Prestige Environmental ChecklistPurpose 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.
histructions 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: 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: Cityyof Edmonds
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6. Proposed timing or schedule (including phasing, if applicable):
Construction beginninglate spring 2014, 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
(STAFF COMMENTS)
8. List any environmental information you know about that has been prepared, or will be prepared, directly related
to this proposal.
None
(STAFF COMMENTS)
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)
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10. List any government approvals or permits that will be needed for your proposal, if known.
Construction Storrnwater General Permit from Department offcology.
(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 NursingFacilii that is approximately 32, 000 sf and remove the esisting parking lot.
The proposed project is a new 80 bed skilled nursing facilitylpartial 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 (1pical 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 walkwa3)s 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 76a' Avenue W, Edmonds, WA 98026
SE'/4, SE'/a, Sec 19, TWN27N, RGE 4E, WM
Leal 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)
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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 clay,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.
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(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 COMMENTS)
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 COMMENTS)
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
parking.
(STAFF COMMENTS)
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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)
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)
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(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)
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(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.
p?
N/A
(STAFF
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 stormwater. It will be collected in catch basins and routed to a detention vault,
and released into the city 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.
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(STAFF
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 I 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 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)
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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 jot 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)
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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 buildingis s 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? List other proposed
measures to reduce or control energy impacts, if any:
High efficiency heating/ cooling systems will be used. NREC compliant.
(STAFF COMMENTS)
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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.
yo
(STAFF COMMENTS)
(1) Describe special emergency services that might be required.
None
(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)
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(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 during construction hours from 7 a.m. to 5
p.m.
(STAFF COMMENTS)
(3) Proposed measures to reduce or control noise impacts, if any:
N/A
(STAFF COMMENTS)
8. 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 nursingfacility). acility). The site is
adjacent 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)
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C. Describe any structures on the site.
Existin)z skilled nursingbuilding, 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.
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(STAFF
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 buildingat t 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 existingfacility acility since it is closed down currently
existingfacility 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.
(STAFF COMMENTS)
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 upon closing the facility. They be able to retain some
of those employees upon opening the new facility.
(STAFF COMMENTS)
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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.
p
(STAFF COMMENTS)
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 nursingfacility.
acility.
(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 nursingfacility.
(STAFF COMMENTS)
C. Proposed measures to reduce or control housing impacts, if any:
None
(STAFF COMMENTS)
10. Aesthetics
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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.
(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:
Variation of materials, Solid Body stained wood trusses and Cultured stone veneer are being added along 76`F' Ave
W to dress up the street approach to the building.
(STAFF COMMENTS)
11. 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 -Parkin lot of 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?
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(STAFF COMMENTS)
y,
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 Ridge Park, Gold Park,
Yost Park, Vision Quest Sports & Fitness, Ja'Warren Hooker Fitness Perfomance.
(STAFF COMMENTS)
b. Would the proposed project displace any existing recreation uses? If so, describe.
No.
(STAFF COMMENTS)
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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)
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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 76`h Ave W. There wiil be (2) driveways accessing 761h 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 761h & 212`h and the 76`h and 208`h 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)
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 upgraded to 7 feet concrete maximum width in the ROW along 76`h Ave W.
(STAFF COMMENTS)
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e. 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.
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)
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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 Sanitarysewer 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.
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Signature of Proponent
Date Submitted
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