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Home My WebLink AboutSHX2012-00005 JARPA - SHX Permit / Conditions - 3/22/2012 P�ON_STAr,,, MASON COUNTY C DEPARTMENT OF COMMUNITY DEVELOPMENT � M � o A O Planning Division r o N i P O Box 279, Shelton, WA 98584 T i� N y y (360)427-9670 OJ �O 1864 Exemption from Shoreline Management Act Case No.: SHX2012-00005 Substantial Development Permit Requirement The Proposal By: CATHIE/LARS AMES/JOHNSON P O BOX 1315 POULSBO,WA 98370 To undertake the following development: Replace decking and some bracing on existing dock on Haven Lake. 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 B-normal maintenance Please contact Allan Borden at ext 365 if you have any questi s Issued: 3/22/2012 /; & Expires: 3/22/2014 Authorized Local Government Official cc: APPLICANT WDFW USACOE WDOE TRIBAL COUNCIL S � -------RECEIVED-_-__---; AGENCY USE ONLY x _ 2 0 1 0 Date receivaB 0 8 2012 , US Army Corps of Engineers MASON C NTY WASHINGTON STATE �..,,,��s„,�, ' Agency reference#: Joint Aquatic Resources Permit ' Application (JARPA) Form' I Tax Parcel#(s): , USE BLACK OR BLUE INK TO ENTER ANSWERS IN WHITE SPACES BELOW. ------------------------------------' Part 1—Project Identification 1. Project Name (A name for your project that you create. Examples: Smith's Dock or Seabrook Lane Development) [hel 2 Part 2—Applicant The person or organization responsible for the project. hel 2a. Name (Last, First, Middle)and Organization (if applicable) 2b. Mailing Address (Street or PC, Box) P, o 1� 2c. City, State, Zip 2d. Phone(1) 2e. Phone(2) 2f. Fax 2 . E-mail (_%d)2_6 ) ( ) 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) 3b. Mailing Address (Street or PO Box) 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/aqr_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. 2To access an online JARPA form with[help]screens,go to http://www.epermitting.wa.gov/site/alias_resourcecenterfjarpa_jarpa_form/9984/J*arpa_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 13 t 3c. City, State, Zip 3d. Phone(1) 3e. Phone(2) 3f. Fax 3 . E-mail Part 4—Property Owner(s) 7Sa C ct information for people or organizations owning the property(ies) where the project will occur. hel 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 JARPA 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. ❑ 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.) [ ] ❑ 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.) ❑ T,FiCval Is"Private 5b. Street Address (Cannot be a PO Box. If there is no address, provide other location information in 5p.) [ ] 5C. city, State, Zip(If the project is not in a city or town, provide the name of the nearest city or town.) [IJJ P1 5d. County r,er JARPA 2010 v1 3/30/2010 Page 2 of 13 5e. Provide the section, township, and range for the project location. nel 1/4 Section Section Township Range 5f. Provide the latitude and longitude of the project location. hel • Example: 47.03922 N lat./-122.89142 W long_ (NAD 83) 5g. List the tax parcel number(s) for the project location. nel • The local county assessor's office can provide this information. _..O L 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) 5i. List all wetlands on or adjacent to the project location. l ) 5j. List all waterbodies (other than wetlands) on or adjacent to the project location. nei fA�V e h ) �-A �2, 5k. Is any part of the project area within a 100-year flood plain? ] ❑ Yes ❑ No on't know 51. Briefly describe the vegetation and habitat conditions on the property. [help] Sc,(VI c�� zcu. C`rrass, 8 lactbcr Uca C-ec mac, , JARPA 2010 v1 3/30/2010 Page 3 of 13 5m. Describe how the property is currently used. Li e�I L5,demon / ct-Q , PQ-c nea3�-eri�, 5n. Describe how the adjacent properties are currently used. hei s D mom. 5o. Describe the structures (above and below ground) on the property, including their purpose(s). nei - we l c I ecK ou-+bu ,'I cl i n� I R.I V cd�-e r' 5p. Provide driving directions from the closest highway to the project location, and attach a map. [ ~ � Y 1124 V-Y\ I l-c., ten ' JARPA 2010 v1 3/30/2010 Page 4 of 13 £L jo 9 o6ed OIOZ/0£/£ h OLOZ Hda`df a ivawyoeuv v&ibf aaS V] :a3ep Pu3 ( c :aleP:Pe1S a6els jo esegd yoea}o salep pua pue laels eql lsp of o luawuoelly bdHvr esn 'sa6els io sasegd uw palonilsuoo aq ll!m loafoid aql lI [ (jea/(/gluow) 6uo!}onjjsuoo joefoid jol salep pua pue gels ag1 aje JeyM •ag -uweld pool jeaA-00 aql uiylinn We sailiniloe gOILIM aleopul Apogjalenn lsajeau ayl of uoilejaa ui in000 1pm luawala yoea aaa4m/4iluapl [ I -pasn aq o}juawdlnba pue spogjaw uo!jonj}suoo og!oads apnloul -og ui pajoayo juawala joafojd yoea jonjjsuoo of ueld no/(nnoy equosa4 •pg :aay10 ❑ (pueldn) Aemgsl3 ❑ u0l1e3lj!p0W lauuegO ❑ ,IBM 6wu!e}9�1 ❑ leu!wJal /Gaa3 ❑ Aonq ❑ 6u!l!d Elaoua3 Elpeay�lln8 ❑ au!� /�!I!�fl ❑ lood 6u!wwimS ❑ ajnjonjjS Ilepn0 ❑ bu Raja ❑ 96pu9 ❑ 6ulu!W ❑ Ja!d /N0 — Wi 1e09 ❑ sJ!eIS ❑ abeioow / euuevy ❑ yo}!Q ❑ youne-I leog ❑ ao!naQ }uawaanseaUN 6upealo pue ❑ /(}}a('/99n9-1 /9�!Q ❑ asnoH WOE! ❑ opua!oS ❑ AananS Ieo!ugo9jo90 ❑ JI9M/ LUeQ ❑ uoijez!I!ge;S Nueq ❑ peo�J ❑ IeOI3 ❑ Panlno ❑ ajnllnoenby ❑ [diaq] (Aldde 1e41 lie Noago) -}oefoid jno/(jo s}uawala jofew ag}a}eolpul 'og luawaoueyu3 lejuawu0nnu3 ❑ aoueualulew ❑ leuo!jeaaoa uolle:podsuejl ❑ leuo!}nj!jsul ❑ lequap!sa Ie!ojawwo: ❑ iay (Aldde 1e41 lie moago) .Aj 6ajeo;oefoid ayj ajeo!pul •qg Fd— iay -pg u! l!elap aaow ap!noid ueo noA -}oafoid lleJano ayj azuewwnS •eg u014dinsea 130r0ad-9 fed 6f. Describe the purpose of the project and why you want or need to perform it. hel 0 6g. Fair market value of the project, including materials, labor, machine rentals, etc. nel 7 6h. Will any portion of the project receive federal funding? [ • If yes, list ea agency providing funds. ❑ Yes MNo ❑ 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. D9,scribe how the project has been designed to avoid and minimize adverse impacts to wetlands. hei Not applicable 7b. Will the project impact wetlands? heI ❑ Yes ❑ No ❑ Don't know 7c. Will the project impact wetland buffers? [ ❑ Yes ❑ No ❑ Don't know 7d. Has a wetland delineation report been prepared? [help] • If yes, submit the report, including data sheets, with the JARPA package. ❑ Yes ❑ No 7e. Have the wetlands been rated using the Western Washington or Eastern Washington Wetland Rating System? hel • If yes, submit the wetland rating forms and figures with the JARPA package. ❑ Yes ❑ No ❑ Don't know JARPA 2010 v1 3/30/2010 Page 6 of 13 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,a lain below why a mitigation plan should not be required. ❑ Yes ❑ No Not applicable 7g. Summarize what the mitigation plan is meant to accomplish, and describe how a watershed approach was used to design the plan. hel 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. Latlpj 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 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. 'Indicate 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. LLejj DARPA 2010 v1 3/30/2010 Page 7 of 13 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. [ ] N//\- 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.) [help] ❑ 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. [net ❑ Not applicable '/^ 81b. Will your projec pact a waterbody or the area around a waterbody? [ ] ❑ Yes o 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 xplain below why a mitigation plan should not be required. ❑ Yes ❑ No m Not applicable JARPA 2010 v1 3/30,12010 Page 8 of 13 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. [ j 8e. Summarize impact(s) to each waterbody in the table below. heI 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 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. s 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. 3 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. [hel 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. [itel JARPA 2010 v1 3/30/2010 Page 9 of 13 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. LteM 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 on the Washington Department of Ecology's 303(d) List? e, • If yes,list the parameter(s) below. • If you don't know, use Washington Department of Ecology's Water Quality Assessment tools at: http//wy, _._ _ 303d/. ❑ Yes ❑ No 9c. What U.S. Geological Survey Hydrological Unit Code (HUC) is the project in? +)el • Go to i pub.epa.aovisuriiiocate index.cfm to help identify the HUC. 9d. What Water Resource Inventory Area Number(WRIA#) is the project in? [hel • Go to http://www ecy.wa.ciov/seryiceslgis/maps/wha/wria.h r to find the WRIA#. 9e. Will the in-water construction work comply with the State of Washington water quality standards for turbidity? L.._;] • Go to http://www.ecy.wa.gov/programs/wg/swgs/criteria.htm!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: http://www.ecy.wa.gov/programs/sea/sma/laws rules/173-26/211 des ❑ Rural Urban ❑ Natural ❑ Aquatic ❑ Conservancy ❑ Other 9g. What is the Washington Department of Natural Resources Water Type? hei • Go to http:iiwwv, wa gov/BusinessPermrtsil opics/ForestPracticesApplications/Pageslfp watertyping.aspx for the Forest Practices Water Typing System. 'Shoreline ❑ Fish ❑ Non-Fish Perennial ❑ Non-Fish Seasonal DARPA 2010 v1 3/30/2010 Page 10 of 13 9h. Will this project be designed to meet the Washington Department of Ecology's most current stormwater manual? [heap] • If n , provide the name of the manual your project is designed to meet. EP/Yes ❑ No Name of manual: 9i. If you know what the pwperty was used for in the past, describe below. ( i rea&J1M 9j. Has a cultural resource (archaeological) survey been performed on the project area? LheM • If yes, attach it your JARPA package. ❑ Yes o 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. [LpjpJ 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. hei DARPA 2010 v1 3/30/2010 Page 11 of 13 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 help(cb-ora.wa.gov. • For a list of agency addresses to send your application, click on the"where to send your completed JARPA" at http://www.epermitting.wa.gov. 10a. Compliance with the State Environmental Policy Act (SEPA). (Check all that apply.) nel • For more information about SEPA, go to www.ecy wa.gov/programs/sea/sepa/e-review.html. ❑ A copy of the SEPA determination or letter of exemption is included with this application. ❑ A SEPA determination is pending with (lead agency). The expected decision date is ❑ I am applying for a Fish Habitat Enhancement Exemption. (Check the box below in 10b.)[LgjPJ ❑ 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.) [help] LOCAL GOVERNMENT Local Government Shoreline permits: ❑ Substantial Development ❑ Conditional Use ❑ Va lance `! f_ 0 Shoreline Exemption Type (explain): I-) If 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 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) JAR PA 2010 v1 3/30/2010 Page 12 of 13 Part 11—Authorizing Signatures Signatures are required before submitting the JARPA package. The JARPA package includes the JARPA form, project plans, photos, etc. Lt- 11a. Applicant Signature (required) hei 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. it+al) Applicant Printed Name A c,`ant 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 13 of 13 Page file s .F .f� •, Do it 1• 11 11 I 1 11143/21/2012 0 inn i o O