HomeMy WebLinkAboutMLA15-00075 - FPA15-00002 SEPA Checklist by ApplicantON COO
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Purpose of checklist.,
JEFFERSON COUNTY
DEPARTMENT OF COMMUNITY DEVELOPMENT
621 Sheridan Street • Port Townsend • Washington
360/379-4450 - 360/379-4451 Fax
www.co.jeffemon.wa.us/commdevelopment
ENVIRONMENTAL CHECKLIST
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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 sign'rficant
adverse impact.
A. BACKGROUND
1. Name of proposed project, if applicable:
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2. Name of applicant:
3. Address and phone number of applicant and contact person:
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4. Date checklist prepared:
5. Agency requesting checklist:
6. Proposed timing or schedule (including phasing, if applicable)
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7. Do you have any plans for future additions, 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.
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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.
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10. List any government approvals or pennits that will be needed for your proposal, If known.
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 thisformto include additional specific information on project description.)
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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.
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B. ENVIRONMENTAL ELEMENTS
1. Earth
a. General description of the site (circle on :Flat rolling hilly, steep slopes, mountainous, other.
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b. What is the steepest slope onntthe 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 so,
describe.
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e. Describe the purpose, type, and approximate quantities of any filling or grading proposed.
Indicate source
off 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 construction
(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:
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a.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. /l/d
Proposed measures to reduce or control emissions or other impacts to air, if any:
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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.
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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 site that would be affected. Indicate
the source of fill material. 1-)1.4
4) Will the proposal require surface water withdrawals or diversions? Give general description,
purpose, and approximate quantities if known.
5) Does the proposal lie within a 100 -year floodplain? If so, note location on the site plan.
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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.
No
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 expecte serve.
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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.
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2) Could waste materials enter ground or surface waters? If so, generally describe.
/A
d. Proposed measures to reduce or control surface, ground, and runoff water impacts, if any:
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4. Plants
a. Check or circle types of vegetation found on the site:
—deciduous tree: ald apl aspen, other
— evergreen tree: iFda , n , other
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— pasture
— crop or groin
—wet soil plants: cattail, buttercup, bullmsh, skunk cabbage, other
— water plants: water lily, eelgmss, milfoil, other
other types of vegetation— ?f%r,s-I/u5
b. What kind and amount of vegetation will be removed or altered?
c. List threatened or endangered species known to be on or near the site.
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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, heron, eagle, songbirds, other:
mammals: deer, bear, elk, beaver, other: /VaaJ&
fish: bass, salmon, trout, herring, shellfish, other: /VcNr!�'
b. List any threatened or endangered species known to be on or near the site.
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c. Is the site part of a migration route? If so, explain.
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d. Proposed measures to preserve 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.
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2) Proposed measures to reduce or control environmental health hazards, if any:
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b. Noise
1) What types of noise exist in the area which may affect your project (for example: traffic,
equipment, operation, other)?
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2) W hat 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?
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?
f. What is the current comprehensive plan designation of the site?
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g. If applicable, what is the current shoreline master program designation of the site?
N/A
h. Has any part of the site been classified as an "environmentally sensitive" or critical area? If so,
specify. Nd
i. Approximately how many people would reside or work in the completed project?
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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 housing.
c. Proposed measures to reduce or control housing impacts, if any:
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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?
�orry
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?
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?
A)x
d. Proposed measures to reduce or control light and glare impacts, if any:
N4�—
12. Recreation
a. What designated and/inform/al recreational opportunities are in the immediate vicinity?
b. Would the proposed project displace any existing recreational uses? If so, describe.
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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.
Na
b. Generally describe any landmarks or evidence of historic, archaeological, scientific, or cultural
importance known to be on or next to the site.
.N/A
c. Proposed measures to reduce or control impacts, if any:
IVIA
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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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b. Is site currently served by public_ transit? If not, what is the approximate distance to the nearest
transit stop? No Cyd 4
c. How many parking spaces would the completed project have? How many would the project
eliminate? 2-3 / VIA
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. .Ud
f. How many vehicular trips per day would be generated by the completed project? If known,
indicate when peak volumes would occur.
g. Proposed measures to reduce or control transportation impacts, if any:
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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.
No
b. Proposed measures to reduce or control direct impacts on public services, if any.
A -11A
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16. Utilities
a. Circle utilities currently available at the site: electricity, natural gas, water, refuse service,
telephone, sanitary sewer, septic system, other.
Aldw—
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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C. SIGNATURE u�
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: ...,..r^ �( �J
...............................................................................................................................
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