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Home My WebLink AboutJARPA - SHX Application - 1/22/1998 11 21 AGENCY USE ONLY �! Agency Reference !1: Date Received: SEPA Lead Agency: MA n Qdm "jjA hig i Other. — DARPA APPLICATION FORM - - for use in Washington State - PLEASE TYPE OR PRINT IN BLUE OR BLACK INK Based on the preceding checklist, I am sending copies of this application to the following: (check all that apply) ® Local Government: for shoreline ❑ Substantial Development ❑ Conditional Use ❑ Variance 13 Exemption; or ❑ Floodplain Management ❑ Critical Areas Ordinance ® Washington Department of Fish and Wildlife for HPA ❑ Washington Department of Ecology Approval to Allow Temporary Exceedance of Water Quality Standards ❑ 401 water Quality Certification Nationwide Permits ❑ Corps Engineers for Section 404 or Section 10 permit(s) 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 L Mailing Address L )14 Work Phone: (3C-0► S - 7 J�o 1 Home Phone: (-?A Fax Number- If an agent is acting for the applicant during the permit process, complete #2 &3. 2. Authorized Agent Mailing Address Work Phone: ( ) Home Phone: Fax Number. ( ) 3. Designation of Authorized Agent, if applicable: 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 4. Relationship of applicant to property: ❑ Owner ❑ Purchaser ❑ Lessee ❑ Other ( En i e a y e e ) 5. Name, address, and phone number of property owner(s), if other than applicant: Application Page I of 5 '.A 6. Location where proposed activity exists or will occur: Waterbody t✓C-(U.4 R. V e-r . DNR Stream Cif]mown) Street Address Tributary of o o r-1 Lega: '1escription: City, County, State, Zip Code Tax -x1 No.: Section .3 Township Range 7. Describe the current use of the property, and structures existing on the property. If any portion of the proposed activity is already completed on this property, indicate month and year of completion. Cctrre-n� ly 4Ae, rep Er f y % S b (45 e,c( CS G yclro e, ec- +r; C )arn+ c,Y) rC Is the property agricultural land? ❑ Yes B No Are you a USDA program participant? ❑ Yes ® No 8. Describe the proposed activity, and the activity's purpose. Include expected water quality and fish impacts, and proposed actions to reduce the duration and severity of those impacts and provide proper protection for fish life. 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, and for a work if applying for a shoreline permit If additional space is needed, please attach a separate sheet. Sew G�CcC� men � �� Preparation of drawings: See Appendix A - sample drawings and checklist for completing the drawings. One set of origins] or good quality reproducible drawings must be attached. NOTE: Applicants are encouraged to submit photograph ,of the project site, but these do not substitute for drawings. THE CORPS OF ENGINEERS REQUIRES DRAWINGS ON 8-1,`2 X 11 INCH SHEETS. Larger drawings may be required by other agencies. Application Page 2 of 5 9. 'Proposed Starting Date: 4115_/98 Fatimated duration of activity: /0 Will the project be constructed in stages? ❑ Yes F No 10. Will any structures be placed: a. waterward of the Ordinary High Water Mark or Line for fresh or tidal waters? ❑ Yes it No b. waterward of Mean High Water Line in tidal waters? ❑ Yes 0 No 11. Will fill material (rock, fill, bulkhead, pilings or other material) be placed waterward of Ordinary High Water Mark or Line for fresh or tidal waters? ❑ Yes No a. If"yes," in fresh water indicate volume in cubic yards: b. If"yes," in tidal waters, indicate volume in cubic yards waterward of the line of mean higher high water: 12. Will material be placed in wetlands? ❑ Yes 13 No If yes, impacted area: (acres) If yes: a. Has a delineation been completed? ❑ Yes 13 No (If yes, please submit with application.) b. Type and composition of fill material (e.g., sand, etc.): c. Material source: d. List all soil series (type of soil) located at the project site, &indicate if they are on the county's list of hydric soils: Soils information can be obtained from the Natural Resources Conservation Service (NRCS), formerly Soil Conservation Service (SCS). 13. will proposed activity cause flooding or draining of wetlands? ❑ Yes ❑ No If yes, impacted area: (acres) 14. Will excavation or dredging be reclused in water or wetlands? ❑ Yes 01 No If yes, velunw- (cubic yards) a Composition of material removed: b. Disposal site for excavated material: c. Method of dredging: 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, FERC license, Forest Practices Application, etc.) Also indicate whether work has been completed and indicate all existing work on drawings. Date of Date Completed? Type of Apyroval Issuinz Agency Identification No. Application Avoroved Yes or No S a?A- ltild y1 (,C� Ste'`6 _Cc) sH x SEPA Lead Agency: SEPA Decision Date: L t `f Application Page 3 of 5 16. Has any agency denied approval for the activity described herein or for any activity directly related to the activity described herein? ❑ Yes 3 No If yes, explain: SECTION B -Use for Shoreline& Corps of Engineers permits only: 17. Total cost of Project. This means the fair market value of the project, including materials, labor, machine rentals, etc. 18. Local government w/jurisdiction: ) Cl S 6 vet» � v Shoreline Environment designation: Zoning designation. 19. For corps 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. SECTION C - Complete for any permit covered by this application 20. 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 eater the above-described location to ' the proposed or completed work. Signamm of Applicant or Authorized Agent (REQUIRED) Date Signature of Landowner (REQUIRED if other than applicant) Data This appl,,-Adon must be signed by the applicant. If an authorized agent is to be designated, the applicant must also siga at Item 18 U.S.0 g'. provides that: whoever,in any manner within the jurisdiction of any department or agency of the Umted States knowingly falsifies, co-,--z►is, or covers up by any trick, scheme, or device a material fad or makes any false, fictitious, or fiaudulent statements or representations or makes or uses any false writing or document knowing same to contain any false, fictitious, or fiwdulent statement or entry, shall be fined not more than$10,000 or imprisoned not more than 5 years or both. Application Page 4 of 5 Attachment#1 During the winter of 1997-1998 a slide of rock and trees covered the eAaust flume of the hydroelectric plant causing the exhaust water to enter Lilliwaup River 100 feet short of the plunge pool. The slide and flume have been inspected by a state fisheries biologist who did issue a temporary permit to continue operation until the slide can be removed. During the low flows of summer we can access the slide with a back hoe without entering the river. Once the winter flows recede we would like to remove the rock from the flume and repair any damages done to it. We would also like to add a concrete cap to the last 75 feet of the flume to avoid a similar situation in the future. All necessary precautions will be taken to assure that no oil,diesel or hydraulic fluids are leaked in to the stream. If at any time petroleum products are noticed along the stream, oil absorbent booms will be properly placed and the leak will be fixed. We- will not allow any curing concrete to come in contact with the stream, if at any time this is observed an absorbent cloth wall will be installed to retain the loose materials. All necessary efforts will be taken to assure that the work occurring along Lilliwaup River will have no negative effects on water quality or aquatic life. p l cA n l � wCA ue r � s o � loti✓ s 3 4 Y e-C, p ve q L Gw 4