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Home My WebLink AboutSHR2012-00008 JARPA Relocate Winter Creek - SHR Permit / Conditions - 4/22/2013r oN-STArF MASON COUNTY BPS c DEPARTMENT OF COMMUNITY DEVELOPMENT k MO ° A N L Planning Division ° Y n P O Box 279, Shelton, WA 98584 (360)427-9670 1864 SHR2012-00008 NOTICE OF SHORELINE MANAGEMENT PERMIT Notice is hereby given that LILLIWAUP GENERATING COMPANY, who is the owner of the described property, has filed an application for a Shoreline Management Permit for the development of: Sub. Dev./Conditional Use Relocate Winter Creek so that its confluence with Lilliwaup Creek (urban shoreline) is farther upstream of the hydroelectric dam's intake. Geotech Report/Stormwater prepared by Jacobs Associates; Habitat Management Plan prepared by BioResources (Kim Schaumburg); and the public hearing for the Shoreline Substantial Development/Conditional Use scheduled for March 12th, 2013. Site Address: 601 N LILLIWAUP ST LILLIWAUP Parcel Number: 323192300000 Location of Project: US HIGHWAY 101 NORTH, FOLLOW TO LILLIWAUP, L ON LILLIWAUP ST FOLLOW TO THE END SITE ADDRESS OF 501, WILL NEED TO WALK INTO SITE Within: NW WW of (Section 19 in T23Nction: 19 Township: 23 N Range: 3 W, W.M. in , Mason County'WashOg over section) of Said development is proposed within WINTER/LILLIWAUP CRE and/or its associated wetlands. Any person desiring to express their view or to be notified of the action taken on the application should notify.- MASON COUNTY DEPARTMENT OF COMMUNITY DEVELOPMENT P O BOX 279 SHELTON,WA 98584 in writing of their interest. The comment period is at least 30 days from the final date of publication given pursuant to WAC 173-14-020. The final date of publication, posting, or mailing of notice is 1/31/2013. Written comments will be accepted up to the date of the hearing. A public hearing will be held on this permit request. Contact this office at(360)427-9670, ext. 287 for date and time of hearing. A Determination of Nonsignificance was issued on 1/18/2013 under WAC 197-11-340. Written comments regarding this determination must be received by 2/1/2013. SHR2012-00008 Page 1 of 1 RECEIVED MASON COUNTY DEPARTMENT OF COMMUNITY DEVELOPMENT JAN 14 2013 Courthouse Annex P.O.Box 279,Shelton,WA 98584 (360)427-9670 426 W. CEDAR ST. j SHORELINE PERMIT APPLICATIONe10 / 1�' S RELINE SUBSTANTIAL DEVELOPMENT PERMIT NO!5 �-+ SHORELINE VARIANCE DATE RECEIVED'"14- La_ SHORELINE CONDITIONAL USE SHORELINE EXEMPTION The Washington State Shoreline Management Act (RCW 90.58) requires that substantial developments within designated shorelines of the state comply with its administrative procedures(WAC 173-14)and the provisions of the Mason County Shoreline Management Master Program.The purpose of this Act and local program is to protect the state's shoreline resources. The program requires that substantial development(any development of which the total cost or fair market value exceeds$5,000.00 or materially interferes with the normal public use of the water or shorelines of the State be reviewed with the goals,polices,and performance standards established in the Master Program. Answer all questions completely. Attach any additional information that my further describe the proposed development. Incomplete applications willbe returned. APPLICANT: ` I t/ �1L ow ADDRESS: yo ZZ g R �GL� T 13 Sew We-e- (street) 1 G/ Q `. (city) (�L/ (fie) Q f(zip) TELEPHONE: Z�C� Z Z q ` �— y b (home) (business) AUTHORIZED REPRESENTATIVE: icy ( IU 0►—S-t° 3 ADDRESS: I 1 q1 J NCO i'1 Q �C.� / SC30 (street)s eo, We p l.✓/� �/ G/— TELEPHONE: (city) Z (�G �b0 state )f ( P) PROPERTY DESCRIPTION: General location(include property address,water body and associated wetlands—identify the of the shoreline): ,1 Ce % S of e. e ;7 q/c_� Legal description (include section, township, and range to the nearest quarter, quarter section or latitude and longitude to the nearest minute. Projects located in open water areas away from land shall provide a longitude location)—include all parcel numbers: �3z l 9 Z 3 00000 , C. f 2, . f 11ly Se c- / 97 7 3 2l,,J . y7 , V7z 076-1 M l Zo yaw , OWNERSHIP:/ Contract Applicant t/ Owner Lessee Purchaser (Identify) Other Owner: S�� /1 t3c v v.e— (street) (city) (state) (zip) DEVELOPMENT DESCRIPTON Development(identify and describe the project, g type of materials to be used,construction �X a p ( fy proposed ro�ect,including the methods,principle dimensions,and other pertinent information): All 4 L Use(identify current use of property with exist improvements: Reason for requesting development: ACKOWLEDGEMENT I hereby declare,to a best of I ge and belief,the forgoing information and all attached information is true and correct. (app IK6t or au rized tahve) (date) ........................■ ■.................................................... TO BE COMPLETED BY LOCAL OFFICIAL Identify and describe existing features of the site and surrounding area: M2 If proposed structures will exceed a height of 35 feet above the existing grade level,indicate the location of any residential units that will have an obstructive view: NA If a Conditional Use or Variance is requested,make reference to the appropriate section in the Master Program: uns�'�,��d �S� /7• S0, 03y REVISED: 06-25-03 ---------------------- -----; 2 0 1 0 MDate received:PrCor" , " US Army Corps ; A\, 2O�s WASHINGTON STATE oi`e�gu�,t,,7' i r+►t, Joint Aquatic Resources Permit ; Agency reference#: Application (DARPA) Form' Parcel#(s): Cax 3 3-rAmd USE BLACK OR BLUE INK TO ENTER ANSWERS IN WHITE SPACES BELOW. i r � � ---------------------------------- i Part 1—Project Identification 1. Project Name (A name for your project that you create. Examples: Smith's Dock or Seabrook Lane Development) [helpf Lilliwaup Falls Power Project—Winter Creek Relocation Part 2—Applicant The person or organization responsible for the project. hel 2a. Name (Last, First, Middle) and Organization (if applicable) Lilliwaup Falls Generating Company 2b. Mailing Address (Street or PO Box) 1402 3rd Ave Suite 1318 2c. City, State, Zip Seattle, WA 98101-2116 2d. Phone(1) 2e. Phone(2) 2f. Fax 2 . E-mail (206) 224-5466 ( ) ( ) cmusgra@simpson.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.) [hel 3a. Name (Last, First, Middle) and Organization (if applicable) Seneca Group, Craig Norsen 31b. Mailing Address (Street or PO Box) 1191 Second Ave Suite 1500 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. • If your project might affect species listed under the Endangered Species Act,you will need to fill out a Specific Project Information Form(SPIF)or prepare a Biological Evaluation. Forms can be found at http://www.nws.usace.army.mil/PublicMenu/Menu.cfm?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://www,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. ZTo access an online JARPA form with[help]screens,go to httpa/www,epermitting.wa gov/site/alias resourcecenter/jarpaJarpa_form/9984/jarpa_form.aspx. For other help,contact the Governor's Office of Regulatory Assistance at 1-800-917-0043 or help@ora.wa.gov. JARPA 2010 v1 3/30/2010 Page 1 of 14 L/'-V n 3c. City, State, Zip Seattle, WA 98101 3d. Phone(1) 3e. Phone(2) 3f. Fax 3 . E-mail (206) 628-3150 (206) 808-7854 craign@senecagroup.com Part 4—Property Owner(s) Contact information for people or organizations owning the property(ies) where the project will occur. [ ] x❑ 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 .DARPA 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. hel ❑ There are multiple project locations (e.g., linear projects). Complete the section below and use DARPA Attachment B 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 X❑ Private 5b. Street Address (Cannot be a PO Box. If there is no address, provide other location information in 5p.) [ ] 501 N Lilliwaup Street 5c. City, State, Zip (If the project is not in a city or town, provide the name of the nearest city or town.) [ ] Lilliwaup, WA 98555 5d. County hel Mason JARPA 2010 v1 3/30/2010 Page 2 of 14 a3,, 3 5e. Provide the section, township, and range for the project location. [ ] % Section Section Township Range NW 19 23N 03W 5f. Provide the latitude and longitude of the project location. hel • Example:47.03922 N lat./-122.89142 W long- (NAD 83) 47.47207 N 123.12043 W 5g. List the tax parcel number(s) for the project location. [ ] • The local county assessor's office can provide this information. 323192300000 51h. Contact information for all adjoining property owners. (If you need more space, use JARPA Attachment C.) [! ] Name Mailing Address Tax Parcel # (if known) No adjacent neighbors 5i. List all wetlands on or adjacent to the project location. hel No wetlands adjacent the proposed project area. 5j. List all waterbodies (other than wetlands) on or adjacent to the project location. [hel Lilliwaup Creek, Winter Creek, Beardsley Creek 5k. Is any part of the project area within a 100-year flood plain? [,,ems] X❑ Yes ❑ No ❑ Don't know 51. Briefly describe the vegetation and habitat conditions on the property. [ ) Site is heavily vegetated with native vegetation. j JARPA 2010 v1 3/30/2010 Page 3 of 14 �3� y 5m. Describe how the property is currently used. hei Hydroelectric Power Plant. 5n. Describe how the adjacent properties are currently used. [ Forest. 5o. Describe the structures (above and below ground) on the property, including their purpose(s). [helms] There is an existing intake structure at the site. 5p. Provide driving directions from the closest highway to the project location, and attach a map. [help] The site is located off Hwy 106, west of Lilliwaup, at the end of Lilliwaup Street. JARPA 2010 v1 3/30/2010 Page 4 of 14 Part 6—Project Description 3� S 6a. Summarize the overall project. You can provide more detail in 6d. [ Relocate approx. 100' of Winter Creek and install bank protection. 6b. Indicate the project category. (Check all that apply) [help] X❑ 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 X❑ 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 X❑ Dredging ❑ Outfall Structure ❑ Swimming Pool ❑ Bulkhead ❑ Fence ❑ Piling ❑ Utility Line ❑ Buoy ❑ Ferry Terminal ❑ Retaining Wall X❑ Channel Modification ❑ Fishway (upland) X❑ Other: Intake structure for hydroelectric facility 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 channel bed of Winter Creek, which presently discharges into Lilliwaup Creek in the vicinity of the hydroelectric facility's intake area, was previously modified (i.e. relocated) to discharge approximately 90 feet upstream, but Winter Creek has since avulsed and changed course. The previously modified (relocated) channel deviates from the present channel in a northwest fork that is located approximately 70 feet upstream from the intake area. In the winter of 1995 the structural integrity of the fill material that redirected the stream into the modified channel failed and was washed out (Moore, Martig, Boad 2011). The modified channel was repaired but failed again during heavy flows in the winter of 2005/2006. Presently, the failed modified channel is filled with coarse alluvial sediments (cobble and gravel). To alleviate erosion and aggradation of sediments at the intake area, approximately 100 feet of Winter Creek's present channel, upstream from its discharge point into Lilliwaup Creek, will be relocated up to (approx.) 25 feet westward, away from the intake area (See separate attachment entitled Lilliwaup Falls Power Project, Winter Creek Channel Relocation at Lilliwaup Falls, December 21, 2012). Proposed activities include: • Relocating approx. 100 feet of Winter Creek's existing channel by moving it westward up to (approx.) 25 feet. Note: Winter Creek will confluence with Lilliwaup Creek in approx. the same location. The new channel bed will vary between 8 feet and 10 feet in width. The west bank will JARPA 2010 v1 3/30/2010 Page 5 of 14 be laid back at a 3:1 slope into the native soil, covered with biodegradable jute matting wh' re appropriate, and replanted with native trees and shrubs. • The construction of streambank protection for approximately 100 feet along the newly relocated east bank of Winter Creek, using large (three to five man) angular granite. The rock will be placed at approx. a 1:1 slope and backed with quarry spalls and filter fabric. At the northernmost end, an anchor point will be installed by burying large angular rock for approx. twenty feet. The purpose of the anchor point is to prevent the stream from avulsing behind the armoring. Native trees and shrubs will be planted between the anchor point wall and the parking area. • The installation of several rock weirs in the new channel to prevent headcutting and channel bed incision. The weirs will be constructed of two to three man round granite rock and will be installed in a manner that replicates natural conditions. • The placement of additional concrete ecology blocks (or large angular rock) along the intake area structure's north border to alleviate or prevent erosion damage to the structure in the event that heavy seasonal flood flows from Winter Creek overspill the proposed rock armoring. • The installation of approx. 25 feet of 18" pipe to extend an existing pipe between an existing overflow channel to the east and the new relocated channel of Winter Creek. All equipment and materials will be driven to the site using existing roads. The equipment shall consist of heavy machinery and hand tools. Project construction is tentatively scheduled to begin, after the receipt of all required permits and approvals, in the dry season of 2012. Construction will be completed during daylight working hours normal to a rural neighborhood. No construction shall take place when Winter Creek is flowing. 6e. What are the start and end dates for project construction? (month/year) [helr] • 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: _unknown End date: _unknown number of days, after issuance of all required permits. ❑ See JARPA Attachment D 6f. Describe the purpose of the project and why you want or need to perform it. net To prevent future damage to the existing Lilliwaup Falls hydroelectric facility intake area. 6g. Fair market value of the project, including materials, labor, machine rentals, etc. [ ] Unknown. 6h. Will any portion of the project receive federal funding? [ ] • If yes, list each agency providing funds. ❑ Yes X❑ No ❑ Don't know JARPA 2010 v1 3/30/2010 Page 6 of 14 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.) [ 7a. Describe how the project has been designed to avoid and minimize adverse impacts to wetlands. hel X❑ Not applicable 7b. Will the project impact wetlands? [ ❑ Yes X❑ No ❑ Don't know 7c. Will the project impact wetland buffers? [ ❑ Yes X❑ No ❑ Don't know 7d. Has a wetland delineation report been prepared? [ • If yes, submit the report, including data sheets,with the JARPA package. ❑ Yes X❑ No 7e. Have the wetlands been rated using the Western Washington or Eastern Washington Wetland Rating System? [ • If yes, submit the wetland rating forms and figures with the JARPA package. ❑ Yes X❑ No ❑ Don't know 7f. Have you prepared a mitigation plan to compensate for any adverse impacts to wetlands? heg • 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 X❑ Not applicable 7g. Summarize what the mitigation plan is meant to accomplish, and describe how a watershed approach was used to design the plan. [help] i JARPA 2010 v1 3/30/2010 Page 7 of 14 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 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/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. hei 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. pr-ip] JARPA 2010 v1 3/30/2010 Page 8 of 14 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.) hei X❑ 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 WDOE's BMPs and the WDFW's WAC construction requirements shall be strictly adhered to. Disturbed areas shall be replanted with native vegetation as per the Habitat Management Plan (Lilliwaup Falls Power Project, Winter Creek Relocation, December 26, 2012). 8b. Will your project impact a waterbody or the area around a waterbody? [ ] X❑ Yes ❑ No 8c. Have you prepared a mitigation plan to compensate for the project's adverse impacts to non-wetland waterbodies? [ ] • 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. X❑ 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. [ ] ---------- Mitigation is meant to prevent water pollutio n and to re-vegetate disturbed areas of the buffer of Winter Creeks. 8e. Summarize impact(s) to each waterbody in the table below. 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 JARPA 2010 v1 3/30/2010 Page 9 of 14 waterbody directly a ected Winter 100, Several Approx. 188 cubic Approx. 100 feet Creek weeks yards to be moved. when Winter Creek is dry 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. Z 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. '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. [ Large angular rock will be used for bank protection to keep Winter Creek from avulsing to the east and damaging the intake facility. 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. hel Approx. 188 cubic yards of alluvial material will be moved by a track excavator. Material will form new west channel bank. 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. hey Agency Name Contact Name Phone Most Recent Date of Contact JARPA 2010 v1 3/30/2010 Page 10 of 14 I A ; Mason County Rebecca Hersha (360) 427-49670 #287 12-2012 " is Grace Miller " " #360 4-19-12 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? [help) • If yes, list the parameter(s) below. • If you don't know, use Washington Department of Ecology's Water Quality Assessment tools at: http.i/www.ecy.wa.gov/programs/wq/303d/. X❑ Yes ❑ No Fecal coliform & dissolved oxygen. 9c. What U.S. Geological Survey Hydrological Unit Code (HUC) is the project in? hel • Go to littp://ctoub.epa.gov/surf/locate/index.cfm to help identify the HUC. 17110018 9d. What Water Resource Inventory Area Number (WRIA#) is the project in? he► • Go to httpJ/www.ecy.wa.gov/services/gis/maps/wria/wria.htni to find the WRIA#. WRIA 16 9e. Will the in-water construction work comply with the State of Washington water quality standards for turbidity? hel • Go to littp://www.ecy.wa.gov/programs/wq/swgs/criteria.htmi for the standards. X❑ Yes ❑ No ❑ Not applicable 9f. If the project is within the jurisdiction of the Shoreline Management Act, what is the local shoreline environment designation? hel • If you don't know, contact the local planning department. • For more information, go to: hftp://www.ecy.wa.gov/programs/sea/sma/laws rules/173-26/211 designations.html. ❑ Rural ❑ Urban ❑ Natural ❑ Aquatic ❑ Conservancy X❑ Other urban residential 9g. What is the Washington Department of Natural Resources Water Type? [,ejpj • Go to httpJ/www.dnr,wa.gov/BusinessPermits/Topics/ForestPracticesAoplications/Pages/fp__watertygog.aspx for the Forest Practices Water Typing System. X❑ Shoreline X❑ 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? [ ) • If no, provide the name of the manual your project is designed to meet. X❑ Yes ❑ No Name of manual: Stormwater Management Manual for Western Washington. 9i. If you know what the property was used for in the past, describe below. [ ) JARPA 2010 v1 3/30/2010 Page 11 of 14 EVA 3 Property is heavily forested. 9j. Has a cultural resource (archaeological) survey been performed on the project area? hem • If yes, attach it to your JARPA package. ❑ Yes X❑ 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. heI The Chinook salmon, the Hood Canal summer-run chum, the bull trout, the Puget Sound steelhead, the marbled murrelet, and the northern spotted owl are the ESA listed threatened or endangered species in the area. 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. [!]eI Riparian habitat. See above. 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.gov/opas/. • Governor's Office of Regulatory Assistance at (800) 917-0043 or helpCcD-ora.wa.gov. JARPA 2010 v1 3/30/2010 Page 12 of 14 EX-3� 13 • For a list of agency addresses to send your application, click on the "�Aihere to send your completed 11 at nttp://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 rjww.ecy.wa gov/programs/sea/sepa/e-review_html. ❑ A copy of the SEPA determination or letter of exemption is included with this application. X❑ A SEPA determination is pending with _Mason County (lead agency). The expected decision date is ❑ I am applying for a Fish Habitat Enhancement Exemption. (Check the box below in 10b.) I ) X❑ This project is exempt (choose type of exemption below). X❑ Categorical Exemption. Under what section of the SEPA administrative code (WAC) is it exempt? WAC 173-27-040 ❑ Other: ❑ SEPA is pre-empted by federal law. 10b. Indicate the permits you are applying for. (Check all that apply.) nel LOCAL GOVERNMENT Local Government Shoreline permits: X❑ 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: X❑ 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) United States Coast Guard permits: ❑ General Bridge Act Permit ❑ Private Aids to Navigation (for non-bridge projects) Part 11—Authorizing Signatures Signatures are required before submitting the JARPA package. The JARPA package includes the JARPA form, project plans, photos, etc. hei JARPA 2010 v1 3/30/2010 Page 13 of 14 f 11 a. Applicant Signature (required) [ 1 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. (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. (initial) Applicant Printed Name Applicant Signature Date 11 b. Authorized Agent Signature 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 all necessary permits have been issued. Authorized Agent Printed Name Authorized Agent Signature Date 11 c. Property Owner Signature (if not applicant). [ 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. ORA publication number: ENV-019-09 JARPA 2010 v1 3/30/2010 Page 14 of 14 Shoreline Management Act Permit Data Sheet and Transmittal Letter to WA AG FROM: TO: Mason County Planning WA State Attorney General - Ecology Division P.O. Box 279 P.O. Box 40100 Shelton, WA 98584 Olympia, WA98504 Submittal Date: 311-') i Date Received by GA: TYPE OF PERMIT: (indicate all that apply) Substantial Development ❑ Variance ❑ Other: Conditional Use ❑ Revision LOCAL GOVERNMENT DECISION: ❑ Approval If Conditional Approval ❑ Denial Planner Name: _6�-rorty yil( 4 Phone: ed34o l Notice of Application Date: 1131 /13 Final Decision Date: 31-l-&Ji3 APPLICANT: REPRESENTATIVE (if primary contact): Name: Li//rwo" /l<'all� Name: /-G AUg/<�-r� Mailing Address: /W.2 "��vL sfr�7 L3/A Mailing Address: //q/. /,5�qo / 52-Z e- Gt/f Phone: ��d Ll) y-_�y[oC� Phone: ,,4 s?o x-- 7F.5Y Email: 0- W 5 Pson Email: PROPERTY OWNER: Same as Applicant ❑ Other: PROPERTY LOCATION: (Section, Township, and Range to the nearest '/4 '/4 Section; Latitude and Longitude; and a street address where available) A16o `/y ac e- /9, TZu„/ -23 :v R 3 w. a Z/7• /79,v 7 n1 /a.3. Tax Parcel Number: ,�33i°i-.73-cz-x)o Shoreline Designation: G��oa, 12c5;d.�1 Waterbody: Shoreline of Statewide Significance? ❑ Yes No PROJECT DESCRIPTION: �rllru� � f'A 11 5 Pt 4-11ey r vv r Ed- k 4ce,�' I:PLAN NING\PAC\FORMS\ShorelineTransmittal 6,12010 Shoreline Management Act Permit Data Sheet and Transmittal Letter to WA DOE FROM: TO: Mason County Planning WA Department of Ecology P.O. Box 279 SW Regional office Shelton, WA 98584 ATTN: Shoreline Permit Reviewer ,��L P.O. Box 47775 Olympia, WA 98504 Submittal Date- -�g 3 Date Received by GA: TYPE OF PERMIT: (indicate all that apply) Substantial Development ❑ Variance ❑ Other: Conditional Use ❑ Revision LOCAL GOVERNMENT DECISION: ❑ Approval Conditional Approval ❑ Denial Planner Name: Grace-AdW" Phone: C3be,) 1_27-gb 0 x 3 o Notice of Application Date: 113 j //3 Final Decision Date- 3/��f3 APPLICANT: REPRESENTATIVE (if primary contact): Name: %ad's Name: Alo ie-a Mailing Address: /z a 3,�f A� . .S� /3i8 Mailing Address: SGA W,4 `I3lol �itc. w� `1Sioi Phone: aa-1_ 541 Phone: C�oc>> Foe— 7,1sy Email: C s+mpseq , com Email: cram Z.) ea i-vq ' cowl :J PROPERTY OWNER: 4same as Applicant ❑ Other: PROPERTY LOCATION: (Section, Township, and Range to the nearest % % Section; Latitude and Longitude; and a street address where available) , V in;Xj 5;_F�c /9 77citi' a 3 ti ,E' 3 W L o .2 /-/7, '/7a .0 7 1V i,73. :!�z-� W Tax Parcel Number: 3,�3 J 9-a3--ocpoo Shoreline Designation: Waterbody: Lllljcy dive;, Shoreline of Statewide Significance? ❑ Yes 4'No PROJECT DESCRIPTION: e /law �all5 �o�.r �r I�ro�Ccf G✓:h��r CaezK %� te�� I:PLAN N I NG\PAC\FORMS\S horelineTransmittal 612010