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Home My WebLink AboutSHX2023-00036 Bulkhead, Dock 2 parcels - BLD Inspections - 9/19/2023 CEIVED AGENCY USE ONLY t a Date received: SEP 19 2023US Army Corps WASHINGTON STATE of Engineer s s , Seattle Drtrd , E15 W. Alder Street , Joint Aquatic Resources Permit Agency reference#: 5�1x2o23-OCJd3(p ; Application (DARPA) Form',2 hel Tax Parcel#(s):`lA3iS.Si� �l3 USE BLACK OR BLUE INK TO ENTER ANSWERS IN THE WHITE SPACES BELOW. i 7oZ3 O -�C� 0001,4 44a3iA- 56 -owis ; t , L------------------------------------- Part 1—Project Identification 1. Project Name (A name for your project that you create. Examples: Smith's Dock or Seabrook Lane Development) h�_elp] Sundown Drive Bulkhead 'l)i�l'15 • Wi-bb o h n 5 a,1_ Part 2—Applicant The person and/or organization responsible for the project. Eel 2a. Name (Last, First, Middle) Staten, Michael Clyde 2b. Organization (If applicable) Envirotech Engineering, PLLC 2C. Mailing Address (Street or PO Box) PO Box 984 2d. City, State, Zip Belfair, Washington 98528 2e. Phone(1) 2f. Phone(2) 2g. Fax 2h. E-mail 360-275-9374 360-689-6045 n/a envirotech@geotechnicalinfo.com '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 htti)://www.nws.usace.army.mil/Missions/CivilWorks/Regulatory/PermitGuidebook/EndangeredSpecies.aspx. • Not all cities and counties accept the DARPA 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 http://www.epermittinci.wa.cioy/site/alias resourcecenter/jarpa jarpa form/9984/6arpa form.aspx. For other help,contact the Governor's Office for Regulatory Innovation and Assistance at(800)917-0043 or help(a)oria.wa.gov. ORIA-16-011 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.) hel 3a. Name (Last, First, Middle) Staten, Michael 3b. Organization (if applicable) Envirotech Engineering PLLC 3c. Mailing Address (Street or PO Box) PO Box 984 3d. City, State, Zip Belfair, Washington 98528 3e. Phone(1) 3f. Phone(2) 3g. Fax 3h. E-mail (360) 275-9374 360-689-6045 n/a envirotech@geotechnicalinfo.com 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. h[ele] ❑ 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 JARPA Attachment A 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 JARPA Attachment E to apply for the Aquatic Use Authorization. 4a. Name (Last, First, Middle) Webb, Mason 4b. Organization (If applicable) 4c. Mailing Address (street or PO Box) 46808 286' Avenue SE 4d. City, State, Zip Enumclaw, Washington 98022 4e. Phone(1) 4f. Phone(2) 4g. Fax 4h. E-mail n/a emeraldcityroofing@yahoo.com ORIA-16-011 Page 2 of 14 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 JARPA Attachment B for each additional project location. 5a. Indicate the type of ownership of the property. (Check all that apply.) hel M Private ❑ Federal ❑ Publicly owned (state,county,city,special districts like schools,ports, etc.) ❑ Tribal ❑ Department of Natural Resources (DNR) —managed aquatic lands (Complete JARPA Attachment E) 5b. Street Address (Cannot be a PO Box. If there is no address,provide other location information in 5p.) h[_elp] 40 N Sundown Drive 5c. City, State, Zip(if the project is not in a city or town,provide the name of the nearest city or town.) hel Hoodsport, Washington 98548 5d. County hel Mason County 5e. Provide the section, township, and range for the project location. h[_elp] '/4 Section Section Township Range NE 18 23N 4W 5f. Provide the latitude and longitude of the project location. [km • Example:47.03922 N lat./-122.89142 W long. (Use decimal degrees-NAD 83) 47.48975 N Lat, -123.24216 W Long. 5g. List the tax parcel number(s) for the project location. h[ elpj • The local county assessor's office can provide this information. 42318-50-00014 5h. Contact information for all adjoining property owners. (If you need more space, use JARPA Attachment C.) hel Name Mailing Address Tax Parcel #(if known) Fuchs, Jeffrey 1821 Oak Street 42318-50-00015 Lake Oswego, Oregon 97034 Johnson, Avery 7143 Interlaaken Drive SW 42318-50-00013 Lakewood, Washington 98499 ORIA-16-011 Page 3 of 14 51i. List all wetlands on or adjacent to the project location. h[kl n/a 5j. List all waterbodies (other than wetlands) on or adjacent to the project location. h[eIe] Lake Cushman 5k. Is any part of the project area within a 100-year floodplain? ht u ® Yes ❑ No ❑ Don't know 51. Briefly describe the vegetation and habitat conditions on the property. h[ el No vegetation on beach. Some vegetation upland such as firs and shrubs 5m. Describe how the property is currently used. hei Single family residence 5n. Describe how the adjacent properties are currently used. h[, M Single family residences 5o. Describe the structures (above and below ground) on the property, including their purpose(s) and current condition. hei Home and septic system 5p. Provide driving directions from the closest highway to the project location, and attach a map. hei From Highway 101 in Hoodsport, take hwy 119 to N Mount Church Drive, then turn left on Mount Tebo Way, then left on N Potlatch Drive, then right on Sundown Drive. House on right side of road. ORIA-16-011 Page 4 of 14 Part 6—Project Description 6a. Briefly summarize the overall project. You can provide more detail in 6b. h[ eld New wood floating docks on all 3 properties. Replace existing/pre-existing rock bulkhead on Parcel 42318-50- 00015, and new bulkhead onrother parcels. All bulkheads will be landward of OHW, consist of rock, and extend entire property frontages. New wood staircase for waterfront access to be shared by Parcels 42318-50- 00013 and 42318-50-00014. 6b. Describe the purpose of the project and why you want or need to perform it. !feel ] This project is to provide new docks for the enjoyment of a waterfront property, and bulkheads to protect and anchor the docks. Furthermore, the bulkhead on Parcel 42318-50-00015 is to maintain similar pre-existing conditions. 6C. Indicate the project category. (Check all that apply) h[ ela] ❑ Commercial ® Residential ❑ Institutional ❑ Transportation ❑ Recreational ❑ Maintenance ❑ Environmental Enhancement 6d. Indicate the major elements of your project. (Check all that apply) [help] ❑ Aquaculture ❑ Culvert ❑ Float ❑ Retaining Wall ❑ Bank Stabilization ❑ Dam /Weir ❑ Floating Home (upland) ❑ Boat House ❑ Dike/ Levee/Jetty ❑ Geotechnical Survey ❑ Road ❑ 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: ORIA-16-011 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. hel • Identify where each element will occur in relation to the nearest waterbody. • Indicate which activities are within the 100-year floodplain. Bulkhead will be constructed with small construction equipment (backhoe) landward of the OHW after dumping rock with dump truck. Docks and stairs will be accomplished by hand, except lift may be needed for stair construction. All activities will be within the 100-year floodplain. All construction will be outside of the waterbody when water level is low. 6f. What are the anticipated start and end dates for project construction? (MonthNear) n[ ell • 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: 2/1/2024 End Date: 4/30/2024 ❑ See JARPA Attachment D 6g. Fair market value of the project, including materials, labor, machine rentals, etc. h[ ell $200,000 6h. Will any portion of the project receive federal funding? h[ eU • 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.) h[ eip 7a. Describe how the project has been designed to avoid and minimize adverse impacts to wetlands. hel ❑ Not applicable 7b. Will the project impact wetlands? h[_.eM ❑ Yes ❑ No ❑ Don't know 7c. Will the project impact wetland buffers? nel ❑ Yes ❑ No ❑ Don't know ORIA-16-011 Page 6 of 14 7d. Has a wetland delineation report been prepared? hel • If Yes,submit the report, including data sheets,with the DARPA package. ❑ Yes ❑ No 7e. Have the wetlands been rated using the Western Washington or Eastern Washington Wetland Rating System? [help] • 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? ei • 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 ❑ Don't know I 7g. Summarize what the mitigation plan is meant to accomplish, and describe how a watershed approach was used to design the plan. o 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. [help l 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 cate or 2 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: ORIA-16-011 Page 7 of 14 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. nei 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. hei 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.) hel ® 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 Project constructed by manual labor and small equipment, avoiding machinery in the water. Net loss of beach will not occur. 8b. Will your project impact a waterbody or the area around a waterbody? hel ® Yes ❑ No ORIA-16-011 Page 8 of 14 8c. Have you prepared a mitigation plan to compensate for the project's adverse impacts to non-wetland waterbodies? hel • 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 ❑ Don't know Project can be mitigated per government requirements and permit conditions. 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. h[ eld n/a 8e. Summarize impact(s) to each waterbody in the table below. bpm Activity (clear, Waterbody Impact Duration Amount of material Area (sq. ft. or dredge, fill, pile name' location of impact3 (cubic yards) to be linear ft.) of drive, etc.) placed in or removed waterbody from waterbody directly affected Bulkhead Lake Adjacent permanent none 230It Cushman Docks Lake Adjacent & permanent none 706 sf Cushman on water Stairs Lake At least 20ft permanent none none Cushman from shore 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. 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. hel Approximately 200 cy of boulders placed outside of the OHW per standard design practice. Backfill behind wall will be about 130 cy of quarry. Rock will be from a local quarry. Docks and stairs will be wood and composite of indeterminant amount. ORIA-16-011 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. he[ ei No dredging will occur in waterbody. Excavation for wall and footings will be either spread evenly upland from the wall or hauled to an approved site. 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. hel Agency Name Contact Name Phone Most Recent Date of Contact Mason County Julie Lewis 360-427-9670 ext 357 08/20/2022 Tacoma Power Wynnae Wright 253-318-2527 07/18/2022 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 3O3(d) List? hel • If Yes,list the parameter(s)below. • If you don't know, use Washington Department of Ecology's Water Quality Assessment tools at:https://ecoloay.wa.gov/Water- S ho re li n es/Water-guality/Water-i m provement/Assessme nt-of-state-waters-303d. ❑ Yes ® No 9c. What U.S. Geological Survey Hydrological Unit Code (HUC) is the project in? hei • Go to hHDJ/cfpub.epa.gov/surf/locate/index.cfm to help identify the HUC. 17110017 9d. What Water Resource Inventory Area Number (WRIA#) is the project in? hei • Go to https://ecology.wa.gov/Water-Shorelines/Water-supply/Water-availabili!y/Watershed-look-up to find the WRIA#. 16 ORIA-16-011 Page 10 of 14 9e. Will the in-water construction work comply with the State of Washington water quality standards for turbidity? help] • Go to hftps:Hecology.wa.gov/Water-Shorelines/Water-quality/Freshwater/Surface-water-quality-standards/Criteria 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? hel • If you don't know,contact the local planning department. • For more information,go to:https://ecology.wa.gov/Water-Shorelines/Shoreline-coastal-management/Shoreline-coastal- plan ni ng/Shoreline-laws-ru les-and-cases. ❑ Urban ❑ Natural ❑ Aquatic ❑ Conservancy ❑ Other: Rural 9g. What is the Washington Department of Natural Resources Water Type? el • Go to http://www.dnr.wa.aov/forest-practices-water-typing 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? h[ eei • If No,provide the name of the manual your project is designed to meet. ® Yes ❑ No Name of manual: Dept. of Ecology Stormwater Management Manual for Western Washington 911. Does the project site have known contaminated sediment? hel • If Yes, please describe below. ❑ Yes M No 9j. If you know what the property was used for in the past, describe below. hell unknown 9k. Has a cultural resource (archaeological) survey been performed on the project area? hel • If Yes,attach it to your JARPA package. ❑ Yes ® No ORIA-16-011 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. hLele7 unknown 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. hf M unknown ORIA-16-011 Page 12 of 14 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.oria.wa.ciov/opas/. • Governor's Office for Regulatory Innovation and Assistance at (800) 917-0043 or helpgoria.wa.gov. • For a list of addresses to send your JARPA to, click on agency addresses for completed JARPA. 10a. Compliance with the State Environmental Policy Act (SEPA). (Check all that apply.) el • For more information about SEPA,go to https://ecology.wa.gov/regulations-permits/SEPA-environmental-review. ❑ A copy of the SEPA determination or letter of exemption is included with this application. ® A SEPA determination is pending with Mason County (lead agency). The expected decision date is n/a ❑ I am applying for a Fish Habitat Enhancement Exemption. (Check the box below in 1 ob.) b 1pa ❑ 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.) hel LOCAL GOVERNMENT Local Government Shoreline permits: ❑ Substantial Development ❑ Conditional Use ❑ Variance ® Shoreline Exemption Type (explain): minor construction/ repair 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 —Attach Exemption Form Washington Department of Natural Resources: ❑ Aquatic Use Authorization Complete JARPA Attachment E 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: ❑ General Bridge Act Permit ❑ Private Aids to Navigation (for non-bridge projects) ORIA-16-011 Page 13 of 14 Part 11—Authorizing Signatures Signatures are required before submitting the DARPA package. The JARPA package includes the JARPA form, project plans, photos, etc. h[ elp 11 a. 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. MCS (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. MCS (initial) Michael Staten ??Gee� —Ge--;21a;C 07/21/23 Applicant Printed Name Date 11 b. Authorized Agent Signature he[ l 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. Michael Staten �.yl ,� 07/21/23 Authorized Agent Printed Name Authorized Agent Signature Date 11 c. Property Owner Signature (if not applicant) h[ ell Not required if project is on existing rights-of-way or easements (provide copy of easement with JARPA). 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 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: ORIA-16-011 rev.07/2017 ORIA-16-011 Page 14 of 14 --------------------------------------, AGENCY USE ONLY 1, WASHINGTON STATE U 9"— Date received: , Joint Aquatic Resources Permit Application (JARPA) held Agency reference#: , Tax Parcel#(s): ' Attachment A: For additional property owners) hI elP� ----- TO BE COMPLETED BY APPLICANT bgjpj --� , Project Name: Location Name(if applicable): Use this attachment only if you have more than one property owner. ; Complete one attachment for each additional property owner --------------------------------------- impacted by the project. Signatures of property owners are not needed for repair or maintenance activities on existing rights-of-way or easements. Use black or blue ink to enter answers in whites aces below. 1. Name (Last, First, Middle)and Organization (if applicable) Jeffrey, Fuchs 2. Mailing Address(Street or PO Box) 1821 Oak Street 3. City, State, Zip Lake Oswego, Oregon 97034 4. Phone (1) 5. Phone(2) 6. Fax 7. E-mail n/a fuchsjp@gmail.com Address or tax parcel number of property you own: 50 N Sundown Drive, Hoodsport, Washington Signature of Property Owner 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. Jeffrey Fuchs Printed Name Signature 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:ORIA-16-012 rev. 10/2016 JARPA Attachment A Rev. 10/2016 Page 1 of 1 --------------------------------------i r,sole a 1 c° • � AGENCY USE ONLYUS Army E°9^V WASHINGTON STATE SP$ ' Date received: Seattle District t Joint Aquatic Resources Permit Application (DARPA) het Agency reference#: t Tax Parcel#(S): t t Attachment B: For additional project location(s) het L TO BE COMPLETED BY APPLICANT h[ elp] t t t t Project Name: Use this attachment only if you have more than one project location. Location Name(if applicable): Use a separate form for each additional location. ------------------------------------ Use black or blue ink to enter answers in whites aces below. 1. Indicate the type of ownership of the property. (Check all that apply.) h[ elpJ ® Private ❑ Federal ❑ Publicly owned (state,county,city,special districts like schools, ports, etc.) ❑ Tribal ❑ Department of Natural Resources (DNR) —managed aquatic lands (Complete JARPA Attachment E) 2. Street Address (Cannot be a PO Box. If there is no address, provide other location information in 16) hel 50 N Sundown Drive 3. City, State, Zip (If the project is not in a city or town, provide the name of the nearest city or town.) h[ eld Hoodsport, Washington 98548 4. County hL eli Mason 5. Provide the section, township, and range for the project location. het 1/4 Section Section Township Range NE 18 23N 4W 6. Provide the latitude and longitude of the project location. h[ elp� • Example:47.03922 N lat./-122.89142 W long(Use decimal degrees-NAD 83) 47.48960 N lat/-123.24255 7. List the tax parcel number(s) for the project location. [Leipl • The local county assessor's office can provide this information. 42318-50-00015 JARPA Attachment B Rev. 10/2016 Page 1 of 3 8. Contact information for all adjoining property owners. (if you need more space,use JARPA Attachment Q.) [help] Name Mailing Address Tax Parcel #(if known) Webb, Mason 46808 2861h Avenue SE 42318-50-00014 Enumclaw, Washington 98022 Cannady, Kelly 3902 SW Kenyon Street 42318-50-00016 Seattle, Washington 98136 9. List all wetlands on or adjacent to the project location. hei n/a 10. List all waterbodies (other than wetlands) on or adjacent to the project location. tieV Lake Cushman 11. Is any part of the project area within a 100-year flood plain? hel ® Yes ❑ No ❑ Don't know 12. Briefly describe the vegetation and habitat conditions on the property. [Lem No vegetation on beach. Some vegetation upland such as firs and shrubs 13. Describe how the property is currently used. h[pM Single family residence JARPA Attachment B Rev.10/2016 Page 2 of 3 14. Describe how the adjacent properties are currently used. hel Single family residences 15. Describe the structures (above and below ground) on the property, including their purpose(s). heI House and septic system 16. Provide driving directions from the closest highway to the project location, and attach a map. hel From Highway 101 in Hoodsport, take hwy 119 to N Mount Church Drive, then turn left on Mount Tebo Way, then left on N Potlatch Drive, then right on Sundown Drive. House on right side of road. 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:ORIA-16-013 rev. 10/2016 JARPA Attachment B Rev. 10/2016 Page 3 of 3 A& sum --------------------------------------, AGENCY USE ONLY ; o US Army Corps WASHINGTON STATE Sea�9a°,�f5 ; Date received: ; Joint Aquatic Resources Permit , Agency reference#: Application (DARPA) hel ; Tax Parcel#(s): ; , Attachment A: For additional property owner(s) he[ l TO BE COMPLETED BY APPLICANT hI_e�l , Project Name: Location Name(if applicable): Use this attachment only if you have more than one property owner. ; Complete one attachment for each additional property owner ------------------------------------ impacted by the project. Signatures of property owners are not needed for repair or maintenance activities on existing rights-of-way or easements. Use black or blue ink to enter answers in whites aces below. 1. Name(Last, First, Middle) and Organization (if applicable) Johnson, Avery 2. Mailing Address (Street or PO Box) 7143 Interlaaken Drive SW 3. City, State, Zip Lakewood, Washington 98499 4. Phone (1) 5. Phone(2) 6. Fax 7. E-mail n/a ajohnson@columbiabank.com Address or tax parcel number of property you own: 30 N Sundown Drive, Hoodsport, Washington Signature of Property Owner 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. Avery Johnson Printed Name Signature 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:ORIA-16-012 rev. 10/2016 JARPA Attachment A Rev. 10/2016 Page 1 of 1 r 6 STArj. 1-------------------------------------- AGENCY USE ONLY ; e 1 1 a: US Army Corps ; ; yyt l��ov WASHINGTON STATE �tflea'me"- ; Date received: ; Joint Aquatic Resources Permit 1 Application (DARPA) hei 1 Agency reference#: , 1 Tax Parcel#(s): ; Attachment B: 1 . ---------------- For additional project location(s) hel L-----TO BE COMPLETED BY APPLICANT-hel-------J 1 I 1 1 Project Name: ; Use this attachment only if you have more than one project location. Location Name(if applicable): Use a separate form for each additional location. I ----------------------------------- -- Use black or blue ink to enter answers in whites aces below. 1. Indicate the type of ownership of the property. (Check all that apply.) hel ® Private ❑ Federal ❑ Publicly owned (state,county,city,special districts like schools, ports, etc.) ❑ Tribal ❑ Department of Natural Resources (DNR) —managed aquatic lands (Complete JARPA Attachment E) 2. Street Address (Cannot be a PO Box.If there is no address, provide other location information in 16) hel 30 N Sundown Drive 3. City, State, Zip(If the project is not in a city or town, provide the name of the nearest city or town.) hel Hoodsport, Washington 98548 4. County hei Mason 5. Provide the section, township, and range for the project location. hei 1/4 Section Section Township Range NE 18 23N 4W 6. Provide the latitude and longitude of the project location. hell • Example:47.03922 N lat./-122.89142 W long(Use decimal degrees-NAD 83) 47.48981 N lat/-123.24203 7. List the tax parcel number(s) for the project location. hei • The local county assessor's office can provide this information. 42318-50-00013 JARPA Attachment B Rev. 10/2016 Page 1 of 3 8. Contact information for all adjoining property owners. (If you need more space, use JARPA Attachment C.) heI Name Mailing Address Tax Parcel#(if known) Webb, Mason 46808 286th Avenue SE 42318-50-00014 Enumclaw, Washington 98022 Hejazi, Seyed 5201 Storm Lake Road 42318-50-00012 Snohomish, Washington 98290 9. List all wetlands on or adjacent to the project location. heI n/a 10. List all waterbodies (other than wetlands) on or adjacent to the project location. h[ eAi Lake Cushman 11. Is any part of the project area within a 100-year flood plain? heI M Yes ❑ No ❑ Don't know 12. Briefly describe the vegetation and habitat conditions on the property. heI No vegetation on beach. Some vegetation upland such as firs and shrubs 13. Describe how the property is currently used. heI Single family residence JARPA Attachment B Rev. 10/2016 Page 2 of 3 14. Describe how the adjacent properties are currently used. hel Single family residences 15. Describe the structures (above and below ground) on the property, including their purpose(s). hel House and septic system 16. Provide driving directions from the closest highway to the project location, and attach a map. eAi From Highway 101 in Hoodsport, take hwy 119 to N Mount Church Drive, then turn left on Mount Tebo Way, then left on N Potlatch Drive, then right on Sundown Drive. House on right side of road. 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:ORIA-16-013 rev. 10/2016 JARPA Attachment B Rev. 10/2016 Page 3 of 3