HomeMy WebLinkAboutEnvironmental Checklist - SEP Application - 3/4/1999 MASON COUNTY
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ENVIRONMENTAL CHECKLIST
Purpose of Checklist:
The State Enyironmental Policy Act (SEPA), chapter 43.21 C 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 adverse 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 ACTIONS
(part D).
There is a $1 10.00 fee required for the processing of the checklist. Please make your
check payable to "Mason County Treasurer."
For non-project actions, the references in the checklist to the works "project",
"applicant", and "property or site" should be read as "proposal", "proposer", and
"affected geographic area", respectively.
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A. BACKGROUND
1. Name of proposed project, if applicable:
2. Name of applicant:
3. Address and phone number of applicant and contact person:
4. Date checklist prepared:
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5. Agency requesting checklist:
6. Proposed timing or schedule (including phasing,, if applicable):
7. Do you have any plans for future expansion, or further activity related to
or connected with this proposal? If yes explain.
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8. List any environmental information you know about that has been
prepared, or will be prepared, directly related to this proposal.
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9. Do you know whether applications are pending for governmental
approvals of other proposals directly affecting the property covered by
your proposal? If yes, explain.
10. List any government approvals or permits that will be needed for your
proposal, if known.
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11. Give a 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 description.) p/mac
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12. What is the 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. (� � �c ! - T /
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B. ENVIRONMENTAL ELEMENTS:
1 . EARTH:
a. General description of the site (circle one): Flat, olling, hilly, steep
slopes, mountainous, other
b. What is the steepest slope on the site (approximate percent slope)?
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. ,7 •%�
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d. Are there surface indications or history of unstable soils in the immediate
vicinity? If so, describe.
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e. Describe the purpose, type, and approximate quantities of any filling or /
.grading proposed. Indicate source of fill.11
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Could erosion occur as a result of clearing, construction, or use? If so,
generally describe.
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g. About what percent of the site will be covered with impervious surfaces
after project constructions (for example, asphalt or buildings)?
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h. Proposed measures to reduce or control erosion, or other impacts to the
earth, if any:
2. AIR:
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.
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b. Are there any off-site sources of emissions or odor that may affect your
proposal? If so, generally describe. �D
C. Proposed measures to reduce or control emissions or other impacts to air,
if any:
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 provide names. If appropriate, state /
what stream or river it flows into.
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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. �G � /4pw,
3) Estimate the amount of fill and dredge material that would be place 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.
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4) Will the proposal require surface water withdrawals or diversions?
Give general description, purpose, and approximate quantities if known.
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5) Does the proposal lie within a 100-year floodplain? If so, note location
on the site plan.
6) Does the proposal involve any discharges of waste materials to surface
waters? If so, describe the type of waste and anticipated volume of
discharge.
b. Ground:
1) Will ground water be withdrawn, or will water be discharged to ground
water? 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 system(s) are expected to serve.
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C. Water Runoff (including storm water):
1) Describe the source of runoff (including storm water) and method of
collection and disposal, if any (include quantities, if known). Where will
this water flow? Will this water flow into other waters? If so, describe.
2) Could waste materials enter ground or surface waters? If so, generally
describe.
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d. Proposed measures to reduce or control surface, ground, and runoff
water impacts, if any:
4. PLANTS:
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
_ 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?
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:
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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:
birds: w ercn; eagle,<sorlg6 Tds, other .Cw
mammals' ee , bear, elk, beaver, other
fish: bassrsafimbr ,�rou ,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? If so, explain.
d. Proposed measures to preserved or enhance wildlife, if any:
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.
b. Would your project affect the potential use of solar energy by adjacent
properties? If so, generally describe. '
C. What kinds of energy conservation features are included in the plans of
this proposal? List other proposed measures to reduce or control energy
impacts, if any: �� ��
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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? If so, describe. �%
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1) Describe special emergency services that might be required.
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2) Proposed measures to reduce or control environmental health hazards,
if any:
b. Noise.
1) What types of noise exist in 4he area which may affect your project (for
example: traffic, equipment, operation, other)?
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
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3) Proposed measures to reduce or control noise impacts, if any:
8. LAND AND SHORELINE USE:
a. What is the current use of the site and adjacent properties?
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b. Has the site been used for agriculture? If so, describe.
C. Describe any structures on the site.
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d. Will any structures be demolished? If so, what?
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e. What is the current zoning classification of the site?
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f. What is the current comprehensive plan designation of the site?
g. If applicable, what is the current shoreline master program designation of
the site? .
h. Has any part of the site been classified as an "environmentally sensitive"
area? If so, specify.
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reside or work in the completed
i. Approximately how people would p
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project?
j. Approximately how many people would the completed project displace?
k. Proposed measures to avoid or reduce displacement impacts, if any:
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I. Proposed measures to ensure the proposal is compatible with existing
an�dy projected/land uses and plans, if any:
9. HOUSING:
a. Approximately how many units would be provided, if any? Indicate
whether high, middle, or low-income housing. 111 A
b. Approximately how many units, if any, would be eliminated? Indicate
whether high, middle, or low-income housing.
C. Proposed measures to reduce or control housing impacts, if any:
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?
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b. What views in the immediate vicinity would be altered or obstructed?
C. Proposed measures to reduce or control aesthetic impacts, if any:
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11. LIGHT AND GLARE
a. What type of light or glare will the proposal produce? What time of day
would it mainly occur? /t"v,7G
b. Could light or glare from the finished project be a safety hazard or
interfere with views?
C. What existing off-site sources of light or glare may affect your proposal:
d. Proposed measures to reduce or control light and glare impacts, if any:
12. RECREATION:
a. What designated and informal recreational opportunities are in the
immediate vicinity? /did .-7,r--
b. Would the proposed project displace any existing recreational uses? 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:
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13. HISTORIC AND CULTURAL PRESERVATION:
a. Are there an laces or objects listed on or proposed for, national, state,
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or local preservation registers known to be on or next to the site? 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.
C. Proposed measures to reduce or control impacts, if any:
14. TRANSPORTATION:
A. Identify public streets and highways serving the site and describe
proposed access to the existing street system. Show on site plans, if any.
b. Is site currently served by public transit? If not, what is the approximate
distance to the existing street system. Show on site plans, if any.
C. How many parking spaces would the completed project have? How many
would the project eliminate?
d. Will the proposal require any new roads or streets, or improvements to
existing roads or streets, not including driveways? If so, generally
describe (indicate whether public or private).
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e. Will the project use (or occur in the immediate vicinity of) water, rail, or air
transportation? If so, generally describe.
f. How many vehicular trips per day would be generated by the completed
project? 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 service (for
example: fire protection, police protection, health care, schools, other)?
If so, generally describe:
b. Proposed measures to reduce or control direct impacts on public
services, if any:
16. UTILITIES:
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a. Circle utilities currently available at the site: electricity, natural gas,
water, refuse service, telephone, sanitary sewer, septic system, other:
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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:
C. Signature:
The above answers are true and complete to the best of my knowledge.
understand that the lead agency is relying on them to make its decision.
Signature:
Date Submitted: �l