HomeMy WebLinkAboutPC-Enviro_ChecklistCITY OF.
DB V'
WASHINGTON Planning, Building, and Community Department
ENVIRONMENTAL CHECKLIST
1. Name of proposed project, if applicable:
2. Name of Applicant:
3. Address and phone number of applicant and contact person:
Applicant: Agent (if applicable):
4. Date checklist prepared:
5. Agency requesting checklist:
6. Proposed timing or schedule (including phasing, if applicable):
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.
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.
10. List any government approvals or permits that will be needed for your proposal, if
known.
11. Give a 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
ENVIRONMENTAL CHECKLIST Page I of 13
Environmental Checklist (continued)
TO BE COMPLETED BY APPLICANT
checklist that ask you to describe certain aspects of your proposal. You need not
repeat those answers on this page.
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.
B. ENVIRONMENTAL ELEMENTS:
Earth:
A. General description of the site (circle one): Flat, rolling, hilly, steep slopes,
mountainous, other.
B. What is the steepest slope on the site (approximate percent slope)?
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.
D. Are there surface indications 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.
F. Could erosion occur as a result of clearing, construction, or use? If so, generally
describe.
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Environmental Checklist (continued)
TO BE COMPLETED BY APPLICANT
G. About what percent of the site will be covered with impervious surfaces after
project construction (for example, asphalt or buildings)?
H. Proposed measures to reduce or control erosion, or other impacts to the earth.
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 know.
B. Are there any off-site sources of emissions or odors that may affect your
proposal? If so, generally describe.
C. Proposed measures to reduce or control emissions or other impacts to air, if any:
3. 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.
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.
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.
4) Will the proposal require surface water withdrawals or diversions? Give general
description, purpose, and approximate quantities if known.
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Environmental Checklist (continued)
TO BE COMPLETED BY APPLICANT
5) Does the proposal lie within a 100-year floodplain? If so, note location on the site
plan.
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.
B. Ground:
1) Will groundwater be withdrawn, or will water be discharged to groundwater?
Give general description, purpose, and approximate quantities if known.
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 any
toxic 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) is (are) expected to serve.
C. Water Runoff (including storm water):
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.
2) Could waste materials enter ground or surface waters? If so, generally describe.
D. Proposed measures to reduce or control surface, ground, and runoff water
impacts, if any:
4. Plants:
A. Check or circle types of vegetation found on the site:
deciduous tree: alder, maple, aspen, other.
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Environmental Checklist (continued)
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? evergreen tree: fir, cedar, pine, other.
? shrubs.
? grass.
? 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?
C. List threatened or endangered species known to be on or near the site:
D. Proposed landscaping, use of native plants, or other measures to preserve or
enhance vegetation on the site, if any:
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: geese, ducks, crows, etc.
Mammals: deer, bear, elk, beaver, other: coyote, raccoon, possum, etc.
Fish: bass, salmon, trout, herring, shellfish, other:
B. List any threatened or endangered species known to be on or near the site.
C. Is the site part of a migration route? If so, explain.
D. Proposed measures to preserve or enhance wildlife, if any:
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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Environmental Checklist (continued)
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B. Would your project affect the potential use of solar energy by adjacent
properties? If so, generally describe.
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:
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.
1) Describe special emergency services that might be required:
2) Proposed measures to reduce or control environmental health hazards, if any:
B. Noise:
1) What types of noise exist in the area which may affect your project (for example:
traffic, equipment, operation, other)?
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.
3) Proposed measures to reduce or control noise impact, if any:
8. Land and Shoreline Use:
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Environmental Checklist (continued)
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A. What is the current use of the site and adjacent properties?
B. Has the site been used for agriculture? If so, describe:
C. Describe any structures on the site:
D. Will any structures be demolished? If so, what?
E. What is the current zoning classification of the site?
F. What is the current comprehensive plan designation of the site?
G. If applicable, what is the current shoreline master program designation of the
site?
H. Has any part of the site been classified as an "environmentally sensitive" area? If
so, specify:
1. Approximately how many people would reside or work in the completed project?
J. Approximately how many people would the completed project displace?
K. Proposed measures to avoid or reduce displacement impacts, if any:
L. Proposed measures to ensure the proposal is compatible with existing and
projected land uses and plans, if any:
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Environmental Checklist (continued)
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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:
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?
C. Proposed measures to reduce or control aesthetic impacts, if any:
11. Light and Glare:
A. What type of light or glare will the proposal produce? What time of day would it mainly
occur?
B. Could light or glare from the finished project be a safety hazard or interfere with
views?
C. What existing off-site sources of light or glare may affect your proposal?
D. Proposed measures to reduce or control light and glare impacts, if any:
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Environmental Checklist (continued)
TO BE COMPLETED BY APPLICANT
12. Recreation:
A. What designated and informal recreational opportunities are in the immediate vicinity?
B. Would the proposed project displace any existing recreational uses? If so,
describe.
C. Proposed measures to reduce or control impacts on recreation including
recreation opportunities to be provided by the project or applicant, if any:
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:
B. Generally describe any landmarks or evidence of historic, archaeological, scientific,
or cultural importance known to be on or next to the site.
C. Proposed measures to reduce or control impacts, if any:
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.
B. Is site currently served by public transit? If not, what is the approximate distance to
the nearest transit stop?
C. How many parking spaces would the completed project have? How many would the
project eliminate?
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Environmental Checklist (continued)
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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):
E. Will the project use (or occur in the immediate vicinity of) water, rail, or air
transportation? If so, generally describe:
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:
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:
B. Proposed measures to reduce or control direct impact on public services, if any:
16. Utilities:
A. Circle utilities currently available at the site:
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:
C. 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.
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Environmental Checklist (continued)
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OWNER/AGENT SIGNATURE:
DATE SUBMITTED:
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Environmental Checklist (continued)
TO BE COMPLETED BY APPLICANT
D. SUPPLEMENTAL SHEET FOR NONPROJECT ACTIONS
(Do not use this sheet for project actions.)
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 of the proposal, or the types of
activities likely to result from the proposal that 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, floodplains, 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?
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Environmental Checklist (continued)
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Proposed measures to avoid or reduce shoreline and land use impacts are:
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.
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