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Page 1 of 13

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

Page 2 of 13

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

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):

________________________________________________________________________________________________________

Page 3 of 13

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: _______________________________________________________________

____________________________________________________________________________________________________

Page 4 of 13

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): ______________________________________________________________________________________________

_________________________________________________________________________________________________________

Page 5 of 13

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:

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

Page 6 of 13

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:

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

)

•

___________Tons/year (short tons) of Nitrous Oxide (N

•

___________Tons/year (short tons) of Perfluorocarbons (PFCs)

•

___________Tons/year (short tons) of Sulfur Hexafluoride (SF

)

•

___________Tons/year (short tons) of Carbon Dioxide equivalent of Hydroflourocarbons (HFCs)

•

_________

__Tons/year (short tons) of Hazardous Air Pollutants (HAPs)

Page 7 of 13

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:

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.

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:

______________________________________________________________________________________________________

____________

____________________________________________________________________________________________

Page 8 of 13

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:

Describe source(s), location(s), height of fixture(s), direction/aim, and proximity to nearest occupied structures:

_________________________________________________________________________________________________________

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:

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: __________________________________________________________________________________________

____________________________________________________________________________________________________

Page 9 of 13

s. Does the proposed action include construction or modification of a solid waste management facility? 9 Yes 9 No

If Yes:

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:

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:

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

b. The prop

osed action may involve construction on slopes of 15% or greater.

E2f

c. The propose

d action may involve construction on land where bedrock is exposed, or

generally within 5 feet of existing ground surface.

E2a

d. The prop

osed action may involve the excavation and removal of more than 1,000 tons

of natural material.

D2a

e. The propose

d action may involve construction that continues for more than one year

or in multiple phases.

D1e

f. The proposed action ma

y result in increased erosion, whether from physical

disturbance or vegetation removal (including from treatment by herbicides).

D2e, D2q

g. The proposed

action is, or may be, located within a Coastal Erosion hazard area.

B1i

h. Other

impacts: _______________________________________________________

___________________________________________________________________

Agency Use Only [If applicable]

Project :

Date :

FEAF 2019

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

The proposed action may affect or is adjacent to a geological feature listed as a

registered National Natural Landmark.

Specific feature: _____________________________________________________

E3c

Other impacts: ____________________________________________________

___________________________________________________________________

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

. 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

c. Th

e proposed action may involve dredging more than 100 cubic yards of mater

ial

from a wetland or water body.

D2a

. 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

e. T

he proposed action may create turbidity in a waterbody, either from upland erosio

runoff or by disturbing bottom sediments.

D2a, D2h

e proposed action may include construction of one or more intake(s) for withdraw

of water from surface water.

D2c

The proposed action may include construction of one or more outfall(s) for discharg

of wastewater to surface water(s).

D2d

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

i. Th

e proposed action may affect the water quality of any water bodies within

downstream of the site of the proposed action.

E2h

. The proposed action may involve the application of pesticides or herbicid

es in or

around any water body.

D2q, E2h

k. The proposed action may require the construction of new, or expansion of existing,

wastewater treatment facilities.

D1a, D2d

Page 3 of 10

l. Other

impacts: _______________________________________________________

___________________________________________________________________

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

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

c. The proposed action may allow or result in residential uses in areas without water and

sewer services.

D1a, D2c

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

f. The p

roposed action may require the bulk storage of petroleum or chemical products

over ground water or an aquifer.

D2p, E2l

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

h. Othe

r impacts: ______________________________________________________

__________________________________________________________________

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

b. The propo

sed action may result in development within a 100 year floodplain.

E2j

c. The pr

oposed action may result in development within a 500 year floodplain.

E2k

d. The pr

oposed action may result in, or require, modification of existing drainage

patterns.

D2b, D2e

e. The pr

oposed action may change flood water flows that contribute to flooding.

D2b, E2i,

E2j, E2k

If there is a dam located on the site of the proposed action, is the dam in need of repair,

or upgrade?

E1e

Page 4 of 10

g. Other impacts: ______________________________________________________

___________________________________________________________________

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

)

ii. More than 3.5 tons/year of nitrous oxide (N

iii. More than 1000 tons/year of carbon equivalent of perfluorocarbons (PFCs)

iv. More than .045 tons/year of sulfur hexafluoride (SF

)

v. More than 1000 tons/year of carbon dioxide equivalent of

hydrochloroflourocarbons (HFCs) emissions

vi. 43 tons/year or more of methane

D2g

D2h

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

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

The proposed action may reach 50% of any of the thresholds in “a” through “c”,

above.

D2g

e. The proposed

action may result in the combustion or thermal treatment of more than 1

ton of refuse per hour.

D2s

f. Other im

pacts: ______________________________________________________

__________________________________________________________________

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

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

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

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

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

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

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

. 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

Proposed action (commercial, industrial or recreational projects, only) involves use of

herbicides or pesticides.

D2q

. Other impacts: _____________________________________________________

__________________________________________________________________

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

The proposed action may sever, cross or otherwise limit access to agricultural la

(includes cropland, hayfields, pasture, vineyard, orchard, etc).

E1a, Elb

c. T

he proposed action may result in the excavation or compaction of the soil profile of

active agricultural land.

E3b

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

e. Th

e proposed action may disrupt or prevent installation of an agricultural land

management system.

El a, E1b

f. Th

e proposed action may result, directly or indirectly, in increased developmen

potential or pressure on farmland.

C2c, C3,

D2c, D2d

The proposed project is not consistent with the adopted municipal Farmla

Protection Plan.

C2c

. Other impacts: _______________________________________________________

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

The proposed action may result in the obstruction, elimination or significant

screening of one or more officially designated scenic views.

E3h, C2b

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

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

e. Th

e proposed action may cause a diminishment of the public enjoyment and

appreciation of the designated aesthetic resource.

E3h

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

Other impacts: ______________________________________________________

__________________________________________________________________

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

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

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

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: ______________________________________________________

__________________________________________________________________

If any of the above (a-d) are answered “Moderate 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

C2, C3

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

b. The proposed

action may result in the loss of a current or future recreational resource.

C2a, E1c,

C2c, E2q

c. The proposed

action may eliminate open space or recreational resource in an area

with few such resources.

C2a, C2c

E1c, E2q

d. The proposed

action may result in loss of an area now used informally by the

community as an open space resource.

C2c, E1c

e. Other

impacts: _____________________________________________________

_________________________________________________________________

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

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

c. Other im

pacts: ______________________________________________________

__________________________________________________________________

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

b. The pr

oposed action may result in the construction of paved parking area for 500 or

more vehicles.

D2j

c. The proposed action

will degrade existing transit access.

D2j

d. The proposed action

will degrade existing pedestrian or bicycle accommodations.

D2j

The proposed action may alter the present pattern of movement of people or goods.

D2j

f. Other impacts: ______________________________________________________

__________________________________________________________________

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

d. The pr

oposed action may involve heating and/or cooling of more than 100,000 square

feet of building area when completed.

D1g

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

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

c. The proposed action may result in routine odors for more than one hour per day. D2o

Page 9 of 10

d. Th

e proposed action may result in light shining onto adjoining properties.

D2n

e. The p

roposed action may result in lighting creating sky-glow brighter than existing

area conditions.

D2n, E1a

f. O

ther impacts: ______________________________________________________

__________________________________________________________________

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

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

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

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

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

g. The p

roposed action involves construction or modification of a solid waste

management facility.

D2q, E1f

h. The propose

d action may result in the unearthing of solid or hazardous waste.

D2q, E1f

i. The proposed

action may result in an increase in the rate of disposal, or processing, of

solid waste.

D2r, D2s

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

k. Th

e proposed action may result in the migration of explosive gases from a landfill

site to adjacent off site structures.

E1f, E1g

l. The proposed

action may result in the release of contaminated leachate from the

project site.

D2s, E1f,

D2r

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

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%.

c. The proposed action is inconsistent with local land use plans or zoning regulations.

C2, C2, C3

d. The proposed action is inconsistent with any County plans, or other regional land use

plans.

C2, C2

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

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

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: _____________________________________________________________

__________________________________________________________________

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

b. The proposed action may create a demand for additional community services (e.g.

schools, police and fire)

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

d. The proposed action may interfere with the use or enjoyment of officially recognized

or designated public resources.

C2, E3

e. The proposed action is inconsistent with the predominant architectural scale and

character.

C2, C3

f. Proposed action is inconsistent with the character of the existing natural landscape.

C2, C3

E1a, E1b

E2g, E2h

g. Other impacts: ______________________________________________________

__________________________________________________________________

PRINT FULL FORM

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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