Environmental Checklist
ENVIRONMENTAL CHECKLIST
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* * * * * OFFICIAL USE ONLY * * * * ,.
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Jurisdiction TC 0 L Other
Phone
SEPA it (a)
Case it (b)
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Representative k: i (' H '"( ':3
Address tJ\)'":\:a\.. fC\'\\ ~{Y\.,\ ~
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Phone ~5~-S \4.C'
Related Cases
Date Received.
dJ/J'1 /1, '12..
I
By 1]
Incomplete X
Submittal
Complete
Information Requested _ L~~ ..,( /(/J'C.r-'fpr;......
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3. Property Address or location (e)
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II. t S/T/R (f)
Proposa I (d)
N17l1i?< q,rri""0 1 ,/0 /'fer".:'
5 Tax Parcel it (g) /VVf't I;i;",v >
6. Total Acres '1 {/
7 Permit Type /illn ,?.{
8 Zoning
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9 Shoreline Environment
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* ,. * ,. * OFFI CIAL USE ON L Y * ,. ,. * *
10 Water Body
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11
Brief Description of the Proposal and Project Name
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12. Estimated Completion Date.
13. List of all Permits, Licenses or Government Approvals Required for the Proposal
(federal, state and local--including rezones)
111. 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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15. Do you know of any plans by others which may affect the property covered by your
proposal? If yes, explain
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'6. Proposed timing or schedule (including phasing, if applicable)
17 List any environmental information you know about that has been prepared, or will be
prepared, directly related to this proposal.
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i ;j~, '3 ~ t, " j,.,1\ ENVI RONMENT AL ELEMENTS
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,~~.J.,Q'.Q"~CiQlJlPJred by Applicant
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a. ~eral description of the site (circle one.) Q,~,
~, steep slopes, mountainous, other
b What is the steepest slope on the site (approximate percent
slope)? There is a small portion on the south
of the site which exceeds 40 percent slope.
Evaluation for
Agency Use Only
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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 tl'lem and note any
prime farmland.
The soil type was found to be ~ gravelly sandy
loam, typical of Everett soils dharacteristics with
some top soils and silts.
d. Are there surface indicators or history of unstable soils in
the immediate vicinity? If so, describe.
e. Describe the purpose, type, and approximate quantities of
any filling or grading proposed. Indicate source of fill.
There is no proposed filling or grading as part of
this annexation.
f. Could erosion occur as a result of clearing, construction, or
use? If so, generally describe.
The proposed annexation will not cause any erosion.
g. About what percent of the site will be covered with
impervious surfaces after project construction (for example.
asphalt or buildings)?
Other than the existing improvements, there will be
no impervious surfaces for this annexation.
h. Proposed measures to reduce or control erosion, or other
impacts to the earth, if any
No measures are required as part of this proposed
annexation.
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.
The proposed annexation will not produce any
emissions.
b. Are there any off-site sources of emissions or odor that may
affect your proposal? If so, generally describe.
The proposed annexation abuts SR-507, and the town
of Yelm, are sources of off-site emissions. However, these
sources will not adversely affect our proposal.
c. Proposed measures to reduce or control emissions or other
impacts to air, if any
As part of this annexation, no measutes ate required.
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To be Completed by Applicant
3 Water
Evaluation for
Agency Use Only
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
There are none.
(2) Will the project require any work over, i.r, or adjacent
to (within 200 feet) the described waters? If yes,
please describe and attach available plans . .
No work is ~einq done as part of this annexat10n~
(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.
No work is being done as part of this annexation.
(4) Will the proposal require surface water withdrawals or
diversions? Give general description, purpose, and
approximate quantities if known
No work is being done as part of this annexation.
(5) Does the proposal lie within a lOa-year flood plain? If
so, note location on the site plan.
No this property is located entirely outside of any
lOO-year floodplain.
(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. However, there are a few existing individual
septic systems and drainfield areas installed under the
jurisdiction of the Thurston County Health Department.
Ground
b
(1) Will ground water be withdrawn, or will water be
discharged to ground water? Give general description,
purpose, and approximately quantities if known.
As part of this annexation, no groundwater will be with-
drawn or discharged.
(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.
Same as 3-a-6.
To be Completed by Applicant
Evaluation for
Agency Use Only
c. Water Runoff (including stormwater)
(1) Describe the source of runoff (including stormwater)
and method of collection and disposal, if any (include
quantities, in known) Where will this water flow? Will
this water flow into other waters? If so, describe.
No.
(2) Could waste materials enter ground or surface waters?
(f so, generally describe.
No change.
.
d Proposed measures to reduce or control surface, ground,
and runoff water impacts, if any
Not applicable.
4 Plants
a Check or circle types of vegetation found on the site
~ Deciduous tree alder, maple, aspen, other
X Evergreen tree fir, cedar, pine, other
-X Shrubs
-X... Grass
X 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?
No vegetation will be removed or altered in this annexation.
c. List threatened or endangered species known to be on or
near the site.
This annexation is farmland and home sites. To my know-
It:l?gEpfopts~EdrE1anacfs~apPn~~e use of native plants, or other
measures to preserve or enhance vegetation on the site, if
any
Not applicable.
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 ~ ~, eagle, ~birds, oth~
Mammals.~ ear, elk, beaver, other
Fish bass. salmon, trout, herring, shellfish, other
b. List any threatened or endangered species known to be on
or near the site.
There are none.
c Is the site part of a migration route? If 50, explain.
To my knowledge, it is not.
d. Proposed measures to preserve or enhance wildlife, if any
None are required as part of this annexation.
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To be Completed by Applicant
Evaluation for
Agency Use Only
6. .Energy and Natural Resources
a What kinds of energy (electric, natural gas, oi I, 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 are 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) 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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(3) Proposed measures to reduce or control noise impacts,
if any
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8. Land and Shoreline Use
b
What is the current use of the site and adjacent properties? \,
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H;:Js the site been used for agriculture! I f so, describe
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a.
Evaluation for
Agency Use Only
To be Completed by Applicant
9.
c.
Describe any structures on the site.
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Will any structures be demolished? If so, what?
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e.
What is the ,current zoning classification bf the 'site?
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What is the current comprehensive plan designation of the \
site? .:n \~ ""''''~';\\1''\ ~'he... \)".,'oo.."C' ~~oU)~" ~~e~~\: bt)~no.os\e.s
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If applicable, what is the current Shoreline Master Program
designation of the site?
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Has any part of the site been classifi~d an. "environmentally
sensitivell area? If so, specify.
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i.
Approximately how many people would reside or work in the
completed project?
3l'b.
j.
Approximately how many people would the completed project
displace? NO~ .
k.
Proposed measures to avoid or reduce displacement impacts,
if any? h
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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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a. Approximately how many units would be provided. if any?
Indicate whether high-, middle-, or low-income housing.
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b. Approximately how many units, if al)y, would be eliminated?
Indicate whether high-, middle-, or low-income housing.
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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? \
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What views in the immediate vicinity would be altered or
obstructed?
~C>'Ne..
b.
c.
Pr.oposed measures to reduce or control aesthetic~ impacts, if
any
~c~e
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To be Completed by Applicant
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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Evaluation for
Agency Use Only
b Could light or glare from the finished project be a safety
hazard or interfere with views?
\X) .
c. What existing off-site sources of light or glare may affect
your proposal?
No.\ e .
d Proposed measures to reduce or control Ioight and glare
impacts, if any
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12. Recreation
a.
What designated and informal recre..ational opQortunities are ('" ~
in the immediate vicinity? \" "'E\Q.. '-":) 0... \ "b '\..o\e.. ~ 6.~ tt.~~~) ~\..
p().("\", oS\t\ ~c'noc\ ~o..c...~\.',~e~ o...\1o.\.\o..'o\e: \:-1) \::"e... ~u.'o "Co .
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.
~O\U e
b. Generally describe any landmarks or evidence of historic,
archaeological, scientific, or cultural importance known to be
on or next to the site \lJ~l,;;,,~'C"\ ~~e.. c..u.:('('e('\ \. "-~ ~ c.c\3~\-) ~~e.... o..~ a...
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c. Proposed measures to reduce or control impacts, if any
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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. ~~.S()'- \
\to.~ \ \(co..o.
b Is site currently served by public transit? If not, what is
the approximate distance to the nearest transit stop?
Ne.
c. How many parking spaces would the completed project have?
How many would the project eliminate?
~~e
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To be Completed by Applicant
"
Evaluatj.-)n for .
Agency Use Only
d Will the proposal require any new roads or streets, or
improvements to existing roads or streets, not including
driveways? I f 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 contr.o/, transportation
impacts, if any ~~.
15 Public Services
a
Would the project result in
services (for example fire
health care, schools, other)?
No
an increased need for public
p,rotection, police protection,
If so, generally describe
b
Proposed measures to reduce
public services, if any.
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or control direct impacts on
16. Utilities
a
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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SIGNATURE
The above 'answers are true and complete to the best of my knowledge. I understand
that the lead agency is relying on them tq make its decision
Date Submitted 1 0 ll\~"'i q"")...
Signature
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To be Completed by Applicant
Evaluation for
Agency Use Only
SUPPLEMENTAL SHEET FOR NON PROJECT ACTIONS
(do not use this sheet for project actions)
Nonproject proposals are those which are not tied to a specific site, such as adoption of
plans, pol icies, or ordinances.
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.
How would the proposal be likely to increase disct.arge to water,
emissions to air. production, storage, or release of toxic or
hazardous substances, or production of noise?
Proposed measures to avoid or reduce such increases are
2 How would 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
3. How would the proposal be likely to deplete energy or natural
resources?
Proposed measures to protect or conserve energy and natural
resources are
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, flood plains, or prime farmlands?
Proposed 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?
Proposed measures to avoid or reduce shoreline and land use
impacts are
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To be Completed by Applicant
6. How would the proposal be likely to increase demands on
transportation or public services and utilities?
Proposed measures to reduce or respond to such demand (s) are
7 Identify, if possible, whether the proposal may conflict with local,
state, or federal laws or requirements for the protection of the
environment.
.
984 13 (Revise~ 10/4/84)
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Evaluation for
Agency Use Only
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