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Home My WebLink AboutMLA16-00094 JARPAWASHINGTON STATE � ,,, Joint Aquatic Resources Permit Application (DARPA) Form" ibLem USE BLACK OR BLUE INK TO ENTER ANSWERS IN THE WHITE SPACES BELOW. Part 1 - Project Identification 1. Project Name (A name for your project that you create. Examples: Smith's Dock or Nealey Bulkhead Replacement Part 2 - Applicant The person and/or organization responsible for the project. JkM AGENCY USE ONLY Date Received: Agency reference #: Tax Parcel #(s): Development)h[ pjpJ OC[ �EF�E 13 z017 14 RS4N r 2a. Name (Last, First, Middle) Terry Nealey 2b. Organization (if applicable) 2c. Mailing Address (Street or PO Box) 227 N Cherry St 2d. City, State, Zip Dayton, W 99328 2e. Phone (1) 2f. Phone (2) 2g. Fax 2h. E-mail ( 509 ) 520-8383 Terrynealey65@gmaii.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 ,it :Iww WfPermitG ideboaklEn aeredS ecles.as x.ro9; . • 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. 7To access an online JARPA form wth [help] screens, go to htip:/lwww.eperrnittirlq.wa.govisite/alias resourcecenter!'a�r a larpa form/99841€arpa fon as x. For other help, contact the Governor's Office for Regulatory Innovation and Assistance at (800) 917-0043 or help@oria.wa.00v. JARPA Revision 2015.1 Page 1 of 15 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.) liel 1 3a. Name (Last, First, Middle) Rotsten, Jenny 3b. Organization (if applicable) Sealevel Bulkhead Builders 3c. Mailing Address (street or Po Box) PO 375 3d. City, State, Zip Kingston, WA 98346 3e. Phone (1) 3f. Phone (2) 3g. Fax 3h. E-mail ( 360 ) 297-2401 ( ) ( 360 ) 297-2308 ienny@sealevelbb.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. ltLeio ® Same as applicant. (Skip to Part 5.) ❑ Repair or maintenance activities on existing rights-of-way 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) Nealey, Terry 4b. Organization (if applicable) 4c. Mailing Address (street or Po Box) 227 N Cherry St 4d. City, State, Zip Dayton, WA 99328-1207 4e. Phone (1) 4f. Phone (2) 4g. Fax 4h. E-mail ( 509 ) 520-8383 ( ) ( ) teLtynealev65@gmail.com JARPA Revision 2015.1 Page 2 of 15 Part 5 - Project Location(s) Identifying information about the property or properties where the project will occur. hf elpl ❑ There are multiple project locations (e.g. linear projects). Complete the section below and use JARPA Attacliment B for each additional project location. 5a. Indicate the type of ownership of the property. (Check all that apply.)hf gm ® 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.)hf elp] 351 Pleasant Harbor Rd, 5c. City, State, Zip (If the project is not in a city or town, provide the name of the nearest city or town.) 1hel Brinnon, WA 98320-9773 5d. County pleiW Jefferson 5e. Provide the section, township, and range for the project location.hf elpl 1/4 Section Section Township Range SE 1/4 10 25 N 02 W 5f. Provide the latitude and longitude of the project location. rheipi • Example: 47.03922 N lat. /-122.89142 long. (Use decimal degrees - NAD 83) 47.66783 / -122.9081 5g. List the tax parcel number(s) for the project location.h[ m The local county assessor's office can provide this information. 988200103 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) Gary & Ying Chin 13808 SE 42nd St Bellevue, WA 98006-2248 988200102 Lou Xu 900 Rhododendron Ln ............................................................................................................ Brinnon, WA 98320 988200104 JARPA Revision 2015.1 Page 3 of 15 5i. List all wetlands on or adjacent to the project location. nei N/A 5j. List all, waterbodies (other than wetlands) on or adjacent to the project location. t ei Hood Canal 5k. Is any part of the project area within a 100-year floodplain? IkM ❑ Yes ❑ No ® Don't know 51. Briefly describe the vegetation and habitat conditions on the property.of M Native groundcover, fir trees, shrubs 5m. Describe how the property is currently used.of eM SFR 5n. Describe how the adjacent properties are currently used.of eM SFR 50. Describe the structures (above and below ground) on the property, including their purpose(s) and current condition.of elp] Owners home, concrete bulkhead 5p. Provide driving directions from the closest highway to the project location, and attach a map. of @M Follow US 101 S, slight left on to Cedar Cove Rd, Continue straight on to pleasant harbor rd, Destination will be on the left. JARPA Revision 2015.1 Page 4 of 15 Part 6 - Project Description 6a. Briefly summarize the overall project. You can provide more detail in 6b.hf elal This proposal includes replacing the existing concrete bulkhead, total of +/-25', with a new vinyl bulkhead. The vinyl sheet piling will be installed +/-3' below beach grade or to refusal, whichever is reached first, with +/-3' above beach grade. Three (3) manta ray anchors will be installed behind the wall, a 2x12 whaler along the face of the wall to attach the anchors to, and a cap installed on the top of the wall. Fill material for behind the wall will be put in place with conveyor over the bank and placed by hand. The wall will be installed in line with the old bulkhead. All materials will be delivered to the site by land through the subject property. 6b. Describe the purpose of the project and why you want or need to perform it.hf elol The 25' section of the bulkhead has been damaged from storm activity and is in need of replacement in order to protect the property and structures. 6c. Indicate the project category. (Check all that apply.)hf ela] ❑ Commercial ® Residential ❑ Institutional ❑ Transportation ❑ Recreational ❑ Maintenance ❑ Environmental Enhancement 6d. Indicate the major elements of your project. (Check all that apply.) fhelDl ❑ 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 ❑ Boat Lift ❑ Dock / Pier ❑ Marina / Moorage Measurement Device ❑ Bridge ❑ Dredging ❑ Mining ❑ Stairs ® Bulkhead ❑ Fence ❑ Outfall Structure ❑ Stormwater Facility ❑ Buoy ❑ Ferry Terminal ❑ Piling / Dolphin ❑ Swimming Pool ❑ Channel Modification ❑ Fishway ❑ Raft ❑ Utility Line ❑ Other: JARPA Revision 2015.1 Page 5 of 15 6e. Describe how you plan to construct each project element checked in 6d. Include specific construction methods and equipment to be used. fhelp] • Identify where each element will occur in relation to the nearest waterbody. • Indicate which activities are within the 100 -year floodplain. This proposal includes replacing the existing concrete bulkhead, total of +/-25', with a new vinyl bulkhead. The vinyl sheet piling will be installed +/-3' below beach grade or to refusal, whichever is reached first, with +/-3' above beach grade. Three (3) manta ray anchors will be installed behind the wall, a 2x12 whaler along the face of the wall to attach the anchors to, and a cap installed on the top of the wall. Fill material for behind the wall will be put in place with conveyor over the bank and placed by hand. The wall will be installed within the same footprint as the old bulkhead. All materials will be delivered to the site by land through the subject property. 6f. What are the anticipated start and end dates for project construction? (MonthNear) fhelpl • 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: Fall 2017 End Date: +/-7-10 days ❑ See JARPA Attachment D 6g. Fair market value of the project, including materials, labor, machine rentals, etc.hf eM 6h. Will any portion of the project receive federal funding? rheipi • 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)[Lel 7a. Describe how the project has been designed to avoid and minimize adverse impacts to wetlands.hf e ❑ Not applicable JARPA Revision 2015.1 Page 6 of 15 7b. Will the project impact wetlands?hf elpl ❑ Yes ❑ No ❑ Don't know 7c. Will the project impact wetland buffers?hf eM ❑ Yes ❑ No ❑ Don't know 7d. Has a wetland delineation report been prepared?hf M • 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 a 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?h( elpl ■ 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 7g. Summarize what the mitigation plan is meant to accomplish, and describe how a watershed approach was used to design the plan.hf M 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. 1hpjpj JARPA Revision 2015.1 Page 7 of 15 Activity (fill, drain, excavate, flood, etc.) Wetland Name' Wetland type and rating category2 Impact area (sq. ft. or Acres) Duration of Impact3 Proposed mitigation type4 Wetland mitigation area (sq. ft. or 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. 3 Indicate 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: 71. 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. fhelpl 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. !hp JARPA Revision 2015.1 Page 8 of 15 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.)hf eM ® 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. hf elo ❑ Not applicable The bulkhead will be constructed in line of the old bulkhead. 8b. Will your project impact a waterbody or the area around a waterbody? Jkm ® Yes ❑ No 8c. Have you prepared a mitigation plan to compensate for the project's adverse impacts to non -wetland waterbodies?hf qio • 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 Review Geotech report 8d. Summarize what the mitigation plan is meant to accomplish. Describe how a watershed approach was used to design the plan. hel If you already completed 7g you do not need to restate your answer here. Ihelpl See geotech report 8e. Summarize impact(s) to each waterbody in the table below. MM JARPA Revision 2015.1 Page 9 of 15 Activity (clear, dredge, fill, pile drive, etc.) Waterbody name' Impact location2 Duration of impact3 Amount of material (cubic yards) to be placed in or removed from waterbody Area (sq. ft. or linear ft.) of waterbody directly affected Remove - concrete Hood Canal In Permanent +/-2 yards +/-25' Pile Drive -sheet pile Hood Canal Adjacent Permanent +/- 8 yards +/-25' Dredge Hood Canal Adjacent Permanent +/- 3 yards +/-25' ' If no official name for the waterbody exists, create a unique name (such as "Stream 1 ") The name should be consistent with other documents provided. 2 Indicate whether the impact will occur in or adjacent to the waterbody. If adjacent, provide the distance between the impact and the waterbody and indicate whether the impact will occur within the 100 -year flood plain. 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.of elpl +/- 8 yards of sheet pile. See plans 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. fhelpl +/-3 yards of material. +/- 2 yards of concrete. Upland JARPA Revision 2015.1 Page 10 of 15 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. Iku Agency Name Contact Name Phone Most Recent Date of Contact Jeff Co Emma Bolin ( ) 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? ltel • If Yes, list the parameter(s) below. If you don't know, use Washington Department of Ecology's Water Quality Assessment tools at: http:fiwww_ecy.wa. ovg Iprogranis/wq/303d{. ❑ Yes ® No 9c. What U.S. Geological Survey Hydrological Unit Code (HUC) is the project in? tLeipj • Go to http:11dfpub.eoa.gov/surf/locate/index.cfrn to help identify the HUC. 17110018 9d. What Water Resource Inventory Area Number (WRIA #) is the project in?h[ PIPJ • Go to http:lfwww,ecy.wa.govlseryiceiWis/maps/wriatwria.htm to find the WRIA #. 17 9e. Will the in -water construction work comply with the State of Washington water quality standards for turbidity?hf PIPJ • Go to ht(p://www.ecv.wa.gov/programs/wo/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?h[ elp] • If you don't know, contact the local planning department. • For more information, go to: ham://www.ecy.wa.gov/pro rami stsea/sma/laws rules/173-251211 designations.html. ® Rural ❑ Urban ❑ Natural ❑ Aquatic ❑ Conservancy ❑ Other: 9g. What is the Washington Department of Natural Resources Water Type? hel • Go to http:/Avww.dnr.wa.goviBusinessPermitslTopics/ForestPracticesApPlicationsMagesltp watertvPing.asr r, for the Forest Practices Water Typing System. JARPA Revision 2015.1 Page 11 of 15 ® 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?hf jo • 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?hf eM • If Yes, please describe below: ❑ Yes ® No 9j. If you know what the property was used for in the past, describe below.hf M Unknown 9k. Has a cultural resource (archaeological) survey been performed on the project area?hf M w If Yes, attach it to your JARPA package. ❑ Yes ® No 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.h[ elpl Marbeld murrelet, spotted owl, chinook salmon, steelhead, killer whale, humpback whale, gray wolf. JARPA Revision 2015.1 Page 12 of 15 I9m. 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. Lel Habitat: Puget Sound Nearshore Species: Pacific Lamprey, River Lamprey,White Sturgeon, Pacific Herring,Longfin Smelt, Surfsmelt,Bull Trout/ Dolly Varden,Chinook Salmon,Chum Salmon,Coastal Res./ Searun Cutthroat, Coho,Pink Salmon,Rainbow Trout/ Steelhead/ Inland Redband Trout,Pacific Cod,Pacific Hake,Walleye Pollock,Black Rockfish,Bocaccio Rockfish Brown Rockfish,Copper Rockfish,Greenstriped Rockfish,Quiliback Rockfish,Redstripe Rockfish,Tiger Rockfish Yellowtail Rockfish,Lingcod,Pacific Sand Lance,English Sole,Rock Sole,Western Toad,Pacific Pond Turtle, Common Loon, Common Murre, Marbled Murrelet,Tufted Puffin,Western grebe,W WA nonbreeding concentrations of: Loons, Grebes, Cormorants, Fulmar, Shearwaters, Storm -petrels, Alcids W WA breeding concentrations of: Cormorants, Storm -petrels, Terns, Alcids, Great Blue Heron, Brant, Cavity -nesting ducks: Wood Duck, Barrow's Goldeneye, Common Goldeneye, Bufflehead, Hooded Merganser,Western Washington nonbreeding concentrations of: Barrow's Goldeneye, Common Goldeneye, Bufflehead, Harlequin Duck,Trumpeter Swan,Waterfowl Concentrations ,Bald Eagle Peregrine Falcon,Mountain Quail,Sooty Grouse,"W WA nonbreeding concentrations of:Charadriidae, Scolopacidae, Phalaropodidae "Band -tailed Pigeon Yellow -billed Cuckoo, Vaux's Swift, Pileated Woodpecker Purple Martin,Dall's Porpoise, Humpback Whale,Gray Whale, Sperm Whale, Harbor Seal, Orca (Killer Whale) Pacific Harbor Porpoise, California Sea Lion,Steller (Northern) Sea Lion,Roosting Concentrations of: Big -brown Bat, Myotis bats, Pallid Bat,Townsend's Big -eared Bat,Keen's Long-eared Bat (formerly Keen's Myotis) Columbian Black -tailed Deer,Pinto (Northern) Abalone, Geoduck ,Butter Clam,Native Littleneck Clam Manila Clam,Olympia Oyster,Pacific Oyster, Dungeness Crab,Pandalid shrimp (Pandalidae),Puget Blue 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 help( oria.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.) fh@M . For more about SEPA, go to www.e +y.wayov/pronrams/sea/seoa e-review.html ❑ A copy of the SEPA determination or letter of exemption is included with this application. ® A SEPA determination is pending with Jefferson County (lead agency). The expected decision date is ❑ I am applying for a Fish Habitat Enhancement Exemption. (check the box below in 1 Ob) hI gm ❑ This project is exempt (choose type of exemption below). ❑ Categorical Exemption. Under what section of the SEPA administrative code (WAC) is it exempt? WAC 173-27_040(b). ❑ Other: ❑ SEPA is pre-empted by federal law. JARPA Revision 2015.1 Page 13 of 15 10b. Indicate the permits you are applying for. (Check all that apply.)hf e LOCAL GOVERNMENT Local Government Shoreline permits: ❑ Substantial Development ❑ Conditional Use ❑ Variance ❑ Shoreline Exemption Type (explain): Other City/County permits: ❑ Floodplain Development Permit ❑ Critical Areas Ordinance STATE GOVERNMENT Washington Department of Fish and Wildlife: ® Hydraulic Project Approval (HPA) ❑ Fish Habitat Enhancement Exemption - Attach Exen,i)tion Form 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 tuxes: ® $150 check enclosed. Check #: Attach check made payable to Washington Department of Fish and Wildlife ❑ My project is exempt from the application fee. (Check appropriate exemption) ❑ HPA processing is conducted by applicant -funded WDFW staff. Agreement # ❑ Mineral prospecting and mining. ❑ Project occurs on farm and agricultural land. (Attach a copy of current land use classification recorded with the county auditor, or other proof of current land use.) ❑ Project is a modification of an existing HPA originally applied for, prior to July 10, 2012. HPA # Washington Department of Natural Resources: ❑ Aquatic Use Authorization Complete 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 Coastal Guard permits: ❑ Private Aids to Navigation (for non -bridge projects) JARPA Revision 2015.1 Page 14 of 15 Part 11 -Authorizing Signature Signatures are required before submitting the JARPA package. the JARPA package includes the JARPA form, project plans, photos, etc.h( g!o 11a. Applicant Signature (required)hf eM 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. (Initial) Terry Nealey See attached owner/applicant agreement Applicant Printed Name Applicant Signature Date 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. Jenny Rotsten V2111 :7 - Authorized Agent Printed Name Aori Agen ignature Date 11 c. Property Owner Signature (if not applicant).hf eM 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. Terry Nealey See attached owner / applicant agreement 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 of agency of the United States knowingly falsifies, conceals, or covers up any trick, scheme, or devise 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. 09/2015 JARPA Revision 2015.1 Page 15 of 15