HomeMy WebLinkAboutSDP2014-00012 JEFFERSON COUNTY
DEPARTMENT OF COMMUNITY DEVELOPMENT
UNIFIED DEVELOPMENT CODE
TYPE I LAND USE PERMIT
SHORELINE SUBSTANTIAL DEVELOPMENT PERMIT EXEMPTION
WASHINGTON STATE SHORELINE MANAGEMENT ACT(RCW 90.58)
PROPONENT: STATE OF WASHINGTON-DOT
REAL ESTATE SERVICES
PO BOX 47338
OLYMPIA WA 98504-7338
DATE ISSUED: June 17, 2014
DATE EXPIRES: June 17, 2015
MLA NUMBER: MLA14-00039 CASE NUMBER:SDP14-00012
PROJECT PLANNER: David Wayne Johnson
PROJECT DESCRIPTION:
Replace structurally deficient guardrails, post and blocks-raise low guardrail and replace non energy absorbing
guardrail terminal ends.
WATERBODY AND/OR ASSOCIATED WETLANDS:HOOD CANAL
PROJECT LOCATION:
FINDINGS:
1.) The Administrator finds that this application complies with applicable provisions of the Unified Development
Code, all other applicable ordinances and regulations, and is consistent with the Jefferson County
Comprehensive Plan and Land Use map.
2.) Jefferson County determined that this proposal is categorically exempt from review under the State
Environmental Policy Act(SEPA) pursuant to WAC 197-11-800(3).
3.) The site plan as submitted with the Shoreline Exemption application on June 4, 2014 has been reviewed for
consistency under the UDC, and has been approved by Jefferson County Department of Community
Development. Any modifications, changes, and/or additions to the stamped, approved site plan dated June 17,
2014 shall be resubmitted for review and approval by Jefferson County Department of Community
Development.
4.) This approval is for a Repair/Maintenance and Replacement of State Highway 101 Gaurdrails only. Any future
permits on this site are subject to review for consistency with applicable codes and ordinances and does not
preclude review and conditions which may be placed on future permits.
5.) The Development Review Division finds that this proposal is consistent with Shoreline Master Program Section
JCC 18.25.560(2) and is consequently exempt from the substantial development permit(SDP) requirements.
Exemptions from the substantial development permit requirements do not exempt a proposed development
from compliance with the applicable policies and standards of the Shoreline Master Program or other applicable
Federal, State, or local permit or license requirements.
CONDITIONS:
1.) The project shall adhere to the Best Management Practices (BMPs)to control stormwater, erosion and
sediment during construction. BMPs shall address permanent measures to stabilize soil exposed during
construction, and in the design and operation of stormwater and drainage control systems.
2.) Work within the jurisdiction of the Shoreline Master Program other than as described above shall receive
separate review from this Department.
3.) The development shall be essentially the same as the original in location, size, configuration, and external
appearance.
•
-
Department of Community Development Staff
c: Department of Ecology, Shorelands Office, Rick Mraz
Washington State Department of Fish &Wildlife,
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AGENCY USE ONLY
III I
Date received:
US Army Corps
WASHINGTON STATE of Engineers
Seattle District
Joint Aquatic Resources Permit Agency reference#:
Application (JARPA) Form1'2 Tax Parcel#(s):
USE BLACK OR BLUE - : IN THE WHITE SPACES BELOW.
_ nn
i .
JUN - 4 2014
I ; y
I
Part 1-Project„ Ides F 1, 4uNTr
I EVELOPMENT
1. Project Name(A name for your project that you create.Examples:Smith's Dock or Seabrook Lane Development) [help]
OR Region Wide Basic Safety—Guardrail
Part 2-Applicant
The person and/or organization responsible for the project. [help]
2a. Name(Last,First,Middle)
Sawyer, Jeff B.
2b. Organization(If applicable)
Washington State Department of Transportation
2c. Mailing Address (Street or PO Box)
P.O. Box 47440
2d. City, State, Zip
Olympia, WA, 98504-7440 •
2e. Phone(1) 2f. Phone(2) 2g. Fax 2h. E-mail
(360) 570-6701 (360)790-9646 (360)570-6697 sawyerj @wsdot.wa.gov
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
htto://www,nws.usace.arm v.m II/Missions/CI vi I Works/Beau latory/Perm ItGuid ebook/Endanaered S oecl es.asex.
• 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
htto://www.eoermittina,wa.aov/site/alias resourcecenter/laroa larva form/9984/laroa form,aso
For other help,contact the Governor's Office for Regulatory Innovation and Assistance at(800)917-0043 or]7elo( ora.wa,aov.
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.) [ti ]
3a. Name(Last, First, Middle)
N/A
3b. Organization(If applicable)
3c. Mailing Address (street or PO Box)
3d. City, State, Zip
3e. Phone(1) 3f. 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. [help]
❑ 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)
N/A
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. [help]
❑ 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.) [help]
❑ Private
❑ Federal
I 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]
US 101 Milepost 301.81 (Vic. Mt. Walker Rd.) to Milepost 314.63 (Vic. Mason Co. Line)
5c. City, State, Zip(If the project is not in a city or town,provide the name of the nearest city or town.) [help]
N/A
5d. County [help
Jefferson
5e. Provide the section,township, and range for the project location. [help]
1/4 Section Section Township Range
2, 10, 11, 15, 16, 21, 28, 29, 31, 32 25 North 2 West
11, 13, 14, 23, 24, 26, 35 26 North 2 West
5f. Provide the latitude and longitude of the project location. [help]
• Example:47.03922 N lat./-122.89142W long.(Use decimal degrees-NAD 83)
47.752947 N lat. /-122.891711 W long. To 47.611448 N lat. /-122.984717
5g. List the tax parcel numbers)for the project location. [help]
• The local county assessor's office can provide this information.
N/A
5h. Contact information for all adjoining property owners. (if you need more space,use JARPA Attachment c.) [help]
Name Mailing Address Tax Parcel #(if known)
...............................:....................................................................................................................................................................................................................
JARPA Revision 2012.2 Page 3 of 14
5i. List all wetlands on or adjacent to the project location. [help]
None
5j. List all waterbodies (other than wetlands) on or adjacent to the project location. thelp]
Dosewallips River, Duckabush River, Hood Canal, Marple Creek, Spencer Creek, Turner Creek and
Walkers Creek
5k. Is any part of the project area within a 100-year floodplain? [help]
® Yes ❑ No ❑ Don't know
51. Briefly describe the vegetation and habitat conditions on the property. [help[
Vegetation generally consists of roadside herbaceous plants and low shrubs.
5m. Describe how the property is currently used. [help[
The property is part of the statewide transportation system of roads and bridges.
5n. Describe how the adjacent properties are currently used. [help[
Most of the adjacent properties are zoned Rural Residential, though portions of the project area go
through Dosewallips State Park and Olympic National Forest.
50. Describe the structures (above and below ground)on the property, including their purpose(s)and current
condition. [helot
None
5p. Provide driving directions from the closest highway to the project location, and attach a map. (help]
Head north on US 101 from Lilliwaup to MP 321.46. This is the southern end of the project area.
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. Ihelp,
This project is located in Thurston, Pierce, Jefferson, and Mason Counties, along portions of US 101, SR
510 and SR 512. It will replace structurally deficient guardrail, guardrail posts and/or blocks, raise low
guardrail and replace non-energy absorbing guardrail terminal ends. This project also includes
miscellaneous items associated with replacing deficient guardrail.
6b. Describe the purpose of the project and why you want or need to perform it [help]
Purpose is to replace structurally deficient guardrail safety features which need to be adjusted or
replaced to sustain safety for the traveling public.
6c. Indicate the project category. (Check all that apply) (help]
❑ Commercial ❑ Residential ❑ Institutional ® Transportation ❑ Recreational
® Maintenance ❑ Environmental Enhancement
6d. Indicate the major elements of your project. (Check all that apply) (help)
El Aquaculture ❑ Culvert El Float ❑ Retaining Wall
Di 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: Guardrail
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. [helpl
• Identify where each element will occur in relation to the nearest waterbody.
• Indicate which activities are within the 100-year floodplain.
Much of this work can be performed by hand (raising/lowering guardrail), with auger trucks, post driver
trucks and/or back hoes required for removing and installing guardrail posts and terminals. Work will
be performed mostly during the day. Traffic control will consist mostly of 2-way, one lane with flagger
control. Some night time shifts are possible if traffic volumes require them.
Equipment to be used includes: Auger truck, dump truck, post driver truck, equipment& materials
trailer, small back hoe and pickup trucks.
6f. What are the anticipated start and end dates for project construction? (Month/Year) (help]
• 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: September 2014 End date: January 2015 ❑ See JARPA Attachment D
6g. Fair market value of the project, including materials, labor, machine rentals, etc. IheIrl
Engineers Estimate for entire project, $1.5 Million.
6h. Will any portion of the project receive federal funding? [help]
• 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.) [help]
7a. Describe how the project has been designed to avoid and minimize adverse impacts to wetlands. [help]
❑ Not applicable
The project will replace/repair existing sub-standard guardrail sections. All work will occur along the
shoulder of various state routes within fill material. Standard BMPs will be installed during construction
to prevent runoff from entering waters of the state. All proposed guardrail and terminal end replacement
locations have been reviewed for potential impacts to wetlands. It has been determined there will be no
impacts to wetlands.
7b. Will the project impact wetlands'? [help]
❑ Yes ® No ❑ Don't know
7c. Will the project impact wetland buffers'? [help]
JARPA Revision 2012.2 Page 6 of 14
❑ 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? [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? [help]
• 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 ® Not applicable
This project will not impact any wetlands.
7g. Summarize what the mitigation plan is meant to accomplish, and describe how a watershed approach was.
used to design the plan. [help)
N/A
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. Ihelp]
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)
N/A
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.
3lndicate the days,months or years the wetland will be measurably impacted by the activity.Enter"permanent"if applicable.
4 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. '[help]
JARPA Revision 2012.2 Page 7 of 14
N/A•
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. [help]
N/A
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]
El 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.
[help]
0 Not applicable
There is no in-water work for this project. Temporary erosion and sediment control (TESC); and spill
prevention control and countermeasures (SPCC) plans will be prepared for this project.
8b. Will your project impact a waterbody or the area around a waterbody? [help]
El Yes ENo
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? [help]
• 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 ❑ Not applicable
Project will not impact any non-wetland water bodies.
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. '(helpl
N/A
8e. Summarize impact(s)to each waterbody in the table below. (helot
Activity (clear, Waterbody Impact Duration Amount of material Area (sq. ft. or
dredge, fill, pile name' location2 of impact3 (cubic yards) to be linear ft.) of
drive, etc.) placed in or waterbody
removed from directly affected
waterbody
N/A
11f 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. Them
N/A
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. (help]
N/A
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. {help]
Agency Name Contact Name Phone Most Recent
Date of Contact
N/A ( )
( )
( )
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? {help]
• if Yes,list the parameter(s)below.
• If you don't know,use Washington Department of Ecology's Water Quality Assessment tools at:
http://www.ecy.wa.gov/programs/wq/303d/.
E] Yes No
N/A
9c.What U.S. Geological Survey Hydrological Unit Code(HtJC) is the project in? {help]
• Go to htto://cfoub epa,aov/surf/locate/index.cfm to help identify the HUC.
17110018— Hood Canal Watershed
9d. What Water Resource Inventory Area Number(WRIA#)is the project in? {helo]
• Go to J tto://www.ecv,wa,gov/services/gis/maos/wrla/wria htrn to find the WRIA#.
16 & 17
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? (help]
• Go to http://www.ecy.wa.gov/programs/wp/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? [help]
• If you don't know,contact the local planning department.
• For more information,go to:http://www.ecv.wa.gov/programs/sea/sma/laws rules/173-26/211 desionations.html.
Rural ❑ Urban ►1 Natural ❑ Aquatic ® Conservancy ❑ Other(Muliple
designations)
9g.What is the Washington Department of Natural Resources Water Type? [helps
• Go to http://www.dnr.wa.gov/BusinessPermits/Topics/ForestPracticesApplications/Pages/fp watertvoing.aspx for the Forest
Practices Water Typing System.
® Shoreline /1 Fish ❑ Non-Fish Perennial ❑ Non-Fish Seasonal (Multiple Types)
9h. Will this project be designed to meet the Washington Department of Ecology's most current stormwater
manual? jhelpL
• If No, provide the name of the manual your project is designed to meet.
❑ Yes ® No
Name of manual: Highway Runoff Manual (WSDOT) (2011)
91 Does the project site have known contaminated sediment? fhelpl
• If Yes, please describe below.
❑ Yes [E] No
9j. If you know what the property was used for in the past, describe below. [help]
This property has historically been a part of a transportation corridor.
9k. Has a cultural resource (archaeological) survey been performed on the project area? Lh j J
• 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. (help]
Bocaccio rockfish, canary rockfish, eulachon, marbled murrelet, Puget Sound Chinook salmon, Puget
Sound steelhead, spotted owl, summer run chum salmon and Yelloweye rockfish.
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. Ihelol
This project will not affect any species or habitat on the WDFW Priority Habitats and Species List.
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.ecv.wa.gov/opas/.
• Governor's Office for Regulatory Innovation and Assistance at (800) 917-0043 or help ora.wa.gov.
• For a list of addresses to send your JARPA to, click on agency addresses for completed JARPA.
1 Oa.Compliance with the State Environmental Policy Act(SEPA). (Check all that apply.) 'help]
For more information about SEPA,go to www.ecv.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 lob.)[help]
This project is exempt (choose type of exemption below).
® Categorical Exemption. Under what section of the SEPA administrative code (WAC) is it exempt?
WAC 468-12-800(1)(u)
❑ Other: _
❑ SEPA is pre-empted by federal law.
JARPA Revision 2012.2 Page 12 of 14
lob. Indicate the permits you are applying for. (Check all that apply.) fhelp1
LOCAL GOVERNMENT
Local Government Shoreline permits:
❑ Substantial Development ❑ Conditional Use ❑ Variance
® Shoreline Exemption Type (explain): Normal maintenance or 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
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:
❑$150 check enclosed. Check#
Attach check made payable to Washington Department of Fish and Wildlife.
❑Charge to billing account under agreement with WDFW. Agreement#
❑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 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:
❑ Private Aids to Navigation (for non-bridge projects)
JARPA Revision 2012.2 Page 13 of 14
Part 11—Authorizing Signatures
Signatures are required before submitting the JARPA package. The JARPA package includes the JARPA form,
project plans, photos, etc. [help]
11 a. Applicant Signature (required) [help]
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 enteig the property where the project is located to inspect the project site or any work
related to the project. J (initial)
JEFF LN•F12- ? hes-1 )-7A- 5J 7 I4
Applicant Printed Name A I' nt Signature Date
pp PP 9
11 b. Authorized Agent Signature [help]
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) [help]
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 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
David W. Johnson
From: David W. Johnson
Sent: Wednesday, June 18, 2014 8:15 AM
To: Mraz, Richard A. (ECY); Dan Dafoe (Daniel.Dafoe @dfw.wa.gov);jsch490 @wadnr.gov
Cc: David W. Johnson
Subject: Shoreline Exemption MLA14-00039
Attached.
David Wayne Johnson- LEED AP- Neighborhood Development
Associate Planner- Port Ludlow Lead Planner
Department of Community Development
Jefferson County
360.379.4465
LEE
AP
ND
Mission: To preserve and enhance the quality of life in Jefferson County by promoting a vibrant economy,
sound communities and a healthy environment.
SAVE PAPER - Please do not print this e-mail unless absolutely necessary
All e-mail may be considered subject to the Public Records Act and as such may be disclosed to a third-party requestor.
Jefferson County Department.of Community Development
r
Better Building Starts Mere
s2a saente.sk.Poet'4 ++'w,4 N MN 1:/OM 4 5*7'dooklocoO:: +.
1
C1"5'//Z!' *N r'
JEFFERSON COUNTY
1
DEPARTMENT OF COMMUNITY DEVELOPMENT
621 Sheridan Street I Port Townsend,WA 98368 I Web:www.co.iefferson.wa.us/communitydevelopment
rwc, -' Tel:360.379.44501 Fax:360.379.4451 I Email:dcd @co.jefferson.wa.us
Building Permits&Inspections I Development Consistency Review'Long Range Planning I Watershed Stewardship Resource Center
Master Permit Application MLA: \ L� _ 3� `
Project Description(include separate sheets as necessary): Replace structurally deficient guardrail,guardrail posts and/or blocks,
raise low guardrail and replace non-energy absorbing guardrail terminal ends.
Tax Parcel Number: N/A Property Size: N/A (acres/square feet)
Site Address and/or Directions to Property: N/A
Property Owner(s)of Record: WSDOT
Telephone: Fax: email:
Mailing Address:
Applicant/Agent(if different from owner): Jeff Sawyer
Telephone: (360)570-6701 Fax: (360)357-2601 email: ieff.sawverwsdot.wa.gov
Mailing Address: 5720 Capitol Blvd S Bldg. 7 Tumwater,WA 98501
What kind of Permit?(Check each box that applies) ❑ Lot or Road Segregation
[Building ❑ Critical Areas Stewardship Plan
❑ Demolition Permit ❑ Variance(Minor, Major or Ream
❑ Single Family ❑ Garage Attached/Detached ❑ Conditional Use[C(a), C(d),or C C 1
❑ Manufactured Home ❑ Modular ❑ Discretionary"D"or Unnamed .. essiFcation
❑ Commercial* ❑ Special Use(Essential Public Fa ies)**
❑ Change of Use ❑ Boundary Line Adjustment JUN - 4 2014
❑Address ❑ Road Approach ❑ Short Plat**
❑ Home Business ❑ Cottage Industry ❑ Binding Site Plan** •
❑ Propane ❑ Long Plat** JEFFERSON COUNTY
❑ Sign ❑ Planned Rural Residential De lo R igfln pfr*
❑ Allowed"Yes" Use Consistency Analysis ❑ Plat Vacation/Alteration*"
❑ Stormwater Management X Shoreline Master Program Exemption/Permit Revisions**
❑ Site Plan Approval Advance Determination (SPAAD)* ❑ Shoreline Management Substantial Development**
❑ Temporary Use ❑ Shoreline Management Variance
❑ Wireless Telecommunication* ❑ Comprehensive Plan/UDC/Land Use District Map Amendment
❑ Forest Practices Act/Release of Six-Year Moratorium ❑ Jefferson County Shoreline Master Program Amendment
*May require a Pre—Application Conference ❑ Tree Vegetation Request
**Requires a Pre-Application Conference
Please identify any other local,state or federal permits required for this proposal, if known:
DESIGNATION OF AGENT
I hereby designate to act as my agent in matters relating to this application for permit(s).
OWNER SIGNATURE: Date:
By signing this application form,the owner/agent attests that the information provided herein,and in any attachments,is true and correct to the best of
his,her or its knowledge. Any material falsehood or any omission of a material fact made by the owner/agent with respect to this application packet may
result in this permit being null and void.
I further agree to save,indemnify and hold harmless Jefferson County against all liabilities,judgments,court costs,reasonable attorney's fees and
expenses which may in any way accrue against Jefferson County as a result of or in consequence of the granting of this permit.
I further agree to provide access and right of entry to Jefferson County and its employees,representatives or agents for the sole purpose of application
review and any required later inspections. Staffs access and right of entry will be assumed unless the applicant informs the County in writing at the time
of the appli t or she wants prior notice. /
Signature: ' -'- Date: -S-12771
The action or actions Applicant will undertake as a result of the issuance of this permit may negatively impact upon one or more threatened or
endangered species and could lead to a potential"take"of an endangered species as those terms are defined in the federal law known as the
"Endangered Species Act"or"ESA."Jefferson County makes no assurances to the applicant that the actions that will be undertaken because this permit
has been issued will not violate the ESA.Any individual,group or agency can file a lawsuit on behalf of an endangered species regarding your action(s)
even if you are in compliance with the Jefferson County development code.The Applicant acknowledges that he,she or it holds individual and non-
transferable responsibility for adhering to and complying with the ESA.The Applicant has read this disclaimer and signs and dates it below.
Signature: Date:
it
• BUILDER STATEMENT
The signer of this statement does hereby certify that they are the Owners of the parcel referenced herein,that they are not licensed contractors and that
they will be assuming the responsibility of the General Contractor for the proposed project.
Signature: N/A Date:
GENERAL CONTRACTOR OR MANUFACTURED HOME INSTALLER: N/A PHONE: FAX:
( ) ( )
MAILING ADDRESS: N/A EMAIL:
CONTRACTOR'S LICENSE NUMBER: N/A WAINS NUMBER:
ARCHITECT/ENGINEER: N/A PHONE:( ) FAX:( )
MAILING ADDRESS: N/A EMAIL:
Project Type: Frame Type: Bathrooms: Shoreline: Type of Sewage Disposal:
❑ New ❑ Wood Existing: Bank Height: ❑ Sewer
❑ Addition ❑ Steel Proposed: ❑ Community System
❑ Alteration/Remod(❑ Concrete Total: ❑ Individual System
❑ Repair ❑ Masonry SEP Permit#:
❑ Demolition ❑ Other: Bedrooms: Setback: Water Supply:
Existing: ❑ Private well ❑ Two Party
Type of Heat: Proposed: ❑ Public
Total: Name of System:
If this is a Commercial Project you must answer the following:
Number of Parking Spaces: Current: Proposed: Number of Ire
Number of occupants(includes owners,tenants,employees,etc) Current: • -IBC Occupancy: IBC Type of construction: 11 you have Food Service? "e /No
If this is a Pro.ane Tank and/or A..Hance Installation .ermit mark all items below ITM .• •I :JUN - 4 2014
Underground Tank: Above ground tank: Size of Propane II a ! Heat
Stove: Cook Stove: Woodstove: Fireplace .nsert: re • JE 1 m-it knaT retaW toH
Is this appliance being installed in a Manufactured/Mobile Home? Yes/No DEPT.OF COMMUNITY DEVELOPMENT
When applying for a permit to install a propane tank you must also submit a site plan showing all of the buildings, all property
lines, tank location and size,distances from the propane tank to all property lines,buildings and septic system components,
including the reserve area.
Square Footage I Current Proposed For Office Use Only Amount Revision
Main Floor Heated EH Bld App Review:
2nd Floor Heated Consistency Review:
Other Heated !Base fee:
Mezzanine Additional Section: % -O
Heated Basement Plan Check fee:
Unheated Basement State Surcharge fee:
Other Unheated Pot Water Review fee:
Garage/Carport SUBTOTAL:
Decks 911/Rd Approach fee:
Other-Basic Guardrail Safety TOTAL:
Receipt N •er: 4012
Cash ck Number: 5 ?-QQ
ESTIMATED COST(REQ RED) vU �� Date: (l 4) It
,��� a S
❑Fair market value of all labor an.materials oundation to finish Initials:
Washington State Olympic Region
V. Department of Tra — Environmental&Hydraulic Services
5720 Capitol Blvd
Lynn Peterson Tumwater,WA 98501
Secretary of Transportation P.O. Box 47440
Olympia,WA 98504-7440
360-570-6700/Fax 360-357-2601
TTY: 1-800-833-6388
www.wsdot.wa.gov
11\131d0-13A30 AlINf11/Ud03 301d u _.
May 28, 2014
AMNI103 NOSa31:13( 1
'KO? 1 NAP It
i
Jefferson County
Department of Community Development
it_l
Attn: Carl Smith =-1J l
621 Sheridan St.
Port Townsend, WA 98368
Re: OR Region Wide Basic Safety—Guardrail
US 101 /Milepost 301.81 to 321.46
Shoreline Substantial Development Permit Exemption
Dear Mr. Smith:
Please find enclosed a Joint Aquatic Resources Permit Application(JARPA) for a
Shoreline Substantial Development Permit Exemption for the project mentioned
above,proposed by the Washington State Department of Transportation (WSDOT).
This project will replace guardrail at several locations on State Route 101 in Jefferson
County. Also enclosed you will find:
• Vicinity map and plan sheets (4 sheets)
• Jefferson County - Master Permit Application
• Check for$532.00
This project will replace structurally deficient guardrail, guardrail posts and/or
blocks, raise low guardrail and replace non-energy absorbing guardrail terminal ends.
This project also includes miscellaneous items associated with replacing deficient
guardrail, including minor fill at terminal ends and placement of concrete barrier.
WSDOT has determined this project to be categorically exempt from a SEPA
threshold determination under WAC 468-12-800(1)(u).
Jefferson County
May 28, 2014
Page 2
If you have any questions or need further assistance,please contact Dave Evans at
360-570-6738 or e-mail evansd @wsdot.wa.gov.
Sincerely,
Jeff Sawyer
Environmental and Hydraulic Manager
Olympic Region
JBS:mc:ip
Enclosures: Listed above
cc: Bill Elliott w/enclosures, 47440
Project File w/o enclosures
SF05282014 (6977)
Screen: 01 REAL PROPERTY MASTER Mode: INQUIRY
Auto Roll : OFF
Parcel # 000000000220 Geo Cd 000000000000
STATE ROADS Nbhd Cd
Loc ID
* Taxpayer Cd STAT 3500 STATE OF WASHINGTON-DOT T/P Chg Dt 9/20/1994
* Title Owner T/P Chg Usr KG
Tax Code 0000 Status OT OTHER EXEM Land Use 4590 HWY & ST R/W
Affidavit Vol/Page / C/U Code
COMPLETE ADDRESS WINDOW
Taxpayer
STAT3500 STATE OF WASHINGTON-DOT
REAL ESTATE SERVICES
PO BOX 47338
OLYMPIA WA 98504-7338
Search Key
CMD 6: End Window CMD 7: End of Job
LA - 020(
JEFFERSON COUNTY DC-0 NO. 148726
DATE CO/LV1U
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