21-100244-SU-Forest Practices Application-01-25-2021-V1FPA/N #:
Region:
Received Date:
Forest Practices Application/Notification
Western Washington Project Name: South Campus Estates
PLEASE USE THE INSTRUCTIONS TO COMPLETE THIS APPLICATION.
1. Landowner, Timber Owner and Operator
Legal Name of LANDOWNER
Legal Name of TIMBER OWNER
Legal Name of OPERATOR
Rebecca Fox, Priscilla Syring, Timothy
❑X Same as Landowner
❑ Same as Landowner
and Susan Hansen
Contract Purchaser: Entitle Fund Two,
Unknown at this time
LLC
Mailing Address:
Mailing Address:
Mailing Address:
6308 48th St E
PO Box 188
Unknown at this time
City, State, Zip:
City, State, Zip:
City, State, Zip:
Tacoma WA 98443
Puyallup WA 98371
Unknown at this time
Phone: _ _
Phone: 253-840-5660
Phone: Unknown at this time
Email: -
Email: Geoff@jkmonarch.com
Email: Unknown at this time
2. Contact Person
.ontact Person: Phone: 253-625-3404
Grant Middleton P.E., Larson and Associates LLC Email: gmiddleton@rrlarson.com
3. Are you converting any portion of the land to non -forestry use within 3 years of harvest?
❑No ❑X Yes If yes, include your SEPA checklist and SEPA determination (if applicable) and county clearing
and grading permit (if applicable).
4. If you are harvesting timber, enter the Forest Tax Number of the Timber Owner:
Unknown
Contact the Department of Revenue at 1-800-548-8829 for tax reporting information or to obtain a number.
a. Are you eligible for EARR Tax Credit? ❑X No ❑Yes
January 2020 — Western Washington FPAIN Page 1 of 9
5. Are you a small forest landowner per RCW 76.09.450? See instructions
[]No ®Yes If yes, Check all that apply. If no, skip to Question 6.
® My entire proposed harvest area is on a single contiguous ownership consisting of one or more
parcels.
❑ My proposed forest practices activities are within an area covered by an approved Forest
Stewardship Plan or Forest Management Plan developed in cooperation with DNR.
❑ I received technical assistance from a DNR small forest landowner Stewardship and Technical
Assistance Forester in preparing this FPA/N.
❑ I have participated in a Washington State University Extension Service and/or DNR-sponsored
Forest Stewardship Coached Planning course.
❑ I have attended a Washington State University Extension Service and/or DNR-sponsored Family
Forest Owner Field Day.
6. Are you substituting prescriptions from an approved state or federal conservation agreement or Watershed
Analysis?
®No ❑Yes Write `HCP' or `Using Prescriptions' in tables that apply. Attach or reference prescriptions
and/or crosswalks for approved state or federal conservation agreements or Watershed Analysis
on file at the Region office.
7. What is the legal description of your forest practices?
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8. Have you reviewed this forest practices activity area to determine whether it may involve historic sites and/or
Native American cultural resources? Read the instructions before answering this question.
®No ❑Yes If you made any contacts, please provide information in Question 28.
9. Do you have a DNR approved Road Maintenance and Abandonment Plan (RMAP)?
❑ No Is a Small Forest Landowner RMAP Checklist required (see instructions)? ®No ❑Yes
❑ Yes Enter your RMAP number:
Is this FPA/N for work that is included in this approved RMAP? ❑ No ❑ Yes
10. Are there potentially unstable slopes or landforms in or around the area of your forest practices activity?
®No []Yes If yes, attach Appendix D. Slope Stability Informational Form and map of areas reviewed for and
locations of unstable slopes and landforms found. If applicable, attach a geotechnical letter,
memo, or report, Watershed Analysis prescriptions, and/or a SEPA Environmental Checklist.
January 2020 —Western Washington FPA/N Page 2 of 9
11. Is this Forest Practices Application/Notification (answer every question):
a. ®No []Yes A request for a multi -year permit? If yes, length requested: ❑ 4 years or ❑ 5 years.
Not everyone qualifies for a multi -year permit. See instructions for details.
b. ®No ❑Yes An Alternate Plan? If yes, include a template or detailed plan. See instructions for details.
c. ®No ❑Yes For a funded Forest Family Fish Passage Program project?
d. ®No [-]Yes Within an urban growth area? If yes, see instructions for additional required documents.
e. ®No ❑Yes Within a public park? If yes, include SEPA Environmental Checklist or SEPA Determination,
except for harvest/salvage of less than 5,000 board feet within a developed public park.
Park name:
f. ®No ❑Yes Within 500 feet of a public park? Park name:
g. ®No []Yes In an approved Conversion Option Harvest Plan (COHP) from the local government? If yes,
include a copy. This only applies to proposals within urban growth areas.
h. ®No ❑Yes Within 200 feet of the Ordinary High Water Mark (OHWM) or floodway of Type S Water?
If yes, check with the county or city to determine whether a substantial development permit
is required under the local shorelines master plan.
I. ®No ❑Yes Within 50 miles of saltwater AND you own more than 500 acres of forest land in Washington
State? If yes, include Marbled Murrelet Form or attach/reference HCP prescriptions.
j. ®No []Yes In or directly adjacent to a potential Channel Migration Zone (CMZ)? If yes, include CMZ
Assessment Form. Attach/reference applicable HCP and/or Watershed Analysis prescriptions.
You are required to verify all waters within 200 feet of your proposed forest practices activities prior to
submitting a Forest Practices Application / Notification. Use the Water Type Classification Worksheet and/or a
Water Type Modification form to explain how you verified water types. See Water Typing Requirements in the
instructions.
* * * * * If not working in or over typed Waters, skip to Question 16 * * * * *
Prior to answering Questions 12-15 in this section please refer to the Forest Practices Application
Instructions and Forest Practices Board Manual Section 5.
12. Are you proposing any of the following projects NOT permitted by current HPAs from WDFW?
a. [-]No ❑ Yes Installing, replacing, or repairing a culvert at or below the bankfull width of Type S or F
Water(s) that exceeds a five percent gradient?
b. []No ❑ Yes Constructing, replacing, or repairing a bridge at or below the bankfull width of unconfined
streams in Type S or F Water(s)?
c. []No ❑ Yes Placing fill material within the 100-year flood level of unconfined streams in Type S or F Water(s)?
13. Have you consulted with DNR and/or WDFW about the proposed hydraulic project(s) in or over Type S or F
Water? [:]No []Yes
January 2020 —Western Washington FPA/N Page 3 of 9
14. If installing, replacing, removing, or maintaining structures in or over any typed Water, complete the table
below. Provide crossing locations and identifiers on your Activity Map. Provide plan details in Question 28 or attach
plan to the FPA/N. Type S and F Waters require detailed plan information. Complex hydraulic projects in Type N
Waters may also be required per WAC 222-24-042(2). See instructions for detailed plan requirements.
*Existing HPAs issued by WDFW will be complied and enforced by WDFW until expiration. Plan details are not
required for hydraulic projects permitted with an existing HPA (see instructions).
**Fords and/or equipment crossings on Type S and F Waters may result in an unauthorized incidental take of certain
threatened or endangered fish species. For more information, see `Background for the State's Incidental Take Permits
for certain threatened and endangered fish species' following Question 22 of the FPA/N Instructions.
15. If conducting any of the following activities in or over typed Water(s), complete the table below. Some
activities will require identifiers on the Activity Map and/or more information in Question 28. See instructions.
** Fords and/or equipment crossings on Type S and F Waters must be identified in Question 14.
16. If constructing or abandoning forest roads, complete the table below. Show the road locations and identifiers
on the Activity Map. Include abandonment plans for all temporary roads and abandonment projects.
January 2020 — Western Washington FPA/N Page 4 of 9
17. If depositing spoils and/or expanding or developing a rock pit for forestry use, complete the table below.
Show locations and identifiers on the Activity Map.
18. If operating within 200 feet of a wetland that is not associated with Type S or F Water, complete the table
below. Wetlands associated with Type S or F water should be listed in Question 25. Show the boundaries of
each wetland, along with its identifier, and Wetland Management Zones on the Activity Map. See instructions
for information.
* * * * * If not harvesting or salvaging timber, skip to Question 27 * * * * *
19. If harvesting or salvaging timber, complete the table below. Show all harvest areas and unit numbers on the
Activity Map. For even -aged harvest units, also show surrounding stand information on the Activity Map.
January 2020 —Western Washington FPA/N Page 5 of 9
20. Reforestation. Check all that apply:
❑ Planting. Tree Species:
❑ Natural. Include a Natural Regeneration Plan
IN Not required because of one or more of the following:
® I am converting some or all of this land to non -forest land in the next 3 years or lands are exempted under
WAC 222-34-050.
❑ Individual dead, dying, down, or wind -thrown trees will be salvaged.
❑ Trees are removed under a thinning program reasonably expected to maximize the long-term productivity of
commercial timber.
❑ I am leaving at least 100 vigorous, undamaged, and well -distributed saplings or merchantable trees per acre.
❑ An average of 190 tree seedlings per acre are established on the harvest area and my harvest will not
damage them.
❑ Road right-of-way or rock pit development harvest only.
* *,Do you own MORE than 80 acres of forest land in Washington? If yes, skip to Question 25 * *
21. Are you using the exempt 20-acre parcel riparian management zone (RMZ) rule (WAC 222-30-023) on Type S,
F, or Np Waters?
® No Skip to Question 25.
❑ Yes Continue to Question 22. See instructions for qualifications and information.
22. Choose the answer below that best fits your situation. Show all RMZs on the Activity Map.
❑ a. ALL of the following apply to me and my land: (If no, answer b.)
- Between June 5, 2006 and today's date I have always owned less than 80 acres of forest land in
Washington.
- Between June 5, 2006 and today's date this parcel has always been 20 acres or less of contiguous
ownership. See RCW 76.09.020 for definition of 'contiguous'.
- Between June 5, 2006 and today's date this parcel has always been owned by me or someone else that
has owned less than 80 acres of forest land in Washington.
b. ONE OR MORE of the following apply tome and/or my land (check all that apply):
If any of the statements below apply AND you use the exempt 20-acre parcel RMZ rule, you are NOT
authorized under the State's Incidental Take Permits (see explanation in FPA instructions under
Question 22).
❑ Between June 5, 2006 and today's date I have owned more than 80 acres of forest land in
Washington.
❑ Between June 5, 2006 and today's date this parcel has been a part of more than 20 acres of
contiguous ownership. See RCW 76.09.020 for definition of 'contiguous'.
❑ Between June 5, 2006 and today's date this parcel has been owned by someone that has owned
January 2020 —Western Washington FPA/N Page 6 of 9
23. If harvesting within 115 feet of a Type S or F Water on an exempt 20-acre parcel, complete the table below.
Show RMZs and stream segment identifiers on the Activity Map. If you are harvesting within 75 feet or within the
maximum RMZ (whichever is less), stream shade must be assessed and met following harvest. Describe in Question
28 how stream shade was determined to be met, using the `Appendix F. Stream Shade Assessment Worksheet' if
necessary.
24. Are you harvesting within 29 feet of a Type Np Water on an exempt 20-acre parcel?
❑ No Skip to Question 27.
❑ Yes See instructions and describe leave tree strategy in Question 28. Then skip to Question 27.
25. If harvesting within 200 feet of any Type S or F Water or periodically inundated areas of their associated
wetlands, complete the table below. Include Desired Future Condition (DFC) for all inner zone harvests unless
you have an HCP prescription. Show RMZs, CMZs, and stream segment identifiers on the Activity Map. If you
are harvesting within 75 feet or within the maximum RMZ, whichever is less, stream shade must be assessed and met
following harvest. Describe in Question 28 how stream shade was determined to be met or use the `Appendix F.
Stream Shade Assessment Worksheet' if necessary.
26. If harvesting within 50 feet of Type Np Water, complete the table(s) below. Show RMZs and stream segment
identifiers on the Activity Map.
.atre�rn
Total 66
Length of No Harvest
agrrtent
Len fh N
50 ,foot Buffers in
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NA
NA
NA
January 2020 —Western Washington FPA/N Page 7 of 9
27. How are the following currently marked on the ground? (Flagging color, paint color, road, fence, etc.)
Harvest/Salvage Boundaries: Will have a combination of lath and flagging and tree protection fencing for retention trees
Clumped Wildlife Reserve Trees/Green Recruitment Trees: NA
Right -of -Way Limits/Road Centerlines: Will be marked with lath and fagging
Stream Crossing Work: NA
Riparian Management Zone Boundaries and Leave/Take Trees: NA
Channel Migration Zone: NA
Wetland Management Zone Boundaries and Leave/Take Trees: NA
28. Additional Information (attach additional pages if necessary): For hydraulic protects in or over Type S, F, or
complex N Water(s) see instructions for required plan information. If applicable, include mitigation measures from a
geotechnical memo, letter, or report.
NA
January 2020 —Western Washington FPA/N Page 8 of 9
29. We acknowledge the following:
• The information on this application/notification is true.
• We understand this proposed forest practice is subject to:
o The Forest Practices Act and Rules AND
o All other federal, state or local regulations.
• Compliance with the Forest Practices Act and Rules does not ensure compliance with the Endangered Species Act
or other federal, state or local laws.
• If we said that we would not convert any portion of the land to non -forestry use, the county or city may deny
development permits on this parcel for the next 6 years.
• The following may result in an unauthorized incidental take of certain endangered or threatened fish species:
o Conversion of land to non -forestry use.
o Harvesting within the maximum RMZ on a 20-acre exempt parcel that was acquired after June 5, 2006.
o Equipment Crossings/Fords in or over Type S and F Waters.
• Inadvertent Discovery — Chapters 27.44, 27.53, 68.50 and 68.60 RCW
o If you find or suspect you have found an archaeological object or Native American cairn, grave, or glyptic
record, immediately cease disturbance activity, protect the area and promptly contact the Department of
Archaeology and Historic Preservation at 360 586-3077.
o If you find or suspect you have found human skeletal remains, immediately cease disturbance activity,
protect the area, and contact the County Coroner or Medical Examiner and local law enforcement as soon as
possible. Failure to report human remains is a misdemeanor.
The landowner understands that by signing and submitting this FPA, he/she is authorizing the Department of
Natural Resources to enter the property in order to review the proposal, inspect harvest operations, and monitor
compliance for up to three years after its expiration date. RCW 76.09.160
Signature of Legal LANDOWNER
Signature of Legal TIMBER OWNER*
Signature of Legal OPERATOR
(If different than landowner)
(If different than landowner)
Print Name: See Owner Authorization
Print Name: See Owner Authorization
Print Name: TBD
Date: 12/30/2020
Date: 12/30/2020
Date:
* NOTE: If you are a "Perpetual Timber Rights Owner, " and are submitting this without the Landowner's Signature, provide
written evidence the landowner has been notified.
Please make a copy of this FPA/N for your records. If this FPA/N contains a hydraulic project requiring WDFW
concurrence review, it will not be available online for public review until after the WDFW concurrence review
period.
January 2020 — Western Washington FPA/N Page 9 of 9