1979, 08-17 Environmental ChecklistS t G l
ENVIRONMENTAL CHECKLIST
File #
Sec . —Twp . —Rge
Introduction: The State Environmental Policy Act of 1971, Chapter 43.21C. RCW, requires all state and local governmental
agencies to consider environmental values both for their own actions and when licensing private proposals. The Act also
requires that an Environmental Impact Statement be prepared for all major actions significantly (and "adversely", as per
WAC 197 -10) affecting the quality of the physical environment. The qurpose of this checklist is to hlep the agencies in-
volved determine whether or not a proposal is such a major action.
Please answer the following questions as completely as you can with the information presently available to you. Please answer
questions as 'yes" or "maybe" if, in your opinion, even only slight impacts will result. The reviewers of the checklist will
be aware of and concern themselves with the degree of impactt. asking you for more information. if necessary. '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 paces, if necessary. You should include references to any reports or
studies of whicn you are aware and whicn are relevant so the answers you provide. Complete answers to these questions now will
help all agencies involved with your proposal to undertake the required environmental review without unnecessary delay.
The following questions apply to your total proposal, not just to the license for which you are currently applying or the pro-
posal for which approval is sought. Your answers should include the impacts which will be caused by your proposal when it is
completed, even though completion may not occur until sometime in the future. This will allow all of the agencies which will
be involved to complete their environmental review now, without duplicating oaperwork in the future.
No application shall be processed until the checklist has been cOmcieted and returned to the appropriate County department.
State law *ermines explanations For every "yes" and "maybe" answer on the checklist. The person completing the farm may ba
required to provide explanations for no answers. and in some cases, more detailed information to aid in a threshold
determination.
NOTE: This is a standard form being used by all state and local agencies in the State of Washington for various types of
proposals. Many of the questions may not apply to your proposal. If a ouestion aces not apply, just answer it 'no"
and continue on to the next question.
ENVIRONMENTAL CHECKLIST FORM
1. BACKGROUND
1. Name of Proponent: HA.rk Gri TVA 1 ri a
2. Aodress of Proponent: 591 . hr r - 1 e
3. Oate Checklist Submitted: , •
4. ,Agency Requiring Checklist: .`1 fil5FN :DK17�fi'i►Tifi'I6[y!IIIII
B. Name of Proposal, if Applicable: Ifl0:i!0111(0 ifiilC•27Cdlrtr
O. Nature and 3rief Description of the Proposal ,ins using bus not 1 1m ed to its size, genera■ cesi,in eiementa, and
other factors that will give an accurate understanding of its scope and nature): A pprnsr . h , 200 SQ . FT .
par flnnr jsf es two Stnty nffirp Moe _ for rinrtnrc :,rri derfi t
Btlill1ing will he prPr:act f•i]3arrete. F4terirlr upl'roxiu,=■tely 32,
high. The Cffice r.i_(,cx will provide close 1)rovimjity with boepito..
7. Location of Proposal (describe the cnysical setting of the Proposal, as well as :ne extent of the land area affected by
any environmental impacts, includi,pg any other information needed •0 give an accurate understanding of the environ-
mentai setting of the proposal): in
l9 ro ject will be located bet∎ ef'n ss nurstre
hnmP to the. pfa}2t anfd A nffina tilfi£x (1veriinile) to the Taast_ 130='1
Phone Number 2 K5-6287
•
..
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to thp smith-
3. Estimates Cate for Completion of the Proposal: Date 1979
9. List of all Permits, Licenses or Government Approvals Required for the Proposal (federal, state and local - including
rezones) :Building Perrzits, S eptic and Drain.field Permits.
( :r- SPACE FOR EXPLANATION i5 iNADEOUATE. ?LEASE ATTACH ADDITIONAL ?AGES.)
10a. 00 you, or the owner in the event you d0 not own- the subject land, have any plans for future additions, expansion, or
further activity related to or connected with this proposal? if yes, explain:
rlo
10h. 0o you own or have options an land nearby or adjacent to this pr000sal's location? If yes, explain:
No
11. Do you know of any plans by others incivaing the owner which may affect the property covered by your proposal or land
adjacent or nearby? If yes, explain: Yes En,m r i cor of Vs 1 1 ay ranero l jin ns i to t
12. Attach any other application form that has been completed regarding The proposal; if none has been completed. tut is
exsected to se filed at some future date, describe the nature of soon application form:
1I. ENVIRONMENTAL IMPACTS
(Explanations sf all "yes" and "maybe" answers are required)
1. Earth. Will the proposal result in: •
(a) Unstable earth conditions or in changes in geologic structures?
(b) Disruptions, dluplacemerts, compaction or avercovering of the soil?
;c) Change in topography or around surface rsiief features?
(d) The destructor„ covering or modification of,any unique geologic
or physical features,
(el Ary increase in wind it water erosion of soils, either on Or off the s'te,
22(
555
1tal
(IF SPACE EXPLANATION IS INADEQUATE, PLEASE ATTACH ADOITIG,,w, PAGES.)
(f) Changes in deposition or erosion of beacn sands, or changes in 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?
Explanation: (o) Building placed on site Will alter surf.,re rel i of
features (mirnr)
2. Air. Will the proposal result in: Yes Maybe No
(a) Air emissions or deterioration of ambient air quality? — -- —X.
(b) The creation of objectionable odors? — _–X.
(c) Alteration of air movement, moisture or temperature, or any change in
climate, either locally or regionally?
Explanation•
3. Water. Will the proposal result in:
(a) Change in currents, or the course or direction of water movements.
in either marine or fresh waters'
(b) Changes in absorption rates, drainage patters, or the rate and
amount of surface water runoff?
(c) Alterations to the course or flaw of flood waters'
(d) Change in the amount of surface water in any water body'
(e) Oischarge into surface water, or in any alteration of surface water
quality, including but not limited to temperature, dissolved
oxygen or turbidity?
(f) Alteration of the direction or rate of flow of ground waters?
(g) Change in the quantity of gound waters, eigher through direct
additions or withdrawals. or through interception of an
aquifer by cuts or excavations? — —
(h) Oeterioration in ground water quality, either througn direct
injection, or through the seepage of leachate, phospetes.
detergents, waterborne virus or bacteria. or other substances
into the gound waters? —
(i) Reduction in the amount of water otherwise available for
public water supplies? — --
Exolanatian: (b) Rlrlg Pliminatos is bre° W t r ui.11 rnin to 1Hnriara ;md
areas and drywells will be used for overflows ar rer.uired
4. Flora. Will the- proposal result in:
(a) Change in the diversity of species, or number of any species of
flora (including trees. shrugs, grass, crops. microflora 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 replenisnment of existing species?
(d) Reduction in acreage of any agricultural crop?
Exoianation: Kr, o-Sri. *i r�• ntS nr, .ai to.
Yes Ma a No
Y
5. Fauna. Will the proposal result in:
(a) Changes in the diversity of species. or number of any species
of fauna (birds, land animals including reptiles, fisn and
shellfish, benthic organisms, insects or microfauna)?
(b) Reduction of the numbers of any unique. rare, or endangered
species of fauna?
(c) Introduction of new species of fauna into an area. or result
in a barrier to the migration or movement of fauna?
(d) Deterioration of existing fish or wildlife habitat?
Explanation:
Yes •Maybe No
x
x
—
6. Na I se. Yes Maybe No
(a) 5111 the proposal increase existing noise levels? —
Exolanation: ACirlitanrs5l Treffir. rni11A 1"1P arrPTFJtPri hnwpvfr shrnilri
h,P R°i rnr
7. Light and Glare. Yes Maybe no
(a) Will the proposal produce new light or glare? — —
Explanation:
2.
(IF SPACE FOR EXPLANATION IS INADEQUATE, PLEASE ATTACH ADDITIONAL PAGES.)
E. Land Use.
(a) Will the proposal result in the alteration of the present or
planned '.and use of an area?
Explanation:
Yes NaYh2 No
9. Natural Resources. Will the proposal result in:
(a) Increase in the rate of use of any natural resources'
(b) Depletion of any nonrenewable natural resource'
Explanation: (?i) Cnnstruet i nn. material
for construction of the building.
Yes Maybe Na
IL
ill be depleted by its use
10. Risk of Uoset. Does the proposal involve a resk of an explosion or the
re ease of hazardous substances (including, but not limited to, oil,
pesticides, chemicals, ar radiation) in the event of an accident or
upset conditions?
Explanation:
Yes. Maybe No
11. Population.
Will the proposal alter the location, distribution, density, or growth
rate of the human population of an area?
Explanation•
Yes Maybe, la_
12. Housing.
Will the proposal affect existing housing, or create a demand for
additional housing?
Explanation:
13. Transportation /Circulation. Will the proposal result in:
(a) Generation of additional vehicular movement?
(b) Effects on existing parking facilities, or demand for new Larking'
(c) Impact upon existing transportation systems?
(d) Alterations to present patterns of circulation or movement
of people and /or goods?
(e) Alterations to waterborne, rail or air traffic?
(f) Increase in traffic hazards to motor venicle5.
bicyclists or pedestrians?
Its
exolanation:(yo Additional traffic n.nuld be generated by this project
bait Dili prQnlide rPntral lnr•Atinn _fnr P'cdinta1 Tloee .. CO New
narI4rE 1a- rAcni ree nn site for nnstntrers
14. ?uolic Services. Will the proposal have an affect upon, or result
in a need for new or altered governmental services in any of
of the following areas:
Fire Protection?
Police protection'
(a)
(b)
r�er fnrirg nrr9ir9.rCe,=..
Y_- Mavbe No
(c) Schools?
(a) Parks or other recreational facilities'
(e) Maintenance of public facilities, including roads? & _
(f) Other governmental services? X
Explanation: a c• structlon t •e and fire "rctect.i cn provide
x
should hsve little effect on both fire and
€-ction.
(r) Additional traffic `enerate3d should be Diinor.
(IF SPACE FOR EXPLSSIATICN I5 INADEQUATE, ?LEASE ATTACH ADDITIONAL PAGES.)
15. Enerov. Will the proposal result in: Yes ant No
(a) Use of suostantial amounts of fuel or energy'
(4) Demand upon existing sources of energy, or require
the development of new sources of energy?
Explanation: (t,) ''iith th' pc. of p'as,t. Th npiR anti modern trnhrningy
demand noon e'Ti anti r.g energy should be minor.
16. Utilities. Will the proposal result in a need for new systems. as Mavoe No
or alterations to the following utilities:
(a) Power or natural gas' — X
(b) Communication systems? Y.
(c) Water? —
(d) Sewer or septic tanks? x _
(e) Storm water drainage' X
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CIF .E FOR EXPLANAT:CN :S INADEQUATE, PLEASE ATTACH ACOITONAL PAGES.)
CO Solid waste and disposal? uL. _
Explanation:$$)BOth 'Ober and ra�turi 1 r?as is needed for hlrig mairtFr&rCe.
(cQWater required for restrooms (d) Nom SF�tic Ttn-ik �r }��1TP
for restrooms (e,1 Landsca.ned heel and rirywP11s (f)1r11,Py
Yes Mavbe N_
17. Human Health. Will the proposal .result in the creation of any health hazards
or potential health hazard (excluding mental health)/
Explanation:
18. Aesthetics. Will the proposal result in 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 public view?
Explanation:
X
19. P.ecreation. 'W111 the proposal result in an impact upon the quality or
quantity of existing recreational opportunities?
Explanation: .. .
ZO. Archeological /Historical. 'Will the proposal result in an alteration of a Yes Maybe NO
significant arcneological or historical site. structure, object or building?
Explanation:
III. SIGNATURE
1. the undersigned, swear under the penalty of perjury that the above i/esponses are
best of my knowledge. I also understand that, snould there be any willful misreoresenta
full disclosure on my par,Spokane County nay withdraw any declaration of nonsignific
reliance upon this checklist.
Gate: tiDG LI? 199 Proponent:
(Please Print or Type)
Proponent:Htdnk Grin9lds Address:
Phone: 521 Sure] ire Drive •
Person completing form: Hank Gri na 1 rl i
Oepar0nent or Office of County Reviewing ecklist:
Staff Members) Reviewing Checklist: s�1
e truthfully and to the
or willful lack of
that i; might issue in
255 -6287
phone :255• -6287
Oate:AllEllst 17 1979
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