Environmental Checklist (2)
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ENVI RONMENT AL CHECKLIST
Purpose of Checklist
The State Environmental Policy Act (SEPAl, 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 lido not knowll or IIdoes not apply. II
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 a significant adverse impact.
Use of Checklist for Nonproject Proposals
Nonproject proposals are those which are not tied to a specifie site, such as adoption of
plans, pol ieles, or ordinances. Complete this checklist for non project proposals, even
though questions may be answered "does not apply. II In addition, complete the
Supplemental Sheet for Nonproject Actions (Part D).
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For nonproject actions, the references in the checklist to the words IIproject,1I
"applicant, II and IIproperty or site" should read as IIproposal, II IIproposer, II and lIaffected
geographic area, II respectively.
Thurston County Planning Department
Olympia Planning Department
Lacey Planning Department
$75.00
65.00
60.00
Submit one (1) copy of all site plan(s). The maximum size of maps shall be
1111 x 1711 on black line paper.
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ENViRONMENTAL CHECKLIST
2.
Proponent (c)
* * * * * OFFICIAL USE ONLY * * * * *
1.
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Jurisdiction TC
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L ,Other
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SEPA It (a)
Case It (b):
Related Cases
Submittal Complete
By
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Phone 2- C/C J -pO '1
Date Received
Information Requested
3. Property Address or location (e)
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4. * S/T/R (f) ffl.'7ab f r ,ll('!f,(')O. ~ ,
5. Tax Parcel Il ~) :D7JDII() '/0 J '-r:~
(AM rnht1" =? 6. Total Acres:. 1./ f:;~ nl2ed 107
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7. Permit Type ~
8. Zoning:..Ol, ~
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9. Shoreline Environment: ~
10. Water Body ~
11. Brief Description of t
Proposa I (d)
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· * * * · OFFICIAL USE ONLY * * * * *
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13.
Estimated Completion Date:
List of all Permits, Licenses or Government Approvals Required for the Proposal
(federal, state and local--includingrezones)
14.
(fry, -(Y) r)ffJe).;06>),')tv?I?
15.
Do you ave any plans for future additions, expansion or further activity related to or
connected with this proposal?~n.
Do you know of any plans by others which may affect the property covered by your
proposal? If yes, explain
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16. Proposed timing or schedule (including phasing, if applicable)
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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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ENVIRONMENTAL ELEMENTS
To be Completed by Applicant
1 . Earth
General description of the ,site (circle one). ~rOlling,
hilly, steep slopes, mountainous, other ,
a.
b.
What is the steepest slo'pe on the site (approximate percent
slope)? V~
c.
What general types of solis 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 far nd.
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^' there ,ur~ hl,tory of un,table ,on, in
the immediate vicir:llty? If so, describe.
d.
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e. Describe the purpose, type, and approximate quantities of
any filling or grading proposed. Indicate source of fill.
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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 bU~.
h. Proposed measures to reduce or control erosion, or other
impacts to the earth, if any
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2. Air
a.
What types of emissions to the air would
proposal (i.e., dust, automobile, odors;
smoke) during construction and when
completed? I f any, generally describe and
quantities if known.
result from the
industrial wood
the project is
give approximate
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b. Are there any off-site sources of emissions or odor that may
affect your proposal? If so, generally describe.
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c. Proposed measures to reduce or control emissions or other
impacts to air, jf any
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Evaluation for
Agency Use Only
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To be Completed by Applicant
3. Water
Evaluation for
Agency Use, Only
a. Su rface
(1) Is there any surface water body on or in the immediate
vicinity of the site (including year-round and seasonal
strea.ms, 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,
p'lease describe and attach available plans.
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(3) Estimate the amount of fill and dredge material that
would be placed in or rell10ved from surface ~ater or
wetlands and indicate the area of the site that would be
affected. Indicate the source of fill material.
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(4) Will th~ 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 lOa-year flood plain? 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 approximately quantities if known.
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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 s~ie 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. ,~~ // ~ ~
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To be Completed by Applicant
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.
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Evaluation ' for' ,
Agency Use Only .
(2) Could waste materials enter ground or surface waters?
I f so, generally describe.
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d. ~ Proposed measures to reduce or control surface,
and runoff water impacts, if any:
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ground,
4.
Plants
..-- a.
Check or circle types of vegetation found on the site
;K: Deciduous tree: alder, maple, aspen, other
- Evergreen tree fir, cedar, pine, other
- Shrubs
:::x Grass
-X Pasture
Crop or grain
~ Wet soil plants: cattail, buttercup, bullrush, skunk
- cabbage, other
Water plants' water lily, eelgrass, mi/foil, other
:K Other types of vegetation
b. ;What kind and amount of vegetation will be removed or
altered? I /t.M. ~
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 hear the site
Birds. hawk, heron, eagle, songbirds, other:
Mammals: deer, bear, 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.
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c.
Is the site part of a migration route? If so, explain.
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Proposed measures to preserve or enha~ 'Wildlife, if any
d.
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To be Completed by Applicant
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 YO'ur 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 ,hazi\lrds, 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
required. ...
emergency services that might be
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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 (f-or example' traffic, equipment,
operation, other)?
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(2)
What types
associated
long-term
operation,
come from
and levels of noise would be created by or
with the project on a short-term or a
basis (for example traffic, construction,
ot/'ler)? Indicate what hours noise would
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 ~se of the site and adjacent properties?
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b. Has the site been used for agriculture?" If so, describe.
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Evaluation for
Agency Use Only
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To be Completed by Applicant
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Evaluation for '\-
Agency Use Only
Describe ~ny structures on the site. /',~ /J. Jl ./"
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Will any structures be demolished? If so, what?
c.
d.
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the current :,pning c1assificat~on of the site?
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is the current comprehensive plan designation
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of the
What is
f.
What
site?
g.
If applicable, what is the current Shoreline Master Program
designation of the ,sit~? H//!-
Has any part of the site been classified an "environmentally
sensitlve"area? If so, specify.
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Approximately how many people would reside or work in the
completed project1 ;:l/ /f-
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Approximately how many people would the completed project
displace?
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Proposed measures to avoid Or reduce displacement impacts,
if any? I'Y#',' .
Proposed measures to ensure .to ~POsal 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- i 0; ~w-jncome housing.
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b. Approximately how many units, if any, 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 Jf1-- i 1\,
1 O. Aes thetics
What is the tallest height of
including antennas, what is
material (s) proposed?
structure(s), not
exterior building
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a.
any proposed
the principal
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What views In the Immediate vicinity would 'be altered or
obstructed? -JJ//J- I
Proposed measures to reduce or control aesthetic impacts, if
any 7t/A
b.
c.
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To be Completed by Applicant
11. Light and Glare
Evaluation for
Agency Use Only
a.
What type of light or glare will the proposal produce? What
time of day would it mainly occur?
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Could light or glare from ;h{ fi~ish~d project be a safety
hazard or interfere with views~~
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What existing off-site sources of light or glare may affect
your propo.." ~
Proposed measures to reduc~or~ntrol light an~ ~;are
impacts, if any. ~
b.
c.
d.
12. Recreation
a.
What desi,gnated and informal recreational opportunities are
in the immediate vicinity?
b.
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displace any
existing recreational
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Would the proposed project
uses? I f so, describe.
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c.
Proposed measures to reduce or control
recreation, including recreation opportunities to
by the project or applicant, if any -b1 M
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impacts on
be provided
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 si~,e? If so, generally describe.
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b.
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Generally describe any landmarks or evidence of historic,
archaeological, scientific, or cultural importance known to be
on or next to the site.
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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
des,cribe, proP,o,ed aeee" to ~exi,tin9 ,treet ,:>,"em. / 1
sho~on~z. '46y. ~;i dev~ r9D7 r cuuy
Is site currently served by public transit? If not. what is
the approximate distance to the nearest transit stop? I ~,
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b.
c.
How many parking spaces would the completed project have?
How many would the project eliminate?
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Evaluation fol"
Agency Use Only
To be Completed by Applicant
d.
Will the proposal r.equire 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). 7f,!1f I
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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How many vehicular trips per daY~~~ld be generated by the
completed project.? If known, indicate when peak, volumes
would occur.
f.
g.
Proposed measures
impacts, if any
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reduce or control
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to
transportation
1 S. Public Services
16. Utilities
a.
Would the, project result in
services (for example' fire
health care, schools, other)?
an Increased need for public
protection, police protection,
If so, generally describe
or~ol direct Impach on
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b.
Proposed measures to reduce
public services, If any.
1,
a.
th~ sl.ts._", ~ctrici~)
~ph~" sa'n'itary
b.
Describe the utilities that are
utility providing the service,
activities on the site or in the
be needed.
proposed for the' project, the
and the generql construction
imm~diateJX::Z;~
SIGNATURE
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.
Date Submitted ~-
2-3 f~jgnature ~
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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.
1. how would the proposal be likely to increase discharge 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
S. 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 utillities?
Proposed measures to reduce or respond to such demand(s) are
7. Identify, if possible, whether the proposii!1 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 '0'
Agency Use Only