SEP-2013-0008 Optional DNS COMMUNITY DEVELOPMENT DEPARTMENT
*Wane p PLANNING DIVISION
jValley}
ROUTING MEMORANDUM VIA EMAIL
OPTIONAL DNS ENVIRONMENTAL CHECKLIST REVIEW
Date: June 20,2013
To: City of Spokane Valley Development Engineering Division
Spokane County Fire District No. 1 —Traci Harvey
Spokane County Division of Utilities—Information Services;Jim Red
Spokane Regional Health District—Don Copley
Orchard Avenue Irrigation District#6
Avista—David Chambers
CenturyLink —Karen Stoddard
Comcast—Bryan Richardson
SEFNCO—Mike Miner
Spokane Transit Authority—Karl Otterstrom
Spokane County Clean Air Agency—April Westby
Spokane Aquifer Joint Board
WA Department of Archaeological and Historic Preservation—Stephenie Kramer
Washington State Department of Ecology(Olympia)
Washington State Department of Ecology(Spokane)—Terri Costello
Spokane Tribe of Indians-Randy Abrahamson(via mail)
From: Martin Palaniuk,Planner
11707 East Sprague Avenue, Suite 106
Spokane Valley, WA 99206
PH: 509.720.5031;FX: 509.921.1008
E-MAIL: mpalaniukl @spokanevalley.org
SUBJECT: Review and Comment on Submitted SEP-2013-0008 - Walter Dock / Pier. The
project is a private dock in the Spokane River. The dock consists of three 6' x 6' sections. One
of the sections will be mounted to an existing cement bulkhead and the remaining two sections
attached to this section. The sections will be supported by six legs that will rest on a 4" x 14"
pad on the river bottom.
LOCATION: Parcel number 45063.2127; located approximately 75 feet NW of the intersection of
Dick Road and South Riverway Avenue, further located in the SE 1/4 of Section 06, Township 25
North, Range 44 East, Willamette Meridian, Spokane County, Washington
Please review the attached SEPA Checklist and submit written comments via mail, facsimile, mail
or in person by July 5, 2013 at 5:00 PM to the attention of the staff person identified above. The
City of Spokane Valley is the lead SEPA agency for the environmental review of the project.
The City of Spokane Valley has reviewed the project for probable adverse environmental impacts and expects
to issue a determination of non significance(DNS)for this project.
The optional DNS process in WAC 197-11-355 is being used. This may be your only opportunity to
comment on the environmental impacts of the proposed project.
Attachments: SEPA Checklist with Site Plan
11707 E.Sprague•Suite 106•Spokane Valley,WA•99206•(509)921-1000•Fax(509)921-1008
COMMUNITY DEVELOPMENT DEPARTMENT
Spokane PLANNING DIVISION
jValley� NOTICE OF APPLICATION
The Planning Division of the City of Spokane Valley Community Development Department has
published this Notice of Application to provide the opportunity to comment on the described
proposal/project. The comment period ends 14 calendar days from the date issued. During this
period written comments may be submitted to the staff contact. The file may be examined
between the hours of 8:00 a.m. and 5:00 p.m., Monday through Friday (except holidays) in the
Permit Center of the City of Spokane Valley City Hall, 11707 East Sprague Avenue, Suite 106,
Spokane Valley, Washington. Questions may be directed to the staff person listed below.
FILE NO/PROPOSAL: SEP-2013-0008 - WALTER DOCK/PIER. Build a private dock in the
Spokane River. The dock consists of three 6' x 6' sections. One of the sections will be
mounted to an existing cement bulkhead and the remaining two sections attached to this
section. The sections will be supported by six legs that will rest on a 4"x 14"pad on the river
bottom.
APPLICANT: Forrest L. Walter; 8023 E South Riverway Ave; Spokane Valley, WA 99212
OWNER:Forrest L. Walter; 8023 E South Riverway Ave; Spokane Valley, WA 99212
APPLICATION DATE: June 14,2013
DETERMINATION OF COMPLETENESS: June 18, 2013
DECISION-MAKING AUTHORITY: City of Spokane Valley Planning Division
WRITTEN COMMENTS: Agencies,tribes, and the public are encouraged to review and provide
written comments on the proposal/project and its probable environmental impacts. All comments
received within fourteen (14) calendar days of the date issued below will be considered prior to
making a decision on this project. Any person may request a copy of the decision for the
proposal once made. Pursuant to City of Spokane Valley Municipal Code(SVMC) 17.90
(Appeals), a written appeal of the decision shall be filed with the City of Spokane Valley
Community Development Department within fourteen(14) calendar days after the date the
notice of the decision is mailed. Standing to appeal a decision shall be determined in accordance
with the provisions of SVMC 17.90.030 (Standing).
PARCEL NUMBER(S)/SITE ADDRESS/GENERAL LOCATION: Parcel number 45063.2127;
located approximately 75 feet NW of the intersection of Dick Road and South Riverway Avenue,
further located in the SE % of Section 06, Township 25 North, Range 44 East, Willamette
Meridian, Spokane County, Washington
COMPREHENSIVE PLAN: Low Density Residential (LDR)
EXISTING ZONING: Single-Family Residential Suburban(R-2)
1
OTHER PERMITS: Joint Aquatic Resources Permit, Floodplain Development Permit, Shoreline
Exemption Permit
REQUIRED STUDIES: None required at time of this notice of application.
ENVIRONMENTAL REVIEW: The City of Spokane Valley Planning Division has reviewed the
proposal/project for probable adverse environmental impacts and expects to issue a
Determination of Non-Significance (DNS) for this project. The optional DNS process in WAC
197-11-355 is being used. THIS MAY BE YOUR ONLY OPPORTUNITY TO COMMENT ON
THE ENVIRONMENTAL IMPACTS OF THE PROPOSED PROJECT.
EXISTING ENVIRONMENTAL DOCUMENTS: None.
APPLICABLE DEVELOPMENT REGULATIONS: SVMC Title 21 (Environmental Controls), 2009
City of Spokane Valley Street Standards, and 2008 Regional Stormwater Manual are primary
development regulations applicable to the site.
PUBLIC HEARING: Pursuant to SVMC 17.80.060, the Planning Division shall be the decision-
maker on a proposal. Therefore, the proposal is not subject to a future public hearing.
COMMENT PERIOD ENDS: July 5,2013 @ 5:00 p.m.
STAFF CONTACT: Martin Palaniuk, Planner
11707 East Sprague Avenue, Suite 106
Spokane Valley, WA 99206
PH: (509) 720.5031
FX: (509) 921.1008
E-MAIL: mpalaniuk @spokanevalley.org
DATE ISSUED: June 20, 2013
SIGNATURE dAZ-11,a4MOW4-
2
Sjoi
Valley.
COMMUNITY DEVELOPMENT DEPARTMENT
PLANNING DIVISION
11707 E Sprague Ave Suite 106 Spokane Valley WA 99206
509.720.5310 Fax:509.921.1008 planning @spokanevalley.org
LEAD AGENCY
ENVIRONMENTAL CHECKLIST REVIEW
DATE: June 18, 2013
Prepared By: Martin Palaniuk, Planner
A. BACKGROUND
1. PROJECT No: SEP-2013-0008(Walter Dock/Pier)
2. DESCRIPTION: 180 square foot private dock with six support legs on the Spokane
River.
3. APPLICANT: Forrest Walter
8023 E South Riverway Ave
Spokane Valley, WA 99212
4. LOCATION: Parcel number 45063.2127;located approximately 75 feet NW of the
intersection of Dick Road and South Riverway Avenue, further
located in the SE 1/4 of Section 06, Township 25 North, Range 44
East, Willamette Meridian, Spokane County, Washington.
City of Spokane Valley June 18,2013
Optional Determination of Non-Significance(DNS) Page 1 of 4
SEPA Project No. SEP-2013-0008
REVIEW OF SUPPLEMENTAL QUESTIONS OF SECTION 14 OF PART A (BACKGROUND) FOR
CRITICAL AQUIFER RECHARGE AREA(CARA)/AQUIFER SENSITIVE AREA(ASA)
The proposal lies within the Aquifer Sensitive Area (ASA). The project will be built upon the
Spokane River. No stormwater effects or hazardous materials will occur.
B. ENVIRONMENTAL ELEMENTS
Italics indicate potential mitigation measures,if any. Bold indicates unresolved issues or additional
information that must be addressed by the applicant prior to final approval, as indicated.
1. EARTH
The SEPA Checklist states the site sloped starting at the river's edge and continuing into the
river. No site disturbance is expected. The dock section will attach to an existing concrete
bulkhead and six legs will extend to the river bottom and rest on 4 inch by 14 inch pads. is
flat. The shoreline is not expected to be disturbed.
2. AIR
No impacts expected.
3. WATER
Surface
The SEPA Checklist states the site is located on the Spokane River. The only anticipated
impact will be the dust created when boring the anchor bolt holes into the concrete bulkhead.
The checklist states the dust will be vacuumed at the point of drilling and not allowed to
enter the river. During the installation,a person with waders will be walking on the riverbed
which consists of rock with no vegetation. No pile-driving or dredging will occur. The
project does lie within the 100-year floodplain and a floodplain development permit will be
required. No impacts are expected.
Ground
The SEPA Checklist states there are no plans for withdrawal or discharge to any surface
water body.No concerns noted.
Water Runoff
The only stormwater run-off will be from the surface of the dock itself. No concerns noted.
4. PLANTS
The Checklist states the only plants on the site is grass along the shoreline atop the bulkhead.
No concerns noted.
5. ANIMALS
The SEPA Checklist states birds, mammals and fish have been observed on site. These
include eagles,songbirds,beaver,trout and other fish. No known threatened or endangered
species have been observed on the site. The surrounding shoreline has been urbanized with
residential homes for a substantial length of time. No specific measures stated as to enhance
and/or preserve wildlife. No concerns noted.
City of Spokane Valley June 18,2013
Optional Determination of Non-Significance(DNS) Page 2 of 4
SEPA Project No. SEP-2013-0008
6. ENERGY AND NATURAL RESOURCES
The development will not require any energy source. No concerns noted.
7A. ENVIRONMENTAL HEALTH HAZARDS
No environmental health hazards are anticipated. No concerns noted.
7B. NOISE
No noise impacts are expected. No concerns noted.
8. SHORELINE AND LAND USES
The site consists of an existing bulkhead along the shoreline and the dock site in the Spokane
River. The bulkhead is part of a residential lot with a single-family residence. The lot
extends from the street down to the ordinary high water mark on the river. The surrounding
uses also consist of single-family residences. The lot designated low density residential in
the Comprehensive Plan and is zoned R-2, Single-family Residential Suburban. The site lies
within the Shoreline Master Plan (SMP) shoreline jurisdiction. The culTent Shoreline
environmental designation is Urban. Under the SMP the Urban designation is intended to
accommodate compatible water-dependent and water-oriented uses in shoreline areas. The
Urban Area is to be managed so that shoreline developments will enhance and maintain the
shoreline for a multiplicity of uses.
9. HOUSING
Not applicable.
10. AESTHETICS
The project will be at water level and should not impact views. No concerns noted.
11. LIGHT AND GLARE
The SEPA Checklist states that the dock will not utilize any lighting. No concerns noted.
12. RECREATION
The dock will provide the property owner an area to house a boat and participate in boating
and swimming activity. Guests will also benefit from this opportunity. No concerns noted.
13. CULTURAL AND HISTORIC PRESERVATION
The Checklist specifies that there are no known historical and cultural resources at the
subject property. Spokane Tribe of Indians may request an onsite meeting to verify if
any culture resources existed on site prior to any construction commencing. Pursuant
to RCW 27.53.060,on the private and public lands of this state it shall be unlawful for
any person, firm, corporation, or any agency or institution of the state or a political
subdivision thereof to knowingly remove, alter, dig into, or excavate by use of any
mechanical,hydraulic,or other means,or to damage,deface,or destroy any historic or
prehistoric archaeological resource or site, or remove any archaeological object from
such site, except for Indian graves or cairns, or any glyptic or painted record of any
tribe or peoples, or historic graves as defined in chapter 68.05 RCW, disturbances of
which shall be a class C felony punishable under chapter 9A.20 RCW,without having
obtained a written permit from the Director of the Washington State Office of
City of Spokane Valley June 18,2013
Optional Determination of Non-Significance(DNS) Page 3 of 4
SEPA Project No. SEP-2013-0008
Archaeology and Historic Preservation for such activities. Upon any discovery of
potential or known archaeological resources at the subject properties prior to or during
future on-site construction,the developer,contractor,and/or any other parties involved
in construction shall immediately cease all on-site construction,shall act to protect the
potential or known historical and cultural resources area from outside intrusion,and
shall notify,within a maximum period of twenty-fours from the time of discovery,the
City of Spokane Valley Community Development Department of said discovery.
14. TRANSPORTATION
The site is accessed South Riverway Ave. No concerns noted.
15. PUBLIC SERVICES
No concerns noted.
16. UTILITIES
The site is served by utilities such as water, electricity,telephone and garbage. The project
will have no impact on these services. No concerns noted.
City of Spokane Valley June 18,2013
Optional Determination of Non-Significance(DNS) Page 4 of 4
SEPA Project No. SEP-2013-0008
SEPA CHECKLIST
Spokane SVMC 21.20
alley Community Development— Planning Division
11703 E Sprague Ave Suite B-3 • Spokane Valley WA 99206
509.720.5310• Fax: 509.688.0037•planning®spokanevalley.org
STAFF USE ONLY
Date Submitted: ( /114 /ZO(3 Received by: Fee: $350,DD
PLUS#: N/A File#: 5P - 2.0/3 -- 000 O
PART I - REQUIRED MATERIAL
**THE APPLICATION WILL NOT BE ACCEPTED IF THE REQUIRED MATERIALS ARE NOT PROVIDED**
El Completed SEPA Checklist RFCFIVED
❑ Application Fee
!M 1 9013
❑ Reduced Site Plan of proposal in 8Y2" by 11" or 11" by 17"size
SPOKANE VAL
El Trip Distribution and Generation Letter, if requested by Development Engineering. DEpp,RTMENT ur
COMM'TOY D VEL OPMENT
PURPOSE OF CHECKLIST:
The State Environmental Policy Act (SEPA), chapter 43.21C RCW, requires all governmental agencies to
consider the environmental impacts of a proposal before making decisions. An environmental impact
statement (EIS) must be prepared for all proposals with probable significant adver._•e impacts on the quality of
the environment. The purpose of this checklist is to provide information to help you and the agency identify
impacts from your proposal (and to reduce or avoid impacts from the proposal, if it can be done) and to help
the agency decide whether an EIS is required.
INSTRUCTIONS FOR APPLICANTS:
This environmental checklist asks you to describe some basic information about your proposal. Governmental
agencies use this checklist to determine whether the environmental impacts of your proposal are significant,
requiring preparation of an EIS. Answer the questions briefly, with the most precise information known, or give
the best description you can.
You must answer each question accurately and carefully, to the best of your knowledge. In most cases, you
should be able to answer the questions from your own observations or project plans without the need to hire
experts. If you really do not know the answer, or if a question does not apply to your proposal, write "do not
know"or"does not apply." Complete answers to the questions now may avoid unnecessary delays later.
Some questions ask about governmental regulations, such as zoning, shoreline, and landmark designations.
Answer these questions if you can. If you have problems,the governmental agencies can assist you.
The checklist questions apply to all parts of your proposal, even if you plan to do them over a period of time or
on different parcels of land. Attach any additional information that will help describe your proposal or its
environmental effects. The agency to which you submit this checklist may ask you to explain your answers or
provide additional information reasonably related to determining if there may be significant adverse impact.
USE OF CHECKLIST FOR NON-PROJECT PROPOSALS:
Complete this checklist for non-project proposals, even though questions may be answered "does not apply."
IN ADDITION, complete the SUPPLEMENTAL SHEET FOR NON-PROJECT ACTIONS(Part D).
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For non-project actions, the references in the checklist to the words "project,"
"applicant," and "property or site" should be read as "proposal," "proposer," and "affected geographic area,"
respectively.
A. BACKGROUND
1. Name of proposed project, if applicable
\ `ire"T-\ -,' -I x--A,"
2. Name of applicant: i
3. Address and phone number of applicant and contact person:
4. Date checklist prepared: j_� 3
5. Agency requesting checklist:C \ 4 -\�,�� ` "��\11\\\4,,i ( i4cjvu\,J ,I )
6. Proposed timing or schedule (including phasing, if applicable):
4I
7. Do you have any plans for future additions, expansion, or further activity related to or
connected with this proposal? 16, If yes, explain.
8. List any environmental information you k ow about that has been prepared, or will be
prepared, directly related to this proposal. ,Ai
9. Do you know whether applications are pending for governmental approvals of other proposals
directly affecting the property covered by your proposal? IU If yes, explain.
10. List any government approvals or permits that will be needed for your proposal, if known./ i1
11. Give brief, complete description of your proposal, including the proposed uses and the size of
the project and site. There are several questions later in this checklist that ask you to describe
certain aspects of your proposal. You do not need to repeat those answers on this page.
(Lead agencies may modify this form to include additional specific information on project
My proposal is to attach a pier consisting of 3—6'X 6'sections.One section will attach to the existing cement bulkhead on one side and two
legs on the other.The other 2 pier sections attach to the mounted pier and have two support leg each.Each of the 6 legs have a 4"X 14"pad
which rest on the bottom of the river.The riverbed at the location of the pier installation consists of round rock with no visible vegetation.
Although I have never seen fish in that area I assume fish could be present at that location. Page 2 of 14
Spokane SEPA CHECKLIST
4000 Valley
12. Location of the proposal. Give sufficient information for a person to understand the precise
location of your proposed project, including a street address, if any, and section, township, and
range, if known. If a proposal would occur over a range of area, provide the range or
boundaries of the site(s). Provide a legal description, site plan, vicinity map, and topographic
map, if reasonably available. While you should submit any plans required by the agency, you
are not required to duplicate maps or detailed plans submitted with any permit applications
related to this checklist.
88023 E.South Riverside Spokane Valley,WA The pier installation is located on the north side of the lot adjacent the Spokane River,east feet
from the EASE LINE OF TRACT 5 as shown on the map marked WALTER PIER PROJECT page 1 of 2.See enlargement p.2 of 2 for a detailed view.
13. Does the proposed action lie within the Aquifer Sensitive Area (ASA)?A0 The general
Sewer Service Area? 'h ( Priority Sewer Service Area?rX G, (See: Spokane County's
ASA Overlay zone Atlas for boundaries).
14. The following questions supplement Part A.
a. Critical Aquifer Recharge Area (CARA) /Aquifer Sensitive Area (ASA).
1. Describe any systems, other than those designed for the disposal of sanitary
waste, installed for the purpose of discharging fluids below the ground surface
(includes systems such as those for the disposal of Stormwater or drainage
from floor drains). Describe the type of system, the amount of material to be
disposed of through the system and the types of material likely to be disposed
of(including materials which may enter the system inadvertently through spills
or as a result of firefighting activities). Ak..4,
2. Will any chemicals (especially organic solvents or petroleum fuels) be stored
in aboveground or underground storage tanks? If so, what types and
quantities of material will be stored? ),I `I
3. What protective measures will be taken to insure that leaks or spills of any
chemicals stored or used on site will not be allowed to percolate to
groundwater? This includes measures to keep chemicals out of disposal
systems. NI,j/ 0
4. Will any chemicals be stored, handled or used on the site in a location where
a spill or leak will drain to surface or groundwaterlor to a Stormwater disposal
system discharging to surface or groundwater? j I
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b. Stormwater
1. What are the depths on the site to groundwater and to bedrock (if known)?
1\1IA
2. Will stormwater be discharged into the ground? If so, describe any potential
impacts. RI
B. ENVIRONMENTAL ELEMENTS EVALUATION FOR
AGENCY USE ONLY
1) Earth
a. General description of the site (check one): Li flat, U rolling, I I hilly,
steep slopes, ❑ mountainous, other ._
V
b. What is the steepest slope on the site (approximate percent slope)?
v
c. What general types of soils are found on the site (for example, clay, sand,
gravel, peat, muck)? If you know the classification of agricultural soils,
specify them and note any prime farmland. r°-
4t---An / / 0
d. Are there surface indications or history of unstable soils in the immediate
vicinity? �i
If so, describe.J 4
e. Describe the purpose, type, and approximate quantities of any filling or
grading proposed. Also indicate source of fill. 8 / 0
f. Could erosion occur as a result of clearing, construction, or use? Ko
If so, generally describe.
g. About what percent of the site will be covered with impervious surfaces
after project construction (for example, asphalt or buildings)?A
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h. Proposed measures to reduce or control erosion, or other impacts to the
earth, if any: ,ro/ l
2) Air f EVALUATION FOR
AGENCY USE ONLY
a. What types of emissions to the air would result from the proposal (i.e.,
dust, automobile, odors, industrial wood smoke) during construction and
when the project is completed? If any, generally describe and give
approximate quantities if known.
b. Are there an off-site sources of emissions or odor that may affect your
proposal? ) a If so, generally describe.
c. Proposed measures to reduce or control emissions or other impacts to air,
if any: `�I A
3) Water
a. Surface:
1) Is there any surface water body on or in the immediate vicinity of the
site (including year-round and seasonal streams, saltwater, lakes,
ponds, wetlands)? If yes, describe type and pro Ide names. If
appropriate, state what stream or river it flows into.
S V6\L \ \)-0(
2) Will the project require any work over, in, or adjacent to (within 200
feet) the described waters? If yes, please describe and attach
available plans.
The project is a simple installation,the only power tool required will be an electric drill used to bore the anchor bolt holes into the existing
cement bulkhead.All dust from the drilling will be vacuumed at the point of work and will not be introduced into the water. Any work in the
water would be done by an individual wading in the river and would have minimal effect on the riverbed which is rocky with no vegetation.
3) Estimate the amount of fill and dredge material that would be placed
in or removed from surface water or wetlands and indicate the area of
the site that would be affected. Indicate the source of fill
material. , \\ is\I 0 ist) 4I,-\"\ --)\-'-'`'-\,44\ te..-,(It\‘‘F"-6)
4) Will the proposal require surface water withdrawals or diversions? /UCH
Give general description, purpose, and approximate quantities ..
if known.
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EVALUATION FOR
AGENCY USE ONLY
5) Does the proposal lie within a 100-year floodplain? `S If so, note
location on the site plan. (7.20-i..3 r s \\,,\ k
(-.;.v...,\,(„wv,A., ,A, ,v\, • , . .-....,
\\ \\ \t„A\ col- \I.
6) Does the proposal involve any discharges of waste materials to
surface waters? 0 If so, describe the type of waste and
anticipated volume o discharge.
b. Ground:
1) Will ground water be withdrawn, or will water be discharged to ground
water? A u Give general description, purpose, and approximate
quantities if known.
2) Describe waste material that will be discharged into the ground from
septic tanks or other sources, if any (for example: Domestic sewage;
industrial, containing the following chemicals; agricultural; etc.).
Describe the general size of the system, the number of such systems,
the number of houses to be served (if applicable), or the number of
animals or humans the systems) are expected to serve.
c. Water runoff(including stormwater):
1) Describe the source of runoff (including storm water) and method of
collection and disposal, if �y (include quantities, if known). Where
will this water flow? /\\) 0'
Will this water flow into other waters? If so, describe.
2) Could waste materials enter ground or surface waters? CS If so,
generally describe.
d. Proposed measures to reduce or control surface, ground, and runoff water
impacts, if any: NA
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EVALUATION FOR
4) Plants AGENCY USE ONLY
a. Check or circle types of vegetation found on the site:
❑ deciduous tree: alder, maple, aspen, other
❑ evergreen tree: fir, cedar, pine, other
[ shrubs
.grass
C pasture
❑ crop or grain
❑ wet soil plants: cattail, buttercup, bullrush, skunk
cabbage, other
❑ water plants: water lily, eelgrass, milfoil, other
other types of vegetation
b. What kind and amount of vegetation will be removed or altered? )1\tvy\,5v
c. List threatened or endangered species known to be on or near the
site.
d. Proposed landscaping, use of native plants, or other measures to
preserve or enhance vegetation on the site, if any:
5) Animals
a. Circle any birds and animals which have been observed on or near the
site or are known to be on or near the site:
At birds: hawk, heron,r.9_aglik songbirds other:
N.mammals: deer, bear, elk, beaver other.
E fish: bass, salmon trout, herring shellfish; other;
b. List any threatened or endangered species known to be on or near the
site.
c. Is the site part of a migration route? Nu If so, explain.
d. Proposed measures to preserve or enhance wildlife, if any: N(I)
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EVALUATION FOR
AGENCY USE ONLY
6). Energy and natural resources
a. What kinds of energy (electric, natural gas, oil, wood stove, solar) will be
used to meet the completed project's energy needs? Describe whether it
will be used for heating, manufacturing, etc. NI 1 \
b. Would your project affect the potential use of solar energy by adjacent
properties? If so, generally describe. )1/41 0
c. What kinds of energy conservation features are included in the plans of
this proposal?)\ ,t,,_,List other proposed measures to reduce or control
energy impacts, if any:
7) Environmental health
a. Are there any environmental health hazards, including exposure to toxic
chemicals, risk of fire and explosion, spill, or hazardous waste, that
could occur as a result of this proposal? f 0 If so, describe
1) Describe special emergency services that might be required./_ i)
2) Proposed measures to reduce or control environmental health
hazards, if any: N )
b. Noise J
1) What types of noise exist in the area which may affect your project
(for example: traffic, equipment, operation, other)? 1\ 0,(\
2) What types and levels of noise would be created by or associated
with the project on a short-term or a long-term basis (for example:
traffic, construction, operation, other)? Indicate what hours noise
would come from the site. NI Uvil�,�
3) Proposed measures to reduce or control noise impacts, if any: Ni I
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8). Land and shoreline use
a. What is the current use of the site and adjacent properties1 \\Q \3\
b. Has the site been used for agriculture? If so, describe. t�
c. Describe any structures on the site. \1 - \�1"'
1
d. Will any structures be demolished? / U If so, what?
e. What is the current zoning classification of the site? IdLc)1.-W-200)\\__ (k-L-Zij
f. What is the current comprehensive plan designation of the site?
g. If applicable, what is the current shoreline master program designation of .i\y\
the site?
h. Has any art of the site been classified as an "environmentally sensitive"
area? 1 d
If so, speci .
i. Approximately how many people would reside or work in the completed
project? 0 o
j. Approximately how many people would the completed project displace? )\lovvz
k. Proposed measures to avoid or reduce displacement impacts, if
any:
I. Proposed measures to ensure the propos I is compatible with existing
and projected land uses and plans, if any: v\' _ Page 9 of 14
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9) Housing
a. Approximately how many units would be provided, if any? Indicate
whether high, middle, or low-income housing.
b. Approximately how many units, if any, would be eliminated? Indicate
whether high, middle, or low-income housing. V` _,
c. Proposed measures to reduce or control housing impacts, if any: u1
10). Aesthetics
a. What is the tallest height of any proposed structure(s), not including
antennas; what is the principal exterior building material(s)
proposed? N'
b. What views in the immediate vicinity would be altered or
obstructed? \
c. Proposed measures to reduce or control aesthetic impacts, if any: Au,
11). Light and glare ii
a. What type of light or glare will the proposal produce?1 0N.Q_,What time of
day would it mainly occur?
b. Could light or glare from the finished project be a safety hazard or
interfere with views? 14 U
c. What existing off-site sources of light or glare may affect your proposal?X1Uk.
d. Proposed measures to reduce or control light and glare impacts, if any: 61
PL-22 V1.0 Page 10 of 14
Spokane SEPA CHECKLIST
Valley
EVALUATION FOR
AGENCY USE ONLY
12) Recreation
a. What designated and informal recreational opportunities are in the
immediate vicinity? '` x., 4\\ c
b. Would the proposed project displace any existing recreational uses? At 6,
If so, describe.
c. Proposed measures to reduce or control impacts on recreation, including
recreation opportunities to be provided by the project or applicant, if any: 14 r\
13). Historic and cultural preservation
a. Are there any places or objects listed on, or proposed for, national, state,
or local preservation registers known to be on or next to the site?to G, If
so, generally describe. `
b. Generally describe any landmarks or evidence of historic, archaeological,
scientific, or cultural importance known to be on or next to the site. A i ,,��
c. Proposed measures to reduce or control impacts, if any: i\\,4 _._,
14). Transportation
a. Identify public streets and highways serving the site, and describe
proposed access to the existing street system.),\I/A Show on site
plans, if any. / t
b. Is site currently served by public transit?NI 0 If not, what is the
approximate distance to the nearest transit stop?
c. How many parking spaces would the completed project have?
How many would the project eliminate? / i.,
�\:..."
PL-22 V1.0 Page 11 of 14
CfTI IN' ��
Spokane SEPA CHECKLIST
. Valley
d. Will the proposal require any new roads or streets, or improvements to
existing roads or streets, not including driveways? No If so, generally
describe (indicate whether public or private). EVALUATION FOR
AGENCY USE ONLY
e. Will the project use (or occur in the immediate vicinity of) water, rail, or air
transportation? Ali If so, generally describe.
f. How many vehicular trips per day would be generated by the completed
project?A 0\ If known, indicate when peak volumes would occur.
g. Proposed measures to reduce or control transportation impacts, if any:
15) Public services
a. Would the project result in an increased need for public services (for ,
example: fire protection, police protection, health care, schools, other)? )\J
If so, generally describe.
b. Proposed measures to reduce or control direct impacts on public
services, if any. N f 0
16) Utilities i)�\; j �(
a. Check utilities currently available at the site: electricity, L natural
gas, 'F water,-"- refuse service,-1--d telephone, sanitary sewer, ❑
septic system, ❑ other-describe .
b. Describe the utilities that are proposed for the project, the utility providing
the service, and the general construction activities on the site or in the
immediate vicinity which might be needed. y\I A
7
C. SIGNATURE
The above answers are true and complete to the best of my knowledge. I understand that the lead
agency is relying on them to make its decision.
Signature: .111114 4.-
PL-22 V1.0 Page 12 of 14
car
Spcm okane SEPA CHECKLIST
.valley
Date \z\ - Submitted:
1
D. SUPPLEMENTAL SHEET FOR NON-PROJECT ACTIONS
(Do not use this sheet for project actions)
Because these questions are very general, it may be helpful to read them in conjunction with the list of
the elements of the environment.
When answering these questions, be aware of the extent the proposal, or the types of activities likely
to result from the proposal, would affect the item at a greater intensity or at a faster rate than if the
proposal were not implemented. Respond briefly and in general terms.
1. How would the proposal be likely to increase discharge to water; emissions to air; production,
storage, or release of toxic or hazardous substances; or production of noise? N r6
a. Proposed measures to avoid or reduce such increases are:
2. How would the proposal be likely to affect plants, animals, fish, or marine life?
Install a prefabricated pier consisting of 3-6'X 6'sections,each supported by 2 alum.legs with 4'X 14'bases.One 6"X 6"section is attached
to an existing cement bulkhead with bolts and the other sections are designed to interlock with each other. When the sections are interlocked
together they will form an"L"shaped pier with the top of the"L"attached to the cement bulkhead.
a. Proposed measures to protect or conserve plants, animals, fish, or marine life are:
3. How would the proposal be likely to deplete energy or natural resources? N/A
A
a. Proposed measures to protect or conserve energy and natural resources are:
4. How would the proposal be likely to use or affect environmentally sensitive areas or areas
designated (or eligible or under study) for governmental protection; such as parks, wilderness, wild
and scenic rivers, threatened or endangered spe,ies habitat, historic or cultural sites, wetlands,
floodplains, or prime farmlands? "lir b w\
a. Proposed measures to protect such resources or to avoid or reduce impacts are:
5. How would the proposal be likely to affect land and shoreline use, including whe her it
would allow or encourage land or shoreline uses incompatible with existing plans? i\ \f„,,,,\ \.A
PL-22 V1.0 Page 13 of 14
❑Tl(X' ��
Spokane SEPA CHECKLIST
42500 Valley
a. Proposed measures to avoid or reduce shoreline and land use impacts
are
6. How would the propo aI b likely to increase demands on transportation or public services and
utilities? .1\ ,.\)‘ ..,4\\N.
a. Proposed measures to reduce or respond to such demand(s) are:
7. Identify, if possible, whether the proposal may co flict with local, state, or federal laws or
requirements for the protection of the environment. 11 i1
E. SIGNATURE
I, the undersigned, swear under penalty of perjury that the above responses are made truthfully and
to the best of my knowledge. I also understand that, should there be any willful misrepresentation or
willful lack of full disclosure on my part, the agency may withdraw any Determination of
Nonsignificance that it might issue in reliance up n this check list.
Date: Signature: -�-- '.
Please print or type:
Proponent:cc)4 I1.S ; '.)°
Address: -O Th E S v v.: 1`�i..) v v b ��\`� _\ A Z��. ,
Phone: o Z- ¢
hone: � �—� -�J A-1
Person completing form (if different from proponent):
Name:
Address:
Phone:
PL-22 V1.0 Page 14 of 14
AGENCY USE ONLY •••
I , t
, „...
Date received: ( q
US Army Corps J�a � 1 � !J
WASHH GTON STATE
U Engineers.
Seattle District
SP0pAKP,NE VA L< Y
Joint Aquatic Resources Permit Agency reference#: nl pnr�rnnFnlT
1 2 Tax Parcel#(s):COMMUNITY DEVELOPMENT
Application (JARPA) Form
•
USE BLACK OR BLUE INK TO ENTER ANSWERS IN THE WHITE SPACES BELOW.
L
Part 1-Project Identification
1. Project Name(A name for your project that you create. Examples:Smith's Dock or Seabrook Lane Development) [help]
Part 2-Applicant
The person and/or organization responsible for the project. [help]
2a. Name (Last, First, Middle)
\\; Ae stvi L
2b. Organization(If applicable)
2c. Mailing Address(Street or PO Box)
,∎)fir\k_A31
2d. City, State, Zip
51)0 , \\i41\\\ \k)46, ia�2� -z
2e. Phone(1) 2f. Phon (2) 2g. Fax 2h. E-mail •
(S cc\A-a- X41 (Sc )CIS 1 14 1 ( -- ) ,
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
http://www.nws.usace.armv.mil/Missions/CivilWorks/Regulatory/PermitGuidebook/End angeredSpecies.aspx.
• 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.epermittino.wa.gov/site/alias resourcecenter/iarpa jarpa form/9984harpa form.aspx_
For other help,contact the Governor's Office of Regulatory Assistance at 1-800-917-0043 or help(a�ora.wa.gov.
JARPA Revision 2012.1 Page 1 of 14
Part 3—Authorized Agent or Contact
Person authorized to represent the applicant about the project. (Note: Authorized agent(s) must sign 11b of this
application.) [help]
3a. Name (Last, First, Middle)
j
3b. Organization (If applicable)
3c. Mailing Address (Street or Po Box)
3d. City, State, Zip
3e. Pholie(1) 3f. Phohe(2) 3g. Fax 3h. E-mail
( ° ) 2_( k (S CIS‘ ( =-- ) N
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.)
n Repair or maintenance activities on existing rights-of-way or easements. (Skip to Part 5.)
H There are multiple upland property owners. Complete the section below and fill out JARPA Attachment A for
each additional property owner.
n 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
( ) ( ) ( )
JARPA Revision 2012.1 Page 2 of 14
Part 5—Project Location(s)
Identifying information about the property or properties where the project will occur. [help]
There are multiple project locations (e.g. linear projects). Complete the section below and use JARPA
Attachment B for each additional project location.
5a. Indicate the type of ownership of the property. (Check all that apply.) [help]
?N Private
❑ Federal
❑ Publicly owned (state, county, city,special districts like schools, ports, etc.)
n 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]
c-,
5c. City, State, Zip(If the project is not in a city or town, provid the name of the nearest city or town.) [help]
(7 \\ ; ' ,„
5d. County [help]
5e. Provide the section, township, and range for the project location. [help]
1/4 Section Section Township Range
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)
5g. List the tax parcel number(s) for the project location. [help]
• The local county assessor's office can provide this information.
j\ 7:1
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)
33
� � k
JARPA Revision 2012.1 Page 3 of 14
5i. List all wetlands on or adjacent to the project location. [help'
G
5j. List all waterbodies (other than wetlands) on or adjacent to the project location. [help]
c'
5k. Is any part of the project area within a 100-year floodplain? [help]
Yes I I No ❑ Don't know
51. Briefly describe the vegetation and habitat conditions on the property. [help]
Lawn is along the complete length of the lot with an 8" wide cement bulkhead
between the river and the lawn. The bulkhead extends from the river up and ends
close to the river's high water mark.
5m. Describe how the property is currently used. [help'
1 cf L\>
5n. Describe how the adjacent properties are currently used. [help]
ems.^ , \;(1) y. y i; 1 y ' )
5o. Describe the structures (above and below ground) on the property, including their purpose(s) and current
condition. [help'
� L�^' 1 IAC A� ` "v.r\►'ti1r L.740 G, ,e. �`\\-z
C,v.\ G' ' o\ ; a -° \I
5p. Provide driving directions from the closest highway to the project location, and attach a map. [help]
Take the I-90 exit at Argonne and go north on Argonne until you get to Trent.At
Trent turn left and go to Vista.At Vista turn right and go north on Vista to Liberty. At
Liberty turn left and go to Dick. At Dick turn right and go north until the road is into
South Riverway. Turn left and to your right is 8023 E. South Riverway.
JARPA Revision 2012.1 Page 4 of 14
Part 6-Project Description
6a. Briefly summarize the overall project. You can provide more detail in 6b. [help]
Erect a pier consisting of 3 - 6' X 6' square sections. Each section is supported by 2
alum. legs each with a 4" X 14" base. One 6"X 6" section is attached to the cement
bulkhead with bolts and the other 2 sections are designed to attached to each other
as well as with the secured section. When constructed the pier forms an "L" shape
61 with the top of the "L" secured to the bulkhead.
6c. Indicate the project category. (Check all that apply) [help]
❑ Commercial N,Residential ❑ Institutional ❑ Transportation ❑ Recreational
I I 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 I I Dike/Levee/Jetty Geotechnical Survey — Road
111 Boat Launch I I Ditch _ Land Clearing Scientific
Measurement Device
❑ Boat Lift N,Dock/ Pier ❑ Marina /Moorage ❑ Stairs
❑ Bridge ❑ Dredging ❑ Mining
❑[ Stormwater facility
❑ Bulkhead I I Fence Outfall Structure
❑ Swimming Pool
❑ Buoy ❑ Ferry Terminal ❑ Piling/Dolphin Utility Line
❑ Channel Modification Fishway H Raft
I I Other:
JARPA Revision 2012.1 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. (help]
• Identify where each element will occur in relation to the nearest waterbody.
• Indicate which activities are within the 100-year floodplain.
All activities are within the 100 year flood plain. The pier will be placed into the
Spokane River. The pier is attached to the cement existing bulkhead with bolts and
the three pier sections are attached and supported with a total of 6 alum legs with
4"X 14" support bases that rest on the bottom of the river bed. The riverbed consists
of rock and no vegetation.
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: v v End date: ,Jvw � S See JARPA Attachment D
6g. Fair market value of the project, including materials, labor, machine rentals, etc. (help]
a _
6h. Will any portion of the project receive federal funding? [help]
• If yes, list each agency providing funds.
❑ Yes ] No n Don't know
Part 7—Wetlands: Impacts and Mitigation
U 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]
11,Not applicable
7b. Will the project impact wetlands? [help]
❑ Yes I I No Don't know
JARPA Revision 2012.1 Page 6 of 14
7c. Will the project impact wetland buffers? [help]
H Yes ❑ No I I Don't know
7d. Has a wetland delineation report been prepared? [help]
• If Yes, submit the report, including data sheets,with the JARPA package.
I I Yes I I 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.
I I Yes I I 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 I I No U 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]
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, Wetland Wetland Impact Duration Proposed Wetland
drain, excavate, Name' type and area (sq. of impact3 mitigation mitigation area
flood, etc.) rating ft. or type4 (sq. ft. or
category2 Acres) acres)
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.
`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:
JARPA Revision 2012.1 Page 7 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'
n Not applicable
The pier consists of 3 - 6" X 6' sections each supported by 2 alum poles with a 4" X
14" bases. One of the piers is attached to an existing cement bulkhead with bolts.
The pier will be either attached directly to the bulkhead with anchor bolts in which
case a vacuum cleaner would be used to contain all cement dust from getting into
the river. Or a steel hanger will be used that would clamped to the bulkhead which
would not require drilling.
The total footprint of this project would be 2.33 sq. feet distributed on the riverbed
which and is spread out over the 6 legs. Considering the riverbed is solid rock with
no vegetation it would appear there would be little if any damage to the
surrounding area.
8b. Will your project impact a waterbody or the area around a waterbody? [help'
Yes I I No
JARPA Revision 2012.1 Page 8 of 14
8c. Have you prepared a mitigation plan to compensate for the project's adverse impacts to non-wetland
waterbodies? [help]
• If Yes,submit the plan with the JARPA package and answer 8d.
• If No,or Not applicable,explain below why a mitigation plan should not be required.
Yes ❑ No ', Not applicable
8d. Summarize what the mitigation plan is meant to accomplish. Describe how a watershed approach was
used to design the plan. s
• If you already completed 7g you do not need to restate your answer here. Ihelpl .9 sj
8e. Summarize impact(s) to each waterbody in the table below. [help] h! .
Activity (clear, Waterbody Impact Duration Amount of material Area (sq. ft. or
dredge, fill, pile name' location2 of impact3 (cubic yards) to be linear ft.) of
drive, etc.) placed in or waterbody
removed from directly affected
waterbody
'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 mate ial, amount (in cubic yards)
you will use, and how and where it will be placed into the waterbody. Ihelpl IN 11
JARPA Revision 2012.1 Page 9 of 14
8g. For all excavating or dredging activities identified in 8e, describe the method for excavating or dredging,
type and amount of material you will remove, and where the material will be disposed. [help]
,4 ,,
Y a'w
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
/
i....Yi-\ -'.1 ' N:t ALAH) ,-;&..,,,
i r ,1/4.,..
ikt,.
,,. .., . .., t, ., ( *(-A )Z61 I \OZ`'1 J6A ZZ=. 4\-' 1 al 1?
i,-;;,,,,,-,4.4.4, . . ..6-.,:,,,PA--,I*4.7 L.,,,v,..; Ao1/4i,:; ( i-A 1Z.0--Cr.r r -4-1 7 -17r
( )
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:
htto://www.ecy.wa.aov/programs/wq/303d/.
❑ Yes X No
9c. What U.S. Geological Survey Hydrological Unit Code (HUC) is the project in? [help]
• Go to http://cfvub.eoa.aov/surf/locate/index.cfm to help identify the HUC.
9d. What Water Resource Inventory Area Number(WRIA#) is the project in? [help]
• Go to http://www.ecy.wa.00v/services/ais/maps/wria/wria.htm to find the WRIA#.
Y
JARPA Revision 2012.1 Page 10 of 14
9e. Will the in-water construction work comply with the State of Washington water quality standards for
turbidity? [help]
• Go to http://www.ecy_wa.gov/programs/wq/swgs/criteria.html for the standards.
❑ Yes ❑ No iN 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: htto://www.ecy.wa.aov/programs/sea/sma/laws rules/173-26/211 desianations.html.
❑ Rural Urban n Natural U Aquatic I Conservancy I I Other
9g. What is the Washington Department of Natural Resources Water Type? [help]
• Go to htto://www.dnr.wa.gov/BusinessPermits/Topics/ForestPracticesApplications/Pages/fp watertyping.aspx for the Forest
Practices Water Typing System.
❑ Shoreline n Fish U 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.
I-1 Yes 1,No
Name of manual: R, r
9i. Does the project site have known contaminated sediment? [help]
• If Yes, please describe below.
❑ Yes 2,No
9j. If you know what the property was used for in the past, describe below. [help]
\4') \
9k. Has a cultural resource (archaeological) survey been performed on the project area? [help]
• If Yes, attach it to your JARPA package.
n Yes 1Z No
JARPA Revision 2012.1 Page 11 of 14
91. Name each species listed under the federal Endangered Species Act that occurs in the vicinity of the project
area or might be affected by the proposed work. (help]
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. [help]
din
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.ecy.wa.gov/opas/.
• Governor's Office of Regulatory Assistance at (800) 917-0043 or helpna,ora.wa.gov.
• For a list of addresses to send your JARPA to, click on agency addresses for completed JARPA.
1 Oa. Compliance with the State Environmental Policy Act(SEPA). (Check all that apply.) [help]
• For more information about SEPA,go to www.ecv.wa.gov/programs/sea/sepa/e-review.html.
I I A copy of the SEPA determination or letter of exemption is included with this application.
A
SPA determination is pending with iv. \f,,) -Ar, (lead agency). The expected decision date is
L.\, may .
❑ I am applying for a Fish Habitat Enhancement Exemption. (Check the box below in lob.) [help]
❑ This project is exempt (choose type of exemption below).
Li Categorical Exemption. Under what section of the SEPA administrative code (WAC) is it exempt?
I Other:
❑ SEPA is pre-empted by federal law.
JARPA Revision 2012.1 Page 12 of 14
I Ob. Indicate the permits you are applying for. (Check all that apply.) [help]
LOCAL GOVERNMENT
Local Government Shoreline permits:
❑ Substantial Development ❑ Conditional Use I I Variance
ig Shoreline Exemption Type (explain):
Other city/county permits:
Floodplain Development Permit I I Critical Areas Ordinance
STATE GOVERNMENT
Washington Department of Fish and Wildlife:
Hydraulic Project Approval (HPA) ❑ Fish Habitat Enhancement Exemption —Attach Exemption Form
Effective July 10, 2012, you must submit a check for$150 to Washington Department of Fish and Wildlife,
unless your project qualifies for an exemption or alternative payment method below. Do not send cash.
Check the appropriate boxes:
I I$150 check enclosed. (Check#
Attach check made payable to Washington Department of Fish and Wildlife.
Charge to billing account under agreement with WDFW. (Agreement#
I I 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.
I 1 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:
I I Aquatic Use Authorization
Complete JARPA Attachment E and submit a check for$25 payable to the Washington Department of Natural Resources.
Do not send cash.
Washington Department of Ecology:
Section 401 Water Quality Certification
FEDERAL GOVERNMENT
United States Department of the Army permits (U.S. Army Corps of Engineers):
❑ Section 404 (discharges into waters of the U.S.) Section 10 (work in navigable waters)
United States Coast Guard permits:
Private Aids to Navigation (for non-bridge projects)
JARPA Revision 2012.1 Page 13 of 14
Part 11—Authorizing Signatures
Signatures are required before submitting the JARPA package. The JARPA package includes the JARPA form,
project plans, photos, etc. [help]
11 a. Applicant Signature (required) [help]
I certify that to the best of my knowledge and belief, the information provided in this application is true, complete,
and accurate. I also certify that I have the authority to carry out the proposed activities, and I agree to start work
only after I have received all necessary permits.
I hereby authorize the agent named in Part 3 of this application to act on my behalf in matters related to this
application`s ' } (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)
r t
Applicant Printed Name Aplicant Signature Date
11 b. Authorized Agent Signature [help]
I certify that to the best of my knowledge and belief, the information provided in this application is true, complete,
and accurate. I also certify that I have the authority to carry out the proposed activities and I agree to start work
only after all necessary permits have been issued.
l 1 (Q r i j•� 1 �i. ., 'mil 5 ��� d
Authorized Agent Printed Name uthorized Agent Signature Date
11 c. Property Owner Signature (if not applicant). [help]
Not required if project is on existing rights-of-way or easements.
I consent to the permitting agencies entering the property where the project is located to inspect the project site
or any work. These inspections shall occur at reasonable times and, if practical, with prior notice to the
landowner.
•
+
Property Owner Printed Name • •perty 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 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 number: ENV-019-09 rev. 06-12
JARPA Revision 2012.1 Page 14 of 14
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