HomeMy WebLinkAboutEnvironmental Checklist - SEP Application ° TO BE COliPLETED BY APPLICA[T WALUATIOR FOR
AGQCY USE ORLY
A. BACKGROUND:
1. Haze of proposed project, if applicable:
2. Haze of applicant: �{ p j3 EST Qy SS <<=-_
3. Address i phone number of applicant & contact persons
(2-S_3)�?_& p 297
4. Date checklist prepared: _y
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5. Agency requesting checklist:
6. Proposed timing or schedule (including phasing, if applicable):
PPlicable):
7. Do you have any plans for future expansion, or further activity A)0
related to or connected with this proposal? If yes. explain.
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 A),*A-)E
for your proposal, if.knovn.
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. )
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To BE (70)II' EnM BY APPLICALT EVALOATIOB, FOR
AGEWT USE OMLy
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.
B. EHVIROKKENTAL ELEKMITSs
1. EARTH s
a._ General description of the site (circle one):
Flat, rolling, hilly, steep slopes, mountainous,
other <�vi� 5v��// S1q p e=S t /�7
b. Vhat' 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 i
you know the classification of agricultural soils, 5V-AJ
specify them and not any prime farmland.
d. Are there surface indications or history of 6 (. O— AA t 140u))tD �
unstable soils in the immediate vicinity? If so, / /l l LJ
describe. / L
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AGE= USE ONLY
e. Describe the purpose, type,. and approximate
quantities of any filling or grading proposed. Aj QAj C
Indicate source of fill.
f. Could erosion occur as a result of clearing,
construction, or use! If so, generally describe. N Q
g. About what percent of the site will be covered with a
impervious surfaces after project constructions 0
(for example, asphalt or buildings)4
h. i Proposed measures to reduce or control erosion, or
other impacts to the earth, if any. :
2. AIR:
a. Mhat 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 any off-site sources of emissions or odor
that may affect your proposal? If so, generally
describe.
K/ '
c. Proposed measures to reduce or control emissions or
o er. impacts to air, if any:
x/
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To BE COMPL M BY APPLICAIT EOALUATIOt FOR
AGMM USE OBIT
3. WATER:
a. Surface:
1) Is there any surface rater body on or in the immediate
vicinity of the site (including year-round and seasonal
streams, saltwater, lakes, ponds, wetlands)? If yes. describe YCS
type and provide names. If appropriate, state what stream or I
river it flows into.
t-Ev® pC.
2) Will the project require any work over, in, or adjacent to
(within 200 feet) of the described waters? If yes, please
describe and attach available plans.
3) Estimate the amount of fill and dredge material that would
be placed in or removed from surface water or wetlands and 0 A
indicate the area of the site that would be affected.
Indicated the source of fill material.
4) Will the proposal require surface water withdrawals or
diversions? Give general description, purpose, and approximateAJ
quantities if known.
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 Ij b
to surface waters? If so, describe the type of waste and
anticipated volume of discharge.
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To BE COMPLETED BY APPLICANT EVALUATION
AGENCY USE ONLY
b. Grounds
1) Mill ground water be withdrawn, or will rater 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 sewages Industrial, containing 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 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.
d. Proposed measures to reduce or control surface; ground, and
runoff water impacts, if any:
4. PLAM:
Ili circle types of vegetation
found on the
a. Check or yp eg
site:
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'deciduous tree: alder, mapl , aspen, other
evergreen trees fir, a r, pine, other
shrubs
grass
pasture
crop or grain
wet soil plants: cattail, buttercup, bullrush, skunk cabbage,
others
water plants: water lily, eelgrass, milfoil, other
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TO BE COMPLETED BT APPLICANT EVALUATION FOR
AGENCT USE ONLY
b. What kind and amount of vegetation will be removed
or altered? o�
c. List threatened or -endangered species known to be
on or near the site. d
d. Proposed landscapings, use -of native plants, or
other measures to preserve or enhance vegetation on
the site, if any:
g. 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: haw won �eagil songbirds, other
mammals: eer arbeaver, o
fish: ba , salmon, trout, herring, a lfish, ther
b. List any threatened or endangered species known to
be on or near the site.
Co Is the site part of a migration route? If so,
explain. O
d. Proposed measures to preserve or enhance wildlife, IV`R
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 N
it will be used for heating, manufacturing, etc.
N/A
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b. Mould you project affect the potential use of solar
energy by adjacent properties? If so, generally v
describe.
K/A
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:
N/A
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7. ERVIROKKEKTAL HEALTH:
a. Are there any environmental health hazards,
including exposure to toxic chemicals, risk of fire
and explosion, spill, or hazardous waste, that
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could occur as a result of this proposal? If so,
describe.
1) describe special emergency services that might
be required.
/A
2) Proposed measures to reduce or control
environmental health hazards, if any: ���� 2Ey41/,ecO
b. Kai::*at
1) types of noise exists in the area which may
affect your project (for example: traffic, /t),grAA!
equipment operation, other)?
K/A
2) What types of levels of noise would be created
by or associated with the project on a short-term d!U
or a long-term basis (for example: traffic,
construction, operation, other)? Indicate what
hours noise would come from the site.
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�s USE (INLY
3) Proposed measures to reduce or control noise
impacts, if any:
8. LAKD AKD SHORELIKE USEs _
a. What is the current use of the site and adjacent
properties? E'S(LIFJJ��
b. Has the site been used for agriculture? If so, A' p
describe. <V
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c. Describe any structures an the site.
d. Will any structures be demolished? If not whet? E(ZH)I+P S IA�
e. What is the current zoning classification of the `S
site?
f. What is the current comprehensive plan designation vt- K p�
of the site? .
g. If applicable, what is the current shoreline master
program designation of the site? AD �� YKOL'b
h. Has any part of the site been classified as an
'environmentally sensitive• area? If so, specify. (�0 l ' ` 0 tA
i. Approximately how many people would reside or cork
in the completed project? (/
H/A
fl J. Approximately how may people would the completed
project displace?
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EVALU
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TO BE COM LEE BT APPLICANT GENCTAUSE ONLY
A6ExCT USE O>Z.T
k. Proposed measures to avoid or reduce displacement
impacts, if any:
/A
compatible
is com
Proposed measures to ensure the proposap
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with existing and projected land uses and plans, if any:
9. HOUSING:
a. Approximately how may units, if any, could be
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a iddle, or low ��
provided? Iadiaate whether high, m
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income housing.
N/A
b. Approximately how many units, if any, would be
eliminated? Indicate whether high, middle, or low-
income housing.
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N/A
c. Proposed measures to reduce or control housing
Jimp cts, if any:
N/
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10. AESTHETICS:
a. What is the tallest height of any proposed
structure(s), not including antennas; what is the
principal al exterior building material(s) proposed?
b. What viers in the immediate vicinity would be
altered or obstructed?
C. Proposed measures to reduce or can aesthetic �`�
��S ►ter
III impacts, if any:
11. LIGHT AND GLARE:
a. What type of light or glare will the proposal
produce? What time of day could it mainly occur?
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AGMWT USE OR.Y
b. Could light or glare from the finished project be a
safety hazard or interfere with viers?
N/
C. Mhat existing off-site sources of light or glare
say affect your proposals
UH/A
d. Proposed measures to reduce or control light and
glare impacts, if any:
H/A
12. RECREATION:
a. What designated and informal recreational ,po5
opportunities are in the immediate vicinity? 1
b. Mould the proposed project displace any existing / Q Q
recreational uses? If -so;, describe. JV
c. Proposed measures to reduce or control impacts on � q
recreation, including recreation opportunities to �V
be provided by the project or applicant, if any:
13. HISTORIC AND CULTURAL PRESERVATION:
a. Are.there any places or objects listed on, or
proposed for, national, state, or local 9
preservation registers known to be on or next to �lJ
the site? If so-generally describe.
b. Generally describe any landmark or evidence of
historic, archaeological, scientific, . or cultural `V 0
importance known to be on or next to the site.
C. Proposed measures to reduce or control impacts, if N
any:
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TO BE COM SM BY APPLICANT ATIOi .FOR
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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.
N/A
c. How many parking spaces would the completed project
have? How many would the project eliminate?
GH/A
d. Mill the proposal require any new roads or streets,
or improvements to existing roads or streets, not
including driveways? If so, generally describe
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(indicate whether -public or private).
e. Will the project use (or occur in the immediate
vicinity of) water, rail, or air transportation?
If so generally describe.
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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
osportation impacts, if any:
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15. PUBLIC SERVICES:
a. Mould the project result in an increased need for
public service (for example: fire protection, b
police protection, health care, schools, other)?
If so generally describe.
H/A
b. Proposed measures to reduce or control direct
impacts on public services, if any:
/A
16. UTILITIES:
a. r ties currently available at the site:
e natural gas, water refuse service,
to , anitary sever, sc system, other.
b. Describe the utilities that are proposed for the
Projects, the utility providing the service, -and the
general construction activities on the site or in
the immediate vicinity which might be needed.
17. SIGHATURE:
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:
Date Submitted:
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