Fillable Form 617.20: FULL ENVIRONMENTAL ASSESSMENT FORM Appendix A (Town of Southold)

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Form 617.20: FULL ENVIRONMENTAL ASSESSMENT FORM Appendix A (Town of Southold)

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617.20
Appendix A
State Environmental Quality Review
FULL ENVIRONMENTAL ASSESSMENT FORM
Purpose: The full EAF is designed to help applicants and agencies determine, in an orderly manner, whether a project or action may
be significant. The question of whether an action may be significant is not always easy to answer. Frequently, there are aspects of
a project that are subjective or unmeasurable. It is also understood that those who determine significance may have little or no formal
knowledge of the environment or may not be technically expert in environmental analysis. In addition, many who have knowledge
in one particular area may not be aware of the broader concerns affecting the question of significance.
The full EAF is intended to provide a method whereby applicants and agencies can be assured that the determination process
has been orderly, comprehensive in nature, yet flexible enough to allow introduction of information to fit a project or action.
Full EAF Components: The full EAF is comprised of three parts:
Part 1: Provides objective data and information about a given project and its site. By identifying basic project data, it assists
a reviewer in the analysis that takes place in Parts 2 and 3.
Part 2: Focuses on identifying the range of possible impacts that may occur from a project or action. It provides guidance
as to whether an impact is likely to be considered small to moderate or whether it is a potentially-large impact. The
form also identifies whether an impact can be mitigated or reduced.
Part 3: If any impact in Part 2 is identified as potentially-large, then Part 3 is used to evaluate whether or not the impact is
actually important.
THIS AREA FOR LEAD AGENCY USE ONLY
DETERMINATION OF SIGNIFICANCE -- Type 1 and Unlisted Actions
Identify the Portions of EAF completed for this project: Part 1 Part 2 Part 3
Upon review of the information recorded on this EAF (Parts 1 and 2 and 3 if appropriate), and any other supporting information, and
considering both the magnitude and importance of each impact, it is reasonably determined by the lead agency that:
A. The project will not result in any large and important impact(s) and, therefore, is one which will not have a
significant impact on the environment, therefore a negative declaration will be prepared.
B. Although the project could have a significant effect on the environment, there will not be a significant effect
for this Unlisted Action because the mitigation measures described in PART 3 have been required, therefore
a CONDITIONED negative declaration will be prepared.*
C. The project may result in one or more large and important impacts that may have a significant impact on the
environment, therefore a positive declaration will be prepared.
*A Conditioned Negative Declaration is only valid for Unlisted Actions
Name of Action
Name of Lead Agency
Print or Type Name of Responsible Officer in Lead Agency Title of Responsible Officer
Signature of Responsible Officer in Lead Agency
Signature of Preparer (If different from responsible officer)
website Date
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Page 1 of 21
PART 1--PROJECT INFORMATION
Prepared by Project Sponsor
NOTICE: This document is designed to assist in determining whether the action proposed may have a significant effect on the
environment. Please complete the entire form, Parts A through E. Answers to these questions will be considered as part of the
application for approval and may be subject to further verification and public review. Provide any additional information you believe
will be needed to complete Parts 2 and 3.
It is expected that completion of the full EAF will be dependent on information currently available and will not involve new studies,
research or investigation. If information requiring such additional work is unavailable, so indicate and specify each instance.
Name of Action
Location of Action (include Street Address, Municipality and County)
Name of Applicant/Sponsor
Address
City / PO State Zip Code
Business Telephone
Name of Owner (if different)
Address
City / PO State Zip Code
Business Telephone
Description of Action:
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Please Complete Each Question--Indicate N.A. if not applicable
A. SITE DESCRIPTION
Physical setting of overall project, both developed and undeveloped areas.
1. Present Land Use: Urban Industrial Commercial Residential (suburban) Rural (non-farm)
Forest Agriculture Other
2.
Total acreage of project area: acres.
APPROXIMATE ACREAGE PRESENTLY AFTER COMPLETION
Meadow or Brushland (Non-agricultural) acres acres
Forested acres acres
Agricultural (Includes orchards, cropland, pasture, etc.) acres acres
Wetland (Freshwater or tidal as per Articles 24,25 of ECL) acres acres
Water Surface Area acres acres
Unvegetated (Rock, earth or fill) acres acres
Roads, buildings and other paved surfaces acres acres
Other (Indicate type) acres acres
3. What is predominant soil type(s) on project site?
a. Soil drainage: Well drained % of site Moderately well drained % of site.
Poorly drained % of site
b. If any agricultural land is involved, how many acres of soil are classified within soil group 1 through 4 of the NYS Land
Classification System?
acres (see 1 NYCRR 370).
4.
Are there bedrock outcroppings on project site? Yes No
a. What is depth to bedrock (in feet)
5.
Approximate percentage of proposed project site with slopes:
0-10% % 10- 15% % 15% or greater %
6.
Is project substantially contiguous to, or contain a building, site, or district, listed on the State or National Registers of
Historic Places? Yes No
7. Is project substantially contiguous to a site listed on the Register of National Natural Landmarks? Yes No
8.
What is the depth of the water table? (in feet)
9.
Is site located over a primary, principal, or sole source aquifer? Yes No
10.
Do hunting, fishing or shell fishing opportunities presently exist in the project area? Yes No
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11. Does project site contain any species of plant or animal life that is identified as threatened or endangered? Yes No
According to:
Identify each species:
12. Are there any unique or unusual land forms on the project site? (i.e., cliffs, dunes, other geological formations?
Yes No
Describe:
13. Is the project site presently used by the community or neighborhood as an open space or recreation area?
Yes No
If yes, explain:
14.
Does the present site include scenic views known to be important to the community? Yes No
15. Streams within or contiguous to project area:
a. Name of Stream and name of River to which it is tributary
16. Lakes, ponds, wetland areas within or contiguous to project area:
b. Size (in acres):
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17.
Is the site served by existing public utilities? Yes No
a. If YES, does sufficient capacity exist to allow connection? Yes No
b. If YES, will improvements be necessary to allow connection? Yes No
18.
Is the site located in an agricultural district certified pursuant to Agriculture and Markets Law, Article 25-AA, Section 303 and
304? Yes No
19. Is the site located in or substantially contiguous to a Critical Environmental Area designated pursuant to Article 8 of the ECL,
and 6 NYCRR 617?
Yes No
20.
Has the site ever been used for the disposal of solid or hazardous wastes? Yes No
B.
Project Description
1.
Physical dimensions and scale of project (fill in dimensions as appropriate).
a. Total contiguous acreage owned or controlled by project sponsor: acres.
b. Project acreage to be developed: acres initially; acres ultimately.
c. Project acreage to remain undeveloped: acres.
d. Length of project, in miles: (if appropriate)
e. If the project is an expansion, indicate percent of expansion proposed. %
f. Number of off-street parking spaces existing ; proposed
g. Maximum vehicular trips generated per hour: (upon completion of project)?
h. If residential: Number and type of housing units:
One Family Two Family Multiple Family Condominium
Initially
Ultimately
i. Dimensions (in feet) of largest proposed structure: height; width; length.
j. Linear feet of frontage along a public thoroughfare project will occupy is? ft.
2. How much natural material (i.e. rock, earth, etc.) will be removed from the site? tons/cubic yards.
3. Will disturbed areas be reclaimed Yes No N/A
a. If yes, for what intended purpose is the site being reclaimed?
b. Will topsoil be stockpiled for reclamation? Yes No
c. Will upper subsoil be stockpiled for reclamation? Yes No
4.
How many acres of vegetation (trees, shrubs, ground covers) will be removed from site? acres.
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5. Will any mature forest (over 100 years old) or other locally-important vegetation be removed by this project?
Yes No
6. If single phase project: Anticipated period of construction: months, (including demolition)
7. If multi-phased:
a. Total number of phases anticipated (number)
b. Anticipated date of commencement phase 1: month year, (including demolition)
c. Approximate completion date of final phase: month year.
d. Is phase 1 functionally dependent on subsequent phases? Yes No
8. Will blasting occur during construction ? Yes No
9. Number of jobs generated: during construction ; after project is complete
10. Number of jobs eliminated by this project .
11. Will project require relocation of any projects or facilities? Yes No
If yes, explain:
12. Is surface liquid waste disposal involved? Yes No
a. If yes, indicate type of waste (sewage, industrial, etc) and amount
b. Name of water body into which effluent will be discharged
13. Is subsurface liquid waste disposal involved? Yes No Type
14. Will surface area of an existing water body increase or decrease by proposal? Yes No
If yes, explain:
15. Is project or any portion of project located in a 100 year flood plain? Yes No
16.
Will the project generate solid waste? Yes No
a. If yes, what is the amount per month? tons
b. If yes, will an existing solid waste facility be used? Yes No
c. If yes, give name ; location
d. Will any wastes not go into a sewage disposal system or into a sanitary landfill? Yes No
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e. If yes, explain:
17. Will the project involve the disposal of solid waste? Yes No
a. If yes, what is the anticipated rate of disposal? tons/month.
b. If yes, what is the anticipated site life? years.
18. Will project use herbicides or pesticides? Yes No
19. Will project routinely produce odors (more than one hour per day)? Yes No
20. Will project produce operating noise exceeding the local ambient noise levels? Yes No
21.
Will project result in an increase in energy use? Yes No
If yes, indicate type(s)
22.
If water supply is from wells, indicate pumping capacity gallons/minute.
23.
Total anticipated water usage per day gallons/day.
24.
Does project involve Local, State or Federal funding? Yes No
If yes, explain:
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25. Approvals Required:
Type Submittal Date
City, Town, Village Board Yes No
City, Town, Village Planning Board Yes No
City, Town Zoning Board Yes No
City, County Health Department Yes No
Other Local Agencies Yes No
Other Regional Agencies Yes No
State Agencies Yes No
Federal Agencies Yes No
C. Zoning and Planning Information
1. Does proposed action involve a planning or zoning decision? Yes No
If Yes, indicate decision required:
Zoning amendment Zoning variance New/revision of master plan Subdivision
Site plan Special use permit Resource management plan Other
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2. What is the zoning classification(s) of the site?
3. What is the maximum potential development of the site if developed as permitted by the present zoning?
4. What is the proposed zoning of the site?
5. What is the maximum potential development of the site if developed as permitted by the proposed zoning?
6. Is the proposed action consistent with the recommended uses in adopted local land use plans? Yes No
7. What are the predominant land use(s) and zoning classifications within a ¼ mile radius of proposed action?
8.
Is the proposed action compatible with adjoining/surrounding land uses with a ¼ mile? Yes No
9.
If the proposed action is the subdivision of land, how many lots are proposed?
a. What is the minimum lot size proposed?
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10. Will proposed action require any authorization(s) for the formation of sewer or water districts? Yes No
11. Will the proposed action create a demand for any community provided services (recreation, education, police, fire protection?
Yes No
a. If yes, is existing capacity sufficient to handle projected demand? Yes No
12.
Will the proposed action result in the generation of traffic significantly above present levels? Yes No
a. If yes, is the existing road network adequate to handle the additional traffic. Yes No
D. Informational Details
Attach any additional information as may be needed to clarify your project. If there are or may be any adverse impacts
associated with your proposal, please discuss such impacts and the measures which you propose to mitigate or avoid them.
E.
Verification
I certify that the information provided above is true to the best of my knowledge.
Applicant/Sponsor Name Date
Signature
Title
If the action is in the Coastal Area, and you are a state agency, complete the Coastal Assessment Form before proceeding with this
assessment.
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PART 2 - PROJECT IMPACTS AND THEIR MAGNITUDE
Responsibility of Lead Agency
General Information (Read Carefully)
!
In completing the form the reviewer should be guided by the question: Have my responses and determinations been
reasonable? The reviewer is not expected to be an expert environmental analyst.
!
The Examples provided are to assist the reviewer by showing types of impacts and wherever possible the threshold of
magnitude that would trigger a response in column 2. The examples are generally applicable throughout the State and for
most situations. But, for any specific project or site other examples and/or lower thresholds may be appropriate for a
Potential Large Impact response, thus requiring evaluation in Part 3.
!
The impacts of each project, on each site, in each locality, will vary. Therefore, the examples are illustrative and have been
offered as guidance. They do not constitute an exhaustive list of impacts and thresholds to answer each question.
!
The number of examples per question does not indicate the importance of each question.
! In identifying impacts, consider long term, short term and cumulative effects.
Instructions (Read carefully)
a.
Answer each of the 20 questions in PART 2. Answer Yes if there will be any impact.
b. Maybe answers should be considered as Yes answers.
c.
If answering Yes to a question then check the appropriate box(column 1 or 2)to indicate the potential size of the impact. If
impact threshold equals or exceeds any example provided, check column 2. If impact will occur but threshold is lower than
example, check column 1.
d. Identifying that an Impact will be potentially large (column 2) does not mean that it is also necessarily significant. Any
large impact must be evaluated in PART 3 to determine significance. Identifying an impact in column 2 simply asks that it
be looked at further.
e.
If reviewer has doubt about size of the impact then consider the impact as potentially large and proceed to PART 3.
f. If a potentially large impact checked in column 2 can be mitigated by change(s) in the project to a small to moderate
impact, also check the Yes box in column 3. A No response indicates that such a reduction is not possible. This must be
explained in Part 3.
Impact on Land
1. Will the Proposed Action result in a physical change to the project
site?
NO YES
Examples that would apply to column 2
C Any construction on slopes of 15% or greater, (15 foot
rise per 100 foot of length), or where the general slopes
in the project area exceed 10%.
C Construction on land where the depth to the water table
is less than 3 feet.
C Construction of paved parking area for 1,000 or more
vehicles.
C Construction on land where bedrock is exposed or
generally within 3 feet of existing ground surface.
C Construction that will continue for more than 1 year or
involve more than one phase or stage.
C Excavation for mining purposes that would remove
more than 1,000 tons of natural material (i.e., rock or
soil) per year.
1
Small to
Moderate
Impact
2
Potential
Large
Impact
3
Can Impact Be
Mitigated by
Project Change
Yes No
Yes No
Yes No
Yes No
Yes No
Yes No
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C Construction or expansion of a santary landfill.
C Construction in a designated floodway.
C Other impacts:
2.
Will there be an effect to any unique or unusual land forms found on
the site? (i.e., cliffs, dunes, geological formations, etc.)
NO YES
C Specific land forms:
Impact on Water
3.
Will Proposed Action affect any water body designated as protected?
(Under Articles 15, 24, 25 of the Environmental Conservation Law,
ECL)
NO YES
Examples that would apply to column 2
C Developable area of site contains a protected water body.
C Dredging more than 100 cubic yards of material from channel of
a protected stream.
C Extension of utility distribution facilities through a protected water
body.
C Construction in a designated freshwater or tidal wetland.
C Other impacts:
4. Will Proposed Action affect any non-protected existing or new body of
water?
NO YES
Examples that would apply to column 2
C A 10% increase or decrease in the surface area of any body of
water or more than a 10 acre increase or decrease.
C Construction of a body of water that exceeds 10 acres of surface
area.
C Other impacts:
1
Small to
Moderate
Impact
2
Potential
Large
Impact
3
Can Impact Be
Mitigated by
Project Change
Yes No
Yes No
Yes No
Yes No
Yes No
Yes No
Yes No
Yes No
Yes No
Yes No
Yes No
Yes No
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5. Will Proposed Action affect surface or groundwater quality or
quantity?
NO YES
Examples that would apply to column 2
C Proposed Action will require a discharge permit.
C Proposed Action requires use of a source of water that does not
have approval to serve proposed (project) action.
C Proposed Action requires water supply from wells with greater
than 45 gallons per minute pumping capacity.
C Construction or operation causing any contamination of a water
supply system.
C Proposed Action will adversely affect groundwater.
C Liquid effluent will be conveyed off the site to facilities which
presently do not exist or have inadequate capacity.
C Proposed Action would use water in excess of 20,000 gallons
per day.
C Proposed Action will likely cause siltation or other discharge into
an existing body of water to the extent that there will be an
obvious visual contrast to natural conditions.
C Proposed Action will require the storage of petroleum or
chemical products greater than 1,100 gallons.
C Proposed Action will allow residential uses in areas without
water and/or sewer services.
C Proposed Action locates commercial and/or industrial uses
which may require new or expansion of existing waste treatment
and/or storage facilities.
C Other impacts:
1
Small to
Moderate
Impact
2
Potential
Large
Impact
3
Can Impact Be
Mitigated by
Project Change
Yes No
Yes No
Yes No
Yes No
Yes No
Yes No
Yes No
Yes No
Yes No
Yes No
Yes No
Yes No
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6. Will Proposed Action alter drainage flow or patterns, or surface water
runoff?
NO YES
Examples that would apply to column 2
C Proposed Action would change flood water flows
C Proposed Action may cause substantial erosion.
C Proposed Action is incompatible with existing drainage patterns.
C Proposed Action will allow development in a designated
floodway.
C Other impacts:
IMPACT ON AIR
7. Will Proposed Action affect air quality?
NO YES
Examples that would apply to column 2
C Proposed Action will induce 1,000 or more vehicle trips in any
given hour.
C Proposed Action will result in the incineration of more than 1 ton
of refuse per hour.
C Emission rate of total contaminants will exceed 5 lbs. per hour
or a heat source producing more than 10 million BTU’s per
hour.
C Proposed Action will allow an increase in the amount of land
committed to industrial use.
C Proposed Action will allow an increase in the density of
industrial development within existing industrial areas.
C Other impacts:
IMPACT ON PLANTS AND ANIMALS
8. Will Proposed Action affect any threatened or endangered species?
NO YES
Examples that would apply to column 2
C Reduction of one or more species listed on the New York or
Federal list, using the site, over or near
the site, or found on the site.
1
Small to
Moderate
Impact
2
Potential
Large
Impact
3
Can Impact Be
Mitigated by
Project Change
Yes No
Yes No
Yes No
Yes No
Yes No
Yes No
Yes No
Yes No
Yes No
Yes No
Yes No
Yes No
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C Removal of any portion of a critical or significant wildlife habitat.
C Application of pesticide or herbicide more than twice a year,
other than for agricultural purposes.
C Other impacts:
9.
Will Proposed Action substantially affect non-threatened or non-
endangered species?
NO YES
Examples that would apply to column 2
C Proposed Action would substantially interfere with any resident
or migratory fish, shellfish or wildlife species.
C Proposed Action requires the removal of more than 10 acres of
mature forest (over 100 years of age) or other locally important
vegetation.
C Other impacts:
IMPACT ON AGRICULTURAL LAND RESOURCES
10. Will Proposed Action affect agricultural land resources?
NO YES
Examples that would apply to column 2
C The Proposed Action would sever, cross or limit access to
agricultural land (includes cropland, hayfields, pasture, vineyard,
orchard, etc.)
C Construction activity would excavate or compact the soil profile of
agricultural land.
C The Proposed Action would irreversibly convert more than 10
acres of agricultural land or, if located in an Agricultural District,
more than 2.5 acres of agricultural land.
1
Small to
Moderate
Impact
2
Potential
Large
Impact
3
Can Impact Be
Mitigated by
Project Change
Yes No
Yes No
Yes No
Yes No
Yes No
Yes No
Yes No
Yes No
Yes No
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C The Proposed Action would disrupt or prevent installation of
agricultural land management systems (e.g., subsurface drain
lines, outlet ditches, strip cropping); or create a need for such
measures (e.g. cause a farm field to drain poorly due to
increased runoff).
C Other impacts:
IMPACT ON AESTHETIC RESOURCES
11. Will Proposed Action affect aesthetic resources? (If necessary, use
the Visual EAF Addendum in Section 617.20, Appendix B.)
NO YES
Examples that would apply to column 2
C Proposed land uses, or project components obviously different
from or in sharp contrast to current surrounding land use
patterns, whether man-made or natural.
C Proposed land uses, or project components visible to users of
aesthetic resources which will eliminate or significantly reduce
their enjoyment of the aesthetic qualities of that resource.
C Project components that will result in the elimination or
significant screening of scenic views known to be important to
the area.
C Other impacts:
IMPACT ON HISTORIC AND ARCHAEOLOGICAL RESOURCES
12.
Will Proposed Action impact any site or structure of historic,
prehistoric or paleontological importance?
NO YES
Examples that would apply to column 2
C Proposed Action occurring wholly or partially within or
substantially contiguous to any facility or site listed on the State
or National Register of historic places.
C Any impact to an archaeological site or fossil bed located within
the project site.
C Proposed Action will occur in an area designated as sensitive
for archaeological sites on the NYS Site Inventory.
1
Small to
Moderate
Impact
2
Potential
Large
Impact
3
Can Impact Be
Mitigated by
Project Change
Yes No
Yes No
Yes No
Yes No
Yes No
Yes No
Yes No
Yes No
Yes No
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C Other impacts:
IMPACT ON OPEN SPACE AND RECREATION
13. Will proposed Action affect the quantity or quality of existing or future
open spaces or recreational opportunities?
NO YES
Examples that would apply to column 2
C The permanent foreclosure of a future recreational opportunity.
C A major reduction of an open space important to the community.
C Other impacts:
IMPACT ON CRITICAL ENVIRONMENTAL AREAS
14.
Will Proposed Action impact the exceptional or unique
characteristics of a critical environmental area (CEA) established
pursuant to subdivision 6NYCRR 617.14(g)?
NO YES
List the environmental characteristics that caused the designation of
the CEA.
Examples that would apply to column 2
C Proposed Action to locate within the CEA?
C Proposed Action will result in a reduction in the quantity of the
resource?
C Proposed Action will result in a reduction in the quality of the
resource?
C Proposed Action will impact the use, function or enjoyment of the
resource?
C Other impacts:
1
Small to
Moderate
Impact
2
Potential
Large
Impact
3
Can Impact Be
Mitigated by
Project Change
Yes No
Yes No
Yes No
Yes No
Yes No
Yes No
Yes No
Yes No
Yes No
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IMPACT ON TRANSPORTATION
15.
Will there be an effect to existing transportation systems?
NO YES
Examples that would apply to column 2
C Alteration of present patterns of movement of people and/or
goods.
C Proposed Action will result in major traffic problems.
C Other impacts:
IMPACT ON ENERGY
16.
Will Proposed Action affect the community’s sources of fuel or
energy supply?
NO YES
Examples that would apply to column 2
C Proposed Action will cause a greater than 5% increase in the
use of any form of energy in the municipality.
C Proposed Action will require the creation or extension of an
energy transmission or supply system to serve more than 50
single or two family residences or to serve a major commercial
or industrial use.
C Other impacts:
NOISE AND ODOR IMPACT
17.
Will there be objectionable odors, noise, or vibration as a result of
the Proposed Action?
NO YES
Examples that would apply to column 2
C Blasting within 1,500 feet of a hospital, school or other sensitive
facility.
C Odors will occur routinely (more than one hour per day).
C Proposed Action will produce operating noise exceeding the
local ambient noise levels for noise outside of structures.
C Proposed Action will remove natural barriers that would act as a
noise screen.
C Other impacts:
1
Small to
Moderate
Impact
2
Potential
Large
Impact
3
Can Impact Be
Mitigated by
Project Change
Yes No
Yes No
Yes No
Yes No
Yes No
Yes No
Yes No
Yes No
Yes No
Yes No
Yes No
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IMPACT ON PUBLIC HEALTH
18. Will Proposed Action affect public health and safety?
NO YES
C Proposed Action may cause a risk of explosion or release of
hazardous substances (i.e. oil, pesticides, chemicals, radiation,
etc.) in the event of accident or upset conditions, or there may be
a chronic low level discharge or emission.
C Proposed Action may result in the burial of “hazardous wastes”
in any form (i.e. toxic, poisonous, highly reactive, radioactive,
irritating, infectious, etc.)
C Storage facilities for one million or more gallons of liquefied
natural gas or other flammable liquids.
C Proposed Action may result in the excavation or other
disturbance within 2,000 feet of a site used for the disposal of
solid or hazardous waste.
C Other impacts:
IMPACT ON GROWTH AND CHARACTER
OF COMMUNITY OR NEIGHBORHOOD
19. Will Proposed Action affect the character of the existing community?
NO YES
Examples that would apply to column 2
C The permanent population of the city, town or village in which the
project is located is likely to grow by more than 5%.
C The municipal budget for capital expenditures or operating
services will increase by more than 5% per year as a result of
this project.
C Proposed Action will conflict with officially adopted plans or
goals.
C Proposed Action will cause a change in the density of land use.
C Proposed Action will replace or eliminate existing facilities,
structures or areas of historic importance to the community.
C Development will create a demand for additional community
services (e.g. schools, police and fire, etc.)
1
Small to
Moderate
Impact
2
Potential
Large
Impact
3
Can Impact Be
Mitigated by
Project Change
Yes No
Yes No
Yes No
Yes No
Yes No
Yes No
Yes No
Yes No
Yes No
Yes No
Yes No
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C Proposed Action will set an important precedent for future
projects.
C Proposed Action will create or eliminate employment.
C Other impacts:
20.
Is there, or is there likely to be, public controversy related to potential
adverse environment impacts?
NO YES
1
Small to
Moderate
Impact
2
Potential
Large
Impact
3
Can Impact Be
Mitigated by
Project Change
Yes No
Yes No
Yes No
If Any Action in Part 2 Is Identified as a Potential Large Impact or If you Cannot Determine the Magnitude of
Impact, Proceed to Part 3
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Part 3 - EVALUATION OF THE IMPORTANCE OF IMPACTS
Responsibility of Lead Agency
Part 3 must be prepared if one or more impact(s) is considered to be potentially large, even if the impact(s) may
be mitigated.
Instructions (If you need more space, attach additional sheets)
Discuss the following for each impact identified in Column 2 of Part 2:
1.
Briefly describe the impact.
2.
Describe (if applicable) how the impact could be mitigated or reduced to a small to moderate impact by
project change(s).
3. Based on the information available, decide if it is reasonable to conclude that this impact is important.
To answer the question of importance, consider:
! The probability of the impact occurring
! The duration of the impact
! Its irreversibility, including permanently lost resources of value
! Whether the impact can or will be controlled
! The regional consequence of the impact
! Its potential divergence from local needs and goals
! Whether known objections to the project relate to this impact.
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Form 617.20: FULL ENVIRONMENTAL ASSESSMENT FORM Appendix A (Town of Southold)

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Completed 16 July 2020

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