEPARTMENT OF COMMUNITY DEVELOPMENT I o AMo N Planning Division o T z P O Box 279, Shelton,WA 98584 N Yly (360)427-9670 OJ #O 1864 Exemption from Shoreline Management Act Case No.: SHX2009-00042 Substantial Development Permit Requirement The Proposal By: JUDY SCOTT P O BOX 1238 BELFAIR,WA 98528 To undertake the following development: Remove existing 6 ft. by 64 ft. dock and old piles on Tiger Lake and replace with 6 ft. wide by 50 ft. long dock fixed on 8 new piles. Within Tiger 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 questio Issued. 9/21/2009 Expires: 9/21/2011 Authorized Local Government Official cc: APPLICANT WDFW USACOE WDOE TRIBAL COUNCIL I h 4 6RX 2.069 - 060H2 . r--------------- --- ---- ---------i 2009 OO9 M AGENCY USE ONLY US WASHINGTON STATE WE.glree s ; Date received: Seattle oimrid i Joint Aquatic Resources Permit ` Application (JARPA) Form h[�] Agency reference#: USE BLACK OR BLUE INK TO ENTER ANSWERS IN WHITE SPACES BELOW. i Tax Parcel#(S): 12�JDrJ"J�f� Ql Part 1—Project Identification , Unique project information that makes it easy to identify. hei -------------------------------------- 1 a. Unique Project Identifier Number(UPI #) LLeM • Don't have one yet?Get one at http://www.el)ermitting.wa.cloy or call the Washington Governor's Office of Regulatory Assistance at(800)917-0043. 1 b. Project Name (Examples:Smith's Dock or Seabrook Lane Development) hel scC)4 b0cy- V-60CLO-0-ropi Part 2—Applicant The person or organization legally responsible for the project. hei 2a. Name (Last, First, Middle)and dd1Organization(if applicable) �T 21b. Mailing Ad ress (Street or PO Box) 2c. City, State, Zip 2d. Phone(1) 2e. Phone(2) 2f. Fax 2 . E-mail ( u ) -7s 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.) LLLeM 3a. Name (Last, First, Middle)and Organization (if applicable) 31b. Mailing Address (Street or PO Box) i?© —6— oS 3c. City, State, Zip '&J�a �V Cl Sa 3d. Phone(1) 3e. Phone(2) 3f. Fax 3 . E-mail JARPA 2009 Page 1 of 11 Part 4—Property Owner(s) hi e ".ontact information for people or organizations owning the property(ies)where the project will occur. Lem —9 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 use 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. hel ❑ There are multiple properties or project locations (e.g., linear projects). Complete the section below and use JARPA Attachment B for each additional property. 5a. Street Address (Cannot be a PO Box. If there is no address, provide other location information in 5n.) [help] 5b. City, State, Zip(If the p ect is not in a city or town,provide the name of the nearest city or town.) hel 5c. County gjpj 5d. Provide the section, township, and range for the project location. hel 1/4 Section Section Township Range 5e. Provide the latitude and longitude of the project location. h[ eM • Example:47.03922 N lat./-122.89142 W long 5f. List the tax parcel number(s)for the project location. h[ eM • The local county assessor's office can provide this information. a-3cv s!� 000 0 1-1 5g. Indicate the type of ownership of the property. (Check all that apply.) h[ elp] ❑ State Owned Aquatic Land ❑ Tribal Private ❑ Other publicly owned (federal,state,county,city,special districts like schools,ports,etc.) JARPA 2009 Page 2 of 11 5h. Contact information for all adjoining property owners, lessees, etc. (If you need more space, use JARPA Attachment C.) Le- Name Mailing Address Tax Parcel # (if known) 5i. Is any part of the project area within a 100-year flood plain? h( eM es ❑ No ❑ Don't know 5j. Briefly describe the vegetation and habitat conditions on the property. hf elpl 5k. Describe how the property is currently used. h[ elp] 1 PC C Cb-+10 v1,- 51. Describe how the adjacent properties are currently used. heI JARPA 2009 Page 3 of 11 5m. Describe the structures (above and below ground)on the property, including their purpose(s). hel � C)c)C 5n. Provide driving directions from the closest highway to the project location, and attach a map. [Lei Powy\ &k r -ra1C� �v y 3cx) , norms Sh6(Z h}on Sam kAk11 . -Tha Cfke LLawCL 0 eC� Part 6—Project Description 6a. Summarize the overall project. You can provide more detail in 6d. hei muv� 'Los and -0't(s (n bcd, . UYA - f QGL Wd l )Ou as k 6b. Indicate the project category. (Check all that apply.) nei ❑ Commercial ❑ Residential ❑ Institutional ❑ Transportation C&Recreational ❑ Maintenance ❑ Environmental Enhancement 6c. Indicate the major elements of your project. (Check all that apply.) h( eM ❑ Aquaculture ❑ Culvert ❑ Float ❑ Road ❑ Bank Stabilization ❑ Dam /Weir ❑ Geotechnical Survey ❑ Scientific Measurement ❑ Boat House ❑ Dike/ Levee/Jetty ❑ Land Clearing Device ❑ Boat Launch ❑ Ditch ❑ Marina / Moorage ❑ Stairs ❑ Boat Lift *'E,Dock/ Pier ❑ Mining ❑ Stormwater facility ❑ Bridge ❑ Dredging ❑ Outfall Structure ❑ Swimming Pool ❑ Bulkhead ❑ Fence 3-Piling ❑ Utility Line ❑ Buoy ❑ Ferry Terminal ❑ Retaining Wall (upland) ❑ Channel Modification ❑ Fishway ❑ Other: JARPA 2009 Page 4 of 11 6d. Describe how you plan to construct each project element checked in 6c. 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 flood plain. - �r�tee. P►1��� w`�-h �a}� far - h 6e. What are the start and end dates for project construction? (month/year) nei • 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: AO End date: �(� - ❑ See JARPA Attachment D 6f. Describe the purpose of the work and why you want or need to perform it. h[ gM C1 rVJ �--7f am k 0 �\kQ&-�OLL "�CLQOJ , 6g. Fair market value of the project, including materials, labor, machine rentals, etc. hel - -- _--- - I0 oa ,O 6h. Will any portion of the project receive federal funding? hei • If yes, list each agency providing funds. ❑ Yes [A 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.) 7a. Describe how the project has been designed to avoid and minimize adverse impacts to wetlands. hei ❑ Not applicable JARPA 2009 Page 5 of 11 7b. Will the project impact wetlands? h[,gjpj ❑ Yes ❑ No ❑ Don't know 7c. Will the project impact wetland buffers? h[ eM ❑ Yes ❑ No ❑ Don't know 7d. Has a wetland delineation report been prepared? h[ em • 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? h( elp] • 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[ eM • If yes,submit the plan with the JARPA package. ❑ Yes ❑ No ❑ Not applicable 7g. Use the table below to list the type and rating of each wetland that will be impacted; the extent and duration of the impact; and the type and amount of compensatory mitigation proposed. If you are submitting a compensatory mitigation plan with a similar table, you may simply state (below)where we can find this information in the mitigation plan. hei Activity causing Wetland type Impact area Duration Proposed Wetland impact (fill, and rating (sq. ft. or acres) of impact2 mitigation mitigation area drain, excavate, category' type3 (sq. ft. or acres) flood, etc. 'Ecology wetland category based on current Western Washington or Eastern Washington Wetland Rating System. Provide the wetland rating forms with the JARPA package. 2 Indicate the time(in months or years,as appropriate)the wetland will be measurably impacted by the activity. Enter"permanent"if applicable. 3 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: 7h. For all filling activities identified in 7g., 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. [Lelpj 7L For all excavating activities identified in 7g., describe the excavation method, type and amount of material in cubic yards you will remove, and where the material will be disposed. hf elpl JARPA 2009 Page 6 of 11 7j. Summarize what the compensatory mitigation plan is meant to accomplish, and describe how a watershed approach was used to design the plan. n� eM 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.) h[ ell ❑ 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. of elpl ❑ Not applicable bf\v,.O,- OYA-4Qa-W " L, Q-s 8b. Will your project impact a waterbody or the area around a waterbody? nel ❑ Yes Jj;z;;6i-No 8c. Summarize impact(s)to each waterbody in the table below. h[ elpl Activity causing Waterbody Impact Duration Amount of material Area (sq. ft. or impact (clear, name location' of impact2 to be placed in or linear ft.) of dredge, fill, pile removed from waterbody drive, etc.) waterbody direct) affected rtn n " 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. z Indicate the time(in months or years,as appropriate)the waterbody will be measurably impacted by the work. Enter"permanent"if applicable. 8d. Have you prepared a mitigation plan to compensate for the project's adverse impacts to non-wetland waterbodies? hel • If yes,submit the plan with the JARPA package. ❑ Yes g No ❑ Not applicable 8e. Summarize what the compensatory mitigation plan is meant to accomplish. Describe how a watershed approach was used to design the plan. • If you already completed 7j., you do not need to restate your answer here. hel JARPA 2009 Page 7 of 11 8f. For all activities identified in 8c., 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. hel N I N 8g. For all excavating or dredging activities identified in 8c., describe the method for excavating or dredging, type and amount of material you will remove, and where the material will be disposed. heM Iv Part 9-Additional Information Any additional information you can provide helps the reviewer(s) understand your project. 9a. If you have already worked with any government agencies on this project, list them below. hel 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? hg • If yes, list the parameter(s)below. • If you don't know, use Washington Department of Ecology's Water Quality Assessment tools at: hftl)://www.ecy.wa.gov/programs/wq/303d/. ❑ Yes o 9c. What U.S. Geological Survey Hydrological Unit Code (HUC) is the project in? LL2121 • Go to http://cfpub.epa.gov/surf/locate/index.cfm to help identify the HUC. 9d. What Water Resource Inventory Area Number (WRIA#) is the project in? h( eM • Go to http://www.ecy.wa.gov/services/gis/maps/wria/wria.htm to find the WRIA#. JARPA 2009 Page 8 of 11 9e. Will the in-water construction work comply with the State of Washington water quality standards for turbidity? [Lel • Go to htti)://www.ecy.wa.goy/programs/wq/swgs/criteria.html 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? Lel • 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. ❑ Rural Urban ❑ Natural ❑ Aquatic ❑ Conservancy ❑ Other 9g. What is the Washington Department of Natural Resources Water Type? heM • Go to http://wvwv.dnr.wa.gov/BusinessPermits/Topics/ForestPracticesApplications/Pages/fp watertyping.aspx for the Forest Practices Water Typing System. ❑ S ;�F ❑ Np ❑ Ns 9h. Will this project be designed to meet the Washington Department of Ecology's most current stormwater manual? Lel • If no, provide the name of the manual your project is designed to meet. ❑ Yes ❑ No Name of manual: 9i. If you know what the property was used for in the past, describe below. hel 9j. Has a cultural resource (archaeological) survey been performed on the project area? Leal j • If yes,attach it to your JARPA package. ❑ Yes V( 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. Lein j N J� 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. hel JARPA 2009 Page 9 of 11 Part 10—Identify the Permits You Are Applying For Use the resources and checklist below to identify the permits you are applying for. • Online Project Questionnaire at http://api)s.ecy.wa.gov/opas/. • Governor's Office of Regulatory Assistance at (800) 917-0043 or help(d)-ora.wa.gov. 10a. Compliance with the State Environmental Policy Act (SEPA). (Check all that apply.) nel • For more information about SEPA,go to www.ecy.wa.gov/programs/sea/sepa/e-review.ht_ml. ❑ A copy of the SEPA determination or letter of exemption is included with this application. A SEPA determination is pending with lead agency). The expected decision date is ❑ I am applying for a Fish Habitat Enhancement Exemption. (Check the box below in 10b.) • Submit the Fish Habitat Enhancement Project form with this application. The form can be found at http://www,epermitting.wa.gov/Portals/ JarpaResourceCenter/images/default/fishenhancement.doc ❑ 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. h[ eM 10b. Indicate the permits you are applying for. (Check all that apply.) h[ elp] LOCAL GOVERNMENT Local Government Shoreline permits: ❑ Substantial Development ❑ Conditional Use ❑ Variance NfShoreline Exemption Type (explain): kf Other city/county permits: ❑ Floodplain Development Permit ❑ Critical Areas Ordinance STATEVERNMENT Washington Department of Fish and Wildlife: 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) JARPA 2009 Page 10 of 11 i J Part 11—Authorizing Signatures Signatures required before submitting the JARPA package. 11 a. Applicant Signature (required) hel 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 the 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 entering the property where the project is located to inspect the project site or any work related to the project. (initial) Applicant Date 11 b. Authorized Agent Signature [Lel 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. Autho ' ed Age Date 11 c. Property Owner Signature (if not applicant) h[ eM 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 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 JARPA 2009 Page 11 of 11 One-Stop JARPA Resource Center Page 1 of 4 Today is Wednesday,April 15,2009 Enter search text here Sign in ( Site Mal, Welcome JARPA Resources Contact Us Transportation Pilots + Text Size - R JARPA> JARPA Contacts JARPA Contacts General Contact ORA's Information Center Hours: 9 am to 4 pm (M-F) Location: Department of Ecology 300 Desmond SE, Lacey WA Phone: (360) 407-7037 or (800) 917-0043 Email: help@ora.wa.gov Resource Agency Contact Information The contact information below is for the offices where you may need to send signed copies of your JARPA form. They can also answer any questions you may have. Department of the Army Permit(s) (Section 404 or Section 10) U.S. Army Corps of Engineers Seattle District Tel (206) 764- Regulatory Branch 3495 P.O. Box 3755 Fax (206) 764- Seattle, WA 98124-3755 6602 Department of Ecology Permits (401 Water Quality Certification) Washington State Department of Mailing Address Tel (360) 407- Ecology - Headquarters P.O. Box 47600 6000 Olympia, WA 98504-7600 Physical Address 300 Desmond Drive Lacey, WA 98504 Central Region 15 West Yakima Avenue, Suite 200 Tel (509) 575- Yakima, WA 98902-3401 2490 Fax (509) 575- 2809 Eastern Region 4601 North Monroe, Suite 202 Tel (509) 329- Spokane, WA 99205-1295 3400 Fax (509) 329- 3529 Northwest Region 3190 - 160th Avenue S.E. Tel (425) 649- Bellevue, WA 98008-5452 7000 Fax (425) 649- http://www.epermitting.org/site/alias__resourcecenter/jarpa jarpa contacts/2489/jarpa_co... 4/15/2009 One-Stop JARPA Resource Center Page 2 of 4 • 7098 Southwest Region Mailing Address: Tel (360) 407- P.O. Box 47775 6300 Olympia, WA 98504-7775 Fax (360) 407- Physical Address: 6305 300 Desmond Drive Lacey, WA 98504 For a map of Ecology Regional Offices, click here. Department of Fish and Wildlife (Hydraulic Project Approval) Locate the Habitat Biologist for your project Send to: Washington State Department of Fish and Wildlife. (Please submit 2 copies.) 1. If you are NOT requesting emergency or expedited processing, submit two copies of your application to the Headquarters office in Olympia. 2. If you are requesting emergency or expedited processing, submit two copies of your application to the appropriate Regional office. 3. Application documents may not exceed 11"x 17". 4. If your application (including the JARPA, plans, photos, etc.) contains more than 30 pages, also include digital files of all application documents on a CD, DVD, or other electronic storage media in common Microsoft program, PDF, TIFF, ]PEG, or GIF formats. Headquarters Habitat Program Tel (360) 902- Receives all applications when 600 Capitol Way North 2534 emergency or expedited processing is Olympia, Washington 98501-1091 TDD (360) 902- NOT being requested. 2207 Fax (360) 902- 2946 Region 1 Habitat Program (Pend Oreille, Ferry, Stevens, Spokane, 2315 North Discovery Tel (509) 892- Lincoln, Whitman, Columbia, Garfield, Place Spokane, WA 99216 1001 Fax (509) Asotin, and Walla Walla Counties) 921-2440 Region 2 Habitat Program (Okanogan, Douglas, Grant, Adams, 1550 Alder Street NW Tel (509) 754- and Chelan Counties) Ephrata, WA 98823-9699 4624 Fax (509) 754- 5257 Region 3 Habitat Program (Franklin, Kittitas, Yakima, and Benton 1701 South 24th Avenue Tel (509) 575- Counties) Yakima, WA 98902-5720 2740 Fax (509) 575- 2474 Region 4 Habitat Program (Whatcom, Skagit, Snohomish, King, 16018 Mill Creek Boulevard Tel (425) 775- Island, and San Juan Counties) Mill Creek, WA 98012-1296 1311 Fax (425) 338- http://www.epennitting.org/site/alias resourcecenter/jarpa jarpa contacts/2489/larpa co... 4/15/2009 One-Stop JARPA Resource Center Page 3 of 4 1066 Region 5 Habitat Program (Lewis, Wahkiakum, Cowlitz, Skamania, 2108 Grand Blvd. Tel (360) 696- Clark, and Klickitat Counties) Vancouver, WA 98661-4624 6211 Fax (360) 906- 6776 Region 6 Habitat Program (Pacific, Pierce, Thurston, Grays Harbor, 48 Devonshire Road Tel (360) 249- Mason, Jefferson, Clallam, and Kitsap Montesano, WA 98563-9618 4628 Counties) Fax (360) 664- 0689 Contact regional offices for questions or assistance. For a map of WDFW regional offices, click here. Local Government (Shoreline Management Act Approval) Appropriate city or county planning, building, or community development department Refer to: htti2 //www mrsc org/research aspx for city and county contact information. Choose your City or County from the list. Coast Guard Section 9 Bridge Permit Commander 13th Coast Guard District Tel (206) 220- (OAN) 7282 915 Second Avenue. Room 3510 Fax (206) 220- Seattle, WA 98174-1067 7265 Attn: Bridge Administrator Private Aids to Navigation Commander 13th Coast Guard District Tel (206) 220- (OAN) 7285 915 Second Avenue, Room 3510 Fax (206) 220- Seattle, WA 98174-1067 7265 Attn: PATON Manager Department of Natural Resources (Aquatic Resources Authorization to use bedlands, tidelands, or shorelands of navigable waters.) DNR Headquarters Tel (360) 902- Northwest Region 1000 Pacific Cascade Region Tel (360) 856- South Puget Sound Region 3500 Northeast Region Tel (360) 577- Southeast Region 2025 Olympic Region Tel (360) 825- 1631 Tel (509) 684- 7474 Tel (509) 925- 8510 http://www.epennitting.org/site/alias_resourcecenter/j arpaj'arpa_contacts/2489/j arpa_co... 4/15/2009 One-Stop JARPA Resource Center Page 4 of 4 • Tel (360) 374- 6131 For a map of DNR regional offices, click here. Contact Webmaster Our Partners Access Washington Governor Chris Gregoire http://www.epermitting.org/site/alias resourcecenter/jarpa jarpa contacts/2489/jarpa co... 4/15/2009