HomeMy WebLinkAboutSEP2002-00110 Environmental Checklist - SEP Application - 10/25/2002 TO BE COMPLETED BY APPLICAIT EVALUATIOR FU8
AGUCY USE OJELY
A. BACKGROUND:
1. Name of proposed project, if applicable: Qua doc-K
2. Name of applicant: t-c,-v„,6,7
3. Address L phone number of applicant contact person:
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4. Date checklist prepared: a L
S. Agency requesting checklist: yAc.S.v1 �C C"�•-µ--� �" �°
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. Do 1-.�t k
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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le. List any government approvals or permits that will be needed
for your proposal, if .known. 11��;,� P�w� ✓V�� So,. Co���/
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 auk you to
describe certain aspects of your proposal. You do not need to
repeat those answers on this page. (Lead agencies may modify
this fora. to include additional specific information on project
description. ) cO (Doc-K
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To BE Co ids'= BY APPLICIBT EVALUATIOY FM
ACT USE Oi[LY
location of the proposal? Give sufficient
12. What is the loc p p
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.
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B. ENVIRONMENTAL ELEMENTS:
i. EARTH:
a. _ General description of the site (circle one) :
Flat, rolling, hilly, steep slopes, mountainous,
other G-<. -O Sion-A
b. What is the steepest slo e an the site (approximate
percent slope)? o.er,-exz-4,
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 not any prime farmland.
d. Are there surface indications or history of
unstable soils in the immediate vicinity? If so,
describe. „Ld
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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 constructions
(for example, asphalt or buildings)? Ao-,,�
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.
H/A
C. Proposed measures to reduce or control emissions or
other impacts to air, if any:
H/A
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AGERGY USE ONLT
3. WATER:
a. Surface:
1) Is there any surface water body on or in the immediate
vicinity of the Bite (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. ��;� P,� Snd-co+�-s�►"``Lfi floG��
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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 cite that would be affected.
Indicated the source of fill material. n p v%�e
4) Will the proposal require surface water withdrawals or
diversions? Give general description, purpose, and approximate
quantities if known. Vto
5) Does the proposal lie within a 100- ear floodplain? If so,
note location on the site plan. Do �"T
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. ^6
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TO BE cXl2iPtXM BY APPLI"IRT EVkLUATIox MR
AGENCT USE OXLy
b. Ground:
1) Will ground rater be withdrawn, or will water be discharged
to ground water? Give general description, purpose, and
approximate quantities, if known. 1-vIST-� (n 0 &,- S It
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 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. k x�S r.e� S< P`C�c. cam... S , Le
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 flaw? Will this water flow
into other waters? If so, describe.
2) Could waste materials ente ground or surface waters? If so
generally describe. �S =+C'Ppl�
d. Proposed measures to reduce or control surface; ground, and
runoff water impacts, if any:
4. PLANTS:
&. 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
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TO BE COMPI.H= BY APPLICAZT EVALUATION FOR
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b. What kind and amount of vegetation will be removed
or altered? v-,o.K,L
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 presery or enhance vegetation an
the site, if any: LA-Jjx o h o`J L*11 c `o tc,,-1-T
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, heron, eagle, songbirds other s
mammals: deer, bear, elk, beaver, other yv�
fish: bass, salmon, trou herring, shellfish, other
b. List any threatened or endangered species known to
he on or near the site.
C. Is the site part of a migration route? If so,
explain. ()o ,.,&t
d. Proposed measures to preserve or enhance wildlife,
if any: Qb,_S v�ot _ppil F
G. 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.
H/A
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b. Mould you project affect the potential use of solar
energy by adjacent properties? If so, generally
describe.
N/A
G. What kinds of energy conservation features are
included in the plane of this proposal? List other
proposed measures to reduce or control energy
impacts, if any:
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
2) Proposed measures to reduce or control
environmental health hazards, if any:
b. Noise.
1) What types of noise exists in the area which may
affect your project (for example: traffic,
equipment operation, other) ?
N/A
2) What types of 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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AGENCY Usfi any
3) Proposed measures to reduce or control noise
impacts, if any: CLo —6"t' Kv�o�
8. LAND AND SHORELINE USE:
a. What is the current use of the Site and adjacent .
properties? �<Cr,,,i�W.� 5,11-0U Cr�,,
b. Has the site been used for agriculture? If so,
describe. k�,p 0O.'S wo�`0.y�p ly
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C. Describe any structures on the site.
d. Will any structures be demolished? If so, what? y�py,Q
e. What is the current zoning classification of the
site? S,1^3(,( I/
f. What is the current comprehensive plan designation
of the site? Go vwt f'
g. If applicable, what is the current shoreline master
program designation of the site? Co,..,--,Ty
h. Has any part of the site been classified as an
•environmentally sensitive` area? If so, specify. Do
i. Approximately how many people would reside or work
in the completed project?
H/A
J. Approximately how may people would the completed
project displace?
N/A
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To BE (X12iPLSM BY APPLICANT EVALUATION FOR
AGENCY USE ONLY
k. Proposed measures to avoid or reduce displacement
impacts, if any:
N/A
1. Proposed measures to ensure the proposal is compatible
with existing and projected land uses andp -plans if any:
9. HOUSING:
a. Approximately how may units, if any, would be
provided? Indicate whether high, middle, or low-
income housing.
FIA
b. Approximately how many units, if any, would be
eliminated? Indicate whether high, middle, or low-
income housing.
N/A
C. Proposed measures to reduce or control housing
impacts, if any:
N/A
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?
b. What views in the immediate vicinity would be
altered or obstructed? vAv--Jt
C. Proposed measures to reduce or control aesthetic
impacts, if any: Cjoo� �C,�t(ru�1c��.� (� T�s G04.,
11. LIGHT AND GLARE:
a. What type of light or glare will the proposal
produce? What time of day would it mainly occur?
N/A
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TO BE CONPLEM BY APPLICAIT EVALUATIOX FOR
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b. Could light or glare from the finished project be a
safety hazard or interfere vith views?
N/A
C. What existing off-site sources of light or glare
way affect your proposal:
N/A
d. Proposed measures to reduce or control light and
glare impacts, if any:
N/A
12. RECREATION:
a. What designated and informal recreational
opportunities are in the immediate vicinity?
b. Would the proposed project displace any existing
recreational uses? If so, describe. KyD
C. Proposed measures to reduce or control impacts on
recreation, including recreation opportunities to
be provide5Lby 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. yi(7vi_e_
b. Generally describe any landmark or evidence of
historic, archaeological, scientific, or cultural
importance knovn to be on or next to the site. ✓� t�.-�� �a-{S ��t'��'(y
C. Proposed measures to reduce or control impacts, if
any: Do
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TO BE CO2g'(.= BY APPLIGAXT EVALUATIOY Fm
AGENCY USE OILY
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. -ey Sty I�r v,c Or,v-c -rbV1•�: . EMT.
b. Is site currently served by public transit? If
not, what is the approximate distance to the
existing etreet system. Show on site plans, if
any.
N/A
C. How many parking spaces would the completed project
have? How many would the project eliminate?
n/n
d. Will the proposal require any new roads or streets,
or improvements to existing roads or streets, not
including driveways? If no, generally describe
(indicate whether public or private).
N/A
e. Will the project use (or occur in the immediate
vicinity of) water, rail, or air transportation?
If so generally describe.
N/A
f. How many vehicular trips per day would be generated
by the completed project? If known, indicate when
peak volumes would occur.
N/A
g. Proposed measures to reduce or control
transportation impacts, ii anys
N/A
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To BE CONPLETED 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.
H/A
b. Proposed measures to reduce or control direct
impacts on public services, if any:
NIA
16. UTILITIES:
a. Clrcle tiea currently available at the site:
t is natural gas, rater, refuse service,
teiephon sanitary serer, septic 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.
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
ESA LISTED SALMONIDS CHECKLIST
Applicant Information Project Information
Name 51`l-V�t. Name s'-, L-o...r.
Phone 3(-D -n SAS Location��ao-'.c.. La��•.e
Description
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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 . OF"'
2 . Has there ever been an ESA listed salmonid stock present in
this watershed? Yes No_Z Uncertain
Please describe . prw
If you answered "yes" to either of the above questions, you
should complete the remainder of this checklist.
September 1999 1
PROJECT SPECIFICS: The questions in this section are specific to
the project and vicinity.
1 . Name of watershed:
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2 . Name of nearest waterbody: _�kpT.e,,,,, L, ,,ke-
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) ?
S . 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) ?
September 1999
2
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 :
i . Surface water? Yes No
Amount
Name of surface water body
ii . 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 water discharge, please give the name of the
waterbody.
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 t
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?
September 1999 3
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.
2 . Will your project either reduce or increase shade along or
over a waterbody? Yes No
Removal of shading vegetation or the building of structures such as docks or
floats often result 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? 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, chemical sprays for vegetation .
management, clearing of parking lots?
Yes No If yes, please describe .
September 1999 4
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?
September 1999 5
� II
RESOURCES
Washington Department of Fish and Wildlife Website
www.wa.gov/wdfw/
This site has useful information on fish habitat .
Washington Department of Ecology Website
www.wa.gov/ecolog.�
Click on the Water Quality button on the left side of this page .
National Marine Fisheries Services Website
Evolutionarily Significant Unit (ESU) maps can be found at
www.nwr.noaa.gov Go to this site and then click on the ESA Salmon
button.
NOTE: Most applicants should have the information necessary to
answer most of the questions in this checklist. Additional
information will need to be obtained by local and state agencies
if it appears that the project is likely to affect ESA listed
species.
September 1999 6