Loading...
Environmental checklist and DNS.pdfOF EDA1 0 4- V m Fsr 1g90 121 5TH AVENUE NORTH, EDMONDS, WA 98020 (425) 771-0220 RCW 197-11-970 Determination of Nonsignificance (DNS) Description of proposal: The Prestige Care redevelopment project proposes to replace an existing 32,000 square foot (88 -bed) skilled nursing facility with a new 48,385 square foot (80 -bed) skilled nursing facility. This consolidated project requires a design review recommendation by the Architectural Design Board and a final decision on the project's design and a conditional use permit for the skilled nursing facility by the Hearing Examiner. (File Nos. PLN20130075 and PLN20130076) Proponent: Prestige Care, Inc. Location of proposal, including street address if any: 21008 76th Avenue West (Tax Parcel # 00614300001501) Lead agency: City of Edmonds An environmental impact statement is not required under RCW 43.21 C.030(2)(c). This decision was made after review of a completed environmental checklist and other information on file with the lead agency. This information is available to the public on request. There is no comment period for this DNS. XX This DNS is issued under 197-11-340(2); the lead agency will not act on this proposal for 14 days from the date below. Comments must be submitted by February 25, 2014. Project Planner: Mike Clugston, AICP, Associate Planner Responsible Official: Rob Chave, Planning Manager Contact Information: City of Edmonds 1 121 5th Avenue North, Edmonds, WA 980201425-771-0220 Date: February 11, 2014 Signature: XX You may appeal this determination to Robert Chave, Planning Manager, at 121 5th Avenue North, Edmonds, WA 98020, by filing a written appeal citing the specific reasons for the appeal with the required appeal fee, adjacent property owners list and notarized affidavit form no later than February 25, 2014 . You should be prepared to make specific factual objections. Contact the project planner to read or ask about the procedures for SEPA appeals. XX Posted on February 11, 2014 , at the Edmonds Public Library and Edmonds Public Safety Building. Published in the Everett Herald. Emailed to the Department of Ecology SEPA Center (SEPAunit(o)ecy.wa.gov). Mailed to property owners within 300 feet of the site. The SEPA Checklist, project plans, location map, and DNS are available at www.edmondswa.gov through the Permits Online link. Search for file number PLN20130075 and PLN20130076. These materials are also available for viewing at the Planning Division — located on the second floor of City Hall: 121 5th Avenue North, Edmonds WA 98020. Page 1 of 2 PLN20130075 & 76 SEPA DNS.docx Mailed notice to the following: XX COMCAST XX Snohomish County Health District Outside rlant Engineer, North Region Attn: Bruce Straughn 1525 75t St. SW Suite 200 3020 Rocker Ave Everett, WA 98203 Everett, WA 98201-3900 XX Washington State Dept. of Transportation XX Puget Sound Energy Attn: Ramin Pazooki Attn: Elaine Babby SnoKing Developer Services, MS 221 PO Box 97034, M/S EST -11V 15700 Dayton Ave. N. Bellevue, WA 98009-9734 PO Box 330310 Seattle, WA 98133-9710 XX Betty Tobin Snohomish Co. PUD XX Prestige Care Inc. (Paul Rasmussen) PO Box 1107 7700 NE Parkway Dr., Suite 300 Everett, WA 98206-1107 Vancouver, WA 98662 XX Tulalip Tribal Council XX Snohomish County Fire District No. 1 6700 Totem Beach Road Headquarters Station No. 1 Marysville, WA 98270 Attn.: Director of Fire Services 12310 Meridian Avenue South XX Carletti Architects, P.S. (David Wilson) Everett, WA 98208-5764 116 E Fir St., Suite A Mount Vernon, WA 98273 XX Community Transit Attn.: Brent Russell 7100 Hardeson Road Everett, WA 98203 cc: File No. / SEPA Notebook Page 2 of 2 PLN20130075 & 76 SEPA DNS.docX Prestige Care Nursing Facility Design Review & Conditional Use Permit 2012 Aerial h®t® 21008 76th Ave. „S4o File #: PL 20130075 & 0076 1 inch = 200 feet OF EDV O� UZ Purpose of Checklist. • 7 A • , e1 The State Environmental Policy Act (SEPA), chapter 43.21C RCW, requires all governmental agencies to consider the environmental impacts of a proposal before making decisions. An environmental impact statement (EIS) must be prepared for all proposals with probable significant adverse impacts on the quality of the environment. The purpose of this checklist is to provide information to help you and the agency identify impacts from your proposal (and to reduce or avoid impacts from the proposal, if it can be done) and to help the agency decide whether an EIS is required. Instructions for Applicants: This environmental checklist asks you to describe some basic information about your proposal. Governmental agencies use this checklist to determine whether the environmental impacts of your proposal are significant, requiring preparation of an EIS. Answer the questions briefly, with the most precise information known, or give the best description you can. You must answer each question accurately and carefully, to the best of your knowledge. In most cases, you should be able to answer the questions from your own observations or project plans without the need to hire experts. If you really do not know the answer, or if a question does not apply to your proposal, write "do not know" or does not apply". Complete answers to the questions now may avoid unnecessary delays later. Some questions ask about governmental regulations, such as zoning, shoreline, and landmark designations. Answer these questions if you can. If you have problems, the governmental agencies can assist you. The checklist questions apply to all parts of your proposal, even if you plan to do them over a period of time or on different parcels of land. Attach any additional information that will help describe your proposal or its environmental effects. The agency to which you submit this checklist may ask you to explain your answers or provide additional information reasonably related to determining if there may be significant adverse impact. Use of checklist for nonproject proposals: Complete this checklist for nonproject proposals, even though questions may be answered "does not apply." IN ADDITION, complete the SUPPLEMENTAL SHEET FOR NONPROJECT ACTIONS (part D). For nonproject actions, the references in the checklist to the words "project," "applicant," and "property or site" should be read as "proposer," and "affected geographic area," respectively. 1. Name of proposed project, if applicable: Prestige Care 2. Name of applicant: Prestige Care Inc. 3. Address and phone number of applicant and contact person: Paul Rasmussen 360.735.7155 7700 NE Parkway Dr. Suite 300 Vancouver. WA 98662 4. Date checklist prepared: December 6, 2013 5. Agency requesting checklist: City ofEdmonds Revised on 8/19111 P71 - SEPA Checklist.doc Page 1 of25 6. Proposed timing or schedule (including phasing, if applicable): Construction beginning late spring 201-4, ending summer 2015. (STAFF 7. Do you have any plans for future additions, expansion, or further activity related to or connected with this proposal? If yes, explain. No 8. List any environmental information you know about that has been prepared, or will be prepared, directly related to this proposal. (STAFF C(.➢MMENTS) P: 9. Do you know whether applications are pending for governmental approvals of other proposals directly affecting the property covered by your proposal? If yes, explain. Department of Health approval will be required. (STAFF COMMENTS) Revised on 8119111 P71--SEPA—Checklist. doe Page 2 of25 10. List any government approvals or permits that will be needed for your proposal, if known. Construction Stormwater General Permit from Department of Ecology. (STAFF COMMENTS) 11. Give brief, complete description of your proposal, including the proposed uses and 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. Remove an existing 89 bed Skilled Nursing Facility that is approximately 32,000 sf and remove the esisting parking lot. The proposed project is a new 80 bed skilled nursing facilitvl partial long term care. It is a one story building with a partial basement with a total floor area of 48,385 square feet. The building will be wood framed with typical concrete foundations and slab on grade. It will be a VA building and I-2 Occupancy. The site is 2.3 acres and the project will add new parking, landscaping and walkways to accommodate the building. (STAFF COMMENTS) 12. 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 range or boundaries of the site(s). Provide 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. 21008 76th Avenue W Edmonds WA 98026 SE I/4, SE t/4, Sec 19, TWN27N, RGE 4E, WM Legal Description: The following_ portions of Willowdale Gardens Divison 1, as recorded in Book 10 of Plats at Page 72, records of Snohomish County, Washington: Lot 15 except the West 318 feet; together with the North 126 feet of Lot 16; also together with the North 250 feet of Lot 17. Situated in the County of Snohomish, State of Washington. (STAFF COMMENTS) Revised on 8/19/11 P71_- SEPA Checktist.doc Page 3 of25 TO BE COMPLETED BY APPLICANT B. ENVIRONMENTAL ELEMENTS 1. Earth a. General description of the site (circle one): Flat, rolling, hilly, steep slopes, mountainous, other: (STAFF COMMENTS) b. What is the steepest slope on the site (approximate percent slope)? 7.5% (STAFF COMMENTS) C. What general types of soils are found on the site (for example, clay, sand, gravel, peat, and muck)? If you know the classification of agricultural soils, specify them and note any prime farmland. Vashon Till (Qvt), a non -sorted mix of c1gy, silt, pebbles, sand, cobbles & boulders (STAFF COMMENTS) d. Are there surface indications or history of unstable soils in the immediate vicinity? If so, describe. None noted or known. Revised on 8119111 P71--SEPA—Cheeklisf. doe Page 4 of25 (STAFF COMMENTS) e. Describe the purpose, type and approximate quantities of any filling or grading proposed. Indicate source of fill. Roughly 2,000 cubic yards fill will be needed for the project to raise site grades as appropriate. (STAFF COMMENT f. Could erosion occur as a result of clearing, construction, or use? If so, generally describe. Yes. Erosion due to construction and grading is possible. Appropriate erosion control measures are outlined in SWPPP. (STAFF g. About what percent of the site will be covered with impervious surfaces after project construction (for example, asphalt or buildings)? 80% (STAFF COMMENTS) h. Proposed measures to reduce or control erosion, or other impacts to the earth, if any: Sediment trap, interceptor swale w/check dams, silt fence, stabilized construction entrance. (STAFF COMMENTS) 2. AIR a. What types of emissions to the air would result from the proposal (i.e., dust, automobile, odors, and industrial wood smoke) during construction and when the project is completed? If any, generally describe and give approximate quantities if known. Normal emissions from construction equipment and some dust will be generated during construction depending on weather conditions. After completion of construction, normal automobile emissions will be generated by on-site (STAFF COMMENTS) Revised on 8/19/11 P71_ SEPA_Checklist.doc Page 5 of25 b. Are there any off-site sources of emissions or odor that may effect your proposal? If so, generally describe. No. (STAFF COMMENTS C. Proposed measures to reduce or control emissions or other impacts to the, if any: The Washington Clear Air Act requires the use of all known, available and reasonable means of controlling air pollution, including dust. Construction impacts will not be significant and the potential for soils to be carried off- site by trucks will be controlled. Water will be used for dust control if needed. (STAFF COMMENTS 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, and wetlands)? If yes, describe type and provide names. If appropriate, state what stream or river it flows into. No. (STAFF COMMENTS (2) Will the project require any work over, in, or adjacent to (within 200 feet) the described waters? If yes, please describe and attach available plans. N/A (STAFF COMMENTS (3) Estimate the amount of fill and dredge material that would be placed in or removed from surface water or wetlands and indicate the area of the site that would be affected. Indicate the source of fill material. N/A (STAFF COMMENTS Revised on 8119111 P71 - SEPA Checklist. doe Page 6 of25 (4) Will the proposal require surface water withdrawals or diversions? Give general description, purpose, and approximate quantities if known. No. (STAFF COMMENTS (5) Does the proposal lie within a 100 -year floodplain? If so, note location on the site plan. No. (STAFF COMMENTS (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. No. (STAFF COMMENTS b. Ground: (1) Will ground water be withdrawn, or will water be discharged to ground water? Give general description, purpose, and approximate quantities if known. No. (STAFF COMMENTS) Revised on 8119111 P71--SEPA—Checklist.doc Page 7 of 25 (2) Describe waste material that will be discharged into the ground from septic tanks or other sources, if any (for example: 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. N/A (STAFF COMMENTS C. Water Runoff (including storm water): (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. The only source of runoff is storinwater. It will be collected in catch basins and routed to a detention vault, and released into the cily storm system. (STAFF COMMENTS) (2) Could waste materials enter ground or surface waters? If so, generally describe. No. (STAFF COMMENTS d. Proposed measures to reduce or control surface, ground, and runoff water impacts, if any: A detention vault will be constructed to control runoff. Revised on 8119111 P71_- SEPA_Checklist.doe Page 8 of25 (STAFF COMMENTS) 4. Plants a. Check or circle types of vegetation found on the site: X deciduous tree: alder, maple, aspen, other: (At some Existing Landscape Islands) X evergreen tree: fir, cedar, pine, other: (At some Existing Landscape Islands) X shrubs (At some Existing Landscape Islands) X grass (At some Existing Landscape Islands) pasture crop or grain wet soil plants: cattail, buttercup, bulrush, skunk cabbage, other: water plants: water lily, eelgrass, milfoil, other: other types of vegetation: (STAFF COMMENTS) b. What kind and amount of vegetation will be removed or altered? Existing Deciduous Trees, Evergreen Trees, Pine Trees, Grass, and shrubs will be removed onlyas s required to accommodate the new building footprint and parking lot. (STAFF COMMENTS) C. List threatened or endangered species known to be on or near the site. None known. (STAFF COMMENTS) Revised on 8/19/11 P71_- SEPA_Checklist.doe Page 9 of25 d. Proposed landscaping, use of native plants, or other materials to preserve or enhance vegetation on the site, if any: 20% or 22,000 sf of the overall site is going to be landscaped at the completion of the project. The landscaping will be installed to be compliant with the City of Edmonds Municipal Code. Native plants will be utilized within the Landscape design. Existing trees, shrubs, and vegetation will be re -used as long as they do not interfere with the new proposed building and parking lot locations. (STAFF COMMENTS) 5. Animals a. Check or circle any birds and animals that have been observed on or near the site or are known to be on or near the site: X birds: hawk, heron, eagle, songbirds, other: mammals: deer, bear, elk, beaver, other: fish: bass, salmon, trout, herring, shellfish, other: (STAFF COMMENTS) b. List any threatened or endangered species known to be on or near the site. None. (STAFF COMMENTS C. Is the site part of a migration route? If so, explain. No (STAFF COMMENTS Revised on 8119111 P71--SEPA—Checklist.doc Page 10 of 25 d. Proposed measures to preserve or enhance wildlife, if any: None. (STAFF COMMENTS) 6. Energy and Natural Resources 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. Electric for building lights, power, and PTAC units in resident rooms. Natural gas for facility heat will be used to meet the completed projects energy needs. There will also be a diesel generator to meet DOH requiredments for emergency backup. (STAFF COMMENTS) b. Would your project affect the potential use of solar energy by adjacent properties? If so, generally describe. No all the neighboring buildings are 2 stories and our building is only one story so we would not block any opportunies for a neighbor to use or continue to use solar power. (STAFF COMMENTS) C. What kinds of energy conservation features are included in the plans of this proposal? Dist other proposed measures to reduce or control energy impacts, if any: High efficiencyhating/ cooling systems will be used. NREC compliant. (STAFF COMMENTS) Revised on 8/19/11 P71_- SEPA_Checklist.doc Page 11 of25 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 of this proposal? If so describe. No (STAFF COMMENTS) (1) Describe special emergency services that might be required. (STAFF COMMENTS) (2) Proposed measures to reduce or control environmental health hazards, if any: None (STAFF COMMENTS b. Noise (1) What types of noise exist in the area which may affect your project (for example: traffic, equipment, operation, other)? Traffic from 76th Ave. (STAFF COMMENTS Revised on 8119111 P71_ SEPA_Checklist.doe Page 12 of 25 (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 hour's noise would come from the site. Normal noises will occur during construction of the building, durin7 construction hours from 7 a.m. to 5 P —in (STAFF COMMENTS) (3) Proposed measures to reduce or control noise impacts, if any: N/A (STAFF COMMENTS S. Land and Shoreline Use a. What is the current use of the site and adjacent properties? The current site is used for the same purpose as the proposed (rehabilitation/ skilled nursing facility). The site is adiacent to residential on the north and west, and various commercial on the south. (STAFF COMMENTS) b. Has the site been used for agriculture? If so, describe. No. (STAFF COMMENTS Revised on 8119111 P71_- SEPA_Checklist.doe Page 13 of25 C. Describe any structures on the site. Existing, skilled nursing building, and associated parking, landscaping and walkways. (STAFF COMMENTS) d. Will any structures be demolished? If so, what? Yes. Building,_ parking, sidewalks and landscaping will be demolished. (STAFF COMMENTS) e. What is the current zoning classification of the site? Multi -family — RM -2.4 (STAFF COMMENTS) f. What is the current comprehensive plan designation of the site? Mixed Use Commercial Plan Designation with a plan overlay of Medical/Highway Activity Center. (STAFF COMMENTS) g. If applicable, what is the current shoreline master plan designation of the site? N/A. Revised on 8/19/11 P71 _- SEPA_Checkl ist. doc Page 14 of 25 (STAFF COMMENTS) h. Has any part of the site been classified as an "environmentally sensitive" area? If so, specify. No. (STAFF COMMENTS) i. Approximately how many people would reside or work in the completed project? (80) employees will work in the new facility with a maximum staff shift of 48 employees in the building at one point in time. Maximum of (80) patient residents at one time. (STAFF COMMENTS) j. Approximately how many people would the completed project displace? (75) employees have already been removed from the existing facility since it is closed down currently. The existing facility used to have a maximum staff shift of (45) employees in the buiding at one time. Maximum of (89) patients used to reside at the facility at one time. k. Proposed measures to avoid or reduce displacement impacts, if any: (3) employees have already been tranfered to other Prestige Care facilities since they closed the doors at the exising facility. The other employees were displaced won closing the facility. They may be able to retain some of those employees upon opening the new facility. (STAFF COMMENTS) Revised on 8119111 P 71---SEPA—Cheeklist. doe Page 15 of25 1. Proposed measures to ensure the proposal is compatible with existing and projected land uses and plans, if any: The project will obtain a Conditional Use Permit and Architectural Design Review approval from the City of Edmonds. (STM AFF COMENTS) U/ 9. Housing a. Approximately how many units would be provided, if any? Indicate whether high, middle, or low-income housing. The new building will have (80) Beds within the skilled nursing facility. (STAFF COMMENTS) b. Approximately how many units, if any would be eliminated? Indicate whether high, middle, or low-income housing. The existing, building had (89) Beds so (9) beds will be eliminated within the new skilled nursing facility. (STAFF COMMENTS C. Proposed measures to reduce or control housing impacts, if any: None (STAFF COMMENTS) 10. Aesthetics Revised on 8119111 P 71---SEPA—Check-list. doe Page 16 of25 11. a. What is the tallest height of any proposed structure(s), not including antennas; what is the principle exterior building material(s) proposed? 27'-0" is the tallest height of the proposed structure. The principal exterior building material is Fiber Cement Board Horizontal lap siding and Fiber Cement Board Shingle lap siding painted. b. What views in the immediate vicinity would be altered or obstructed? None. (STAFF COMMENTS C. Proposed measures to reduce or control aesthetic impacts, if any: Variation of materials, Solid Body stained wood trusses and Cultured stone veneer are being added along 76"' Ave W to dress up the street approach to the building. (STAFF COMMENTS) Light and Glare a. What type of light or glare will the proposal produce? What time of day would it mainly occur? Overhead pole mounted Security Site -Parking lot lighting will be provided. Wall packs at the perimeter of the building will be provided for security as well. These lights would be on a sensor so as to only come on at hours that the site is dark. The pole lights and building wall packs would be down lights and shielded so as to not allow the site lighting to travel on to adjacent neighboring sites. (STAFF COMMENTS) b. Could light or glare from the finished project be a safety hazard or interfere with views? No Revised on 8119111 P71--SEPA—Checklist. doe Page 17 of25 (STAFF COMMENTS) C. What existing off-site sources of light or glare may affect your proposal? None (STAFF COMMENTS) d. Proposed measures to reduce or control light and glare impacts, if any: Down lights and shields so as not to affect adjacent properties. (STAFF COMMENTS 12. Recreation a. What designated and informal recreational opportunities are in the immediate vicinity? City of Edmonds Municipal Golf Course, Edmonds-Woodward Highschool Fields, Pine Ridg-e Park, Gold Park, Yost Park, Vision Quest Sports & Fitness, Ja'Warren Hooker Fitness Perfomance. (STAFF COMMENTS) "x b. Would the proposed project displace any existing recreation uses? If so, describe. No. (STAFF COMMENTS) Revised on 8119111 P71--SEPA—Checklist. doe Page 18 of25 C. Proposed measures to reduce or control impacts on recreation, including recreation opportunities to be provided by the project or applicant, if any: N/A (STAFF COMMENTS 13. Historic and Cultural Preservation a. Are there any places or objects listed on, or proposed for, national, state, or local preservation registers known to be on or next to the site? If so, generally describe. No. (STAFF COMMENTS) b. Generally describe any landmarks or evidence of historic, archaeological, scientific, or cultural importance known to be on or next to the site. N/A (STAFF COMMENTS) C. Proposed measures to reduce or control impacts, if any: N/A (STAFF COMMENTS Revised on 8119111 P71---SEPA—Checklist.doc Page 19 of25 14. Transportation a. Identify public streets and highways serving the site, and describe proposed access to the existing street system. Show on site plans, if any. The site is located on 76h Ave W. There wfil be (2) driveways accessing 76h Ave W. from the parking lot. (STAFF COMMENTS b. Is site currently served by public transit? If no, what is the approximate distance to the nearest transit stop? Yes, there are bus stops at the 76h & 212'h and the 76h and 208"' intersection, both within 0.15 miles. (STAFF COMMENTS) C. How many parking spaces would the completed project have? How many would the project eliminate? (59) stalls provided with the new project and (54) are eliminated from the old project. (STAFF COMMENTS)—e"'(",,," 114 A"%"V" A, d. Will the proposal require any new roads, streets, or improvements to existing roads or streets, not including driveways? If so, generally describe (indicate whether public or private). The existing sidewalk needs to be Lipp graded to 7 feet concrete maximum width in the ROW along 76th Ave W. (STAFF COMMENTS) Revised on 8119111 P71_- SEPA_Cliecklist.doc Page 20 of25 e. Will the project use (or occur in the immediate vicinity of) water, rail, or air transportation? If so, generally describe. No. (STAFF COMMENTS L How many vehicular trips per day would be generated by the completed project? If known, indicate when peak volumes would occur. The existing facility that is being removed has 89 beds for skilled nursing. The new facility has 80 beds for skilled nursing which is a decrease in traffic impacts to the site. (STAFF COMMENTS g. Proposed measures to reduce or control transportation impacts, if any: None (STAFF COMMENTS 15. Public Services a. Would the project result in an increased need for public services (for example: fire protection, police protection, health care, schools, other)? If so, generally describe. No. (STAFF COMMENTS Revised on 8119111 P71---SEPA—Checklist.doc Page 21 of 25 b. Proposed measures to reduce or control direct impacts on public services, if any: N/A (STAFF COMMENTS) 16. Utilities a. Circle utilities currently available at the site: electricity, natural gas, water, refuse service, telephone, sanitary sewer, septic system, other: Water, natural gas, electricity, sanitary sewer, refuse service, and telephone are provided to the site currently. (STAFF COMMENTS) 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. Water Sanitary sewer and storm are provided through the City of Edmonds. Electricity is through Snohomish PUD, Natural Gas is through PSE. Refuse is through Allied Waste. (STAFF COMMENTS) I declare under penalty of perjury laws that the above answers are true and correct to the best of my knowledge. I understand that the lead agency is relying on them to make its decision. Revised on 8/19/11 P71_ SEPA_Checklist.doc Page 22 of 25 Signature of Proponent Date Submitted Revised on 8119111 P71_- SEPA_Checklist.doe Page 23 of25