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Home My WebLink AboutFPA97-00028 - FPA Permit / Conditions - 9/9/1997 _ y F C, WASHINGTON STATE DEPARTMENTOF � `9� Natural Resources Jt {FER M.BELCHER Resources-- CoM`ioner of Public Lands KALEEI�COTTINGHAM Supervisor S E P A ., Lead Agency G Notice 1V i� Re: FP-09- 2 40 1 A J 7 2 The department has determined according to WAC 197-11-938 (4) that ASS,'\r.•. Cc> is the lead agency for purposes of compliance with State Environmental- Policy Act for the above referenced forest practice application(s) . Should you disagree with this determination, you may petition the Dept. of Ecology to resolve the issue pursuant to WAC 197-11-946. The application(s) are subject to a 30-day period of approval unless you determine a detailed statement under RCW 43.21C.030(2) (c) is required. Please notify our office by the due date on the application your recommendations for approval , disapproval or conditioning of ch>_ application by the due date. BC/sc 880510 SOUTH PUGET SOUND REGION 1 28329 SE 448 ST 1 PO BOX 68 1 ENUMCLAW,WA 98022-0068 1 FAX:(360)825-1672 1 TEL:(360)825-1631 w�+ Equal Opportunity/Affirmative Action Employer RECYCLED PAPER %J* P?-,C==CIS i PL-TCATION/NOT -C='-'_ON � 2 4 Q PROCESS AND CONDITIONS FP•- Date Received: Review Co—eats Due: ?inal Due Date: xaioi OT XAM o! -_`Din! O%V= xma OF Opal.L:0A RE ji SUBDIVISION ( SEC:0N(s) I 7 ? Nth I RGE T-/W CLAss 0' A??LT_C;,O!* S I I I ❑ CLASS IZ ❑ CLASS ZZI Cl LASS III-T Type of Operation Acres/Miles CLASS IV-G P � ,� ❑ CLASS Iv-s ❑ APPLICATION APPROVED CONDITIONS TO THIS APPLICATION / NOTT_FICATION THIS OPERATION REQUIRES- 0 IIydr-ulie• Proj.ct AVyrov-1 O Cagli-ae- ..itb -7prov-1 Co"itioa. ❑ r=viroas..ntal CL.ckli.t Gar>al.t.d TPA Form Map 2 Otb.r APPROVAL CONDITIONS : Landowner is advised that the city/county say*place a six year =ratoriu=t on- all building adevelopment permits since this site is. being logged as a forestry operation. ❑ PRE-PILE REVIEW COMPLETE ❑ APPLICATION INCOMPLETZ APPLICATION COMPLETE ❑ APPLICATION ON HOLD ❑ AP ICATION DISAPPROVED A1tT'POL`rr Or NATIIRAI. RZSO%MCZS SICKAT07t.': T:LE: DATZ: I INITIAL: DZP I R:GZONs AGZKCY COTZZS sm" FXXX. C0712S SLYr: ZTTZC-2VZ DATZ: ZZ7ZRATZON DATZ: 1 - 17 n�ri CO?ZZS DZSTRXNC= TO: z P TOItZSTnt COLOCf TZSntitZZS Arrzt-r= D07IAN TRIZZs JO w�\ QTmLS: 4� � LOCAL Gommma Ts ATT=C-m n=XAX TRSDl: S V OTROtS: LOCAL GOVZRNKorr: ATTlCT= Z1071AN TRIZZ s 071MRS t LOCAL. GOVSRMIXIrr j FORM DNA 00 - 27 I9-951 I FpA 11tUM8ER: Ir ,YASHNGrON STATE DEPARTMENT C «) ' Natural Resources FOREST PRACTICES APPLICATION / NOTIFICATION I. GENERAL INFORMATION SECTION Ms P$ aril I°n ��'�►" REFER TO THE INSTRUCTIONS TO SSIST IN THE COMPLETION OF THIS FORM. TYPE OR PRINT IN PERMANENT INK. c FULL LEGAL NAME AND /OR FULL LEGAL NAME AND/OR 3. FULL LEGAL NAME AND/OR COMPANY ;DIVISION NAME OF LANDOWNER COMPANY/DIVISION NAME OF TIMBER OWNER COMPANY/DIVISION NAME OF OPERATOR �Q 5- BUSINESS ADDRESS BUSINESS ADDRESS BUSINESS ADDRESS Q Sir L CITY STATE ZIP CITY STATE ZIP CITY STATE ZIP � 95Jdrs PHONE: 1 ) PHONE: ( ) PHONE: (3 6C] ) �-- Unified Business Identifier (or SSN #) UBI I i Unified Business Identifier (or SSN #) UBI [ I Unified Business Identifier (or SSN #) UBI f I SSN I : SSN I I — SSN (�- 4.TYPE OF LEGAL ENTITY TYPE OF LEGAL ENTITY TYPE OF LEGAL ENTITY f 1 CORPORATION SOLE PROPRIETOR l I CORPORATION V.SOLE PROPRIETOR f 1 CORPORATION [SOLE PROPRIETOR [1 PARTNERSHIP p ( 1 PARTNERSHIP ( ] PARTNERSHIP I I OTHER(specify): r.3 / 4 OTHER(specify): y�39 H� 282.q [ ] OTHER (specify): 5. FOREST TAX REPORTING ACCOUNT NUMBER: [hQ 1) A S:d `7 J7 1 ?"For tax reporting information or tax numbers_call 1-800-548-8829. 6. [ 1 YES [ NO - IS THE OPERATION WITHIN CITY LIi611TS? COUNTY /M INS-0 i✓ NAME OF CITY(s): 7. [ I YES K NO - IS THE OPERATION WITHIN A PUBLIC PARK? If yes, an Environmental Checklist is required. ( I YES K NO - IS THE OPERATION WITHIN 500 FEET OF A PUBLIC PARK? NAME OF PARK: 8 a. LEGAL SUB-DIVISION OF OPERATION(S): 8 b. PARCEL OR LOT NUMBER: SUB-DIVISION (1/4, 1/4) SECTION TWP RANGE PARCEL OR TAX (E)(W) LOT NUMBER(S) 0 Q IF 9. K YES [ I NO - WAS THE LAND PLATTED AFTER JANUARY 1,=DLANU ING SHORT LATS17 (You May Contact County Assessor for Verificationronmental Checklist Is Required. 10. ( ] YES Del NO - LANDOWNER INTENDS TO CLEAR, IMPROVE OnRE "ec��^ NOTE: 1. If yes, attach a completed Environmental Checklist. 2. A local government clearing and/or grading Permit may be required. 3. See the instructions for more Information relating to conversions. THE FOLLOWING IS PROVIDED FOR YOUR INFORMATION: If the Forest Practices Application or Notification does not state that there is an intent to convert the forest land to non-forestry uses the county, city, town or regional governments may deny any permits or approvals for conversion to non-forestry land uses for a period of six (6) years from the date of the application or notification. See the instructions under item # 10, and regulations, including but not limited to, RCW 76.09.060, RCW 76.09.170(7), WAC 222-20-010, WAC 222-20-040 and 222-20-050. 11. [ I YES [VI NO - DO YOU HAVE AN APPROVED CONVERSION OPTION HARVEST PLAN (COHP)? If yes, include a copy of the approved plan. NOTE: Not all Local Governments issue COHP's. (For FPA Fee Information see the Instructions) ;"EP 0 9 1997 FORM DNR QQ-19 (1-95) II. WATER SECTION All work within Type 1-3 Waters will require a Hydraulics Project Approval (HPA). Work within Type 4-5 Waters may require an HPA. Completion of this section will serve as your request for an HPA from the Department of Fish and Wildlife. If you are operating within 200 feet of a Type 1 or 1 + Water, contact the local government for shoreline management information. 12. [ 1 YES it NO - WILL THERE BE ANY ACTIVITIES THAT WILL BE WITHIN OR OVER THE ORDINARY HIGH WATER MARK OF ANY WATER? (If you will not be working in or above any typed water, go to question 13.) If YES, check V) the activities you will be doing in each type of water. The location of all culverts and bridges must be shown on the base map. Culvert Base Map information must include culvert diameter. Bridge location information must show whether the bridge is temporary or permanent. (For Water Type information see WAC 222-16-030. EYES [ 1 NO Are all waters shown on the Base Map. (If No, please show all unmarked water locations.) ,A) (B) (C) DI (E) (F) (G) (H) (I) Water Road Water Falling & Cable Suspending- Ground Operate Apply Other Activity Type Const. Crossing Bucking Yarding Cables Skidding Other Chemicals (Show under Over (Skidder or Equipment question 29) Water Tractor) 1 2 3 4 5 13. [ 1 YES [S}-N0 WILL THERE BE: ANY ACTIVITIES WITHIN 200 FEET OF A TYPE 1 - 3 WATERS? FEET If Yes, how close? (Measure all distances horizontally.) Show the location of all Riparian Management Zones (RMZs) on the Base Map. (See WAC Chapter 222-30.) 14. [ 1 YES �4 NO WILL THERE BE ANY ACTIVITIES WITHIN 25 FEET OF TYPE 4-5 WATERS? 15, [ 1 YES [-f NO ARE YOU AWARE OF ANY WATER INTAKES IN YOUR UNIT OR WITHIN 1/2 MILE DOWNSTREAM OF THIS OPERATION? 16. [ 1 YES [ 'NO WILL YOU BE REMOVING TREES WITHIN THE MAXIMUM WIDTH RIPARIAN MANAGEMENT ZONE? (For maximum Width Riparian Zone Information see WAC 222-30-020(3) and W.) (For Information Relating to Shade Requirements see WAC 222-3Ci-040.) III. WETLAND SECTION 17. [ 1 YES [Sf NO - DO WETLANDS EXIST INSIDE OR WITHIN 200 FEET (horizontally) OF YOUR PROPOSED FOREST PRACTICES BOUNDARY? (If wetlands do not exist within or around this application go to Section IV.) If YES, show the location and classification of all Wetlands and Wetland Management Zones on the Base Map, and check ( ✓ ) the appropriate squares in the following table describing your work within a Wetland or Wetland Management Zone. (For wetland typing information see WAC 222-16-035.) Wetland (A) (B) (C) (D) (E) (F) (G) (H) 11 Type Road Water Falling & Cable Suspending Ground Operate Apply Other Constr. Crossing Bucking Yarding Cables Over Skidding Other Chemicals (Show under Wetlands (Skidder or Equipment question 29) Tractor) A B Forested 18. [ 1 YES [-> NO WILL YOUR PROJECT BE FILLING OR DRAINING A WETLAND? I ACRES) If Yes, how many acres will you be filling or draining? (Enter acreage to the nearest 1/10 acre) A mitigation plan and a SEPA checklist must accompany this application if you are filling or draining more than 1/2 acre of any wetland. FORM DNR QQ-19 (1-95) 2 IV. ROAD SECTION 19. [ 1 YES Nf'NO - IS THERE ANY ROAD WORK OR ROCK PIT DEVELOPMENT ASSOCIATED WITH THIS APPLICATION: (If YES, complete all blocks that apply and LABEL EACH TYPE SEPARATELY ON MAP.) (If you will not be doing any work involving roads go to Section V.) TYPE OF ACTIVITY TOTAL LENGTH TOTAL LENGTH OF STEEPEST SIDE IN FEET ENDHAULOVERHAUL SLOPE ROAD (no sidecast) CROSSES CONSTRUCTION (in percent) Show All Locations On Ma NEW ROAD CONSTRUCTION EXISTING ROAD RECONSTRUCTION EXISTING ROAD MAINTENANCE I I ROAD ABANDONMENT (Provide a Detailed Plan), f 1 ROCK PIT DEVELOPMENT Indicate Pit Locations on Map. Show timber harvest volumes and acreaae in auestion 20. V. TIMBER HARVEST SECTION 20. [ 1 YES [ 1 NO - WILL YOU BE HARVESTING TIMBER AS A PART OF THIS PROPOSAL? (If YES, complete all blocks that apply and :show on map.) (If you will not be harvesting timber as a part of this proposal, go to Section VI.) UNIT TYPE OF HARVEST TREES PER METHOD OF ACRES PERCENT OF ESTIMATED » '(Even-aged, Uneven-aged ACRE HARVEST VOLUME TO VOLUME TO BE Salvage and/or REMAINING (per BE CUT HARVESTED Right of Way) AFTER (Ground Cable, Highlead, type of HARVEST Skyline, Shovel, Rubber Tired harvest) (in MBF1 (For Harvest Type Information Skidder, Tracked Skidder, see "Even-aged Harvest" (Only count Animal, Helicopter or Balloon.) under trees that meet WAC 222-16-010) the reawremems under Even-aged Show the location of each harvest in WAC ZfJ c)(7) harvest type on Mao. 222-16-0101 For even-aged harvests, provide surrounding stand information on the base map as required under WAC 222-30-025. See instructions. 21. [ 1 YES ["0 - WILL YOU BE HARVESTING TIMBER OR LEAVING TREES WITHIN TWO TREE LENGTHS OF ANY OVERHEAD POWER LINES? (If yes, the applicant needs to notify the appropriate Power Company.) 22. INDICATE HOW THE FOLLOWING WILDLIFE TREES WILL BE LEFT: (Check all that apply) * See WAC 222-30-020 (1 1) for Wildlife Reserve Tree, Green Recruitment Tree and Down Log leave requirements. WILDLIFE RESERVE TREES GREEN RECRUITMENT TREES [ I YES [ 1 NO CLUMPED (Show on Map) [ I AGES ( 1 NO CLUMPED (Show on Map) [WYES [ 1 NO EVENLY DISTRIBUTED (Throughout Unit) [y'YES [ 1 NO EVENLY DISTRIBUTED (Throughout Unit) NOTE: WAC 222-30-0200 1) requires that 2 down logs per acre be left in areas where green recruitment trees are required. 23. [ YES [ 1 NO - WILL YOU BE LEAVING A DOUBLE-WIDE RMZ(s) FOR GREEN-UP? (For Western Washington Only) INDICATE DOUBLE-WIDE RMZ LOCATION(s) ON MAP 24. REFORESTATION METHOD: Reforestation is required for lands harvested after January 1, 1975 as shown under WAC 222-34-010 (West: of Cascades Summit), or WAC 222-34-020 (East of Cascades Summit). [ 1 PLANTING (Species: ) PT NATURAL (Applicant must submit a Reforestation PlanSee nstructlons.) [ I REFORESTATION NOT REQUIRED under WAC 222-34-010, 222-34-020 or 222-34-050. FORM DNR QQ-19 (1-95) 3 VI. CHEMICAL APPLICATION SECTION 25. ] YES [ NO - THIS FOREST PRACTICE INVOLVES THE APPLICATION OF PESTICIDES OR FERTILIZER? If Y S, answer the questions below.) (If no, go to Section VII.) [ 1 FERTILIZER APPLICATION - ACRES ( ) For fertilizer applications answer question 28 and show application locations on the Base Map.. [ 1 PESTICIDE TREATMENT - ACRES ( ) For pesticide applications answer questions 26 27 and 28, and indicate areas to be treated on the Base af�Tv p. l5—escribe in the "General Description Section", the purpose of the pesticide treatment(s) you are proposing. 26. LIST THE EPA REGISTRATION NUMBERS, TRADE NAMES, AND RATES OF APPLICATION FOR ALL CHEMICALS PROPOSED, INCLUDING ALL ADJUVANTS. EPA REG. No. Trade Name of Chemical Application Unit of Measure Rate of Active Ingredient Per Acre 27. [ ] YES [ ] NO - WILL THIS PESTICIDE BE USED UNDER A DEPARTMENT OF AGRICULTURE EXPERIMENTAL USE PERMIT? If yes, include a copy of the Experimental Use Permit. 28. CHEMICAL INFORMATION CONTACT PERSON PHONE # 1 1 (Additional information may be required for activities relating tot e app (cation of pestici�es.) VII. GENERAL DESCRIPTION SECTION 29. Provide any details that will give a1bettner understanding of your project. � -� r'rf�F'S Q,E'er;�;� /is�1 /�Q..y,.s ,.�✓i j • ,- THE FOLLOWING IS PROVIDED FOR YOUR INFORMATION: RCW 76.09,220 (8) provides any aggrieved person the right to appeal the approval or disapproval of a forest practices application. RCW 43.21C.075 provides any aggrieved person the right to appeal issues arising under the State Environmental Policy Act. Appeals must be filed within 30 days of the approval or disapproval of the forest practices application. Appeals must be filed with the FOREST PRACTICES APPEALS BOARD,PO BOX 40903,4224-6th Ave SE Bldg#2,Lacey,WA 98504-0903. Appeals must be filed in writing on the form required in Title 223-08. Concurrently with filing of the Forest Practices Appeals Board, copies of the appeals must also be filed with the OFFICE OF THE SUPERVISOR, DEPT OF NATURAL RESOURCES, 1 111 Washington St SE, 4th Floor Natural resources Bldg., PO BOX 47001, Olympia, WA 98504-7001, and with the ATTORNEY GENERAL, PO BOX 40100, OLYMPIA, WA 98504-0100. Compliance with this application/ notification does not ensure compliance with the Endangered Species Act, or other federal, state, or local laws. SIGNATURE BLOCKS We affirm that the information contained herein is true, and understand that this proposed Forest Practice is subject to the current rules and regulations of the forest rac ces act, as well as any applicable Federal, State or Local rules and regulations. LANDOWNER TIMBER OWNER OPERATOR Signature: Signature: Signature: Print: Print: Pri t: Date of Landowner Signature: Date of Timber Owner Signature: Date of Op rotor Signature: FORM DNR QQ-19 (1-95) 4 FOREST PRACT CE BASE MAP TOWNSHIP 23 NORTH , RANGE 01 WEST ( W . M . ) SECTION 28 A P P L I C A T I O N # 240427AO i i i 91 OB 5 I I 1 / 00 ti 9d / 10 124 r 1 89 106 1 3 SCALE 0 1000 2000 3000 4000 5000 6000 FEET 1 Mile (5290 n) MAP DATE: Septerrber 09, 1997 CONTOUR INTERVAL : 40 Feet LEGEND : See Instructions NAD 21 DISCLAIMER : See Legend Water/Wetlands including their location and class may be incorrectly displayed or not shown on the Base Map. Applicants are responsible for verification and correction. 09/09/97 PAGE 1 FOREST PRACTICES TRAX SYSTEM REPORT PRE-CLASS ID = 14522 SEC TWN RGB CONTROL TP NAME DESCRIPTION MAP LOCATION WATER TRIBUTARY NUMBER CD SOURCE 20 230 010 W S2 *0477801CAM S2*04778CAM IR 23 SW4 SW4 UNN STR UNION R 20 230 010 W S2 -0477802CBM S2*04778CBM IR 23 SE4 SW4 UNN STR UNION R 20 230 010 W S2 *0978301C S2*09783C DS 23 NE4SW4 UNN STR BULDUCS LK 20 230 010 W S2 *0978601C S2*09786C IR 23 NW4SE4 UNION R HOOD CANAL 20 230 010 W S2 *1101801C S2*11018C IR 23 NE4SW4 UNN LK 20 230 010 W S2 *1238001C S2*12380C IR 23 NE4NE4 UNN DRN DIT UNION R 20 230 010 W S2 *1289601CAW S2*12896CAW DS 23 142NW4 UNN SPR 20 230 010 W S2 *1289602CBW S2*12896CBW DS IR 23 N2NW4 UNN STR UNION R 20 230 010 W S2 *1306901C S2*13069C DM IR 23 S2 NE4 NW4 UNN STR - UNION R 20 230 010 W S2 *1403801CAW S2*14038CAW DS IR 23 SW4SE4 UNN SPR UNION R 20 230 010 W S2 *1403802CBW S2*14038CBW DS IR 23 SE4SW4 UNION R HOOD CANAL. 20 230 010 W S2 *1536301C S2*15363C DS 23 SW4 UNN STR UNION R 20 230 010 W S2 -1753601C S2*17536C DS 23 N2 NW4 NE4 COURTNEY CR * UNION R 20 230 010 W S2 *1944101C S2*19441C DS IR 23 NE4 NW4 NE4 COURTNEY CR * UNION R 20 230 010 W S2 *1952501C S2*19525C DM 23 NW4NW4NE4 COURTNEY CR * UNION R 20 230 010 W S2 -0073801CAW 52-00738CAW IR 23 N2NW4SB4 UNN STR UNION R 20 230 010 W S2 -0073802CBW 52-00738CBW IR 23 N2NW4SE4 UNION R LYNCH COVE 20 230 010 W S2 -0073901C 52-00739C DS IR 23 NE4SW4 UNN STR i 20 230 010 W S2 -0100901C S2-01009C DS ST PS RE IR 23 SW4SW4 UNN STR UNION R j 20 230 010 W S2 -2514301C 52-25143C FS 23 SE4SW4 UNN STR UNION R 20 230 010 W S2 -2854101P 52-28541P DS 23 NE4NE4 UNN SPR UNION R 21 230 010 W G2 *0968501C G2*09685C DM 23 E2 W2 NW4 WELL 21 230 010 W G2 -2478301C G2-24783C DM 23 SW4SE4NW4 WELL 21 230 010 W G2 -2547101C G2-25471C DM 2� W2NW4 WELL 21 230 010 W G2 -2896201A G2-28962A DM CI 23 SE4SW4. WELL 21 230 010 W S2 *0425001C S2*04250C FS IR 23 . SW4 SW4 SW4 UNN STR UNION R 21 230 010 W S2 *0425101C S2*04251C DS IR 23 62 E2 NW4 SW4 UNN STR UNION R 21 230 010 W S2 *0579601C S2*05796C DS IR 23 NE4 SW4 UNN STR 21 230 010 W S2 *1173001C S2*11730C IR. 23 SW4NW4 UNN SPR Irk 111 21 230 010 W S2 *1241701C S2*12417C DS 23 W2 E2 NW4 SW4 UNN STR UNION R 4V 21 230 010 W S2 *1241801C S2*12418C DS 23 E2 E2 NW4 SW4 UNN STR UNION R � I 23 NW4SW4 UNN STR UNION R 21 230 010 W S2 -248370IG 52-24837G IR ��- 09/09/97 PAGE 2 FOREST PRACTICES TRAX SYSTEM REPORT PRE-CLASS ID = 14522 SEC TWN RGE CONTROL TP NAME DESCRIPTION MAP LOCATION WATER TRIBUTARY NUMBER CD SOURCE Ip 28 230 010 W G2 -2902201A G2-29022A CI 23 NE4NW4 WELLS 2 R 28 230 010 W S2 *0501501CBBF S2*05015CBBF DM 23 SW4SW4 UNN STR UNION R 28 230 010 W S2 *0570401C S2*05704C DM 23 NW4SW4 UNN STR UNION R 28 230 010 W S2 *0763501C S2*07635C DM 23 SW4SW4 UNN STR UNION R ! 28 230 010 W S2 -256420IGBKK S2-25642GBKK EQ FR IR 23 SEC 28 UNN STR COULTER CR 29 230 010 W S2 *0151501C S2*01515C IS IR 23 NE4 SW4 NE4 UNN STR UNION R 1 � 29 230 010 W S2 *0176301C S2*01763C DS 23 NE4 SE4 UNN STR UNION R 29 230 010 W S2 *0501501CABF S2*05015CABF DM 23 SE4SE4 UNN STR UNION R j 29 230 010 W S2 *2228801C S2*22288C DM IR 23 82 SW4 SE4 UNN STR LYNCH COVE 29 230 010 W S2 -0060901C 52-00609C DS 23 SW4NB4NW4 UNN SPR UNION R 29 230 010 W S2 -2139801C 52-21398C FR IR 23 SE4 NW4 UNION R LYNCH COVE 29 230 010 W 07 MS00106 SHSW 07ALERT SESW 23 i ,I i T h � 4 OD r•� 1 1 FOREST PRACTICE RESOURCE MAP TOWNSHIP 23 NORTH , RANGE 01 WEST ( W . M . ) SECTION 28 APPLICATION # : � e 0 1000 2000 30W 4000 5000 FEET 1 We This box disploys resource information not shown on the map, but is found within this section. For information on the identified resource, contact the agency listed. Agency Point of Concern Phone No. Dept. al Ecology - SW Ground Water (3601407-6300 Date Map Created: September 09, 1997 Dept. of Ecology - SW Surface Water H60)407-6300 NAD 21 LEGEND: See Instructions DISCLAIMER: See Legend .This information applies to the entire section. _..---