HomeMy WebLinkAboutEnvironmental Checklist - SEP Application - 9/8/1989 MERE ow
ENVIRONMENTAL CHECKLIST SEP 81989
Purpose of Checklist
-�E NERAL OS'ERVICES
The State Environmental Policy Act (SEPA) , Chapter 43. 21C RCM, 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 adverso
Impacts on the quality of the envlronment. 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 a::.ks you to describe some basic information
about your proposal . Governmental agencies use this checklist to
determine whether environmental Impacts of your proposal aro 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,
shoreilae, 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 , evon If you
plan to do them over a period of time or on different parcels of land.
Attach any additional information that will 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 Nonproject Proposals
Complete this checklist for nonproject proposals, even though questions
may be answered "does not apply." IN ADDITION, complete the SUPPLEMENTAL
SHEET FOR NONPROJECT ACTIONS (Part D).
For nonproject actions, the references in the checklist to the words
"project, " *applicant, " and "property or site* should be read as
"proposal ," "proposer,* and "affected geographic area," respectively.
A. BACKGROUND /
1. Name of proposed project, If applicable:
yo l> � s ' vv�o t/ w L�
L
ENVIRONMENTAL CHECKLIST
2. Name of appII can t: r7 /
3. Address and telephone number of applicant and contract person:
vi
4. Date checklist prepared:
3. Agency requesting checklists
Llt'�
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.
ND
a. List any environmental information you know about that has been
prepared or will be prepared, directly related to this proposal.
9. r90 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. . J
&rz
11. 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.
k" -5 To .,,,e
-2-
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 mnp.
tie 325 3 Hwy
,.5/
TO BE COMPLETED BY APPLICANT d ;
B. ENVIRONMENTAL ELEMENTS
1. tarth
(a) general description of the site (circle one): flat, rolling, hilly ,
steep slopes, mountainous, other P,A u4 � �V-1TL r SL'2 t-
(b) What If the steepest slope on the site (approximate percent slope) ? �I
-� - ��o tc) at_ge� /J neraI types of soils are found on the sito (for example, c_IaX,_
tks nd grave ;peat, muck)? If you know the classlflcatlon of agrlcuItural
s, specify them and note any prime farmland.
(d) Are there surface IndLcatlons 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.
b
�� ►.� ss NOv� �
(g) About what percent of the site will be covered with Impervious
surfaces after project construction (for example, asphalt or buildings)?
r -3-
ENVIRONMENTAL CHECKLIST
(h) Proposed measures to reduce or control erosion, or other Impacts to
i
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 con siructIon
and when the project is completed? If any, generally describe and give
approximate quantities If known.
AVPZ�
(b)•1. Are. there. any off-site sources of emmissions or cdor that may affect. "
your proposal? . If • so, generally describe.
(c) Proposed measures to reduce or control emissions or other impacts to
air, 1f any:
d�S fI)akv
3. Water
(a) Surface
ill 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)? 1f 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 (withn 200 -
feet) the described waters? If yes, please describe and attach available
plans. NO
3) Estimate the amount of ftll 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.
_4-
e< '
ENVIRONMENTAL CHECKLIST
d) 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 floodplaln? If so, note
location on the site plan.
N'D
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) MIII ground water bo withdrawn, or w111 water. be discharged to ground
water? Give general description, purpose, and approximate quantities if
known.
r
2) Describe waste material that will be discharged Into the ground from
septic tanks or other sources, if any ( for example: domestic sewage;
lndu'strlal, 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.
y•. AAA rY r
(c) Water Runoff ( including storm water)
1) Describe the source of runoff ( Including storm water) and method of
collection and disposal, it any ( Include quantities, if known) . Where
will this water flow? Mill this wator . flow into other water? If so,
describe.
2) Could waste materials enter ground or surface waters? If so, generally
describe.
n
-5-
ENVIRONMENTAL CHECKLIST
(d) Proposed measures to reduce or control surface, ground, and runoff
water Impacts, if any:
4. Plants
(a) Chock or circle types...S(f vegetation found on the site:
deciduous troe: �`_alda �0"le, aspen, other j
evergreen tree: f pine, other
shrubs
grass
crop or grain
wet soil plantst cattell, buttercup, bullrush, skunk cabbage, other
water plants: water Illy, oelgrass, mllfoll, other
other types of vegetation
(b) What kind~and amount of vegetation will be removed yr al?ered?
i
TG1,Sh'I/-' S G 049 ev ir' ?3-e r2 /u ',l'u S Gam,
(c) List threatened or endangered specles 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 anyt L
)17
' " � , ('fie c1 ) �� ELT i
S. An ale .
(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: )
birdst hawk heron, eagle, songbirds, other: 21-2
mammals: deer boar, elk, beaver, other: A- 10/V r-
fish: bass, salmon, trout, herring, shellfish, other: /`/a /�
(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-
• 1� I
ENVIRONMENTAL CHECKLIST
i
6. Energy and Natural Resources
(a) What kinds of energy (electric, natural gas, oil , wood stove, solar)
will be used to most the completed project' s energy needs? Describe
whether it will be used for heating, manufacturing, etc.
( b) Would your project affect the potential use of solar energy by
adjacent properties? If so generally describe.
j D D , 9 Y
(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 anys
7. Enviro <mental Health
(a) Are there any environmental health hazards , Including exposure to
toxic chemicals, risk of fire and exploslon, spl11 , or hnzardous waste,
that could occur as a result of this proposal? If so, describe.
i
1 ) Describe special emergency services that might be required.
2) Proposed measures to reduce or control environmental health hazards,
It any:
(b) Noise
1 ) Whet types of noise exist In the area which may affect your project
( for example: traffic, equipment, operation, other) ?
A/0
2) What types and levels of noise would be created by or associated with
the project on a short-ter■ or a long-ter■ basis ( for example: traffic
construction, operation, other)? Indicate what hours noise would come fro■
the site.
-7-
I
ENVIRONMENTAL CHECKLIST i
3) Proposed measures to reduce or control noise impacts, If any:
S. Land and Shoreline Use
(a) What Is the current use of the site and adjacent properties?
- X " %7--
(b) Ha the site been used for agriculture? If so, describe,
(c) Describe .any structures on ;he site, '�/� Q rl-7--r
(d) Will any structures be demolished? If so, what?
(a) What is the current zoning classif.icatlon of the site?
A/0
J
(f) What is the current comprehensive plan designation of the site?
D (jF-- Xio
(g) If appllcabie, what Is the current shoreline master program
designation of the site?
0.//V
(h) Has any part -of the site been classified as an "environmentally
sensitive" area? If so, Specify—
( 1 ) Approximately ho many people would reside or work in the completed
project? / F o / V,�
(j) Approximately how many people would the completed project displace?
(k) Proposed measures to aviroid or reduce displacement Impacts, if any:
r
y
( 1 ) Proposed measures to ensure, the proposal is compatible with existing
and projected land uses and plans, if anyt
N 1`
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.
�G awl T� ;1,2d
(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 materIaI s)
proposed?
(b) What views In
the Immeddiiate vicinity would be altered or obstructed?
(c) Proposed measures to reduce or control aesthetic impact, If any:
U� GAS N � -�--
11. Light and Glare
(a) What type of Ilght 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 opportunitles ' are in the
immediate vicinity?
-9-
ENVIRONMENTAL CHECKLIST
(b) Mould the proposed project displace any oxlsting recroatlonai uses?
Of so, describe.
C/
(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.
/V�
(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:
I ,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.
V E tN Il-l- y G 1`1
(b) Is site currently served by public transit? If not, what is the
approximate distance to the nearest transit stop?
,U Ald 7- J/? a c,A,.i
(c) How many parking spaces would the completed project have? How many
would the project eliminate?
�d
—lo—
:
ENVIRONMENTAL CHECKLIST
(d) M111 the proposal require any now roads or streets, or improvements
to existing roads or streets, not including driveways? if so, generally
describe ( Indicate whether public or private).
(e) M111 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 peakvolumes would occur.
(g) Proposed measures to: reduce or control transportation Impacts, if
any.
15. Public Services
(a) Mould the project result In an Increased need for public services
( for examples fire protection, police protection, health care, schools,
other)? if so, generally describe.
(b) Proposed measures to- reduce or control direct Impacts on public
servicZT
, if any.
�0
1es
(a) Circle utilitles currently available at the site: electricity,
natural gas wate refuse services, telephone, sanitary sewer, septic
system, oths
(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.
u _ t -f
C. 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.
Signatures
Date Submitted: C�,— � �; rt . •
-11-