HomeMy WebLinkAboutEnvironmental Checklist - SEP Application - 6/17/1989 ENVIRONMENTAL CHECKLIST
2. Name of app I i cant: 169az .8, �OY%
3. Address and telephone number of applicant and contact person:
4. Date checklist prepared: —117—0 7
5. Agency requesting checklist:
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6. Proposed timing or schedule ( including phasing, if applicable) :
7. Do you have any plans for future additions, 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 applicatlons 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.
i1 . Give brief, complete description of your proposal , including the
proposed uses and 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.
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ENVIRONMENTAL CHECKLIST
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 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.
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TO BE COMPLETED BY APPLICANT
B. ENVIRONMENTAL ELEMENTS
1. Earth
(a) General description of the site (circ)le one) : flat, rolling, hlIly ,
steep slopes, mountainous, other __ •
(b) What 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 you know the; ciassification of agricultural
soils, specify them and note any prime fa�miand.
(d) Are there surface Indications or ,history of unstable soils in the
immediate vicinity? If so, describe.
(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.
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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) ?
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ENVIRONMENTAL CHECKLIST
(h) Proposed measures to reduce or control erosion, or other impacts to
the earth, If any:
2. A 1 r NET
(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.
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(b) Are there any. off-site sources of emmissions or odor that may affect-.
your proposal? If so, generally describe.
N/A •
(c) Proposed measures to reduce or control emissions or other impacts to
air, if any:
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NA
3. Water
(a) Surface
1 ) Is there any surface hater 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) W111 the project require any work over, in, or adjacent to (withn 200
feet) the described waters? If yes, please describe and attach available
plans. cc
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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ENVIRONMENTAL CHECKLIST
4 ) Will the proposal require surface water withdrawals or diversions?
Give general description, purpose, and approximate Quantities if known.
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5) Does the proposal Ile 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.
(b) Ground
1 ) WiII ground water be withdrawn, or wlII water be discharged to ground
water? Give general description, purpose, and approximate quantities If
known.
N/A �d
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.
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(c) Water Runoff ( including storm water)
i ) 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 water? If so,
describe.
2) Could waste materials enter ground or surface waters? If so, generally
describe.
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ENVIRONMENTAL CHECKLIST
(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
crop or grain
wet soil plants: cattail , buttercup, bullrush, skunk cabbage, other
water plants: water Illy, eelgrass, mllfoil, other
other types of vegetation
(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.
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(d) Proposed landscaping, use of native plants, or other measures to
preserve or enhance vegetation on the site, If any:
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S. Animals
(a) 'Clrcl9 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, er , ea le songbirds, other:
mammals: dee bear, elk, beaver, other: /�JE12� UTJ�F/L rSC'9l4
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fish: bass, salmon rout, herring, shellfis other:
(b) List any threatened or endangered species known to be on or near the
site. .9 -Z-/lZiLt%6i/ OF.
(c) is the site part of a migration route? If so explain.
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(d) Proposed measures to preserve or enhance wildlife, if any:
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ENVIRONMENTAL CHECKLIST
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.
N/A
( b)l Would your ''project' affect the potentla'l 'Use of solar energy' by '
- adjacent properties? If so, generally describe.- '-
N/A y0
• (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: "
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N/A
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.
N/A /VO'✓E
2) Proposed measures to reduce or control environmental health hazards,
f any: yO,vE
(b) Noise
1 ) What types of noise exist in the area which may affect your project
( for example: traffic, equipment, operation, other)?
N/A
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.
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ENVIRONi4ENTAL CHECKLIST
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?
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(b) Has the site been used for agriculture? If so, describe.
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c) Describe any structures on the site.
(d) Will any structures be demolished? If so, what?
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(e) What is the current zoning ciassif.lcation of the site?
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(f) What is the current comprehensive plan designation of- the site?
( g) If applicable, what I's the current shoreline master program
designation of the site? NUT
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(h) Has any part -of the site been classified as an *environmentally
sensitive' area? If so, specify.
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( i ) Approximately how many people would reside or work in the completed
project?�fi�'
(j) Approximately how many people would the completed project displace?
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( k) Proposed measures to avoid or reduce displacement impacts, if any:
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N/A ND.vE- J
( I )• Proposed measures to ensure the proposal is compatible with existing
and projected land uses and plans, If any:
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ENVIRONMENTAL CHECKLIST .
9. Housing
(a) Approximately how many units would be provided , If any? 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.
• N
(c) Proposed measures to reduce or control housing impacts, if any:
N/A
10. Aesthetics .
(a) What is the' tallost height of any proposed structure( s ) , note
incIuding. antennas; what is the principal exterior building materlal (s)-
proposed?
(b) What views In the immediate vicinity would be altered or obstructed?
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. (c) Proposed measures to reduce or control aesthetic impact, 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?
(b) Could light or glare from the finished project be a safety hazard or
?interfere with views?
N/A
(c) What existing off-s.lte sources of Iight or glare may affect your
proposal?
(d) Proposed measures to reduce -or control light and glare impacts , if
anyz(�
12. Recreation
(a) What designated and informal recreational opportunities are in the
immediate vicinity?
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ENVIRONMENTAL CHECKLIST
(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:: + , . Az
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. �U
(b) Generally describe any landmarks or evidence of historic,
archaeological , scientific, or cultural Importance known to be on or next
to the site.
o control Impacts, if any:
• (c) Proposed measures to reduce r p , y
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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. �j� •
(b) Is site currently served by public transit? If not, what is the
approximate distance to the nearest transit stop?
(c) How many parking spaces would the completed project have? How many
would the project eliminate?
A
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ENVIRONMENTAL CHECKLIST
(d) Mill 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) .
N/A
(e) Ul I the project use (or occur In the immediate vicinity of) water,
rail , or air transportation? If so, generally describe.
C. N/A .
(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: -
N/A
15. Public Services
(a) Would the project result in an increased need for public services
(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
serviirces, If any.
N/ -
16. Utilities -
(a) Circle util,_1„tles currently avallablj�--at- the site: electrlcit
naturp_-i gas,(ater,,_efuse service te l ephone,,, sanitary sewer,�sept i c ,
Csystem, 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.
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C. Signature
The above answers are true and complete to the best of my knowledge. 1
understand that the lead agency is rely ng on them to make its decision.
Signature: l/
Date Submitted:
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