U.S. Department of Agriculture
FARMLAND CONVERSION IMPACT RATING
PART I (To be completed by Federal Agency)
Date Of Land Evaluation Request
Name of Project
Federal Agency Involved
Proposed Land Use
County and State
PART II (To be completed by NRCS)
Date Request Received By
NRCS
Person Completing Form:
Does the site contain Prime, Unique, Statewide or Local Important Farmland?
(If no, the FPPA does not apply - do not complete additional parts of this form)
YES NO
Acres Irrigated
Average Farm Size
Major Crop(s)
Farmable Land In Govt. Jurisdiction
Acres: %
Amount of Farmland As Defined in FPPA
Acres: %
Name of Land Evaluation System Used
Name of State or Local Site Assessment System
Date Land Evaluation Returned by NRCS
Alternative Site Rating
PART III (To be completed by Federal Agency)
Site A Site B Site C Site D
A. Total Acres To Be Converted Directly
B. Total Acres To Be Converted Indirectly
C. Total Acres In Site
PART IV (To be completed by NRCS) Land Evaluation Information
A. Total Acres Prime And Unique Farmland
B. Total Acres Statewide Important or Local Important Farmland
C. Percentage Of Farmland in County Or Local Govt. Unit To Be Converted
D. Percentage Of Farmland in Govt. Jurisdiction With Same Or Higher Relative Value
PART V (To be completed by NRCS) Land Evaluation Criterion
Relative Value of Farmland To Be Converted (Scale of 0 to 100 Points)
PART VI (To be completed by Federal Agency) Site Assessment Criteria
(Criteria are explained in 7 CFR 658.5 b. For Corridor project use form NRCS-CPA-106)
Maximum
Points
Site A Site B Site C Site D
1. Area In Non-urban Use
(15)
2. Perimeter In Non-urban Use
(10)
3. Percent Of Site Being Farmed
(20)
4. Protection Provided By State and Local Government
(20)
5. Distance From Urban Built-up Area
(15)
6. Distance To Urban Support Services
(15)
7. Size Of Present Farm Unit Compared To Average
(10)
8. Creation Of Non-farmable Farmland
(10)
9. Availability Of Farm Support Services
(5)
10. On-Farm Investments
(20)
11. Effects Of Conversion On Farm Support Services
(10)
12. Compatibility With Existing Agricultural Use
(10)
TOTAL SITE ASSESSMENT POINTS
160
PART VII (To be completed by Federal Agency)
Relative Value Of Farmland (From Part V) 100
Total Site Assessment (From Part VI above or local site assessment) 160
TOTAL POINTS (Total of above 2 lines) 260
Site Selected:
Date Of Selection
Was A Local Site Assessment Used?
YES
NO
Reason For Selection:
Name of Federal agency representative completing this form: Date:
(See Instructions on reverse side) Form AD-1006 (03-02)
City of Altus--Proposed Detention Pond
Economic Development Administration