HomeMy WebLinkAboutSHX2018-00024 JARPA - SHX Permit / Conditions - 6/8/2018 STgTFO MASON COUNTY
�P C 16-1 Department of Community Services
o A o v� Planning Division
o N i 615 W Alder St, Shelton, WA 98584
N Y y (360)427-9670
OJ �O
1864
Exemption from Shoreline Management Act
Case No.: SHX2018-00024 Substantial Development Permit Requirement
The Proposal By: CRAIG LEVERSON
PO BOX 7759
TACOMA, WA 98417
Parcel Number: 223305000072
Site Address: 75 NE HAVEN LN TAHUYA
To undertake the following development:
CONCRETE BLOCK BULKHEAD INSTALLED TO STOP SHORELINE EROSION AND DAMAGE.
6"X17" BLOCKS STACKED 4 COURSES TALL 24" OVERALL AT HIGHEST POINT. BACK FILL 3/4
MINUS WITH BARRIER TO RETAIN FILL. LABOR WILL BE COMPLETELY MANUAL. LENGTH OF
BULKHEAD ALONG SHORELINE TO BE 46'. (SEE ENF2016-00021)
Within HAVEN LAKE and/or its associated wetlands is exempt from the requirement of substantial
development because the development is categorized under WAC 173-27-040(2) as being category:
A-does not exceed dollar threshold
Please contact Marissa Watson at ext 367 if you have any questions.
Issued:6/8/2018 uthorized Local Government Official
SHX2018-00024 June 08, 20V
RECEIVED
r--------"-------'-ARR-1-0 Zola-----
AGENCY USE ONLY
WAS H I N GTC?N STATE of Engir sera Ps ; Date recei�ed: 6'15 W. Alder Street
SaattM Pstra i
Joint Aquatic Resources Permit '
1,2 [help Agency reference#:��
Application (JARPA) Form ) � n[�
USE BLACK OR BLUE INK TO ENTER ANSWERS IN THE WHITE SPACES BELOW.
Tax Parcel# s
-------------------------------------
Part 1—Project Identification
1. Project Name (A name for your project that you create.Examples:Smith's Dock or Seabrook Lane Development) hel j
Part 2—Applicant
The person and/or organization responsible for the project. [helps
2a. Name(Last, First,Middle)
2b. Organiz tion(If applicable)
n.� A
2c. Mailing Address (Street or PO Box)
I)o -9,r y r7r75C7
2d. City, State, Zip
2e. Phone(1) 2f. Phone(2) 2g. Fax 2h. E-mail
Pill-
'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
t)ttp://www.nws.usace.army.mil/Missions/CivilWorks/Regulatory/PermitGuidebook/EndangeredSpecies ash.
• 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.
zTo access an online JARPA form with[help]screens,go to
http://www.eperniitting.wa,goy/site/alias resourcecenter/Iarpa iarpa form/9984(.Larpa form.asp
For other help,contact the Governors Office for Regulatory Innovation and Assistance at(800)917-0043 or help(CVOria.wa.goy.
ORIA-16-011 Page 1 of 14
Part 3—Authorized Agent or Contact
Person authorized to represent the applicant about the project. (Note: Authorized agents) must sign 1 lb of this
application.) (ri_ef�al
3a. Name'(Last, First,Middle)
3b. Organization (If applicable)
3c. Mailing Address (street or Po Box)
3d. City, State, Zip
3e. Phone(1) X Phone(2) 3g. Fax 3h. E-mail
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. [tiOP1
,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)
4b. Organization (If applicable)
4c. Mailing Address (street or Po Box)
4d. City, State, Zip
4e. Phone(1) 0. Phone(2) 4g. Fax 4h. E-mail
ORIA-16-011 } Page 2 of 14
Part 5-Project Location(s)
Identifying information about the property or properties where the project will occur. [,elp]
❑ 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.) eI
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.) [help]
5c. City, State, Zip(If the project is not in a city or town, provide the name of the nearest city or town.) [help)
--T-AI A ,14� 5"e e,
5d. County [help]
ma-s�r.l
5e. Provide the section, township, and range for the project location. hel
'/.Section Section Township Range
5f. Provide the latitude and longitude of the project location. [help]
• 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. [t,elA
• The local county assessor's office can provide this information.
-3 3 CAS-L)Oo `z a-
5h. Contact information for all adjoining property owners. (If you need more space,use DARPA Attachment C.) hel
Name Mailing Address Tax Parcel #(if known)
�- 3zao�a"'d cviav
a 3 305-0 0-v-e:71
ORIA-16-011 Page 3 of 14
5i. List all wetlands on or adjacent to the project location. [hem]
5j. List all waterbodies (other than wetlands) on or adjacent to the project location.
5k. Is any part of the project area within a 100-year floodplain? [Lei ]
Klyes ❑ No -k&m't rune
51. Briefly describe the vegetation and habitat conditions on the property. [�ieipI
LuhA---'try.- , i/GC�._�•1'�9--.�Tt+cJ�
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5m. Describe how the property is currently used. [help]
5n. Describe how the adjacent properties are currently used. [help]
A-4--
5o. Describe the structures (above and below ground)on the property, including their purpose(s)and current
condition. [help]
5p. Provide driving directions from the closest highway to the project location, and attach a map. LbLIO
'P'1 tarn 11 G aLt w TA W S,yA R&Ab `t- ✓ ,��1't*� f er
A10 4A-,le-) IA44 - iV put
ORIA-16-011 Page 4 of 14
Part 6—Project Descrip
tion
6a. Briefly summarize the overall project. You can provide more detail in 6b. [he1p]
use .1� ; -► 6 wit- �a Sr V
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6b. Describe the purpose of the project and why you want or need to perform it. ljotim
•-TZ) '�;Vp e Z-NJ Cf�l'='/ Z- _r• 1�-•�-^;v; N#t:. wvA-v73fL- i-eve� 414
li� FC'T wI_ !,I'Y-+�? !�iT Yt '+f'1-^�� �1�� Z.`M`�✓l r�.�-c�: ��11x✓�
Al"T OP
6c. Indicate the project category. (Check all that apply) [help]
❑ Commercial Residential ❑ Institutional ❑ Transportation ❑ Recreational
❑ Maintenance Enhancement-.
6d. Indicate the major elements of your project. (Check all that apply) [help]
❑ Aquaculture ❑ Culvert ❑ Float ❑ Retaining Wall
XBank Stabilization ❑ Dam/Weir ❑ Floating Home (upland)
❑ Boat House ❑ Dike/ Levee/Jetty ❑ Geotechnical Survey ❑ Road
❑ Boat Launch ❑ Ditch ❑ Land Clearing 7 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. [help]
• Identify where each element will occur in relation to the nearest waterbody.
• Indicate which activities are within the 100-year floodplain.
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C' -s Fa c- t t pi�a►' r CPa1,t- • may
6f. What are the anticipated start and end dates for project construction? (Month/Year)
• If the project will be constructed in phases or stages,use JARPA Attachment Q to list the start and end dates of each phase
or stage.
Start Date: . zv; , End Date: Zvr — ❑ See DARPA Attachment D
6g. Fair market value of the project, including materials, labor, machine rentals, etc. hel l
-- -------------
61h. Will any portion of the project receive federal funding? [npip�
• If yes,list each agency providing funds.
❑ Yes 106o ❑ Don't know v�
Part 7—Wetlands: Impacts and Mitigation
Cl 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. [heipi
Not applicable
7b.Will the project impact wetlands? Ltgipj
❑ Yes XNo ❑ Don't know
7c. Will the project impact wetland buffers? [help
i
❑ Yes 21 No ❑ Don't know
ORIA-16-011 Page 6 of 14
7d. Has a wetland delineation report been prepared? Eneipl
• If Yes,submit the report,including data sheets,with the JARPA package.
❑ Yes XNo
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.
U Yes ❑ No Don't know
7f. Have you prepared a mitigation plan to compensate for any adverse impacts to wetlands? [hel
• 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
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7g. Summarize what the mitigation plan is meant to accomplish, and describe how a watershed approach was
used to design the plan. [hem
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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.
'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. r,etpi
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. tiel
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.
[_new]
❑ Not applicable — _,--
"o AAve- ,.b &-j w.Y b L,JV;!:� M V e,<�'V F� 1�r sL 7-z►X',
8b. Will your project impact a waterbody or the area around a waterbody? [held]
❑ YesQo
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? [s,eipj
• 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 XNo ❑ Don't know
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8d. Summarize what the mitigation plan is meant to accomplish. Describe how a watershed approach was
used to design the plan.
i
• If you already completed 7g you do not need to restate your answer here, h[._gl_p,]
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8e. Summarize impact(s)to each waterbody in the table below. [he(pj
Activity(clear, Waterbody Impact Duration Amount of material Area (sq.ft. or
dredge, fill, pile name' locationz of impact' (cubic yards) to be linear ft.) of
drive, etc.) placed in or removed waterbody
from waterbody directly affected
'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.
2Indicate 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. [heipj
tr=�I L 6
€
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. I
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. [(tq!pj
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? [heM
• If Yes,list the parameter(s)below.
• If you don't know,use Washington Department of Ecology's Water Quality Assessment tools at:
htt�liwww ecv wa av,'oro rq_amstrr�c�303dI
❑ Yes ❑ No
9c.What U.S. Geological Survey Hydrological Unit Code (HUC) is the project in? [hei
• Go to h1t :1� lcffp epa. ovlsurfilocate/index.cfm to help identify the HUC.
9d. What Water Resource Inventory Area Number(WRIA#) is the project in? [,c!lPJ
• Go to http:llwww.ecy.wa.gov/waterlwria/index.htm!to find the WRIA#.
Me i5
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? hel
• Go to htt :t/wwtiv.ec .w ov! ro rams/w /swas/criteria,html 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? [r,eip]
• If you don't know,contact the local planning department.
• For more information,go to:htt ap /www.ecy.wa-Q vtprograms/sea/sma/laws rules/1 73-2612 1 1 desi nations.html.
❑ Urban ❑ Natural ❑ Aquatic ❑ Conservancy IYOther:
9g. What.is the Washington Department of Natural Resources Water Type? hel
• Go to http://www.dnr.wa.Clov/forest-practices-water-typing for the Forest Practices Water Typing System.
IF-5horeline ❑ 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? hei
• If No,provide the name of the manual your project is designed to meet.
❑ Yes ❑ No ---�---- -
Name of manual:
9i. Does the project site have known contaminated sediment? [help]
• If Yes, please describe below,
❑ Yes —�
9j. If you know what the property was used for in the past, describe below. t3 3J
i
9k. Has a cultural resource (archaeological)survey been performed on the project area? hel
• If Yes,attac 't 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. Le,,jLj
y owe ►
fiI4v0l•e. Myr✓e /1--7' ►
9m. Name each species or habitat on the Washington Department of Fish and Wildlife's Priority Habitats and
Species List that mi ht be affected by the proposed work. (31eM
�f e! Gce,, ell
E
1
f
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.gov/opas/.
• Governor's Office for Regulatory Innovation and Assistance at(800) 917-0043 or helpAoria.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.) hel
• For more information about SEPA,go to�vww.ecv.wa.dov/prograi-nsisea/sepa/e-review.html.
❑ A copy of the SEPA determination or letter of exemption is included with this application
(XA SEP determination is pending withN (lead agency). The expected decision date
Is,�[
❑ 1 am applying for a Fish Habitat Enhancement Exemption. (Check the box below in 10b.) hel
This project is exempt(choose type of exemption below).
❑ Categorical Exemption. Under what section of the SEPA administrative code (WAC) is it exempt?
Other:&L
❑ SEPA is pre-empted by federal law.
101b. Indicate the permits you are applying for. (Check as that apply.) hl elpl
LOCAL GOVERNMENT
Local Government Shoreline permits:
❑ Substantial Development ❑ Conditional Use ❑ Variance
Shoreline Exemption Type (explain):
Other City/County permits: �1—
❑ 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:
C1 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 JARPA package. The JARPA package includes the DARPA form,
project plans, photos, etc. [nei.pi
11a. Applicant Signature (required) tni,j
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, 1 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)
( � � r / ice
Applicant Printed Name Applica Signature Date
i
11 b. Authorized Agent Signature t,mr�p]
i
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. i
Authorized Agent Printed Name Authorized Agent Signature Date
11 c. Property Owner Signature (if not applicant) pwipa
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 Prop y Owner Signature Date
18 U.S.0§1001 provides that:Whoever,in any manner ithin 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. ORl�ublication number: ORIA-16-011 rev.0712017
ORIA-16-011 Page 14 of 14
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