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Full Environmental Assessment Form
Part 1 - Project and Setting
Instructions for Completing Part 1
Part 1 is to be completed by the applicant or project sponsor. Responses become part of the application for approval or funding,
are subject to public review, and may be subject to further verification.
Complete Part 1 based on information currently available. If additional research or investigation would be needed to fully respond to
any item, please answer as thoroughly as possible based on current information; indicate whether missing information does not exist,
or is not reasonably available to the sponsor; and, when possible, generally describe work or studies which would be necessary to
update or fully develop that information.
Applicants/sponsors must complete all items in Sections A & B. In Sections C, D & E, most items contain an initial question that
must be answered either “Yes” or “No”. If the answer to the initial question is “Yes”, complete the sub-questions that follow. If the
answer to the initial question is “No”, proceed to the next question. Section F allows the project sponsor to identify and attach any
additional information. Section G requires the name and signature of the applicant or project sponsor to verify that the information
contained in Part 1is accurate and complete.
A. Project and Applicant/Sponsor Information.
Name of Action or Project:
Project Location (describe, and attach a general location map):
Brief Description of Proposed Action (include purpose or need):
Name of Applicant/Sponsor: Telephone:
E-Mail:
Address:
City/PO: State: Zip Code:
Project Contact (if not same as sponsor; give name and title/role): Telephone:
E-Mail:
Address:
City/PO: State: Zip Code:
Property Owner (if not same as sponsor): Telephone:
E-Mail:
Address:
City/PO: State: Zip Code:
FEAF 2019
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B. Government Approvals
B. Government Approvals, Funding, or Sponsorship. (“Funding” includes grants, loans, tax relief, and any other forms of financial
assistance.)
Government Entity If Yes: Identify Agency and Approval(s)
Required
Application Date
(Actual or projected)
a. City Counsel, Town Board, 9 Yes 9 No
or Village Board of Trustees
b. City, Town or Village 9 Yes 9 No
Planning Board or Commission
c. City, Town or 9 Yes 9 No
Village Zoning Board of Appeals
d. Other local agencies 9 Yes 9 No
e. County agencies 9 Yes 9 No
f. Regional agencies 9 Yes 9 No
g. State agencies 9 Yes 9 No
h. Federal agencies 9 Yes 9 No
i. Coastal Resources.
i. Is the project site within a Coastal Area, or the waterfront area of a Designated Inland Waterway? 9 Yes 9 No
ii. Is the project site located in a community with an approved Local Waterfront Revitalization Program?
9 Yes 9 No
iii. Is the project site within a Coastal Erosion Hazard Area? 9 Yes 9 No
C. Planning and Zoning
C.1. Planning and zoning actions.
Will administrative or legislative adoption, or amendment of a plan, local law, ordinance, rule or regulation be the 9 Yes 9
N
o
only approval(s) which must be granted to enable the proposed action to proceed?
If Yes, complete sections C, F and G.
If No, proceed to question C.2 and complete all remaining sections and questions in Part 1
C.2. Adopted land use plans.
a. Do any municipally- adopted (city, town, village or county) comprehensive land use plan(s) include the site 9 Yes 9 No
where the proposed action would be located?
If Yes, does the comprehensive plan include specific recommendations for the site where the proposed action 9 Yes 9 No
would be located?
b. Is the site
of the proposed action within any local or regional special planning district (for example: Greenway;
9 Yes 9 No
Brownfield Opportunity Area (BOA); designated State or Federal heritage area; watershed management plan;
or other?)
If Yes, identify the plan(s):
_______________________________________________________________________________________________________
______________________________________________________________________________________________________
_
_
________________________________________________________________________________________________________
c. Is the proposed action located wholly or partially within an area listed in an adopted municipal open space plan, 9 Yes 9 No
or an adopted municipal farmland protection plan?
If Yes, identify the plan(s):
________________________________________________________________________________________________________
________________________________________________________________________________________________________
________________________________________________________________________________________________________
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C.3. Zoning
a. Is the site of the proposed action located in a municipality with an adopted zoning law or ordinance. 9 Yes 9 No
If Yes, what is the zoning classification(s) including any applicable overlay district?
_________________________________________________________________________________________________________
_________________________________________________________________________________________________________
b. Is the use permitted or allowed by a special or conditional use permit? 9 Yes 9 No
c. Is a zoning change requested as part of the proposed action? 9 Yes 9 No
If Yes,
i. What is the proposed new zoning for the site? ___________________________________________________________________
C.4. Existing community services.
a. In what school district is the project site located? ________________________________________________________________
b. What police or other public protection forces serve the project site?
_________________________________________________________________________________________________________
c. Which fire protection and emergency medical services serve the project site?
__________________________________________________________________________________________________________
d. What parks serve the project site?
__________________________________________________________________________________________________________
__________________________________________________________________________________________________________
D. Project Details
D.1. Proposed and Potential Development
a. What is the general nature of the proposed action (e.g., residential, industrial, commercial, recreational; if mixed, include all
components)?
_________________________________________________________________________________________________________
b. a. Total acreage of the site of the proposed action? _____________ acres
b. Total acreage to be physically disturbed? _____________ acres
c. Total acreage (project site and any contiguous properties) owned
or controlled by the applicant or project sponsor? _____________ acres
c. Is the proposed action an expansion of an existing project or use? 9 Yes 9 No
i. If Yes, what is the approximate percentage of the proposed expansion and identify the units (e.g., acres, miles, housing units,
square feet)? % ____________________ Units: ____________________
d. Is the proposed action a subdivision, or does it include a subdivision? 9 Yes 9 No
If Yes,
i. Purpose or type of subdivision? (e.g., residential, industrial, commercial; if mixed, specify types)
________________________________________________________________________________________________________
ii. Is a cluster/conservation layout proposed? 9 Yes 9 No
iii. Number of lots proposed? ________
iv. Minimum and maximum proposed lot sizes? Minimum __________ Maximum __________
9 Yes 9 No
_____ months
_____
_____ month _____ year
e. Will the proposed action
be constructed in multiple phases?
i. If No, anticipated period of construction:
ii. If Yes:
Total number of phases anticipated
Anticipated commencement date of phase 1 (including demolition)
Anticipated completion date of final phase
_____ month _____year
Generally describe connections or relationships among phases, including any contingencies where progress of one phase may
determine timing or duration of future phases: _______________________________________________________________
____________________________________________________________________________________________________
____________________________________________________________________________________________________
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f. Does the project include new residential uses? 9 Yes 9 No
If Yes, show numbers of units proposed.
One
Family Two Family Three Family Multiple Family (four or more)
Initial Phase ___________ ___________ ____________ ________________________
At completion
of all phases ___________ ___________ ____________ ________________________
g. Does the proposed action include new non-residential construction (including expansions)? 9 Yes 9 No
If Yes,
i. Total number of structures ___________
ii. Dimensions (in feet) of largest proposed structure: ________height; ________width; and _______ length
iii. Approximate extent of building space to be heated or cooled: ______________________ square feet
h. Does the proposed action include construction or other activities that will result in the impoundment of any 9 Yes 9 No
liquids, such as creation of a water supply, reservoir, pond, lake, waste lagoon or other storage?
If Yes,
i. Purpose of the impoundment: ________________________________________________________________________________
ii. If a water impoundment, the principal source of the water: 9 Ground water 9 Surface water streams 9 Other specify:
_________________________________________________________________________________________________________
iii. If other than water, identify the type of impounded/contained liquids and their source.
_________________________________________________________________________________________________________
iv. Approximate size of the proposed impoundment. Volume: ____________ million gallons; surface area: ____________ acres
v. Dimensions of the proposed dam or impounding structure: ________ height; _______ length
vi. Construction method/materials for the proposed dam or impounding structure (e.g., earth fill, rock, wood, concrete):
________________________________________________________________________________________________________
D.2. Project Operations
a. Does the proposed action include any excavation, mining, or dredging, during construction, operations, or both? 9 Yes 9 No
(Not including general site preparation, grading or installation of utilities or foundations where all excavated
materials will remain onsite)
If Yes:
i .What is the purpose of the excavation or dredging? _______________________________________________________________
ii. How much material (including rock, earth, sediments, etc.) is proposed to be removed from the site?
Volume (specify tons or cubic yards): ____________________________________________
Over what duration of time? ____________________________________________________
iii. Describe nature and characteristics of materials to be excavated or dredged, and plans to use, manage or dispose of them.
________________________________________________________________________________________________________
________________________________________________________________________________________________________
iv. Will there be onsite dewatering or processing of excavated materials? 9 Yes 9 No
If yes, describe. ___________________________________________________________________________________________
________________________________________________________________________________________________________
v. What is the total area to be dredged or excavated? _____________________________________acres
vi. What is the maximum area to be worked at any one time? _______________________________ acres
vii. What would be the maximum depth of excavation or dredging? __________________________ feet
viii. Will the excavation require blasting? 9 Yes 9 No
ix. Summarize site reclamation goals and plan: _____________________________________________________________________
________________________________________________________________________________________________________
________________________________________________________________________________________________________
b. Would the proposed action cause or result in alteration of, increase or decrease in size of, or encroachment 9 Yes 9 No
into any existing wetland, waterbody, shoreline, beach or adjacent area?
If Yes:
i. Identify the wetland or waterbody which would be affected (by name, water index number, wetland map number or geographic
description): ______________________________________________________________________________________________
_________________________________________________________________________________________________________
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ii.
iii.
Describe how the proposed action would affect that waterbody or wetland, e.g. excavation, fill, placement of structures, or
alteration of channels, banks and shorelines. Indicate extent of activities, alterations and additions in square feet or acres:
_________________________________________________________________________________________________________
_________________________________________________________________________________________________________
_________________________________________________________________________________________________________
_________________________________________________________________________________________________________
Will the proposed action cause or result in disturbance to bottom sediments? Yes 9 No
If Yes, describe: __________________________________________________________________________________________
iv. Will the proposed action cause o
r result in the destruction or removal of aquatic vegetation?
9 Yes 9 No
If Yes:
acres of aquatic vegetation proposed
to be removed: ___________________________________________________________
expected acreage of aquatic vegetation remaining after project completion:________________________________________
purpose of proposed removal (e.g. beach clearing, invasive species control, boat access): ____________________________
____________________________________________________________________________________________________
proposed method of plant removal: ________________________________________________________________________
if chemical/herbicide treatment will be used, specify product(s): _________________________________________________
v. Describe any proposed reclamation/mitigation following disturbance: _________________________________________________
_________________________________________________________________________________________________________
c. Will the proposed action use, or create a new demand for water? 9 Yes 9 No
If Yes:
i.
Total anticipated water usage/demand per day: __________________________ gallons/day
ii. Will the proposed action obtain water from an existing public water supply? 9 Yes 9 No
If Yes:
Name of district or service area: _________________________________________________________________________
Does the existing public water supply have capacity to serve the proposal? 9 Yes 9 No
Is the project site in the existing district? 9 Yes 9 No
Is expansion of the district needed? 9 Yes 9 No
Do existing lines serve the project site? 9 Yes 9 No
iii. Will line extension within an existing district be necessary to supply the project? 9 Yes 9 No
If Yes:
Describe extensions or capacity expansions proposed to serve this project: ________________________________________
____________________________________________________________________________________________________
Source(s) of supply for the district: ________________________________________________________________________
iv. Is a new water supply district or service area proposed to be formed to serve the project site? 9 Yes 9 No
If, Yes:
Applicant/sponsor for new district: ________________________________________________________________________
Date application submitted or anticipated: __________________________________________________________________
Proposed source(s) of supply for new district: _______________________________________________________________
v. If a public water supply will not be used, describe plans to provide water supply for the project: ___________________________
_________________________________________________________________________________________________________
vi. If water supply will be from wells (public or private), what is the maximum pump
ing capacity: _______ gallons/minute.
d. Will the proposed action generate liquid wastes? 9 Yes 9 No
If Yes:
i. Total anticipated liquid waste generation per day: _______________ gallons/day
ii. Nature of liquid wastes to be generated (e.g., sanitary wastewater, industrial; if combination, describe all components and
approximate volumes or proportions of each): __________________________________________________________________
_________________________________________________________________________________________________________
_________________________________________________________________________________________________________
iii. Will the proposed action use any existing public wastewater treatment facilities? 9 Yes 9 No
If Yes:
Name of wastewater treatment plant to be used: _____________________________________________________________
Name of district: ______________________________________________________________________________________
Does the existing wastewater treatment plant have capacity to serve the project? 9 Yes 9 No
Is the project site in the existing district? 9 Yes 9 No
Is expansion of the district needed? 9 Yes 9 No
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9 Yes 9 No
Do existing sewer lines serve the project site?
Will
a line extension within an existing district be necessary to serve the project?
9 Yes 9 No
If Yes:
Describe extensions or capacity expansions proposed to serve this project: ____________________________________
____________________________________________________________________________________________________
____________________________________________________________________________________________________
iv. Will a new wastewater (sewage) treatment district be formed to serve the project site? 9 Yes 9 No
If Yes:
Applicant/sponsor for new district: ____________________________________________________________________
Date application submitted or anticipated: _______________________________________________________________
What is the receiving water for the wastewater discharge? __________________________________________________
v. If public facilities will not be used, describe plans to provide wastewater treatment for the project, including specifying proposed
receiving water (name and classification if surface discharge or describe subsurface disposal plans):
________________________________________________________________________________________________________
________________________________________________________________________________________________________
vi. Describe any plans or designs to capture, recycle or reuse liquid waste: _______________________________________________
________________________________________________________________________________________________________
_________________________________________________________
_
______________________________________________
e. Will the proposed action disturb more than one acre and create stormwater runoff, either from new point 9 Yes 9 No
sources (i.e. ditches, pipes, swales, curbs, gutters or other concentrated flows of stormwater) or non-point
source (i.e. sheet flow) during construction or post construction?
If Yes:
i.
How much impervious surface will the project create in relation to total size of project parcel?
_____ Square feet or _____ acres (impervious surface)
_____ Square feet or _____ acres (parcel size)
ii.
Describe types of new point sources. __________________________________________________________________________
_________________________________________________________________________________________________________
iii. Where will the stormwater runoff be directed (i.e. on-site stormwater management facility/structures, adjacent properties,
groundwater, on-site surface water or off-site surface waters)?
_
_______________________________________________________________________________________________________
________________________________________________________________________________________________________
If to surface waters, identify receiving water bodies or wetlands: ______________________________________
__________
____________________________________________________________________________________________________
____________________________________________________________________________________________________
Will stormwater runoff flow to adjacent properties? 9 Yes 9 No
iv. Does the proposed plan minimize impervious surfaces, use pervious materials or collect and re-use stormwater?
9 Yes 9 No
f. Does the proposed action include, or will it use on-site, one or more sources of air emissions, including fuel 9 Yes 9 No
combustion, waste incineration, or other processes or operations?
If Yes, identify:
i. Mobile sources during project operations (e.g., heavy equipment, fleet or delivery vehicles)
_________________________________________________________________________________________________________
ii. Stationary sources during construction (e.g., power generation, structural heating, batch plant, crushers)
______________________________________________________________________________________________________
__
iii. Stationary sources during operations (e.g., process emissions, large boilers, electric generation)
________________________________________________________________________________________________________
g. Will any air emission sources named in D.2.f (above), require a NY State Air Registration, Air Facility Permit, 9 Yes 9 No
or Federal Clean Air Act Title IV or Title V Permit?
If Yes:
i. Is the project site located in an Air quality non-attainment area? (Area routinely or periodically fails to meet 9 Yes 9 No
ambient air quality standards for all or some parts of the year)
ii. In addition to emissions as calculated in the application, the project will generate:
___________Tons/year (short tons) of Carbon Dioxide (CO
2
)
___________Tons/year (short tons) of Nitrous Oxide (N
2
O)
___________Tons/year (short tons) of Perfluorocarbons (PFCs)
___________Tons/year (short tons) of Sulfur Hexafluoride (SF
6
)
___________Tons/year (short tons) of Carbon Dioxide equivalent of Hydroflourocarbons (HFCs)
_________
__Tons/year (short tons) of Hazardous Air Pollutants (HAPs)
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h. Will the proposed action generate or emit methane (including, but not limited to, sewage treatment plants, 9 Yes 9 No
landfills, composting facilities)?
If Yes:
i.
Estimate methane generation in tons/year (metric): ________________________________________________________________
ii. Describe any methane capture, control or elimination measures included in project design (e.g., combustion to generate heat or
electr
icity, flaring): _______________________________________________________________________________________
_
_________________________________________________________________________________________________________
i. Will the proposed action result in the release of air pollutants from open-air operations or processes, such as 9 Yes 9 No
quarry or landfill operations?
If Yes: Describe operations and nature of emissions (e.g., diesel exhaust, rock particulates/dust):
_________________________________________________________________________________________________________
_________________________________________________________________________________________________________
j. Will the proposed action result in a substantial increase in traffic above present levels or generate substantial 9 Yes 9 No
new demand for transportation facilities or services?
If Yes:
i. When is the peak traffic expected (Check all that apply): Morni
ng Evening Weekend
Randomly between hours of __________ to ________.
ii. For commercial activities only, projected number of truck trips/day and type (e.g., semi trailers and dump trucks): _____________
iii.
iv.
v.
Parking spaces: Existing ___________________
Proposed ___________ Net increase/decrease _____________________
Does the proposed action include any shared use parking? Yes No
9 Yes 9 No
vi. Are public/private transportation service(s) or facilities available with
in ½ mile of the proposed site?
vii Will the proposed action include access to public transportation or accommodations for use of hybrid, electric 9 Yes 9 No
or other alternative fueled vehicles?
viii
. W
ill the proposed action include plans for pedestrian or bicycle accommodations for connections to
existing 9 Yes
9 No
pede
strian or bicycle routes?
k. Will the proposed action (for commercial or industrial projects only) generate new or additional demand 9 Yes 9 No
for energy?
If Yes:
i. Estimate annual electricity demand during operation of the proposed action: ____________________________________________
_________________________________________________________________________________________________________
ii. A
nticipated sources/suppliers of electricity for the project (e.g., on-site combustion, on-site renewable, via grid/local utility, or
other):
_______________________________________________________________________________________________________
_
iii. Will the proposed action require a new, or an upgrade, to an existing substation?
9 Yes 9 No
l. Hours of operation. Answer all items which apply.
i. During Construction: ii. During Operations:
Monday - Friday: _________________________ Monday - Friday: ____________________________
Saturday: ________________________________ Saturday: ___________________________________
Sunday: _________________________________ Sunday: ____________________________________
Holidays: ________________________________ Holidays: ___________________________________
If the proposed action includes
any modification of existing roads, creation of new roads or change in existing access, describe:
__
______________________________________________________________________________________________________
____________
____________________________________________________________________________________________
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m. Will the proposed action produce noise that will exceed existing ambient noise levels during construction, 9 Yes 9 No
operation, or both?
If yes:
i. Provide details including sources, time of day and duration:
_______________________________________________________________________________________________________
_______________________________________________________________________________________________________
ii. Will the proposed action remove existing natural barriers that could act as a noise barrier or screen?
9 Yes 9 No
Describe: _________________________________________________________________________________________________
_________________________________________________________________________________________________________
n. W thill prope os actioed havn e outd lighoor ting? 9 Yes 9 No
If yes:
i.
Describe source(s), location(s), height of fixture(s), direction/aim, and proximity to nearest occupied structures:
_________________________________________________________________________________________________________
_________________________________________________________________________________________________________
ii
.
Will proposed action remove existing natural barriers that could act as a light barrier or screen? 9 Yes 9 No
Describe: _________________________________________________________________________________________________
_________________________________________________________________________________________________________
o. Does the proposed action have the potential to produce odors for more than one hour per day? 9 Yes 9 No
If Yes, describe possible sources, potential frequency and duration of odor emissions, and proximity to nearest
occupied structures: ______________________________________________________________________________________
________________________________________________________________________________________________________
________________________________________________________________________________________________________
p. 9 Yes 9 No Will the proposed action include any bulk storage of petroleum (combined capacity of over 1,100 gallons)
or chemical products 185 gallons in above ground storage or any amount in underground storage?
If Yes:
i. Product(s) to be stored _________________________________________________________
_____________________________
ii. Volume(s) ______ per unit time ___________ (e.g., month, year)
iii. Generally, describe the proposed storage facilities:________________________________________________________________
________________________________________________________________________________________________________
q. Will the proposed action (commercial, industrial and recreational projects only) use pesticides (i.e., herbicides, 9 Yes 9 No
insecticides) during construction or operation?
If Yes:
i.
Describe proposed treatment(s):
________________________________________________________________________________________________________
_______________________________________________________________________________________________________
_
________________________________________________________________________________________________________
________________________________________________________________________________________________________
ii. Will the proposed action use Integrated Pest Management Practices? 9 Yes 9 No
r. Will the proposed action (commercial or industrial projects only) involve or require the management or disposal 9 Yes 9 No
of solid waste (excluding hazardous materials)?
If Yes:
i. Describe any solid waste(s) to be generated during construction or operation of the facility:
Construction: ____________________ tons per ________________ (unit of time)
Operation : ____________________ tons per ________________ (unit of time)
ii.
Describe any proposals for on-site minimization, recycling or reuse of materials to avoid disposal as solid waste:
Construction: ________________________________________________________________________________________
____________________________________________________________________________________________________
Operation: __________________________________________________________________________________________
____________________________________________________________________________________________________
iii. Proposed disposal methods/facilities for solid waste generated on-site:
Construction: ________________________________________________________________________________________
____________________________________________________________________________________________________
Operation: __________________________________________________________________________________________
____________________________________________________________________________________________________
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s. Does the proposed action include construction or modification of a solid waste management facility? 9 Yes 9 No
If Yes:
i.
Type of management or handling of waste proposed for the site (e.g., recycling or transfer station, composting, landfill, or
other disposal activities): ___________________________________________________________________________________
ii. Anticipated rate of disposal/processing:
________ Tons/month, if transfer or other non-combustion/thermal treatment, or
________ Tons/hour, if combustion or thermal treatment
iii.
If landfill, anticipated site life: ________________________________ years
t. Will the proposed action at the site involve the commercial generation, treatment, storage, or disposal of hazardous
9 Yes 9 No
waste?
If Yes:
i.
Name(s) of all hazardous wastes or constituents to be generated, handled or managed at facility: ___________________________
_________________________________________________________________________________________________________
_______________________________________________________________________________________________________
__
ii. Generally describe processes or activities involving hazardous wastes or constituents: ___________________________________
_________________________________________________________________________________________________________
________________________________________________________________________________________________________
iii. Specify amount to be handled or generated _____ tons/month
iv. Describe any proposals for on-site minimization, recycling or reuse of hazardous constituents: ____________________________
________________________________________________________________________________________________________
________________________________________________________________________________________________________
v. Will any hazardous wastes be disposed at an existing offsite hazardous waste facility? 9 Yes 9 No
If Yes: provide name and location of facility: _______________________________________________________________________
________________________________________________________________________________________________________
If No: describe proposed management of any hazardous wastes which will not be sent to a hazardous waste facility:
________________________________________________________________________________________________________
________________________________________________________________________________________________________
E. Site and Setting of Proposed Action
E.1. Land uses on and surrounding the project site
a. Existing land uses.
i. Check all uses that occur on, adjoining and near the project site.
9 Urban 9 Industrial 9 Commercial 9 Residential (suburban) 9 Rural (non-farm)
9 Forest 9 Agriculture 9 Aquatic 9 Other (specify): ____________________________________
ii. If mix of uses, generally describe:
__________________________________________________________________________________________________________
__________________________________________________________________________________________________________
b. Land uses and covertypes on the project site.
Land use or
Covertype
Current
Acreage
Acreage After
Project Completion
Change
(Acres +/-)
Roads, buildings, and other paved or impervious
surfaces
Forested
Meadows, grasslands or brushlands (non-
agricultural, including abandoned agricultural)
Agricultural
(includes active orchards, field, greenhouse etc.)
Surface water features
(lakes, ponds, streams, rivers, etc.)
Wetlands (freshwater or tidal)
Non-vegetated (bare rock, earth or fill)
Other
Describe: _______________________________
________________________________________
Page 10 of 13
c. Is the project site presently used by members of the community for public recreation? 9 Yes 9 No
i. If Yes: explain: __________________________________________________________________________________________
d. Are there any facilities serving children, the elderly, people with disabilities (e.g., schools, hospitals, licensed 9 Yes 9 No
day care centers, or group homes) within 1500 feet of the project site?
If Yes,
i. Identify Facilities:
________________________________________________________________________________________________________
________________________________________________________________________________________________________
e. Does the project site contain an existing dam? 9 Yes 9 No
If Yes:
i. Dimensions of the dam and impoundment:
Dam height: _________________________________ feet
Dam length: _________________________________ feet
Surface area: _________________________________ acres
Volume impounded: _______________________________ gallons OR acre-feet
ii. Dam=s existing hazard classification: _________________________________________________________________________
iii. Provide date and summarize results of last inspection:
_______________________________________________________________________________________________________
_______________________________________________________________________________________________________
f. Has the project site ever been used as a municipal, commercial or industrial solid waste management facility, 9 Yes 9 No
or does the project site adjoin property which is now, or was at one time, used as a solid waste management facility?
If Yes:
i. Has the facility been formally closed? 9 Yes 9 No
If yes, cite sources/documentation: _______________________________________________________________________
ii. Describe the location of the project site relative to the boundaries of the solid waste management facility:
_______________________________________________________________________________________________________
_______________________________________________________________________________________________________
iii. Describe any development constraints due to the prior solid waste activities: __________________________________________
_______________________________________________________________________________________________________
g. Have hazardous wastes been generated, treated and/or disposed of at the site, or does the project site adjoin 9 Yes 9 No
property which is now or was at one time used to commercially treat, store and/or dispose of hazardous waste?
If Yes:
i. Describe waste(s) handled and waste management activities, including approximate time when activities occurred:
_______________________________________________________________________________________________________
_______________________________________________________________________________________________________
h. Potential contamination history. Has there been a reported spill at the proposed project site, or have any 9 Yes 9 No
remedial actions been conducted at or adjacent to the proposed site?
If Yes:
i. Is any portion of the site listed on the NYSDEC Spills Incidents database or Environmental Site 9 Yes 9 No
Remediation database? Check all that apply:
9 Yes – Spills Incidents database Provide DEC ID number(s): ________________________________
9 Yes – Environmental Site Remediation database Provide DEC ID number(s): ________________________________
9 Neither database
ii. If site has been subject of RCRA corrective activities, describe control measures:_______________________________________
________________________________________________________________________________________________________
_
_______________________________________________________________________________________________________
iii. Is the project within 2000 feet of any site in the NYSDEC Environmental Site Remediation database? 9 Yes 9 No
If yes, provide DEC ID number(s): ______________________________________________________________________________
iv. If yes to (i), (ii) or (iii) above, describe current status of site(s):
_______________________________________________________________________________________________________
_______________________________________________________________________________________________________
Page 11 of 13
v. Is the project site subject to an institutional control limiting property uses? 9 Yes 9 No
If yes, DEC site ID number: ____________________________________________________________________________
Describe the type of institutional control (e.g., deed restriction or easement): ____________________________________
Describe any use limitations: ___________________________________________________________________________
Describe any engineering controls: _______________________________________________________________________
Will the project affect the institutional or engineering controls in place? 9 Yes 9 No
Explain: ____________________________________________________________________________________________
___________________________________________________________________________________________________
___________________________________________________________________________________________________
E.2. Natural Resources On or Near Project Site
a. What is the average depth to bedrock on the project site? ________________ feet
b. Are there bedrock outcroppings on the project site? 9 Yes 9 No
If Yes, what proportion of the site is comprised of bedrock outcroppings? __________________%
c. Predominant soil type(s) present on project site: ___________________________ __________%
___________________________ __________%
____________________________ __________%
d. What is the average depth to the water table on the project site? Average: _________ feet
e. Drainage status of project site soils: 9 Well Drained: _____% of site
9 Moderately Well Drained: _____% of site
9 Poorly Drained
_____%
of site
f. Approximate proportion of proposed action site with slopes: 9 0-10%: _____% of site
9 10-15%: _____% of site
9 15% or greater: _____% of site
g. Are there any unique geologic features on the project site? 9 Yes 9 No
If Yes, describe: _____________________________________________________________________________________________
________________________________________________________________________________________________________
h. Surface water features.
i. Does any portion of the project site contain wetlands or other waterbodies (including streams, rivers, 9 Yes 9 No
ponds or lakes)?
ii. Do any wetlands or other waterbodies adjoin the project site? 9 Yes 9 No
If Yes to either i or ii, continue. If No, skip to E.2.i.
iii. Are any of the wetlands or waterbodies within or adjoining the project site regulated by any federal, 9 Yes 9 No
state or local agency?
iv. For each identified regulated wetland and waterbody on the project site, provide the following information:
Streams: Name ____________________________________________ Classification _______________________
Lakes or Ponds: Name ____________________________________________ Classification _______________________
Wetlands:
Name ____________________________________________ Approximate Size ___________________
Wetland No. (if regulated by DEC) _____________________________
v. Are any of the above water bodies listed in the most recent compilation of NYS water quality-impaired 9 Yes 9 No
waterbodies?
If yes, name of impaired water body/bodies and basis for listing as impaired: _____________________________________________
___________________________________________________________________________________________________________
i. Is the project site in a designated Floo dway?
9 Yes 9 No
j. Is the project site in the 100-year Floodplain?
9 Yes 9 No
k. Is the project site in the 500-year Floodplain?
9 Yes 9 No
l. Is the project site located over, or immediately adjoining, a primary, principal or sole source aquifer? 9 Yes 9 No
If Yes:
i. Name of aquifer: _________________________________________________________________________________________
Page 12 of 13
m. Identify the predominant wildlife species that occupy or use the project site: ______________________________
______________________________ _______________________________ ______________________________
______________________________ ____________________________
___ ______________________________
n. Does the project site contain a designated significant natural community? 9 Yes 9 No
If Yes:
i.
Describe the habitat/community (composition, function, and basis for designation): _____________________________________
________________________________________________________________________________________________________
ii. Source(s) of description or evaluation: ________________________________________________________________________
iii. Ex
tent of community/habitat:
Curren
tly: ______________________ acres
Following completion of project as proposed: _____________________ acres
Gain or loss (indicate + or -): ______________________ acres
o. Does project site contain any species of plant or animal that is listed by the federal government or NYS as 9 Yes 9 No
endangered or threatened, or does it contain any areas identified as habitat for an endangered or threatened species?
p. Does the project site contain any species of plant or animal that is listed by NYS as rare, or as a species of 9 Yes 9 No
special concern?
q. Is the project site or adjoining area currently used for hunting, trapping, fishing or shell fishing? 9 Yes 9 No
If yes, give a brief description of how the proposed action may affect that use: ___________________________________________
________________________________________________________________________________________________________
E.3. Designated Public Resources On or Near Project Site
a. Is the project site, or any portion of it, located in a designated agricultural district certified pursuant to 9 Yes 9 No
Agriculture and Markets Law, Article 25-AA, Section 303 and 304?
If Yes, provide county plus district name/number: _________________________________________________________________
b. Are agricultural lands consisting of highly productive soils present? 9 Yes 9 No
i. If Yes: acreage(s) on project site? ___________________________________________________________________________
ii. Source(s) of soil rating(s): _________________________________________________________________________________
c. Does the project site contain all or part of, or is it substantially contiguous to, a registered National 9 Yes 9 No
Natural Landmark?
If Yes:
i. Nature of the natural landmark: 9 Biological Community 9 Geological Feature
ii. Provide brief description of landmark, including values behind designation and approximate size/extent: ___________________
________________________________________________________________________________________________________
________________________________________________________________________________________________________
d. Is the project site located in or does it adjoin a state listed Critical Environmental Area? 9 Yes 9 No
If Yes:
i. CEA name: _____________________________________________________________________________________________
ii. Basis for designation: _____________________________________________________________________________________
iii. Designating agency and date: ______________________________________________________________________________
If Yes:
i. Species and listing (endangered or threatened):______________________________________________________________________________
_
___________________________________________________________________
____________________________________________________
________________________________________________________________________________________________________________________
If Yes:
i. Species and listing:___________________________________________
_________________________________________________________
_______________________________________________________________________________________________________________________
Page 13 of 13
e. Does the project site contain, or is it substantially contiguous to, a building, archaeological site, or district 9 Yes 9 No
which is listed on the National or State Reg
ister of Historic Places, or that has been determined by the Commissioner of the NYS
Office of Parks, Recreation and Historic Preservation to be eligible for listing on the State Register of Historic Places?
If Yes:
i. Nature of historic/archaeological resource: 9 Archaeological Site 9 Historic Building or District
ii. Name: _________________________________________________________________________________________________
iii. Brief description of attributes on which listing is based:
_______________________________________________________________________________________________________
f. Is the project site, or any portion of it, located in or adjacent to an area designated as sensitive for 9 Yes 9 No
archaeological sites on the NY State Historic Preservation Office (SHPO) archaeological site inventory?
g. Have additional archaeological or historic site(s) or resources been identified on the project site? 9 Yes 9 No
If Yes:
i. Describe possible resource(s): _______________________________________________________________________________
ii. Basis for identification: ___________________________________________________________________________________
h. 9 Yes 9 No
Is the project site within fives miles of any officially designated and publicly accessible federal, state, or local
scenic or aesthetic resource?
If Yes:
i. Identify resource: _________________________________________________________________________________________
ii. Nature of, or basis for, designation (e.g., established highway overlook, state or local park, state historic trail or scenic byway,
etc.): ___________________________________________________________________________________________________
iii. Distance between project and resource: _____________________ miles.
i. Is the project site located within a designated river corridor under the Wild, Scenic and Recreational Rivers 9 Yes 9 No
Program 6 NYCRR 666?
If Yes:
i. Identify the name
of the river and its designation: ________________________________________________________________
ii. Is the activity consistent with development restrictions contained in 6NYCRR Part 666? 9 Yes 9 No
F. Additional Information
Attach any additional information which may be needed to clarify your project.
If you have identified any adverse impacts which could be associated with your proposal, please describe those impacts plus any
measures which you propose to avoid or minimize them.
G. Verification
I certify that the information provided is true to the best of my knowledge.
Applicant/Sponsor Name ___________________________________ Date_______________________________________
Signature________________________________________________ Title_______________________________________
PRINT FORM
Page 1 of 10
Full Environmental Assessment Form
Part 2 - Identification of Potential Project Impacts
Part 2 is to be completed by the lead agency. Part 2 is designed to help the lead agency inventory all potential resources that could
be affected by a proposed project or action. We recognize that the lead agency=s reviewer(s) will not necessarily be environmental
professionals. So, the questions are designed to walk a reviewer through the assessment process by providing a series of questions that
can be answered using the information found in Part 1. To further assist the lead agency in completing Part 2, the form identifies the
most relevant questions in Part 1 that will provide the information needed to answer the Part 2 question. When Part 2 is completed, the
lead agency will have identified the relevant environmental areas that may be impacted by the proposed activity.
If the lead agency is a state agency and the action is in any Coastal Area, complete the Coastal Assessment Form before proceeding
with this assessment.
Tips for completing Part 2:
Review all of the information provided in Part 1.
Review any application, maps, supporting materials and the Full EAF Workbook.
Answer each of the 18 questions in Part 2.
If you answer Yes” to a numbered question, please complete all the questions that follow in that section.
If you answer No” to a numbered question, move on to the next numbered question.
Check appropriate column to indicate the anticipated size of the impact.
Proposed projects that would exceed a numeric threshold contained in a question should result in the reviewing agency
checking the box “Moderate to large impact may occur.”
The reviewer is not expected to be an expert in environmental analysis.
If you are not sure or undecided about the size of an impact, it may help to review the sub-questions for the general
question and consult the workbook.
When answering a question consider all components of the proposed activity, that is, the Awhole action@.
Consider the possibility for long-term and cumulative impacts as well as direct impacts.
Answer the question in a reasonable manner considering the scale and context of the project.
1. Impact on Land
Proposed action may involve construction on, or physical alteration of, NO YES
the land surface of the proposed site. (See Part 1. D.1)
If “Yes”, answer questions a - j. If “No”, move on to Section 2.
Relevant
Part I
Question
(s)
No, or
small
impact
may occur
Moderate
to large
impact may
occur
a. The propose
d action may involve construction on land where depth to water table is
less than 3 feet.
E2d
9
9
b. The prop
osed action may involve construction on slopes of 15% or greater.
E2f
9
9
c. The propose
d action may involve construction on land where bedrock is exposed, or
generally within 5 feet of existing ground surface.
E2a
9
9
d. The prop
osed action may involve the excavation and removal of more than 1,000 tons
of natural material.
D2a
9
9
e. The propose
d action may involve construction that continues for more than one year
or in multiple phases.
D1e
9
9
f. The proposed action ma
y result in increased erosion, whether from physical
disturbance or vegetation removal (including from treatment by herbicides).
D2e, D2q
9
9
g. The proposed
action is, or may be, located within a Coastal Erosion hazard area.
B1i
9
9
h. Other
impacts: _______________________________________________________
___________________________________________________________________
9
9
Agency Use Only [If applicable]
Project :
Date :
Page 2 of 10
2. Impact on Geological Features
The proposed action may result in the modification or destruction of, or inhibit
access to, any unique or unusual land forms on the site (e.g., cliffs, dunes, NO YES
minerals, fossils, caves). (See Part 1. E.2.g)
If “Yes”, answer questions a - c. If “No”, move on to Section 3.
Relevant
Part I
Question(s)
No, or
small
impact
may occur
Moderate
to large
impact may
occur
a. Id
entify the specific land form(s) attached: _____________________________
___
___________________________________________________________________
E2g
9 9
b.
The proposed action may affect or is adjacent to a geological feature listed as a
registered National Natural Landmark.
Specific feature: _____________________________________________________
E3c
9
9
c.
Other impacts: ____________________________________________________
__
___________________________________________________________________
9
9
3. Impacts on Surface Water
The proposed action may affect one or more wetlands or other surface water NO YES
bodies (e.g., streams, rivers, ponds or lakes). (See Part 1. D.2, E.2.h)
If “Yes”, answer questions a - l. If “No”, move on to Section 4.
Relevant
Part I
Question(s)
No, or
small
impact
may occur
Moderate
to large
impact may
occur
a. The proposed action may create a new water body.
D2b, D1h
9
9
b
. The proposed action may result in an increase or decrease of over 10% or mo
re than a
10 acre increase or decrease in the surface area of any body of water.
D2b
9
9
c. Th
e proposed action may involve dredging more than 100 cubic yards of mater
ial
from a wetland or water body.
D2a
9
9
d
. The proposed action may involve construction within or adjoining a freshwater or
tidal wetland, or in the bed or banks of any other water body.
E2h
9
9
e. T
he proposed action may create turbidity in a waterbody, either from upland erosio
n,
runoff or by disturbing bottom sediments.
D2a, D2h
9
9
f
.
Th
e proposed action may include construction of one or more intake(s) for withdraw
al
of water from surface water.
D2c
9
9
g.
The proposed action may include construction of one or more outfall(s) for discharg
e
of wastewater to surface water(s).
D2d
9
9
h.
The proposed action may cause soil erosion, or otherwise create a
source of
stormwater discharge that may lead to siltation or other degradation of receiving
water bodies.
D2e
9
9
i. Th
e proposed action may affect the water quality of any water bodies within
or
downstream of the site of the proposed action.
E2h
9
9
j
. The proposed action may involve the application of pesticides or herbicid
es in or
around any water body.
D2q, E2h
9
9
k. The proposed action may require the construction of new, or expansion of existing,
wastewater treatment facilities.
D1a, D2d
9
9
Page 3 of 10
l. Other
impacts: _______________________________________________________
___________________________________________________________________
9
9
4. Impact on groundwater
The proposed action may result in new or additional use of ground water, or NO YES
may have the potential to introduce contaminants to ground water or an aquifer.
(See Part 1. D.2.a, D.2.c, D.2.d, D.2.p, D.2.q, D.2.t)
If “Yes”, answer questions a - h. If “No”, move on to Section 5.
Relevant
Part I
Question(s)
No, or
small
impact
may occur
Moderate
to large
impact may
occur
a. The pr
oposed action may require new water supply wells, or create additional demand
on supplies from existing water supply wells.
D2c
9
9
b. Water supply demand from
the proposed action may exceed safe and sustainable
withdrawal capacity rate of the local supply or aquifer.
Cite Source: ________________________________________________________
D2c
9
9
c. The proposed action may allow or result in residential uses in areas without water and
sewer services.
D1a, D2c
9
9
d. The pr
oposed action may include or require wastewater discharged to groundwater.
D2d, E2l
9 9
e. The pr
oposed action may result in the construction of water supply wells in locations
where groundwater is, or is suspected to be, contaminated.
D2c, E1f,
E1g, E1h
9
9
f. The p
roposed action may require the bulk storage of petroleum or chemical products
over ground water or an aquifer.
D2p, E2l
9
9
g. The pr
oposed action may involve the commercial application of pesticides within 100
feet of potable drinking water or irrigation sources.
E2h, D2q,
E2l, D2c
9
9
h. Othe
r impacts: ______________________________________________________
__________________________________________________________________
9
9
5. Impact on Flooding
The proposed action may result in development on lands subject to flooding. NO YES
(See Part 1. E.2)
If “Yes”, answer questions a - g. If “No”, move on to Section 6.
Relevant
Part I
Question(s)
No, or
small
impact
may occur
Moderate
to large
impact may
occur
a. The pr
oposed action may result in development in a designated floodway.
E2i
9
9
b. The propo
sed action may result in development within a 100 year floodplain.
E2j
9
9
c. The pr
oposed action may result in development within a 500 year floodplain.
E2k
9
9
d. The pr
oposed action may result in, or require, modification of existing drainage
patterns.
D2b, D2e
9
9
e. The pr
oposed action may change flood water flows that contribute to flooding.
D2b, E2i,
E2j, E2k
9
9
f.
If there is a dam located on the site of the proposed action, is the dam in need of repair,
or upgrade?
E1e
9
9
Page 4 of 10
g. Other impacts: ______________________________________________________
___________________________________________________________________
9
9
6. Impacts on Air
NO YES The proposed action may include a state regulated air emission source.
(See Part 1. D.2.f., D.2.h, D.2.g)
If “Yes”, answer questions a - f. If “No”, move on to Section 7.
Relevant
Part I
Question(s)
No, or
small
impact
may occur
Moderate
to large
impact may
occur
a. If the proposed action requires federal or state air em
ission permits, the action may
also emit one or more greenhouse gases at or above the following levels:
i. More than 1000 tons/year of carbon dioxide (CO
2
)
ii. More than 3.5 tons/year of nitrous oxide (N
2
O)
iii. More than 1000 tons/year of carbon equivalent of perfluorocarbons (PFCs)
iv. More than .045 tons/year of sulfur hexafluoride (SF
6
)
v. More than 1000 tons/year of carbon dioxide equivalent of
hydrochloroflourocarbons (HFCs) emissions
vi. 43 tons/year or more of methane
D2g
D2g
D2g
D2g
D2g
D2h
9
9
9
9
9
9
9
9
9
9
9
9
b. The proposed action
may generate 10 tons/year or more of any one designated
hazardous air pollutant, or 25 tons/year or more of any combination of such hazardous
air pollutants.
D2g
9
9
c. The proposed action may require a state air registration, or may produce an emissions
rate of total contaminants that may exceed 5 lbs. per hour, or may include a heat
source capable of producing more than 10 million BTU=s per hour.
D2f, D2g
9
9
d.
The proposed action may reach 50% of any of the thresholds in “a” through “c”,
above.
D2g
9
9
e. The proposed
action may result in the combustion or thermal treatment of more than 1
ton of refuse per hour.
D2s
9
9
f. Other im
pacts: ______________________________________________________
__________________________________________________________________
9
9
7. Impact on Plants and Animals
The proposed action may result in a loss of flora or fauna. (See Part 1. E.2. m.-q.) NO YES
If “Yes”, answer questions a - j. If “No”, move on to Section 8.
Relevant
Part I
Question(s)
No, or
small
impact
may occur
Moderate
to large
impact may
occur
a. The propose
d action may cause reduction in population or loss of individuals of any
threatened or endangered species, as listed by New York State or the Federal
government, that use the site, or are found on, over, or near the site.
E2o
9
9
b. The propose
d action may result in a reduction or degradation of any habitat used by
any rare, threatened or endangered species, as listed by New York State or the federal
government.
E2o
9
9
c. The proposed
action may cause reduction in population, or loss of individuals, of any
species of special concern or conservation need, as listed by New York State or the
Federal government, that use the site, or are found on, over, or near the site.
E2p
9
9
d. The propose
d action may result in a reduction or degradation of any habitat used by
any species of special concern and conservation need, as listed by New York State or
the Federal government.
E2p
9
9
Page 5 of 10
e. T
he proposed action may diminish the capacity of a registered Nation
al Natural
Landmark to support the biological community it was established to protect.
E3c
9
9
f. T
he proposed action may result in the removal of, or ground disturbance in, any
portion of a designated significant natural community.
Source: ____________________________________________________________
E2n
9
9
g. The proposed action may substantially interfere with nesting/breeding, foraging, or
over-wintering habitat for the predominant species that occupy or use the project site.
E2m
9
9
h
. The proposed action requires the conversion of more than 10 acres of fore
st,
grassland or any other regionally or locally important habitat.
Habitat type & information source: ______________________________________
__________________________________________________________________
E1b
9
9
i.
Proposed action (commercial, industrial or recreational projects, only) involves use of
herbicides or pesticides.
D2q
9
9
j
. Other impacts: _____________________________________________________
_
__________________________________________________________________
9
9
8. Impact on Agricultural Resources
The proposed action may impact agricultural resources. (See Part 1. E.3.a. and b.) NO YES
If “Yes”, answer questions a - h. If “No”, move on to Section 9.
Relev
ant
Part I
Question(s)
No, or
small
impact
may occur
Moderate
to large
impact may
occur
a. The proposed action may impact soil classified within soil group 1 through 4 of the
NYS Land Classification System.
E2c, E3b
9 9
b.
The proposed action may sever, cross or otherwise limit access to agricultural la
nd
(includes cropland, hayfields, pasture, vineyard, orchard, etc).
E1a, Elb
9
9
c. T
he proposed action may result in the excavation or compaction of the soil profile of
active agricultural land.
E3b
9
9
d.
The proposed action may irreversibly convert agricultural land to non-agricultu
ral
uses, either more than 2.5 acres if located in an Agricultural District, or more than 10
acres if not within an Agricultural District.
E1b, E3a
9
9
e. Th
e proposed action may disrupt or prevent installation of an agricultural land
management system.
El a, E1b
9
9
f. Th
e proposed action may result, directly or indirectly, in increased developmen
t
potential or pressure on farmland.
C2c, C3,
D2c, D2d
9
9
g.
The proposed project is not consistent with the adopted municipal Farmla
nd
Protection Plan.
C2c
9
9
h
. Other impacts: _______________________________________________________
_
9
9
Page 6 of 10
9. Impact on Aesthetic Resources
The land use of the proposed action are obviously different from, or are in NO YES
sharp contrast to, current land use patterns between the proposed project and
a scenic or aesthetic resource. (Part 1. E.1.a, E.1.b, E.3.h.)
If “Yes”, answer questions a - g. If “No”, go to Section 10.
Relevant
Part I
Question(s)
No, or
small
impact
may occur
Moderate
to large
impact may
occur
a. Pr
oposed action may be visible from any officially designated federal, state, or local
scenic or aesthetic resource.
E3h
9
9
b.
The proposed action may result in the obstruction, elimination or significant
screening of one or more officially designated scenic views.
E3h, C2b
9
9
c. Th
e proposed action may be visible from publicly accessible vantage points:
i. Seasonally (e.g., screened by summer foliage, but visible during other seasons)
ii. Year round
E3h
9
9
9
9
d. The
situation or activity in which viewers are engaged while viewing the proposed
action is:
i. Routine travel by residents, including travel to and from work
ii. Recreational or tourism based activities
E3h
E2q,
E1c
9
9
9
9
e. Th
e proposed action may cause a diminishment of the public enjoyment and
appreciation of the designated aesthetic resource.
E3h
9
9
f. Ther
e are similar projects visible within the following distance of the proposed
project:
0-1/2 mile
½ -3 mile
3-5 mile
5+ mile
D1a, E1a,
D1f, D1g
9
9
g.
Other impacts: ______________________________________________________
__________________________________________________________________
9
9
10. Impact on Historic and Archeological Resources
The proposed action may occur in or adjacent to a historic or archaeological NO YES
resource. (Part 1. E.3.e, f. and g.)
If “Yes”, answer questions a - e. If “No”, go to Section 11.
Relevant
Part I
Question(s)
No, or
small
impact
may occur
Moderate
to large
impact may
occur
E3e
9
9
b. The
proposed action may occur wholly or partially within, or substantially contiguous
to, an area designated as sensitive for archaeological sites on the NY State Historic
Preservation Office (SHPO) archaeological site inventory.
E3f
9
9
c. Th
e proposed action may occur wholly or partially within, or substantially contiguous
to, an archaeological site not included on the NY SHPO inventory.
Source: ____________________________________________________________
E3g
9
9
a. The proposed actio
n may occur wholly or partially within, or substantially contiguous
to, any buildings, archaeological site or district which is listed on the National or
State Register of Historical Places, or that has been determined by the Commissioner
of the NYS Office of Parks, Recreation and Historic Preservation to be eligible for
listing on the State Register of Historic Places.
Page 7 of 10
d. Othe
r impacts: ______________________________________________________
__________________________________________________________________
9
9
e.
If any of the above (a-d) are answeredModerate to large impact may
occur”, continue with
the following questions to help support conclusions in Part 3:
i. The proposed action may result in the destruction or alteration of all or part
of the site or property.
ii. The proposed action may result in the alteration of the property’s setting or
integrity.
iii. The proposed action may result in the introduction of visual elements which
are out of character with the site or property, or may alter its setting.
E3e, E3g,
E3f
E3e, E3f,
E3g, E1a,
E1b
E3e, E3f,
E3g, E3
h,
C2, C3
9
9
9
9
9
9
11. Impact on Open Space and Recreation
The proposed action may result in a loss of recreational opportunities or a NO YES
reduction of an open space resource as designated in any adopted
municipal open space plan.
(See Part 1. C.2.c, E.1.c., E.2.q.)
If “Yes”, answer questions a - e. If “No”, go to Section 12.
Relevant
Part I
Question(s)
No, or
small
impact
may occur
Moderate
to large
impact may
occur
a. The prop
osed action may result in an impairment of natural functions, or “ecosystem
services”, provided by an undeveloped area, including but not limited to stormwater
storage, nutrient cycling, wildlife habitat.
D2e, E1b
E2h,
E2m, E2o,
E2n, E2p
9
9
b. The proposed
action may result in the loss of a current or future recreational resource.
C2a, E1c,
C2c, E2q
9
9
c. The proposed
action may eliminate open space or recreational resource in an area
with few such resources.
C2a, C2c
E1c, E2q
9
9
d. The proposed
action may result in loss of an area now used informally by the
community as an open space resource.
C2c, E1c
9
9
e. Other
impacts: _____________________________________________________
_________________________________________________________________
9
9
12. Impact on Critical Environmental Areas
The proposed action may be located within or adjacent to a critical NO YES
environmental area (CEA). (See Part 1. E.3.d)
If “Yes”, answer questions a - c. If “No”, go to Section 13.
Relevant
Part I
Question(s)
No, or
small
impact
may occur
Moderate
to large
impact may
occur
a. The pro
posed action may result in a reduction in the quantity of the resource or
characteristic which was the basis for designation of the CEA.
E3d
9
9
b. The proposed
action may result in a reduction in the quality of the resource or
characteristic which was the basis for designation of the CEA.
E3d
9
9
c. Other im
pacts: ______________________________________________________
__________________________________________________________________
9
9
Page 8 of 10
13. Impact on Transportation
The proposed action may result in a change to existing transportation systems. NO YES
(See Part 1. D.2.j)
If “Yes”, answer questions a - f. If “No”, go to Section 14.
Relevant
Part I
Question(s)
No, or
small
impact
may occur
Moderate
to large
impact may
occur
a. Projected traffic increase may exceed capacity of existing road network.
D2j
9
9
b. The pr
oposed action may result in the construction of paved parking area for 500 or
more vehicles.
D2j
9
9
c. The proposed action
will degrade existing transit access.
D2j
9
9
d. The proposed action
will degrade existing pedestrian or bicycle accommodations.
D2j
9
9
e.
The proposed action may alter the present pattern of movement of people or goods.
D2j
9
9
f. Other impacts: ______________________________________________________
__________________________________________________________________
9
9
14. Impact on Energy
The proposed action may cause an increase in the use of any form of energy. NO YES
(See Part 1. D.2.k)
If “Yes”, answer questions a - e. If “No”, go to Section 15.
Relevant
Part I
Question(s)
No, or
small
impact
may occur
Moderate
to large
impact may
occur
a. The proposed action will require a new, or an upgrade to an existing, substation. D2k
9 9
b. The 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
commercial or industrial use.
D1f,
D1q, D2k
9 9
c. The pr
oposed action may utilize more than 2,500 MWhrs per year of electricity.
D2k
9
9
d. The pr
oposed action may involve heating and/or cooling of more than 100,000 square
feet of building area when completed.
D1g
9
9
e. Other Impacts: ________________________________________________________
____________________________________________________________________
15. Impact on Noise, Odor, and Light
The proposed action may result in an increase in noise, odors, or outdoor lighting. NO YES
(See Part 1. D.2.m., n., and o.)
If “Yes”, answer questions a - f. If “No”, go to Section 16.
Relevant
Part I
Question(s)
No, or
small
impact
may occur
Moderate
to large
impact may
occur
a. The proposed action may produce sound above noise levels established by local
regulation.
D2m
9
9
b. The propo
sed action may result in blasting within 1,500 feet of any residence,
hospital, school, licensed day care center, or nursing home.
D2m, E1d
9
9
c. The proposed action may result in routine odors for more than one hour per day. D2o
9
9
Page 9 of 10
d. Th
e proposed action may result in light shining onto adjoining properties.
D2n
9
9
e. The p
roposed action may result in lighting creating sky-glow brighter than existing
area conditions.
D2n, E1a
9
9
f. O
ther impacts: ______________________________________________________
__________________________________________________________________
9
9
16. Impact on Human Health
The proposed action may have an impact on human health from exposure NO YES
to new or existing sources of contaminants. (See Part 1.D.2.q., E.1. d. f. g. and h.)
If “Yes”, answer questions a - m. If “No”, go to Section 17.
Relevant
Part I
Question(s)
No,or
small
impact
may cccur
Moderate
to large
impact may
occur
a. The proposed action is located within 1500 feet of a school, hospital, licensed day
care center, group home, nursing home or retirement community.
E1d
9 9
b. The si
te of the proposed action is currently undergoing remediation.
E1g, E1h
9
9
c. There is a comp
leted emergency spill remediation, or a completed environmental site
remediation on, or adjacent to, the site of the proposed action.
E1g, E1h
9
9
d.
The site of the action is subject to an institutional control limiting the use of the
property (e.g., easement
or deed restriction).
E1g, E1h
9
9
e. The proposed
action may affect institutional control measures that were put in place
to ensure that the site remains protective of the environment and human health.
E1g, E1h
9
9
f. The
proposed action has adequate control measures in place to ensure that future
generation, treatment and/or disposal of hazardous wastes will be protective of the
environment and human health.
D2t
9
9
g. The p
roposed action involves construction or modification of a solid waste
management facility.
D2q, E1f
9
9
h. The propose
d action may result in the unearthing of solid or hazardous waste.
D2q, E1f
9
9
i. The proposed
action may result in an increase in the rate of disposal, or processing, of
solid waste.
D2r, D2s
9
9
j. The p
roposed action may result in excavation or other disturbance within 2000 feet of
a site used for the disposal of solid or hazardous waste.
E1f, E1g
E1h
9
9
k. Th
e proposed action may result in the migration of explosive gases from a landfill
site to adjacent off site structures.
E1f, E1g
9
9
l. The proposed
action may result in the release of contaminated leachate from the
project site.
D2s, E1f,
D2r
9
9
m. Othe
r impacts: ______________________________________________________
__________________________________________________________________
Page 10 of 10
17. Consistency with Community Plans
The proposed action is not consistent with adopted land use plans. NO YES
(See Part 1. C.1, C.2. and C.3.)
If “Yes”, answer questions a - h. If “No”, go to Section 18.
Relevant
Part I
Question(s)
No, or
small
impact
may occur
Moderate
to large
impact may
occur
a. The proposed action’s land use components may be different from, or in sharp
contrast to, current surrounding land use pattern(s).
C2, C3, D1a
E1a, E1b
9
9
b. The proposed action will cause the permanent population of the city, town or village
in which the project is located to grow by more than 5%.
C2
9
9
c. The proposed action is inconsistent with local land use plans or zoning regulations.
C2, C2, C3
9
9
d. The proposed action is inconsistent with any County plans, or other regional land use
plans.
C2, C2
9
9
e. The proposed action may cause a change in the density of development that is not
supported by existing infrastructure or is distant from existing infrastructure.
C3, D1c,
D1d, D1f,
D1d, Elb
9
9
f. The proposed action is located in an area characterized by low density development
that will require new or expanded public infrastructure.
C4, D2c, D2d
D2j
9
9
g. The proposed action may induce secondary development impacts (e.g., residential or
commercial development not included in the proposed action)
C2a
9 9
h. Other: _____________________________________________________________
__________________________________________________________________
9
9
18. Consistency with Community Character
The proposed project is inconsistent with the existing community character. NO YES
(See Part 1. C.2, C.3, D.2, E.3)
If “Yes”, answer questions a - g. If “No”, proceed to Part 3.
Relevant
Part I
Question(s)
No, or
small
impact
may occur
Moderate
to large
impact may
occur
a. The proposed action may replace or eliminate existing facilities, structures, or areas
of historic importance to the community.
E3e, E3f, E3g
9
9
b. The proposed action may create a demand for additional community services (e.g.
schools, police and fire)
C4
9
9
c. The proposed action may displace affordable or low-income housing in an area where
there is a shortage of such housing.
C2, C3, D1f
D1g, E1a
9
9
d. The proposed action may interfere with the use or enjoyment of officially recognized
or designated public resources.
C2, E3
9
9
e. The proposed action is inconsistent with the predominant architectural scale and
character.
C2, C3
9
9
f. Proposed action is inconsistent with the character of the existing natural landscape.
C2, C3
E1a, E1b
E2g, E2h
9
9
g. Other impacts: ______________________________________________________
__________________________________________________________________
9
9
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Full Environmental Assessment Form
Part 3 - Evaluation of the Magnitude and Importance of Project Impacts
and
Determination of Significance
Part 3 provides the reasons in support of the determination of significance. The lead agency must complete Part 3 for every question
in Part 2 where the impact has been identified as potentially moderate to large or where there is a need to explain why a particular
element of the proposed action will not, or may, result in a significant adverse environmental impact.
Based on the analysis in Part
3, the lead agency must decide whether to require an environmental impact statement to further assess
the proposed action or whether available information is sufficient for the lead agency to conclude that the proposed action will not
have a significant adverse environmental impact. By completing the certification on the next page, the lead agency can complete its
determination of significance.
Reasons Supporting This Determination:
To com
plete this section:
Identify the impact based on the Part 2 responses and describe its magnitude. Magnitude considers factors such as severity,
size or extent of an im
pact.
Assess th
e importance of the impact. Importance relates to the geographic scope, duration, probability of the impact
occurring, number of people affected by the impact and any additional environmental consequences if the impact were to
occur.
The assessment should take into consideration any design element or project changes.
Repeat this process for each Part 2 question where the impact has been identified as potentially moderate to large or where
there is a need to explain why a particular element of the proposed action will not, or may, result in a significant adverse
environmental impact.
Provide the reason(s) why the impact may, or will not, result in a significant adverse environmental impact
For Conditional Negative Declarations identify the specific condition(s) imposed that will modify the proposed action so that
no significant adverse environmental impacts will result.
Attach additional sheets, as needed.
Determination of Significance - Type 1 and Unlisted Actions
SEQR Status: Type 1 Unlisted
Identify portions
of EAF completed for this Project: Part 1 Part 2 Part 3
Agency Use Only [IfApplicable]
Project :
Date :
FEAF 2019
Upon review of the information recorded on this EAF, as noted, plus this additional support information
and consi
dering both the magnitude and importance of each identified potential impact, it is the conclusion of the
as lead agency that:
A.
This project will result in no significant adverse impacts on the environment, and, therefore, an environmental impact
statement need not be prepared. Accordingly, this negative declaration is issued.
B. Alth
ough this project could have a significant adverse impact on the environment, that impact will be avoided or
substantially mitigated because of the following conditions which will be required by the lead agency:
There will, therefo
re, be no significant adverse impacts from the project as conditioned, and, therefore, this conditioned negative
declaration is issued. A conditioned negative declaration may be used only for UNLISTED actions (see 6 NYCRR 617.7(d)).
C. This Project may result in one or more significant adverse impacts on the environment, and an environmental impact
statement must be prepared to further assess the impact(s) and possible mitigation and to explore alternatives to avoid or reduce those
impacts. Accordingly, this positive declaration is issued.
Name of Action:
Name of Lead Agency:
Name of Responsible Officer in Lead Agency:
Title of Responsible Officer:
Signature of Responsible Officer in Lead Agency: Date:
Signature of Preparer (if different from Responsible Officer) Date:
For Further Information:
Contact Person:
Address:
Telephone Number:
E-mail
:
For Type 1 Actions and Conditioned Negative Declarations, a copy of this Notice is sent to:
Chief Execu
tive Officer of the political subdivision in which the action will be principally located (e.g., Town / City / Village of)
Other involved agencies (if any)
Applicant (if any)
Environmental Notice Bulletin: http://www.dec.ny.gov/enb/enb.html
Page 2 of 2
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