Short Environmental Assessment Form Page 2
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45. Is the proposed action,
NO
YES
N/A
a. A permitted use under the zoning regulations?
b. Consistent with the adopted comprehensive plan?
NO
YES
6. Is the proposed action consistent with the predominant character of the existing built or natural
landscape?
7. Is the site of the proposed action located in, or does it adjoin, a state listed Critical Environmental Area?
NO
YES
If Yes, identify: __________________________________________________________________________
_______________________________________________________________________________________
8. a. Will the proposed action result in a substantial increase in traffic above present levels?
NO
YES
b. Are public transportation service(s) available at or near the site of the proposed action?
c. Are any pedestrian accommodations or bicycle routes available on or near site of the proposed action?
9. Does the proposed action meet or exceed the state energy code requirements?
NO
YES
If the proposed action will exceed requirements, describe design features and technologies:
_______________________________________________________________________________________
_______________________________________________________________________________________
10. Will the proposed action connect to an existing public/private water supply?
NO
YES
If No, describe method for providing potable water: ______________________________________
_______________________________________________________________________________________
11. Will the proposed action connect to existing wastewater utilities?
NO
YES
If No, describe method for providing wastewater treatment: ________________________________
_______________________________________________________________________________________
NO
YES
12. a. Does the site contain a structure that is listed on either the State or National Register of Historic
Places?
b. Is the proposed action located in an archeological sensitive area?
NO
YES
13. a. Does any portion of the site of the proposed action, or lands adjoining the proposed action, contain
wetlands or other waterbodies regulated by a federal, state or local agency?
b. Would the proposed action physically alter, or encroach into, any existing wetland or waterbody?
If Yes, identify the wetland or waterbody and extent of alterations in square feet or acres: _______________
_______________________________________________________________________________________
_______________________________________________________________________________________
14. Identify the typical habitat types that occur on, or are likely to be found on the project site. Check all that apply:
Shoreline
Forest
Agricultural/grasslands
Early mid-successional
Wetland
Urban
Suburban
NO
YES
15. Does the site of the proposed action contain any species of animal, or associated habitats, listed
by the State or Federal government as threatened or endangered?
16. Is the project site located in the 100 year flood plain?
NO
YES
17. Will the proposed action create storm water discharge, either from point or non-point sources?
NO
YES
If Yes,
a. Will storm water discharges flow to adjacent properties?
NO
YES
b. Will storm water discharges be directed to established conveyance systems (runoff and storm drains)?
If Yes, briefly describe:
NO
YES
_______________________________________________________________________________________
_______________________________________________________________________________________
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