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Home My WebLink Aboutstamped_017 JARPA ApplicationORIA-revised 02/2020 Page 1 of 14 WASHINGTON STATE Joint Aquatic Resources Permit Application (JARPA) Form 1,2 [help] 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 Seabrook Lane Development) [help] Marrowstone Inn Part 2–Applicant The person and/or organization responsible for the project. [help] 2a. Name (Last, First, Middle) Andrew Nordstrom 2b. Organization (If applicable) 2c. Mailing Address (Street or PO Box) 4014 Hunts Point 2d. City, State, Zip Bellevue, Washington 98004 2e. Phone (1) 2f. Phone (2) 2g. Fax 2h. E-mail (206) 650- 3573 andrewlnordstrom@gmail.com 1Additional 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. • 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.epermitting.wa.gov/site/alias__resourcecenter/jarpa_jarpa_form/9984/jarpa_form.aspx. For other help, contact the Governor’s Office for Regulatory Innovation and Assistance at (800) 917-0043 or help@oria.wa.gov. AGENCY USE ONLY Date received: Agency reference #: Tax Parcel #(s): DocuSign Envelope ID: A95D0A37-EAEF-467D-A246-E698B96FFFAA ORIA-revised 02/2020 Page 2 of 14 Part 3–Authorized Agent or Contact Person authorized to represent the applicant about the project. (Note: Authorized agent(s) must sign 11b of this application.) [help] 3a. Name (Last, First, Middle) Tori Masterson or John Sampson 3b. Organization (If applicable) Hoedemaker Pfeiffer LLC 3c. Mailing Address (Street or PO Box) 6113 13th Avenue South 3d. City, State, Zip Seattle, Washington 98108 3e. Phone (1) 3f. Phone (2) 3g. Fax 3h. E-mail (206) 545-8434 tori@hoedemakerpfeiffer.com or john@Hoedemakerpfeiffer.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. [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) 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 DocuSign Envelope ID: A95D0A37-EAEF-467D-A246-E698B96FFFAA ORIA-revised 02/2020 Page 3 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 ☐ 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] 10 Beach Drive 5c. City, State, Zip (If the project is not in a city or town, provide the name of the nearest city or town.) [help] Nordland, Washington, 98358 5d. County [help] Jefferson 5e. Provide the section, township, and range for the project location. [help] ¼ Section Section Township Range Southeast 8 29 North 1 East 5f. Provide the latitude and longitude of the project location. [help] • Example: 47.03922 N lat. / -122.89142 W long. (Use decimal degrees - NAD 83) 48.016557, -122.698591 5g. List the tax parcel number(s) for the project location. [help] • The local county assessor’s office can provide this information. 921084011, 921084010 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) See Attachment C DocuSign Envelope ID: A95D0A37-EAEF-467D-A246-E698B96FFFAA ORIA-revised 02/2020 Page 4 of 14 5i. List all wetlands on or adjacent to the project location. [help] Wetland A, Wetland B 5j. List all waterbodies (other than wetlands) on or adjacent to the project location. [help] Oak Bay, Kilisut Harbor 5k. Is any part of the project area within a 100-year floodplain? [help] ☒ Yes ☐ No ☐ Don’t know 5l. Briefly describe the vegetation and habitat conditions on the property. [help] Upland vegetation onsite is dominated by a mix of mowed lawn areas and patches of trees and shrubs throughout. A larger forested/ shrub patch exists along the western property boundary. Vegetation within the forested / shrub areas of the site is dominated by Pacific crabapple (Malus fusca), Scouler’s willow (Salix scouleriana), English hawthorne (Crataegus monogyna), Nootka rose (Rosa nutkana), and non-native invasive Himalayan blackberry (Rubus armeniacus). Understory and herbaceous vegetation throughout the remainder of the site is dominated by colonial bentgrass (Agrostis capillaris), tall fescue (Schedonorus arundinaceus), and soft rush (Juncus effusus). 5m. Describe how the property is currently used. [help] The property is currently used as a beachfront resort (event space and vacation rental cabins). 5n. Describe how the adjacent properties are currently used. [help] Adjacent properties to the north and east are currently used for residential development. Properties adjacent to the west are undeveloped natural areas connecting Oak Bay and Scow Bay. There are no properties located adjacent to the south, as the property is bordered by Oak Bay in that direction. 5o. Describe the structures (above and below ground) on the property, including their purpose(s) and current condition. [help] Rental cottages are scattered on the property and few contain an extension that includes an outdoor shower and restroom. A larger clubhouse (lodge) resides on the property as well. Gravel driveways connect the cottages. 5p. Provide driving directions from the closest highway to the project location, and attach a map. [help] To access the subject property from WA-19 North/Beaver Valley Road in the Port Ludlow area, turn right onto Oak Bay Road. After 9.9 miles, turn right onto WA-16 / Flagler Road. Continue for 2.8 miles and turn right onto Robbins Road. After 0.2 mile, take a slight right to continue on Robbins Road. Continue for 217 feet and turn right onto Resort Road. After 131 feet, turn right to stay on Resort Road and continue for 203 feet where the subject property will be located on the left. DocuSign Envelope ID: A95D0A37-EAEF-467D-A246-E698B96FFFAA ORIA-revised 02/2020 Page 5 of 14 Part 6–Project Description 6a. Briefly summarize the overall project. You can provide more detail in 6b. [help] The proposed project is to renovate and improve the existing resort facility. Existing infrastructure onsite includes a main lodge, ten cabins, a mobile home with an attached deck and detached garage, equipment and utility sheds, a barn, a boat launch, rock bulkhead to the south adjacent to Oak Bay, and internal gravel and dirt access roads and paths. Renovation activities include remodeling the main lodge to include a commercial kitchen for event purposes, remodeling and upgrading all of the existing cabins and the mobile home and associated garage, replacing the onsite septic system to meet current standards for waste management and to support continued use of the existing cabins onsite, and upgrading and expanding internal site access for accessibility. The proposed renovation activities will also include improving existing access paths throughout the site leading to the cabins. In addition to the remodel activities, the applicant proposes the addition of a sauna, gravel parking areas and expanded site access to the proposed parking areas, and two glamping tents on the subject property. 6b. Describe the purpose of the project and why you want or need to perform it. [help] The purpose of the project is to enable continued use as a resort and to provide infrastructure and aesthetic upgrades to support use of the site as a special events venue. 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] ☐ Aquaculture ☐ Bank Stabilization ☐ Boat House ☐ Boat Launch ☐ Boat Lift ☐ Bridge ☐ Bulkhead ☐ Buoy ☐ Channel Modification ☐ 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 Measurement Device ☐ Stairs ☐ Stormwater facility ☐ Swimming Pool ☒ Utility Line ☒ Other: Minor cabin remodeling DocuSign Envelope ID: A95D0A37-EAEF-467D-A246-E698B96FFFAA ORIA-revised 02/2020 Page 6 of 14 6e. Describe how you plan to construct each project element checked in 6d. Include specific construction methods and equipment to be used. [help] • Identify where each element will occur in relation to the nearest waterbody. • Indicate which activities are within the 100-year floodplain. Remodeling of cabins and the main lodge will be with typical construction methods suitable for stick-frame structures. For more information, see attached Shoreline and Wetland Assessment Report and architectural plans. 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 2021 End Date: ☐ See JARPA Attachment D 6g. Fair market value of the project, including materials, labor, machine rentals, etc. [help] $1.2 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 All project elements are outside of wetlands and their buffers. Silt fencing will be placed around construction activities upslope and outside of the wetland buffers in order to prevent siltation into the wetlands. 7b. Will the project impact wetlands? [help] ☐ Yes ☒ No ☐ Don’t know 7c. Will the project impact wetland buffers? [help] ☐ Yes ☒ No ☐ Don’t know DocuSign Envelope ID: A95D0A37-EAEF-467D-A246-E698B96FFFAA ORIA-revised 02/2020 Page 7 of 14 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 ☐ Don’t know Not Applicable 7g. Summarize what the mitigation plan is meant to accomplish, and describe how a watershed approach was used to design the plan. [help] Mitigation sequencing will be used to ensure that all avoidance and minimization measures are taken. Very minimal activities are proposed within shoreline and wetland setbacks and these will be mitigated by immediate restoration, decreasing impervious surfaces within the shoreline management zone, and a landscaping plan which will restore areas of native vegetation within the project site. 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. [help] Activity (fill, drain, excavate, flood, etc.) Wetland Name1 Wetland type and rating category2 Impact area (sq. ft. or Acres) Duration of impact3 Proposed mitigation type4 Wetland mitigation area (sq. ft. or acres) 1 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: DocuSign Envelope ID: A95D0A37-EAEF-467D-A246-E698B96FFFAA ORIA-revised 02/2020 Page 8 of 14 7i. For all filling activities identified in 7h, describe the source and nature of the fill material, the amount in cubic yards that will be used, and how and where it will be placed into the wetland. [help] 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] 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. [help] ☐ Not applicable No in water work will be proposed for this project. 8b. Will your project impact a waterbody or the area around a waterbody? [help] ☐ Yes ☒ No DocuSign Envelope ID: A95D0A37-EAEF-467D-A246-E698B96FFFAA ORIA-revised 02/2020 Page 9 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 ☐ Don’t know Not Applicable 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. [help] 8e. Summarize impact(s) to each waterbody in the table below. [help] Activity (clear, dredge, fill, pile drive, etc.) Waterbody name1 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 1 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. [help] DocuSign Envelope ID: A95D0A37-EAEF-467D-A246-E698B96FFFAA ORIA-revised 02/2020 Page 10 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] 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 Jefferson County Shannon Cartmel (360) 379-4454 June 21, 2021 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: https://ecology.wa.gov/Water- Shorelines/Water-quality/Water-improvement/Assessment-of-state-waters-303d. ☐ Yes ☒ No 9c. What U.S. Geological Survey Hydrological Unit Code (HUC) is the project in? [help] • Go to http://cfpub.epa.gov/surf/locate/index.cfm to help identify the HUC. 17110019 9d. What Water Resource Inventory Area Number (WRIA #) is the project in? [help] • Go to https://ecology.wa.gov/Water-Shorelines/Water-supply/Water-availability/Watershed-look-up to find the WRIA #. (WRIA) 17 – Quilcene / Snow DocuSign Envelope ID: A95D0A37-EAEF-467D-A246-E698B96FFFAA ORIA-revised 02/2020 Page 11 of 14 9e. Will the in-water construction work comply with the State of Washington water quality standards for turbidity? [help] • Go to https://ecology.wa.gov/Water-Shorelines/Water-quality/Freshwater/Surface-water-quality-standards/Criteria 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: https://ecology.wa.gov/Water-Shorelines/Shoreline-coastal-management/Shoreline-coastal- planning/Shoreline-laws-rules-and-cases. ☐ Urban ☒ Natural ☐ Aquatic ☐ Conservancy ☒ Other: Residential 9g. What is the Washington Department of Natural Resources Water Type? [help] • Go to http://www.dnr.wa.gov/forest-practices-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? [help] • If No, provide the name of the manual your project is designed to meet. ☒ Yes ☐ No Name of manual: 9i. Does the project site have known contaminated sediment? [help] • If Yes, please describe below. ☐ Yes ☒ No 9j. If you know what the property was used for in the past, describe below. [help] A Beachfront Resort 9k. Has a cultural resource (archaeological) survey been performed on the project area? [help] • If Yes, attach it to your JARPA package. ☐ Yes ☒ No It is presently underway. DocuSign Envelope ID: A95D0A37-EAEF-467D-A246-E698B96FFFAA ORIA-revised 02/2020 Page 12 of 14 9l. 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] Marbled Murrelet (Brachyramphus marmoratus) Southern Resident Killer Whale (Orcinus orca) Gray Whale (Eschrichtius robustus) Humpback Whale (Megaptera novaeangliae) Boccacio Rockfish (Sebastes paucispinis) Yelloweye Rockfish (Sebastes ruberriumus) Steelhead Trout (Oncorhynchus mykiss) Chinook Salmon (Oncorhyncus tshawytscha) Chum Salmon (Oncorhynchus kisutch) Bull Trout (Salvenlinus confluentus) 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.) [help] • For more information about SEPA, go to https://ecology.wa.gov/regulations-permits/SEPA-environmental-review. ☐ 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 September 1, 2021 . ☐ 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. 10b. Indicate the permits you are applying for. (Check all that apply.) [help] 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 DocuSign Envelope ID: A95D0A37-EAEF-467D-A246-E698B96FFFAA ORIA-revised 02/2020 Page 13 of 14 Washington Department of Fish and Wildlife: ☐ Hydraulic Project Approval (HPA) ☐ Fish Habitat Enhancement Exemption – Attach Exemption Form 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 ☐ Non-Federally Regulated Waters FEDERAL AND TRIBAL GOVERNMENT United States Department of the Army (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: For projects or bridges over waters of the United States, contact the U.S. Coast Guard at: d13-pf-d13bridges@uscg.mil ☐ Bridge Permit ☐ Private Aids to Navigation (or other non-bridge permits) United States Environmental Protection Agency: ☐ Section 401 Water Quality Certification (discharges into waters of the U.S.) on tribal lands where tribes do not have treatment as a state (TAS) Tribal Permits: (Check with the tribe to see if there are other tribal permits, e.g., Tribal Environmental Protection Act, Shoreline Permits, Hydraulic Project Permits, or other in addition to CWA Section 401 WQC) ☐ Section 401 Water Quality Certification (discharges into waters of the U.S.) where the tribe has treatment as a state (TAS). DocuSign Envelope ID: A95D0A37-EAEF-467D-A246-E698B96FFFAA ORIA-revised 02/2020 Page 14 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] 11a. 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 entering the property where the project is located to inspect the project site or any work related to the project. _________ (initial) Applicant Printed Name Applicant Signature Date 11b. 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 11c. Property Owner Signature (if not applicant) [help] Not required if project is on existing rights-of-way or easements (provide copy of easement with JARPA). I consent to the permitting agencies entering the property where the project is located to inspect the project site or any work. These inspections shall occur at reasonable times and, if practical, with prior notice to the landowner. Property Owner Printed Name Property Owner Signature Date 18 U.S.C §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: ORIA-16-011 rev. 09/2018 DocuSign Envelope ID: A95D0A37-EAEF-467D-A246-E698B96FFFAA 8/5/2021Andrew Nordstrom