EAF PrelimDft-Label 15sep08 (2)

8/14/2019 EAF PrelimDft-Label 15sep08 (2)

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15Sep08 FULL EAF - - PRELIMINARY REVIEW DRAFT Page 1 of 36

617.20

Appendix A

State Environmental Quality Review

Full Environmental Assessment Form

Introduction: The Full Environmental Assessment Form (EAF) provides an orderly and documented

framework to assist the lead agency in identifying potential environmental impacts of a proposed action

and evaluating those potential impacts to determine the environmental significance of the proposedaction. The determination of significance is the lead agencys conclusion either that a project may have

significant adverse environmental impacts so environmental review must continue with an environmental

impact statement, or that an action will have no significant adverse environmental impacts and the

environmental review will conclude. The formal statement that potentially significant adverse

environmental impacts have been identified, and which leads to the more in-depth environmental review

of an environmental impact statement ie called a positive declaration; a negative declaration, in contrast,

is an affirmation that the action will not have a significant adverse impact on the environment and so will

require no further environmental review.

The Full EAF is structured in three parts, which when completed will support the determination of

significance by the lead agency.

Part 1 of the Full EAF must be completed by the sponsor of, or applicant for, the project or action. Part 1

is a series of questions that asks the sponsor to describe the proposed project plus its specific setting,

broader surroundings, and regulatory context. Questions in the first section ask about operational needs

and characteristics as well as physical specifications. The information provided in Part 1 will be used by

reviewing agencies to help identify potential impacts of the proposed action and, together with any

available application materials or plans, will be the primary basis for the lead agencys determination of

significance.

Part 2 of the Full EAF must be completed by the lead agency. In Part 2, the lead agency should compare

information provided by the sponsor in Part 1 to a standardized set of indicators that will help the lead

agency identify potential environmental impacts. Part 2 is intended to help the lead agency systematically

discern the full range of possible impacts that may occur from a project or action. The questions are

designed to help a reviewer determine whether any element of a proposed project may impact one or more

factors of the environment.

Part 3 of the Full EAF must also be completed by the lead agency. For each potential impact identified

in Part 2 by a yes response to a screening question, the lead agency should narratively explain the

potential impact, and then evaluate that impacts significance, including consideration of magnitude,

importance, and inclusion of or potential for mitigation. Each impact discussion should contain a brief,

well-reasoned elaboration supporting the lead agencys decision as to whether that impact is potentially

significant, or non-significant. The combined discussion of all potential impacts in Part 3 is intended to

provide the supporting documentation for the lead agencys determination of significance. Based on the

descriptions, discussions and conclusions articulated in Part 3, the lead agency may then complete the

certification at the end of Part 3 to finalize its negative or positive declaration, without needing to prepare

a separate negative or positive declaration.


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Part 1 - - Project and Setting

Instructions for Completing Part 1:

Part 1 is to be completed by the project sponsor or applicant.

Complete the entire form, Parts A through K. Responses to these questions will be considered as part of

the application for approval or funding, or of an agencys proposed direct action, and may be subject to

further verification and public review. Note that after Question A, the basic identification of the project

and sponsor, Part 1 is structured so that you may skip questions when sections are not relevant to the

specific proposal. Before skipping any section, however, please be certain that no elements of the topic

pertain to your project or action. The lead agency may request that you supplement or complete omitted

sections before proceeding with its analysis and determination of significance, if it believes that you have

omitted relevant sections. You may also provide any additional information which you believe will be

needed by the lead agency to complete Parts 2 and 3; attach additional pages as necessary.

Completion of the Full EAF is expected to be based on information currently available and should not

require new studies, research or investigation. For any question where information is not currently

available, please specifically indicate that the information does not exist or is not available to the sponsor.

Where additional research or investigation would be needed to respond, please answer as well as possible

based on information that is available.

A. Project Information

A1. Applicant information

Name of Applicant/Sponsor Telephone:

Address

City/PO State: Zip Code:

Project Contact Telephone:

Address


Name of Property Owner

(If different from sponsor)

Telephone:

Address


A2. Project Identification


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Project Name:

Project Location (include map showing general location):

Project Description (including purpose or need):

B. Non-Physical Actions

If the entire proposed action is identified as a non-physical action by answering yes to any items in a

AND to b, you may skip to Part 1, Question H.

a.i. Does the proposed action involve the adoption or amendment of a land use plan?

9 Yes 9No

a.ii.. Does the proposed action involve the adoption or amendment of a local law or ordinance?

9 Yes 9No

a.iii. Does the proposed action involve the adoption or amendment of policy, rules or regulations?

9 Yes 9 No

b. Are the adoption or amendment of the plan, law, ordinance, policy, rules or regulations the only

components of the proposed action, or the only approval(s) which must be granted for it?

9 Yes 9No

C. Construction and Operations

C1. Timing

a. Will project be constructed in a single phase? 9 Yes 9No If yes answer b., If no answer c - f

b. Anticipated period of construction: ______ months

c. Total number of phases anticipated _____ (number)


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d. Anticipated date of commencement phase 1 _____ month _____ year, (including demolition)

e. Approximate completion date of final phase _____ month _____year

f. Describe connections and relationships of phase 1to subsequent phases?

C2. Project Parameters (complete all applicable sections)

a. Project acreage to be developed or affected: _____acres initially; _____acres ultimately ; _____If applicable, length of project, in miles

b. Project area to remain undeveloped ___ acres.

c. Total acreage including project area and contiguous properties, which are owned or controlled by

project sponsor: ____ acres

d. Is project an expansion? 9 Yes 9No If yes, what is % of proposed expansion? ___________

e. Does the project include residential uses? 9 Yes 9No

If yes: number and type of housing units:One Family Two Family Three Family Multiple Family( four or more)

Initially ___________ ___________ ____________ ____________________

Ultimately ___________ ___________ ___________ ____________________

f. Dimensions (in feet) of largest proposed structure _____height; _____width; _____ length.

g. Estimate square footage of building space which will be heated or cooled ______square Feet

h. Hours of operation: 9 Not Applicable 9 Applicable,

If applicable, specify proposed hours of operation.

Monday -Friday:

Saturday:

Sunday:

Holidays:

C3. Transportation

a. Estimated number of vehicle trips to be generated by project:

Maximum vehicular trips generated per hour ?_____

Average number of trips per hour? ____Total number of trips yearly? ___

b. Number of parking spaces (on or off-street):

Existing?_____

Total at project completion (new + existing)? ________


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C5.1 Runoff

a. How much impervious surface will the project create? _____ acresor Sq feet _____

b. Will the project create new point source stormwater discharges such as ditches, pipes, swales,

curbs, gutters, or other concentrated flows of stormwater?

9 Yes 9 No

If yes answer the following questions

c. Where will the discharge(s) be directed - - e.g., on-site facility, onto adjacent properties or into

surface waters?

d. Describe discharges, including estimated volume of runoff, and identify any receiving properties,

wetlands, and/or waterbodies:

e. Will the project require approval of a storm water management system?

9 Yes 9 No, If yes, answer question f.

f. List required approvals

C5.2 Will liquid waste be generated? 9 Yes 9 No (If yes answer applicable C5.2 sub-questions)

a. Is surface liquid waste disposal involved 9 Yes 9 No

b. If yes, indicate type of waste (sewage, industrial, etc) and amount

c. Name of water body into which effluent will be discharged:

d. Is subsurface liquid waste disposal involved? 9 Yes 9 No

e. If yes, indicate type of waste (sewage, industrial, etc) and amount:

f. Describe any other liquid waste disposal:

g. Will waste water be processed at a waste water treatment facility? 9 Yes 9 No

If yes, will an expansion of an existing facility or construction of a new facility be required?

9 Yes 9 No

C5.3 Will surface area of an existing wetland or water body increase, decrease, or be encroached upon

by proposal? 9 Yes 9 No (If yes answer applicable C5.3 sub-questions)

a. Identify any wetland or waterbodies present in the project area:

b. Is it federally regulated? _____

If yes, area by which federally-regulated waterbody will be increased or decreased by proposal_____


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c. Is it State regulated freshwater wetland?9 Yes 9No, If yes, what is its classification? _____Area of State regulated fresh water wetlands increased or decreased by proposal_____acres.

d. Is it State regulated tidal wetlands? 9 Yes 9 No, If yes area of tidal wetland increased or

decreased by the proposal ______acres

e. Is it a locally regulated wetland or waterbody? 9 Yes 9No, If yes area of waterbody orwetland increased or decreased by the proposal ______ acres.

f. Is an area of a non-protected water body or wetland present? 9 Yes 9No, If yes area ofwaterbody or wetland increased or decrease by the proposal ______acres.

C5.4 Will the project include or result in the formation of a pond or dammed water body?

9 Yes 9 No (If yes answer applicable C 5.4 sub-questions)

a What is the purpose of the pond?

b. What will be the principal source of the water 9 Ground water 9 Surface water streams

9 Surface water runoff

c. Do local land use rules allow a pond at the site? 9 Yes 9 No

If yes, is a local approval required to create a pond? 9 Yes 9 No

C5.5 Will the project use or create a new demand for water?9 Yes 9 No (If yes answer applicable C5.5 sub-questions)

a. Total anticipated water usage per day _____ gallons/day. Identify water source:

b. If water is from wells, indicate pumping capacity _____ gallons/minute.

c. If water is from wells, could the withdrawals pull in subsurface contaminants from the project site

or adjoining properties? Describe/cite sources.

C5.6 Is the proposed project in, or does it include, a lake or other waterbody? 9 Yes 9 No

(if yes answer a-c)

a. Will bottom sediments be disturbed?

b. Will aquatic vegetation be removed from site 9 Yes 9 No If yes ________? Acres

Describe method of plant removal:


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i. If yes, What is the expected acreage of aquatic vegetation remaining after the project has been

completed? ______

.ii Describe the purpose of removal (e.g. beach clearing, invasive species control, boat access, etc.)

c. Will project involve introduction of biological agents? ..

C6. Noise, Odor and Light

a. Will blasting occur during construction or operation? 9 Yes 9 No

If yes, describe:

b. Will the project produce operating noise exceeding the ambient noise levels? 9 Yes 9 No

If yes, provide details including hours sound is produced over 24hr period, week and year:

c. Propose action will remove natural barriers that would act as noise screen.

d. Will the project have outdoor lighting? ? 9 Yes 9 No

If yes describe:

e. Will the project routinely produce odors (more than one hour per day)? 9 Yes 9 No

If yes, describe:

C7. Production and Disposal of Hazardous Materials and Solid Waste

C.7.1 Will proposed activities at the site involve hazardous waste(s) and or constituent(s) (i.e.

generation, treatment, storage, disposal)? 9 Yes No 9

a. If yes, what is the amount per month? _____tons

b. If yes, how will waste be managed?

c. If an existing hazardous waste facility will be utilized, give name ___________, and

location__________.

d. Will any wastes not go into a hazardous waste facility? 9 Yes 9 No

If yes explain:

C7.2 Will the project involve the management or disposal of solid waste. 9 Yes 9 No

a. If yes, what is the anticipated method of disposal:

b. If yes, what is the anticipated rate of disposal: _____tons/month,

Tons/hour ________ if incineration.

c. If yes what is the anticipated site life? _____years.


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d. Does the proposed action involve construction or modification of a solid waste management

facility? 9 Yes 9 No

C7.3 Does the proposed project require the storage of petroleum or chemical products?

9 Yes 9 No

If yes, Identify________ Volume______

C8. Herbicides and Pesticides

a. Will the project use herbicide or pesticides? 9 Yes 9 No If yes answer b.-d.

b. If yes, explain purpose

c. If yes, specify targets:

d. If yes, indicate application frequency and dates of application

C9. Energy Use

a. Will the project result in an increase in energy use? 9 Yes 9 No

If yes, describe.

b. a. Is this site served by existing public utilities?

If yes, Identify:

c. Estimate annual electricity demand resulting from the proposed project? _____

d. Estimate consumption of fuel that will result from post -construction project operations?

Fuel Type______ Gallons/Year_______

e. Identify energy conservation elements incorporated into the project design. _________

C10. Air Emissions

a. Will the proposed project include or use one or more air emission sources from fuel combustion,

waste incineration or other process?

9 Yes 9No

b. If yes, specify and describe:

i. Mobile sources / construction -

ii. Mobile sources / operation -


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iii. Stationary sources / construction -

iv. Stationary sources / operation -

c. Will any of the sources above require a State Facility Permit or Title V Permit from the NYSDEC?

9 Yes 9 No If yes answer i.-v.

i. The project will generate _______ Tons/year of Carbon Dioxide (CO2)

ii. The project will generate _______Tons/year of Nitrous Oxide (N20)

iii. The project will generate _______Tons/year of Perfluorocarbons (PFCs)

iv. The project will generate ______Tons/year of Sulfur Hexafluoride (SF6)

v. The project will generate ______Tons of carbon equivalent /year of Hydroflorocarbons (HCFS)

d. Will the project emit methane (eg, sewage treatment plants, municipal land fills, manure or other

composting facilities, including CAFOs)?

If yes, estimate methane generation in tons/year______.

e. Will the proposed action result in the release of air pollutants from processes out in the open, suchas quarry or landfill operations?

f. The project will require a state air registration, or would produce an emissions rate of total

contaminants that would exceed 5 lbs. per hour, or would include a heat source capable of producing

more than 10 million BTUs per hour. 9 Yes 9 No If yes describe:

D. Site Description

D1. Site History.

a. Describe any previous projects or proposals involving this project area:

b. Did any previous site proposals result in the creation of an Environmental Impact Statement?

If yes, provide title, date and lead agency information:

D2. Total Acreage of Project Area

a. Describe the existing physical condition and existing land use of the total acreage under project

sponsors control.

Approximate Acreage Within

Entire Property Boundary

Current After Project Completion Change

a. Meadowland or Brushland

(non-agricultural)


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b. Forested

c. Agricultural (includes

orchards, cropland, pasture, etc)

d. Freshwater wetland

e. Tidal wetland

f. Surface water features

g. Un-vegetated (rock, earth or

fill)

h. Roads, Buildings and Other

Paved/Impervious Surfaces

i. Other (indicate type)

D3. Does the project site contain any biological community or habitat types that are of high ecologicalvalue. 9 Yes 9 No Cite source(s):

a. If yes, describe:

b. Acres of community/habitat

presently:_________

Acres of community/habitat

after completion of project as

proposed: __________

Difference:__________

D4. Does project site contain any species of plant or animal life that is identified as threatened or

endangered, or any areas identified as habitat for a threatened or endangered species?

9 Yes 9 No (If yes answer b-c)

a. Identify species

b. Describe nature of use of site by the species (resident habitat, seasonal habitat, transient use only,

etc)

c. Source(s) of information:

D5. What are the predominant soil type(s) present on project site:

a. Soil Drainage: 9 Well Drained _____% of Site 9 Moderately Well Drained _____% of site

9 Poorly Drained _____% of Site

b. Are agricultural lands consisting of highly productive soils present? 9 Yes 9 NoIf yes, acreage?_____

Cite source(s) from which determination is based.


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D6. Are there any unique or unusual land forms or geological features on the project site? (e.g., cliffs,

dunes, minerals, fossils, caves or other geological formations) 9 Yes 9 No

a. Describe:

D7. Are there bedrock outcroppings on the project site? 9 Yes 9 No

a. If yes, what % of the site is comprised of bedrock outcroppings? _____%

b. What is the average depth to bedrock? (In feet) _____

D8. Approximate percentage of proposed project site with slopes:?

9 0-10% _____% 9 10-15% _____% 9 15% or greater _____%

D9. What is the depth to the water table? _____ (in feet)

D10. Is the site located over a primary, principal or sole source aquifer? 9 Yes 9 No

Cite source of information from which determination is based . _________

D11. Does any portion of the project site contain wetlands or other waterbodies, or do any wetlands or

waterbodies adjoin the site (including streams, rivers, ponds or lakes)? 9 Yes 9 No

a. If yes, are any of wetlands or waterbodies within the project site federally, state or locally

regulated? 9 Yes 9 NoIf yes, indicate in responses to items c, d, and e as applicable.

b. Please attach a map of all wetland(s) or waterbody(ies) within and adjoining the project site.

c.i. Stream(s) Name:

(1).

(2).

(3).

c.iii Total length of

each stream on project

site:

(1).

(2).

(3).

c.iv. Average depth

of stream reach(es)

on site:

(1).

(2).

(3).

c.ii.. Stream(s) Number &

Class/best use:

(1).

(2).

(3).

d.i. Pond(s)/Lakes(s)

Name:

(1).

(2).

(3).

d.iii Total area of each

Pond or Lake:

(1).

(2).

(3).

d.iv. Average depth

of each Pond or

Lake:

(1).

(2).

(3).

d.ii.. Pond(s)/Lakes(s)

Number & Class/best use:

(1).

(2).

(3).


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e.i. Wetland(s) Name:

(1).

(2).

(3)

e.iii. Total area of each Wetland(s):

(1).

(2).

(3)

e.ii. Wetland(s) Number &

Classification:

(1).

(2).

(3)

D12. Floodplain, Floodway or Coastal Erosion Hazard Area (CEHA)

a. Is any portion of the project site located in a designated floodway? 9 Yes 9 No

b. Is any portion of the project site located in a 100 year flood plain? 9 Yes 9No

c. Is any portion of the project site located in a 500 year flood plain? 9 Yes 9 No

d. Is any portion of the project site located within a designated Coastal Erosion Hazard Area (CEHA)?

9 Yes 9 No

D13. Does the project site contain an existing dam? 9 Yes 9 No

a. If yes, what is the dams existing hazard classification?

b. Provide date and summarize results of last inspection:

D14. Is there a dam upstream of the project site? 9 Yes 9 No (If yes answer a)

a. Would any portion of the project site be within the area subject to flooding in the event of a failure

of that dam?

b. Will the project result in requiring a change to an existing dams hazard classification?

9 Yes 9 No

D15. Is the project site designated for open space/recreation, or presently used by the community for

open space or recreation (formally or informally)? 9 Yes 9 No

a. If yes, explain:

D16. Is the project site or adjoining area currently used for hunting, trapping, fishing or shell fishing?

9 Yes 9 No


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D17. Is the proposed action located wholly or partially within a priority project area listed in the

current New York State Open Space Conservation Plan, a local open space plan, and/or a county

farmland protection plan? 9 Yes 9 No

a. If yes, list plan priority project area number and title (if applicable) ________

b. If yes, describe resource value the plan seeks to protect on the project site as described in the plan:

D18. Contaminated Site Considerations

a. Is the project site listed on the NYS Registry of Inactive Hazardous Waste Disposal Sites?

9 Yes 9 No If yes, please provide Registry Site number ___________

b. Has the project site ever had a petroleum or hazardous chemical release?

9 Yes 9 No 9 Unknown

If yes, please provide spill case number _____

c. Is the project site subject to an environmental easement limiting property uses to protect public

health and the environment?

9 Yes 9 No If yes, please provide the site number _______

d. Is there is a deed restriction on the property related to past contamination on the property?

9 Yes 9 No Provide letter from County Clerks Office to support.

D19. Hazardous Materials

a. Have hazardous wastes ever been generated, treated and/or disposed of at the site?

9 Yes 9 No If yes describe:

b. Has a hazardous waste facility (Part A) application for the site ever been filed with EPA or NYS

to comply with the federal Resource Conservation and Recovery Act (RCRA)?

9 Yes 9 No

If yes, was the site subject to RCRA corrective activities? 9 Yes 9 No

If yes, list or attach description of control measures.

D20. Former Solid Waste Management Facilities

a. Has the project site ever been used as a solid waste management facility? 9 Yes 9 No

b. Does the project site adjoin property which is now or was at one time used as a solid waste

management facility? 9 Yes 9 No


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c.i. If yes to a or b: has the site been formally closed? 9 Yes 9 No

c.ii. Has the compatibility of the proposed project with that solid waste management facility been

evaluated? 9 Yes 9 No

If yes, provide documentation.

E. Surrounding Area and Uses: Setting of proposed project

E1. Present Land Use(s) surrounding the site of the proposed project

9 Urban 9 Industrial 9 Commercial 9 Residential (suburban) 9 Rural (non-farm)

9 Forest 9 Agriculture 9 Aquatic 9 Other:

Describe (generally):

E2. Is the site, or any portion of it, located in a designated agricultural district certified pursuant to

Agriculture and Markets Law, Article 25-AA, Section 303 and 304? 9 Yes 9 No

E3. Does the site contain all or part of, or is it substantially contiguous to, a registered National

Natural Landmark?

9 Yes 9 No

a. If yes, is the landmark: Biological Community 9 Geological Feature 9

Provide Brief Description:

E4. Would the proposed project visible from any officially designated and publicly accessible federal,

state, or local scenic or aesthetic resource? 9 Yes 9 No

a. If yes, identify resource: _________

b. If yes, identify designation: ________

E5. Does the site contain, or is it substantially contiguous to, a building, archaeological site or district

which is listed on or has been determined to be eligible for the State or National Registers of HistoricPlaces? 9 Yes 9 No (If yes answer questions a and b. as applicable)

a. If Yes: 9 Archeological Site 9 Historic Building or District Name:__________

Provide brief description of traits on which listing is based:


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b. Additional archaeological or historic site(s) or resources which may exist in general area of project:

Cite source(s):

E6. Do existing public utilities serve the site? 9 Yes 9 No If yes, answer a & b.

a. Which utilities?

b. Describe extensions or capacity expansions proposed to serve this project:

E7. Is the site located in or substantially contiguous to a Critical Environmental Area (CEA)

designated pursuant to Article 8 of the ECL, and 6 NYCRR 617? 9 Yes 9 No.

a. If yes, CEA name and basis for designation: _________________

E8. Is the proposed project located in an area that fails to meet ambient air quality standards for all or

part of the year? 9 Yes 9 No

E9. Are there any facilities serving sensitive human populations (e.g. hospitals, playgrounds,

schools) within two miles of the project site?

9 Yes 9 No If yes, answer a and b.

a. Describe facility/-ies and location relative to project site.

b. Describe any potential project components which could directly affect those populations.

E10. Is the proposed project located within or near an environmental justice community of concern?

9Yes 9Noa. If yes, characterize the community/-ies.

F. Zoning and Planning Information

F1. Existing zoninga. What is/are the zoning classification(s) of the site?

b. What is the zoning classification(s) surrounding the site?

c. What is the maximum development potential of the site if fully built out according to the present

zoning (in numbers of units, or total commercial/industrial square feet)?


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F2. Is a zoning change proposed? 9 Yes 9 No

a. If yes, what is the proposed new zoning for the site?

b. What would the maximum development potential of the site be if fully built out according to the

proposed zoning?

F3. Community services

a. If project proposes to use public water supply:

i. Is project site presently served? 9 Yes 9 No

ii. Will project require line extension within an existing district? 9 Yes 9 No

iii. Will project require formation of a new district? 9 Yes 9 No

b. If project proposes to use public waste water treatment:

i. Is project site presently served? 9 Yes 9 No

ii. Will project require line extension within an existing district? 9 Yes 9 No

iii. Will project require formation of a new district? 9 Yes 9 No

c. Will the proposed action create a demand for any community provided services (recreation,

education, police, fire protection)? 9 Yes 9 No

If yes, describe:

d. Will proposed action result in the generation of traffic significantly above present levels?

9 Yes 9No

If yes, is the existing road network adequate to handle the additional traffic. 9 Yes 9 No

e. Is the site in a coastal area? 9 Yes 9No

i. If yes, is there a local waterfront revitalization plan? 9 Yes 9NoTitle and date adopted _______________________________

ii. If yes, is the site in or contiguous to a designated heritage area or greenway corridor? 9Yes 9No

Name of area/corridor ____________________________________

F4. List applicable land use plans for geographic region of the project area.


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F5. If the proposed action is the subdivision of land, how many lots are proposed?

a. What is the minimum lot size proposed?

b. Total project size is ____ acres on a ____ acre parcel

c. Will cluster development be utilized? 9 Yes 9NoIf yes, describe:

G. Effect on local employment

G1. Number of jobs generated: during construction _____; _____ after project is complete _____

G2. Number of jobs eliminated by this project _____

G3. Will project require relocation of any existing projects or facilities? 9 Yes 9 No

a. If yes, explain:

H. Government Approvals

H1. Does project involve Local, State, Federal or Tribal, funding? 9 Yes 9 No

a. If yes, explain:

b.i. Is the project site within a Coastal Zone Management Area, or covered by a Local Waterfront

Revitalization Plan? 9 Yes 9 No

b.ii. Will the proposed project require a Coastal Consistency determination? 9 Yes 9 No

H2.

Approvals Required: If yes, describe

Anticipated

Application

Date

a. City, Town, Village Board

9 Yes 9 No


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b. City, Town, Village Planning Board

9 Yes 9 No

c. City, Town, Village, Zoning Board

9 Yes 9 No

d. Other Local Agencies

9 Yes 9 No

e. Regional Agencies

9 Yes 9 No

f. State Agencies

9 Yes 9 No

g. Federal Agencies

9 Yes 9 No

h. Native American Nations

9 Yes 9 No

I. 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 identify such impacts plus

any measures which you propose to avoid or minimize them.

J. Verification

I certify that the information provided is true to the best of my knowledge.

Applicant/Sponsor Name ________________________ Date___________

Signature_________________ Title________________


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Part 2- Identification of Potential Project Impacts

Instructions for Part 2:

Part 2 is to be completed by the lead agency. Part 2 is designed to help the lead agency inventory all

potential resources which could be affected by a proposed project or action. Therefore, answer every

one of the 21 questions in Part 2. Answer Yes if there may be any impact. Maybe answers should be

considered as Yes answers. In identifying impacts, consider the possibility for long term and

cumulative effects as well as direct impacts.

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.

Before beginning Part 2, review all of the information provided in Part 1 as well as any underlyingapplication and supporting materials to ensure that Part 1 accurately describes all components of the

proposed activity, that is, the whole action, because SEQR requires that all component activities or

stages of a proposal should be reviewed simultaneously, except in rare cases which must be explicitly

justified (see 6 NYCRR Part 617.2(ag).

The lead agencys reviewer(s) will not necessarily be environmental professionals. In completing Part

2, reviewers should be guided by the question: Have my responses and determinations been reasonable

for the scale and context of this project? The impacts of each project, on each site, in each locality, will

vary. Therefore, examples used in Part 2 are illustrative and are offered as guidance. They do not

constituted an exhaustive list of impacts and thresholds to answer each question, and each lead agencysreviewers are expected to consider potential impacts in the specific context of each project. When an

Other Impacts element is checked, please provide notes briefly identifying those impact(s).


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Part 2 Questions

1. Impact on Land:

Will any element of the project have any of the following

effects?

If Yes to one or more item, explain in Part 3.

Yes No

a. Creation of over 1000 square feet of impervious

surfaces.9 9

b. Construction on land where depth to water table is less

than 3 feet.9 9

c. Any construction on slopes of 15% or greater, or where

the general slopes in the project area exceed 10%.9 9

d. Construction on land where bedrock is exposed, or

generally within 5 feet of existing ground surface.9 9

e. Excavation that would remove more than 1,000 tons of

natural material.9 9

f. Construction would continue for more than one year 9 9

g. Construction would occur in multiple phases/years 9 9

h. Project could result in increased erosion, whether from

physical disturbance or vegetation removal (including from

treatment by herbicides)?

9 9

i. Project would be located within, but incompatible withstandards for, a Coastal Erosion hazard area.

9 9

j. Other impacts 9 9

2. Impact on Geological Features:


effects?


Yes No

a. Proposed action inhibit access to or result in the

modification to or destruction of any unique or unusual land

forms on the site? (e.g., cliffs, dunes, minerals, fossils,

caves)

Specific land forms: _____________________ 9 9


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b. Action may result in the modification or destruction of

any geological feature listed as a registered National

Natural Landmark? Specific feature: 9 9

c. Other impacts:9 9

3. Impact on Surface Water:


effects?

If Yes to one or more item, explain in Part 3.Yes No

a. Project area or site contains one or more wetlands or

other water bodies (streams, rivers, ponds or lakes).9 9

b. Proposed action would create a new water body.9 9

c. Project will result in a 10% increase or decrease in the

surface area of any body of water, or more than a 10 acre

increase or decrease.

9 9

d. Project would involve dredging more than 100 cubic

yards of material from a wetland or water body.9 9

e. Construction proposed within a freshwater or tidal

wetland or its regulated adjacent area, or in bed or banks ofother water body.

9 9

f. Proposed action will create turbidity from upland erosion

or by disturbing bottom sediments of waterbody.9 9

g. Project would include construction of one or more

intake(s) for withdrawal of water from surface water.9 9

h. Project would include construction of one or more

outfall(s) for discharge of wastewater to surface water9 9

i. Project would create concentrated discharges of

Stormwater that could cause soil erosion or siltation ordegradation of receiving water bodies.

9 9

j. The project does not have an approved storm water

management plan.9 9


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k. Project may compromise the water quality,

classification, or designated best use of any water bodies

(potable water, swimming, or fishing) within or

downstream of the project area.

9 9

l. Will the application of pesticides occur in or around any

water body?9 9

m. Liquid effluent is proposed to be conveyed off the siteto facilities which do not yet exist, or to existing facilities

which do not have adequate capacity.

9 9

n. Other impacts9 9

4. Impact on groundwater:


effects?


Yes

No

a. Proposed action would involve wastewater discharge to

groundwater.9 9

b. Project would require new water supply wells, or create

additional demand on supplies from existing water supply

wells.

9 9

c. Project demand will exceed sustainable and safe

withdrawal capacity rate for local supply/aquifer.

Cite Source ______

9 9

d. Proposed actions will require the storage of petroleum or

chemical products over ground water or an aquifer.9 9

e. Does the proposed project have the potential to introduce

contaminants to ground water or an aquifer?9 9

f. Proposed action would involve the application of

pesticides near potable drinking water or irrigation sources9 9

g. Other impacts9 9

5. Impact on flooding:

Will Any element of the project includes the following

examples?


Yes

No


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a. Proposed action will result in development in a

designated floodway?9 9

b. Proposed project is within 100 year floodplain9 9

c. Project is a critical facility and is proposed to be located

in a 500 year floodplain?9 9

d. Proposed action will result in or require modification ofexisting drainage patterns. 9 9

e. Proposed action would change flood water flows.9 9

f. If a dam exists upstream of the project site, either on or

above project sponsors property, would the project result

in a need to change the dams hazard classification (i.e.,

would project introduce or increase population and

infrastructure in the zone which would be flooded in the

event of a dam failure)?

9 9

g. If a dam exists on the project site, has it failed to meet

one or more safety criteria on its most recent inspection?

Date of last inspection:

9 9

h. Other Impacts 9 9

6. Impacts on Air:


effects?If Yes to one or more item, explain in Part 3.

Yes No

a. The project would be located in an area which fails to

meet one or more ambient air quality standards for some or

all of the year.

9 9

b. Would the project require federal or state air emission

permits?9 9

c. If yes to b, would the project involve any of the

following levels of emissions of greenhouse gases:

i. The project will generate greater than 1000

tons/year of carbon dioxide (CO2)

9 9

ii. The project will generate greater than 3.5

tons/year of Nitrous Oxide (N20)9 9


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iii. The project will generate greater than more than

1000 tons of carbon equivalent of perfluorocarbons

(PFCs)

9 9

iv. The project will generate greater than .045 tons

of per year of sulfur hexafluoride (SF6)9 9

v. The project will generate greater than 1000 tons

of carbon equivalent of Hydrochloroflurocarbons(HCFCs) emissions

9 9

d. The project is estimated to generate or produce 43

tons/year or more of methane.9 9

e. The project will require a state air registration, or would

produce an emissions rate of total contaminants that would

exceed 5 lbs. per hour, or would include a heat source

capable of producing more than 10 million BTUs per

hour.

9 9

f. The project would require a local air emissions permit.

9 9

g. Proposed action will induce 1,000 or more vehicle trips

in any given hour..9 9

h. The project would meet or exceed any of the following

thresholds:

i. The project would generate 160,000 or more new

vehicle trips per year or 2.4 million vehicle miles

traveled per year.

9 9

ii. The project would result in greater than 100,000gallons of fuel consumption per year from post-

construction operations (including on-site use and

off-site fleet use)

9 9

iii. The project would utilize more than 2,500

MWhrs per year of electricity.9 9

iv. The project will involve heating and/or cooling

of more than 100,000 square feet of building area

when completed.

9 9

v. The project would reach 50% of any two ormore of the above thresholds 9 9

i. Proposed action will result in the incineration of more

than 1 ton of refuse per hour.9 9

j. Other Impacts 9 9


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7. Impact on Plants and Animals:


effects?


Yes

No

a. Proposed action would cause reduction in population or

loss of individuals of any threatened or endangered

species, as listed by New York State or the Federalgovernment, that are using the site, or are found on, over,

or near the site.

9 9

b. Proposed action would result in a reduction or

degradation of any habitat used by any threatened or

endangered species, as listed by New York State or the

Federal government.

9 9

c. Project would result in direct exposure of any threatened

or endangered species, as listed by New York State or the

Federal government, to pesticides (including herbicides).

9 9

d. Action may diminish the capacity of a registered

National Natural Landmark to support the biological

community it was established to protect.

9 9

e. Removal of, or ground disturbance in, any portion of a

designated significant natural community.

Source: _________

9 9

f. Proposed action would substantially interfere with any

key life function of any resident or migratory terrestrial,

avian or aquatic wildlife species.

9 9

g. Proposed action requires the removal of more than 10

acres of forest, grassland or any other locally important

habitat.

Habitat type & information source: _________________

9 9

h. Proposed action would cause a reduction in

population(s) or loss of individuals of any plant or animal

populations critical to support a valued resource or habitat.

9 9

i project involves introduction of biological agents.9 9

j. Other Impacts9 9


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8. Impact on Agricultural Resources:


effects?


Yes

No

a. The proposed action would sever, cross or otherwise limit

access to agricultural land (includes cropland, hayfields,

pasture, vineyard, orchard, etc).

9 9

b. Construction activity would excavate or compact the soil

profile of active agricultural land or highly productive soils.9 9

c. The proposed action would irreversibly convert more than

10 acres of agricultural land or, if located in an Agricultural

District, more than 2.5 acres of an agricultural land to non-

agricultural uses.

9 9

d. The proposed action would disrupt or prevent installation

of agricultural land management systems9 9

e. Proposed project could result, directly or indirectly, inincreased development potential or pressure on farmland.

9 9

f. Proposed project would include the application of

pesticides near any sensitive agricultural areas (e.g., grazing

animals or vineyards).

9 9

g. Other Impacts 9 9

9. Impact on Aesthetic Resources:Will any element of the project have any of the following

effects?


a. Proposed project or project components would be visible

from any federal, state, or locally-designated aesthetic

resource.

If yes, continue with i - iii.

9 9

i. One or more project components would result in

the obstruction, elimination or significant screeningof scenic views known to be important to the area.

9 9

ii. Proposed project would cause a diminishment of

the public enjoyment and appreciation of the

designated aesthetic resource.

9 9


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iii. Proposed land uses or project components

obviously differ from or are in sharp contrast to

current land use patterns within and adjoining the

designated resource.

9 9

b. Proposed project or project components might be

visible from other publicly-accessible vantage points.

Specify:

9 9

c. Other impacts 9 9

10. Impact on Historic and Archeological Resources:


effects?


a. The proposed project would occur wholly or partially

within or substantially contiguous to any facility or site

listed on the State or National Register of Historic Places,

or determined to be eligible for such listing.

9 9

b. Proposed project would occur in or near an area

designated as sensitive for archaeological sites on the NY

State Historic Preservation Office (SHPO) archaeological

site inventory.

9 9

c. Proposed project would occur in or near an

archaeological site not included on the NY SHPOinventory.

Source: __

9 9

If any of the above questions are answered yes continue with the following questions to help

support conclusions in Part 3

i. Proposed project would result in the destruction

or alteration of the site or property. 9 9

ii. Proposed project would result in the isolation or

alteration of the site or property, or its setting.

9 9

iii. Proposed project would result in the

introduction of visual, audible, or atmospheric

elements which are out of character with the site or

property, or would alter its setting.

9 9


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iv. Proposed project would result in the neglect of

the property, and could result in its deterioration or

destruction.

9 9

d. Other Impacts 9 9

11. Impact on Open Space and Recreation:Will any element of the project have any of the following

effects?


Yes

No

a. Proposed project would result in a reduction of an open

space resource as designated in the NYS Open Space

Conservation Plan, any local open space plan, or county

farmland protection plan.

9 9

b. Proposed project would result in an impairment of

ecosystem services provided by an undeveloped area (e.g.,stormwater storage, nutrient cycling, wildlife habitat).

9 9

c. Proposed project would eliminate open space or

recreational resource in an area with few such resources.9 9

d. Proposed project would result in the permanent loss of a

current or future recreational resource.9 9

e. Proposed project would result in loss of an area now

used informally by the community as an open space

resource.

9 9

f. Other Impacts 9 9

12. Impact on Critical Environmental Areas:


effects?


Yes No

a. Proposed action would be located within or adjacent to a

critical environmental area (CEA).

If yes, respond to i - iii.

9 9

i. Proposed action will result in a reduction in the

quantity of the resource or characteristic which was

the basis for designation of the CEA.

9 9


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ii. Proposed action will result in a reduction in the

quality of the resource or characteristic which was

the basis for designation of the CEA.

9 9

iii. Other impacts 9 9

13. Impact on Transportation:


effects?


a. Alteration of present patterns of movement of people

and/or goods.9 9

b. Proposed action will result in increased traffic9 9

c. Construction of paved parking area for 1,000 or more

vehicles. 9 9

d. Project provides little or no public transportation access9 9

e. Project provides few or no pedestrian and bicycle

accommodations.9 9

f. Other Impacts 9 9

14. Impact on Energy:


effects?


a. Is existing utility capacity currently insufficient to allow

connection? 9 Yes 9 No9 9

b. Has the project failed to incorporate energy conserving

opportunities?9 9

c. Proposed action will cause a substantial increase in the

use of any form of energy in the municipality.9 9

d. Other Impacts 9 9


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15. Impact on Noise, Odor, and Light:


effects?

If Yes to one or more item, explain in Part 3.Yes

No

a. Project will produce sound above ambient noise levels

beyond project boundary.9 9

b. Blasting within 1,500 feet of a hospital, school or othersensitive facility.

9 9

c. Odors will occur routinely (more than one hour per day).9 9

d. Bright lighting will shine obtrusively onto adjoining

properties9 9

e. Lighting will create sky-glow brighter than existing area

conditions.9 9

f. Other Impacts

9 9

16. Impact on Unhealthy Exposures:


effects?


Question 16a - 16e are applicable to sites at or adjacent to

spill sites or inactive hazardous waste sites9 9

a. Is the location of the proposed project currently

undergoing remediation?9 9

b. Is there a current emergency spill remediation or a NYS

DEC enforcement action pending that involves the site?9 9

c. Is the proposal inconsistent with any environmental

easement restrictions? 9 9

d. Is the proposal inconsistent with any deed restrictions? 9 9

Question 16e is applicable if the proposed project site wassubject to RCRA corrective activities as identified in Part 1

question D.19

9 9

e. Will any of the proposed activities affect control

measures that were put in place to ensure that the site

remains protective of the environment and human health?

9 9


32/36


Question 16.f is applicable if the proposed project will

entail the handling of hazardous waste as indicated in Part

1 question C.7.1

9 9

f. Is it uncertain that adequate control measures will be put

in place to ensure that future generation, treatment and/or

disposal of hazardous wastes will be protective of the

environment and human health.

9 9

Questions 16g-16n are applicable for sites at or adjacent

past, present or future solid waste facilities (Where applicablesupport with NYSDEC or other documented information source)

9 9

g. The proposed action involves construction or

modification of a solid waste management facility.9 9

h. The proposed action may result in the unearthing of

solid waste.9 9

i. Proposed action may result in the migration of explosive

gases from a landfill site and/or collection of explosive

gases within buildings.

9 9

j. The proposed action may result in the construction of

water supply wells where groundwater may be

contaminated from landfill runoff.

9 9

k. Proposed action may result in the exposure of the public

to fugitive leachate..9 9

l. Propose action may result in the excavation or other

disturbance within 2000 feet of a site used for the disposal

of solid or hazardous waste.

9 9

m. Storage facilities for one million or more gallons of

liquified natural gas or other flammable liquids.9 9

n. Proposed action will allow residential uses in areas

without water and sewer services.9 9

o. Proposed action is commercial or industrial use which

requires construction of new or expansion of existing

wastewater treatment facilities.

9 9

p. Liquid effluent is proposed to be conveyed off the site to

facilities which do not yet exist, or to existing facilitieswhich do not have adequate capacity.

9 9

q. Other9 9


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17. Impact on Community:


effects?

If Yes to one or more item, explain in Part 3.Yes

No

a. Proposed land uses or project components would be

obviously different from or in sharp contrast to current

surrounding land use pattern(s).

9 9

b. The permanent population of the city, town or village in

which the project is located is likely to grow by more than

5%.

9 9

c. The municipal budget for capital expenditures or

operating services will increase by more than 5% per year

as a result of the project.

9 9

d. Proposed action will conflict with officially adopted

plans or goals.9 9

Proposed action will cause a change in the density of landuse.

9 9

e. Proposed action will replace or eliminate existing

facilities, structures, or areas of historic importance to the

community.

9 9

f. Development will create a demand for additional

community services (e.g. schools, police and fire, etc.) that

existing budgets could not meet as a result of increased

costs.

9 9

g. Proposed action will set an important precedent forfuture projects.

9 9

h. Proposed action will create or eliminate employment.9 9

i. Is the proposed action consistent with recommended uses

in local land use plans.9 9

j. Is the proposed action compatible with

adjoining/surrounding land uses within 1/4 mile?9 9

k. Proposed action will allow an increase in the amount of

land committed to industrial use 9 9

l. Will the application of pesticides occur near any sensitive

facilities (i.e. schools, day cares, hospitals)?9 9

m. Proposed action would conflict with the cultural

purposes an area is designated for through treaty or other

legal authority with a Native American population.

9 9


34/36


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Part 3- Evaluation of Importance of Potential Impacts

Instructions

Part 3 must be completed by the Lead Agency.

For each potential impact identified in Part by a yes response, provide a brief narrative whichdiscusses each of the following questions. Attach as many sheets as needed to address all potential

impacts.

1. Briefly describe the impact and its general magnitude, including at least the likely extent, resource(s)

or population(s) affected, and project elements expected to cause the impact.

2. If the impact is avoided or substantially reduced by design measures included in project designs,

describe those measures.

3. If the impact could be mitigated or reduced to an inconsequential impact by project change(s),

describe those measures.

4. Based on the information available, decide if the impact is also important. To assess impact

importance, the lead agency must consider:

The probability that the impact would actually occur

The duration of the impact

Whether the impact is, or is not, reversible, including identification and values of any resources

which could be permanently lost

Whether the impact will be controlled by design measures included in the project, or could be

avoided, limited or controlled by other measures

Any regional or broader consequences of the impact

Any potential divergence of the project from local needs and goals

Whether known objections to the project relate to this impact.

After these analyses are created for each identified potential impact, the lead agency must determine if

there are any significant adverse environmental impacts from the project which are not substantially

avoided or mitigated by project design. Based on that analysis, the lead agency must reach its

determination of significance, that is, whether to require an environmental impact statement to explore

alternatives to avoid or mitigate significant adverse environmental impacts, or whether available

information is sufficient for the lead agency to conclude that the project will have no unmitigated

significant adverse environmental impacts. By completing the certification on the next page, the lead

agency can complete its determination of significance.


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Determination of Significance Type 1 and Unlisted Actions

Identify portions of EAF completed for this Project: 9 Part 1 9 Part 2 9 Part 3

Upon review of the information recorded on this EAF, as noted, plus this additional supporting

information _____________________________________________________________________

_______________________________________________________________________________ ,and considering both the magnitude and importance of each identified potential impact, it is the

conclusion of this lead agency that:

9 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.

9B. Although this project could have a significant adverse impact on the environment, that impactwill be avoided or substantially mitigated because of the following conditions which will be required

by the lead agency _________________________________________________________________

________________________________________________________________________________ .

There will therefore be no significant adverse impacts from the project as conditioned, and therefore

this conditioned negative declaration is issued. *

(* A conditioned negative declaration may ONLY be used with UNLISTED actions.)

9 C. This project may result in one or more significant adverse impacts on the environment, and an

environmental impact statement must therefore be prepared to explore alternatives to avoid ormeasures to mitigate 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:

Signature of preparer (if different from responsible officer):

Date:

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