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HomeMy WebLinkAboutSHX2016-00001 JARPA Replace Dock - SHX Inspections - 1/21/2016 yoN_srgTFO MASON COUNTY �P c DEPARTMENT OF COMMUNITY DEVELOPMENT o A = Planning Division o T z 426 W Cedar St, Shelton, WA 98584 ? N Y y (360)427-9670 OJ a0 1864 Exemption from Shoreline Management Act Case No.: SHX2016-00001 Substantial Development Permit Requirement The Proposal By: PAUL MILLER 401 NE MOUNTAIN VIEW DR TAHUYA,WA 98588 To undertake the following development: Replace dock at bulkhead with 8 ft. wide by 36 ft. long wooden structure supported by six untreated doug fir piles; remove old dock from lake site. Within LAKE WOOTEN 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 Allan Borden at ext 365 if you have any questions Issued: 1/21/2016 Expires: 1/21/2018 Authorized Local Government Official lla t Ze'6 cc: APPLICANT WDFW USACOE WDOE TRIBAL COUNCIL --------------------Rcc M AGENCY USE ONLY 0 � ' o~P• w' F ' � : Date received: JAN 5 2016 WASHINGTON STATE US Army c , of Engineers• i �� /�j •/�(�J� Seattle District : �C�1, V�o Joint Aquatic Resources Permit Agency reference#: Application (JARPA) Form',2 Tax Parcel#(s): USE BLACK OR BLUE INK TO ENTER ANSWERS IN THE WHITE SPACES BELOW. i lJ�\ n/Y, ' � Part 1—Project Identification 1. Project Name (A name for your project that you create. Examples:Smith's Dock or Seabrook Lane Development) [ ] /le,c' sDOCK Part 2—Applicant The person and/or organization responsible for the project. [ ] 2a. Name (Last, First, Middle) 2 172R& RA1r_ 2b. Organization (If applicable) 2c. Mailing Address (Street or PO Box) D rc 2d. City, State, Zip 2e. Phone(1) 2f. Phone(2) 2g. Fax 2h. E-mail (36 >z7S Yq ( ) ( ) i �r s o.yc 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 • Not all cities and counties accept the JARPA for their local Shoreline permits. If you need a Shoreline permit,contact the appropriate city or county government to make sure they accept the JARPA. 2To access an online JARPA form with[help)screens,go to For other help,contact the Governor's Office for Regulatory Innovation and Assistance at(800)917-0043 or JARPA Revision 2012.2 Page 1 of 14 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.) [ I 3a. Name (Last, First, Middle) z EC I I m 3b. Organization (If applicable) k O CoJstt4roti 3c. Mailing Address (Street or Po Box) P. O 3d. City, State, Zip Z 3e. Phone(1) 3f. Phone(2) 3g. Fax 3h. E-mail ( 3�.0 ) �,t,�-- 56 4� ( ) ( ) Part 4—Property Owner(s) Contact information for people or organizations owning the property(ies) where the project will occur. Consider both upland and aquatic ownership because the upland owners may not own the adjacent aquatic land. [ K 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 upland property owners. Complete the section below and fill out for each additional property owner. ❑ Your project is on Department of Natural Resources (DNR)-managed aquatic lands. If you don't know, contact the DNR at (360) 902-1100 to determine aquatic land ownership. If yes, complete to apply for the Aquatic Use Authorization. 4a. Name (Last, First, Middle) 4b. Organization (If applicable) 4c. Mailing Address (street or Po Box) 4d. City, State, Zip 4e. Phone(1) 4f. Phone(2) 4g. Fax 4h. E-mail JARPA Revision 2012.2 Page 2 of 14 Part 5-Project Location(s) Identifying information about the property or properties where the project will occur. [ ] ❑ There are multiple project locations (e.g. linear projects). Complete the section below and use for each additional project location. 5a. Indicate the type of ownership of the property. (Check all that apply.) [ ] N Private ❑ Federal ❑ Publicly owned (state, county,city,special districts like schools, ports,etc.) ❑ Tribal ❑ Department of Natural Resources (DNR) —managed aquatic lands (Complete ) 5b. Street Address (Cannot be a PO Box. If there is no address, provide other location information in 5p.) [ ] 901 r 11w. 4- . 5c. City, State, Zip(If the project is not in a city or town, provide the name of the nearest city or town.) [ ] S 5d. County [ ] AASod 5e. Provide the section, township, and range for the project location. [ ] '/4 Section Section Township Range N W 23/V z 5f. Provide the latitude and longitude of the project location. [ ] • Example:47.03922 N lat./-122.89142 W long. (Use decimal degrees-NAD 83) 5g. List the tax parcel number(s)for the project location. [ ] • The local county assessor's office can provide this information. Z 3 19 5h. Contact information for all adjoining property owners. (If you need more space, use ) ( ] Name Mailing Address Tax Parcel # (if known) d j7£u1SC 4AI lC A i-+�Y A GtJA . T9SV 8 6 Z(o y Z' Rvh. A), hr q,4 SIgNc!rq &AocGA S A le ,4 . l/.r— 77-0 JARPA Revision 2012.2 Page 3 of 14 5i. List all wetlands on or adjacent to the project location. [ - 6N� 5j. List all waterbodies (other than wetlands) on or adjacent to the project location. [ WLOoTFKJ LA 5k. Is any part of the project area within a 100-year floodplain? [ XYes ❑ No ❑ Don't know 51. Briefly describe the vegetation and habitat conditions on the property. [ j '� egee^S. tfld54,, S 5m. Describe how the property is currently used. PA I V AT1F-(des J9414A 5n. Describe) howl the adjacent properties are currently used. [ C &WN 4L 5o. Describe the structures (above and below ground) on the property, including their purpose(s) and current condition. [ ) ) PC,L,-5 E- /P ol,� Mtwel� Q oo P 5p. Provide driving directions from the closest highway to the project location, and attach a map. [ 12d, Can Ha tu-u-y , yd k'i y 1-77-0 n V t om✓ look ��SS v� �n f�� Fi��e D / JARPA Revision 2012.2 Page 4 of 14 Part 6—Project Description 6a. Briefly summarize the overall project. You can provide more detail in 6b. [ ] �rX �(0 , Dock D(IU� � p� uh fir ���t:f' r-r',A 1►,� "d 44� D&`t,xy 6b. Describe the purpose of the project and why you want or need to perform it. [ ] 6c. Indicate the project category. (Check an that apply) [ ❑ Commercial � Residential ❑ Institutional ❑ Transportation ❑ Recreational ❑ Maintenance ❑ Environmental Enhancement 6d. Indicate the major elements of your project. (Check an that apply) [ ] ❑ Aquaculture ❑ Culvert ❑ Float ❑ Retaining Wall ❑ Bank Stabilization ❑ Dam /Weir (upland) ❑ Floating Home ❑ Boat House ❑ Dike / Levee / Jett ❑ Road y ❑ Geotechnical Survey ❑ Boat Launch ❑ Ditch ❑ Land Clearing ❑ Scientific Measurement Device ❑ Boat Lift Dock / Pier ❑ Marina / Moorage ❑ Stairs ❑ Bridge ❑ Dredging ❑ Mining ❑ Stormwater facility ❑ Bulkhead ❑ Fence ❑ Outfall Structure ❑ Swimming Pool ❑ Buoy ❑ Ferry Terminal ❑ Piling/Dolphin ❑ Utility Line ❑ Channel Modification ❑ Fishway ❑ Raft ❑ Other: — -- _— _-- i I JARPA Revision 2012.2 Page 5 of 14 6e. Describe how you plan to construct each project element checked in 6d. Include specific construction methods and equipment to be used. [ I • Identify where each element will occur in relation to the nearest waterbody. • Indicate which activities are within the 100-year floodplain.P115 &jC� tbck Vz)e 6f. What are the anticipated start and end dates for project construction? (MonthNear) • If the project will be constructed in phases or stages, use to list the start and end dates of each phase or stage. Start date: Z, 20 l End date: ��— �o�� ❑ See JARPA Attachment D 6g. Fair market value of the project, including materials, labor, machine rentals, etc. [ 10 ate" 6h. Will any portion of the project receive federal funding? [ I • If yes, list each agency providing funds. ❑ Yes VJ 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.) [ 7a. Describe how the project has been designed to avoid and minimize adverse impacts to wetlands. [ ''Not applicable 7b. Will the project impact wetlands? [ ❑ YesNo ❑ Don't know JARPA Revision 2012.2 Page 6 of 14 7c.Will the project impact wetland buffers? [ ❑ Yes 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 Flo 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 �,'fVo ❑ Don't know 7f. Have you prepared a mitigation plan to compensate for any adverse impacts to wetlands? [ • 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 RNot applicable 7g. Summarize what the mitigation plan is meant to accomplish, and describe how a watershed approach was used to design the plan. [ IVIA 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 type4 (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: JARPA Revision 2012.2 Page 7 of 14 7L 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. [ IV IA 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. [ CIA 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.) [ 0 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. [ l ❑ Not applicable D /" -J- 44 4S�'C-v Co oA i y CCI—k I�e, sit Yl v 4hR I 'S y 8b. Will your project impact a waterbody or the area around a waterbody? [ ❑ Yes �Oo JARPA Revision 2012 2 Page 8 of 14 • 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. ❑ Yes rUlNo ❑ 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. [ ] 1411k 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 impact' (cubic yards) to be linear ft.) of drive, etc.) placed in or waterbody removed from directly affected waterbody K3r° � - i��or�,� F ��m 1, 2Y8 . '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. 3Indicate 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. [ ] JARPA Revision 2012.2 Page 9 of 14 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. [ afie,dq��y�� (2, ems 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. [ Agency Name Contact Name Phone Most Recent Date of Contact 9b. Are any of the wetlands or waterbodies identified in Part 7 or Part 8 of this JARPA on the Washington Department of Ecology's 303(d) List? I I • If Yes, list the parameter(s) below. • If you don't know, use Washington Department of Ecology's Water Quality Assessment tools at: ❑ Yes ❑ No 9c. What U.S. Geological Survey Hydrological Unit Code (HUC) is the project in? [ • Go to to help identify the HUC. 9d. What Water Resource Inventory Area Number (WRIA#) is the project in? [ • Go to to find the WRIA#. JARPA Revision 2012.2 Page 10 of 14 9e. Will the in-water construction work comply with the State of Washington water quality standards for turbidity? [ • Go to 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? [ • If you don't know, contact the local planning department. • For more information, go to: ❑ Rural ' Irban ❑ Natural ❑ Aquatic ElConservancy ❑ Other 9g. What is the Washington Department of Natural Resources Water Type? [ • Go to 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? [ • If No, provide the name of the manual your project is designed to meet. El Yes No /t/ � Name of manual: 9i. Does the project site have known contaminated sediment? [ • If Yes, please describe below. ❑ Yes P No 9j. If you know what the property was used for in the past, describe below. [ )Q4jaN�J 9k. Has a cultural resource (archaeological) survey been performed on the project area? [ • If Yes,attach it to your JARPA package. ❑ Yes >(No JARPA Revision 2012.2 Page 11 of 14 91. 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. ��rt, � �✓lv�t/ 9m. 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. P N-(, Part 10—SEPA Compliance and Permits Use the resources and checklist below to identify the permits you are applying for. • Online Project Questionnaire at • Governor's Office for Regulatory Innovation and Assistance at (800) 917-0043 or • For a list of addresses to send your JARPA to, click on 10a. Compliance with the State Environmental Policy Act (SEPA). (check all that apply.) [ ) • For more information about SEPA, go to ❑ A copy of the SEPA determination or letter of exemption is included with this application. RA S PA determination is pending with V1 q4 do �(lead agency). The expected decision date is 5,1Za/�- ❑ I am applying for a Fish Habitat Enhancement Exemption. (check the box below in 1 ob.) ❑ 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. JARPA Revision 2012.2 Page 12 of 14 10b. Indicate the permits you are applying for. (Check all that apply.) 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 — Effective July 10, 2012, you must submit a check for$150 to Washington Department of Fish and Wildlife, unless your project qualifies for an exemption or alternative payment method below. Do not send cash. Check the appropriate boxes: ' 3$150 check enclosed. Check# Attach check made payable to Washington Department of Fish and Wildlife. ❑My project is exempt from the application fee. (Check appropriate exemption) ❑ HPA processing is conducted by applicant-funded WDFW staff. Agreement# ❑ Mineral prospecting and mining. ❑ Project occurs on farm and agricultural land. (Attach a copy of current land use classification recorded with the county auditor, or other proof of current land use.) ❑ Project is a modification of an existing HPA originally applied for, prior to July 10, 2012. HPA# Washington Department of Natural Resources: ❑ Aquatic Use Authorization Complete and submit a check for$25 payable to the Washington Department of Natural Resources. Do not send cash. Washington Department of Ecology: ❑ Section 401 Water Quality Certification 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: ❑ Private Aids to Navigation (for non-bridge projects) DARPA Revision 2012.2 Page 13 of 14 I i Part 11—Authorizing Signatures Signatures are required before submitting the JARPA package. The JARPA package includes the JARPA form, project plans, photos, etc. 11a. Applicant Signature (required) [ 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 auth rize 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 en g the property where the project is located to inspect the project site or any work related to the project. (initial) PA',I le /-1/-/6- Applicant Printed Name Applicant Signature Date 11 b. Authorized Agent Signature [ 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. RttL MI��e� Property Owner Printed Name l5ro-pe4 OwnerSigpnature 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 for Regulatory Innovation and Assistance(ORIA)at(800) 917-0043. People with hearing loss can call 711 for Washington Relay Service. People with a speech disability can call(877)833-6341. ORIA publication number: ENV-019-09 rev.08/2013 JARPA Revision 2012.2 Page 14 of 14