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HomeMy WebLinkAboutSEP Application - 12/1/1993 TO BE COMPLETED BY APPLICANT EVALUATION FOR AGENCY USE ONLY A. BACKGROUND: 1. Name f propoqqd project, if a plicable: Ur Gcr Owe t �' 2. Name of applicant: v qq &G-S, fA C0oA%,0A 3. Address I hone number of applicant b contact person: (!�)U�'IgcoK 19rc,g "cDoK+a1� i- •ti. Quz77 -s33 1 s3o P•U, 53.2-95 3y 1�o;nne 19brciee✓\ I� +hS� yg5.�c5 S 4So-o3S� 3 Mobil 4. Date checklist prepared: IVZ- I- 'i3 5. Agency requesting checklist: _ M#1Sov\ CG, DN R + V� I= 6. Proposed timing or schedule (including phasing, if applicable) : A, S, p . P 7. Do you have any plans for future expansion, or further activity related o or connected with this pro osI al? If yes, explain. No R� fk,� -f',w-2 fi4- 14 leer CAh e- (�oss�ble �v\s+►a ��v4��av� �� Trvc k we19 k scw1e So e. List any environmental information you know about that has been prepared, or will be prepared, directly related to this proposal. A,,,) `in �oro4AI,ov1 used tr fk-.e_ prev\ov5 zin / )iA- 4e►4w, tPer^, + -2SS\.Iej 16_9 moeov� Co, P(t4vxv\ih5 peF4\ 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. ^t6 10. List any government approvals or permits that will be needed for your proposal, if known. 01N1 R. ldh,eA ever LeWJ h�e&C y rip. Be if �1�9so� Co a{ O tV q' 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. ) Te /n/n e a v el eey,ovC o?vck �oC AH /"ra)ecT i�P4 lks pA waU e deerAf, v5N4 - 'o<- -t�e rock saziwrC e , f��/'ro� 36 Acres cool �e mha�d a14 rec64i;MAeCJ Ipt� rneW1^y �T P�►�►C� N� Ta�Sa� ' py► ioX�Jas �pr /GCfz A%A +k Ae be i^eP (1�1/I I CC% :..11�� e0l'l 1 �e frOvS �r,�eS wff� SoN^ e 1 TO BE COMPLETED BY APPLICANT EVALUATION FOR AGENCY USE ONLY 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. SeC41DV'\ 1- 0?6 - y II nn �16 t"I fe crO NAI 51'e l}o^ svt\Ag's FAQ am 15i"\'& /� L B. ENVIRONMENTAL ELEMENTS: 1. EARTH: a. Qeaeral description of the site (circle one) : la ` rolling, hilly, steep slopes, mountainous, other b. What is the steepest slope on the site (approximate percent slope)? P " 1 1 f 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 not any prime farmland. kook w;M '4bou i a- � `' Afyer o�' d. Are there surface indications or history of unstable soils in the immediate vicinity? If so, describe. f1c, 2 + M ,BE COMPLETED BY APPLICANT EVALUATION FOR AGENCY USE ONLY e. Describe the purpose, type, and approximate quantities of any filling or grading proposed. r f Indicate source of fill. �QJ 000 y�5 or bed T T"P saj I C��ot,•1�v:s MAJ&-'Al fb be 05ed a.s YAe beeA. Tw.poc� e� -fire �es1�Pe/ far ba4k cd���►�� ��� -�ror•. WNI IMMY+ S% ke CLv\ 0+4vve Se_A)pivkyg �ro&^ (pro(>dsetk r\ f. Could erosion occur as a result of clearing, construction, or u e? If so, generally dg cribe. ?!,e roeh IS �etr�eWbl0_ O-V\CA w� l phsvrb MoS o� Ike � iK WI C AY16 (av �.3vv��ke�(- -iAj4 thou( re�Ack w L(� be S ��(>eal by (ZookecX bAek56fe3 Prowl- W-}INAVA W! 6k1+ ?e(nCLO, d�Isb g. About what percent of the site will be covered with impervious surfaces after project constructions (for example, asphalt or buildings)? 17Dl o-' h. Proposed measures to reduce or control erosion, or other impacts to the earth, if any. :S1114 -re 11C1015 f>oP-e/ o�, icAiK Gv:� ROC bwckslo(�es �'Y-or, W e 4 Iutn�J o,K'e t9 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. (� r WASkeldh). V16vke e"e<erf 4or ew►issiows efevt4A trow� �ceSe mo,j6cS our +kp 062er o.vak 4..4der oo,\J W wAk eveC fruc.le5 Nk15 k �- be h w U (�vt 5 rock 'row- 'f l 4 b. Are there any off-site sources of emissions or odor that may affect your proposal? If so, generally describe. n V C. Proposed measures to reduce or control emissions or other impacts to air, if any: II n Clew. F,I er,5 cA d Proper cock 11 'Ll e(J M 47A 4av\eiNc e o� (Ma�cllt�eC� C�eV 4bv,j ke 4i—� 3 tO 'BE COMPLETED BY APPLICANT EVALUATION FOR AGENCY USE ONLY 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 type and provide names. If appropriate, state what stream or 'r river it flows into. Jdk,, :s 0 K L ocAf ell 6-&CJ t- }o 4'Q PrOPOtleV P ► � wkICL\ c 0VX5 1HA \© OA(�- 1aj4el PDD14� 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. MCI 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. Indicated the source of fill material. 4) Will the proposal require surface water withdrawals or diversions? Give general description, purpose, and approximate quantities if known. +`( 5) Does the proposal lie within a 100-year floodplain? If so, note location on the site plan. /V` 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. 4 J 'TO 'BE COMPLETED BY APPLICANT EVALUATION FOR AGENCY USE ONLY b. Ground: 1) Will ground rater be withdrawn, or will rater be discharged to ground rater? Give general description, purpose, and / n approx}mate quan ities, if knQrn. --b pe L) Seo ► s cL w ✓+tef SdU{ C e �oJ pn� �uS � coN �ro` 16N+ 1W,5kf be- oe-ecjej- wow ever (:)rOff( A-L3 DLL S -}one VJA`` er c'-')'V1A6 - rovti pinv.s cf }t, -Ep �rr1�w4�e �� ycf d ie {open} gv.c� �1nv�'} C-00I be �t"- w so,U Cc 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 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. n oy\-Q c. Water Runoff (including storm rater) : 1) Describe the source of runoff (including storm rater) and method of collection and disposal, if any (include quantities, if known). Where will this rater flow? Will this rater flow into other laters? If so, describe. The ojroQAeJ %S PQ� G (x& - . 1 0.bSor� V\na51 aIt fp\Ln v�s*�ef avLLA execSS IS 310 f PeJ by a Cock .bArnef- ov-,6 st t i CenLe eGoic eJ o,Iav\9 ( 'PJ 1 AVA. 2) Could waste materi is enter ground or surface waters? If so generally describe. Ni C� d. Proposed measures to reduce or control surface, ground, and runoff rater impacts, if any: S , f f e i�c,vac) � rack kA(('%P-(- 4. PLANTS: a. Check or circle types of vegetation found on the ' / site: o� deciduous tree: er a a en, other evergreen tree: a ar pine other SP/vCeJ {level /ac-L shrubs V grass pasture crop or grain wet soil plants: cattail, buttercup, bullrush, skunk cabbage, others rater plants: rater lily, eelgrass, milfoil, other 5 I TO BE COMPLETED BY APPLICANT EVALUATION FOR AGENCY USE ONLY b. What kind and amount of v etaion will be removed rw.5 or altered? S .SKAf I/ s) covkt ferc�Y 5 4--tee s /9pfFbxt r%�I ld 3 X �o u A,-re 5 noul avU w k*'fie v ey- S C(}��l✓15 h�e r; eel A-A4r C C. List threatened or endangered species known to be on or near the site. �o�e d. Proposed landscaping, use of native plants, or other measures to preserve orenhance vegetation on n the site, if any: 'Topsot 1 frorv%- Scthlp�tnSS0.Y�� lW��ot�CCQ ai,\ej qJ*e-eJ on rack S 10PC.S 4c, �pe VSeej fot eXVVkV st00 a4� a c urretn k 5 eej Crc kArc� aA 6v 1'A'Al e,� W W.� 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: awk, er n agle, o ird . other mammals: ear ear e e er other fish: bass, salmon, trou erring, shellfish, other b. List any threatened or endangered species known to be on or near the site. rl c3 0 V-0- c. Is the site part of a migration route? If so, explain. 'i d. Proposed measures to preserve or enhance wildlife, �rf►c ,. I n bt�N9 6C bfrj ho0se iV\ frees kA.5 bcer� \� as ��r r45 � �Hti} �' ec9 pW S7��e/C u�r � l be /10T�th rcv�ov° v+�r�lY�r�l3 �1�e►� �s wtir�� �bsol���l� �ee4esA✓`, 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. / � ov\ e- 6 L ' TO- BE COMPLETED BY APPLICANT EVALUATION FOR AGENCY USE ONLY b. Would you project affect the potential use of solar energy by adjacent properties? If so, generally describe. /)6vv 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 6 h� 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. 116 1) describe sp7g,rmergency1 se vices that mi ht be required. 1 e UW\ so 14 -6w e( 5 � b e k'.epV Oh st4e 46C WYb) btokev, kjJrsv1%C Floid koe, G o,a ike 6e,6+ t, (rk e4k�\c4> (sV cf�Hv\��� ve aAvrk xA m6"i,vk eo,,iiNrrl r� Jl 2) Protosed measures to reduce or control environmental health hazards, if any: b. Noise. 1) What types of noise exists in the area which may affect your project (for example: traffic, equipment operation, other)? n 60 e 2) What types of 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 hoes noise would come from the site. Tc ,P,04 wo-r k hfS doejn5 Irk be tcaJ"� �0:30 „�,,,�,� 4�O fv - A)ol'S e C145 a 5Ce" Q 00 1- /ev V r it Ca. f�e.1 ase e/s ca►� �oflre �� be �leW✓c' �'✓cw, -�ne ex S� S Q H PeWr os o✓/a�S vDoTnf{' SI e 4 \� e,a'f d Tw,wrv\C� e 4r►�J COWL1, rc A l }p Pg11C I►v s pAD li++__c e V'o%Se cJ 0�G Ve c c w� use /vim s ec�S a vo I-t,� Gies rassi �le gerY--S' Kbpfw�5»e P. �o fwl����/Pi9.�S /���owPc,� ftiry r1eisl�lxrGoo -9- c! of ar -P`+-51 TO' BE COMPLETED BY APPLICANT EVALUATION FOR AGENCY USE ONLY 3> Proposed measures to reduce or control noise I impacts, if any: fiolv✓ e el iots horsier I e . YAe- p1T �elmS off C+ ,•niti1mvw. YoeloW 0+6-C 9r11vnJ (eve(.s wA cv } nol s -e (evets dots tic4!(y, I J ' so CHI Iecj rer Ck. (cock bec w. eau IA h e 8. LAND AND SHORELINE USE: Plk eJ 1+16A� Co C'f -to Pro Y'A-J a. What is the current use of the site and adjacent properties? fi rock n , i a vL J c, Seec�'AA Q 1''GA 0-J fc( ' row)n 5 h9 6v':J d00) fir }fees b. Has the site been used for agriculture? If so, describe. Yes, �' .0VJ Wk g �q,3I (%J Jr-e eS C. Describe any structures on the site. V1 o✓\ e- d. Will any structures be demolished? If so, what? n0 e. What is the current zoning clan ification of the site? �P �rPs��q�lod� Z,407 f. What is the current comprehensive plan design tion' a,r� �e�ares �,��,0 ✓� of the site? TO to e v 5 r d a s o ro LAO3' C See EVJGsur�e g. If applicable, what is the current shoreline master program designation of the site? j f h. Has any part of the site been classified as an 'environmentall sensitive• area? If so, specify. yes • %h,eP�ore io�i�ear a�ou t w e k�oIS i. Approximately how many people would reside or work in the completed project? a^ o2O prey le dep.e",Kq o►� y+r\avo 4 a V r'c c h �o b e Y t,dtD J. Approximately how may people would the completed project displace�0D p F- a TO BE COMPLETED BY APPLICANT EVALUATION FOR AGENCY USE ONLY k. Proposed meaeures o avoid or reduce displacement impacts, if any: A 1. Proposed measures to ensure the proposal is compatible with existing and projected land uses and plans, if any: ,GLIv vA%g4iov\ of M)V1� �o%-3 wwttAv� S 9. HOUSING: a. Approximately how may units, if any, would be provided? Indicate whether high, middle, or low- income housing. /1 ovex e- b. Approximately how many units, if any, would be eliminated? Indicate whether high, middle, or low- income housing. V1 0V'k-e- c. Proposed measures to reduce or control housing impacts, if any: le. AESTHETICS: a. What is the tallest height of any proposed structure(s), not including antennas; what is the principal ext rior building material(s) proposed? //4 b. What views in the immediate vicinity would be altered or obstructed? C. Proposed measures to reduce or control aesthetic impacts, if any: dl o� e 11. LIGHT AND GLARE: a. What type of light or glare will the proposal produce? What time of day would it mainly occur? 9 • EVALUATION TO BE COMPLETED Y APPLICANT 8 APPL ALUATIOH FOR AGENCY USE ONLY b. Could light or glare from the finished project be a safety hazard or interfere with views? 00 C. What existing off-site sources of light or glare may affect your proposal:1�ooe d. Proposed measures to reduce or control light and glare impacts, if any:��� 12. RECREATION: a. What designated and informal recreational opportun ties are in the immediate vicinity? b. Would the proposed project displace any existing recreational uses? If so, describe. V C. Proposed measures to reduce or control impacts on recreation, including recreation opportunities to be provided by the project or applicant, if any: rl6N 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? If so genera}*y describe. ( (/ v b. Generally describe any landmark or evidence of historic, archaeological, scientific, or cultural importance known to be on or next to the site. /// C) C. Proposed measures to reduce or control impacts, if any: 18 TO' BE COMPLETED BY APPLICANT EVALUATION FOR AGENCY USE ONLY 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. e / heG� —. Ae eT 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? 0 von 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 whetherjublic or private). ,Qh y dspn$ef U a�cQ (/►�l v�v n (►i�1�ecQ b ��� � �r��or� P 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. )00 g. Proposed measures to reduce or control transportation impacts, if any: 11 TO BE COMPLETED BY APPLICANT EVALUATION FOR AGENCY USE ONLY 15. PUBLIC SERVICES: a. Mould the project result in an increased need for public service (for example: fire protection, police protection, health care, schools, other)? If so generally describe. r 6 b. Proposed measures to reduce or control direct impacts on public services, if any: 00 16. UTILITIES: a. Circle utilities currently available at the site: electricity, natural gas, rater, refuse service, telephone, san�tary serer, septic system, other. AvV1-�e- 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. �oV) 17. 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: Date Submitted: 12 L J