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Home My WebLink About541 West Ave_BLD686_2026 FOR OFFICE USE ONLY UNDERGROUND STORAGE TANK (UST) Site ID # __________________________ 30-DAY NOTICE FS ID # __________________________ (See back of form for instructions) Please ïƒ¼ the appropriate box: Intent Intent to Install to Close HQ (360)407-7170 / Central (509)575-2490 / Eastern (509)329-3400 / Northwest (425)649-7000 / Southwest (360)407-6300 OWNER INFORMATION SITE INFORMATION (this form will be returned to this address) Tag or UBI number UST Owner/Operator Site Name Mailing Address/PO Box Site Physical Address City Zip Code City Zip Code Owner/Operator Phone Number Site Phone Number Owner/Operator Email Address TANK INFORMATION Substance Date Project is Tank ID Stored Capacity Expected to Begin Comments: 1) SERVICE PROVIDER INFORMATION - check the appropriate boxes PLEASE NOTE: INDIVIDUALS PERFORMING UST SERVICES MUST BE ICC CERTIFIED OR HAVE PASSED ANOTHER QUALIFYING EXAM APPROVED BY THE DEPARTMENT OF ECOLOGY. Installer Decommissioner Site Assessor Service Provider Company Name Contact Person Certified Service Provider Name Contact Phone Number ICC Certification # Contact Email Address 2) SERVICE PROVIDER INFORMATION (REQUIRED IF USING MORE THAN ONE PROVIDER) - check the appropriate boxes Installer Decommissioner Site Assessor Service Provider Company Name Contact Person Certified Service Provider Name Contact Phone Number ICC Certification # Contact Email Address ECY 020-95 (Rev. Feb. 2012) AFTER COMPLETING THIS FORM, RETURN TO: Instructions DEPARTMENT OF ECOLOGY TOXICS CLEANUP PROGRAM Please Read Carefully P.O. BOX 47655 OLYMPIA, WA 98504-7655 GENERAL Under WAC 173-360-200 and 173-360-385, owners and operators are required to notify Ecology 30 days prior to beginning underground storage tank (UST) installation or decommissioning projects. Please use a separate form for each activity. Once this form is received and processed by Ecology, it is date stamped and returned to the owner listed on the form. Installation and decommissioning projects may begin 30 days after the date stamped on the form. If a project cannot meet the deadlines described below, you must submit an additional 30-Day Notice. The 30-day wait period may be waived on these additional 30-Day Notices by contacting the inspector in your region. SITE AND OWNER INFORMATION Fill in the site and owner information and be sure to provide telephone numbers and email addresses so that any problems can be resolved quickly. Include the facility compliance tag or UBI number for tank closures. TANK INFORMATION List tanks to be installed or closed, substance stored (e.g. gas, diesel, etc), tank size and date the project is expected to begin. The contact person listed on this form must confirm the exact date an installation and/or decommissioning project will begin at least three business days before proceeding. Please report tank ID number(s) for tanks to be closed and assign new Tank ID number(s) to tanks being installed. If you are installing new tanks, do not assign a Tank ID number that has previously been used at the facility. Use the Comments box to include additional information, such as when product was removed so that no more than one inch of residue remains in the system. TANK INSTALLATIONS List the installation company. The date stamped on the form indicates the beginning of a 90-day period in which an installation project must begin. Once, processed, this form also allows you to receive a one-time drop of product, for UST system testing purposes only. The fuel drop is not required to occur within this 90-day period. To dispense product and receive additional deliveries, you must complete the Business License registration and obtain your facility compliance tag from Ecology. The registration information must be submitted to the Department of Revenue within 30 days of installation to receive a Business License with the appropriate tank endorsement(s). If, at any time, your tank(s) store greater than one inch of product, you must begin using an acceptable release detection method to monitor for leaks every month. PERMANENT TANK CLOSURES List the closure and site assessor companies. Upon receiving a completed 30-day closure form, Ecology will stamp the date received on the form and return a copy to the owner. Decommissioning projects must be completed 90 days after the stamped date. No work may begin within the first 30 days unless a waiver has been obtained from Ecology. Contact your local fire marshal and planning department prior to tank closure to find out if any additional permits are required by county or other local jurisdictions. Compliance with the State Environmental Policy Act (SEPA) Rules, Chapter 197-11 WAC, may be required. A site assessment is required at the time of closure. Contamination found or suspected at the site must be reported to the appropriate Ecology regional office within 24 hours. If the contamination is confirmed, a site characterization report must be submitted to the regional office within 90 days; if contamination is not confirmed, a site assessment report must be submitted to the above address within 30 days. The following are examples of tanks that are exempt from notification requirements. ï¶ Farm or residential tanks, 1,100 gallons or less, used to store motor fuel for personal or farm use only. The fuel must be used for farm purposes and cannot be for resale. ï¶ Tanks used for storing heating oil that is used solely for the purpose of heating the premises. ï¶ Tanks with a capacity of 110 gallons or less. ï¶ Equipment or machinery tanks such as hydraulic lifts or electrical equipment tanks. ï¶ Emergency overflow tanks, catch basins, or sumps. If you need this document in a format for the visually impaired, call Toxics Cleanup Program at (360) 407-7170. Persons with hearing loss can call 711 for Washington Relay Service. Persons with speech disability, call (877) 833-6341. ECY 020-95 (Rev. Feb. 2012) FOR OFFICE USE ONLY UNDERGROUND STORAGE TANK (UST) Site ID # __________________________ 30-DAY NOTICE FS ID # __________________________ (See back of form for instructions) Please ïƒ¼ the appropriate box: Intent Intent to Install to Close HQ (360)407-7170 / Central (509)575-2490 / Eastern (509)329-3400 / Northwest (425)649-7000 / Southwest (360)407-6300 OWNER INFORMATION SITE INFORMATION (this form will be returned to this address) Tag or UBI number UST Owner/Operator Site Name Mailing Address/PO Box Site Physical Address City Zip Code City Zip Code Owner/Operator Phone Number Site Phone Number Owner/Operator Email Address TANK INFORMATION Substance Date Project is Tank ID Stored Capacity Expected to Begin Comments: 1) SERVICE PROVIDER INFORMATION - check the appropriate boxes PLEASE NOTE: INDIVIDUALS PERFORMING UST SERVICES MUST BE ICC CERTIFIED OR HAVE PASSED ANOTHER QUALIFYING EXAM APPROVED BY THE DEPARTMENT OF ECOLOGY. Installer Decommissioner Site Assessor Service Provider Company Name Contact Person Certified Service Provider Name Contact Phone Number ICC Certification # Contact Email Address 2) SERVICE PROVIDER INFORMATION (REQUIRED IF USING MORE THAN ONE PROVIDER) - check the appropriate boxes Installer Decommissioner Site Assessor Service Provider Company Name Contact Person Certified Service Provider Name Contact Phone Number ICC Certification # Contact Email Address ECY 020-95 (Rev. Feb. 2012) AFTER COMPLETING THIS FORM, RETURN TO: Instructions DEPARTMENT OF ECOLOGY TOXICS CLEANUP PROGRAM Please Read Carefully P.O. BOX 47655 OLYMPIA, WA 98504-7655 GENERAL Under WAC 173-360-200 and 173-360-385, owners and operators are required to notify Ecology 30 days prior to beginning underground storage tank (UST) installation or decommissioning projects. Please use a separate form for each activity. Once this form is received and processed by Ecology, it is date stamped and returned to the owner listed on the form. Installation and decommissioning projects may begin 30 days after the date stamped on the form. If a project cannot meet the deadlines described below, you must submit an additional 30-Day Notice. The 30-day wait period may be waived on these additional 30-Day Notices by contacting the inspector in your region. SITE AND OWNER INFORMATION Fill in the site and owner information and be sure to provide telephone numbers and email addresses so that any problems can be resolved quickly. Include the facility compliance tag or UBI number for tank closures. TANK INFORMATION List tanks to be installed or closed, substance stored (e.g. gas, diesel, etc), tank size and date the project is expected to begin. The contact person listed on this form must confirm the exact date an installation and/or decommissioning project will begin at least three business days before proceeding. Please report tank ID number(s) for tanks to be closed and assign new Tank ID number(s) to tanks being installed. If you are installing new tanks, do not assign a Tank ID number that has previously been used at the facility. Use the Comments box to include additional information, such as when product was removed so that no more than one inch of residue remains in the system. TANK INSTALLATIONS List the installation company. The date stamped on the form indicates the beginning of a 90-day period in which an installation project must begin. Once, processed, this form also allows you to receive a one-time drop of product, for UST system testing purposes only. The fuel drop is not required to occur within this 90-day period. To dispense product and receive additional deliveries, you must complete the Business License registration and obtain your facility compliance tag from Ecology. The registration information must be submitted to the Department of Revenue within 30 days of installation to receive a Business License with the appropriate tank endorsement(s). If, at any time, your tank(s) store greater than one inch of product, you must begin using an acceptable release detection method to monitor for leaks every month. PERMANENT TANK CLOSURES List the closure and site assessor companies. Upon receiving a completed 30-day closure form, Ecology will stamp the date received on the form and return a copy to the owner. Decommissioning projects must be completed 90 days after the stamped date. No work may begin within the first 30 days unless a waiver has been obtained from Ecology. Contact your local fire marshal and planning department prior to tank closure to find out if any additional permits are required by county or other local jurisdictions. Compliance with the State Environmental Policy Act (SEPA) Rules, Chapter 197-11 WAC, may be required. A site assessment is required at the time of closure. Contamination found or suspected at the site must be reported to the appropriate Ecology regional office within 24 hours. If the contamination is confirmed, a site characterization report must be submitted to the regional office within 90 days; if contamination is not confirmed, a site assessment report must be submitted to the above address within 30 days. The following are examples of tanks that are exempt from notification requirements. ï¶ Farm or residential tanks, 1,100 gallons or less, used to store motor fuel for personal or farm use only. The fuel must be used for farm purposes and cannot be for resale. ï¶ Tanks used for storing heating oil that is used solely for the purpose of heating the premises. ï¶ Tanks with a capacity of 110 gallons or less. ï¶ Equipment or machinery tanks such as hydraulic lifts or electrical equipment tanks. ï¶ Emergency overflow tanks, catch basins, or sumps. If you need this document in a format for the visually impaired, call Toxics Cleanup Program at (360) 407-7170. Persons with hearing loss can call 711 for Washington Relay Service. Persons with speech disability, call (877) 833-6341. ECY 020-95 (Rev. Feb. 2012) SEPA ENVIRONMENTAL CHECKLIST UPDATED 2014 Purpose of checklist: Governmental agencies use this checklist to help determine whether the environmental impacts of your proposal are significant. This information is also helpful to determine if available avoidance, minimization or compensatory mitigation measures will address the probable significant impacts or if an environmental impact statement will be prepared to further analyze the proposal. Instructions for applicants: This environmental checklist asks you to describe some basic information about your proposal. Please answer each question accurately and carefully, to the best of your knowledge. You may need to consult with an agency specialist or private consultant for some questions. You may use â€œnot applicableâ€ or "does not apply" only when you can explain why it does not apply and not when the answer is unknown. You may also attach or incorporate by reference additional studies reports. Complete and accurate answers to these questions often avoid delays with the SEPA process as well as later in the decision- making process. 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. Instructions for Lead Agencies: Please adjust the format of this template as needed. Additional information may be necessary to evaluate the existing environment, all interrelated aspects of the proposal and an analysis of adverse impacts. The checklist is considered the first but not necessarily the only source of information needed to make an adequate threshold determination. Once a threshold determination is made, the lead agency is responsible for the completeness and accuracy of the checklist and other supporting documents. Use of checklist for nonproject proposals: For nonproject proposals (such as ordinances, regulations, plans and programs), complete the applicable parts of sections A and B plus the SUPPLEMENTAL SHEET FOR NONPROJECT ACTIONS (part D). Please completely answer all questions that apply and note that the words "project," "applicant," and "property or site" should be read as "proposal," "proponent," and "affected geographic area," respectively. The lead agency may exclude (for non-projects) questions in Part B - Environmental Elements â€“that do not contribute meaningfully to the analysis of the proposal. A. background 1. Name of proposed project, if applicable: 7-Eleven Store No. 21001 Fuel System Replacement 2. Name of applicant: 7-Eleven, Inc. 3. Address and phone number of applicant and contact person: Address: P.O. Box 711, Dallas, TX 75221 Contact Person: Amanda Grindle, Permit Coordinator on behalf of 7-Eleven, Inc. Phone: (253) 882-4546 Email: agrindle@muircontracting.com SEPA Environmental checklist (WAC 197-11-960) May 2014 Page 1 of 11 4. Date checklist prepared: May 7, 2015 5. Agency requesting checklist: City of Arlington 6. Proposed timing or schedule (including phasing, if applicable): Construction to begin immediately upon issuance of permits. 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. In accordance with WAC Chapter 173-360, Underground Storage Tank Regulations, a Site Assessment Report will be prepared and submitted to the Washington Dept. of Ecology within 30 days of tank removal. 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. No. 10. List any government approvals or permits that will be needed for your proposal, if known. Washington Dept. of Ecology 30-Day UST Removal & Installation Notification; Puget Sound Clean Air Agency Gas Station Notice of Construction, City of Arlington Commercial Construction Permit, City of Arlington Fire UST Removal Removal & Installation Operating Permits 11. Give brief, complete description of your proposal, including the proposed uses and the 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. (Lead agencies may modify this form to include additional specific information on project description.) Replace existing fuel system, including removal of three 12,000-gal gasoline underground storage tanks and installation of one 20,000-gal gasoline underground tank and one 20,000-gal split tank (12K diesel/8K gasoline). Replace product, vent, and vapor piping, dispensers, and related appurtenances. Replace concrete tank and drive slabs. 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 the range or boundaries of the site(s). Provide a 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. Site Address: 541 West Avenue, Arlington, WA 98223. Parcel No. 00618100100100. Legal Description: WRAGE ADD TO ARLINGTON BLK 001 D-00 - LOT 1 PLUS PTN VAC ALLEY LESS S/H. Vicinity map & site plan attached. B. ENVIRONMENTAL ELEMENTS 1. Earth a. General description of the site (circle one): Flat, rolling, hilly, steep slopes, mountainous, other _____________ b. What is the steepest slope on the site (approximate percent slope)? Less than two percent. SEPA Environmental checklist (WAC 197-11-960) May 2014 Page 2 of 11 c. What general types of soils are found on the site (for example, clay, sand, gravel, peat, muck)? If you know the classification of agricultural soils, specify them and note any agricultural land of long-term commercial significance and whether the proposal results in removing any of these soils. Native soils consist primarily of poorly graded to well graded sands, silty sands, gravelly sands, and silt. d. Are there surface indications or history of unstable soils in the immediate vicinity? If so, describe. No. e. Describe the purpose, type, total area, and approximate quantities and total affected area of any filling, excavation, and grading proposed. Indicate source of fill. Approximately 295 CY of soil will be excavated and removed. Approximately 275 CY, including clean excavation spoils and clean pit-run fill, will be used as backfill for all excavations and trenches. f. Could erosion occur as a result of clearing, construction, or use? If so, generally describe. Erosion could occur during excavation activities and/or while soil is stockpiled pending soil sample results This will be mitigated by the contractor adhering to standards BMPâ€™s and implementing an erosion control plan. g. About what percent of the site will be covered with impervious surfaces after project construction (for example, asphalt or buildings)? 100% (No change) h. Proposed measures to reduce or control erosion, or other impacts to the earth, if any: Standard BMPâ€™s and an erosion control plan will be implemented. 2. Air a. What types of emissions to the air would result from the proposal during construction, operation, and maintenance when the project is completed? If any, generally describe and give approximate quantities if known. The site is currently an operating gasoline station. Additional emissions are not expected except for minor amounts of dust produced during the excavation. b. Are there any off-site sources of emissions or odor that may affect your proposal? If so, generally describe. No. c. Proposed measures to reduce or control emissions or other impacts to air, if any: Any stockpiled materials will be sprayed with water as necessary to keep down dust and soils will be covered with visqueen until removed from site. 3. Water a. Surface Water: 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, wetlands)? If yes, describe type and provide names. If appropriate, state what stream or river it flows into. No. 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. SEPA Environmental checklist (WAC 197-11-960) May 2014 Page 3 of 11 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. 4)Will the proposal require surface water withdrawals or diversions? Give general description, purpose, and approximate quantities if known. No. 5) Does the proposal lie within a 100-year floodplain? If so, note location on the site plan. No. 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. b. Ground Water: 1)Will groundwater be withdrawn from a well for drinking water or other purposes? If so, give a general description of the well, proposed uses and approximate quantities withdrawn from the well. Will water be discharged to groundwater? Give general description, purpose, and approximate quantities if known. No. 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. No. c. Water runoff (including stormwater): 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. No change to existing catch basins located on site for stormwater collection. 2) Could waste materials enter ground or surface waters? If so, generally describe. No. Residual fuel will be removed from tanks and lines, and tanks cleaned and emptied prior to removal. 3) Does the proposal alter or otherwise affect drainage patterns in the vicinity of the site? If so, describe. No. d. Proposed measures to reduce or control surface, ground, and runoff water, and drainage pattern impacts, if any: Silt filters will be installed at all surface drain locations. 4. Plants a. Check the types of vegetation found on the site: ____deciduous tree: alder, maple, aspen, other ____evergreen tree: fir, cedar, pine, other ____shrubs ____grassX SEPA Environmental checklist (WAC 197-11-960) May 2014 Page 4 of 11 ____pasture ____crop or grain ____ Orchards, vineyards or other permanent crops. ____ wet soil plants: cattail, buttercup, bullrush, skunk cabbage, other ____water plants: water lily, eelgrass, milfoil, other ____other types of vegetation b. What kind and amount of vegetation will be removed or altered? None. c. List threatened and endangered species known to be on or near the site. None. d. Proposed landscaping, use of native plants, or other measures to preserve or enhance vegetation on the site, if any: None. e. List all noxious weeds and invasive species known to be on or near the site. None. 5. Animals a. List any birds and other animals which have been observed on or near the site or are known to be on or near the site. Examples include: birds: hawk, heron, eagle, songbirds, other: mammals: deer, bear, elk, beaver, other: fish: bass, salmon, trout, herring, shellfish, other ________ b. List any threatened and endangered species known to be on or near the site. None. c. Is the site part of a migration route? If so, explain. No. d. Proposed measures to preserve or enhance wildlife, if any: None. e. List any invasive animal species known to be on or near the site. None. 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. No additional energy will be required. b. Would your project affect the potential use of solar energy by adjacent properties? If so, generally describe. No. SEPA Environmental checklist (WAC 197-11-960) May 2014 Page 5 of 11 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: None. 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 new environmental hazards or exposures will be created. 1) Describe any known or possible contamination at the site from present or past uses. None. 2) Describe existing hazardous chemicals/conditions that might affect project development and design. This includes underground hazardous liquid and gas transmission pipelines located within the project area and in the vicinity. None. 3) Describe any toxic or hazardous chemicals that might be stored, used, or produced during the project's development or construction, or at any time during the operating life of the project. None. 4) Describe special emergency services that might be required. None. 5) Proposed measures to reduce or control environmental health hazards, if any: Existing electronic fuel monitoring system is currently in operation at this facility and will continuously monitor the new fuel system. New tanks and piping are double-walled and corrosion-resistant. b. Noise 1)What types of noise exist in the area which may affect your project (for example: traffic, equipment, operation, other)? None. 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)? Indi- cate what hours noise would come from the site. Short term construction noise may occur during normal business hours until project is complete. 3) Proposed measures to reduce or control noise impacts, if any: Noise-generating operations will be restricted to normal business hours throughout project. 8. Land and shoreline use a.What is the current use of the site and adjacent properties? Will the proposal affect current land uses on nearby or adjacent properties? If so, describe. Site is currently a gas station with convenience store. The surrounding properties are Commercial/Retail properties. b. Has the project site been used as working farmlands or working forest lands? If so, describe. How much agricultural or forest land of long-term commercial significance will be converted to other uses as a result of the proposal, if any? If resource lands have not been designated, how many acres in farmland or forest land tax status will be converted to nonfarm or nonforest use? Unknown. 1) Will the proposal affect or be affected by surrounding working farm or forest land normal business operations, such as oversize equipment access, the application of pesticides, tilling, and harvesting? If so, how: No. SEPA Environmental checklist (WAC 197-11-960) May 2014 Page 6 of 11 c. Describe any structures on the site. One 2,400 SF convenience store and one 875 SF steel canopy; both to remain. d. Will any structures be demolished? If so, what? No. e. What is the current zoning classification of the site? Old Town Business District 1 (OTBD-1) f. What is the current comprehensive plan designation of the site? Old Town Business District 1 (OTBD-1) g. If applicable, what is the current shoreline master program designation of the site? Not applicable. h. Has any part of the site been classified as a critical area by the city or county? If so, specify. No. i. Approximately how many people would reside or work in the completed project? None. j. Approximately how many people would the completed project displace? None. k. Proposed measures to avoid or reduce displacement impacts, if any: Not applicable. L. Proposed measures to ensure the proposal is compatible with existing and projected land uses and plans, if any: None. m. Proposed measures to ensure the proposal is compatible with nearby agricultural and forest lands of long-term commercial significance, if any: None. 9. Housing a. Approximately how many units would be provided, if any? Indicate whether high, mid- dle, or low-income housing. None. b. Approximately how many units, if any, would be eliminated? Indicate whether high, middle, or low-income housing. None. c. Proposed measures to reduce or control housing impacts, if any: None. 10. Aesthetics a. What is the tallest height of any proposed structure(s), not including antennas; what is the principal exterior building material(s) proposed? Not applicable - no new structures proposed. b. What views in the immediate vicinity would be altered or obstructed? None. c. Proposed measures to reduce or control aesthetic impacts, if any: None. 11. Light and glare a. What type of light or glare will the proposal produce? What time of day would it mainly occur? None. b. Could light or glare from the finished project be a safety hazard or interfere with views? No. SEPA Environmental checklist (WAC 197-11-960) May 2014 Page 7 of 11 c. What existing off-site sources of light or glare may affect your proposal? None. d. Proposed measures to reduce or control light and glare impacts, if any: None. 12. Recreation a. What designated and informal recreational opportunities are in the immediate vicinity? None. b. Would the proposed project displace any existing recreational uses? If so, describe. No. c. Proposed measures to reduce or control impacts on recreation, including recreation opportunities to be provided by the project or applicant, if any: None. 13. Historic and cultural preservation a. Are there any buildings, structures, or sites, located on or near the site that are over 45 years old listed in or eligible for listing in national, state, or local preservation registers located on or near the site? If so, specifically describe. No. b. Are there any landmarks, features, or other evidence of Indian or historic use or occupation? This may include human burials or old cemeteries. Are there any material evidence, artifacts, or areas of cultural importance on or near the site? Please list any professional studies conducted at the site to identify such resources. No. c. Describe the methods used to assess the potential impacts to cultural and historic resources on or near the project site. Examples include consultation with tribes and the department of archeology and historic preservation, archaeological surveys, historic maps, GIS data, etc. Historic maps, GIS data. d. Proposed measures to avoid, minimize, or compensate for loss, changes to, and disturbance to resources. Please include plans for the above and any permits that may be required. Not applicable. 14. Transportation a. Identify public streets and highways serving the site or affected geographic area and describe proposed access to the existing street system. Show on site plans, if any. Site is accessible via West Ave. to the West and W. Division Street to the North. b. Is the site or affected geographic area currently served by public transit? If so, generally describe. If not, what is the approximate distance to the nearest transit stop? No. No transit in area. c. How many additional parking spaces would the completed project or non-project proposal have? How many would the project or proposal eliminate? No change to existing parking spaces (fourteen total). SEPA Environmental checklist (WAC 197-11-960) May 2014 Page 8 of 11 d. Will the proposal require any new or improvements to existing roads, streets, pedestrian, bicycle or state transportation facilities, not including driveways? If so, generally describe (indicate whether public or private). No. e. Will the project or proposal use (or occur in the immediate vicinity of) water, rail, or air transportation? If so, generally describe. No. f. How many vehicular trips per day would be generated by the completed project or proposal? If known, indicate when peak volumes would occur and what percentage of the volume would be trucks (such as commercial and nonpassenger vehicles). What data or transportation models were used to make these estimates? No change to daily traffic volumes is anticipated. g.Will the proposal interfere with, affect or be affected by the movement of agricultural and forest products on roads or streets in the area? If so, generally describe. No. h. Proposed measures to reduce or control transportation impacts, if any: Not applicable. 15. Public services a. Would the project result in an increased need for public services (for example: fire protection, police protection, public transit, health care, schools, other)? If so, generally describe. No. b. Proposed measures to reduce or control direct impacts on public services, if any. Not applicable. 16. Utilities a. Circle utilities currently available at the site: electricity, natural gas, water, refuse service, telephone, sanitary sewer, septic system, other ___________ 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. No change to existing utility services. C. Signature The above answers are true and complete to the best of my knowledge. I understand that the lead agency is relying on them to make its decision. Signature: ___________________________________________________ Name of signee __________________________________________________Amanda Grindle, Permit Coordinator Position and Agency/Organization ____________________________________7-Eleven, Inc. Date Submitted: May 7, 2015 SEPA Environmental checklist (WAC 197-11-960) May 2014 Page 9 of 11 D. supplemental sheet for nonproject actions [help] (IT IS NOT NECESSARY to 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; pro- duction, storage, or release of toxic or hazardous substances; or production of noise? Proposed 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: 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: SEPA Environmental checklist (WAC 197-11-960) May 2014 Page 10 of 11 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. SEPA Environmental checklist (WAC 197-11-960) May 2014 Page 11 of 11 PLAN AND PROCEDURES FOR THE UNANTICIPATED DISCOVERY OF CULTURAL RESOURCES AND HUMAN SKELETAL REMAINS ________________ PROJECT, CITY OF ARLINGTON, WASHINGTON 1. INTRODUCTION _________________________ plans to construct the ________________________ project. The purpose of this project is to ____________________________________. The following Unanticipated Discovery Plan (UDP) outlines procedures to follow, in accordance with state and federal laws, if archaeological materials or human remains are discovered. 2. RECOGNIZING CULTURAL RESOURCES A cultural resource discovery could be prehistoric or historic. Examples include: â€¢ An accumulation of shell, burned rocks, or other food related materials â€¢ Bones or small pieces of bone, â€¢ An area of charcoal or very dark stained soil with artifacts, â€¢ Stone tools or waste flakes (i.e. an arrowhead, or stone chips), â€¢ Clusters of tin cans or bottles, logging or agricultural equipment that appears to be older than 50 years, â€¢ Buried railroad tracks, decking, or other industrial materials. When in doubt, assume the material is a cultural resource. 3. ON-SITE RESPONSIBILITIES STEP 1: STOP WORK. If any ____________________ employee, contractor or subcontractor believes that he or she has uncovered a cultural resource at any point in the project, all work adjacent to the discovery must stop. The discovery location should be secured at all times. STEP 2: NOTIFY MONITOR. If there is an archaeological monitor for the project, notify that person. If there is a monitoring plan in place, the monitor will follow its provisions. STEP 3: NOTIFY PROJECT MANAGEMENT AND CULTURAL RESOURCES PROGRAM. Contact the Project Manager and the Cultural Resources (CR) Program Manager: Project Manager: Name: Number: Email: If you canâ€™t reach the CR Program manager, contact your projectâ€™s assigned Cultural Resources Specialist or an alternate: Assigned CR Specialist: Alternate CR Specialist: Name: Kerry Lyste Name: Tara Duff Number: 360-657-3687 ext 14 Number: 360-652-7362 ext 226 Email: klyste@stillaguamish.com Email: tduff@stillaguamish.com The Project Manager or the Cultural Resources Program will make all other calls and notifications. If human remains are encountered, treat them with dignity and respect at all times. Cover the remains with a tarp or other materials (not soil or rocks) for temporary protection in place and to shield them from being photographed. Do not call 911 or speak with the media. 4. FURTHER CONTACTS AND CONSULTATION A. Project Managerâ€™s Responsibilities: â€¢ Protect Find: The Project Manager is responsible for taking appropriate steps to protect the discovery site. All work will stop in an area adequate to provide for the total security, protection, and integrity of the resource. Vehicles, equipment, and unauthorized personnel will not be permitted to traverse the discovery site. Work in the immediate area will not resume until treatment of the discovery has been completed following provisions for treating archaeological/cultural material as set forth in this document. â€¢ Direct Construction Elsewhere On-site: The Project Manager may direct construction away from cultural resources to work in other areas prior to contacting the concerned parties. â€¢ Contact CR Manager: If the CR Program Manager has not yet been contacted, the Project Manager will do so. 2 B. Project Managerâ€™s Responsibilities: â€¢ Identify Find: The Project Manager (or a CR Specialist if so delegated), will ensure that a qualified professional archaeologist examines the find to determine if it is archaeological. o If it is determined not archaeological, work may proceed with no further delay. o If it is determined to be archaeological, the CR Manager or CR Specialist will continue with notification. o If the find may be human remains or funerary objects, the CR Manager or CR Specialist will ensure that a qualified physical anthropologist examines the find. If it is determined to be human remains, the procedure described in Section 5 will be followed. â€¢ Notify DAHP: The Project Manager (or a CR Specialist if so delegated) will contact the involved federal agencies (if any) and the Department of Archaeology and Historic Preservation (DAHP). â€¢ Notify Tribes: If the discovery may relate to Native American interests, the Manager or Specialist will also contact the projectâ€™s Tribal Liaison, or, if the project is not assigned a Liaison, the Executive Tribal Liaison. Federal/State Agencies: Agency: Dept of Natural Resources Name: Boyd Norton (WaDNR) Title: Forest Practice Coordinator Number: 360-854-2816 Email: boyd.norton@wa.dnr.gov Department of Archaeology and Historic Preservation: Dr. Allyson Brooks State Historic Preservation Officer 360-586-3066 Tribal Liaisons: Project Tribal Liaison Name: Stephanie Kramer Number: 360-586-3083 Email:Stephenie.Kramer@dahp.wa.gov 3 The Tribal Liaison, or CR Program Manager or Specialist, will contact the interested and affected Tribes. Tribes consulted on this project are: Tribe: Stillaguamish Tribe of Indians Name: Shawn Yanity Title: Tribal Chair Number: 360-652-7362 Email: syanity@stillaguamish.com C. Further Activities â€¢ Archaeological discoveries will be documented as described in Section 6. â€¢ Construction in the discovery area may resume as described in Section 7. 5. SPECIAL PROCEDURES FOR THE DISCOVERY OF HUMAN SKELETAL MATERIAL Any human skeletal remains, regardless of antiquity or ethnic origin, will at all times be treated with dignity and respect. If the project occurs on federal lands (e.g., national forest or park, military reservation) the provisions of the Native American Graves Protection and Repatriation Act of 1990 apply, and the responsible federal agency will follow its provisions. Note that state highways that cross federal lands are on an easement and are not owned by the state. If the project occurs on non-federal lands, _______ will comply with applicable state and federal laws, and the following procedure: A. Notify Law Enforcement Agency or Medical Examinerâ€™s Office: City of Arlington Police Department:(360) 403-3400 In addition to the actions described in Sections 3 and 4, the Project Manager will immediately notify the local law enforcement agency or medical examinerâ€™s office. The medical examiner (with assistance of law enforcement personnel) will determine if the remains are human, whether the discovery site constitutes a crime scene, and will notify DAHP. Agency: SNOHOMISH COUNTY MEDICAL EXAMINER Number: (425) 438-6200 4 B. Participate in Consultation: Per RCW 27.44.055, RCW 68.50, and RCW 68.60, DAHP will have jurisdiction over non-forensic human remains. City of Arlington personnel will participate in consultation. C. Further Activities: â€¢ Documentation of human skeletal remains and funerary objects will be agreed upon through the consultation process described in RCW 27.44.055, RCW 68.50, and RCW 68.60. â€¢ When consultation and documentation activities are complete, construction in the discovery area may resume as described in Section 7. 6. DOCUMENTATION OF ARCHAEOLOGICAL MATERIALS Archaeological deposits discovered during construction will be assumed eligible for inclusion in the National Register of Historic Places under Criterion D until a formal Determination of Eligibility is made. Cultural Resources Program staff will ensure the proper documentation and assessment of any discovered cultural resources in cooperation with the federal agencies (if any), DAHP, affected tribes, and a contracted consultant (if any). All prehistoric and historic cultural material discovered during project construction will be recorded by a professional archaeologist on State of Washington cultural resource site or isolate form using standard techniques. Site overviews, features, and artifacts will be photographed; stratigraphic profiles and soil/sediment descriptions will be prepared for subsurface exposures. Discovery locations will be documented on scaled site plans and site location maps. Cultural features, horizons and artifacts detected in buried sediments may require further evaluation using hand-dug test units. Units may be dug in controlled fashion to expose features, collect samples from undisturbed contexts, or interpret complex stratigraphy. A test excavation unit or small trench might also be used to determine if an intact occupation surface is present. Test units will be used only when necessary to gather information on the nature, extent, and integrity of subsurface cultural deposits to evaluate the siteâ€™s significance. Excavations will be conducted using state-of-the-art techniques for controlling provenience. Spatial information, depth of excavation levels, natural and cultural stratigraphy, presence or absence of cultural material, and depth to sterile soil, regolith, or bedrock will be recorded for each probe on a standard form. Test excavation units will be recorded on unit-level forms, which include plan maps for each excavated level, and material type, number, and vertical provenience (depth below surface and stratum association where applicable) for all artifacts recovered from the level. A stratigraphic profile will be drawn for at least one wall of each test excavation unit. 5 Sediments excavated for purposes of cultural resources investigation will be screened through 1/8-inch mesh, unless soil conditions warrant Â¼-inch mesh. All prehistoric and historic artifacts collected from the surface and from probes and excavation units will be analyzed, catalogued, and temporarily curated. Ultimate disposition of cultural materials will be determined in consultation with the federal agencies (if any), DAHP, and the affected tribes. Within 90 days of concluding fieldwork, a technical report describing any and all monitoring and resultant archaeological excavations will be provided to the Project Manager, who will forward the report to the City of Arlington Natural Resources Manager for review and delivery to the federal agencies (if any), SHPO, and the affected tribe(s). If assessment activity exposes human remains (burials, isolated teeth, or bones), the process described in Section 5 above will be followed. 7. PROCEEDING WITH CONSTRUCTION Project construction outside the discovery location may continue while documentation and assessment of the cultural resources proceed. The City of Arlington Natural Resources Manager, or other City representative, must determine the boundaries of the discovery location. In consultation with DAHP and affected tribes, Project Manager and Cultural Resources Program staff will determine the appropriate level of documentation and treatment of the resource. If federal agencies are involved, the agencies will make the final determinations about treatment and documentation. Construction may continue at the discovery location only after the process outlined in this plan is followed and City of Arlington (and the federal agencies, if any) determine that compliance with state and federal laws is complete. 6 Permit #: 686 Permit Date: 05/28/15 Permit Type: FUEL TANK Project Name: 7-Eleven Fuel System Replacement Applicant Name: Muir Contracting Applicant Address: 3745 N 30th Street Applicant, City, State, Zip: Tacoma, WA 98407 Contact: Amanda Grindle Phone: 253-882-4546 Email: agrindle@muircontracting.com Scope of Work: Replace exisitng fuel system Valuation: 250000.00 Square Feet: 2400 Number of Stories: 1 Construction Type: Occupancy Group: ID Code: Permit Issued: 07/30/2015 Permit Expires: Form Permit Type: Status: COMPLETE Assigned To: Launa Black Property Parcel # Address Legal Description Owner Name Owner Phone Zoning 549 Other Retail 00618100100100 541 WEST AVE 7 ELEVEN INC Trade - Food NEC Contractors Contractor Primary Contact Phone Address Contractor Type License License # Wilkey Construction, 4557 Skyway CONSTRUCTION Labor & 530-741-2233 WILKECI894CG Inc. Drive CONTRACTOR Industries 3745 N 30th Muir Contracting Amanda Grindle 253-882-4546 APPLICANT Street 1700 W Industrial Core States Group 479-877-3464 AIA/PE Drive, #B Inspections Date Inspection Type Description Scheduled Date Completed Date Inspector Status C20. BUILDING Final Approval all slabs & 10/07/2015 10/07/2015 10/07/2015 BUILDING Approved FINAL curbs project complete. C20. BUILDING 10/02/2015 Slab rebar over fuel tanks. 10/02/2015 10/02/2015 BUILDING Approved FINAL R20. ACCESSORY Slab connection pins canopy 10/01/2015 STRUCTURE to tank area and 10/01/2015 10/01/2015 BUILDING Approved FINAL interconnecting rebar. C20. BUILDING 09/30/2015 Canopy slab rebar 09/30/2015 09/30/2015 BUILDING Completed FINAL Plan Reviews Date Review Type Description Assigned To Review Status 05/28/2015 OPERATING BUILDING No concerns with the SEPA Checklist or with issuance of the operating permit. 05/28/2015 OPERATING Marc Hayes The General Contractor will need to submit a TESC prior to beginning any construction activity. 06/04/2015 BLD SEPA Issued 6/16/15 / Comment period ends 6/30/15 Fees Fee Description Notes Amount SEPA $529.00 Mechanical Base Permit Fee $25.00 Mechanical Commercial Plan Review Table 4-1 $800.00 Total $1,354.00 Attached Letters Date Letter Description 07/30/2015 Building Permit Payments Date Paid By Description Payment Type Accepted By Amount 07/30/2015 Amanda Grindle 55450209 cc $1,354.00 Outstanding Balance $0.00 Notes Date Note Created By: 07/06/2015 Waiting for 7-Eleven to decide on a construction contractor. -lp Launa Black Uploaded Files Date File Name 07/30/2015 1210283-686_Issued Permit.pdf 07/06/2015 1171472-Approved Operating Permit.pdf 06/04/2015 1124660-30 Day Notice 21001 Arlington.pdf 05/28/2015 1114186-541_Operating Permit.pdf 05/28/2015 1114170-541_Plans - 7-11 Arlington Fuel System Replacement_Part1.pdf 05/28/2015 1114171-541_Plans - 7-11 Arlington Fuel System Replacement_Part2.pdf 05/28/2015 1114165-541_Plans - 7-11 Arlington Fuel System Replacement_Part3.pdf 05/28/2015 1114162-541_City of Arlington SEPA Checklist.pdf Date: 03/04/2026 Permit #: 686 Permit Date: 05/28/2015 Review Date: 05/28/2015 Permit Type: FUEL TANK Review Type: OPERATING Target Date: 06/05/2015 Scheduled 00:00 Time: Completed 06/12/2015 Date: Description: No concerns with the SEPA Checklist or with issuance of the operating permit. The General Contractor will need to submit a TESC prior to beginning any construction activity. Review Status: Assigned To: Marc Hayes Time In: 00:00 Time Out: 00:00 Hours: 0.0 Property Information Parcel#: 00618100100100 7 ELEVEN INC 7 ELEVEN INC 2711 NORTH HASKELL AVE 541 WEST AVE DALLAS, TX 75204 Zoning: 549 Other Retail Trade - Food NECLot: Block: