HomeMy WebLinkAboutSEP2016-00079 Dock - SEP Determinations - 8/24/2016 ON.STA MASON COUNTY
�Py C °Irr- DEPARTMENT OF COMMUNITY DEVELOPMENT
o A U y= Planning Division
i o T 615 W Alder St, Shelton, WA 98584
ooJ } ~ (360)427-9670
1864
DETERMINATION OF NONSIGNIFICANCE
(WAC 197-11-340)
SEP2016-00079
Description of Proposal: REPLACING TWO DOCKS WITH ONE
Proponent: MICHAEL MOORE
Location of Proposal: 210 E LAKESHORE DR ALLYN
Parcel Number: 122205000032
Legal Description: LAKELAND VILLAGE 1 TR 32 & N1/2 TR 33
Directions to Site:
Lead Agency: Mason County
The Lead Agency for this proposal has determined that it does not have a probable significant
adverse impact on the environment. An Environmental Impact Statement (EIS) is not required
under RCW 43.21 C.030(2)(c). This decision was made after review of a completed
Environmental Checklist and other information on file with the Lead Agency. This information is
available to the public upon request.
Please contact Kell McAboy at ext. 365 with any questions. This DNS is issued under WAC
197-11-340(2). The Lead Agency will not act on this proposal for 14 days from the date shown
below, when the determination is final. Comments must be submitted to Dept. of Community
Development, 615 W Alder St, Shelton WA 98584 by 9/7/2016. Appeal of this determination
must be filed within a 14-day period following this final determination date, per Mason County
Code Chapter 15.11 Appeals.
Authorized Local Govern ent Official Date
SEPA Environmental Checklist Mason Count,,Permit Center Use:
Single Family DNS: $385 sEP
❑ Other DNS: 0 to 9.99 acres: $630
Parcel#: I)P a 0-5D r 0003.2
10 to 20 acres: $755
Over 20 acres: $945 Date Rcvd:
❑ DS/EIS: $2,525+70 Per hr RECEIVED
AUG 16 416
-sec suet
Purpose of checklist:
Governmental agencies use this checklist to help determine whether the environmental impacts of your
proposal are significant. This information is also helpful to determine if available avoidance, minimization
or compensatory mitigation measures will address the probable significant impacts or if an environmental
impact statement will be prepared to further analyze the proposal.
Instructions for applicants: Jhel
This environmental checklist asks you to describe some basic information about your proposal. Please
answer each question accurately and carefully, to the best of your knowledge. You may need to consult
with an agency specialist or private consultant for some questions. You may use "not applicable" or
"does not apply" only when you can explain why it does not apply and not when the answer is unknown.
You may also attach or incorporate by reference additional studies reports. Complete and accurate
answers to these questions often avoid delays with the SEPA process as well as later in the decision-
making process.
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.
Instructions for Lead Agencies:
Please adjust the format of this template as needed. Additional information may be necessary to
evaluate the existing environment, all interrelated aspects of the proposal and an analysis of adverse
impacts. The checklist is considered the first but not necessarily the only source of information needed to
make an adequate threshold determination. Once a threshold determination is made, the lead agency is
responsible for the completeness and accuracy of the checklist and other supporting documents.
A. BACKGROUND help
1. Name of proposed project, if applicable: rneip
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2. Name of applicant: h� of
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3. Address and phone number of applicant and contact person: bhp
`Zlo E' t� SE�oer: 7�rZ
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SEPA Environmental checklist(WAC 197-11-960)(MC version-non project portion omitted): 2016 Page 1 of 11
Date checklist prepared: 1bpLpj
.5,, Agency requesting checklist: hei
6. Proposed timing or schedule (including phasing, if applicable): lb,eM
7. Do you have any plans for future additions, expansion, or further activity related to or connected with
this proposal? If yes, explain. hf el
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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. r,I elpl
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. 1nei � i
10. List any government approvals or permits that will be needed for your proposal, if known. heip
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11. Give 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.) rhe�p
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12. 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. rheipi
Parcel #(s):
Address: 2k6 L L.Pa%c.c:SH62C D2 A►_t_'<Jo <6!;-Zy-
Legal Description:
Twp/Range/Section and/or GPS location:
SEPA Environmental checklist(WAC 197-11-960)(MC version-non project portion omitted): 2016 Page 2 Of 11
4. Date checklist prepared: fhe�
5. Agency requesting checklist: hLe -A-leso-T
6. Proposed timing or schedule (including phasing, if applicable): rhel
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7. Do you have any plans for future additions, expansion, or further activity related to or connected with
this proposal? If yes, explain. LeM
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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. beg
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. 1heM 1A4
10. List any government approvals or permits that will be needed for your proposal, if known. 1help
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11. Give 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.) hgj
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12. 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. rheipl
Parcel #(s): 112220 -So --p 0 O 3 2-
Address: 21,() L L A tc.C.S HO RC D 2 � A
Legal Description: V;t WaA 1 - 1-9-
Twp/Range/Section and/or GPS location: ZZ N /o`W 112-0
SEPA Environmental checklist(WAC 197-11-960)(MC version-non project portion omitted): 2016 Page 2 of 11
B. ENVIRONMENTAL ELEMENTS Jhem
1. Earth
a. General description of the site hem
(circle one):ela ,, rolling, hilly, steep slopes, mountainous, other.
'br. What is the steepest slope on the site (approximate percent slope)? hem
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 agricultural land of
long-term commercial significance and whether the proposal results in removing any of these
soils. lteirs
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d. Are there surface indications or history of unstable soils in the immediate vicinity? If so,
describe. qgi
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e. Describe the purpose, type, total area, and approximate quantities and total affected area of any
filling, excavation, and grading proposed. Indicate source of fill. 'hey
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f. Could erosion occur as a result of clearing, construction, or use? If so, generally describe. hel
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g. About what percent of the site will be covered with impervious surfaces after project
construction (for example, asphalt or buildings)?Them
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h. Proposed measures to reduce or control erosion, or other impacts to the earth, if any: jbelp
2. Air
a. What types of emissions to the air would result from the proposal during construction, operation,
and maintenance when the project is completed? If any, generally describe and give
approximate quantities if known. hem
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b. Are there any off-site sources of emissions or odor that may affect your proposal? If so,
generally describe. hL eM
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c. Proposed measures to reduce or control emissions or other impacts to air, if any: fhe��l
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SEPA Environmental checklist(WAC 197-11-960)(MC version-non project portion omitted): 2016 Page 3 of 11
3. Water
a. Surface Water: Fhelol
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. nt�J
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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. nei
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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. jt
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4) Will the proposal require surface water withdrawals or diversions? Give general description,
purpose, and approximate quantities if known. hI e�
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5) Does the proposal lie within a 100-year floodplain? If so, note location on the site plan. -neia
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. hf eM
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b. Ground Water:
1) Will groundwater be withdrawn from a well for drinking water or other purposes? If so, give a
general description of the well, proposed uses and approximate quantities withdrawn from
the well. Will water be discharged to groundwater? Give general description, purpose, and
approximate, quantities if known. net
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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. nei
NA
c. Water runoff(including stormwater):
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. fheipl
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SEPA Environmental checklist(WAC 197-11-960)(MC version-non project portion omitted): 2016 Page 4 of 11
3. Water
a. Surface Water: hf eM
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. 1Hgm
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. hf eM
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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. help
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4) Will the proposal require surface water withdrawals or diversions? Give general description,
purpose, and approximate quantities if known. h( eM
NO
5) Does the proposal lie within a 100-year floodplain? If so, note location on the site plan. -help
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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. h[ eM
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b. Ground Water:
1) Will groundwater be withdrawn from a well for drinking water or other purposes? If so, give a
general description of the well, proposed uses and approximate quantities withdrawn from
the well. Will water be discharged to groundwater? Give general description, purpose, and
approximate
� quantities if known. hf eM
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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. hf eM
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c. Water runoff(including stormwater):
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. help
SEPA Environmental checklist(WAC 197-11-960)(MC version-non project portion omitted): 2016 Page 4 of 11
2) Could waste materials enter ground or surface waters? If so, generally describe. Jnefp
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3) Does the proposal alter or otherwise affect drainage patterns in the vicinity of the site? If so,
describe.
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d. Proposed measures to reduce or control Surface, ground, and runoff water, and drainage pattern
impacts, if any: b/,
4. Plants -Lt
a. Check the types of vegetation found on the site: fnei
deciduous tree: alder, maple, aspen, other
evergreen tree: fir, cedar, pine, other
shrubs
grass
pasture
crop or grain
orchards, vineyards or other permanent crops
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?1hey
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c. List threatened and endangered species known to be on or near the site.JtLel
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d. Proposed landscaping, use of native plants, or other measures to preserve or enhance
vegetation on the site, if any: b
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e. List all noxious weeds and invasive species known to be on or near the site.
5. Animals
a. List any birds and other animals which have been observed on or near the site or are known to
be on or near the site. Examples include: fneln
birds: hawk, heron, eagle, songbirds, other:
mammals: de , bear, elk, beaver, other:
fish: as , salmon(!rout,�Ierring, shellfish, other:
SEPA Environmental checklist(WAC 197-11-960)(MC version-non project portion omitted): 2016 Page 5 of 11
b. List any threatened and endangered species known to be on or near the site. h�pel l
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c. Is the site part of a migration route? If so, explain. 1bf1pJ
d. Proposed measures to preserve or enhance wildlife, if any: h
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e. List any invasive animal species known to be on or near the site.
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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. hI eM QC) K)E,-
b. Would your project affect the potential use of solar energy by adjacent properties?
If so, generally describe. jteM
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What kinds of energy conservation features are included in the plans of this proposal?
List other proposed measures to redi�ce r control energy impacts, if any: m?Ipl
-Z. 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. h( elpl pJQ�
1) Describe any known or possible contamination at the site from present or past uses.
2) Describe existing hazardous chemicals/conditions that might affect project development and
design. This includes underground hazardous liquid and gas transmission pipelines located
within the project area and in the vicinity.
3) Describe any toxic or hazardous chemicals that might be stored, used, or produced during
the project's development or construction, or at any time during the operating life of the
project. 1 Job /61 0Vr(,
4) Describe special emergency services that might be required.
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5) Proposed measures to reduce or control environmental health hazards, if any:
SEPA Environmental checklist(WAC 197-11-960)(MC version-non project portion omitted): 2016 Page 6 of 11
b. List any threatened and endangered species known to be on or near the site. h)gm
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c. Is the site part
/Joff)a migration route? If so, explain. r,( f fM
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d. Proposed measures to preserve or enhance wildlife, if any: 1Hem
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e. List any invasive animal species known to be on or near the site.
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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. hL eI N)O Q c
b. Would your project affect the potential use of solar energy by adjacent properties?
If so, generally describe. hj eM
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c. What kinds of energy conservation features are included in the plans of this proposal?
List other proposed measures to red
r control energy impacts, if any: hf gm
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. Help 1j�d
1) Describe any known or possible contamination at the site from present or past uses.
Ate-
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2) Describe existing hazardous chemicals/conditions that might affect project development and
design. This includes underground hazardous liquid and gas transmission pipelines located
within the project area and in the vicinity.
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3) Describe any toxic or hazardous chemicals that might be stored, used, or produced during
the project's development or construction, or at any time during the operating life of the
project. l J /61 Doi=11,
4) Describe special emergency services that might be required.
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5) Proposed measures to reduce or control environmental health hazards, if any:
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SEPA Environmental checklist(WAC 197-11-960)(MC version-non project portion omitted): 2016 Page 6 of 11
b. Noise
1) What types of noise exist in the area which may affect your project (for example:
traffic, equipment, operation, other)?jtzi
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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)? Indi-
cate what hours noise would come from the site. 1tg!pJ
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3) Proposed measures to reduce or control noise impacts, if any: nei
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8. Land and shoreline use
a. What is the current use of the site and adjacent properties?Will the proposal affect current land
uses on nearby or adjacent properties? If so, describe. hei
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b. Has the project site been used as working farmlands or working forest lands? If so, describe.
140
How much agricultural or forest land of long-term commercial significance will be converted to
other uses as a result of the proposal, if any?
If resource lands have not been designated, how many acres in farmland or forest land tax
status will be converted to nonfarm or nonforest use? hel
1) Will the proposal affect or be affected by surrounding working farm or forest land normal
business operations, such as oversize equipment access, the application of pesticides,
tilling, and harvesting? If so, how:
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c. Describe any structures on the site. he)
d. Will any structures be demolished? If so, what?jLel
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e. What is the current zoning classification of the site? rhelpi
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What is the current comprehensive plan designation of the site?
g. If applicable, what is the current shoreline master program designation of the site? rhelpl
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h. Has any part of the site been classified as a critical area by the city or county? If so, specify.
SEPA Environmental checklist(WAC 197-11-960)(MC version-non project portion omitted): 2016 Page 7 of 11
i. Approximately how many p ople would reside or work in the completed project?Jhglp
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j. Approximately how many people would the completed project displace? met
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k. Proposed measures to a oid or reduce displacement impacts, if any: fhef
L. Proposed measures to a sure the proposal is compatible with existing and projected land
uses and plans, if any: h b
m. Proposed measures to ensure the proposal is compatible with nearby agricultural and forest
lands of long-term commi,rcial significance, if any:
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9. Housing
a. Approximately how many its would be provided, if any? Indicate whether high, middle, or low-
income housing. jtey
b. Approximately how many units, if any, would be eliminated? Indicate whether high,
middle, or low-income housing. 1tieip
c. Proposed measures to reduce or control housing impacts, if any: 1hey
10. Aesthetics
a. What is the tallest height of any proposed structure(s), not including antennas; what is
the principal exterior buildin� material(s) proposed?1heM
b. What views in the immediat( vicinity would be altered or obstructed? rhelpi
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c. Proposed measures to redulce or control aesthetic impacts, if any: Jtg1p
11. Light and glare
a. What type of light or glare v fill the proposal produce? What time of day would it mainly
occur? 1hqlp
b. Could light or glare from the finished project be a safety hazard or interfere with views? )hei
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c. What existing off-site sourcj s of light or glare may affect your proposal?ltelp
t
d. Proposed measures to reduce or control light and glare impacts, if any: [help]
i
SEPA Environmental checklist(WAC 197-11-960)(MC version-non project portion omitted): 2016 Page 8 of 11
i. Approximately how many p ople would reside or work in the completed project? hefQ
j. Approximately how many people would the completed project displace? fhei
k. Proposed measures to a oid or reduce displacement impacts, if any: here
L. Proposed measures to a sure the proposal is compatible with existing and projected land
uses and plans, if any: rh
m. Proposed measures toe ure the proposal is compatible with nearby agricultural and forest
lands of long-term commercial significance, if any:
9. Housing
a. Approximately how many its would be provided, if any? Indicate whether high, middle, or low-
income housing. fhel
b. Approximately how many u its, if any, would be eliminated? Indicate whether high,
middle, or low-income hou ing. fhei
c. Proposed measures to red Ice or control housing impacts, if any: JheM
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?Lpl
b. What views in the immediatt vicinity would be altered or obstructed? hf e(
c. Proposed measures to red T
e or control aesthetic impacts, if any: hf eM
11. Light and glare
a. What type of light or glare will the proposal produce? What time of day would it mainly
occur? hele
b. Could light or glare from th finished project be a safety hazard or interfere with views?IbLel
c. What existing off-site sources of light or glare may affect your proposal?lftglp
d. Proposed measures to re uce or control light and glare impacts, if any: [help]
SEPA Environmental checklist(WAC 197-11-960)(MC version-non project portion omitted): 2016 Page 8 of 11
12. Recreation
a. What designated and informal recreational opportunities are in the immediate vicinity? (helal
b. Would the proposed project displace any existing recreational uses? If so, describe. Jtlelp
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c. Proposed measures to reduce or control impacts on recreation, including recreation
opportunities to be provided by the project or applicant, if apy: he
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13. Historic and cultural preservation
a. Are there any buildings, structures, or sites, located on or near the site that are over 45 years old
listed in or eligible for listing in national, state, or local preservation registers located on or near
the site? If so, specifically de cribe. lbero
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b. Are there any landmarks, fe tures, or other evidence of Indian or historic use or occupation?
This may include human buri Is or old cemeteries. Are there any material evidence, artifacts, or
areas of cultural importance n or near the site? Please list any professional studies conducted
at the site to identify such res urces. JLel
c. Describe the methods used to assess the potential impacts to cultural and historic resources on
or near the project site. Exam les include consultation with tribes and the department of
archeology and historic prese ation, archaeological surveys, historic maps, GIS data, etc. JLeM
d. Proposed measures to avoid, inimize, or compensate for loss, changes to, and disturbance to
resources. Please include plan for the above and any permits that may be required.
14. Transportation
a. Identify public streets and high ays serving the site or affected geographic area and describe
proposed access to the existing street system. Show on site plans, if any. JLefo
b. Is the site or affected geographi area currently served by public transit? If so, generally
describe. If not, what is the approximate distance to the nearest transit stop? t!M
c. How many additional parking sTroposal
ces would the completed project or non-project proposal have?
How many would the project o eliminate? h( e�Pl
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SEPA Environmental checklist(WAC 197-11-960)(MC version-non project portion omitted): 2016 Page 9 of 11
d. Will the proposal require any new or improvements to existing roads, streets, pedestrian, bicycle
or state transportation facilities, not including driveways? If so, generally describe (indicate
whether public or private). 1n NIA
e. Will the project or proposal use (or occur in the immediate vicinity of) water, rail, or air
transportation? If so, generally describe. mei
f. How many vehicular trips per day wo Id be generated by the completed project or proposal? If
known, indicate when peak volumes ould occur and what percentage of the volume would be
trucks (such as commercial and nonp ssenger vehicles). What data or transportation models
were used to make these estimates? el
g. Will the proposal interfere with, affect r be affected by the movement of agricultural and forest
products on roads or streets in the ar a? If so, generally describe.
h. Proposed measures to reduce or cor trol transportation impacts, if any: 1help
15. Public services
a. Would the project result in an increa ed need for public services (for example: fire protection,
police protection, public transit, health care, schools, other)? If so, generally describe. jt eM
b. Proposed measures to reduce or c ntrol direct impacts on public services, if any. fb
16. Utilities
a. Circle utilities currently available at the site: Help
electricity, natural gas, wat refuse service, telephone,
sanitary sewer, septic syste other
b. Describe the utilities that are prop sed for the project, the utility providing the service, and the
general construction activities on he site or in the immediate vicinity which might
be needed. rheip
SEPA Environmental checklist(WAC 197-11-960)(MC version-non project portion omitted): 2016 Page 10 of 11
d. Will the proposal require any new or improvements to existing roads, streets, pedestrian, bicycle
or state transportation facilities, not including driveways? If so, generally describe (indicate
whether public or private). net NIA
e. Will the project or proposal use (or oc ur in the immediate vicinity of)water, rail, or air
transportation? If so, generally describe. jkM
f. How many vehicular trips per day wo Id be generated by the completed project or proposal? If
known, indicate when peak volumes ould occur and what percentage of the volume would be
trucks (such as commercial and nonp ssenger vehicles). What data or transportation models
were used to make these estimates? el
g. Will the proposal interfere with, affect r be affected by the movement of agricultural and forest
products on roads or streets in the ar a? If so, generally describe.
h. Proposed measures to reduce or co trol transportation impacts, if any: lbpjpj
15. Public services
a. Would the project result in an increa ed need for public services (for example: fire protection,h
police protection, public transit, heal h care, schools, other)? If so, generally describe. ( M
b. Proposed measures to reduce or c ntrol direct impacts on public services, if any. net
16. Utilities
a. Circle utilities currently available at the site: bgl ]
electricity, natural gas, wat r, refuse service, telephone,
sanitary sewer, septic syste , other
b. Describe the utilities that are prop sed for the project, the utility providing the service, and the
general construction activities on he site or in the immediate vicinity which might
be needed. fb
SEPA Environmental checklist(WAC 197-11-960)(MC version-non project portion omitted): 2016 Page 10 of 11
C. SIGNATURE hey
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 cision.
Signature:
Date Signed:
Print Name of Signee: > a
If applicable, Position and Agency/Organization:
Date Submitted:
SEPA Environmental checklist(WAC 197-11-960)(MC version-non project portion omitted): 2016 Page 11 of 11
geoAdvantage:Mason County of Washington State(App4) Page 1 of 1
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