Fillable APPENDIX 6.6 AML CATEGORICAL EXCLUSION DETERMINATION FORM (REVISED (Office of Surface Mining)

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APPENDIX 6.6 AML CATEGORICAL EXCLUSION DETERMINATION FORM (REVISED (Office of Surface Mining)

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OSMRE NEPA HANDBOOK 1 JULY 2019
APPENDIX 6.6 AML CATEGORICAL EXCLUSION DETERMINATION FORM
(REVISED JULY 2019)
ABANDONED MINE LANDS
CATEGORICAL EXCLUSION DETERMINATION
State: PA #
Project Name:
Project Description/Proposed Action: [Provide a detailed description of the project/proposed action (include what will be done and how)]
Yes responses require submission of an Environmental Assessment (EA).
I. GENERAL EXCEPTIONS
Does the project type specifically require an EA in 516 DM Chapter 13, as
specified in Item I of
Appendix 6.5 of OSMRE’s NEPA Handbook (2019)?
No Yes
II. DEPARTMENT OF THE INTERIOR EXCEPTIONS
Will the project have any of the following:
1.
A
si
gnificant
ad
verse effect
on publ
ic health or safety?
No Yes
2. An adverse effect on any of the following unique geographic
characteristics? If yes, check the ones that apply.
No
Yes
Parks (State,
Local, or National)
Wild or Scenic Rivers
Recreation or Refuge Lands
Wetlands
Wilderness Areas
Floodplains
Ecologically Significant or Critical
Ar
eas Sole
o
r Principal Drinking Water
Prime Farmland
Aquifers
3. Highly controversial environmental effects? No Yes
4. Highly uncertain and potentially significant environmental effects or
unique or unknown environmental risks?
No Yes
5. A precedent for future action or a decision in principle about future
actions with potentially significant environmental effects?
No Yes
6. Directly related to other actions with individually insignificant but
cumulatively significant environmental effects?
No Yes
7. Adverse effects on properties listed or eligible for listing on the National
Register of Historic Places?
No Yes
8. Adverse effects on species listed or proposed to be listed on the List of
Endangered or Threatened Species, or have adverse effects on designated
Critical Habitat for these species?
No Yes
9. Require compliance with Executive Order 11988 (Floodplain
Management), Executive Order 11990 (Wetlands Protection) or The Fish
and Wildlife Coordination Act?
No Yes
10. Threaten to violate a Federal, State, Tribal or local law or requirement
imposed for the protection of the environment?
No Yes
11. Involve unresolved conflicts concerning alternative uses of available
resources (NEPA Sec. 102(2)(E))?
No Yes
12. Have a disproportionate, significant adverse effect on low income or
minority populations (EO 12898)?
No Yes
13. Restrict access to and ceremonial use of Indian sacred sites by Indian
religious practitioners or adversely affect the physical integrity of such
sacred sites (EO 13007)
No Yes
14. Contribute to the introduction, continued existence, or spread of noxious
Weeds or non-native invasive species known to occur in the area or actions
that may promote the introduction, growth, or expansion of the range of
such species (Federal Noxious Weed Control Act and EO 13112)?
No
OSMRE NEPA HANDBOOK 2 JULY 2019
Yes
III. RESOURCE IMPACT EXCEPTIONS
Are there any unresolved issues, or adverse effects requiring specialized
mitigation, for any of the following resources?
If yes, check the ones that apply.
No Yes
Topography
Land Use (includes prime farmland)
Soils
Vegetation (includes wetlands)
Hydrology
Fish and Wildlife
Historic and Cultural
Recreation
Air Quality
Noise
Other
(includes socioeconomics)
IV. ATTACH CONSULTATION LETTERS AND A LOCATION MAP
V. RESPONSIBLE OFFICIAL CERTIFICATION
Signature:
OSMRE NEPA HANDBOOK 3 JULY 2019
Date:
Name and Title:
VI. OSMRE DETERMINATION
This project conforms with the exclusion criteria in 516 DM Chapter 13, and is excluded
from further NEPA compliance.
This project does not conform with the exclusion criteria in 516 DM Chapter 13, and
requires an Environmental Assessment. As such, OSMRE will complete an Evaluation
of a Proposed Action template (see Appendix 4.1 of OSMRE’s NEPA Handbook (2019)).
OSMRE Reviewer Signature: Date:
Name and Title:
Signature: Date:
Name and Title:
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APPENDIX 6.6 AML CATEGORICAL EXCLUSION DETERMINATION FORM (REVISED (Office of Surface Mining)

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Completed 26 January 2021

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