PLN20120033 Environmental Checklist.pdfF D
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ENVIRONMENTAL E L T COUNTER
Purpose of 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 questionsfromyour 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:
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
"proposer," and "affected geographic area," respectively:
1. Name of proposed project, if applicable: �-t ;I i i hn 6o 4v I C. e�, i G (- I, c t',
2. Name of applicant: —ro i-n I D 1 ( i I! hC (_LI-
3. Address and phone number of applicant and contact person:
4. Date checklist prepared:.���7
5. Agency requesting checklist: Q2 o Edmonds
Revised on 8119111 P71- SEPA Checklist.doc Page 1 of 24
6. Proposed timing or schedule (including phasing, if applicable):
(STAFF COMMENT
7. Do you have any plans for future additions, expansion, or further activity related to or connected with this
proposal? If yes, explain.
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(STAFF COMMENTS)
8. List any environmental information you know about that has been prepared, or will be prepared, directly related
to this proposal.
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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.
(STAFF COMMENTS)
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10. List any government approvals or permits that will be
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(STAFF
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seeded for yourLLproposal,.if known.
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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. _
(STAFF COMMENTS)
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 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.
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(STAFF COMMENTS) \/o' V I C- V' W 'ILA-6n 1 + r l
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TO BE COMPLETED BY APPLICANT
B. ENVIRONMENTAL ELEMENTS
1. Earth
a. General description of the site (circle one): Flat, rolling, hilly ste=slopes,)nountainous, other:
b.
C.
(STAFF COMMENTS)
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 prime farmland.
(STAFF COMMENTS) USpA Sv ry2y MzCQ ��Al decszm d
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Are there surface indications or history of unstable soils in the immediate vicinity? If so, describe.
(A0.
(STAFF COMMENTS)
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e. Describe the purpose, type and approximate quantities of any filling or grading proposed. Indicate source
of fill.
f.
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(STAFF COMMENTS)
Could erosion occur as a result of clearing, construction, or use? If so, generally describe.
(STAFF COMMENTS)
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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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(STAFF COMMENTS)
h. Proposed measures to reduce or control erosion, or other impacts to the earth, if any:
(STAFF COMMENTS)
2. AIR
a. 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 annroximate nuantities if known.
(STAFF COMMENT
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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 CO
C. Proposed measures to reduce or control emissions or other impacts to the, if any:
[�Idh6.
(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.
b-
(2)
(STAFF COMMENTS)
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.
(STA`F(1F COMMENTS) `` P�-nl��,go�;r J� aiiscsn�a� eF s�to� �.�i�e�
(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 COMMENTS) No 111 �
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Revised on 8119111 P71 - SEPA Checklist. do Page 6 of24
(4) Will the proposal require surface water withdrawals or diversions? Give general description,
purpose, and approximate quantities if known.
(STAFF COMMENTS)
(5) Does the proposal lie within a 100-year floodplain? If so, note location on the site plan. .
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(STAFF COMMENTS)
(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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(STAFF COMMENTS)
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.
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(STAFF COMMENTS)
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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.
(STAFF COMMENTS)
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. 1Z i,",h -�� i- t b V I r,. c LA- �✓ I U Ij �
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(STAFF COMMENTS)
(2) Could waste materials enter ground or surface waters? If so, generally describe.
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(STAFF COMMENTS)
d. Proposed measures to reduce or control surface, ground, and runoff water impacts, if any:
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(STAFF COMMENTS) &qQe,k Iny�fP>r1� d Researc�g Snc �,.��cwn��s
Revised on 8/19/11 P71- SEPA Checklist. doc Page 8 of 24
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
pasture
crop or grain
wet soil plants: cattail, buttercup, bulrush, skunk cabbage, other:
Water plants: water lily, eelgrass, milfoil, other:
other types of vegetation: "j 6 &W U �—°� k 0
(STAFF CO
b. What kind and amount of vegetation will be removed or altered?
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(STAFF COMMENTS)
C. List threatened or endangered species known to be on or near the site.
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(STAFF COMMENTS)
Revised on 8119111 P71 - SEP,4 Checklist. doc Page 9 of24
Proposed landscaping, use of native plants, or other materials to preserve or enhance vegetation on the site,
if any:
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(STAF11F COMMENTS),rl % �� �,^al coeMj,.ter-
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5. Animals
a. Check or circle any birds and animals that have been observed on or near the site or are known to be on or
near the site:
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Fbirds: hawk, heron, eagle, songbirds, other:
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mammals: deer, bear, elk, beaver, other: hh � 1IO i
fish: bass, salmon, trout, herring, shellfish, other: I V U V7 Z o- V-1 h G1
(STAFF COMMENTS)
b. List any threatened or endangered species known to be on or near the site.
NoV-1�,.
(STAFF CO
C. Is the site part of a migration route? If so, explain.
(STAFF COMMENTS)
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d. Proposed measures to preserve or enhance wildlife, if anv:
(STAFF COMMENTS)
6. Energy and Natural Resources
Pill
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.
(STAFF COMMENTS)
b. Would your project affect the potential use of solar energy by adjacent properties? . If so, generally
describe.
I�ld•
(STAFF COMMENTS)
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:
(STAFF CO
Revised on 8119111 P71 - SEPA Checklist. doc Page 11 of 24
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.
(STAFF COMMENTS)
(1) Describe special emergency services that might be required.
(STAFF
(2) Proposed measures to reduce or control environmental health hazards, if any:
(STAFF COMMENTS)
b. Noise
(1) What types of noise exist in the area which may affect your project (for example: traffic, equipment,
operation, other)?
_Qoh6.
(STAFF COMMENTS)
Revised on 8119111 P71 - SEPA Checklist.doc Page 12 of 24
(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.
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(STAFF COMMENTS)
(3) Proposed measures to reduce or control noise impacts, if any:
(STAFF COMMENTS)
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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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(STAFF COMMENTS)
b. Has the site been used for agriculture? If so, describe.
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(STAFF COMMENTS)
Revised on 8119111 P71 - SEPA Checklist.doc Page 13 of 24
C. Describe any structures on the site.
(STAFF COMMENTS)
d. Will any structures be demolished? If so, what?
bOZ� huh GLI�DtLI.
(STAFF COMMENTS)
e. What is the current zoning classification of the site?
(STAFF COMMENTS)
f. What is the current comprehensive plan designation of the site?
(STAFF COMMENTS)
g. If applicable, what is the current shoreline master plan designation of the site?
Dob+ CA- tZh��
(STAFF COMMENTS)
Revised on 8119111 P71 - SEPA Checklist. doc Page 14 of24
h. Has any part of the site been classified as an "environmentally sensitive" area? If so, specify.
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an Er-ons; e,r. Are -k..-
Approximately how many people would reside or work in the completed project?
(STAFF COMMENTS)
j. Approximately how many people would the completed project displace?
n Qs
(STAFF COMMENTS)
k. Proposed measures to avoid or reduce displacement impacts, if any:
(STAFF COMMENTS)
1. Proposed measures to ensure the proposal is compatible with existing and projected land uses and plans, if
anve
(STAFF COMMENTS) MI&T. M.
tj
Revised on 8119111 P71 - SEPA Checklist. doc Page 15 of 24
9. Housing
a. Approximately how many units would be provided, if any? Indicate whether high, middle, or low-income
housing.
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(STAFF COMMENTS)
b. Approximately how many units, if any would be eliminated? Indicate whether high, middle, or low-income
housing.
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(STAFF COMMENTS)
C. Proposed measures to reduce or control housing impacts, if any:
(STAFF COMMENTS)
10. Aesthetics
a. What is the tallest height of any proposed structure(s), not including antennas; what is the principlt-
exterior building material(s) proposed?
(STAFF COMMENTS) onee_ a.✓ ; ;
Revised on 8119111 P71 - SEPA Checklist. doc Page 16 of 24
b. What views in the immediate vicinity would be altered or obstructed?
(STAFF
(STAFF
11. Light and Glare
a. What type of light or
o vn e) 1 t6
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will the proposal produce? What time of day would it mainly occur?
J
(STAFF COMMENTS)
b. Could light or glare from the finished project be a safety hazard or interfere with views?
(STAFF COMMENTS)
C. What existing off -site sources of light or glare may affect your proposal?
(STAFF COMMENTS)
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d. Proposed measures to reduce or control light and glare impacts, if any:
(STAFF COMMENTS)
12. Recreation
a. What designated and informal recreational opportunities are in the immediate vicinity?
f�ohe-,
-
(STAFF COMMENTS)
b. Would the proposed project displace any existing recreation uses? If so, describe.
�U-
(STAFF COMMENTS)
C. Proposed measures to reduce or control impacts on recreation, including recreation opportunities to be
provided by the project or applicant, if any:
bo e c-7 h n+ t '1/ .
(STAFF COMMENTS)
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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.
Wo.
(STAFF COMMENTS)
b. Generally describe any landmarks or evidence of historic, archaeological, scientific, or cultural importance
known to be on or next to the site.
(STAFF COMMENTS)
C. Proposed measures to reduce or control impacts, if any:
b®� h0 Gv171���i
(STAFF COMMENTS)
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.
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(STAFF CO
Revised on 8119111 P71 - SEPA Checklist.doc Page 19 of 24
b. Is site currently served by public transit? If no, what is the approximate distance to the nearest transit
stop?
Do hod how'
C.
d.
e.
(STAFF COMMENTS)
How many parking spaces would the completed project have? How many would the project eliminate?
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(STAFF COMMENTS)
Will the proposal. require any new roads, streets, or improvements to existing roads or streets, not including
driveways? If so, generally describe (indicate whether public or private).
1�0•
(STAFF COMMENTS)
Will the project use (or occur in the immediate vicinity of) water, rail, or air transportation? If so,
generally describe.
N�•
(STAFF COMMENTS)
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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.
(STAFF COMMENTS)
g. Proposed measures to reduce or control transportation impacts, if any:
Q o V) e-,
(STAFF COMMENTS)
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.
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(STAFF COMMENTS)
b. Proposed measures to reduce or control direct impacts on public services, if any:
13o �► ej,
(STAFF COMMENTS)
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16. Utilities
a. Circle utilities currently available at the site: electricity, natural gas, water, refuse service, telephone,
sanitary sewer eptic system, other:
1 . a 6w6 ( e, q V `, r,A
(STAFF COMMENTS)
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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(STAFF COMMENTS)
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 agency is relying on them to make its decision.
Signature of Proponent
Rev;e�ae�l by : 2 0
G-erN M�-c.1,�.�a Anaac:,x�c_ P1z,,Ner
C;;V o.F F..olh,cnof3
,-a/ I I / i 5
Date Submitted
Revised on 8119111 P71 - SEPA Checklist.doc Page 22 of 24