HomeMy WebLinkAboutSEP Application - 4/27/1995 MASON COUNTY
ENVIRONMENTAL CHECKLIST
Purpose of Checklist:
The State Environmental 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 $105.00 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.
I
Tt7 BE COMPLETED BY APPLICANT ��'�f `' EVALUATION FOR
%44 AGENCY USE ONLY
A. BACKGROUND:
1. Name of proposed project, if applicable: Z,Q>*4ep
2. Name of applicant:
3. Address & phone number of applicant & contact person:
W -
4. Date checklist prepared: 7/
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.
8. List any environmental information you know about that has been
prepared, or will be prepared, directly related to this
proposal.
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.
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. ) > K v r _ y o-L, a ` i/ azv
1
I�
'M 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 lto this checklist.
tot
ve6�F�
B. ENVIRONMENTAL ELEMENTS:
1. EARTH:
a. General descrLption of the site (circle one) :
Flat, rolling, hilly, steep slopes, mountainous,
other
b. What is the steepest slope on the site (approximate
percent slope)? YJ lot
C. What general types of soils ound on the site
(for example, clay, sand, grave peat, muck)? If
you know the classification of agricultural soils,
specify them and not any prime farmland.
d. Are there surface indications or history of
unstable soils in the immediate vicinity? If so,
describe. I -0
2
i
TO BE COMPLETED BY APPLICANT EVALUATION FOR
AGENCY USE ONLY
e. Describe the purpose, type, and approximate
quantities of any filling or grading proposed.
Indicate source of fill.
f. Could erosion occur as a result of clearing,
construction, or use? If so, generally describe.
g. About what percent of the site will be covered with
impervious surfaces after project constructions
(for example, asphalt or buildings)?
CtA ► ,�-,'rtr
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.
b. Are there any off-site sources of emissions or odor
that may affect your proposal? If so, generally
describe. W
C. Proposed measures to reduce or control emissions or
other impacts to air, if any:
3
TO BE COMPLETED BY APPLICANT EVALUATION FOR
AGENCY USE ONLY
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.
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
indicate the area of the site that would be affected.
Indicated the source of fill material.
r6y
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.
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
TO BE COMPLETED BY APPLICANT EVALUATION FOR
AGENCY USE ONLY
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.
C-Al ,�
2) Describe waste material that will be discharged into the
srouAd...frow sapt,ic tanks or other sources, if any (for example,
!'Domestic sewage: Industrial, containing the general size of
-fhe `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.
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. I z
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,
others
water plants: water lily, eelgrass, milfoil, other
5
TO BE COMPLETED BY APPLICANT EVALUATION FOR
AGENCY USE ONLY
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:
S. 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: har eron, eagle, songbirds, other
mammals: deer bear, elk, beaver, other
fish: bass, salmon, trout, 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 preserve or enhance wildlife,
if any:
6. ENERGY AND NATURAL RESOURCES:
a. What kinds of energy (electric, ,natural gas, oil,
wood stove, solar) wi�ed to meet the
completed project's energy needs? Describe whether
it will be used for heating, manufacturing, etc.
6
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.
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:
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. y\
10
1) describe special emergency services that might
be required.
2) Proposed measures to reduce or control
environmental health hazards, if any:
YL4I4
b. Noise.
1) What types of noise exists in the area which may
affect your project (for example: traffic,
equipment operation, other)?
2) What types of levels of noise would be created
by or associated with the project on a shorerm
or a long-term basis (for example:,traffic
construction, operation, other)? Indicate what
hours noise would come from the site.
7
TO BE COMPLETED BY APPLICANT EVALUATION FOR
AGENCY USE ONLY
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?
b. Has the site been used for agriculture? If so,
describe. M
C. Describe any structures on the site.
d. Will any structures be demolished? If so, what?
1`mot.
e. What is the current zoning classification of the
site? k
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.
i. Approximately how many people would reside or work
in the completed project?
�. Approximately how may (eople would the completed
project displace?
8
TO BE COMPLETED BY APPLICANT EVALUATION FOR
AGENCY USE ONLY
k. Proposed measures to avoid or reduce displacement
impacts, if any:
1. Proposed measures to ensure the proposal is compatible
with existing and projected land uses and plans, if any:
9. HOUSING:
a. Approximately how may units, if any, would be
provided? Indicate whether high, middle, or low-
income housing.
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?
rO r
b. What views in the immediate vicinity would be
altered or obstructed? (�V
C. Proposed measures to reduce or control aesthetic
impacts, if any:
11. LIGHT AND GLARE:
a. What type of light or glare will the proposal
produce? What time of day would it mainly occur?
9
TO BE COMPLETED BY APPLICANT EVALUATION FOR
AGENCY USE ONLY
b. Could light or glare from the finished project be a
safety hazard or interfere with views?
r'/'
C. What existing off-site sources of light or glare
may affect your proposal: (l^
VV _"`
d. Proposed measures to reduce or control light and
glare impacts, if any: 111 m
12. RECREATION:
a. What designated and informal recreational
opportunities are in the immediate vicinity?
'1'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:
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 generally describe.
b. Generally describe any landmark or evidence of
historic, archaeological, scientific, or cultural
importance known to be on or next to the site.
14 . - t
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.
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? \
l�i4 m.ttoP� C�/lo�o�co �`��`��
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).
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:
11
L
,® -TO BE COMPLETED BY APPLICANT EVALUATION FOR
AGENCY USE ONLY
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:
''l
16. UTILITIES:
a. Circle utilities currently ava lable at the site:
electricity, natural gas, ,t-e , efuse service,
telephones sanitary sever, sep c system, oTher.
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.
03
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 -- --