HomeMy WebLinkAboutSHX2007-00023 Bulkhead Replacement - SHX Permit / Conditions - 4/16/2007 �oN-STA MASON COUNTY
P DEPARTMENT OF COMMUNITY DEVELOPMENT
N1 c 7
o A o = Planning Division
i o T z P O Box 279, Shelton, WA 98584
N Y y (360)427-9670
OJ �O
1864
Exemption from Shoreline Management Act
Case No.: SHX2007-00023 Substantial Development Permit Requirement
The Proposal By: BRUCE JOHNSON
P.O. BOX 6980
TACOMA, WA 98406
To undertake the following development:
BULKHEAD REPLACEMENT
Within MASON 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
B-normal maintenance
Please contact Rebecca Hersha at ext 593 if you have any questions.
Issued: 4/16/07
Expires: 4/16/09 Authorized Local Government Official
cc: APPLICANT WDFW USACOE WDOE TRIBAL COUNCIL
� ' . az
AGENCY USE ONLY
Agency Reference#: SN x 2L7 c�,-T—00 0 D Date Received:
Circulated by: maso vt C a (local govt or agency)
JOINT AQUATIC RESOURCE ERMIT APPLICATION FORM (JARPA)
(for use in Washington State)
PLEASE TYPE OR PRINT IN BLACK INK. £
TO FILL IN ELECTRONICALLY USE F11 TO MOVE THROUGH THE FORM
❑ Application for a Fish Habitat Enhancement Project per requirements of RCW 77.55.290. You must submit a copy of this
completed JARPA application form and the(Fish Habitat Enhancement JARPA Addition)to your local Government
Planning Department and Washington Department of Fish &Wildlife Area Habitat Biologist on the same day.
NOTE: LOCAL GOVERNMENTS-You must submit any comments on these projects to WDFW within 15 working days.
Based on the instructions provided, I am sending copies of this application to the following: (check a! app
❑ Local Government for shoreline: []Substantial Development ❑Conditional Use ❑varia a )�Exemptio []Revision
❑Floodplain Management ❑Critical Areas Ordinance
❑ Washington Department of Fish and Wildlife for HPA(Submit 3 copies to WDFW Region)
❑ Washington Department of Ecology for 401 Water Quality Certification(to Regional Office-Federal Permit Unit)
❑ Washington Department of Natural Resources for Aquatic Resources Use Authorization Notification
❑ Corps of Engineers for: ❑ Section 404 ❑ Section 10 permit
❑ Coast Guard for: ❑ General Bridge Act Permit ❑ Private Aids to Navigation (for non-bridge projects)
❑ For Department of Transportation projects only: This project will be designed to meet conditions of the most current
Ecology/Department of Transportation Water Quality Implementing Agreement
SECTION A-Use for all permits covered by this application. Be sure to ALSO complete Section C(Signature Block)for all
permit applications.
1.APPLICANT
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MAILING ADDRESS
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�f+ PHONE E-MAIL ADDRESS HOME PHONE FAX#
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/fan agent Is acting for the applicant during the permit process,complete#2. Be sure agent signs Section C(Signature Block)
for all permit applications
2.AUTHORIZED AGENT
MAILING ADDRESS
WORK PHONE E-MAIL ADDRESS HOME PHONE FAX#
3. Relationship of applicant to property: K OWNER ❑ PURCHASER ❑ LESSEE ❑
4. Name, address and phone number of property owner(s)if other than applicant:
5. Location(street address,including city,county and zip code,where proposed activity exists or will occur)
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Local government with jurisdiction(city or county) 'Mas
Waterbody you are working in MaSo n La�<Z Tributary f WRIA#
Is this waterbody on the 303(d)List" YES NO
If YES,what parameter(s)?
"For 303d List, Shoreline designation V
htti)://www.ecy.wa.gov/programs/wq/303d/index.htmi Zoning designation 5,►��E ""^�r
'/.Section Section Township Range Government Lot
a 2/V, Z 4s m s' DNR stream type if known
Latitude and Longitude: Tax Parcel Number :��-a2 3 3 J .1- 000 -1 S
ECY 070-15(Rev. 11/04) JARPA Contact the State of Washington Office of Regulatory Assistance for latest version or call 360/407-7037 or 800/917-0043
1
6. 'Describe the current use of the property,and structures existing on the property. Have you completed any portion of the proposed
activity on this property? ❑ YES ,W NO
For any portion of the proposed activity already completed on this property,indicate month and year of completion.
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Is the property agricultural land? ❑ YES NO Are you a USDA program participant? ❑ YES 42&NO
7a. Describe the proposed work that needs aquatic permits: Complete plans and specifications should be provided for all work waterward
of the ordinary high water mark or line,including types of equipment to be used. If applying for a shoreline permit,describe all work
within and beyond 200 feet of the ordinary high water mark. If you have provided attached materials to describe your project, you still
must summarize the proposed work here. Attach a separate sheet if additional space is needed.
R�,.,.o ve, C�r-eo r e-f�_ -(-:r..b� �u.l k�e.a�.� Sns'f�I l -T 3 );2k)a-•M �e-�'f eI� 3 '(2-f�1t-�9A
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C-eL6rrt} 44,eve- jS ne ccc�eSS TC� v,�ac��'her�/f �c`c_� aS- tY""f 'Y' a 't cY�cfa�^� )
PREPARATION OF DRAWINGS: See sample drawings and guidance for completing the drawings. ONE SET OF ORIGINAL OR GOOD QUALITY REPRODUCIBLE
DRAWINGS MUST BE ATTACHED. NOTE: Applicants are encouraged to submit photographs of the project site,but these DO NOT substitute for drawings. THE CORPS
OF ENGINEERS AND COAST GUARD REQUIRE DRAWINGS ON 8-112 X 11 INCH SHEETS. LARGER DRAWINGS MAYBE REQUIRED BY OTHER AGENCIES.
7b. Describe the purpose of the proposed work and why you want or need to perform it at the site. Please explain any specific needs that
have influenced the design. 1� L ( / �{
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7c. Describe the potential impacts to characteristic uses of the water body. These uses may include fish and aquatic life,water quality,
water supply, recreation and aesthetics. Identify proposed actions to avoid,minimize,and mitigate detrimental impacts and provide
proper protection of fish and aquatic life. Identify which guidance documents you have used. Attach a separate sheet if additional
space is needed.
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'mat" k S79-` o^�' Y►%a c14 e-CY sife 1 I( SQ'rel kIL,k X-otAl- e h V t ronw"%Zt
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7d. For in water constructionk,will your project be in compliance with the State of Washington water quality standards for turbidity
or
WAC 173.201A-110? YES NO (See USEFUL DEFINITIONS AND INSTRUCTIONS)
8. Will the project be constructed in stages? YES ❑ NO
Proposed starting date: L a-*,z, ,��s u s + p r l y �to wo b e it �,oo-1
Estimated duration of activity: wee (cs
9. Check if any temporary or permanent structures will be placed:
❑ Waterward of the ordinary high water mark or line for fresh or tidal waters AND/OR
❑ Waterward of the mean higher high water for tidal waters?
10.Will fill material (rock,fill, bulkhead,or other material)be placed:
❑ Waterward of the ordinary high water mark or line for fresh waters?
If YES,VOLUME(cubic yards) /AREA (acres)
❑ Waterward of the mean higher high water for tidal waters?
If YES,VOLUME (cubic yards) /AREA (acres)
ECY 070-15(Rev. 11/04) JARPA Contact the State of Washington Office of Regulatory Assistance for latest version or call 360/407-7037 or 800/917-0043
2
r11. Will material be placed in wetlands? ❑ YES NO
If YES:
A. Impacted area in acres:
B. Has a delineation been completed? If YES, please submit with application. ❑ YES ❑ NO
C. Has a wetland report been prepared? If YES, please submit with application ❑ YES ❑ NO
D. Type and composition of fill material (e.g.,sand, etc.)
E. Material source:
F. List all soil series(type of soil) located at the project site,and indicate if they are on the county's list of hydric soils. Soils information
can be obtained from the natural Resources Conservation Service(NRCS).
G. WILL PROPOSED ACTIVITY CAUSE FLOODING OR DRAINING OF WETLANDS? ❑ YES ❑ NO
If YES, IMPACTED AREA IS ACRES OF DRAINED WETLANDS.
NOTE:If your project will impact greater than%:of an acre of wetland,submit a mitigation plan to the Corps and Ecology for approval along with the JARPA form.
NOTE:A 401 water quality certification will be required from Ecology in addition to an approved mitigation plan if your project impacts wetlands that are: a)greater than Nacre in size,
orb)tidal wetlands or wetlands adjacent to tidal water. Please submit the JARPA form and mitigation plan to Ecology for an individual 401 certification if a)orb)applies.
12. Stormwater Compliance for Nationwide Permits Only: This project is (or will be)designed to meet ecology's most current
stormwater manual,Oran Ecology approved local stormwater manual. ❑ YES ❑ NO
If YES-Which manual will your project be designed to meet?
If NO-For clean water act Section 401 and 404 permits only-Please submit to Ecology for approval, along with this JARPA
application, documentation that demonstrates the stormwater runoff from your project or activity will comply with the water quality
standards,WAC 173.201(A)
13.Will excavation or dredging be required in water or wetlands? Ar YES ❑ NO
If YES: RQ .tiaV e Qvara9¢- 12-" Jeep a�- vta`t+ZriaJ � 103.� `t3 net o'F t�k�{c�ace� 1ari�((f
A. Volume: (cubic yards)/area (acre)
b,1{�,w, t�r •f c orHa,�-f�„� b!.ak 1�
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B. Composition of material to be removed,A,(y-
C. Disposal site for excavated material: b :
D. Method of dredging: lrkar.Q
14. Has the State Environmental Policy Act(SEPA)been completed YES ❑ NO
SEPA Lead Agency:
SEPA Decision: DNS, MDNS, EIS,Adoption, Exemption Decision Date(end of comment period)
SUBMIT A COPY OF YOUR SEPA DECISION LETTER TO WDFW AS REQUIRED FOR A COMPLETE APPLICATION
15. List other Applications,approvals or certifications from other federal,state or local agencies for any structures,construction discharges
or other activities described in the application(i.e.preliminary plat approval, health district approval,building permit,SEPA review,
federal energy regulatory commission license(FERC),Forest practices application,etc.). Also,indicate whether work has been
completed and indicate all existing work on drawings. NOTE:For use with Corps Nationwide Permits,identify whether your project has
or will need an NPDES permit for discharging wastewater and/or stormwater.
TYPE OF APPROVAL ISSUING AGENCY IDENTIFICATION DATE OF APPLICATION DATE APPROVED COMPLETED?
NO.
16. Has any agency denied approval for the activity you're applying for or for any activity directly related to the activity described herein?
❑ YES X NO
If YES,explain:
ECY 070-15(Rev. 11/04) JARPA Contact the State of Washington Office of Regulatory Assistance for latest version or call 360/407-7037 or 800/917-0043
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SECTION B - Use for Shoreline and Corps of Engineers permits only:
17a.Total cost of project. This means the fair market value of the project, including materials, labor, machine rentals,etc.
17b. If a project or any portion of a project receives funding from a federal agency,that agency is responsible for ESA consultation. Please
indicate if you will receive federal funds an what federal agency is providing those funds. See instructions for information on ESA."
FEDERAL FUNDING YES NO If YES, please list the federal agency.
18. Local government with jurisdiction: Alias-o r C c a H
19. For Corps,Coast Guard and DNR permits, provide names,addresses and telephone numbers of adjoining property owners,lessees,
etc. - Please note: Shoreline Management Compliance may require additional notice—consult your local government.
NAME ADDRESS PHONE NUMBER
SECTION C- This section MUST be completed for any permit covered by this application
0. Application is hereby made for a permit or permits to authorize the activities described herein. I certify that I am familiar with the
information contained in this application, and that to the best of my knowledge and belief,such information is true,complete,and
accurate. I further certify that I possess the authority to undertake the proposed activities. I hereby grant to the agencies to which
this application is made,the right to enter the above-described location to inspect the proposed, in-progress or completed work. I
agree to start work ONLY after all neces permits have been received.
DATE
SIGNATURE OF APPLICANT
DATE
SIGNATURE OF AUTHORIZED AGENT
I HEREBY DESIGNATE TO ACT AS MY AGENT IN MATTERS RELATED TO THIS APPLICATION FOR
PERMIT(S). I UNDERSTAND THAT IF A FEDERAL PERMIT IS ISSUED, I MUST SIGN THE PERMIT.
SIGNATURE OF APPLICANT DATE
SIGNATURE OF LANDOWNER(EXCEPT PUBLIC ENTITY LANDOWNERS, E.G. DNR)
THIS APPLICATION MUST BE SIGNED BY THE APPLICANT AND THE AGENT,IF AN AUTHORIZED AGENT IS DESIGNATED.
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.
COMPLETED BY LOCAL OFFICIAL
A. Nature of the existing shoreline. (Describe type of shoreline, such as marine, stream, lake, lagoon, marsh, bog, swamp,flood
plain,floodway, delta;type of beach,such as accretion, erosion, high bank, low bank, or dike; material such as sand,gravel, mud,clay,
rock, riprap; and extent and type of bulkheading, if any)
B. In the event that any of the proposed buildings or structures will exceed a height of thirty-five feet above the average grade level,
indicate the approximate location of and number of residential units,existing and potential,that will have an obstructed view:
C. If the application involves a conditional use or variance, set forth in full that portion of the master program which provides that the
proposed use may be a conditional use,or, in the case of a variance,from which the variance is being sought.-
These Agencies are Equal Opportunity and Affirmative Action employers.
For special accommodation needs,please contact the appropriate agency in the instructions
ECY 070-15(Rev. 11/04) JARPA Contact the State of Washington Office of Regulatory Assistance for latest version or call 360/407-7037 or 800/917-0043
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