HomeMy WebLinkAboutSEP2002-00046 Environmental Checklist - SEP Application - 7/1/2002 MASON CO. ENVIRONMENTAL CHECKLIST
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A. BACKGROUND
1. Name of proposed project, if applicable:
2. Name of applicant:
3. Address and phone number of applicant and contact person:
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4. Date checklist prepared:
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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 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 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. P
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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.)i 1'
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.
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B. ENVIRONMENTAL ELEMENTS:
1. EARTH:
a. General description of the site (circle one): Flat rolling, hilly, steep
slopes, mountainous, other
b. What is the steepest slope on the site (approximate percent slope)?
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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 k)o '
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. NJ
g. About what percent of the site will be covered with impervious surfaces
after project constructions (for example, asphalt or buildings)?
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h. Proposed measures to reduce or control erosion, or other impacts to the
earth, if any: ) f
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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.
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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:
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.
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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.
3) Estimate the amount of fill and dredge material that would be place 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) 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 lie within a 100-year floodplain? If so, note location
on the site plan. Ye- 5
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.
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b. Ground:
1) Will ground water be withdrawn, or will water be discharged to ground
water? Give general description, purpose, and approximate quantities, if
known.
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):
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 i to other waters? If so, describe.
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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:
4. PLANTS.-
a. Check or circle types of vegetation found on the site:
deciduous tree: alder, mapl , aspen, other 5 COxo�_ TY--e-Z
_ evergreen tree- fir, cedar, pine, other a
_ shrubs sn' 1^'�o r)
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?
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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
preserve or enhance vegetation on the site, if any:
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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 *eroa§' irds they . . . . . . . . . . .
mamma . b a , other . . . . . . . . . . . . .
fish: bass, erring, shellfish, other . . . . . .
b. List any threatened or endangered species known to be on or near the
site. ^ K k)ow
C. Is the site part of a migration route? If so, explain.
d. Proposed measures to preserved or enhance wildlife, if any:
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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.
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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:
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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.
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1) Describe special emergency services that might be required.
2) Proposed measures to reduce or control environmental health hazards,
if any-
b. Noise.
1) What types of noise exist in the area which may affect your project (for
example: traffic, equipment, operation, other)? .
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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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.
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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?
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f. What is the curre ensive plan designation of the site?
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g. If applicable, what is the current shoreline master program designation of
the site? 06 N VJ
h. Has any part of the site been classified as an "environmentally sensitive"
area? If so, specify. `
i. Approximately how many people would reside or work in the completed
project?
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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I. Proposed measures to ensure the proposal is compatible with existing
and projected land uses and plans, if any:
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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 income
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C. Proposed measures to reduce or control housing impacts, if any:
10. AESTHETICS: N)
a. What is the tallest he of any proposed structure(s), not including
antennas; what is the principal exterior building material(s) proposed?
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b. What views in the immediate vicinity would be altered or obstructed?
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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?
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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:
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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?
b. Would the proposed project displace any existing recreational uses? If
so, describe. a
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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 any:
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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.
b. Generally describe any landmarks or evidence of historic, archaeological,
scientific, or cultural importance known to be on or next to the site.
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C. Proposed
. p sed measures to reduce or control impacts, if any:
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.
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? lv//�
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 immediate 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.
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g. Proposed measures to reduce or control transportation impacts, if any:
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:
b. Proposed measures to reduce or control direct impacts on public
services, if any:
16. UTILITIES:
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a. Circl uti ' ' t the site: elect ' ral gas,
w ter efuse sery ce blephon anitary se yste , 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-
C. Signature:
The above answers are true and m knowledge.complete to the best of
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understand that the lead agency is relying on them to make its decision.
Signature:
Date Submitted:
ESA LISTED SALMONIDS CHECKLIST
AAPplicant Information Project Info rmation
Name \J Name
Phon c.o ' —2 -S BLS Location_
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 `''r�
Please describe. KQOVJ-- C 3
2 . Has there ever been an ESA listed salmonid stock present in
this watershed? Yes No Uncertain
Please describe.
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: n C�
2 . Name of nearest waterbody: SS i Oil Cf QeJC_
3 . What is the distancq from this project to the nearest body of
water? TO ;+
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 us
e between the project and the
Potentially affected ffected \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
0 other (explain) : No1K_
6. If yes, are there any resident salmonid o u
P P lations above the blockage? Yes No
Don't know
7 . What percent of the project will be impervious surface
urface i
nclu( ding pavement & roof area) ?
September 1999
2
FIBH KI:G ATtON: The following questions will help determine if
this project could interfere with migration of adult and
Juvenile fish.
Moth increases and decreases in water flows can affect fish migration.
1. Does the project require the withd awal of:
i . Surface water? Yes No
Amount
Name of surface water body
ii . Ground water? Yes No
Amount 2-1
From where
Depth of well
2 . Will any water be rerouted? Yes No
If yes,, will this require a channel chang;�—?
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
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
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WATER QUALITYS The following questions will help determine if
this pro3ect could adversely inWact water duality. Such impacts
can cause problems for listed species.
Watsr Quality can be made worse by runoff from
impervious surfaces, altering Water
temperature, dischar
ging contaminants, etc.
1. Do you know of any problems with water
streams within this watershed? YeS Noalty in any of the
If yes, describe. --f''1�[r C��
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.
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3 . Will the project increase nutrient loading or have the
Potential to increase nutrient loading or contaminants
(fertilizers, other was 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
In-water or near water work will often increase turbidity. NO
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 X_ If yes, please describe.
September 1999
4
VEGETATION: The following Questions are designed
if the Project will affect riparian vegetation�,etheredetermine .
adversely impacting salmon. '
1 . Will the project involve the removal of any vegetation from
the stream banks? Yes No—)C
If yes, please describe the existing conditions, and the
amount and type of vegetation to be removed.
2 . If an vegetation is removed, do you plan to re-plant?
Yes No If yes, what types of_ plants will
You use.
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September 1999
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