HomeMy WebLinkAboutECF_Environmental_Checklist_190710_v1.pdfarea," 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.
A. BACKGROUND hel
1. Name of proposed project, if applicable: JbLel
2. Name of applicant: hel
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3. Address and phone number of applicant and contact person: Jhel
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4. Date checklist prepared:Itg_[pl
5. Agency requesting checklist: Jhel
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6. Proposed timing or schedule (including phasing, if applicable): JbLel
7. Do you have any plans for future additions, expansion, or further activity related to or
connected with this proposal? If yes, explain. Jhel
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8. List any environmental information you know about that has been prepared, or will
be prepared, directly related to this proposal. Jhel
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. JLel
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10. List any government approvals or permits 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 this form to include additional specific information on
project description.) hel
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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. Jhel 0 q La L' i I � d N -C— � VV
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B. ENVIRONMENTAL ELEMENTS JbLel
1. EARTH
a. General description of the site Jhel
(check or circle one): lat, oiling, hilly, steep slopes, mountainous, other
b. What is the steepest slope on the site (approximate percent slope)?h[ g
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. ihgjpl
d. Are there surface indications or history of unstable soils in the immediate vicinity? If so,
describe. hel
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.hI elpl
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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 buildings)?hf elpl
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h. Proposed measures to reduce or control erosion, or other impacts to the earth,
if any: JhLel
2. AIRhf elp1
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. 1hel
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b. Are there any off-site sources of emissions or odor that may affect your proposal? If so,
generally describe. 1hel I d 0
c. Proposed measures to reduce or control emissions or other impacts to air, if any:h[ elpl
3. WATER Jbgel
a. Surface Water:
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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. hel
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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.hf elpl
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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. 1hel
4) Will the proposal require surface water withdrawals or diversions? Give general
description, purpose, and approximate quantities if known.h[ elpl
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5) Does the proposal lie within a 100 -year floodplain? If so, note location on the site
plan. 1hel N 0
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. hf elpl
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b. Ground Water:
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 general
description, purpose, ann�``
dapproximate 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 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. hel
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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. JLLel
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2) Could waste materials enter ground or surface waters? If so, generally l
describe. hel 4�`' hA_1�AIV.dC?Ks w,,,;LS�� w pw� GI
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3) Does the proposal alter or otherwise affect drainage patterns in the vicinity of
the site? If so, describe. Jhel
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d. Proposed measures to reduce or control surface, ground, and runoff water, and drainage
pattern impacts, if any: hel
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4. PLANTS 1hel
a. Check the types of vegetation found on the site: 1hel
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
b. What kind and amount of vegetation will be removed or altered? hel
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C. List threatened and endangered species known to be on or near the site. Jhel
d.
Proposed landscaping, use of native plants, or other measures to preserve or
enhance vegetation on the � slIite, if any: hf elpl
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e. List all noxious weeds and invasive species known to be on or near the site.hf elpl
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5.
ANIMALS h[ elpl
a. List any birds and other animals which have been observed on or near the site or
are known to be on or near the site. LbLel
Examples include:
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.
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c. Is the site part of a migration route? If so, explain. hel
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d. Proposed measures to preserve or enhance wildlife, if any: hel
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e. List any invasive animal species known to be on or near the site. hf elpl
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6. ENERGY AND NATURAL RESOURCEShf elpl
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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. Jhel
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b. Would your project affect the potential use of solar energy by adjacent properties?
If so, generally describe. JLel
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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: h[ elpl
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7. ENVIRONMENTAL HEALTH Jhel
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 If so, describe. hel f I��l rn�I-& I I' L \vu ds �VWC4� s
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1) Describe any known or possible contamination at the site from present or past uses.
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2) Describe existing hazsrdods �d'Vi aIs onPtYonsV m htff affect project
development and design. This includes underground hazardous liquid and gas
transmission pipelines located within the project area and in the vicinity. h1
3) Describe any toxic or hazardous chemicals that might be stored, used, or produced
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during the project's development or construction, or at any time during the
operating life of the project. ibgjpl
4) Describe special emergency services that might be required.hf elpl
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5) Proposed measures to reduce or control environmental health hazards, if any: !2el
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b. Noise 1hel
1) What types of noise exist in the area which may affect your project (for example:
traffic, equipment, operation, other)? hel
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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 hours noise would come from the site. 1hel
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3) Proposed measures to reduce or control noise impacts, if any:hf elpl
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B. LAND AND SHORELINE USE JgjpJ
What is the current use of the site and adjacent properties? Will the proposal affect
current land uses on nearby or ad' cent properties? If so, describe. hel
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Rev: 08/2016
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 as a result 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 non -forest use? hel 11
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: hel
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C. Describe any structures on the site.h( elpl
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d. Will any structures be demolished? If so, what?hf glpl
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e. What is the current zoning classification of the site? Ittlo
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f. What is the current comprehensive plan designation of the site? 1hel
g. If applicable, what is the current shoreline master program designation of the site?hf elpl
h. Has any part of the site been classified as a critical area by the city or county? If so,
specify. JhgjpJ
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i. Approximately how many people would reside or work in the completed project?[Lel
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j. Approximately how many people would the completed project displace? LtLel
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k. Proposed measures to avoid or reduce displacement impacts, if any: hj elpl
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I.
Proposed measures to ensure the proposal is compatible with existing and projected land
uses and plans, if any: Jhel
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m.
Proposed measures to reduce or control impacts to agricultural and forest lands of long-
term commercial significance, if any: Jhel
9. HOUSING Lhel
a. Approximately how many units would be provided, if any? Indicate whether high, middle,
or low-income housing. Jhel
b. Approximately how many units, if any, would be eliminated? Indicate whether high,
middle, or low-income housing. Jhel
c. Proposed measures to reduce or control housing impacts, if any: 1hel
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10. AESTHETICS Lhel
a. What is the tallest height of any proposed structure(s), not including antennas; what is
the principal exterior building material(s) proposed? hel
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b. What views in the immediate vicinity would be altered or obstructed? hf jp
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c. Proposed measures to reduce or control aesthetic impacts, if any: h[ elpl
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11. LIGHT AND GLARE[help]
a. What type of light or glare will the proposal produce? What time of day would it mainly
occur? hel �I
b. Could light or glare from the finished project be a safety hazard or interfere with views?
hel
c. What existing off-site sources of light or glare may affect your proposal? Itg1121
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d. Proposed measures to reduce or control light and glare impacts, if any: hf elpl
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12. RECREATION JbLel
a. What designated and informal recreational opportunities are in the immediate vicinity?
hel 0 un D .
b. Would the proposed project elpl
oject displace any existing recreational uses? If so, describe. hf
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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:hf elpl
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13. HISTORIC AND CULTURAL PRESERVATION.[helpl
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. 1hel
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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.
nlhel
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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.hf elpl 0o
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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. JtgjpJ
14. TRANSPORTATION hel
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. hel
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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? hel
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c. How many additional parking spaces would the completed project or non -project
proposal have? How many would the project or proposal eliminate?hf jP
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d. 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). hel
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e. Will the projector proposal use (or occur in the immediate vicinity of) water, rail, or air
transportation? If so, generally describe. hel
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f. How many vehicular trips per day would be generated by the completed projector
proposal? If known, indicate when peak volumes would occur and what percentage of the
volume would be trucks (such as commercial and non -passenger vehicles). What data or
transportation models were used to make these estimates? hf elpl
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H:\CED\Data\Forms-Templates\Self-Help Handouts\Planning\envchecklist.doc � I' f A� O �n�+ Rev: 08/2016
g. 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. hel
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h. Proposed measures to reduce or control transportation impacts, if any:hf elpl
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1S. PUBLIC SERVICES hel
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. 1hel �J
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b. Proposed measures to reduce or control direct impacts on public services, if any. h� elpl
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16.
UTILITIES hel
a. Circle utilities currently available at the site: Jbel
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natural gas,
water,
refuse s�ervi
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r
septic system,
other
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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. Jhel (2 i
C. SIGNATURE JbLel
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.
Proponent Signature;
___���
Name of Signee (printed): _ (�iJt 5 Sn�/cam
Position and Agency/Organization: /so-,"i9y
Date Submitted: 5 1 I'l 111
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