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HomeMy WebLinkAboutSHX2012-00031 JARPA - SHX Permit / Conditions - 6/4/2012 SON-srATFO MASON COUNTY �P c DEPARTMENT OF COMMUNITY DEVELOPMENT o S o i Planning Division i o T Z P O Box 279, Shelton, WA 98584 7 N Y ti (360)427-9670 OJ a0 1864 Exemption from Shoreline Management Act Case No.: SHX2012-00031 Substantial Development Permit Requirement The Proposal By: KEN &CYNTHIA TAKEGAMI &WENNEMARK 1001 COOPER POINT RD SUITE 140 OLYMPIA, WA 98502 To undertake the following development: Installation of an 8' X 30' chain-anchored float. SEPA case #SEP2011-00033 was issued for this float and beach stairs on 7/13/11. Within PICKERING PASSAGE 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 Grace Miller at ext 360 if you have any questions. Issued: 6/4/2012 Expires: 6/4/2014 Authorized Local Government Official cc: APPLICANT WDFW USACOE WDOE TRIBAL COUNCIL �%,4, TAKEGAMI AND WENNEMARK FLOAT PROJECT. Dive conducted on Distance and August 8,2011 corrected tidal °,,s,.0�z" T1 T2 T3 T4 T5 T6 el in evate t along 250 .0 MACROALGAE AND _-16 160 % COVERAGE PER -12 0 SQUARE METER: 2 G _ 230 G= Gracilaria 1G _ 220 u= ulva -9.0 PROPOSED on T5 FLOAT at 210' 200 -5.0 25' 10, _ 180 -3.6 _ 160 2U 3 U -3.0 20 U 3-5 U _ 140 IOU 3U� -2.3 10 uo- _ 120 2U T 20 V► -1.0 - 100 - 80 - 60 APPROVED MASON COUNTY DCD PI ANNING - 40 SITE PLAN REQUIRED TO BE -)N SITE CHANGES SUBJECT 1'0 Ar" OVAL By __.-- — Date . —. - 20 1 �'�""" '- / Distance and rlo eao wi ctct:uK t eh,1)1 7ch dr leya ion( tidal elevation(MLLv) in feet along 0 T3 glo, 4J 4 y,)-d Of-tW,4(. BASELINE intersection of the beach and bluff PL i ------------------------------------- i AGENCY USE ONLY 2010 'J � �'�'� � Date received: ; US Army Cops WASHINGTON STATE °sm"gD ; Joint Aquatic Resources Permit ; Agency reference#: Application (DARPA) 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 Doric or Seabrook Lane Development) hel NWSE Trail and Float Project Part 2—Applicant The person or organization responsible for the project. hel 2a. Name (Last,First, fuBddle) and Organization(it applicable) NWSE Holdings, LLC Ken Takegami & Cynthia Wennemark 2b. Mailing Address (Street or PO Box) 1001 Cooper Point Road, Suite 140-266 2c. City, State, Zip Olympia, WA 98502 2d. Phone(1) 2e. Phone(2) 2f. Fax 2g. E-mail (931)-393-4747 (931)-808-7910 (931)-455-6689 weluv2cats@aol.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.) heI 3a. Name (Last,First, I ckne) and Organization (if applicable) McMurry, Key L Key Environmental Solutions, LLC. 3b. Mailing Address (street or Po Box) 550 Mill Creek Road 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)7643495. • If your project might affect species listed under the Endangered Species Act,you will need to fill out a specific Project Information Form(BPIF)or prepare a Biological Evaluation. Forms can be found at http:!/www.nwsmsace.army.mil/PUblicMenu.Menu.cim?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://wwiw.dnr.wa.gov/Publications:agr_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. 2To access an online JARPA form with[help)screens,go to http:;,www.epermitting.ria.gov/site/alias_resourcecenterljarpa_jarpa_torm!9984/jarpa form.aspx. 6-1- .. t--4 t►,o r_~ new'-z flffirw of Reoulatory Assistance at 1-800-917-0043 or heip@ora.wa.gov. 3c. City, State, Zip Raymond, WA 98577 3d. Phone(1) 3e. Phone(2) 3f. Fax 3 E-mail (360)-942-3184 (360)-562-5763 (360)-942-0260 key@keyenvironmentalsolutions_com Office Cell Part 4—Property Owner(s) Contact information for people or organizations owning the property(ies) where the project will occur. hel ® 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 4g. E-mail Part 5—Project Location(s) Identifying information about the property or properties where the project will occur. hei ❑ There are multiple project locations (e.g., linear projects). Complete the section below and use JARPA Ai achrnel i 6 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 ® Private 5b. Street Address (Cannot be a PO Box. If there is no address,provide other location information in 5p.) 181 E Bergeson Road 5c. City, State, Zip(If the project is not in a city or town,provide the name of the nearest city or town.) hep] Shelton, WA 98584 Harstine Island 5d. County heln Mason 3c. City, State, Zip Raymond, WA 98577 3d. Phone(1) 3e. Phone(2) 3f. Fax 3 . E-mail (360)-942-3184 (360)-562-5763 (360)-942-0260 keyCa)keyenvironmentalsolutions.com Office Cell Part 4—Property Owner(s) Contact information for people or organizations owning the property(ies) where the project will occur. hel ® 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. fhelpl ❑ 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.) i,( eipl ❑ 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 ® Private 5b. Street Address (Cannot be a PO Box. If there is no address,provide other location information in 5p.) hel 181 E Bergeson Road 5c. City, State, Zip(if the project is not in a city or town,provide the name of the nearest city or town.) hel Shelton, WA 98584 Harstine Island 5d. County hel Mason 5e. Provide the section, township, and range for the project location. [ ) 1/4 Section Section Township Range NW1/4 3 20N 2W 5f. Provide the latitude and longitude of the project location. • Example: 47.03922 N lat./ 122.89142 W long. (NAD 83) 47.25891 122.91355 5g. List the tax parcel number(s) for the project location. [ ) • The local county assessor's office can provide this information. 220031290120 5h. Contact information for all adjoining property owners. (If you need more space, use JARPA Attachment G.) Imm Name Mailing Address Tax Parcel #(if known) ROSALYN LEE ET AL JANE LEE 455 RICHMOND RD 220031290130 LA CANADA CA 91000-3536 SANDRA J KRAMER 450 E BERGESON RD 220031290021 SHELTON WA 98584 5i. List all wetlands on or adjacent to the project location. hel There are several wet areas that will be crossed with boardwalks, all are very mucky areas with little to no vegetation. Trail was permitted and completed in September, 2011. 5j. List all waterbodies (other than wetlands) on or adjacent to the project location.(�elol Adjacent to project location is Pickering Passage, there is one NS stream & one NP stream. These streams are not shown on the DNR streamtype map. 5k. Is any part of the project area within a 100-year flood plain? hel ❑ Yes ® No ❑ Don't know 51. Briefly describe the vegetation and habitat conditions on the property. [he!-1 Big leaf maple, alder, cedar, spruce, Indian plum, holly, salal, vine maple, nettles and devils club. There are several wet areas mucky, with very little vegetation-some skunk cabbage, water parsley, and salmon berry. There is one NS stream and one NP stream. 5m_ Describe how the property is currently used. M Single Family Residence. 5n. Describe how the adjacent properties are currently used. hei Single Family Residences. 5o. Describe the structures (above and below ground) on the property, including their purpose(s). (i,ei Small single family residence, currently a vacation home, in the future will become a permanent residence. 5p. Provide driving directions from the closest highway to the project location, and attach a map. 2 Take WA-3 north out of Shelton. Turn right at Grant Ferry Road/E Pickering. Continue onto E Harstine Bridge Road. Turn left at E North Island. Travel 1 mile. Turn left onto E Bergeson Road. 181 will be on left. Part 6—Project Description 6a. Summarize the overall project. You can provide more detail in 6d. (_ Construct a 5' wide trail with raised boardwalks and a staircase down to the beach from the house. The trail material will be wood chips. The trail will be approximately 545 feet long meandering back and forth across the width of the property. There will be one footbridge, 3 boardwalk areas, and a stepped trail to the beach ending in the uplands. Also install an 8' X 30' float on the parcel in Pickering Passage. Trail was permitted and completed in September, 2011. 6b. Indicate the project category. (Check all that apply) ( _ ❑ Commercial ® Residential ❑ institutional ❑ Transportation ® Recreational ❑ Maintenance ❑ Environmental Enhancement 6c. Indicate the major elements of your project. (check all that apply) Ihetpl ❑ 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 ❑ Dock/ Pier ❑ Mining ❑ Stormwater facility ❑ Bridge ❑ Dredging ❑ Outfall Structure ❑ Swimming Pool Piling El Utility Line ❑ Bulkhead ❑ Fence ❑ 9 ❑ Buoy ❑ Ferry Terminal ❑ Retaining Wall ❑ Channel Modification ❑ Fishway (upland) 5m_ 'Describe how the property is currently used. ft Single Family Residence. 5n. Describe how the adjacent properties are currently used. LLeIA Single Family Residences. 5o. Describe the structures (above and below ground) on the property, including their purpose(s). fhem Small single family residence, currently a vacation home, in the future will become a permanent residence. 5p. Provide driving directions from the closest highway to the project location, and attach a map. nee Take WA-3 north out of Shelton.Turn right at Grant Ferry Road/E Pickering. Continue onto E Harstine Bridge Road. Turn left at E North Island. Travel 1 mile. Turn left onto E Bergeson Road. 181 will be on left. Part 6-Project Description 6a. Summarize the overall project. You can provide more detail in 6d. he! Construct a 5' wide trail with raised boardwalks and a staircase down to the beach from the house. The trail material will be wood chips. The trail will be approximately 545 feet long meandering back and forth across the width of the property. There will be one footbridge,3 boardwalk areas, and a stepped trail to the beach ending in the uplands. Also install an 8' X 30' float on the parcel in Pickering Passage. Trail was permitted and completed in September,2011. 6b. Indicate the project category. (check all that apply) lte! ❑ Commercial ® Residential ❑ Institutional ❑ Transportation ® 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 ® Stairs ❑ Boat Launch ❑ Ditch E] Marina/Moorage ❑ Boat Lift El Dock/Pier ❑ Mining ❑ Stormwater facility ❑ Bridge ❑ Dredging ElOutfali Structure ❑ Swimming Pool ❑ Bulkhead El Fence ❑ Piling Utility Line ❑ Buoy ❑ Ferry Terminal ❑ Retaining Wall ❑ Channel Modification ❑ Fishway (upland) 6d. Describe how you plan to construct each project element checked in 6c. Include specific construction methods and equipment to be used. [ • Identify where each element will occur in relation to the nearest waterbody. • Indicate which activities are within the 100-year flood plain. The trail, boardwalks, bridge and stairs will be all be constructed by hand. The boardwalks will be constructed over the wet areas, the bridge will be constructed over the NS stream and the stairs will be built down to the beach ending in the upland area above the OHWL. Trail was permitted and completed in September, 2011. An 8' X 30' float will be installed (see attached drawings). 6e. What are the start and end dates for project construction? (month/year) [ • If the project will be constructed in phases or stages, use 'ARPA Attachment L,to list the start and end dates of each phase or stage. Start date: March 2011 End date: September 2012 ❑ See DARPA Attachment D 6f. Describe the purpose of the project and why you want or need to perform it. lie► ] The property owners would like be able to enjoy their property and need to have access to the beach part of their property. The property owners would like to have a place for a boat, possibly a sailboat and a place for their kayaks. Trail was permitted and completed in September, 2011. 6g. Fair market value of the project, including materials, labor, machine rentals, etc. [ 6h. Will any portion of the project receive federal funding? I • If yes, list each agency providing funds. ❑ Yes ® No ❑ Don't know Part 7—Wetlands: Impacts and Mitigation ® Check here if there are wetlands or wetland buffers on or adjacent to the project area. (If there are none, skip to Part 8.) hei 7a. Describe how the project has been designed to avoid and minimize adverse impacts to wetlands. hel ❑ Not applicable will constructed out of wood chips. Boardwalks will be constructed over the wet areas and will allow The trap wl be p natural hydrology to occur. The wet areas are very mucky with little to no vegetation. Trail will be built from the top down to keep construction impacts to a minimum. All mucky areas were avoided. Trail was permitted and completed in September, 2011. 7b. Will the project impact wetlands? thel ❑ Yes ® No ❑ Don't know 7C. Will the project impact wetland buffers? [help ❑ Yes ® No ❑ Don't know 7d. Has a wetland delineation report been prepared? hei • 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? [ I • 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? help • 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 ® Not applicable 7g. Summarize what the mitigation plan is meant to accomplish, and describe how a watershed approach was used to design the plan. Liieip 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. nel ❑ Not applicable The trail will be constructed out of wood chips. Boardwalks will be constructed over the wet areas and will allow natural hydrology to occur.The wet areas are very mucky with little to no vegetation. Trail will be built from the top down to keep construction impacts to a minimum. All mucky areas were avoided.Trail was permitted and completed in September, 2011. 7b. Will the j roect impact wetlands? i,ei P ❑ Yes ® No ❑ Don't know 7c. Will the project impact wetland buffers? hel ❑ Yes ® No ❑ Don't know 7d. Has a wetland delineation report been prepared? h[ e�l.J • 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? ljhelp • 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? Help • 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 ® Not applicable 7g. Summarize what the mitigation plan is meant to accomplish, and describe how a watershed approach was used to design the plan. nel L 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. Activity (fill, Wetland Wetland Impact Duration Proposed Wetland drain, excavate, Name' type and area (sq. of impact3 mitigation mitigation area flood, etc.) rating ft. or type' (sq. ft. or category' Acres) acres) N/A N/A N/A N/A N/A N/A N/A 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 JAR PA 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 yards that will be used, and how and where it will be placed into the wetland. No fill is occurring in the wet areas. 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. [ No excavation will occur in wet areas, all boardwalk work will be constructed by hand. All wetlands and mucky areas were avoided. Trail was permitted and completed in September, 2011. I J 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.) [ l ® 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. ❑ Not applicable The trail was designed to avoid and minimize stream crossing. There is one stream crossing that is unavoidable. It will have a full spanning footbridge installed over it. The stairs to the beach were designed to end in the upland area to avoid any beach impacts and impacts to any potential forage fish area. Trail was permitted and completed in September, 2011. 8' X 30' float will be installed in Pickering Passage, in a north/south direction. A certified dive and HMP was performed by MSA. 8b. Will your project impact a waterbody or the area around a waterbody? [ l ❑ Yes ® No 8c. Have you prepared a mitigation plan to compensate for the project's adverse impacts to non-wetland waterbodies? [ I • 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 ® Not applicable 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. The trail is being constructed by hand and will be made out of wood chips. The float is designed to be removed and is being placed in an area that is avoiding eelgrass and other macroalgae. Trail was permitted and completed in September, 2011. 8' X 30' float will be installed in Pickering Passage, in a north/south direction. A certified dive and HMP was performed by MSA. 8e. Summarize impact(s) to each waterbody in the table below. MIA 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 N/A N/A N/A N/A N/A N/A Part 8-1iWaterbodies (other than wetlands): Impacts and Mitigation In Part 8, `waterbodies"refers to non-wetland waterbodies. (See Part 7 for information related to wetlands.) ® 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. helal ❑ Not applicable The trail was designed to avoid and minimize stream crossing. There is one stream crossing that is unavoidable. It will have a full spanning footbridge installed over it. The stairs to the beach were designed to end in the upland area to avoid any beach impacts and impacts to any potential forage fish area. Trail was permitted and completed in September, 2011. 8' X 30' float will be installed in Pickering Passage, in a north/south direction. A certified dive and HMP was performed by MSA. 8b. Will your project impact a waterbody or the area around a waterbody? [,ielol ❑ Yes ® No 8c. Have you prepared a mitigation plan to compensate for the project's adverse impacts to non-wetland waterbodies? Ltmigl • If yes, submit the plan with the DARPA package and answer 8d. • If No,or Not applicable,explain below why a mitigation plan should not be required. ❑ Yes ❑ No ® Not applicable 8d. Summarize what the mitigation plan is meant to accomplish. Describe how a watershed approach was used to design the plan. • If you already completed 7g., you do not need to restate your answer here. hei The trail is being constructed by hand and will be made out of wood chips. The float is designed to be removed and is being placed in an area that is avoiding eelgrass and other macroalgae. Trail was permitted and completed in September, 2011. 8' X 30' float will be installed in Pickering Passage, in a north/south direction. A certified dive and HMP was performed by MSA. 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 to be placed in or linear ft.) of drive, etc.) removed from waterbody waterbody directly affected N/A N/A N/A N/A N/A N/A If no official name for the waterbody exists,create a unique name(such as"Stream 1' The name should be consistent with other documents provided. 2 Indicate whether the impact will occur in or adjacent to the waterbody. If adjacent,provide the distance between the impact and the waterbody and indicate whether the impact will occur within the 100-year flood plain. 3 Indicate 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. [ I No fill will be placed in any of the wet areas, or NS and NP stream and no fill will be placed in Pickering Passage 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. No excavating or dredging activities will occur in any waterbody that occurs on the parcel. 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. [helm Agency Name Contact Name Phone Most Recent Date of Contact Mason County Grace Miller ( 360)-427-9670 Ext. 360 8/2/2010, 4/28/2011 WDFW Margie Schirato Bigelow (360) 427-2179 8/23/2010 ( ) 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? [ ) • If yes, list the parameter(s) below. • If you don't know, use Washington Department of Ecology's Water(duality Assessment tools at: 1 t t .ecy'.Ilia.goyYI'=rog ram s/wgi303d• ® Yes ❑ No Hood Canal low oxygen levels 9c. What U.S. Geological Survey Hydrological Unit Code (HUC) is the project in? • Go to iap://cfpub.epa.gov/surf/locate./index.cfii to help identify the HUC. 17110018 9d. What Water Resource Inventory Area Number (WRIA#) is the project in? [ • GO t0 _i��"'WWN eCV wa QOV SLrV'C@S%Q1s1inaDs!v,,i"iaiyyiia.iiim to find the WRIA#. WRIA 14 9e. Will the in-water construction work comply with the State of Washington water quality standards for turbidity? helr:] • Go to httn:!/Nrruw.ecYwa qov/programs!wq/swgs/criteria.htrnl 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? he► is.,, A,n 't Unnw r nntnM tha Incal olannina department. __ i • For more information, go to: tit tP:',yJVAV.eCy.wa.goov_/Pragramsisealsma/faws rules;173-26/211 designations.html. ® Rural ❑ Urban ❑ Natural ❑ Aquatic ❑ Conservancy ❑ Other 9g. What is the Washington Department of Natural Resources Water Type? i,el • Go to i)tlp:/www drrr wa goviBusinessPermits!l opicsiForesiPracticesf,pplicationsiPages/fp watertVping.aspx for the Forest Practices Water Typing System. ® Shoreline ❑ Fish ® Non-Fish Perennial ® Non-Fish Seasonal 9h. Will this project be designed to meet the Washington Department of Ecology's most current stormwater manual? heio • 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. Logging performed on the project area? hel 9j. Has a cultural resource (archaeological) survey been P J L—el • If yes, attach it to your JARPA package. ❑ Yes ® 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. [ Any listed species occurring in Pickering Passage, including salmonids, forage fish, eelgrass and marine mammals. Trail was permitted and completed in September, 2011. 8' X 30' float will be installed in Pickering Passage, in a north/south direction. A certified dive and HMP was performed by MSA. 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. I Any listed species occurring in Pickering Passage, including salmonids, forage fish, eelgrass and marine mammals. Trail was permitted and completed in September, 2011. 8' X 30' float will be installed in Pickering Passage, in a north/south direction. A certified dive and HMP was performed by MSA • For more information,go to:hltp://www.ecy.wa.gov/programs/sea/smaAaws rules/173-26/211 desianations.htmi. ® Rural ❑ Urban ❑ Natural ❑ Aquatic ❑ Conservancy ❑ Other 9g. What is the Washington Department of Natural Resources Water Type? hel • Go to httpl/www dnr wa gov/BusinessPermitsiTopics/ForestPracteesApplicabons/Pages/fp watertypina.aspx for the Forest Practices Water Typing System. ® Shoreline ❑ Fish ® Non-Fish Perennial ® Non-Fish Seasonal 9h. Will this project be designed to meet the Washington Department of Ecology's most current stormwater manual? LLLeV • 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. h[be► Logging 9j. Has a cultural resource (archaeological) survey been performed on the project area? BmM • If yes,attach it to your JARPA package. ❑ Yes ® 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. hel Any listed species occurring in Pickering Passage, including salmonids, forage fish, eelgrass and marine mammals. Trail was permitted and completed in September, 2011.8'X 30'float will be installed in Pickering Passage, in a north/south direction. A certified dive and HMP was performed by MSA. 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 Any listed species occurring in Pickering Passage, including salmonids, forage fish, eelgrass and marine mammals. Trail was permitted and completed in September, 2011. 8'X 30'float will be installed in Pickering Passage, in a north/south direction. A certified dive and HMP was performed by MSA 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.clov/opas/. • Governor's Office of Regulatory Assistance at (800) 917-0043 or helpC- ora.wa.gov. • For a list of agency addresses to send your application, click on the "where to send your completed DARPA"at http://www.epermitting.wa.gov. 10a. Compliance with the State Environmental Policy Act(SEPA). (check all that apply.) hel • For more information about SEPA,go to www.ecy.wa.gov/lprograms/sea/sepate-t,eview.htmi. ® 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 I Ob.)[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. 10b. Indicate the permits you are applying for. (check all that apply.) hei LOCAL GOVERNMENT Local Government Shoreline permits: ❑ Substantial Development ❑ Conditional Use ❑ Variance ® Shoreline Exemption Type (explain): Other city/county permits: ❑ Floodplain Development Permit ® Critical Areas Ordinance STATE GOVERNMENT 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) RGP- Float United States Coast Guard permits: n ori.,,3to niHc tr% mnvinntinn (for non-bridae nroiects) Part 11—Authorizing Signatures Signatures are required before submitting the JARPA package. The JARPA package includes the JARPA form, project plans, photos, etc. (iitin) 11 a. Applicant Signature (required) [ 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. C)," (initial) ApplicaniePrinted Nkme Applicant Sighature V D 11 b. Authorized Agent Signature rneiil 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. I Key Environmental Solutions LLC. Key McMurry � 11/23/2011 Authorized Agent Printed Name Authori gent Signature Date 11c. Property Owner Signature (if not applicant). fhe ) 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. Part 11—Authorizing Signatures Signatures are required before submitting the JARPA package. The JARPA package includes the JARPA form, project plans, photos, etc. hel 11a. Applicant Signature (required) hel I certify that to the best of my knowledge and belief, the information provided in this application is true, complete, and accurate. I also certify that I have the authority to carry out the proposed activities, and I agree to start work only after I have received all necessary permits. I hereby authorize the agent named in Part 3 of this application to act on my behalf in matters related to this application.S�,u_ (initial) By initialing here, I state that 1 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. Cxs.%- (initial) t=o, IAN,6� K v. cA. (LD 1 ,0 ApplicantPrinted-Nkme Applicant Sighature Dat 11 b. Authorized Agent Signature h[ elg 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. Key Environmental Solutions LLC. Key McMurry I 11/23/2011 Authorized Agent Printed Name AuthorizWAaent Signature Date 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.