Environmental Checklist
CITY OF YELM
ENVIRONMENTAL CHECKLIST
Instruct 70ns
The State Environmental POllCY Act (SEPA) requlres all governmental
agencies to consider the environmental lmpacts of a proposal before
making decisions The purpose of thls checkllst 15 to provide
lnformation to help ldentlfy impacts from your proposal, to reduce
or avoid impacts from the proposal if it can be done and to help
the Cltf decide whether an EIS lS requlred .':;n envlronmental
impact statement lEIS) must be prepared for an} proposal with
probable slgnlflcant adverse lmpacts on envlronmental quality
This environmental checklist asks you to descrlbe "'Oine bas c
information aboLt your proposal The City will use this checkllst
to determlne whether the environmental lmpacts of ~our proposal a-e
slgnlficant and requ're preparatlon of an EIS )ou ~ust answer
each question accurately, carefully and to the best of Icur
hno...Jledge ;'.nswer the questions brlefly' but give the best.
descrlptlon YOU can In most cases you should be ab'e to answer
the questlons frcm your own observations or project ~lans without
the need for e)(perts If you do not know the answer 'or 1 T a
quest,on does not appl/ to lour proposal, wrlte co not ~now or
does not appl~ Complete answers to the questlons now may avold
delays later If the space provided is too small, feel free to
attach additional sheets
Some questlons ask about governmental regulations such as zoning
shoreline, and landmark designations Ans\ver these questlons if
you can If YOU have p'oblems the c:ty staff can aSslst IOU
The checkllst questions app'} to all parts of your Droposal e~en iT
you plan to do them over a period of time or on different parce's
of land Attach any additional lnformation that Wi 11 help descrlbe
your proposal or lts environmental effects YOU may be asked to
explain your answers or prOVide additional 'nformatlon for
determinlng if there may be significant adverse imoacts
Nonproject Proposals Only
Complete both the check11st (even though rnany cuesticns may be
answered does not apply) and the Supplemental Sheet for
Nonproject Actions (part D) For nonproJect actlons the references
ln the ckeckllst to the words proJect, aopllcant and property
or Site should be read as proposal proposer and affected
geographic area respectively
CITY OF YELM
CITY USE ONL Y
FEE -_____~~__Q.9
DATE REC D
BY
FILE NO
- j
I
i
I
I
I
ENVIRONMENTAL CHECKLIST
A
BACKGF,OUi'W
Name of proposed proJect, 1 r any
2 Name of applicant
3 Address and phone number of applicant and of any other contact
person
4 Date cneckllst prepared
5 Agency requesting checklist
6
Proposed timing
aap I ; ce.o 1 e)
or
scnedu1e
includlng
pnaslnQ
; f
7
Do YOU have any p I ens for
further acti~ltv related to
fut'..Jre addltions
or connected with
exoans i on o;~
th,s proposal?
If yes explain
8
List any environmental ,nformation
been preaared or wlll be prepared
pr'oposa 1
/ou k~GW abcut that nas
directl; ~eiated tc thiS
9 Do you ~now whether applications are pendlng for governmental
approvals of other proposals directly affecting the property
covered by your proposal? If jes explain
10 List any government approvals or perm,ts that Will be needed
for your proposa I if known
CrTY OF YELM ENVIRONVENTAL CHECKLIST
forms\sepa
PAGE
11 G,ve brleT complete description of your proposal including
the proposed uses and the size of the project and site There
are several questlons later in this chechlist that ask you to
describe certain aspects of your proposal You do not need to
repeat those answers on this page
12 Location of the proposal Give sufficient lnformatlon for a
per"son to understand the preClse location of your pr"oposed
project Including a street address, if any and section
township, and range if known If a proposal would occur over
a range of aree, prOVide tne range or boundaries of the
site(s) Provide a legal descr'ption site plan VICini!:.;'
map and topographic ~ap if re5sonably availab'e You need
not duplicate maps or detalled plans submitted \.-,Il~h any perml,-
appllcat'ons related to thls chec~list
8 ENVIRONMENTAL ELEMENTS
Earth
a General descrictlon of ~ne 51te (circle one)
flat
rolling
h I 1 1
:3~eep slopes
mounta:nou~
other-
b What 1 s the steepest s lor:e on the site (approx lme,te
percent slope)?
c What general types of soils ar-e found on the slte (fo'
example clay sarHj,9r-avel pe3.t m'_lck)? If you knO'..J the
classlflcation of agr~icultural so'ls speCify them anc
note any prlme farmlard
d
Are tnere surface indlcations or
SOliS ln the Immediate Vlclnity~
history of unstable
If so, describe
CITY OF YELM ENVIRONMENTAL CYECKLIST
forms\sepa
PAGE 2
e Descrlbe the purpose type and approximate quantities of
any fill ing or gradlng proposed Indicate source of
f 1 1 1
f
Could erosion
constructlon or
occur
use'>
as a result of clearing
If so, generally descrlbe
9 About what percent of the site will be covered with
lmperViOUS surfaces after project construction such as
asphalt or buildlngs?
h Proposed measures to reduce or control erOSlon, or other
lmpacts to the earth if any
2 Air
a What types of emissions to the air would resul: from [ne
proposal (i e dust automob,le exhaust, odors
lndustrlal wood sMoke) durlng construct'on and when ~ne
pro~ect is completed? If any G,:enerally describe and
give approximate quantltles if known
b
f:.,re
tnere any off-slte sources
affect your proposal? If
'"
0:
emISSions or odor ~nat
genera'!v describe
ma\!
so
c Proposed measures to reduce or control emissions or other
imD8cts to alr If any
3 Water
a Surface Water
1) Is there any surface water body or wetiand on or ,n :ne
immediate vlcinitv of the site (includ~ng year-round and
seasonal stree,ms saltwater lakes ponds)? If \,es
describe type and provlde names State what stream or
river it flows Into?
CITY OF YELM ENVIRONMENTAL CHECKLIST
forms\sepa
PAGE 3
2) Will the project require any work over in or adjacent
to (within 300 feet) the descnbed waters? If yes
please descr,be and attach available plans
3)
Est,mate
would be
'"Jet lands
affected
the amount of fll! and dredge materlal the,t
placed In or removed from surface water or
and ,nd,cate the area of the site that would be
Ind,cate the so~rce of fill material
4)
Will the pr'oposal requIre surface water
d,verslons? G,ve general descrlotion
approxImate quant,t,es If vnown
Wl thcl~awa 1 s or
pur Dose and
5) Does the proposal l,e wi~h'n a 'GO-year floodplain"" ~t
so note elevation on the slte pian
6 )
Does the prODosa 1 1 rvo 1 \;e
materIalS to surface waters~
waste and antlcloated volume
any discharges
If so deser lbe
of d,scharge
of \oJaste
the type of
b Grouncwater
1) W,ll groundwater be wlthcira',.;n or will water be
discharged to grcund',.Jate""" Give general descrIption
purpose and appro~imate quantities if known
2) Descrlbe the underlYIng aquifer with regard to quallty
and auantity sensitivity protection recharge areas
etc
3) Descrlbe waste material that will be dlscharged into or
onto the ground from sept,c tan~s or other sources If
any (such as domestlc sewage. industr,al byproducts.
agricultural chemlcals)
CITY OF YELM ENVIRONMENTAL CHECKLIST
forms\sepa
PAGE 4
c
Water Runoff (lncluding storm water)
Descrlbe the source of runoff (lncludlng
method of collection and disposal
qua n tit 1 e s 1 f f- n 0 y n ) '-II her e w I lit h : s
this water flow lnto other waters? If
storm water) and
lT any (include
water fim-':? Will
so describe
2) Could "'Jaste materlals enter grounj or surface waters? ::Lf
so generall~ describe
d Proposed measures to reduce or =ontrcl su~face ground
and runoff water Impacts
1T any
4 Plants
a
Check or clrcle types
+'
0,
\egetatlon
rcur"':c
on
t r:e
~ ' +- C:
'- 1 ......,_
deciduous tree
evergreen tree
:::;hrubs
a'rigr ~ao e oa~
aspen, other
f OJ (' cedar"' 01 ne
:;t--er
gr25se2
pasture
c r 0 p S 0 r g r a 1 n s'
\vet so:l plants catt.all but:ercup bulrush
skun~ cabbage other
\,.Jater plants water ili/ eelgrass mi1foii other
other types of vegetatlon
b What Kind and amount of vegetatl~n wlll be removed or
altered?
c List threatened or endangered species kno~n to be on or
near the Site
d
Proposed
measures
if any
landscaping
to preserve
use of native alants
or enhance vegeta~io~ on
or other
the slL::
5 Animals
a Circle any birds and anima s which have been observed on
or near the site or are known to be on or ne~r the Site
birds
hawk heron ducks eagle songbirds
other
mammals
fiSh bass
deer bear
salmon
elk
trout
beaver other
shellfish other
CITY OF YELM ENVIRONMENTAL CHECKLIST
forms\sepa
PAGE 5
b List any priority, threatened or endangered species known
to be on or near the slte
c
Is the site part of a m1gration route?
If so e,,<plal1:
d
Proposed '7Ieasures to ereserve or enhance '..fl!dlife
~ T
any
6 Energy and Natural Resources
a What kinds at energy (electrlc natural gas gasollne, heating
011 wcod solar etc ) wi 11 be used to meet the completed
proJect's energy needs? Descr,be whether it ~111 be used for
heatlng manufacturlng transportatlon etc
b
Would
enerGY
descr' l te
y o",r
bv
pro~ect
. . ,
aelac.enc;
affect the potent:3.
prope!~les~ If
use
Of sOiar
.-::enera 11 I
30
c What ~1nds of energy conservatlon features are lncluoed
Ii! the ola.ns of thcs proposal? L.ist o_her proposed
measures to reduce or control energy impa,::;ts !! an'/
7 Environmental Health
a Are the rea n;/ en \/ 1 r 0 n men c; a n e a 1 t h h a ::: a r d sin c 1 u d " n 9
e~pOSLire to tO~lC chemlcals risk of f re and e~plos'on,
sp ill::
of th1s
of hazar deus waste that could
proposal? If so descr,be
occur as a result
1)
Descr1be
required
special
emergency
serVlces
.. J..
LnaL
. 'J...
mlgnL
be
2) Proposed meaSc..ires La reeuce or contro 1 en', 1 ronmenta
health ha::ards
If any
b
1)
Noise
What types of nOlse eXlst
your project (for example
other)?
in the area which may affect
traffic equip'7lent operation
CITY OF YELM ENVIRON~ENTAL CHECKLIST
forms\sepa
PAGE 6
2) What types and levels of n01se would be created by or
associated w1th the project on a short-term or a long-
term basis (fer example traffic construction
e~eratlon other)0 Indicate what hours n01se would come
from the site
3)
Proposed measures to 'educe or con~ro! nOlse lnpacts
ani
l f
8
Land and Shoreline Use
a INhat 15 the current use of
the s~te and adjacent
Dr'oe:ert les'")
b
Hes the site
ag,-'cu't....!re or
been
used
forestry'?
-.,:
..L,
for
so
m1nerai
excavation
deSCr'lce
c Descrlbe ani structures en the site
d
W~ll an~ ~trLlctLi-e3 be demol1shej~
1..T so what"'l
e What 1S the current comDrehenSlve pian deSl;nat1on at ,:he
slte?
T W~at IS the current zoning class,f,cat'cn af the s1te
9 If applicable y.Jhat 15 the current shc~"'ellne master
program designation of the site~
h Has any' part of the Site been class1fled as a nature!
resource critical or environmentally sensitive
area? If so, speCify
Appro,imately ho~ many people would reSide or work 1~ tre
ccmoleted project0
.J ApDrox1mately how manv people would the completed proJect
d'splace?
I-
i'-
Proposed
ImDacts
measures
If any'
to
avoid
or
reduoe
d i sp 1 acerr,en t
CITY OF YELM E~VIPONMENTAL CHECKLIST
forms\sepa
PAGE 7
Proposed measures to ensure the proposa lis compat i b 1 e
with eX1stlng and projected land uses and plans lf any
9
Housing
a Aooro~lmatelY how many
Indlcate whether high
units would be provided If ar~?
mlddle or lOW-income housing
b
ApproX1mately how many unlts
eliminated" Indlcate whether high
housing
if ani
middle or
\..Jou 1 d ~.P
lOW-income
c Proposed measures to reduce or control housing imoacts
if any
10
Aesthetics
a What 1S the
. -.., ,
ta! iese
:ie~ght
Of
an ./
~rooosed structure 51
no'C lncludlnJ e~ntenne.s, l..j~B.t lC:. the pr"!nclpal exter-:or
bUilding materlal(3) p~oposed~
b Whs: Views ln tre lmmecoate vicinlty wou'j De alteree or
oDstructed?
c proposed measures to reduce or contra aestr,et ic 1!T;~;aC"::5
if any
1 1
Light and Glare
a What type of
What time of
l' . .
,lgnt or
day would
glare \,nll
it ma nly
the proposai
occur"
P('OCUCi~r'\
b
Could light or giare from the
safety hazard or lnterfere with
F . , ,
,lnlsnea
Views"
project
t;.e
a
CITY OF YELM ENVIRONMENTAL CHEC~LIST
forms\sepa
P'''''''-
'-',\.;:C
8
c What existlng off-site sources of light or glare may
affect your proposal?
d
Proposed
Impacts,
rneas:Jres
If anj'
to
reeuce
or control
1 i gh t and
g-:are
12 Recreation
a What designated and lnfermal recreational opportunit'es
are In the lmmedlate V'clnltj'~
b
Would the
p r' oposed
re~reatlonal
uses?
T"':
-l..~
proJect ~lsp'ace
so descr' 1 be
an I
eXIS1:ing
cPr oposed measur es te r educe or con t ro '1 1 mDac t s or p [~OV i 'je
recreation opportunities
13
Historic and Cultural Preservation
a Are there any places or ODJects li3ted on or
for natlorl3.1 st3.te or lcca1 ~rese.:v3.tion
Known to be on or ne<t to the site? If so
de3crlbe
propcsed
registers
generallY
b Generally cescrlbe an; landmari<s or eVlc.:ence of hlstorlc
archeo'ogical SCientific or cultural lmoortance known
to be on or next to the slte
C
Proposed measures to rejuce or control Impacts
If any
14 Transportation
a Identify side\..;alks trai ls Dubl ic streets and hlgh\..;a;,'s
serving the site and des::rlbe proposed access to the
eyistlng street system Show on Site p-ans if any
b
Is sete current-;
means~ If not what
served bj' public transit? B'I \.-/hat
plans eXist for transit serv'ce~
C '-{ow many pad' ,rig spaces would the completed project have?
How many would the project ellmlnate?
CITY OF YELM ENVIRONMENTAL CHECKLIST
forms\sepa
PAGE 9
d IN1ll the proposal require any new sidewalks trails
roads or streets, or ,nprove~ents to existlng sidewalks,
trails, roads or streets not including driveways? _,
so, generally describe ('ndicate whether public or
private)
e
'v-I1ll the project
of) water rall
describe
use (or occur In the 1mmedlate
or air transportation" If so
vicinity
general'>
f
How many vehlcular trios
the completed project"
volumes would occur
per day would be generated by
If ~nown ,ndicate when pea~
g
Procosed
lmpacts
measur'es
to
reduce
or
control
transportatlcn
- ..:
I! any
-'! c:.
:;..i
Public Services
a Would the project result ii
services (for e'c."!c."e
protectlon hearth care
generally describe
an 'ncreased need ;or public
fire protection police
schools other)~ ~~ so
b Proposed measures to reduce or control dlrect imoacts on
public services If any
16 Utilities
a Circle utilities currently available at the site
electriclty, natural gas water, refuse service
telephone san1tary sewer septic system other
b Oeser ibe the ut 111 ties tn?-t e.re proposed for the project
the utility providing ~ne service and the genera
construction activities on the Site or ,n the immediate
vicinity WhlCh mlght be needed
C SIGNATURE
The above answers are true and complete to the best of my
~nowledge I understand that the City of Yelm lS relYlng on
them to make lts decision
Signature
Date Submitted
CITY OF YELM ENVIRONMENTAL CHECKLIST
forms\sepa
PAGE 10
. ... ..
SUPPLEMENTAL ENVIRONMENTAL CHECKLIST FOR NONPROJECT ACTIONS
(Do not use this sheet for project act,ons )
When answerlng these auest,ons, be aware of the extent of the
Droposal or the types of act,v,ties l,vely to result from the
proposal woulj affect the item at a greater intens,ty or at a
faster rate than lf the proDosal were not Implemented Respond
briefly and In general terms
How would the proposal be likel'! to Increase discharge to
water emissions to air, production storage or release or
toxIc or hazardous substances, or production of nOIse?
Proposed measures to avoId or reduce such Increases are
2
Ho~ would the proposal be l,hely to affect plants
fish, or mar,ne ',fe?
anlmals
Proposed measuI'es to protect or conser've 0 1 ants
fish or marine l,re are
a.nima:s
3 How would the proposal De likely to deplete energy or natural
resources?
Proposed measures to protect or conserve energy and natural
resources are
/
4 How would the proposal be l,kely to use or affect cr,t,ca' or
environmentallv sensitive areas or areas designated (or
eligible or under study) for governmental protection such as
parks, WIlderness \..,.,ld and scenic rivers threatened or
endangered soecies hab,tat historic or cultural sltes
wetlands floodpla,ns or natural resource areas?
CITY OF YELM ENVIRONMENTAL CHEG~LIST
forms\sepa
PAGE 11
1 .. .
Proposed measures to protect such resources or to avoid or
reduce impacts are
5
How would the proposal De likely to affect
use including \-Jhether It would allow or
shorellne uses lncomoatible with eXlsting
land and shorellne
encourage land or
plans?
Proposed measures to avoid or reduce shorellne and land Lse
lmpacts are
6
How wou 1 d the pr ooosa 1
transportation or public
be llf~ell to increase
serVlces and utilit'es~
demands
en
Proposed measures to reduce or reEcond to such demanars) are
7
Identlfy if Dossible whether the
local, state or federa: laws
protection of the enjlrOnment
proposal may confllct
or requ"rements for
w , ,~n
':.he
CITY OF YELM ENVIRONMENTAL CHEC~LIST
forms\sepa
PAGE 12
-~----~---------~ -- ~ ~----
\ - -----------------
\ '
.,\
, \
,-;' \ \
.~ "'~~ ~
_ a. -fla+ }~";; ef s /0 r e. ~;~
p Db ..., 41"" I'(n f)~
t, cl'1- f sr" d If r& vIY1 '?r-"r
d ~ 1~\Dn e-
f, '~ f)
't' \ o",e-
h \h 0 VI e-
~ ~\ ~ 0 Vl e-
\ .
b\ V\ 0
/ U JJ IA
3,. fr- n t?
p
!}. ..H "
s IV; :-
filA
~\ N /A
~\ IV/A
.:B~ NO
? '\ ' ..r
\
\
e\ I I'J6
\.;1. 'f'C! $ S ~ bJ't'
D\ J. tlJA
\
I, .;;. -
~ 1"" Ifp (" fORk) rl ~) p;" e.
1\ \ I -
...'::.,~~~~
\ - ::-~-- -
\ -----
\ -::
d () yv' e ~ 1" " c...
~
, \
St1..e>+erh br1>t)t'l'"
\
~ .~ a-~ eo
~ ;von V
~ _~c~ ---
~.- ----- - -. - -
-- - - ----------
- --' -' -~--------- ..----------- ~
-.- -.----- ~- ~
\
\
\
\
\
\
\
\
L"'\
~\~
\ b
t
!
\ cJ
PI 'a"
:5Pn t Ie> I ...ds / h" ~ ',t'So
-IfYl I, Y"'l t{ I .t 1'1 .J "l e..
f Ish
V7 () n e:.
\
tv 0 l'\ e.-.
No
M 1} Itl e.,.
!Ilk
NjA
N/I~
rJO '\ .
~ I'IJ". ~
N/A '"
fill-< "
~ f'J/~
S~ tJ / k
/
\
\ e. '
1\'- fI/A
1\ '" tJ/A ~
\ b ' NIp.,
\ I'
\ (!,.
\ /
J N/~
/ Il N /1:"
r ' N/A
P' Atlo t'i e-
b NO
\ c. tJ~ VI ~
\
l' /VItA
/4 fI o-t ~ p"',) ') e pT
I \'" & /.. ,,1-... I C _'e. c.' I . ,I 1.1:-
t> w. t' Q r '" "'r e-t
-
..."" .,-..... . ../. .....--.. .........................
------------- -- ~ ----- -
--- -- .-.-.------.- ~ --
.r-/// .
,
\
}.\ ti,'h H} e. 1,.-vJ P 4.:. -r-
\!? tfJPr"
~j "'.:>, I .:, r' GO 1"
~ ~:I1'r;$;::
\
IV ti ~ h Ci ~r ~) I n ~
tl'O.,e
Wro
J
\
1:
\
:
\
\
\
\
\
1
-'- - ~- --- -------- --- ---- -- -
- -~ -~---------------~--~