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Home My WebLink AboutSHX2024-00012 Repair Bulkhead - SHX Application - 4/4/2024 CEIVED ----------------ECEMED---- M AGENCY USE ONLY i t WASHINGTON STATE os , °�?g i Date received: APR - 4 2024 Seattle Dstncl i , Joint Aquatic Resources Permit ; Age re 61 : W. Alder Street Application (JARPA) Form' h[ elpl 'rem - Coo Z USE BLACK OR BLUE INK TO ENTER ANSWERS IN THE WHITE SPACES BELOW, 3 - Tax Parcel#(s) aaao- 56 ' 0 3 C) [- Part 1—Project Identification 1. Project Name (A name for your project that you create.Examples:Smith's Dock or Seabrook Lane Development) [help] Theoharis bulkhead repair Part 2—Applicant The person and/or organization responsible for the project. h[ eip] 2a. Name (Last,First,Middle) Theoharis, Dustin 2b. Organization(If applicable) 2c. Mailing Address (Street or PO Box) 2073 E Scorpio PI 2d. City, State, Zip Chandler, AZ 85249 2e. Phone(1) 2f. Phone(2) 2g. Fax 2h. E-mail 253-335-1283 dtrane12@gmail.com 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 resourcecenterharpa 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 oria.wa.goy. ORIA-revised 0212020 Page 1 of 14 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.) nl eip 3a. Name (Last,First,Middle) Merrill, Steve C 3b. Organization (If applicable) Jesfield Construction Company, Inc 3c. Mailing Address (street or Po Box) PO Box 1590 3d. City, State, Zip Allyn, WA 98524 3e. Phone(1) 3f. Phone(2) 3g. Fax 3h. E-mail 360-275-6684 360-535-2106 smerrill@hctc.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. hel 0 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) 0. Phone(2) 4g. Fax 4h. E-mail ORIA-revised 02/2020 Page 2 of 14 Part 5—Project Location(s) Identifying information about the property or properties where the project will occur. nL I ] ❑ 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.) [helms] 0 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.) ham] 17131 NE North Shore Rd 5c. City, State, Zip(If the project is not in a city or town,provide the name of the nearest city or town.) hel Tahuya, WA 98588 5d. County ni eip] Mason 5e. Provide the section, township, and range for the project location, hf elp] '/4 Section Section Township Range 29 22N 3W 5f. Provide the latitude and longitude of the project location. hf eU • Example:47.03922 N lat./-122.89142 W long. (Use decimal degrees-NAD 83) 47.374252 N lat / -123.095918 W long 5g. List the tax parcel number(s)for the project location. heI • The local county assessor's office can provide this information. 32220-50-03050 5h. Contact information for all adjoining property owners. (If you need more space,use DARPA Attachment C.) hel Name Mailing Address Tax Parcel#(if known) Armand W Tiberio 1847 Pointe Woodworth DR NE 32220-50-93051 ..._. _. Tacoma, WA 98422 Monika Atkinson 4219 Serene Way 32220-50-03047 Brian Butts ..... ..._ Lynnwood, WA.__Y _. 98087 ORIA-revised 0212020 Page 3 of 14 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. heM Hood Canal 5k. Is any part of the project area within a 100-year floodplain? hei ID Yes ❑ No ❑ Don't know 51. Briefly describe the vegetation and habitat conditions on the property. !2eM Minimal landscapaing plants & shrubs. 5m. Describe how the property is currently used. h[ pM Single family residential 5n. Describe how the adjacent properties are currently used. h�elpl Single family residential 5o. Describe the structures (above and below ground)on the property, including their purpose(s) and current condition. hf gM Manufactured home, to be demolished and replaced with new home. Septic system &well Concrete bulkhead and boat ramp 5p. Provide driving directions from the closest highway to the project location, and attach a map. hf U Follow North Shore Rd to address. Property is adjacent to the road on the water. ORIA-revised 02/2020 Page 4 of 14 Part 6-Project Description 6a. Briefly summarize the overall project. You can provide more detail in 6b. h[ elp] The corner of the bulkhead at the boat ramp is severely cracked and at risk of failing. Repair includes cutting away the damaged section of the bulkhead and pouring back a new section of bulkhead in the same footprint. 6b. Describe the purpose of the project and why you want or need to perform it. hel The purpose of the project is to repair the damaged corner of the bulkhead and prevent it from failing. 6c. Indicate the project category. (check all that apply) [help] ❑ Commercial I] 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 I] Bulkhead ❑ Fence ❑ Outfall Structure ❑ Swimming Pool ❑ Buoy ❑ Ferry Terminal ❑ Piling/Dolphin ❑ Utility Line ❑ Channel Modification ❑ Fishway ❑ Raft ❑ Other: ORIA-revised 02/2020 Page 5 of 14 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. Excavate dirt from behind the corner of the bulkhead and stage material on the upland area of the property. Make a vertical saw cut in the bulkhead at each side of the corner and remove approximately 11 lineal feet of the bulkhead wall. Cut and remove associated section of bulkhead footing if necessary. Dowel re-bar into the existing wall and create a re-bar cage, form up and pour concrete back for new section of bulkhead. Backfill behind the replaced section with material previously removed. An excavator will be used to excavate the dirt and remove the damaged concrete. This work is adjacent to Hood Canal and within the floodplain. 6f. What are the anticipated start and end dates for project construction? (Month/Year) hL elo) • 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: July 2024 End Date: September 2024 ❑ See JARPA Attachment D 6g. Fair market value of the project, including materials, labor, machine rentals, etc. hel $19,850 6h. Will any portion of the project receive federal funding? hf go • ff yes,list each agency providing funds. ❑ Yes El 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.) h[ elpi 7a. Describe how the project has been designed to avoid and minimize adverse impacts to wetlands. h( gla] ❑ Not applicable 7b. Will the project impact wetlands? hel ❑ Yes ❑ No ❑ Don't know 7c.Will the project impact wetland buffers? Ij,plW ❑ Yes ❑ No ❑ Don't know ORIA-revised 0212020 Page 6 of 14 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? aipj • 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? hf eV • If Yes,submit the plan with the DARPA package and answer 7g. • If No,or Not applicable,explain below why a mitigation plan should not be required. ❑ 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. [Lem 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. hel Activity(fill, Wetland Wetland Impact Duration Proposed Wetland drain, excavate, Name' type and area (sq. of impact' 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. 2 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/ln-lieu fee B Page number(s)for similar information in the mitigation plan, if available: ORIA-revised 02/2020 Page 7 of 14 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. nei 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. h( eio] 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.) bgpj O 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. hel ❑ Not applicable All materials will be brought in and staged from the landward side of the bulkhead. All work will be done at low tide, no work done in the water. Standard best practices will be used to minimize any turbidity in the water or any erosion from the landward side of the project. 8b.Will your project impact a waterbody or the area around a waterbody? t ei 0 Yes ❑ No ORIA-revised 02/2020 Page 8 of 14 8c. 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 and answer 8d. • If No,or Not applicable,explain below why a mitigation plan should not be required. ❑ Yes I] No ❑ Don't know Minimal impacts to the environment 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. [help] N/A 8e. Summarize impact(s)to each waterbody in the table below. hel 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 Bulkhead repair Hood Canal Adjacent permanent no change 11 If 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. 2Indicate 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. nel None ORIA-revised 02/2020 Page 9 of 14 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. h[ eIW None 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. [help 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 of this DARPA on the Washington Department of Ecology's 303(d) List? hel • 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.govM/ater- S horeli nes/W ater-qua lity/Water-improveme nt/Assessment-of-state-waters-303d. ❑ Yes ❑ No Not known 9c.What U.S. Geological Survey Hydrological Unit Code (HUC) is the project in? ht elpl • Go to ham://cfr)ub.ei)a.ciov/surf/locate/index.cfm to help identify the HUC. 17110018 9d. What Water Resource Inventory Area Number(WRIA#) is the project in? [held • Go to https://ecology.wa.gov/Water-Shorelines/Water-supply/Water-availabilityMatershed-look-up to find the WRIA#. 15 ORIA-revised 02/2020 Page 10 of 14 9e.Will the in-water construction work comply with the State of Washington water quality standards for turbidity? LbLeM • Go to https://ecology.wa.gov/Water-Shorelines/Water-Quality/Freshwater/Surface-water-quality-standards/Criteria for the standards. ❑ Yes ❑ No 0 Not applicable 9f. If the project is within the jurisdiction of the Shoreline Management Act, what is the local shoreline environment designation? LbLeM • If you don't know,contact the local planning department. • For more information,go to: https://ecologv.wa.govMater-Shorelines/Shoreline-coastal-management/Shoreline-coastal- pla n n i n g/S ho rel i n e-1 aws-ru Ies-a n d-ca ses. EI Urban ❑ Natural ❑ Aquatic ❑ Conservancy ❑ Other: 9g.What is the Washington Department of Natural Resources Water Type? of elpl • Go to httg://www.dnr.wa.aov/forest-practices-water-typing for the Forest Practices Water Typing System. B 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? heI • If No,provide the name of the manual your project is designed to meet. EI Yes ❑ No Name of manual: 9i. Does the project site have known contaminated sediment? [Leipj • If Yes, please describe below. ❑ Yes EI No 9j. If you know what the property was used for in the past, describe below. h[ elp] Single family residential 9k. Has a cultural resource (archaeological)survey been performed on the project area? n[ M • If Yes,attach it to your DARPA package. ❑ Yes EI No ORIA-revised 02/2020 Page 11 of 14 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. ftAi Marbled Murrelet Yellow-billed Cudkoo Bull Trout Dolly Varden Monarch Butterfly 9m. 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. [Lem Unknown 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.) [hel • For more information about SEPA,go to hftps://ecology.wa.gov/regulations-permits/SEPA-environmental-review. ❑ A copy of the SEPA determination or letter of exemption is included with this application. El A SEPA determination is pending with Mason County (lead agency). The expected decision date is June 2024 ❑ 1 am applying for a Fish Habitat Enhancement Exemption. (Check the box below in 10b.)(help] ❑ 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. ORIA-revised 02/2020 Page 12 of 14 10b. Indicate the permits you are applying for. (Check all that apply.) hel LOCAL GOVERNMENT Local Government Shoreline permits: ❑ Substantial Development ❑ Conditional Use ❑ Variance EI Shoreline Exemption Type (explain): Maintenance Other City/County permits: El Floodplain Development Permit ❑ Critical Areas Ordinance STATE GOVERNMENT Washington Department of Fish and Wildlife: El 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 ❑ Non-Federally Regulated Waters 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: d13-pf-d13bridges@uscs.mil ❑ Bridge Permit ❑ Private Aids to Navigation (or other non-bridge permits) 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 WQC) ❑ Section 401 Water Quality Certification (discharges into waters of the U.S.)where the tribe has treatment as a state (TAS). ORIA-revised 0212020 Page 13 of 14 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) het 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 1 agree to start work only after I have received all necessary permits. I hereby authorize 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 entp'ngie property where the project is located to inspect the project site or any work related to the project. J (initial) ��srinr �1tiEdNAlZR�S '/2— 4- App cant Printed Name Applicant Signature Date 11 b. Authorized Agent Signature ' el ] 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. A1 C - H t:Q21! t-L- Z 9 2 q- Authorized Agent Printed Name Authorized Agent Signature Date 11 c. Property Owner Signature(if not applicant) h[eM Not required if project is on existing rights-of-way or easements (provide copy of easement with DARPA). 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§tatements 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 ublication number: ORIA-16-011 rev.09/2018 ORIA-revised 0212020 Page 14 of 14