HomeMy WebLinkAboutEx 4 SEPA ChecklistSEPA Environmental checklist September 2023 Page 1
(WAC 197-11-960)
SEPA 1 Environmental Checklist
Purpose of checklist
Governmental agencies use this checklist to help determine whether the environmental impacts of your
proposal are significant. This information is also helpful to determine if available avoidance, minimization, or
compensatory mitigation measures will address the probable significant impacts or if an environmental impact
statement will be prepared to further analyze the proposal.
Instructions for applicants
This environmental checklist asks you to describe some basic information about your proposal. Please answer
each question accurately and carefully, to the best of your knowledge. You may need to consult with an
agency specialist or private consultant for some questions. You may use “not applicable” or “does not apply”
only when you can explain why it does not apply and not when the answer is unknown. You may also attach
or incorporate by reference additional studies reports. Complete and accurate answers to these questions
often avoid delays with the SEPA process as well as later in the decision-making process.
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.
Instructions for lead agencies
Please adjust the format of this template as needed. Additional information may be necessary to evaluate the
existing environment, all interrelated aspects of the proposal and an analysis of adverse impacts. The checklist
is considered the first but not necessarily the only source of information needed to make an adequate
threshold determination. Once a threshold determination is made, the lead agency is responsible for the
completeness and accuracy of the checklist and other supporting documents.
Use of checklist for nonproject proposals
For nonproject proposals (such as ordinances, regulations, plans and programs), complete the applicable parts
of sections A and B, plus the Supplemental Sheet for Nonproject Actions (Part D). Please completely answer all
questions that apply and note that the words "project," "applicant," and "property or site" should be read as
"proposal," "proponent," and "affected geographic area," respectively. The lead agency may exclude (for non-
projects) questions in “Part B: Environmental Elements” that do not contribute meaningfully to the analysis of
the proposal.
1 https://ecology.wa.gov/Regulations-Permits/SEPA/Environmental-review/SEPA-guidance/Checklist-guidance
Exhibit E
Exhibit 4ZON2025-00011
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A. Background
Find help answering background questions2
1. Name of proposed project, if applicable:
Mats Mats Bay
2. Name of applicant:
Horizon Tower / Verizon Wireless
3. Address and phone number of applicant and contact person:
Horizon Tower
117 Town & Country Dr, Ste A
Danville, CA 94526
Contact: Bill North – The North Group, Inc.
425-876-2909
4. Date checklist prepared:
July 29, 2025
5. Agency requesting checklist:
Jefferson County
6. Proposed timing of schedule (including phasing, if applicable):
Construction 2026 / no phasing
7. Do you have any plans for future additions, expansion, or further activity related to or
connected with this proposal? If yes, explain.
No Future activity is included in this proposal or anticipated at this time
8. List any environmental information you know about that has been prepared, or will be
prepared, directly related to this proposal.
Phase 1 report
NEPA
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.
No
10. List any government approvals or permits that will be needed for your proposal, if known.
SEPA Determination
WCF Type III approval
Building Permit
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11. Give 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.)
The proposed facility will consist of the construction of a new 150’ monopole wireless
telecommunications facility with antennas, radios, cabling, and ground equipment within a
50’x50’ fenced lease area. The site will improve Verizon Wireless coverage and capacity in
the Port Ludlow and Swansonville areas and is designed for additional carrier collocation.
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 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.
No assigned address – Port Ludlow, WA 98365
Latitude 47.937389° N, Longitude -122.695797° W
Parcel #821081015, Jefferson County
Zoning: RR-5.
B. Environmental Elements
1. Earth
Find help answering earth questions3
a. General description of the site:
Undeveloped rural parcel with rolling terrain and moderate vegetation.
Circle or highlight one: Flat, rolling, hilly, steep slopes, mountainous, other:
b. What is the steepest slope on the site (approximate percent slope)?
There are no slopes within the immediate area of the proposed site.
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
agricultural land of long-term commercial significance and whether the proposal
results in removing any of these soils.
Sand and gravel. No agricultural soils of long-term significance.
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d.Are there surface indications or history of unstable soils in the immediate vicinity? If
so, describe.
No.
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.
Leveling and gravel placement within a 50’x50’ lease area, minimal excavation.
f.Could erosion occur because of clearing, construction, or use? If so, generally describe.
No significant erosion anticipated.
g.About what percent of the site will be covered with impervious surfaces after project
construction (for example, asphalt or buildings)?
Less than 5,000 sq ft of impervious gravel surface.
h.Proposed measures to reduce or control erosion, or other impacts to the earth, if any.
Standard BMPs during construction.
2.Air
Find help answering air questions 4
a.What types of emissions to the air would result from the proposal during construction,
operation, and maintenance when the project is completed? If any, generally describe
and give approximate quantities if known.
Temporary construction emissions only; minimal ongoing emissions from maintenance vehicles.
b.Are there any off-site sources of emissions or odor that may affect your proposal? If
so, generally describe.
No.
c.Proposed measures to reduce or control emissions or other impacts to air, if any:
Not applicable; emissions minimal.
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3. Water
Find help answering water questions 5
a. Surface:
Find help answering surface water questions 6
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.
Mats Mats Bay is nearby but over 200’ from site; no direct impact.
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.
No.
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.
Not applicable.
4. Will the proposal require surface water withdrawals or diversions? Give a general
description, purpose, and approximate quantities if known.
No.
5. Does the proposal lie within a 100-year floodplain? If so, note location on the site
plan.
No.
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.
No.
b. Ground:
Find help answering ground water questions7
1. Will groundwater 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 groundwater?
Give a general description, purpose, and approximate quantities if known.
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No.
2. Describe waste material that will be discharged into the ground from septic tanks
or other sources, if any (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.
None.
c. Water Runoff (including stormwater):
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.
Stormwater will infiltrate on-site.
2. Could waste materials enter ground or surface waters? If so, generally describe.
No.
3. Does the proposal alter or otherwise affect drainage patterns in the vicinity of the
site? If so, describe.
No.
d. Proposed measures to reduce or control surface, ground, and runoff water, and
drainage pattern impacts, if any:
No significant surface or ground water impact anticipated. Consequently, no
reduction measures are required.
4. Plants
Find help answering plants questions
a. Check the 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
☐ orchards, vineyards, or other permanent crops.
☐ wet soil plants: cattail, buttercup, bullrush, skunk cabbage, other
☐ water plants: water lily, eelgrass, milfoil, other
☐ other types of vegetation
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b. What kind and amount of vegetation will be removed or altered?
Minimal clearing of trees and brush within lease area and access route.
c. List threatened and endangered species known to be on or near the site.
None known.
d. Proposed landscaping, use of native plants, or other measures to preserve or enhance
vegetation on the site, if any.
Existing vegetation around perimeter will remain for screening.
e. List all noxious weeds and invasive species known to be on or near the site.
None observed.
5. Animals
Find help answering animal questions 8
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.
Songbirds, hawks, deer commonly observed in the area.
• Birds: hawk, heron, eagle, songbirds, other:
• Mammals: deer, bear, elk, beaver, other:
• Fish: bass, salmon, trout, herring, shellfish, other:
b. List any threatened and endangered species known to be on or near the site.
Per the Washington Fish and Wildlife Priority Habitats and Species report dated
7/29/2025 no listed species are identified or observed on site.
c. Is the site part of a migration route? If so, explain.
None known – Please see Washington Fish and Wildlife PHS report dated 7/29/2025.
d. Proposed measures to preserve or enhance wildlife, if any.
No measures needed.
e. List any invasive animal species known to be on or near the site.
None known.
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6. Energy and natural resources
Find help answering energy and natural resource questions9
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.
Electricity for telecom equipment.
b. Would your project affect the potential use of solar energy by adjacent properties? If
so, generally describe.
No.
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.
Low-power telecom equipment with efficient components.
7. Environmental health
Health Find help with answering environmental health questions 10
a. Are there any environmental health hazards, including exposure to toxic chemicals,
risk of fire and explosion, spill, or hazardous waste, that could occur because of this
proposal? If so, describe.
No.
1. Describe any known or possible contamination at the site from present or past
uses.
There are no known contaminates from past or present use.
2. Describe existing hazardous chemicals/conditions that might affect project
development and design. This includes underground hazardous liquid and gas
transmission pipelines located within the project area and in the vicinity.
There are no known or existing hazardous chemicals or conditions on the property.
3. Describe any toxic or hazardous chemicals that might be stored, used, or produced
during the project's development or construction, or at any time during the
operating life of the project.
Diesel backup generator with contained fuel system.
4. Describe special emergency services that might be required.
None required.
5. Proposed measures to reduce or control environmental health hazards, if any.
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All RF emissions meet FCC guidelines.
b.Noise
1.What types of noise exist in the area which may affect your project (for example:
traffic, equipment, operation, other)?
Typical rural background noise.
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)?
Temporary construction noise; negligible operational noise.
3.Proposed measures to reduce or control noise impacts, if any:
No noise is anticipated therefore, no measures are proposed.
8. Land and shoreline use
Find help answering land and shoreline use questions 11
a.What is the current use of the site and adjacent properties? Will the proposal affect
current land uses on nearby or adjacent properties? If so, describe.
Undeveloped; adjacent rural residential.
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 because 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 nonfarm or nonforest use?
No.
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?
No.
c.Describe any structures on the site.
None.
d.Will any structures be demolished? If so, what?
No.
e.What is the current zoning classification of the site?
RR-5.
f.What is the current comprehensive plan designation of the site?
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Rural Residential.
g. If applicable, what is the current shoreline master program designation of the site?
Not applicable.
h. Has any part of the site been classified as a critical area by the city or county? If so,
specify.
No.
i. Approximately how many people would reside or work in the completed project?
None.
j. Approximately how many people would the completed project displace?
None.
k. Proposed measures to avoid or reduce displacement impacts, if any.
Not applicable.
l. Proposed measures to ensure the proposal is compatible with existing and projected
land uses and plans, if any.
Facility designed per county code. The project will be located on an undeveloped lot
with existing vegetation around the perimeter utilized as screening.
m. Proposed measures to reduce or control impacts to agricultural and forest lands of
long-term commercial significance, if any:
Not applicable.
9. Housing
Find help answering housing questions 12
a. Approximately how many units would be provided, if any? Indicate whether high,
middle, or low-income housing.
None.
b. Approximately how many units, if any, would be eliminated? Indicate whether high,
middle, or low-income housing.
None.
c. Proposed measures to reduce or control housing impacts, if any:
Not applicable.
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10. Aesthetics
Find help answering aesthetics questions 13
a. What is the tallest height of any proposed structure(s), not including antennas; what is
the principal exterior building material(s) proposed?
150’ monopole with non-reflective finish.
b. What views in the immediate vicinity would be altered or obstructed?
Minimal; screened by vegetation. No view alteration or obstruction is anticipated.
Included in the application are photo simulations which provide detail that visual impact
will be negligible.
c. Proposed measures to reduce or control aesthetic impacts, if any:
Painted finish and fenced enclosure with privacy slats. The facility is being placed on a 6
acre undeveloped property with existing vegetation around the facility perimeter
providing screening.
11. Light and glare
Find help answering light and glare questions 14
a. What type of light or glare will the proposal produce? What time of day would it
mainly occur?
None.
b. Could light or glare from the finished project be a safety hazard or interfere with
views?
No.
c. What existing off-site sources of light or glare may affect your proposal?
None.
d. Proposed measures to reduce or control light and glare impacts, if any:
Not applicable.
12. Recreation
Find help answering recreation questions
a. What designated and informal recreational opportunities are in the immediate
vicinity?
None on-site; nearby marine and hiking areas.
b. Would the proposed project displace any existing recreational uses? If so, describe.
No.
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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:
Not applicable.
13. Historic and cultural preservation
Find help answering historic and cultural preservation questions 15
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? If so, specifically describe.
None known.
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.
None known; NEPA review to be completed.
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 data, etc.
NEPA review and consultation as required.
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.
There are no anticipated loss, changes to, or disturbance of resources. Therefore, no
measures to avoid are proposed.
14. Transportation
Find help with answering transportation questions 16
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.
Access via Swansonville Road and Fleet Drive.
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?
No.
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c. Will the proposal require any new or improvements to existing roads, streets,
pedestrian, bicycle, or state transportation facilities, not including driveways? If so,
generally describe (indicate whether public or private).
No.
d. Will the project or proposal use (or occur in the immediate vicinity of) water, rail, or
air transportation? If so, generally describe.
No.
e. How many vehicular trips per day would be generated by the completed project or
proposal? If known, indicate when peak volumes would occur and what percentage of
the volume would be trucks (such as commercial and nonpassenger vehicles). What
data or transportation models were used to make these estimates?
One to two per month for maintenance.
f. 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.
No.
g. Proposed measures to reduce or control transportation impacts, if any:
Not applicable.
15. Public services
Find help answering public service questions17
a. 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.
No.
b. Proposed measures to reduce or control direct impacts on public services, if any.
Not applicable.
16. Utilities
Find help answering utilities questions 18
a. Circle utilities currently available at the site: electricity, natural gas, water, refuse
service, telephone, sanitary sewer, septic system, other:
electricity
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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New electrical service and fiber connection extended to site within utility easement.
C. Signature
Find help about who should sign 19
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.
Type name of signee: Bill North
Position and agency/organization: The North Group, Inc.
Date submitted: July 29, 2025
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