HomeMy WebLinkAboutSEP2014-00055 - SEP Application - 8/26/2014 �P
Zolw WIS
SEPA CHECKLIST
$385 - Single Family (Mason County Permit Center Use)
$630 - Non-Single Family 0 to 9.99 Acres SEP -
$755 -10 to 20 Acres
$945 - Over 20 Acres Date Rcv&
$2,525 + 70/hr- EIS (DS) CANCELLE D PN:
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) and to help the agency decide whether an EIS is required.
Instructions for Applicants:
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 an� .phtbtsEofgur knowledge. In most cases, you should be
able to answer the questions from your own ob t r e la 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.
There is a fee required, for the processing of the checklist, see above for the appropriate fee. Please make your check
payable to"Mason County Treasurer'.
A. BACKGROUND
1. Name of proposed project: _T1/v\t, C l-C- 0%l^'
2. Name of applicant: 3�6�CA J .
Property owner: V v-\,
3. Applicant mailing address:
Applicant phone numbers: 2L`p L`�S�`llo(oC1
4. Date checklist prepared:
5. Agency requesting checklist: CANCELLED
Mason County SEPA Checklist 1
6. Proposed timing or schedule (including phasing, if applicable):
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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.
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10. List any government approvals or permits that will be needed for your proposal, if known. ,9
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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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. (0�s 1
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Mason County SEPA Checklist 2
B. ENVIRONMENTAL ELEMENTS
1. EARTH:
a. General description of the site (circle one): Flat, Iling, hilly, steep slopes, mountainous, other(explain).
b. What is the steepest slope on the site (approximate percent slope)? N I�—
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.
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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. ri t
f. 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)? r--� (I-*,,,-
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.
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c. Proposed measures to reduce or control emissions or other impacts to air, if any:
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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)the described waters? If yes,
please describe and attach available plans.
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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. 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. �Jc,
5) Does the proposal lie within a 100-year floodplain? If so, note location on the site plan.
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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 groundwater be withdrawn, or will water be discharged to groundwater? Give general description,
purpose, and approximate quantities, if known.
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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.
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 flow into other waters?
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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:
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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? N 3 N t
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c. List threatened or endangered species known to be on or near the site.
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d. Proposed landscaping, use of native plants, or other measures to preserve or enhance vegetation on the site,
if any: N (�
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: hawk, her n 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.
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c. Is the site part of a migration route? If so, explain. (P.-
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)will be used to meet the completed project's
energy needs? Describe whether it will be used for heating, manufacturing, etc.
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b. Would your project affect the potential use of solar energy by adjacent properties: If so, generally describe.
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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: t3
Mason County SEPA Checklist 6
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.
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 the area that may affect your project(for example: traffic, equipment,
operation, other)? h�/P'`
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. 0 'I_
3) Proposed measures to reduce or control noise impacts, if any:
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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.
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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? FJ
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? OJ G
h. Has any part of the site been classified as an "environmentally sensitive" area? If so, specify. /J
i. Approximately how many people would reside or work in the completed project? . DJ f;�N_
j. Approximately how many people would the completed project displace? ry tA—
k. Proposed measures to avoid or reduce displacement impacts, if any: o6
I. Proposed measures to ensure the proposal is compatible with existing and projected land uses and plans:
9. HOUSING:
a. Approximately how many units would be provided, if any? Indicate whether high, middle, or low-income
housing. p [IN-
b. Approximately how many units, if any, would be eliminated? Indicate whether high, middle, or low-income
housing. 1-3 I P'
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? tJ I �,
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?
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? G3�rPtT� b�
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b. Would the proposed project displace any existing recreational uses? If so, describe. NcD
c. Proposed measures to reduce or control impacts on recreation, including recreation opportunities to be
provided by the project or applicant, if any: 7) � !�
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. t3 r
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: tJ
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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. s,3 t!)-
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.
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c. How many parking spaces would the completed project have? How many would the project eliminate?
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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 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. 0
g. Proposed measures to reduce or control transportation impacts, if any:
16. 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: q_.� Q
b. Proposed measures to reduce or control direct impacts on public services, if any: N tP_
16. UTILITIES:
a. Circle utilities currently available at the site: Celectft�A� , natural gas, wat r, refuse service, telephone,
sanitary sewer, eptic 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 that might be needed. qJ!,t-11
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. I
Applicant Signature: Date:
Mason County SEPA ftecklist) 10
ESA LISTED SALMONIDS CHECKLIST
This worksheet was designed to help project proponents, and government agencies, identify when a project needs
further analysis regarding adverse effects on ESA(Endangered Species Act) listed salmonids. Salmonids are salmon,
trout and chars, e.g. bull trout. For our purposes, "ESA Listed Salmonids" is defined as fish species listed as
endangered, threatened or being considered for listing.
If ESA listed species are present or ever were present in the watershed where your project will be located, your project
has the potential for affecting them, and you need to comply with the ESA. The questions in this section will help
determine if the ESA listings will impact your project.
The Fish Program Manager at the appropriate Department of Fish and Wildlife (DFW) regional office can
provide information for the following two questions.
1. Are ESA listed salmonids currently present in the watershed in which your project will be located?
YES _ NO� Please describe.
2. Has there ever been an ESA listed salmonid stock present in this watershed?
YES_ NO 4 Uncertain_ Please describe.
If you answered "yes" to either of the above questions, you should complete the
remainder of this checklist.
PROJECT SPECIFICES: The questions in this section are specific to the project and vicinity.
1. Name of watershed:
2. Name of nearest waterbody:
3. What is the distance from this project to the nearest body of water: Often a buffer
between the project and a stream can reduce the chance of a negative impact to fish.
4. What is the current land use between the project and the potentially affected water body (parking lots, farmland,
etc.)?
5. Is the project above a:
natural permanent barrier(waterfall) YES_ NO
natural temporary barrier(beaver pond) YES_ NO
man-made barrier(culvert, dam) YES_ NO_
• other(explain):
6. If yes, are there any resident salmonid populations above the blockage?
YES_ NO_ Don't know
7. What percent of the project will be impervious surface (including pavement&roof area)?
Mason County SEPA Checklist 11
FISH MIGRATION: The following questions will help determine if this project could interfere with migration of adult
and juvenile fish. Both increases and decreases in water flows can affect fish migration.
1. Does the project require the withdrawal of:
a. Surface water? YES_ NO
Amount
Name of surface water body
b. Ground water? YES NO
Amount
From where
Depth of well
2. Will any water be rerouted: YES— NO—
If yes, will this require a channel change?
3. Will there be retention or detention ponds? YES— NO—
If yes, will this be an infiltration pond or a surface discharge to either a municipal storm water system or a surface
water body? If to a surface waterbody, please give the name of the waterbody.
YES— NO—
4. Will this project require the building of new roads? YES_ NO—
Increased road mileage may affect the timing of water reaching a stream and may impact fish habitat.
5. Are culverts proposed as part of this project? YES— NO
6. Will topography changes affect the duration/direction of runoff flows? YES— NO—
If yes, describe the changes.
7. Will the project involve any reduction of the floodway or floodplain by filling or other partial blockage of flows?
YES_ NO—
If yes, how will the loss of flood storage be mitigated by your project?
WATER QUALITY: The following questions will help determine if this project could adversely impact water quality.
Such impacts can cause problems for listed species.
Water quality can be made worse by runoff from impervious surfaces, altering water temperature, discharging
contaminants, etc.
1. Do you know of any problems with water quality, in any of the streams,within this watershed?
YES— NO — If yes, describe.
Mason County SEPA Checklist 12
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2. Will your project either reduce or increase shade along or over a waterbody?
YES_ NO_ If yes, describe.
Removal of shading vegetation or the building of structures such as docks or floats often results in a change in
shade.
3. Will the project increase nutrient loading or have the potential to increase nutrient loading or contaminants
(fertilizers, other waste discharges, or runoff) to the waterbody? If yes, describe.
YES _ NO_
4. Will turbidity be increased because of construction of the project or during operation of the project?
YES_ NO_
In-water or near water work will often increase turbidity.
5. Will your project require long-term maintenance, i.e. bridge cleaning, highway salting, and chemical sprays for
vegetation management, clearing of parking lots?
YES_ NO_ If yes, please describe.
VEGETATION: The following questions are designed to determine if the project will affect riparian vegetation,
thereby, adversely impacting salmon.
1. Will the project involve the removal of any vegetation from the stream banks:
YES _ NO _
If yes, please describe the existing conditions, and the amount and type of vegetation to be removed.
2. If any vegetation is removed, do you plan to re-plant?
YES _ NO_ If yes, what types of plants will you use?
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.
Applicant Signature: Date: L�P Lt
Mason County SEPA Chec 13