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ENVIRONMENTAL CC LIST
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Purpose of Checklist.
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.
A. BACKGROUND
1. Name of proposed project, if applicable: Community Health Center of Snohomish Edmonds Medical Dental Clinic_
2. Name of applicant: Wad Ousimovitch
3. Address and phone number of applicant and contact person:
Had Ousimovitch
4109 SW Orchard St.
Seattle, WA 98136
Tel: 206-948-8815 e-mail: vla&.voka.us
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4. Date checklist prepared: 02115/2012
5. Agency requesting checklist: Citgo Edmonds
6. Proposed timing or schedule (including phasing, if applicable):
VA
9.
Design and Permit: Present though the end ofJune 2013.
Construction: beginning of July 2013 through June 2014.
Clinic operation: July 2014
(STAFF COMMENTS)
Do you have any plans for future additions, expansion, or further activity related to or connected with this
proposal? If yes, explain.
The owner is considering potential for a future Child Care Development Center on the site. This would fall under
separate permit.
STAFF COMMENTSr.<.:.,roam.
List any environmental information you know about that has been prepared, or will be prepared, directly related
to this proposal.
A Phase 1 Environmental Report has been prepared for the project. As well as a Geotechnical Report
(STAFF COMMENTS)
Do you know whether applications are pending for governmental approvals of other proposals directly affecting
the property covered by your proposal? If yes, explain.
No
(STAFF COMMENTS)
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10. List any government approvals or permits that will be needed for your proposal, if known.
(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.
The project is a 25, 000sf two stot•y Medical dental building for Community Health Centers of Snohomish Count.
Located on a 2.3 acre site on the west sideHighivay 99 in Edmonds Washington. There will be on grade parking and
landscaping on the North, South and West sides of 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.
A PORTION OF S. 31 T 27N R 4E WM
PARCEL A:
TRACT 21 SKELTON'S LAKE MCALEER 5 ACRE TRACTS ACCORDING TO THE PLAT THEREOF RECORDED
IN VOLUME 6 OF PLATS PAGE 21 RECORDS OF SNOHOMISH COUNTY WASHINGTON•
EXCEPT THE WEST 183 FEET THEREOF;
AND EXCEPT THAT PORTION OF THE SOUTH 338.16 FEET THEREOF LYING EAST OF THE EAST LINE OF
THE WEST 183 FEET THEREOF.
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THAT PORTION OF TRACT 20 SKELTON'S LAKE MCALEER 5 ACRE TRACTS ACCORDING TO THE PLAT
THEREOF RECORDED IN VOLUME 6 OF PLATS PAGE 21 RECORDS OF SNOHOMISH COUNTY
WASHINGTON LYING WESTERLY OF STATE ROAD NO. I AS CONVEYED TO THE STATE OF WASHINGTON BY
DEED RECORDED UNDER RECORDING NO. 350566•
EXCEPT THE SOUTH 200 FEET THEREOF•
SITUATED IN THE COUNTY OF SNOHOMISH STATE OF WASHINGTON.
(STAFF COMMENTS)
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)?
The proposed site design will inchide rockeries and/or retaining walls. There will be some smaller areas of 3H:1 V
slopes,eg nerally conned to swales and rain garden areas. Generally, site slopes will not be steeper than 15%.
(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.
Site soils include silty sand and fill materials, underlain by dense silty sands (glacial till).
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d. Are there surface indications or history of unstable soils in the immediate vicinity? If so, describe.
(STAFF COMME
e. Describe the purpose, type and approximate quantities of any filling or grading proposed. Indicate source
of fill.
In general, the proposed project site will be an export site. Some import of gavel base, pavement, rockery, and
topsoil materials is anticipated. Import quantities are estimated to be approximately 2,200-CY of material.
(STAFF COMMENTS)
f. Could erosion occur as a result of clearing, construction, or use? If so, generally describe.
Yes, erosion could occur as a result of construction. However, implementation of required Temporary Erosion
and Sedimentation Control (TESC) measures are anticipated to adequately control erosion and reduce risk of
materials leaving the site via runoff.
(STAFF COMMENTS)
g. About what percent of the site will be covered with impervious surfaces after project construction (for
example, asphalt or buildings)?
The proposed site buildout results in approximately 67% impervious area. An estimated max future buildout is
estimated to result in approximately 78% impervious area.
(STAFF COMMENTS)
h. Proposed measures to reduce or control erosion, or other impacts to the earth, if any:
Multiple required TESC measures are anticipated to be employed during and after completion of
construction. These include: stabilized construction entrance, inlet protections, silt fencing street sweeping,
wheel washes, plastic covering of stockpiles and exposed areas, grcwel stabilization, seeding, temporary
sedimentation settling basins, etc. Monitoring of runoff will likely be required by the state Department of
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(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.
None
(STAFF COMMENTS)
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:
NA
(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)
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(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.
No
(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.
None
(STAFF COMMENTS)
(4) Will the proposal require surface water withdrawals or diversions? Give general description,
purpose, and approximate quantities if known.
(STAFF
(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
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(STAFF
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)
(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.
None
(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.
Runoff is limited to that which will originate from the site. A small strip of vegetated area immediately to
the west of the site may generate some run-on flows. Proposed collection systems include pervious
pavements, rain gardens, swales, and catch basins. Proposed conveyance systems include surface.flows
(gutters), swales, and pipes. It is anticipated that almost all runoff water will be collected onsite. Some will
be infiltrated, some will be detained in a flow control and water quality treatment system (a wetvardt is
anticipated. Flows will then be treated to remove phosphorous, per cit? requirements. Flows are conveyed
via an existin municipal nunicipal system to Lake Ballinger, which then drains to Lake Washington.
(STAFF COMMENTS)
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(2) Could waste materials enter ground or surface waters? If so, generally describe.
While it is possible for waste material to enter ground or surface waters, the proposed design follows
applicable design uidelines to reduce likelihoods to acceptable levels. General site traffic will be of no
greater risk than a typical commercial retail site, limited mainly to passenger and small delivery vehicles.
On site activities will be health and dental clinic services. Onsite materials and waste materials are strictly
controlled and managed. Trash and rec} cling containers will be confined to specially designated and
controlled areas.
(STAFF COMMENT
d. Proposed measures to reduce or control surface, ground, and runoff water impacts, if any:
Measures to reduce and control surface, ground and runoff impacts areeg nerally described in the response to
3.c. (1), above. Low Impact Development (LID) approaches, such as pervious pavement, and amended soil
infiltration are anticipated to be included in the design. The proposed site stormwater system will meet
applicable city and state requirements. Onsite waste management (trash recycling) and onsite activities will
".X.- �,y��
4. Plants
a. Check or circle types of vegetation found on the site:
X deciduous tree: alder, ma le, aspen, other: Maple
X evergreen tree: fir, cedar me, other: Pine
X shrubs
X I grass
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?
Shrubs and Grass will be replaced with planting and landscapes per the City of Edmonds Design requirements.
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C.
d.
(STAFF COMMENTS)
List threatened or endangered species known to be on or near the site.
None
(STAFF COMMENTS)
Proposed landscaping, use of native plants, or other materials to preserve or enhance vegetation on the site,
if any:
New landscaping will use native plants and materials to enhance the site.
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:
birds: hawk, heron, eagle, songbirds, other: NA
mammals: deer, bear, elk, beaver, other: NA
(STAFF COMMENTS)
b. List any threatened or endangered species known to be on or near the site.
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(STAFF
C. Is the site part of a migration route? If so, explain.
No
(STAFF COMMENTS)
d. Proposed measures to preserve or enhance wildlife, if any:
Landscape and Planting will consist of entirely native plants to this area.
(STAFF
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.
Natural Gas
(STAFF
b. Would your project affect the potential use of solar energy by adjacent properties? If so, generally
describe.
No
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(STAFF COMMENTS
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:
The project will be compliant with the Washington State enemy code and be a LEED Silver bjjilding. It will use
measures such as damlighting control, room occupancy sensors, and Daylight sensors.
(STAFF COMMENTS)
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:
NA
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(STAFF COMMENTS)
b. Noise
(1) What types of noise exist in the area which may affect your project (for example: traffic, equipment,
operation, other)?
None
(STAFF COMMENTS)
(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.
During Construction there will be Earthmoving equipment, cranes, drilling and Hammering noises corning
from the project site on a short term Basis, and only during normal working hours.
(STAFF COMMENTS)
(3) Proposed measures to reduce or control noise impacts, if any:
Sort -term noise is expected to occur only during normal working hours.
(STAFF COMMENTS)
h. Land and Shoreline Use
a. What is the current use of the site and adjacent properties?
Zoned General Commercial: Currently the lot is empty its most current use was an RV Sales lot. Adjacent to the
North is a Les Schwab, and Adjacent to west is a multi- ainily resident complex.
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(STAFF COMMENTS)
b. Has the site been used for agriculture? If so, describe.
(STAFF COMMENTS)
C. Describe any structures on the site.
None
(STAFF COMMENTS)
d. Will any structures be demolished? If so, what?
NA
(STAFF COMMENTS)
e. What is the current zoning classification of the site?
General Commercial
(STAFF COMMENTS)
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What is the current comprehensive plan designation of the site?
Edmonds Zoned: General Commercial
g. If applicable, what is the current shoreline master plan designation of the site?
None
(STAFF COMMENTS)
h. Has any part of the site been classified as an "environmentally sensitive" area? If so, specify.
No
Approximately how many people would reside or work in the completed project?
40 Healthcare Employees
(STAFF COMMENTS)
j. Approximately how many people would the completed project displace?
None
(STAFF COMMENTS)
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k. Proposed measures to avoid or reduce displacement impacts, if any:
NA
(STAFF COMMENTS)
1. Proposed measures to ensure the proposal is compatible with existing and projected land uses and plans, if
any:
Complies with Edmonds General Commercial Zoning requirements and Code.
(STAFF COMMENTS)
9. Housing
a. Approximately how many units would be provided, if any? Indicate whether high, middle, or low-income
housing.
None
(STAFF COMMENTS)
b. Approximately how many units, if any would be eliminated? Indicate whether high, middle, or low-income
housing.
NA
(STAFF COMMENTS)
C. Proposed measures to reduce or control housing impacts, if any:
NA
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(STAFF COMMENTS)
10. Aesthetics
a. What is the tallest height of any proposed structure(s), not including antennas; what is the principle
exterior building material(s) proposed?
34' to top of Parapet. 42' to top of screened rooftop unit. Exterior materials: Concrete, Bick• Wood, Metal
Siding
(STAFF COMMENTS)
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:
Landscaping.
11. Light and Glare
a. What type of light or glare will the proposal produce? What time of day would it mainly occur?
None. Materials are not hightl
.y reflective and lat•geglazed areas have overhangs screening them.
(STAFF COMMENT
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b. Could light or glare from the finished project be a safety hazard or interfere with views?
No
(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:
NA
(STAFF COMMENTS); L�,
�,^� �� • :gib �,,,,,. w � O,i.. ;,<�.,d� y '� t t„y p ,�,_a;
12. Recreation
a. What designated and informal recreational opportunities are in the immediate vicinity?
None
(STAFF COMMENTS)
b. Would the proposed project displace any existing recreation uses? If so, describe.
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(STAFF
C. Proposed measures to reduce or control impacts on recreation, including recreation opportunities to be
provided by the project or applicant, if any:
NA
(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
b. Generally describe any landmarks or evidence of historic, archaeological, scientific, or cultural importance
known to be on or next to the site.
None
(STAFF COMMENTS)
C. Proposed measures to reduce or control impacts, if any:
NA
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Page 19 of 24
(STAFF
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.
Highway 99- There will be two driveways accessing the Site from Highway 99
See Site plans and Trafic Study
(STAFF COMMENTS)
b. Is site currently served by public transit? If no, what is the approximate distance to the nearest transit
stop?
Yes
(STAFF COMMENTS)
C. How many parking spaces would the completed project have? How many would the project eliminate?
-144S
paces
- None
(STAFF COMMENTS)
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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).
(STAFF COMMENTS)
C. Will the project use (or occur in the immediate vicinity of) water, rail, or air transportation? If so,
generally describe.
No
(STAFF COMMENTS)
f. How many vehicular trips per day would be generated by the completed project? If known, indicate when
peak volumes would occur.
70 trips during the weekday PM peak hour
(STAFF COMMENTS)
g. Proposed measures to reduce or control transportation impacts, if any:
Bike Parking and encouraged use of public Transit
(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. It is a healthcare building that would provide more public services.
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(STAFF
b. Proposed measures to reduce or control direct impacts on public services, if any:
NA
(STAFF COMMENTS)
16. Utilities
a. Circle utilities currently available at the site: electricity, natural gas, water, refuse service, telephone,
sanitary sewer, septic system, other:
Electricity, Gas, Water, Refuse, Telephone, Sanitary Sewer
(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.
All Utilities are currentiv Stubbed to the site, which if sixe correctly will preclude the contractor fiom enterins into
the right of way for connection purposes.
Power: SNOPUD
Water/Sewer: OlyLnpic View Water District
Gas: PSE
(STAFF
AID"WAr,I BM
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.
_.. j Z8
Signature of Proponent Date Submitted
N j
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N
(do not use this sheet for project actions)
Because these questions are very general, it may be helpful to read them in conjunction with the list of the elements of the
environment.
When answering these questions, be aware of the extent the proposal or the types of activities likely to result from the proposal,
would affect the item at a greater intensity or at a faster rate than if the proposal were not implemented. Respond briefly and in
general terms.
1. How would the proposal be likely to increase discharge to water; emissions to air; production, storage, or release of
toxic or hazardous substances; or production of noise?
Proposal measures to avoid or reduce such increases are:
2. How would the proposal be likely to affect plants, animals, fish, or marine life?
Proposed measures to protect or conserve plants, animals, fish, or marine life are:
3. How would the proposal be likely to deplete energy or natural resources?
Proposed measures to protect or conserve energy and natural resources are:
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4. How would the proposal be likely to use or affect environmentally sensitive areas or areas designated (or eligible or
under study) for governmental protection; such as parks, wilderness, wild and scenic rivers, threatened or endangered
species habitat, historic or cultural sites, wetlands, floodplains, or prime farmlands?
Proposed measures to protect such resources or to avoid or reduce impacts are:
5. How would the proposal be likely to affect land and shoreline use, including whether it would allow or encourage land
or shoreline uses incompatible with existing plans?
Proposed measures to avoid or reduce shoreline and land use impacts are:
6. How would the proposal be likely to increase demands on transportation or public services and utilities?
Proposed measures to reduce or respond to such demand(s) are:
7. Identify, if possible, whether the proposal may conflict with local, state, or federal laws or requirements for the
protection of the environment.
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