Environmental Checklist.pdfWA
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Purpose of Checklist:
ENVIRONMENTAL CHECKLIST
The State Environmental Policy Act (SEPA), chapter 43.21C RCW, 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 adverse impacts on the quality of the environment. 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 asks you to describe some basic information about your proposal. Governmental agencies use this
checklist to determine whether the environmental impacts of your proposal are 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, shoreline, 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, 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.
Use of checklist for nonproject proposals:
For nonproject proposals complete this checklist and the supplemental sheet for nonproject actions (Part D). the leasd agency may
exclude any question for the environmental elements (Part 13) which they determine do not contribute meaningfully to the analysis of
the proposalFor nonproject actions, the references in the checklist to the words "project," "applicant," and "property or site" should be
read as "proposer," and "affected geographic area," respectively.
A. BACKGROUND
1. Name of proposed project, if applicable:
..........�.�.._.�..._.�.. �
2. Name of applicant:
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3. Address and, phpue nunlber of applicant and contact person:
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4. Date checklist prepared: _.............." ..j":
5. agency requesting checklist: Lot r 3(ityL)Lals
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6. Proposed timing or schedule (including phasing, if applicable): 4"
7
(STAFF COMM E
Do you have any plans for future additions, expansion, or further activity related to or connected with this
DrODosal? If ves. explain. I
(STAFF CO
8. List any environmental information you know about that has been prepared, or will be prepared, directly related
to this proposal.
(9(k:51V -01
(STAFF COMMENT'S)--,,,,,.,,,, . .......
9. Do you know whether applications are pending for governmental approvals of other proposals directly affecting
the prqperty covered by your proposal? If yes, explain.
(STAPFCCI ilii M
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10. List any government approvals or permits that will be needed for your proposal, if known.
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.
12.
(ST I; lir COM E
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 range or boundaries of the site(s). Provide 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.
(STA FF GOM Col l+ T ,) �.... ...................... ..... �.....�.. _.
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TO BE COMPLETED BY APPLICANT
B. ENVIRONMENTAL ELEMENTS
Earth
a.
General description of the site (circle one): Flat, r!U' rw hilly, steep slopes, mountainous, other:
(STAFF COM'.MrLNT'S�) �..... .......................................................................... �.
b. What is the steepest slope on the site (approximate percent slope)?
(STAFFCOMM
C. What general types of soils are found on the site (for example, clay, sand, gravel, peat, and muck)? If you
know the classification of agricultural soils, specify them and note any agricultural land of longterm
� soils.
commercial ' s��n►�iCance��Wther h� �r o�el��r'm removing of these
(STAFF C'OMMI
d. Are there surface indications or history of unstable soils in the immediate vicinity? If so, describe. A10-
(STAFFCOMM'
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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.
f.
(.STAFF COMMENTS
Could erosion occur as a result of cleariniz, construction, or use? If so, eeneraliv describe.
( 'fA FF CCI M M
g. About what percent of the site will be covered with impervious surfaces after project construction (for
example, asphalt or buildings)?
(STAFFCt.)1VI';CWIIl�1"" )w. _.................
..............._ . _.
It. Proposed measures to reduce or control erosion, or other impacts to the earth, if any:
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2. AIR
a.
(STA FF CI'IMlVll:l`I'") ............. ._._._.
What types of emissions to the air would result from the proposal (i.e., dust, automobile, odors, and
industrial wood smoke) during construction and when the project is completed? If any, generally describe
and give approximate quantities if known.
( "TAFF C.Ol4 M
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b. Are there any off-site sources of emissions or odor that may effect your proposal? If so, generally describe.
(STAFF
C. Proposed measures to reduce or control emissions or other impacts to the, if any:
/V IA -
(STAFF COMMENTS)
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, and wetlands)? If yes, describe type and provide names. If
appropriate, state what stream or river it flows into.
N0
(STAFF COMMENTS) .-.-............. _. _ . _ _._._. ___ .........
(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.
(STAFF COM
(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.
)"
(STAFF COMM
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(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.
(STAFF
(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.
A/0
b. Ground:
(1) Will ground water 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 ground water? Give general description, purpose, and approximate
quantities if known.
(STAFF l' F C OM i C'
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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.
(S T' F 1R C lM M
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 into other waters?
If so, describe
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(STA 17 COM ME N
(2) Could wqte materials enter ground or surface waters? If so, generally describe.
( TAFF CO Ml
(3) Does the proposal alter or otherwise affect drainage patterns in the vicinityof the site? If so,
describe.
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(STA FF CO
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d. Proposed measures to reduce or control surface, ground, runoff water, and drainage pattern impacts, if
any:
°r FF COMMENTS
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
ic grass
pasture
crop or grain
Orchards, vineyards or other permanent crops
wet soil plants: cattail, buttercup, bulrush, skunk cabbage, other:
water plants: water lily, eelgrass, milfoil, other: _
other types of vegetation:
(STAFF COM
b. What kind and amount of vegetation will be removed or altered?
(STAFFCOMM
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C. List threatened or endangered species known to be on or near the site.
(STAFF COMMENTS) . ............_._.
d. Proposed landscaping, use of native plants, or other materials to preserve or enhance vegetation on the site,
if an :
(m AFl 'OMMENTS)
e. List all noxious weeds and invasive species known to be on or near the site.
..
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5. Animals
a. List any birds and other animals that have been observed on or near the site or are known to be on or near
the site. Examples include:
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birds: hawk, heron, eagle, songbirds, other: -
mammals: deer, bear, elk, beaver, other:
fish: bass, salmon, trout, herring, shellfish, other: N C4e
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(STAFF COMMENTS)
b. List any threa(ened or endangered species known to be on or near the site.
(STAFF COMM
C. Is the site part of a migration route? If so, explain.
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(STAFF COMMENT
d. Proposed measures to preserve or enhance wildlife, if any:
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(STAFF COMMENTS)
e. List any invasive animal species known to be on or near the site.
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(STAFF COMMENTS)
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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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( TAF°l+ COMME T) w....... _ _....._............... _..................
b. Would your project affect the potential use of solar energy by adjacent properties? If so, generally
describe.
(STAFF COMMENTS)
s"I'S)
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:
.�........... .",r0_ca.. _ C �,, . .. ....... ��..._...��.._
(STA F F
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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(STAFF COM Cvi'i,'C "'1'"�4)� �. _� �_..� � m � �� � _� � �..................._....................
(1) Describe any known or possible contamination at the site from present or past uses.
� ............ ....._...... _......... _.. ......
(STAFF COMMENTS)
(2) Describe existing hazardous chemicals/conditions that might affect project development and design.
This includes undergrand hazardous liquid and gas transmission pipelines located within the project
area and in the vicinity.
�.� ..-........._.� _ .__.. ................_ . ....__�...._.�.__. .......... ..... .._........
......�....._.....�..� � ..
(STA F F CO M l
(3) Describe any toxic or hazardous chemicals that might be stored, used, or produced during the
project's development or constructions, or at any time during the operating life of the project.
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(STAFF C:C1MG't`E
(4) Describe special emergency services that might be required.
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(STAFF C COMMENTS)-
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(5) Proposed measures to reduce or control environmental health hazards, if any:
(STAFF COMM
b. Noise
(1) What types of noise exist in the area which may affect your project (for example: traffic, equipment,
operation, other)?
(;"STAFF' CCIi'1?1M
(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 hour's noise
would come from the site.
910ri -herrn
_.Q melw) 4Ihsk
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(STAFF CO
(3) Proposed measures to reduce or control noise impacts, if any:
(STAFIX` COM1V1EN,rs)
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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
nearbNyd Yor
"I(yamdjac1ent properties? I�ff so, describe.
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(STAFF lw COM M`+I.
b. Has the project site been used as working farmlands or working forest lands? If so, describe. 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 nonfrom or nonforest use?
(ST F F CO6"4"11"x'1 F NTS} ......_.. - ...................... mm ...... _.._.............
(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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(STAFF COMMENT
C. Describe any structures on the site.
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(STAFF
F
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d. Will joy structures be demolished? If so, what?
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(STAFF ...... . .... . .........
e. What is the current zoning classification of the site?
(STAFF COMM ENTS)
E What is the current comprehensive plan designation of the site?
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L2' ......... - ... . ......
(STAFF CO
g. If applicable, what is the current shoreline master plan designation of the site?
. . . ........ ---- ..................... . .......
(STA FF CO
h. Has any part of the si�c been classified critical area by the city? If so, specify.
SUMIAMEM
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Approximately how many people would reside or work in the completed project?
(. 1'A 'FCOM MEN
j. Approximately how many people would the completed project displace?
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(STAFF t: C3M'!" %'N
k. Proposed measures to avoid or reduce displacement impacts, if any:
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(STAFF (""ti lMEN
Proposed measures to ensure the proposal is compatible with existing and projected land uses and plans, if
any:
A
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(STAFF
( TAf+"F "O
M. Proposed measures to ensure the proposal is compatible with nearby agricultural and forest lands of long-
term commercial significance, 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
Ill
.................................. ................
(STAFF COMM ENTS)
b. Approximately how many units, if any would be eliminated? Indicate whether high, middle, or low-income
housing.
61
(STAFFCOMMEN
C. Proposed measures to reduce or control housing impacts, if any:
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(STAFF COMMEN
10. Aesthetics
a. What is the tallest height of any proposed structure(s), not including antennas; what is the principle
exterior building material(s) proposed?
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(STAFF COMMENT
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b. What views in the immediate vicinity would be altered or obstructed?
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(S'1 A F CO M'M 1+ N
C. Proposed measures to reduce or control aesthetic impacts, 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?
... ._....__... .............. ................. ..._................................. ...... ..... .......
(STAFF COMM'.
b. Could light or glare from the finished project be a safety hazard or interfere with views?
( TF.F COM M
C. What existing off-site sources of light or glare may affect your proposal?
0YU
(S`1 AFF CGMME
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d. Proposed measures to reduce or control light and glare impacts, if any:
(STAFF COMMENTS) 'TMENTS) _........... ---------- -
12. Recreation
a. What designated and informal recreational opportunities are in the immediate vicinity?
(STAFF COM M l:l"�'1 Vii........_ _.� ._.._............... � ......... ....... �.� � ....._ � ..........................
b. Would the proposed project displace any existing recreation uses? If so, describe.
(STAFF CMf) 11"1 EN
C. Proposed measures to reduce or control impacts on recreation, including recreation opportunities to be
provided by the project or applicant, if any:
,yOtu
(STAFF COMM
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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 describe.
NO
(STAFF COMM
b. Are there any landmarks, features, or other evidence of Indian or historic use or occupation? This may
include human burials or old cemeteries. Are there any material evidence, artifacts, or areas of cultural
importance on or near the site? Please list any professional studies conducted at the site to identify such
resources.
Almk'
(STA FF CO
C. Describe the methods used to assess the potential impacts to cultural and historic resources on or near the
project site. Examples include consultation with tribes and the Department of Archeology and Historic
Preservation, archaeological surveys, historic maps, GIS date, etc.
(STA F +INOMi'MlENTS)
d. Proposed measures to avoid, minimize, or compensate for loss, changes to, and disturbance to resources.
Please include plans for the above and any permits that may be required.
(STAFF COMM E`I'S).u............. .... ......................................_.............................._......._................................m
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14. Transportation
a.
Identify public streets and highways serving the site or affected geographic area, and describe proposed
access to the existing street system. Show on site plans, if any.
(STAFF COMM
b. Is the site or affected geographic area currently served by public transit? If so, generally describe. If not,
what is the approximate distance to the nearest transit stop?
�� . _....... tr..�-_W............_� _........... .
(STAFF COMM
C. How many additional parking spaces would the completed project or nonproject proposal have? How
many would the project or proposal eliminate?
(STAFF COMMENTS) TS)
d. Will the proposal require any new or improvements to existing roads, streets, pedestrian, bicycle or state
transportation facilityes not including driveways? If so, generally describe (indicate whether public or
private).
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e. Will the project or proposal use (or occur in the immediate vicinity of) water, rail, or air transportation? If
so, �generally describe.
(STAFl+ (IIM'IMll!
L How many vehicular trips per day would be generated by the completed project? If known, indicate when
peak volumes would occur and what percentage of the volume would be trucks (such as commercial and
anpassenger vehicles). What data or transporation models were used to make these estimates?
( 17AF COM ME
g. Will the proposal interfere with, affect or be affected by the movement of agricultural and forest products
on roads or streets in the area? If so, generally describe.
AJO
(STAFF COMMENTS) . ................................. _-................. ......
h. Prused measures to reduce or control transportation impacts, if any:
o7 ............................. - -------------- -
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(STA FFCOMMENTS) .......... ----
15. Public Services
Would the project result in an increased need for public services (for example: fire protection, police
protection, public transit, health care, schools, other)? If so, generally describe.
. ......... A
(s'rAFF COMM
b. Proposed measures to reduce or control direct impacts on public services, if any:
P/A
(s,rAFFCONI M
16. Utilities
a. Circle utilities currently available at the site: a ter"
mita rLysewet , septic system, other:
. . . . . . . . ............... ................................. . .... ......
(STA FF COMM
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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.
(STA F F COM M 1+TS)......_.............__..__._.....__....................................... _ __.. ..... _..--- _..------- _------------------ .... ....... ..._.--
C. SIGNATURE
I declare under penalty of perjury laws that the above answers are true and correct to the best of my knowledge. I understand
that the lead ao cy is relying on them to make its decision.
,.
i:...,,--- _...... .........r ..... _... w..�.. —
Signature of Proponent
Date Submitted
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D. SUPPLEMENTAL SHEET FOR NONPROJECT ACTIONS
(do not use this sheet for project actions)
Because these questions are very general, it may be helpful to read them in conjunction with the list of the elements of the
environment.
When answering these questions, be aware of the extent the proposal, or the types of activities likely to result from the proposal,
would affect the item at a greater intensity or at a faster rate than if the proposal were not implemented. Respond briefly and in
general terms.
1. How would the proposal be likely to increase discharge to water; emissions to air; production, storage, or release of
toric or hazardous substances; or production of noise?
PrODOSal measures to avoid or reduce such increases are:
2. How wotild the proposal be likely to affect plants, animals, fish, or marine life?
Proposed measures to protect or conserve plants, animals, fish, or marine life are:
.- ! nom.,- . - Al
3. proposal be likely to deplete energy or natural resources?
How would /,"
a
' d the _u1 A. /1 /,",
Proposed measures to protect or conserve energy and natural resources are:
n A P
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4. How would the proposal be likely to use or affect environmentally sensitive areas or areas designated (or eligible or
under study) for governmental protection; such as parks, wilderness, wild and scenic rivers, threatened or endangered
species habitat, historic or cultural sites, wetlands, floodplains, or prime farmlands?
measures to protect such resources or to avoid or reduce impacts are:
5. How would the proposal be likely to affect land and shoreline use, including whether it would allow or encourage land
or shoreline uses incompatible with existing plans?
measures to avoid or reduce shoreline and land use impacts are:
6. How would the proposal be likely to increase demands on transportation or public services and utilities?
measures to reduce or respond to such demand(s) are:
,i A — . ..,W.. __ r,
7. Identify, if possible, whether the proposal may conflict with local, state, or federal laws or requirements for the
protection � of the environment.
w
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