planned action chklst 12/21/98 - city of tukwila · 2019. 12. 16. · proposal to redevelop boeing...

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CITY OF TUKWILA Department of Community Development 6300 Southcenter Boulevard, Tukwila, WA 98188 Telephone: (206) 431-3670 FAX: (206) 431-3665 SEPA PLANNED ACTION INFORMATION In 1992 a programmatic environmental impact statement (EIS) was prepared for the Duwamish Corridor master plan, a proposal to redevelop Boeing properties in Tukwila’s Manufacturing Industrial Center (MIC) over a 10 year period. This current subarea plan/EIS updates and extends the previous analysis of the corridor’s Boeing properties (about 650 acres) to the entire MIC subarea (about 1,370 acres). It also builds on the information developed for the City’s Comprehensive Plan and Comprehensive Plan EIS efforts of 1994. The Proposed Action applies the “planned action” option for SEPA review as the center of a permit streamlining program of early, comprehensive environmental review, and supporting capital and regulatory revisions. REQUIREMENTS: Planned actions are developments that satisfy all of the criteria in TMC 21.04.152 (Planned Actions Identified). A proposal must initially qualify as a planned action, then pass a second screen to ensure consistency with the Comprehensive Plan and mitigation of all significant negative environmental impacts. The initial qualification criteria are summarized below. 1. The action is a “permitted use” located within the MIC/L (TMC 18.36.020) and MIC/H (TMC 18.38.020) zones and/or is an accessory use (TMC 18.36.030 and 18.38.030 respectively). 2. The action is: a. not an “essential public facility” as defined in RCW 36.70.200 and TMC 18.06.270, b. not a conditional or unclassified use, in the respective MIC/L or MIC/H zones, c. not a development, any portion of which includes shoreline modifications waterward of the ordinary high water mark, d. not a development associated with 16th Avenue Bridge construction activities. PROCEDURES: A Planned Action application form may be submitted with the underlying development permit. At the time you submit your application you must have all of the items listed on the attached “Complete Application Checklist.” You may request a waiver from items on the checklist that are not applicable to your project. Please discuss this waiver request with City staff either at a pre-application meeting or at the time of application submittal. Within 28 days of receiving your application, City staff will determine if it is complete based on the attached checklist. If not complete City staff will mail to you a letter outlining what additional information is needed. If you do not submit requested materials within 90 days from the City’s request for additional information the City may cancel your application. City staff will review the development for substantive impacts and consistency with the Comprehensive Plan. The SEPA Responsible Official will decide if a development qualifies as a planned action.

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  • CITY OF TUKWILA Department of Community Development 6300 Southcenter Boulevard, Tukwila, WA 98188 Telephone: (206) 431-3670 FAX: (206) 431-3665

    SEPA PLANNED

    ACTION

    INFORMATION In 1992 a programmatic environmental impact statement (EIS) was prepared for the Duwamish Corridor master plan, a proposal to redevelop Boeing properties in Tukwila’s Manufacturing Industrial Center (MIC) over a 10 year period. This current subarea plan/EIS updates and extends the previous analysis of the corridor’s Boeing properties (about 650 acres) to the entire MIC subarea (about 1,370 acres). It also builds on the information developed for the City’s Comprehensive Plan and Comprehensive Plan EIS efforts of 1994. The Proposed Action applies the “planned action” option for SEPA review as the center of a permit streamlining program of early, comprehensive environmental review, and supporting capital and regulatory revisions. REQUIREMENTS: Planned actions are developments that satisfy all of the criteria in TMC 21.04.152 (Planned Actions Identified). A proposal must initially qualify as a planned action, then pass a second screen to ensure consistency with the Comprehensive Plan and mitigation of all significant negative environmental impacts.

    The initial qualification criteria are summarized below.

    1. The action is a “permitted use” located within the MIC/L (TMC 18.36.020) and MIC/H (TMC 18.38.020) zones and/or is an accessory use (TMC 18.36.030 and 18.38.030 respectively).

    2. The action is: a. not an “essential public facility” as defined in RCW 36.70.200 and TMC 18.06.270, b. not a conditional or unclassified use, in the respective MIC/L or MIC/H zones, c. not a development, any portion of which includes shoreline modifications waterward of the ordinary high

    water mark, d. not a development associated with 16th Avenue Bridge construction activities.

    PROCEDURES: A Planned Action application form may be submitted with the underlying development permit. At the time you submit your application you must have all of the items listed on the attached “Complete Application Checklist.” You may request a waiver from items on the checklist that are not applicable to your project. Please discuss this waiver request with City staff either at a pre-application meeting or at the time of application submittal. Within 28 days of receiving your application, City staff will determine if it is complete based on the attached checklist. If not complete City staff will mail to you a letter outlining what additional information is needed. If you do not submit requested materials within 90 days from the City’s request for additional information the City may cancel your application. City staff will review the development for substantive impacts and consistency with the Comprehensive Plan. The SEPA Responsible Official will decide if a development qualifies as a planned action.

  • COMPLETE APPLICATION CHECKLIST

    The materials listed below must be submitted with your application unless specifically waived in writing by the Public Works Department and the Department of Community Development. Please contact each Department if you feel that certain items are not applicable to your project and should be waived. Application review will not begin until it is determined to be complete. ADDITIONAL MATERIALS MAY BE REQUIRED. The initial application materials allow project review to begin and vest the applicant’s rights. However, the City may require additional information as needed to establish consistency with development standards. City staff are available to answer questions about application materials at 206-431-3670 (Department of Community Development) and 206-433-0179 (Department of Public Works).

    Check items submitted

    with application

    Information Required. May be waived in unusual cases, upon approval of both Public Works and Planning

    APPLICATION MATERIALS:

    1. Application Checklist (1 copy) indicating items submitted with application. 2. Completed ESA Screening Checklist and Planned Action Criteria Checklist. 3. One set of all drawings submitted with the Planned Action reduced to 8 1/2” x 11” or 11” x 17”. 4. Application Fee: See Land Use Fee Schedule. 5. Underlying permit application that triggers SEPA Review.

    PROJECT DESCRIPTION AND ANALYSIS:

    6. Vicinity Map with site location. 7. Provide two copies of sensitive area studies such as wetland or geotechnical reports if needed per

    Tukwila’s Sensitive Areas Ordinance (TMC 18.45). See Geotechnical Report Guidelines and Sensitive Area Special Study Guidelines for additional information.

    8. Provide four (4) copies of any drawings needed to describe the proposal other than those submitted with the underlying permit. Maximum size 24” x 36”.

    http://www.tukwilawa.gov/wp-content/uploads/DCD-Permits-Land-Use-Permit-Fees.pdfhttp://tukwilawa.gov/wp-content/uploads/PW-Bulletin-B4-Geotechnical-Report-Guidelines.pdfhttp://tukwilawa.gov/wp-content/uploads/DCD-Sensitive-Area-Special-Study-Guidelines.pdfhttp://tukwilawa.gov/wp-content/uploads/DCD-Sensitive-Area-Special-Study-Guidelines.pdf

  • CITY OF TUKWILA Department of Community Development 6300 Southcenter Boulevard, Ste 100, Tukwila, WA 98188 Telephone: (206) 431-3670

    SEPA PLANNED

    ACTION

    APPLICATION

    FOR STAFF USE ONLY Permits Plus Type: P-PACT Planner: File Number:

    Application Complete Date: Project File Number:

    Application Incomplete Date: MIC Planned Action EIS File Number: E96-0034

    Other File Numbers:

    NAME OF PROJECT/DEVELOPMENT: _______________________________________________ ______________________________________________________________________________________

    LOCATION OF PROJECT/DEVELOPMENT: Give street address or, if vacant, indicate lot(s), block and subdivision, access street, and nearest intersection. _______________________________________________________________________________________ _______________________________________________________________________________________

    LIST ALL TAX LOT NUMBERS (this information may be found on your tax statement). _______________________________________________________________________________________

    DEVELOPMENT COORDINATOR : The individual who:

    • has decision making authority on behalf of the owner/applicant in meetings with City staff, • has full responsibility for identifying and satisfying all relevant and sometimes overlapping development

    standards, and • is the primary contact with the City, to whom all notices and reports will be sent.

    Name:

    Address:

    Phone: FAX:

    E-mail:

    Signature: Date: ______________________________________

  • CITY OF TUKWILA Department of Community Development 6300 Southcenter Boulevard, Ste 100, Tukwila, WA 98188 Telephone: (206) 431-3670

    AFFIDAVIT OF OWNERSHIP AND HOLD HARMLESS

    PERMISSION TO ENTER PROPERTY STATE OF WASHINGTON ss COUNTY OF KING

    The undersigned being duly sworn and upon oath states as follows:

    1. I am the current owner of the property which is the subject of this application.

    2. All statements contained in the applications have been prepared by me or my agents and are true and correct to the best of my knowledge.

    3. The application is being submitted with my knowledge and consent.

    4. Owner grants the City, its employees, agents, engineers, contractors or other representatives the right to enter upon Owner’s real property, located at __________________________________________________________ for the purpose of application review, for the limited time necessary to complete that purpose.

    5. Owner agrees to hold the City harmless for any loss or damage to persons or property occurring on the private property during the City’s entry upon the property, unless the loss or damage is the result of the sole negligence of the City.

    6. Non-responsiveness to a City information request for ninety (90) or more days, shall be cause to cancel the application(s) without refund of fees.

    EXECUTED at __________________________ (city), __________(state), on______________________________, 20______

    ____________________________________________________________ (Print Name)

    ____________________________________________________________ (Address)

    ____________________________________________________________ (Phone Number)

    ____________________________________________________________ (Signature) On this day personally appeared before me ______________________________________to me known to be the individual who executed the foregoing instrument and acknowledged that he/she signed the same as his/her voluntary act and deed for the uses and purposes mentioned therein. SUBSCRIBED AND SWORN TO BEFORE ME ON THIS _________ DAY OF ___________________________, 20________

    ___________________________________________________________ NOTARY PUBLIC in and for the State of Washington residing at __________________________________________________

    My Commission expires on_____________________________________

  • W:\APPLICATIONS - Land Use Apps & Handouts\CURRENT LAND USE APPLICATIONS\SEPA Environmental Review Application FINAL 5-9-16.doc

    City of Tukwila Endangered Species Act Screening Checklist

    Date: ______________________________

    DIRECTIONS:

    This Screening Checklist has been designed to evaluate the potential for your project to result in adverse effects to salmonids - Chinook, Coho, Cutthroat trout or char - as defined by Section 9 of the Endangered Species Act (ESA). If potential effects are identified, the project may need further evaluation.

    Please review and answer each question carefully. Consider all phases of your project including, but not limited to, construction, normal operation, potential emergency operation, and ongoing and scheduled maintenance. To answer these questions, you may need to refer to site plans, grading and drainage plans, critical areas studies, or other documents you have prepared for your project. The City will evaluate your responses to determine if additional action is indicated.

    Applicant Name:

    Street Address:

    City, State, Zip:

    Telephone:

  • W:\APPLICATIONS - Land Use Apps & Handouts\CURRENT LAND USE APPLICATIONS\SEPA Environmental Review Application FINAL 5-9-16.doc

    If ESA listed species are present or ever were present in the watershed where your project will be located, your project has the potential to affect them, and you need to comply with the ESA. The questions in this section will help determine if the ESA listings will impact your project.

    For more information on potential salmonid presence in your project area contact the Washington Department of Fish and Wildlife Habitat Biologist for your region, Washington Department of Fish and Wildlife or use the SalmonScape tool, WDFW SalmonScape.

    1. Are ESA listed salmonids currently present in the watershed within which your project will be located?Yes___ No___Please describe.

    2. Has there ever been an ESA listed salmonid stock present in this watershed?

    Yes___ No___ Uncertain___

    Please describe.

    If you answered "yes" to either of the above questions you should complete the remainder of this checklist.

    http://wdfw.wa.gov/conservation/habitat/ahb/http://wdfw.wa.gov/conservation/habitat/ahb/http://apps.wdfw.wa.gov/salmonscape/

  • City of Tukwila ESA Screening Checklist

    \\citystore\City Common\Teri - DCD\Kirby\SEPA to fix\SEPA Environmental Review Application FINAL 5-9-16.docx W:\APPLICATIONS - Land Use Apps & Handouts\CURRENT LAND USE APPLICATIONS\SEPA Environmental Review Application FINAL 5-9-16.doc

    Part A - PROJECT SPECIFICS: Project and Vicinity

    1. Name of watershed: _____________________________________________________________

    2. Name of nearest water body: ______________________________________________________

    3. What is the distance from this project to the nearest body of water? _______________________

    4. What is the current land use between the project and the potentially affected water body (parkinglots, farmland, etc)?

    5. Is the project above a:• Natural permanent barrier (waterfall) Yes___ No___ • Natural temporary barrier (beaver pond) Yes___ No___ • Man-made barrier (culvert, dam) Yes___ No___ • Other (explain):

    6. If answered Yes in #5, are there any resident salmonid populations above the blockage?Yes___ No___ Don’t know___

  • City of Tukwila ESA Screening Checklist

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    Part B - Project Specifics: Grading and Land Alteration

    1. Does the project involve grading or land alteration of any kind?Yes No ____

    If your project DOES NOT involve grading please skip to Part C.

    2. Will the project involve the modification of a watercourse bank between Ordinary High Water (OHW)and the top of the bank? If yes, which water course?This includes any grading on any slope leading to a river or stream, but does not require work below OHW.Yes No ____

    3. Will the project involve the modification of a watercourse bank or bottom below OHW? If yes, pleaseexplain.Yes No ____

    4. Could the construction, operation, or maintenance of equipment for the project result in sedimenttransport off site or increased rates of erosion and/or sedimentation in watercourses? If no, pleaseexplain.Most projects involving grading have the potential to result in increased erosion and/or sedimentation as a result of landdisturbance.Yes No ____

    5. If the project involves grading, have you prepared a Temporary Erosion and Sedimentation ControlPlan?Yes No ____

    If no, are you exempt under TMC 16.54.90?Yes No ____

    6. Will the project result in new impervious services? Include all hard surface are such as rooftops, asphaltor concrete paving, compacted surfaces, etc.Yes No ____

    7. What percent of the project will be impervious surface (including pavement & roof area)?

    _____________________________________________________________________________

  • City of Tukwila ESA Screening Checklist

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    Part C – Project Specifics: Water Quality

    1. Will the project generate stormwater from the creation of impervious surfaces that will not be infiltratedon site? Please explain.For the purpose of this analysis, infiltration includes the use of a stormwater treatment and management systemintended to contain all stormwater on site by allowing it to seep into the ground.Yes No ____

    2. Will the project result in the processing or handling, storage, or treatment of hazardous substances?This does not include fuel properly stored in a vehicle fuel tank, but does include fuel or other chemicals stored on-siteduring construction.Yes No ____

    3. Will the project require long-term or re-occurring maintenance requiring the use of fertilizers,pesticides, or other chemicals?This may include landscape maintenance, bridge or parking lot cleaning, ice removal/melt, repeated chemicalvegetation clearing, etc.Yes No ____

    4. Will turbidity be increased during construction or operation of the project? Please explain anymeasures to be taken to ensure turbidity is not increased.Construction near the water or below OHW often will increase turbidity, both on-site and downstream.Yes No ____

    5. Will the project either reduce or increase shade along or over a water body?Removal of trees/vegetation or the building of over-water structures (docks or floats) will often result in a change toshade.Yes No ____

    6. Will the project require debris removal from below OHW of a water course? Debris includes, but is notlimited to, fallen trees, logs, shrubs, rocks, piles, riprap, submerged metal, broken concrete, pipes, or other constructionmaterial.Yes No ____

  • City of Tukwila ESA Screening Checklist

    W:\APPLICATIONS - Land Use Apps & Handouts\CURRENT LAND USE APPLICATIONS\SEPA Environmental Review Application FINAL 5-9-16.doc

    Part D – Project Specifics: Flow Alterations and Fish Migration

    1. Will the project involve the direct alteration of the channel or bed of a water course? This includes bothtemporary and permanent modifications. If yes, please explain.Yes No ____

    2. Will the project involve any physical alteration to a wetland which is connected to a water course?Few wetlands are isolated, most contain either surface or subsurface connection to a flowing water course.Yes No ____

    3. Will water be rerouted, either temporarily or permanently as a result of the project? If yes, please explain.Yes No ____

    4. Will a culvert be installed or removed as part of this project?Yes No ____

    5. Will the project require withdrawal of surface water? If yes, please include amount and name or waterbody.Yes No ____

    6. Will the project result in the withdrawal, injection, or interception or groundwater? Examples of projects thatmight affect groundwater include, but are not limited to, construction of a new well, changes in withdrawal from an existingwell, projects involving prolonged dewatering, installation of French drains, swales, or sewer lines. Projects that require ageotechnical report pursuant to TMC 18.45.060 should answer Yes.Yes No ____

    7. Will topography changes on the site affect the duration/direction of surface runoff flows? If yes, pleasedescribe changes.Yes No ____

    8. Will the project include bank stabilization? If yes, explain.Bank stabilization includes, but is not limited to, riprap, rock, logs, soil, vegetated revetments, concrete structures, or similar.Yes No ____

    9. Will there be retention or detention ponds? If yes, will this be an infiltration pond or a surface dischargeto either a municipal storm water system or a surface water body?Yes No ___

    10. Will the project involve any reduction of the floodplain or floodway by filling or other partial blockage offlows? If yes, how will the loss of flood storage be mitigated by your project?Yes No ___

    11. Will project include the construction of a new wetland or waterway that is connected by surface flow toan existing waterway that contains salmonids?Yes No ___

  • City of Tukwila ESA Screening Checklist

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    Part E – Project Specifics: Vegetation

    1. Will the project involve the removal of any vegetation? If yes, please describe existing conditions andthe amount and type of vegetation to be removed.Yes No ___

    2. Will the project involve the removal of any vegetation within 200 feet of OHW of a water course? Ifyes, please describe type, size, method, and amount of vegetation to be removed.A tree is defined by TMC 18.06.845 as any self-supporting woody plant, generally characterized by one main trunk, with apotential diameter of 2inches or more at breast height and a minimum height of 10 feet.Yes No ____

    3. If vegetation is to be removed, do you plan to mitigate by replanting? Please explain.Yes No ____

  • SEPA Checklist

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    STATE ENVIRONMENTAL POLICY ACT CHECKLIST Please respond to all questions. Use separate sheets as necessary. Department of Ecology provides a guidance on filling the SEPA checklist at Department of Ecology Applicant Responses: Agency Comments

    A. BACKGROUND

    1. Name of proposed project, if applicable:

    2. Name of Applicant:

    3. Date checklist prepared:

    4. Agency requesting checklist:

    City of Tukwila

    5. Proposed timing or schedule (including phasing, if applicable):

    6. Do you have any plans for future additions, expansion, or further activity related to orconnected with this proposal? If yes, explain.

    7. List any environmental information you know about that has been prepared, or will beprepared, directly related to this proposal.

    8. Do you know whether applications are pending for governmental approvals of otherproposals directly affecting the property covered by your proposal? If yes, explain.

    http://www.ecy.wa.gov/programs/sea/sepa/apguide/EnvChecklistGuidance.html

  • SEPA Checklist

    W:\APPLICATIONS - Land Use Apps & Handouts\CURRENT LAND USE APPLICATIONS\SEPA Environmental Review Application FINAL 5-9-16.doc

    Please respond to all questions. Use separate sheets as necessary.

    Applicant Responses: Agency Comments

    9. List any government approvals or permits that will be needed for your proposal.

    10. Give brief, complete description of your proposal, including the proposed uses and thesize of the project and site. There are several questions later in this checklist that askyou to describe certain aspects of your proposal. You do not need to repeat thoseanswers on this page.

    11. Location of the proposal. Give sufficient information for a person to understand theprecise location of your proposed project, including a street address, if any, the tax lotnumber, and section, township, and range. If a proposal would occur over a range ofarea, provide the range or boundaries of the site(s). Provide a legal description, siteplan, vicinity map, and topographic map, if reasonably available. While you shouldsubmit any plans required by the agency, you are not required to duplicate maps ordetailed plans submitted with any permit applications related to this checklist.

    12. Does the proposal lie within an area designated on the City's Comprehensive Land UsePolicy Plan Map as environmentally sensitive?

  • SEPA Checklist

    W:\APPLICATIONS - Land Use Apps & Handouts\CURRENT LAND USE APPLICATIONS\SEPA Environmental Review Application FINAL 5-9-16.doc

    Please respond to all questions. Use separate sheets as necessary.

    Applicant Responses: Agency Comments

    B. ENVIRONMENTAL ELEMENTS

    1. 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 andnote any prime farmland and whether the proposal results in removing any of thesesoils.

    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 gradingproposed. Indicate source of fill.

  • SEPA Checklist

    W:\APPLICATIONS - Land Use Apps & Handouts\CURRENT LAND USE APPLICATIONS\SEPA Environmental Review Application FINAL 5-9-16.doc

    Please respond to all questions. Use separate sheets as necessary.

    Applicant Responses: Agency Comments

    f. Could erosion occur as a result of clearing, construction, or use?If so, generally describe.

    g. About what percent of the site will be covered with impervious surfaces afterproject construction (for example, asphalt or buildings)?

    h. Proposed measures to reduce or control erosion, or other impacts to the earth, ifany:

    2. Air

    a. What types of emissions to the air would result from the proposal (for example,dust, automobile odors, industrial wood smoke) during construction and when theproject is completed? If any, generally describe and give approximate quantities ifknown.

    b. Are there any off-site sources of emissions or odor that may affect your proposal?If so, generally describe.

  • SEPA Checklist

    W:\APPLICATIONS - Land Use Apps & Handouts\CURRENT LAND USE APPLICATIONS\SEPA Environmental Review Application FINAL 5-9-16.doc

    Please respond to all questions. Use separate sheets as necessary.

    Applicant Responses: Agency Comments

    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 orriver it flows into.

    2. Will the project require any work over, in, or adjacent to (within 200 feet) thedescribed waters? If yes, please describe and attach available plans.

    3. Estimate the amount of fill and dredge material that would be placed in orremoved from surface water or wetlands and indicate the area of the site thatwould be affected. Indicate the source of fill material.

    4. Will the proposal require surface water withdrawals or diversions? Givegeneral description, purpose, and approximate quantities, if known.

  • SEPA Checklist

    W:\APPLICATIONS - Land Use Apps & Handouts\CURRENT LAND USE APPLICATIONS\SEPA Environmental Review Application FINAL 5-9-16.doc

    Please respond to all questions. Use separate sheets as necessary.

    Applicant Responses: Agency Comments

    5. Does the proposal lie within a 100-year floodplain? If so, note location on thesite 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 from a well for drinking water or otherpurposes? If so, give a general description of the well, proposed uses andapproximate quantities withdrawn from the well? Will water be discharged togroundwater? Give general description, purpose, and approximate quantities ifknown.

    2. Describe waste materials that will be discharged into the ground from septictanks or other sources, if any (for example: Domestic sewage; industrial,containing the following chemicals...; agricultural; etc). Describe the generalsize of the system, the number of such systems, the number of houses to beserved (if applicable), or the number of animals or humans the system(s) areexpected to serve:

  • SEPA Checklist

    W:\APPLICATIONS - Land Use Apps & Handouts\CURRENT LAND USE APPLICATIONS\SEPA Environmental Review Application FINAL 5-9-16.doc

    Please respond to all questions. Use separate sheets as necessary.

    Applicant Responses: Agency Comments

    c. Water Runoff (including storm water):

    1. Describe the source of runoff (including storm water) and method of collectionand disposal, if any (include quantities, if known). Where will this water flow?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, generallydescribe.

    3. Does the proposal alter or otherwise affect drainage patterns in the vicinity ofthe site? If so, describe.

    d. Proposed measures to reduce or control surface, ground, and runoff water, anddrainage pattern impacts if any:

  • SEPA Checklist

    W:\APPLICATIONS - Land Use Apps & Handouts\CURRENT LAND USE APPLICATIONS\SEPA Environmental Review Application FINAL 5-9-16.doc

    Please respond to all questions. Use separate sheets as necessary.

    Applicant Responses: Agency Comments

    4. Plants

    a. Check or circle types of vegetation found on the site:

    Deciduous tree: alder, maple, aspen, other Evergreen tree: fir, cedar, pine, other Shrubs Grass Pasture Crop or grain Wet soil plants: cattail, buttercup, bulrush, 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 orenhance vegetation on the site, if any:

    e. List all noxious weeds and invasive species known to be on or near the site.

  • SEPA Checklist

    W:\APPLICATIONS - Land Use Apps & Handouts\CURRENT LAND USE APPLICATIONS\SEPA Environmental Review Application FINAL 5-9-16.doc

    Please respond to all questions. Use separate sheets as necessary.

    Applicant Responses: Agency Comments

    5. Animals

    a. List any birds or animals which have been observed on or near the site or areknown to be on or near the site:

    Birds: Hawk, heron, eagle, songbirds, other: Mammals: Deer, bear, elk, beaver, other: Fish: Bass, salmon, trout, herring, shellfish, other: 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:

    e. List any invasive animal species known to be on or near the site:

    6. Energy and Natural Resources

    a. What kinds of energy (electric, natural gas, oil, wood stove, solar) will be used to meetthe completed project's energy needs? Describe whether it will be used for heating,manufacturing, etc.

  • SEPA Checklist

    W:\APPLICATIONS - Land Use Apps & Handouts\CURRENT LAND USE APPLICATIONS\SEPA Environmental Review Application FINAL 5-9-16.doc

    Please respond to all questions. Use separate sheets as necessary.

    Applicant Responses: Agency Comments

    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 thisproposal? 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 ofthis proposal? If so, describe.

    1. Describe any known or possible contamination at the site from present or past uses.

    2. Describe existing hazardous chemicals/conditions that might affect project development and design.This includes underground hazardous liquid and gas transmission pipelines located within the project area

    and in the vicinity.

    3. Describe any toxic or hazardous chemicals that might be stored, used, or produced during the project'sdevelopment or construction, or at any time during the operating life of the project.

  • SEPA Checklist

    W:\APPLICATIONS - Land Use Apps & Handouts\CURRENT LAND USE APPLICATIONS\SEPA Environmental Review Application FINAL 5-9-16.doc

    Please respond to all questions. Use separate sheets as necessary.

    Applicant Responses: Agency Comments

    4. Describe special emergency services that might be required.

    5. 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 (forexample: traffic, equipment, operation, other)?

    2. What types and levels of noise would be created by or associated with theproject on a short-term or 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 impacts, if any:

  • SEPA Checklist

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    Please respond to all questions. Use separate sheets as necessary.

    Applicant Responses: Agency Comments

    8. Land and Shoreline Use

    a. What is the current use of the site and adjacent properties? Will the proposal affectcurrent land uses on nearby or adjacent properties? If so, describe.

    b. Has the project sire been used as working farmlands or working forest lands? If so,describe. How much agricultural or forest land of long-term commercial significancewill be converted to other uses as a result of the proposal, if any? If resource landshave not been designated, how many acres in farmland or forest land tax status willbe converted to nonfarm or nonforest use?

    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:

    c. Describe any structures on the site.

    d. Will any structures be demolished? If so, what?

  • SEPA Checklist

    W:\APPLICATIONS - Land Use Apps & Handouts\CURRENT LAND USE APPLICATIONS\SEPA Environmental Review Application FINAL 5-9-16.doc

    Please respond to all questions. Use separate sheets as necessary.

    Applicant Responses: Agency Comments

    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? Ifso, specify.

    i. Approximately how many people would reside or work in the completed project?

  • SEPA Checklist

    W:\APPLICATIONS - Land Use Apps & Handouts\CURRENT LAND USE APPLICATIONS\SEPA Environmental Review Application FINAL 5-9-16.doc

    Please respond to all questions. Use separate sheets as necessary.

    Applicant Responses: Agency Comments

    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 projectedland uses and plans, if any:

    m. Proposed measures to ensure the proposal is compatible with nearby agricultural

    and forest lands of lon-termcommercial significance, if any:

  • SEPA Checklist

    W:\APPLICATIONS - Land Use Apps & Handouts\CURRENT LAND USE APPLICATIONS\SEPA Environmental Review Application FINAL 5-9-16.doc

    Please respond to all questions. Use separate sheets as necessary.

    Applicant Responses: Agency Comments

    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 whetherhigh, 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; whatis the principal exterior building material(s) proposed?

    b. What views in the immediate vicinity would be altered or obstructed?

  • SEPA Checklist

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    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 itmainly occur?

    Please respond to all questions. Use separate sheets as necessary.

    Applicant Responses: Agency Comments

    b. Could light or glare from the finished project be a safety hazard or interfere withviews?

    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:

  • SEPA Checklist

    W:\APPLICATIONS - Land Use Apps & Handouts\CURRENT LAND USE APPLICATIONS\SEPA Environmental Review Application FINAL 5-9-16.doc

    Please respond to all questions. Use separate sheets as necessary.

    Applicant Responses: Agency Comments

    12. Recreation

    a. What designed and informal recreational opportunities are in the immediatevicinity?

    b. Would the proposed project displace any existing recreational uses? If so, describe.

    c. Proposed measures to reduce or control impacts on recreation, including recreationopportunities to be provided by the project or applicant, if any:

    13. Historic and Cultural Preservation

    a. Are there any buildings, structures, or sites located on or near the site that are over45 years old listed in or eligible for listing in national, state or local preservationregisters located on or near the site? If so, specifically describe.

  • SEPA Checklist

    W:\APPLICATIONS - Land Use Apps & Handouts\CURRENT LAND USE APPLICATIONS\SEPA Environmental Review Application FINAL 5-9-16.doc

    b. Are there any landmarks, features, or other evidence of Indian or historic use oroccupation. This may include human burials or old cemeteries. Are there anymaterial 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.

    c. Describe the methods used to assess the potential impacts to cultural and historicresources on or near the project site. Examples include consultation with tribes andthe department of archeology and historic preservation, archaeological surveys, historic maps, GIS data, etc.

    Please respond to all questions. Use separate sheets as necessary.

    Applicant Responses: Agency Comments

    d. Proposed measures to avoid, minimize, or compensate for loss, changes to, anddisturbance to resources. Please include plans for the above and any permits that maybe required.

    14. Transportation

    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, ifany.

  • SEPA Checklist

    W:\APPLICATIONS - Land Use Apps & Handouts\CURRENT LAND USE APPLICATIONS\SEPA Environmental Review Application FINAL 5-9-16.doc

    Please respond to all questions. Use separate sheets as necessary.

    Applicant Responses: Agency Comments

    b. Is the site or affected geographic area 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 or non-project proposalhave? How many would the project eliminate?

    d. Will the proposal require any new or improvements to existing roads or streets, orimprovements to existing roads or streets, not including driveways? If so, generallydescribe (indicate whether public or private).

    e. Will the project or proposal 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? Ifknown, indicate when peak volumes would occur and what percentage of the volumewould be trucks (such as commercial and nonpassenger vehicles). What data ortransportation models were used to make these estimates?

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    g. Will the proposal interfere with, affect or be affected by the movement of agriculturaland forest products on roads or streets in the area? If so, generally describe.

    h. 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: fireprotection, police protection, public transit, health care, schools, other)? If so,generally describe.

    b. Proposed measures to reduce or control direct impacts on public services, if any.

    16. Utilities

    a. Circle utilities currently available at the site:

    electricity, natural gas, water, refuse service, telephone, sanitary sewer, septicsystem

    other: ____________________________________________________________

    b. Describe the utilities that are proposed for the project, the utility providing theservice, and the general construction activities on the site or in the immediatevicinity which might be needed.

  • SEPA Checklist

    W:\APPLICATIONS - Land Use Apps & Handouts\CURRENT LAND USE APPLICATIONS\SEPA Environmental Review Application FINAL 5-9-16.doc

    (NON-PROJECT PROPOSALS (E.G., SUBURBAN PLANS AND ZONING CODE TEXT CHANGES) MUST COMPLETE THE FOLLOWING PAGES).

    C. SUPPLEMENTAL SHEET FOR NON-PROJECT PROPOSALS(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 elements ofthe environment.

    When answering these questions, be aware of the extent the proposal, or the types of activities likely to result fromthe proposal, would affect the item at a greater intensity or at a faster rate than if the proposal were notimplemented. Respond briefly and in general terms.

    Please respond to all questions. Use separate sheets as necessary.

    Applicant Responses: Agency Comments

    1. How would the proposals 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:

  • SEPA Checklist

    W:\APPLICATIONS - Land Use Apps & Handouts\CURRENT LAND USE APPLICATIONS\SEPA Environmental Review Application FINAL 5-9-16.doc

    Please respond to all questions. Use separate sheets as necessary.

    Applicant Responses: Agency Comments

    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 orareas designated (or eligible or under study) for governmental protection; such asparks, wilderness, wild and scenic rivers, threatened or endangered species habitats,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 itwould allow or encourage land or shoreline uses incompatible with existing plans?

  • SEPA Checklist

    W:\APPLICATIONS - Land Use Apps & Handouts\CURRENT LAND USE APPLICATIONS\SEPA Environmental Review Application FINAL 5-9-16.doc

    Please respond to all questions. Use separate sheets as necessary.

    Applicant Responses: Agency Comments

    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 publicservice 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 Federallaws or requirements for the protection of the environment.

    D. SIGNATURE

    Under the penalty of perjury the above answers under ESA Screening Checklist and State Environmental Policy Act Checklist are true and complete to the best of my knowledge. I understand that the lead agency is relying on them to make its decision.

    Signature:

    Date Submitted:

    PLANNED ACTION CRITERIA CHECKLISTDIRECTIONS:STATE ENVIRONMENTAL POLICY ACT CHECKLISTA. BACKGROUNDPlease respond to all questions. Use separate sheets as necessary.Please respond to all questions. Use separate sheets as necessary.B. ENVIRONMENTAL ELEMENTS1. EarthPlease respond to all questions. Use separate sheets as necessary.2. AirPlease respond to all questions. Use separate sheets as necessary.3. Watera. Surface:Please respond to all questions. Use separate sheets as necessary.b. Ground:Please respond to all questions. Use separate sheets as necessary.c. Water Runoff (including storm water):d. Proposed measures to reduce or control surface, ground, and runoff water impacts, if any:Please respond to all questions. Use separate sheets as necessary.4. Plantsa. Check or circle types of vegetation found on the site: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. Animalsa. Circle any birds or animals which have been observed on or near the site or are known to be on or near the site: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 Resources7. Environmental Health8. Land and Shoreline Usea. 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?Please respond to all questions. Use separate sheets as necessary.h. Has any part of the site been classified as an "environmentally sensitive" area? If so, specify.i. 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:Please respond to all questions. Use separate sheets as necessary.9. Housinga. 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. AestheticsPlease respond to all questions. Use separate sheets as necessary.11. Light and GlarePlease respond to all questions. Use separate sheets as necessary.12. Recreationa. What designed 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 PreservationPlease respond to all questions. Use separate sheets as necessary.14. TransportationPlease respond to all questions. Use separate sheets as necessary.15. Public ServicesPlease respond to all questions. Use separate sheets as necessary.16. Utilitiesd. SignatureSignature:

    NAME OF PROJECTDEVELOPMENT 1: NAME OF PROJECTDEVELOPMENT 2: subdivision access street and nearest intersection 1: subdivision access street and nearest intersection 2: DEVELOPMENT COORDINATOR: Name: Address: Phone: FAX: Email: Date: Street Address: City State Zip: Telephone: applicant name: Check Box2: OffCheck Box3: OffCheck Box4: OffCheck Box5: OffCheck Box6: OffText71: Text73: Check Box7: OffCheck Box8: OffCheck Box9: OffCheck Box10: OffCheck Box11: OffCheck Box12: OffCheck Box13: OffCheck Box14: OffCheck Box15: OffText74: Text75: Text76: Text77: Text78: Text79: Check Box16: OffCheck Box17: OffCheck Box18: OffCheck Box19: OffCheck Box20: OffCheck Box21: OffCheck Box22: OffCheck Box23: OffCheck Box24: OffCheck Box25: OffCheck Box26: OffCheck Box27: OffCheck Box28: OffCheck Box29: OffText80: Check Box30: OffCheck Box31: OffCheck Box32: OffCheck Box33: OffCheck Box34: OffCheck Box35: OffCheck Box36: OffCheck Box37: OffCheck Box38: OffCheck Box39: OffCheck Box40: OffCheck Box41: OffCheck Box42: OffCheck Box43: OffCheck Box44: OffCheck Box45: OffCheck Box46: OffCheck Box47: OffCheck Box48: OffCheck Box49: OffCheck Box50: OffCheck Box51: OffCheck Box52: OffCheck Box53: OffCheck Box55: OffCheck Box56: OffCheck Box57: OffCheck Box58: OffCheck Box59: OffCheck Box60: OffCheck Box61: OffCheck Box62: OffCheck Box63: OffCheck Box64: OffCheck Box65: OffCheck Box66: OffCheck Box67: OffCheck Box68: OffCheck Box69: OffCheck Box70: OffText81: Text82: Text83: Name of proposed project if applicable: Name of Applicant: Date checklist prepared: Proposed timing or schedule including phasing if applicable: connected with this proposal If yes explain: Text84: Text85: Text86: Text87: Text88: Text89: Text90: Text91: Text92: Text93: Text94: Text95: Text96: Text97: Text98: Text99: Text100: Text101: Text102: Text103: Text104: Text105: Text106: Text107: Text108: Text109: Text110: Text111: Text112: Text113: Text114: Text115: Text116: Text117: Text118: Text119: Text120: Text121: Text122: Text123: Text124: Text125: Text126: Text127: Text128: Text129: Text130: Text131: Text132: Text133: Text134: Text135: Text136: Text137: Text138: Text139: Text140: Text141: Text142: Text143: Text144: Text145: Text146: Text147: Text148: Text149: Text150: Text151: Text152: Text153: Text154: Text155: Text156: Text157: Text158: Text159: Text160: Text161: Text162: Text163: Text164: Text165: Text166: Text167: Text168: Text169: other: Text170: Text171: Text172: Text173: Text174: Text175: Text176: Text177: Text178: Text179: Text180: Text181: Text182: Text183: Date Submitted: Text184: Text185: Text186: Text187: Date1: