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ABOUT THE SEPA CHECKLIST Submittal Instructions Complete & (City of Sammamish)

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801 228
th
Ave NE
Sammamish, WA 98019
425-295-0500 | www.sammamish.us
2020-01-SEPAP Page 1 of 25
SEPA CHECKLIST FOR PROJECTS
ABOUT THE SEPA CHECKLIST
Submittal Instructions
Complete & save this form
before uploading it to
MyBuildingPermit.com in the
“File Upload” section along
with the rest of the submittal
documents.
Code Reference
SEPA Procedures
Chapter 20.15 SMC
Questions?
Submit Project Guidance
Visit the Permit Center
City of Sammamish
801 228th Ave SE
Sammamish, WA 98075
www.sammamish.us
The City of Sammamish uses the information provided in the SEPA (State
Environmental Policy Act) Checklist to help determine whether the
environmental impacts of a proposal are significant.
The information is also helpful to determine if there are mitigation measures
that will address the probable significant impacts or if an environmental
impact statement will be needed to further analyze the proposal.
Complete and accurate answers often avoid delays with the SEPA process as
well as later in the decision-making process.
INSTRUCTIONS FOR APPLICANTS
The checklist questions apply to all parts of your project/proposal, even if
you plan to do them over a period of time or on different parcels of land.
• Please answer each question accurately and carefully, to the best of
y
our knowledge.
• You may need to consult with an agency specialist or private
consultant for some questions.
• If you run out of space on the form, please attach additional pages.
• Use “not applicable/does not apply" only when you can explain why
it does not apply and not when the answer is unknown.
• Attach any additional information that will help describe you
r
project/proposal or its environmental effects including additional
s
tudies and reports.
Th
e City may ask you to explain your answers or provide additional
information reasonably related to determining if there may be significant
adverse impact.
2020-01-SEPAP Page 2 of 25
SEPA CHECKLIST FOR PROJECTS
f. Proposed timing or schedule:
‒ Include phasing, if applicable.
g
. Do you have any plans for future additions, expansion, or further activity related to or connected with thi
s
p
roposal? If yes, explain
.
Background Section continued on next page
A. BACKGROUND [help]
a. Name of proposed project:
(if applicable)
APPLICANT INFORMATION
b. Applicant Name:
c. Address:
Phone:
E-M
ail:
CONTACT INFORMATION (IF DIFFERENT FROM ABOVE)
Contact Name:
Address:
Phone:
E-Mail:
APPLICATION INFORMATION
d. Date checklist prepared:
e. Agency requesting checklist:
2020-01-SEPAP Page 3 of 25
SEPA CHECKLIST FOR PROJECTS
A. BACKGROUND - CONTINUED [help]
h. List any environmental information you know about that has been prepared, or will be prepared, directly
related to this proposal.
i. Do you know whether applications are pending for governmental approvals of other proposals directly
affecting the property covered by your proposal? If yes, explain.
j. List any government approvals or permits that will be needed for your proposal, if known.
k. 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 checklist that ask you to describe certain aspects of your proposal. You do
not need to repeat those answers on this page.
l. 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.
2020-01-SEPAP Page 4 of 25
SEPA CHECKLIST FOR PROJECTS
B. ENVIRONMENTAL ELEMENTS [help]
1. EARTH [help]
a. General description of the site (check one below):
☐
Flat
☐
☐
Hilly
☐
☐
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 whether the proposal results in removing
any of these soils.
‒ Note any agricultural land of long-term commercial significance.
d
. Are there surface indications or history of unstable soils in the immediate vicinity? If so, describe.
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.
Earth sub-section continued on next page
Environmental Elements Section continued on next page
2020-01-SEPAP Page 5 of 25
SEPA CHECKLIST FOR PROJECTS
B. ENVIRONMENTAL ELEMENTS - CONTINUED [help]
1. EARTH (CONTINUED) [help]
f. Could erosion occur as a result of clearing, construction, or use? If so, describe.
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, if any:
2. AIR [help]
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.
b
. Are there any off-site sources of emissions or odor that may affect your proposal? If so, generally
describe.
Ai
r sub-section continued on next page
Environmental Elements Section continued on next page
2020-01-SEPAP Page 6 of 25
SEPA CHECKLIST FOR PROJECTS
B. ENVIRONMENTAL ELEMENTS - CONTINUED [help]
2. AIR (CONTINUED) [help]
c. Proposed measures to reduce or control emissions or other impacts to air, if any:
3. WATER [help]
a. Surface Water
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) W
ill 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
w
etlands and indicate the area of the site that would be affected.
‒
Indicate the source of fill material.
Water sub-section continued on next page
Environmental Elements Section continued on next page
2020-01-SEPAP Page 7 of 25
SEPA CHECKLIST FOR PROJECTS
B. ENVIRONMENTAL ELEMENTS - CONTINUED [help]
3. WATER (CONTINUED) [help]
a. Surface Water (continued)
4) Will the proposal require surface water withdrawals or diversions?
‒
Give general a description, purpose, and approximate quantities if known.
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 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 description, purpose, and approximate quantities if known.
Water sub-section continued on next page
Environmental Elements Section continued on next page
2020-01-SEPAP Page 8 of 25
SEPA CHECKLIST FOR PROJECTS
B. ENVIRONMENTAL ELEMENTS - CONTINUED [help]
3. WATER (CONTINUED) [help]
b. Ground Water (continued)
2) Describe waste material that will be discharged into the ground from septic tanks or other sources, if any
(e.g. 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.
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.
2) Could waste materials enter ground or surface waters? If so, generally describe.
3) Does the proposal alter or otherwise affect drainage patterns in the vicinity of the site? If so, describe.
d. Proposed measures to reduce or control surface, ground, and runoff water, and drainage pattern impacts, if
a
ny:
E
nvironmental Elements Section continued on next page
2020-01-SEPAP Page 9 of 25
SEPA CHECKLIST FOR PROJECTS
B. ENVIRONMENTAL ELEMENTS - CONTINUED [help]
4. PLANTS [help]
a. Check the 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
☐
Orchards, vineyards, 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?
c. List threatened and 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
s
ite, if any:
e. List all noxious weeds and invasive species known to be on or near the site.
Environmental Elements Section continued on next page
2020-01-SEPAP Page 10 of 25
SEPA CHECKLIST FOR PROJECTS
B. ENVIRONMENTAL ELEMENTS - CONTINUED [help]
5. ANIMALS [help]
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. For example:
Birds: hawk, heron, eagle, songbirds, other (please specify)
Mammals: deer, bear, elk, beaver, other (please specify)
Fish: bass, salmon, trout, herring, shellfish, other (please specify)
b. List any threatened and 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.
Environmental Elements Section continued on next page
2020-01-SEPAP Page 11 of 25
SEPA CHECKLIST FOR PROJECTS
B. ENVIRONMENTAL ELEMENTS - CONTINUED [help]
6. ENERGY & NATURAL RESOURCES [help]
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.
b. Would your project affect the potential use of solar energy by adjacent properties? If so, 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 [help]
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 any known or possible contamination at the site from present or past uses.
Environmental Health sub-section continued on next page
Environmental Elements Section continued on next page
2020-01-SEPAP Page 12 of 25
SEPA CHECKLIST FOR PROJECTS
B. ENVIRONMENTAL ELEMENTS - CONTINUED [help]
7. ENVIRONMENTAL HEALTH (CONTINUED) [help]
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's development or construction, or at any time during the operating life of the project.
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 (for example: traffic, equipment,
operation, other)?
Environmental Health sub-section continued on next page
Environmental Elements Section continued on next page
2020-01-SEPAP Page 13 of 25
SEPA CHECKLIST FOR PROJECTS
B. ENVIRONMENTAL ELEMENTS - CONTINUED [help]
7. ENVIRONMENTAL HEALTH (CONTINUED) [help]
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 impacts, if any:
8. LAND & SHORELINE USE [help]
a. What is the current use of the site and adjacent properties? Will the proposal affect current land uses on
nearby or adjacent properties? If so, describe.
b. H
as 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?
Land & Shoreline Use sub-section continued on next page
Environmental Elements Section continued on next page
2020-01-SEPAP Page 14 of 25
SEPA CHECKLIST FOR PROJECTS
B. ENVIRONMENTAL ELEMENTS - CONTINUED [help]
8. LAND & SHORELINE USE (CONTINUED) [help]
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?
e. What is the current zoning classification of the site?
f. What is the current comprehensive plan designation of the site?
Land & Shoreline Use sub-section continued on next page
Environmental Elements Section continued on next page
2020-01-SEPAP Page 15 of 25
SEPA CHECKLIST FOR PROJECTS
B. ENVIRONMENTAL ELEMENTS - CONTINUED [help]
8. LAND & SHORELINE USE (CONTINUED) [help]
g. If applicable, what is the current shoreline master program designation of the site?
h. Has any part of the site been classified as a critical area by the city or county? 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.
m. Proposed measures to ensure the proposal is compatible with nearby agricultural and forest lands of long-
term commercial significance, if any.
Land & Shoreline Use sub-section continued on next page
Environmental Elements Section continued on next page
2020-01-SEPAP Page 16 of 25
SEPA CHECKLIST FOR PROJECTS
B. ENVIRONMENTAL ELEMENTS - CONTINUED [help]
9. HOUSING [help]
a. Approximately how many units would be provided, if any:
Indicate the housing type provided by checking the appropriate box(es) below.
☐
High-income housing
☐
Middle-income housing
☐
Low-income housing
b. Approximately how many units would be eliminated, if any:
Indicate the housing type provided by checking the appropriate box(es) below.
☐
High-income housing
☐
Middle-income housing
☐
Low-income housing
c. Proposed measures to reduce or control housing impacts, if any.
10. AESTHETICS [help]
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.
Environmental Elements Section continued on next page
2020-01-SEPAP Page 17 of 25
SEPA CHECKLIST FOR PROJECTS
B. ENVIRONMENTAL ELEMENTS - CONTINUED [help]
11. LIGHT & GLARE [help]
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.
12. RECREATION [help]
a. What designated and informal recreational opportunities are in the immediate vicinity?
Recreation sub-section continued on next page
Environmental Elements Section continued on next page
2020-01-SEPAP Page 18 of 25
SEPA CHECKLIST FOR PROJECTS
B. ENVIRONMENTAL ELEMENTS - CONTINUED [help]
12. RECREATION (CONTINUED) [help]
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 & CULTURAL PRESERVATION [help]
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 located on or near the site? If so,
specifically describe.
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.
Historic & Cultural Preservation sub-section continued on next page
Environmental Elements Section continued on next page
2020-01-SEPAP Page 19 of 25
SEPA CHECKLIST FOR PROJECTS
B. ENVIRONMENTAL ELEMENTS - CONTINUED [help]
13. HISTORIC & CULTURAL PRESERVATION (CONTINUED) [help]
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.
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.
14. TRANSPORTATION [help]
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.
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?
Transportation sub-section continued on next page
Environmental Elements Section continued on next page
2020-01-SEPAP Page 20 of 25
SEPA CHECKLIST FOR PROJECTS
B. ENVIRONMENTAL ELEMENTS - CONTINUED [help]
14. TRANSPORTATION (CONTINUED) [help]
c. How many additional parking spaces would the completed project or non-project proposal have?
‒ How many would the project or proposal eliminate?
d. Will the proposal require any new or improvements to existing roads, streets, pedestrian, bicycle or state
transportation facilities, not including driveways?
‒ If so, describe (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, describe.
f. How many vehicular trips per day would be generated by the completed project or proposal?
‒ If known, indicate when peak volumes would occur and what percentage of the volume would be trucks (such as
commercial and no passenger vehicles).
‒ What data or transportation models were used to make these estimates?
Transportation sub-section continued on next page
Environmental Elements Section continued on next page
2020-01-SEPAP Page 21 of 25
SEPA CHECKLIST FOR PROJECTS
B. ENVIRONMENTAL ELEMENTS CONTINUED [help]
14. TRANSPORTATION (CONTINUED) [help]
h. 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, describe.
i. Proposed measures to reduce or control transportation impacts, if any.
15. PUBLIC SERVICE [help]
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, describe.
b. Proposed measures to reduce or control direct impacts on public services, if any.
Environmental Elements Section continued on next page
2020-01-SEPAP Page 22 of 25
SEPA CHECKLIST FOR PROJECTS
B. ENVIRONMENTAL ELEMENTS CONTINUED [help]
16. UTILITIES [help]
a. Utilities currently available at the site:
(check all that apply)
☐
Electricity
☐
Natural gas
☐
Water
☐
Refuse service
☐
Telephone
☐
Sanitary sewer
☐
Septic system
☐
Other:
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 [help]
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.
Signature:
Name of Signee:
Position/Title:
Agency/Organization:
Date Submitted:
2020-01-SEPAP Page 23 of 25
SEPA CHECKLIST FOR PROJECTS
ADDITIONAL PAGE FOR OVERFLOW RESPONSES
SECTION:
Continuation from Page Number: Continuation from Question Number:
SECTION:
Continuation from Page Number: Continuation from Question Number:
Background
Background
2020-01-SEPAP Page 24 of 25
SEPA CHECKLIST FOR PROJECTS
ADDITIONAL PAGE FOR OVERFLOW RESPONSES
SECTION:
Continuation from Page Number: Continuation from Question Number:
SECTION:
Continuation from Page Number: Continuation from Question Number:
Background
Background
2020-01-SEPAP Page 25 of 25
SEPA CHECKLIST FOR PROJECTS
ADDITIONAL PAGE FOR OVERFLOW RESPONSES
SECTION:
Continuation from Page Number: Continuation from Question Number:
SECTION:
Continuation from Page Number: Continuation from Question Number:
Background
Background
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