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Home My WebLink AboutPRE19-00039 JARPAis ; . WASHINGTON STATE�9 snnnw nn+� Joint Aquatic Resources Permit Application (DARPA) Forml,2 h� USE BLACK OR BLUE INK TO ENTER ANSWERS IN THE WHITE SPACES.BELOW. Part 1—Project Identification " c' 4 L 1fj NOV 2 7 ?019 I -------------------------- AGENCY USE ONLY ! Date received: Agency reference #: Tax Parcel #(s): L-- - - - - -- - - -'----- - - - - - I 1. Project Name (A name for your project that you create. Examples: Smith's Dock or Seabrook Lane Development) hef i WDFW Point Whitney Access Renovations Part 2—Applicant The person and/or organization responsible for the project. 2a. Name (Last, First, Middle) Christina Gourley 2b. Organization (If applicable) Washington Department of Fish and Wildlife 2c. Mailing Address (Street or PO Box) 600 Capitol Way North 2d. City, State, Zip Olympia, WA. 98501-1091 2e. Phone (i) 2f. Phone (2) 2g. Fax 2h. E-mail (360) 902-8392 (360) 902-8300 (360) 902-8367 Chris.Gourley@dfw.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 htt ://www-nws.usace_arm y.mil/Mission 1CivilWorks/Re g uIato /Pe rm i IG uidebo ok/E nq@ nq ered5 gecies.as px. • 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 ]}ttp://www,ppermittina,wa.nov/s€te/alias resourcecenterfiarpa iarpa form19984/}area form asox. For other help, contact the Governor's Office for Regulatory Innovation and Assistance at (800) 917-0043 or hefp@oria.wa.gov. ORIA-16-011 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.) [I,eiUl 3a. Name (Last, First, Middle) 3b. Organization (If applicable) 3c. Mailing Address (Street or PO Box) 3d. City, State, Zip 3e. Phone (1) 3f. Phone (2) 3g. Fax 31h. 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. ft�] ® 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 41h. E-mail ORIA-16-011 Page 2 of 15 Part 5—Project Location(s) Identifying information about the property or properties where the project will occur. hi eiP ❑ 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.) [[] ❑ Private -~—_.. El Federal NOV 2 7 C019 ® Publicly owned (state, county, city, special districts like schools, ports, etc.) � , ❑ Tribal ❑ Department of Natural Resources (DNR) — managed aquatic lands (Co pleta Attach ent E) 5b. Street Address (Cannot be a PO Box. If there is no address, provide other location information in 5p.) ft1qP1J Point Whitney Road 5c. City, State, Zip (If the project is not in a city or town, provide the name of the nearest city or town.) he! ] Brinnon, WA 98320 5d. County [tielo Jefferson 5e. Provide the section, township, and range for the project location. h( elgI '/4 Section Section Township Range NE'/4 7 26N 1W 5f. Provide the latitude and longitude of the project location. [het ] • Example: 47.03922 N lat. /-122.89142 W long. (Use decimal degrees - NAD 83) 47.761791,-122.851412 5g. List the tax parcel number(s) for the project location. [lielp] IJ • The local county assessor's office can provide this information. 601071001 5h. Contact information for all adjoining property owners. (If you need more space, use JARPA Attachment C.) h[ EIM Name Mailing Address Tax Parcel # (if known) Walter Dickerman 2230 Bee Mill Rd. Brinnon, WA 98320 601074014 Reed C Gunstone Gift Trust PO Box 4118 Sequim, WA 98382 601074001 ORIA-16-011 Page 3 of 15 51. List all wetlands on or adjacent to the project location. hf elpl The beach is listed as Estuarine intertidal aquatic bed unconsolidated shore, regularly flooded. 5j. List all waterbodies (other than wetlands) on or adjacent to the project location. hf elpl The project is adjacent to Quilcene and Dabob Bays within Hood Canal 5k. Is any part of the project area within a 100-year floodplain? hel ] ® Yes ❑ No ❑ Don't know Zone A — Panel 5300690865B 51. Briefly describe the vegetation and habitat conditions on the property. [Lem Low -growing vegetation is present at the site. The parking area is graveled and has no vegetation. The parking area is not suitable habitat, though the beach and lagoon offer a variety of habitats for shorebirds, shellfish, forage fish, juvenile fish, and many other species. 5m. Describe how the property is currently used. [help] The parking area is a state-owned access area for the public. There is a boat launch on the east side of the parking area that is used when cleared of sediment. There is a bathroom on -site (flush toilets and sinks) that are also for public access. Users access the parking area to support recreational opportunities of this site including shellfish harvest, boating, and fishing. Other buildings and facilities on -site are leased and are not used by WDFW. 5n. Describe how the adjacent properties are currently used. h[ eip] Adjacent properties are primarily residential, including full-time and vacation homes. 5o. Describe the structures (above and below ground) on the property, including their purpose(s) and current condition. [help.] Public restroom and interpretive center are in good condition and were renovated within the last year. A kiosk is in good condition and is available to alert users of points of interest, safety, and other concerns. It was replaced within the last year. Formal office and lab buildings are in fair condition and currently used to provide office work areas for leasees. 5p. Provide driving directions from the closest highway to the project location, and attach a map. he[ el ] Take US highway 101 north through the town of Brinnon. Approximately 3 miles north of Brinnon, turn right onto Bee Mill Road. Continue on Bee Mill Road (turns into Point Whitney Road) for 2.2 miles. The access is at the end of the road. ORIA-16-011 Page 4 of 15 Part 6—Project Description 6a. Briefly summarize the overall project. You can provide more detail in 6b. hLelp] This project focuses on improvements of the boat launch. The current launch will be left in place and new planks will be placed on top of the launch with steel bars/rails. This will raise the elevation of the ramp, keeping it in the same footprint, so the ramp will not be above the average. Articulated concrete mat will be placed along the sides of the new launch at an elevation that may meet but not exceed the beach elevation. The ramp is being raised to improve safety and reduce impacts on beach substrates in the area. Mitigation for the work will include removal of 2 piles within the lagoon area and the grading to the west end of the "point" to match the grade of the beach. This is a slight reduction in parking area, though no parking area is currently delineated. 6b. Describe the purpose of the project and why you want or need to perform it. [heip] Sediments move rapidly within the area, especially with storm events. Because the launch was placed below grade, it is constantly covered in beach sediment and does not provide a safe launching area for users. By raising the elevation to just below or at grade of the current beach, sediment will not be hand removed by users to access waters and there is a lower potential impact on forage fish and shellfishing areas. It also provides users a tool to launch boats without getting tires, trailers, and vehicles stuck in beach sediments. 6c. Indicate the project category. (Check all that apply) (!)eip] ❑ Commercial ❑ Residential ❑ Institutional ❑ Transportation ® Recreational ❑ Maintenance ❑ Environmental Enhancement 6d. Indicate the major elements of your project. (Check all that apply) [help] ❑ Aquaculture ❑ Culvert ❑ Float ❑ Retaining Wall ❑ Bank Stabilization ❑ Dam / Weir ❑ Floating Home (upland) ❑ Boat House ❑ Dike / Levee / Jetty ❑ Geotechnical Survey ❑ Road M 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: LIB HE D V/L- 1 •� I NOV 2 7 2019 I i IL �. u ORIA-16-011 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. [heipl • Identify where each element will occur in relation to the nearest waterbody. • Indicate which activities are within the 100-year floodplain. A current boat launch exists at the site. Steel rails will be placed on top of the current launch and gaps between the rails will be filled with gravel. The new pre -cast concrete planks (28 planks, 4'x12'x6") will be placed on top of the rails and slid into place to approximately elevation -2.0. The planks are secured together with metal plates. Articulated concrete mats will line either side of the launch and the 4 foot wide mats (110 feet long) will be keyed into the substrate to help alert users when they have left the designated ramp and to aid in erosion of the launch. The mats are cabled together. 6f. What are the anticipated start and end dates for project construction? (MonthNear)[LyjJPJ • 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: July 2020 End Date: September 2021 ❑ See JARPA Attachment D 6g. Fair market value of the project, including materials, labor, machine rentals, etc. hel $300,000 6h. Will any portion of the project receive federal funding? her • 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.) nei 7a. Describe how the project has been designed to avoid and minimize adverse impacts to wetlands. ijei l ❑ Not applicable 71b. Will the project impact wetlands? [Lei ❑ Yes ❑ No ❑ Don't know 7c. Will the project impact wetland buffers? [helpl ❑ Yes ❑ No ❑ Don't know ORIA-16-011 Page 6 of 15 7d. Has a wetland delineation report been prepared? hei ] • 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? [helq] ■ 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? [llcip] • 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 7g. Summarize what the mitigation plan is meant to accomplish, and describe how a watershed approach was used to design the plan. [het 1,1019 1' 71h. 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. [l,_ eip] Activity (fill, drain, excavate, flood, etc.) Wetland Name' Wetland type and rating category' Impact area (sq. ft. or Acres) Duration of impact3 Proposed mitigation type Wetland mitigation area (sq. ft. or acres) n nu upiivai name Tor the wenana exists, create a unique name (such as Welland 1" ). The name should be consistent with other project documents, such as a wetland delineation report. 2 Ecology wetland category based on current Western Washington or Eastern Washington Wetland Rating System. Provide the wetland rating forms with the JARPA package. ' Indicate the days, months or years the wetland will be measurably impacted by the activity. Enter "permanent" if applicable. { Creation C , Re-establishmentlRehabilitation R , Enhancement . Preservation P , Mitigation Bank/ln-lieu fee ([3 Page number(s) for similar information in the mitigation plan, if available: ORIA-16-011 Page 7 of 15 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. h i 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. Leto 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 elpl ® 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. h[�] ❑ Not applicable All project work is in and adjacent to the aquatic environment. All work will be done within the smallest extent possible for maintaining assets. No equipment will drive on the beach and will stay within the footprint of the current boat launch. The current launch is covered with sediment due to its elevation. By raising the elevation, fewer sediments will be disturbed as users attempt to use the popular launch. Eelgrass beds at the terminus of the ramp will also be impacted less due to the availability of the launch. Currently, users often drive off the launch area, potentially impacting fish life, aquatic plant life, and risking vehicle and human safety. This maintenance activity will reduce those risks. 8b. Will your project impact a waterbody or the area around a waterbody? hf eM ® Yes ❑ No ORIA-16-011 Page 8 of 15 8c. Have you prepared a mitigation plan to compensate for the project's adverse impacts to non -wetland waterbodies? [hel • 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 Mitigation for this project includes 900 square feet of mitigation of removal of a graveled area, sometimes used for parking. This area will be regraded to meet the vegetation line at the west point to allow for increased plant growth and sediment movement. In addition, 2 creosote piles within the lagoon will be removed, reducing unwanted harmful chemicals in the system and opening additional area for shellfish establishment on the south side of the point. 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. [h-_LIp) The increase of the footprint with the maintenance to the boat launch will be approximately 744 square feet below MHHW. The removal of the angular gravel and piles was an acceptable mitigation for Habitat Biologists to issue a Hydraulic Project Approval under RCW 77.55. Currently, the boat launch is covered in sediment and is often found "cleared" of sediment by users. Some users attempt to launch their boats without knowing where the launch is, potentially disturbing forage fish and shellfish, as well as power -loading near eelgrass beds. Given the limited amount of space at the site and the minimal square foot impact of the maintenance activities, it is anticipated that the proposed mitigation and proposed activities ill fey iq ate mitigation for impacts anticipated. fr rJJJ =; V- ff i 8e. Summarize impact(s) to each waterbody in the table below. hel ] f Activity (clear, Waterbody Impact Duration Arrld-Unit-of ateaterial Are (sq. ft. or dredge, fill, pile name' location2 of impact3 (cubic yards) to-BL!,— —_.[near ft.) of drive, etc.) placed in or removed waterbody from waterbodix directly affected Concrete planks Dabob Bay Above Permanent 7 CY 428 SF ABOVE, FILL MHHW current footprint Concrete planks Dabob Bay Below Permanent 19 CY 1156 SF BELOW, FILL MHHW current footprint Gravel (CUT) Dabob Bay Dabob Bay Above MHHW Permanent Permanent _ 5 CY 136 SF ABOVE 744 SF BELOW 428 SF ABOVE, Gravel (CUT) Below MHHW 12 CY Gravel (FILL) Dabob Bay Above Permanent 12 CY MHHW current footprint Gravel (FILL) Dabob Bay Below Permanent 31 CY 1156 SF BELOW, MHHW current footprint Articulated Above Permanent Concrete Mats Dabob Bay MHHW 3 CY 136 SF ABOVE FILL Articulated Below Permanent Concrete Mats Dabob Bay MHHW 14 CY 744 SF BELOW FILL n no ofnciai 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. ' Indicate the days, months or years the waterbody will be measurably impacted py the work. Enter "permanent" if applicable. ORIA-16-011 Page 9 of 15 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. hl elp) Boat launch planks are precast in the WDFW Lacey Shop and cured before being brought on site. Rails will be placed and gravels will backfill the spaces. All gravels will be placed between the rails, between the existing boat launch and the new launch planks. New planks will be slid into place with an excavator working within the current launch footprint. Articulated concrete mat is a product that is precast and assembled before being brought on site. It is placed with a spreader bar on an excavator and is placed from the ramp footprint after the ramp is placed. 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. h[ elpl Gravels will be excavated from the beach for the placement of the articulated concrete mats. No materials will be hauled off site. WDFW Habitat has instructed that the sediment be placed to the west of the new launch and sediment will transport as necessary and as it naturally would. 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. Inch] Agency Name Contact Name Phone Most Recent Date of Contact WDFW Chris Waldbillig 360-874-7258 07/29/19 WDFW Darrin Masters 360-764-9942 03/22/19 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 3O3(d) List? [help] s If Yes, list the parameter(s) below. • If you don't know, use Washington Department of Ecology's Water Quality Assessment tools at: httpsil/ecolo.gy.wa.govNVater- ShorelinesNUater-peal itv/Water-imArovement/Assessment-of-state-waters-303d. M Yes ❑ No ORIA-16-011 Page 10 of 15 Listing40303: Category 5 for bacteria g ry (parameter) in water (media). �. � N0� III 9c. What U.S. Geological Survey Hydrological Unit Code (HUC) is the project iri?- [held • Go to h :!!c ub.e a. ovisurfil cat !in x.cfm to help identify the HUC. —� 17110018 9d. What Water Resource Inventory Area Number (WRIA #) is the project in? hW&J • Go to httos:!lecologv wa.ciov/Water-Shorelines/Water-supoly/Water-availability/Watershed-look-up to find the WRIA #. 17 9e. Will the in -water construction work comply with the State of Washington water quality standards for turbidity? Lkuj • Go to httoslHecol ogy_wa.qov/Water-ShoreIinesMlater-quality_IFreshwater/Surface-water-duality-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? 1r,eluj • If you don't know, contact the local planning department. • For more information, go to: https:l/ecology.wa.gov/Water-Shorelines/Shoreline-coast l-management/Shoreline-cQastal- Wanning/Shoreline-laws-rules-and-cases. ❑ Urban ❑ Natural ❑ Aquatic M Conservancy ❑ Other: 9g. What is the Washington Department of Natural Resources Water Type? hel I ■ Go to httj)://www-dnr.wa.,qov/forest-practices-water-ty_ping 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? [12e • 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? tjeio1 • If Yes, please describe below. ❑ Yes ® No 9j. If you know what the property was used for in the past, describe below. [L1g1pJ ORIA-16-011 Page 11 of 15 The dikes on the site were built in 1953 to contain the lagoons for shellfish rearing. The boat launch has been available for public access for a number of years and the Navy owned the property before WDFW. A pier was removed within the last 10 years at the site as well. 9k. Has a cultural resource (archaeological) survey been performed on the project area? hf elol • If Yes, attach it to your JARPA package. ® Yes ❑ No Please work with Adam Rorabaugh for Cultural Resources ORIA-16-011 Page 12 of 15 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. L"1 Marbled murrelet (Brachyramphus marmoratus) — Threatened Streaked horned lark (Erlemophila alpestris strigata) — Threatened Yellow -billed cuckoo Threatened c (Coccyzus americanus) — Bull trout (Salvelinus confluentus) — Threatened Hood Canal Summer run Chum (Oncorhynchus keta) —Threatened ' 0%� V 2 7 Puget Sound Chinook (O. tshawytscha) — Threatened Puget Sound Steelhead (O. mykiss) — Threatened �" t 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. @Ai Common Name Sdentlflc Name Priority Area U;sRliy Feature Full Record Re;ohnion Type Padge Sand Lance Ammt5dyte5 now run _•. : c•+•ri liex�p[erus Breeding Area AS MAPPED line Record Padgc Sand lance Ammodytes Breeding Area AS MAPPED Line Show am show hexapterus Record Northam Spotted Owl Stdx Management Buffer TOWNSHIP Area Show Full fOin•ri occidentalls Record Estuarine and Marine Null Aquatic Habitat AS MAPPED Area Show Full Wetland (show) Record Northern Spotted Owl Stdx how Full (show) occidentalls Management Buffer TOWNSHIP Area Record Part 10—SEPA Compliance and Permits Use the resources and checklist below to identify the permits you are applying for. • Online Project Questionnaire at htt :lie s.oria.wa. ov/o as/. • Governor's Office for Regulatory Innovation and Assistance at (800) 917-0043 or help(moria.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.) lhelp] • For more information about SEPA, go to htt s://ecola .wa. ov/re ulatigns- grmlt /SEPA-environmental-review. ❑ A copy of the SEPA determination or letter of exemption is included with this application. ® A SEPA determination is pending with WDFW (lead agency). The expected decision date is no later than December 31 2019 ❑ I am applying for a Fish Habitat Enhancement Exemption. (check the box below in 10b.) Il,elpi ❑ 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 13 of 15 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 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 DARPA 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 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: ❑ General Bridge Act Permit ❑ Private Aids to Navigation (for non -bridge projects) 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). ORIA-16-011 Page 14 of 15 Part 11—Authorizing Signatures Signatures are required before submitting the JARPA package. The JARPA package includes the JARPA form, project plans, photos, etc. IneM 11 a. Applicant Signature (required) Fein 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. M (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) Christina L Gourley �,� 11/27/19 Applicant Printed Name ApplicanfGignature %f Date ' 11 b. Authorized Agent Signature [help] V > 1/ I certify that to the best of my knowledge and belief, the information provided in thl licatio e, compl ' and accurate. I also certify that I have the authority to carry out the proposed activities a ree to w only after all necessary permits have been issued. Authorized Agent Printed Name Authorized Agent Signature 11 C. Property Owner Signature (if not applicant) [help] Date 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.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 PLJb1ic@fion number: ORIA-16-011 rev. 08/2018 ORIA-16-011 Page 15 of 15