Fillable Form 1: WASHINGTON STATE Joint Aquatic Resources Permit (City of Lacey)

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Form 1: WASHINGTON STATE Joint Aquatic Resources Permit (City of Lacey)

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The Form 1: WASHINGTON STATE Joint Aquatic Resources Permit (City of Lacey) form is 19 pages long and contains:

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  • 108 check-boxes
  • 198 other fields

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AGENCY USE ONLY
Date received:
Agency reference #:
Tax Parcel #(s):
2 0 1 0
WASHINGTON STATE
Joint Aquatic Resources Permit
Application (JARPA) Form
1
USE BLACK OR BLUE INK TO ENTER ANSWERS IN 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]
2
Part 2–Applicant
The person or organization responsible for the project. [help]
2a. Name (Last, First, Middle) and Organization (if applicable)
2b. Mailing Address (Street or PO Box)
2c. City, State, Zip
2d. Phone (1) 2e. Phone (2) 2f. Fax 2g. E-mail
( ) ( ) ( )
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) and Organization (if applicable)
3b. Mailing Address (Street or PO Box)
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.army.mil/PublicMenu/Menu.cfm?sitename=REG&pagename=mainpage_ESA
• If you are applying for an Aquatic Resources Use Authorization you will need to fill out and submit an Application for Authorization to Use State-
Owned Aquatic Lands form to DNR, which can be found at http://www.dnr.wa.gov/Publications/aqr_use_auth_app.doc
• Not all cities and counties accept the JARPA for their local Shoreline permits. If you think you will need a Shoreline permit, contact the appropriate
city or county government to make sure they will accept the JARPA.
2
To 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 of Regulatory Assistance at 1-800-917-0043 or help@ora.wa.gov.
JARPA 2010 v1 3/30/2010 Page 1 of 13
3c. City, State, Zip
3d. Phone (1) 3e. Phone (2) 3f. Fax 3g. E-mail
( ) ( ) ( )
Part 4–Property Owner(s)
Contact information for people or organizations owning the property(ies) where the project will occur. [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 property owners. Complete the section below and fill out JARPA Attachment A for each
additional property owner.
4a. Name (Last, First, Middle) and Organization (if applicable)
4b. Mailing Address (Street or PO Box)
4c. City, State, Zip
4d. Phone (1) 4e. Phone (2) 4f. Fax 4g. E-mail
( ) ( ) ( )
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]
State Owned Aquatic Land (If yes or maybe, contact the Department of Natural Resources (DNR) at (360) 902-1100)
Federal
Other publicly owned (state, county, city, special districts like schools, ports, etc.)
Tribal
Private
5b. Street Address (Cannot be a PO Box. If there is no address, provide other location information in 5p.) [help]
5c. City, State, Zip (If the project is not in a city or town, provide the name of the nearest city or town.) [help]
5d. County [help]
JARPA 2010 v1 3/30/2010 Page 2 of 13
5e. Provide the section, township, and range for the project location. [help]
¼ Section Section Township Range
5f. Provide the latitude and longitude of the project location. [help]
• Example: 47.03922 N lat. / -122.89142 W long. (NAD 83)
5g. List the tax parcel number(s) for the project location. [help]
• The local county assessor’s office can provide this information.
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)
5i. List all wetlands on or adjacent to the project location. [help]
5j. List all waterbodies (other than wetlands) on or adjacent to the project location. [help]
5k. Is any part of the project area within a 100-year flood plain? [help]
Yes No Don’t know
5l. Briefly describe the vegetation and habitat conditions on the property. [help]
JARPA 2010 v1 3/30/2010 Page 3 of 13
5o. Describe the structures (above and below ground) on the property, including their purpose(s). [help]
5p. Provide driving directions from the closest highway to the project location, and attach a map. [help]
5m. Describe how the property is currently used. [help]
5n. Describe how the adjacent properties are currently used. [help]
JARPA 2010 v1 3/30/2010 Page 4 of 13
Part 6–Project Description
6a. Summarize the overall project. You can provide more detail in 6d. [help]
6b. Indicate the project category. (Check all that apply) [help]
Commercial Residential Institutional Transportation Recreational
Maintenance Environmental Enhancement
6c. 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
Geotechnical Survey
Land Clearing
Marina / Moorage
Mining
Outfall Structure
Piling
Retaining Wall
(upland)
Road
Scientific
Measurement Device
Stairs
Stormwater facility
Swimming Pool
Utility Line
Other:
6d. Describe how you plan to construct each project element checked in 6c. 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 flood plain.
6e. What are the 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: _______________ End date: _______________
See JARPA Attachment D
JARPA 2010 v1 3/30/2010 Page 5 of 13
6f. Describe the purpose of the project and why you want or need to perform it. [help]
6g. Fair market value of the project, including materials, labor, machine rentals, etc. [help]
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
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
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
JARPA 2010 v1 3/30/2010 Page 6 of 13
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 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,
drain, excavate,
flood, etc.)
Wetland
Name
1
Wetland
type and
rating
category
2
Impact
area (sq.
ft. or
Acres)
Duration
of impact
3
Proposed
mitigation
type
4
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:
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]
JARPA 2010 v1 3/30/2010 Page 7 of 13
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
8b. Will your project impact a waterbody or the area around a waterbody? [help]
Yes No
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
JARPA 2010 v1 3/30/2010 Page 8 of 13
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
name
1
Impact
location
2
Duration
of impact
3
Amount of material
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]
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]
JARPA 2010 v1 3/30/2010 Page 9 of 13
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
( )
( )
( )
9b. Are any of the wetlands or waterbodies identified in Part 7 or Part 8 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:
http://www.ecy.wa.gov/programs/wq/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.
9d. What Water Resource Inventory Area Number (WRIA #) is the project in? [help]
• Go to http://www.ecy.wa.gov/services/gis/maps/wria/wria.htm to find the WRIA #.
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/swqs/criteria.html for the standards.
Yes No Not applicable
9f. If the project is within the jurisdiction of the Shoreline Management Act, what is the local shoreline
environment designation? [help]
• If you don’t know, contact the local planning department.
• For more information, go to: http://www.ecy.wa.gov/programs/sea/sma/laws_rules/173-26/211_designations.html.
Rural Urban Natural Aquatic Conservancy Other
9g. What is the Washington Department of Natural Resources Water Type? [help]
• Go to http://www.dnr.wa.gov/BusinessPermits/Topics/ForestPracticesApplications/Pages/fp_watertyping.aspx for the Forest
Practices Water Typing System.
Shoreline Fish Non-Fish Perennial Non-Fish Seasonal
JARPA 2010 v1 3/30/2010 Page 10 of 13
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. If you know what the property was used for in the past, describe below. [help]
9j. Has a cultural resource (archaeological) survey been performed on the project area? [help]
• If yes, attach it to your JARPA package.
Yes No
9k. 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]
9l. 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]
JARPA 2010 v1 3/30/2010 Page 11 of 13
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 help@ora.wa.gov
.
• For a list of agency addresses to send your application, click on the “where to send your completed
JARPA” at http://www.epermitting.wa.gov.
10a. Compliance with the State Environmental Policy Act (SEPA). (Check all that apply.) [help]
• For more information about SEPA, go to www.ecy.wa.gov/programs/sea/sepa/e-review.html.
A copy of the SEPA determination or letter of exemption is included with this application.
A SEPA determination is pending with _______________ (lead agency). The expected decision date is
____________.
I am applying for a Fish Habitat Enhancement Exemption. (Check the box below in 10b.) [help]
This project is exempt (choose type of exemption below).
Categorical Exemption. Under what section of the SEPA administrative code (WAC) is it exempt?
Other:
SEPA is pre-empted by federal law.
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
Washington Department of Ecology:
Section 401 Water Quality Certification
Washington Department of Natural Resources:
Aquatic Resources Use Authorization
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:
General Bridge Act Permit Private Aids to Navigation (for non-bridge projects)
JARPA 2010 v1 3/30/2010 Page 12 of 13
JARPA 2010 v1 3/30/2010 Page 13 of 13
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.
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 of Regulatory Assistance (ORA). 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
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Form 1: WASHINGTON STATE Joint Aquatic Resources Permit (City of Lacey)

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Completed 3 August 2020

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