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HomeMy WebLinkAbout2019 FEAF Part 1Page 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 No 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 or 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 pumping 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: 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 (CO2) •___________Tons/year (short tons) of Nitrous Oxide (N2O) •___________Tons/year (short tons) of Perfluorocarbons (PFCs) •___________Tons/year (short tons) of Sulfur Hexafluoride (SF6) •___________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: 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 electricity, 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): † Morning † 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 within 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. Will the proposed action include plans for pedestrian or bicycle accommodations for connections to existing 9 Yes 9 No pedestrian 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.Anticipated 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 th ill prop e os actio ed hav n e outd ligh oor 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: __________________________________________________________________________________________ ____________________________________________________________________________________________________ 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: 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.Extent of community/habitat: •Currently: ______________________ 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 Register 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_______________________________________