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HomeMy WebLinkAboutJARPA.,ar, .'"� M F WASHINGTON STATE o nglneuCorps re I' Joint Aquatic Application (J#L]kM ' USE BLACK OR BLUE INK TO ENTE RS IN THE WHITE SPACES OEC 2 8 2017 JEFFERSON COUNTY ICD Part 1—Project Identification r--------------------------------------s AGENCY USE ONLY I I Date received: I I I I 1 , I I I 1 Agency reference #: 1 1 � I 1 Tax Parcel #(s): I 1 --------------------------------------- 1 I Y 1. Project Larne (A name for your project that you create. Examples: Smith's Dock or Seabrook Lane Development) JLqS1J C) 0 hl 'V\ (Au I a I 5 Part 2—Applicant The person and/or organization responsible for the project.n(�ei ) 2a. Name (Last, First, Middle) P. 4 L•l .Jfl F-2 e�hnC:"- 2b, Organization (if applicable) 2c. Mailing Address (Street or Pa Box) P 0 C) 2d. 2d. City, State, Zip 0V_ 2e. Phone (1) 2f. Phone (2) 2g. Fax 21h. E-mail :ya0-1,3.f_" a500 Qi1 C��c.�a3f ��f1• lAdditional 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 htlo://www.nws, usace =army.mil/MissionsiGivilWarks/Requiatory/PermitGuidebook]Endancered5pecies.a$DX. • 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 http://www.ej)ermitting.wa.gr)v/site/alias msourceoenter/iarna lama form/9984raMa form.aspx. For other help, contact the Governors Office for Regulatory Innovation and Assistance at (800) 917-0043 or helpCroria.wa.nov. ORIA-16-011 Page 1 of 14 P61 Part 3 -Authorized Agent or Contact Person authorized to represent the applicant about the proiect. (Note: Authorized aaent(s) must sign 11 h of thic Part 4 -Property Owner(s) Contact information for people or organizations owning the property(ies) where the project will occur. Consider both inland and aquatic ownership because the upland owners may not own the adjacent aquatic land.hf�l ❑ 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. 9(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 (mast, First, Middle) 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 ORIA-16-011 Page 2 of 14 Part 5 -Project Location(s) Identifying information about the property or properties where the project will occur. h[ ell ❑ There are multiple project locations (e.g. linear projects). Complete the section below and use JARPA Attachment S for each additional project location. 5a. Indicate the type of ownership of the property. (Check all that apply.)hi elp ❑ Private ❑ Federal 9f Publicly owned (state, county, city, special districts like schools, ports, etc.) ❑ Tribal XDepartment 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.) Lpj-pj 5c. City, State, Zip (If the project is not in a city or town. provide the name of the nearest city or town.)hLIA 5d. County hel 5e. Provide the section, township, and range for the project location. Leip] 'P. Section Section Township Range 5f.. Provide the latitude and longitude of the project location. hLeipj • Example: 47.03922 N lat. / -122.89942 W long. (Else decimal degrees - NAD 83) LfR.0-5FD &� — ray-Co70 5g. List the tax parcel number(s) for the project location. hel • The local county assessor's office can provide this information, 5h. Contact information for all adjoining property owners. (lf you needmore space, use JARPA Attachment C.) het Name Mailing Address Tax Parcel # (if known) VJA-L- �q(-k _.._T_... ........... ORIA-16-011 Page 3 of 14 5i. List all wetlands on or adjacent to the project location. hey 5j. List ail waterbodies (other than wetlands) on or adjacent to the project location. [mw] M �-/ 5+ --V-Y P r,-1 5k. Is any part of the project area within a 1 00-year floodplain? [het] ❑ Yes ❑ No 4ST Don't know 51. Briefly describe the vegetation and habitat conditions on the property.[Leipj Ja m i S �jC.Vvl �� rYY1 M a,4- C1 -n2-r, inti 5m. Describe how the property is currently used.him] 5n. Describe how the adjacent properties are currently used. heI ny5�cs-y &,q/ Sn e- P,,L r- k, 'CWld X111 VCkii`I/\ F7 0 LkAI Yr 50. Describe the structures (above and below ground) on the property, including their purpose(s) and current condition. E �6 5p. Provide driving directions from the closest highway to the project location, and attach a map. 1h@!M Ile, ORIA-16-011 Page 4 of 14 Part 6 -Project Description 6a. Briefly summarize the overall protect. You can provide more detail in 6b. tgM 1U, WA 6b. Describe the purpose of the � project and why you want or need to perform it. heI M0.0 � } ri Va 0.0 F -i In B;,L. I ���- ��b��t�� � P-0 '+- 6c. Indicate the project category. (Check all that appty) Lnel ❑ Commercial ❑ Residential ❑ Institutional ❑ Transportation `Recreational ❑ Maintenance ❑ Environmental Enhancement 6d. Indicate the major elements of your project. (check all that apply) [heipt ❑ Aquaculture ❑ Bank Stabilization ❑ Boat House ❑ Boat Launch ❑ Boat Lift ❑ Bridge ❑ Bulkhead 8� Buoy ❑ Channel Modification ❑ Other: ❑ Culvert ❑ Dam/ Weir ❑ Dike / Levee / Jetty ❑ Ditch ❑ Dock / Pier ❑ Dredging ❑ Fence ❑ Ferry Terminal ❑ Fishway ❑ Float ❑ Floating Home ❑ Geotechnical Survey ❑ Land Clearing ❑ Marina / Moorage ❑ Mining ❑ Outfall Structure ❑ Piling/Dolphin ❑ Raft ❑ Retaining Wall (upland) ❑ Road ❑ Scientific d Measurement Device ❑ Stairs ❑ Stormwater facility ❑ Swimming Pool ❑ Utility Line 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. Lei2) • Identify where each element will occur in relation to the nearest waterbody. • Indicate which activities are within the 100-year floodplain. Id-`'ilk Y1��C' L�6rl�ilsti ` k(—oL4:)k cL I>rr ux e-A 0 x A ncl&o r- A 10 to A0 �n �-,k) +tq q h y C1 V-OLLL (I C- ar 6f. What are the anticipated start and end dates for project construction? (montwear) LLeipl • If the project will be constructed in phases or stages, use .DARPA Attachment Q to list the start and end dates of each phase or stage. Start Date:713?[) U 1-7 End Date: 11—ht) ,?,Q l i ❑ See JARPA Attachment D fig. Fair market value of the project, including materials, labor, machine rentals, etc. hell] tr �r -,?�-dD 6h. Will any portion of the project receive federal funding? ttLet + If yes, list each agency providing funds. ❑ Yes ZL 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.) het ] 7a. Describe how the project has been designed to avoid and minimize adverse impacts to wetlands. Lejn) Not applicable 7b. Will the project impact wetlands' hel ❑ Yes <5 No ❑ Don't know 7c. Will the project impact wetland buffers? tt W ❑ Yes KNo ❑ Don't know ORIA-16-011 Page 6 of 14 7d. Has a wetland delineation report been prepared? h[ elpl • If Yes, submit the report, including data sheets, with the JARPA package. ❑ Yes VfNo 7e. Have the wetlands been rated using the Western Washington or Eastern Washington Wetland Elating System? hLelpj • If Yes, submit the wetland rafting farms and figures with the JARPA package. ❑ Yes 9 No ❑ Don't know 7f. Have you prepared a mitigation plan to compensate for any adverse impacts to wetlands?hf e • 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 W—A 7g. Summarize what the mitigation plan is meant to accomplish, and describe how a watershed approach was used to design the plan. [hete] NIA 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. hel Activity (fill, drain, excavate, flood, etc.) Wetland Name' Wetland type and rating category2 Impact area (sq. ft. or Acres) Duration of impact3 Proposed mitigation type 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. 3Indicate 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: ORIA-16-011 Page 7 of 14 7ii. For all filling activities identified in 7h, describe the source and stature of the fill material, the amount in cubic yards that will be used, and how and where it will be placed into the wetland. bQjpj 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. [hp1p 101Pr 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.)hej ei l ❑ 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. het ) ❑ Not applicable T i t i 8b. Will your project impact a waterbody or the area around a waterbody? nes ❑ Yes XNo 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?hi elpl ■ 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 Z�r Don't know 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. hel 101A 8e. Summarize impact(s) to each waterbody in the table below. heto Activity (clear, dredge, fill, pile drive, etc.) Waterbody name' Impact location Duration of impact3 Amount of material (cubic yards) to be placed in or removed from waterbody Area (sq. ft. or linear ft.) of waterbody directl 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. 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. LbLem A)/1 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. hei 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. Iheipl Agency Name Contact Name Phone Most Recent Date of Contact D A)r� 1 J Kc�im`,A5�) N 1W%CC @rl 36D 732- 073 l i `7 9b. Are any of the wetlands or waterbodies identified in Part 7 or Part 8 of this JARPA on the Washington i Department of Ecology's 303(d) List? hel • If Yes, list the parameter(s) below. • if you don't know, use Washington Department of Ecology's Water Quality Assessment tools at:__htp:flww4v.ecy.wa.covloroarams,'WA/303d1. ❑ Yes & No 9c. What U.S. Geological Survey Hydrological Unit Cade (HUC) is the project in? hei -] + Go to h1tp=11ef�ub.ep3.gov/surflEacate/index.cfni to help identify the HUC- 9d. What Water Resource Inventory Area Number (WRIA #) is the project in? t • Go to �Jlwww ecy.wa.govlwaterlwhahndex.html to find the WMA #. U) NX 17 QLAa ICC- e. A© LJ 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? he • Go to htt .11www.ec .wa. ovl ro ranis/w /sw s/criteria.htmi for the standards. YYes ❑ No ❑ Not applicable 9f. if the project is within the jurisdiction of the Shoreline Management Act, what is the local shoreline environment designation? hLo • If you don't know, contact the local planning department. • For more information, go to: http:llwww-ecy.wa.gov/prggramsiseats-ma/laws rules/173-26/211 designations.html. ❑ Urban ❑ Natural `Aquatic ❑ Conservancy ❑ Other: 9g. What is the Washington Department of Natural Resources Water Type? Neto • Go to http�Iw�,r ddnr.wa.,goyj'xorest- radices -water -typing for the Forest Practices Water Typing system. Shoreline ❑ Fish ❑ Non -Fish Perennial ❑ Non -Fish Seasonal 9h. Will this project be designed to meet the Washington Department of Ecology's most current stormwater manual? Lhei, • if No, provide the name of the manual your project is designed to meet. ❑ Yes ❑ No NIA -4 s Name of manual: 9i. Does the project site have known contaminated sediment?Lei j • if Yes, please describe below. ❑ Yes 10 No 9j. If you know what the property was used for in the past, describe below. hei A 9k. Has a cultural resource (archaeological) survey been performed on the project area? heI pj • if Yes, attach it to your DARPA package. ❑ Yes Yl 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.of e 9m. Name each species or habitat on the Washington Department of Fish and Wildlife's Priority Habitats and Species mist that might be affected by the proposed work. ItLeM Part 10—SEPA Compliance and Permits Use the resources and checklist below to identify the permits you are applying for. • Online Project Questionnaire at httg://apps.oria.wa.gov/opas/. • Governor's Office for Regulatory Innovation and Assistance at (800) 917-0043 or helm2oria.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.) [Lelp) • For more information about SEPA, go to YAm,.ecy.wa.gov/programs/sea/sepale-review..htmi, ❑ 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.) [help] 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. ORIA-16-011 Page 12 of 14 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 Exemption 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 boxes $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): ❑ All parts of project (except compensatory mitigation) occur landward of Ordinary High Water Line (OWHL). ❑ 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 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 I FEDERAL GOVERNMENT United States Department of the Army permits (U.S. Army Corps of Engineers): ❑ Section 404 (discharges into waters of the U.S.) VSection 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 ----------- US US Army Corps r j! _ r of Engineers F: D�fe ;reeeived: r,, -- : o j ❑.£ 3Fyi� i WASHINGTON STATE SeatlleDstrcl ,, �itc,�tc0IJVICeRvee-lved i '�- __.�Fee NIA -9 Jointr /� t r # /� �y ` f p c r I r r .point Aquatic Resources Permit 4.Jati �evvA_ 13h.caNrj ;.fl-Re1ew2i,•'ypplication T 3pel feta .2_-_;. !'aturi Use .0 0)(le-.2 Application (DARPA) hf do RE i .N _yA�pp iea i.rin Number- -----------� Attachment EEr '-3'rc�si{s]:• C{�rslit-�: , Aquatic Use Authorization on AORPtatc4:fs Department of [datura[ Resources ! �,{,� (DNR) -managed aquatic lards Complete this attachment and submit it with the completed JARPA form only if you are applying for an Aquatic Use Authorization with DNR. Call (360) 902-1100 or visit www. bit.lyldnr aquatic lease for more information. DNR recommends you discuss your proposal with a DNR land manager before applying for regulatory permits. Contact your regional land manager for more information on potential permit and survey requirements. You can find your regional land manager by calling (360) 902-1100 or going to http-.//Wvw.dnr.wa.goy/Publicationslagr land manager map.pdf. hf PJ a The applicant may not begin work on DNR managed aquatic lands until DNR grants an Aquatic Use Authorization. Include a $25 non-refundable application processing fee, payable to the "Washington Department of Natural Resources." (Contact your Land Manager to determine if and when you are required to pay this fee.) LkM DNR may reject the application at any time prior to issuing the applicant an Aquatic Use Authorization.ridgM ;i L � ry•{rLY 'fix-'�'"�i"1'.JS•�' (i' F 1 �_ yam" ��� +r' .art +''"•Fi � � 1/ �'i�i w }p �• £ �y*yier cC''y&"�AIMIW HIM.' 7f. +:`,fi7} ^a .x }�,`F-* 30 d 'fir' S. ..z iis �:#`E•``,ki •. w t t u"rd • i �;3' T E�<1�� i � x �F �'�' �'1Ca ,��. krr k .v" `al1_n ?+` •. �..e: ,n -. �'k••. i, �jn rv., xSy»f;�ify .�f. rev tib d`�.�`+`SY' ,.€�., vl:.ari=i f S�`:. .�1.. }u . .ri.-,. �A _`t` -i nb'hr.'�.�+-i-...�....s:9SrM1lkS'. ❑ Corporation Individual ❑ Limited Partnership ❑ Marital Community (Identify spouse): ❑ General Partnership ❑ Government Agency ❑ Limited Liability Company ❑ Other (Please Explain): Home State of Registration: JARPA Attachment E Revision 2012.1 Page 1 of 2 TO'�7eGC?i7�3 �(� ■■y�@tux yt� §" Wli�y�C DiRp� Li�i��. Signature for projects on DNR managed aquatic lands: Applicant must obtain the signature of DNR Aquatics District Manager OR Assistant Division Manager if the project is located on DNR -'managed aquatic lands. I, a designated representative of the Dept. of Natural Resources, am aware that the project is being proposed on Dept. of Natural. Resources -managed aquatic lands and agree that the applicant or his/her representative may pursue the necessaryregulatory permits. My signature does not authorize the use of DNR -managed aquatic lands for this project. Printed Name signakwe Dept. of Natural Resources Dept. of Natural Resources Date District Manager or Assistant Division Manager District Manager or Assistant Division Manager v If you require this document in another format, contact the Governors Office of Regulatory Assistance (ORA) 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. ORA Publication ENV -'049-12 JARPA Attachment E Revision 2012.1 Page 2 of 2 Ta` State: c''N a sn i n5+ on county of 1&fre smn MOORING BIJOY AFF1DAIfrf 7 j SS: P/ ys nj.� ,, mcso ip . 92 ��6 3� �icj1 1t�T A�� 3 ig `i�`duly:5tivo'n on oat decses acd sats teat -i oto:n a m6i r6ng buoy in Iv,yc_tery Bay; v:ith th.e frIlcwins; dz,eri'tion: Ltatien: La'_ -Rude ! l� Lgngltude r L LAD -83 [?esCrapti�a; a t#'at use e Fly ryp�httetfc�{7esan boar?,'t.heck,one, �.I%�ve�ot©iie:Lr�tl,��+as:onttiebca' ! �.- 1_'^.Gvea;�� �Slezoilet i (te.'.+E.a i+6187Y1 .� j•1iC'L'fIt1:T c f1 2 t91) ! i l:'1Z� c ii2f '41+{7 mIjpr pos v ry that. a Hy boa;: mobrea.to. this bupy will • Net i:21h'' oveZ .(i itis. Q • u pan4, • Nat&68rgeany;;tailetwaste into '1lysery Bay Nat. allow gray %mg.er (from shawexs, ]aurdry+ or it hen.) os other s.uk tances.to-drain irtia [%P.,,A-ery uay ll=. of a16, tPkw te•anc'gray water aro.periy in up..tarid sesv:a�systerns_flr at a mat pur:rr-oirstalior, Narie_ I cectify i at 1 ICamv.orihave satisience that i e) � �ih l C � IvV s the pe€3onwho.ap;peared'i re-vne arid;s-theov.r.eroftherroo:^ngbucydes uibeai�bovir.i=;jrthes cert'ry tt:a:tiseid persor;Farnowledge thefoiegc ngstate n:eni to -be the freeand,roluntary actrf said pe san. ' ��� t rts SWORN AND Sll �� SU PjN z, 3SGRID b�io�a rra t:+s J day c G:� �b , s /► yh ♦f y �`�rd. �t wA a- e, r'1 Noary Pu'bbc Name: In and for ;he�SzateafiikfashIngtan i�+� `�+d i(e..•4'�� k: Corr mission en iresrlvp iiAs%,••• '►� A peadil•-.E jansarv27, 2010 - Pad~ 1 of 1