ENVIRONMENTAL CHECKLIST

Transcription

1 MUCKLESHOOT INDIAN TRIBE COMMUNITY DEVELOPMENT DEPARTMENT - PLANNING DIVISION ND Avenue SE Auburn, Washington Tel: (253) The National Environmental Policy Act (NEPA) requires the Community Development Department to promote the general welfare of Tribal Community members and others living on Reservation lands, by creating and maintaining conditions which humanity and nature can exist in productive and enjoyable harmony. The purpose of the this checklist is to provide information to help you and the Muckleshoot Indian Tribe Community Development Department to identify, and where possible avoid, the impacts of this proposal and to determine whether an Environmental Impact Statement (EIS) is required. The checklist questions apply to all parts of the proposal, even if they are planned over a period of time, and describes basic information about the proposal. ENVIRONMENTAL CHECKLIST I. APPLICANT/PROPOSAL INFORMATION Name: OWNER Name: APPLICANT Address: Address: City/State/Zip: City/State/Zip: Phone: Fax: Phone: Fax: Name: Address: PROJECT CONTACT PROPERTY LEGAL DESCRIPTION City/State/Zip: Phone: Fax: TAX PARCEL NUMBER(S): 1

2 PROJECT NAME: Description of Proposal: Location of Project: Vicinity (What are the known cross streets): Section Township Range Address: SIZE OF PROPERTY: a) Acreage of Site: b) Number of existing buildings c) Total square feet of proposed buildings NOTE: If the land on which the development is proposed is part of a larger ownership, attach a scaled drawing showing the relationship of the development site to the entire ownership. LAND USE: Describe existing land use within the project site: What is the land use of the surrounding area? North: East: South: 2

3 West: What is the zoning or environmental designation for this property? Muckleshoot City of Auburn King County Is the proposed use compatible with existing zoning and surrounding land uses? Yes No If answer is no, please explain: Estimated date for completion of the proposal: List all permits, licenses, or governmental approvals needed for this proposal: MIT Building Permits -Planning Division Zone change - MIT Planning Division Boundary Line Adjustment - Planning Division Fee-to-Trust application - Bureau of Indian Affairs Water / Sewer Construction-Indian Health Service MIT Utilities Public Works Department Puget Sound Energy Electric Service Telephone service - U.S.West Local Cable service Natural Gas hook-ups - Enumclaw Natural Gas JARPA US Army Corps of Engineers Section 401 Water Quality Permit NPDES Environmental Protection Agency OTHER Do you have any plans for future additions, expansion or further activity related to or connected with this proposal? If yes, please explain: 3

4 Do you know of any plans by others that may affect the property covered by your proposal? If yes, explain: Attach any other application form that has been completed regarding the proposal, if none has been completed, but is expected to be filed at some future date, describe the nature of such application form: Subdivision Application MIT Water / Sewer application Indian Health Service application MIT Building permit application(s) Specify type and composition of soil and sub-soils to such depth that the subsurface drainage and storm-water infiltration potential can be fully evaluated. If available, also provide: a) A copy of current Soil Conservation Soil Survey map delineating property boundaries and indicating soil types encountered within said property for all proposed projects. b) For proposals involving on-site sewage disposal systems, provide soil log information as per the King County Health Department criteria. Soil Logs shall be stamped or signed by a professional Engineer, Registered Sanitation or Licensed Designer. Attach comments of school officials regarding the adequacy of school facilities to handle the potential population increase associated with your project. II. ENVIRONMENTAL IMPACTS Introduction: The Muckleshoot Tribal Council requires an Environmental Review be prepared for all major actions significantly affecting the quality of the environment. The purpose of this checklist is to help those involved determine whether or not a 4

5 proposal is such a major action. Please answer the following questions as completely as you can with the information presently available to you. Where explanations of your answers are required, or where you believe an explanation would be helpful to government decision makers, include your explanation in the space provided, or use additional pages if necessary. You should include references to any reports or studies conducted on the property that are relevant to the answers you provide. NOTE: This is a standard form being used by the Muckleshoot Indian Tribe for various types of proposals. Many of the questions may not apply to your proposal. If a question does not apply, just answer it "No" and continue on to the next question.explanations of all "Yes" and "Maybe" questions are required. 1) EARTH. Will the proposal result in: YES MAYBE NO a. Unstable earth conditions or changes to geologic substructures? b. Disruptions, displacements, compaction or overcovering of the soil? c. Change in topography or ground surface relief features? d. The destruction, covering or modification of any unique geologic or physical features? e. Any increase in wind or water erosion of soils, either on or off the site? f. Changes in deposition or erosion of beach sands, or changes on siltation, deposition or erosion which may modify the channel of a river or stream or the bed of the ocean or any bay, inlet, or lake? 2) AIR. Will the proposal result in: YES MAYBE NO a. Air emissions or deterioration of ambient air quality? b. The creation of objectionable odors? c. Alteration of air movement, moisture or temperature, or any change in climate, either locally or regionally? 5

6 3) WATER. Will the proposal result in: YES MAYBE NO a. Changes in currents, or the source or direction of water movements, in either marine or fresh waters? b. Changes in absorption rates, drainage patterns or the rate and amount of surface water runoff? c. Alterations to the course or flow of flood waters? d. Change in the amount of surface water in any water body? e. Discharge into surface waters, or in any alteration of surface water quality, including but not limited to temperature, dissolved oxygen or turbidity? f. Alteration in the direction or rate of flow of ground waters? g. Change in the quantity of ground waters, either through direct additions or withdrawals, or through interception of an aquifer by cuts or excavations? h. Deterioration in ground water quality, either through direct injection, or through the seepage of leachate, phosphates, detergents, waterborne virus or bacteria, or other substances into the ground waters? i. Reduction in the amount of water otherwise available for public water supplies? 4) FLORA. Will the proposal result in: YES MAYBE NO a. A change in the diversity of species, or numbers of any species of flora (including trees, shrubs, grass, crops, micro-flora and aquatic plants)? b. Reduction of the numbers of any unique, rare or endangered species of flora? c. Introduction of new species of flora into an area, or in a barrier to the normal replenishment existing species? d. Reduction in acreage of any agricultural crop? 6

7 5). FAUNA. Will the proposal result in: YES MAYBE NO a. Changes in the diversity of species, or numbers of any species of fauna (birds, land animals, including reptiles, fish and shellfish, benthic organisms, insects or micro-fauna)? b. Reduction of the numbers of any unique, rare or endangered species of fauna? c. Introduction of new species of flora into an area, or result in a barrier to the migration or movement of fauna? d. Deterioration to existing fish or wildlife habitat? 6) NOISE. Will the proposal: YES MAYBE NO a. Increase existing noise levels? 7) LIGHT AND GLARE. Will the proposal: YES MAYBE NO a. Result in an increase in new light or glare? 8) LAND USE. Will the proposal result in: YES MAYBE NO a. Alteration of the present or planned land use or an area? 9) NATURAL RESOURCES. Will the proposal result in: YES MAYBE NO 7

8 a. Increase in the rate of use of any natural resources? b. Depletion of any nonrenewable natural resource? 10) HAZARDOUS MATERIALS. Will the proposal result in: a. A risk of an explosion or the release of hazardous substances (including, but not limited to oil, pesticides, chemicals or radiation) in case of an accident: YES MAYBE NO 11) POPULATION. Will the proposal: YES MAYBE NO a. Alter the location, distribution, density, or growth rate of the population of the area? 12) HOUSING. Will the proposal: YES MAYBE NO a. Affect existing housing, or create a demand for additional housing? 13) TRANSPORTATION / CIRCULATION. Will the YES MAYBE NO proposal result in: a. Generation of additional vehicular movement? b. Effects on existing parking facilities, or demand for new parking? c. Impacts to existing transportation systems? d. Alterations to present patterns of circulation or movement of people or goods? e. Alterations to waterborne, rail or air traffic? 8

9 f. Increase in traffic hazards to motor vehicles, bicyclists or pedestrians? 14) PUBLIC SERVICES. Will the proposal have an YES MAYBE NO effect upon, or result in a need for new or altered governmental services in any of the following areas? a. Fire Protection? b. Police Protection? c. School systems? d. Parks or other recreational facilities? e. Maintenance of public facilities, including roads? f. Other governmental services? 15) ENERGY. Will the proposal result in: YES MAYBE NO a. Use of substantial amounts of fuel or energy? b. Demand upon existing sources of energy, or require the development of new sources of energy? 16) UTILITIES. Will the proposal result in need YES MAYBE NO for additional: a. Power or natural gas? b. Communication systems? c. Water Service? d. Sewer service or Septic tanks? e. Storm water drainage? f. Solid waste disposal? 9

10 17) HUMAN HEALTH. Will the proposal result in: YES MAYBE NO a. The operation of any health or potential health Hazard (excluding mental health)? 18). AESTHETICS. Will the proposal result in: YES MAYBE NO a. The obstruction of any scenic vista or view open to the public, or will the proposal result in the creation of an aesthetically offensive site open to the public? 19). RECREATION. Will the proposal result in: YES MAYBE NO a. An impact upon the quality or quantity of existing recreational opportunities? 20). ARCHEOLOGICAL / HISTORICAL. Will the proposal result in: a. The alteration of a significant Archeological or historical site, structure, object or building? YES MAYBE NO 10

11 VERIFICATION I,, being first duly sworn on oath, state that I have carefully reviewed the information, submitted by me, in connection with this permit application and verify that this information is true to the best of my knowledge and belief. SIGNATURE DATE SUBSCRIBED AND SWORN BEFORE ME THIS DAY OF, 20. NOTARY PUBLIC IN AND FOR THE STATE OF, RESIDING AT NOTE: SECTION 12 of the Muckleshoot Interim Business Licensing Ordinance requires that prior to any business related construction activity or Business operation on the Reservation, a Federal Indian Traders License must be acquired, in addition to a Tribal License. Applications for a Federal Indian Trader's License shall be made to: BUREAU OF INDIAN AFFAIRS Puget Sound Agency 3006 Colby Ave. Everett, Washington 11