The URL can be used to link to this page

Environmental Assessment Form [[729,165,1819,240][16][B,I,][Times New Roman]]Short Environmental Assessment Form [[934,244,1134,309][14][B,I,][Times New Roman]]Part 1 [[1098,244,1148,309][14][B,I,][Times New Roman]]- [[1131,244,1632,309][14][B,I,][Times New Roman]]Project Information Instructions for Completing Responses become part of the Part 1 – Project Information. The applicant or project sponsor is responsiblefor the completion of Part 1. 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. Complete all items in Part 1. You may also provide any additional information which you believe will be needed by or useful to the lead agency; attach additional pages as necessary to supplement any item. Part 1 –Project and Sponsor Information îÍÊÈÔÅÛÃé×ÐÖéÈÍÊÛÕ×ððù Name of Action or Project: ûÏ×ÎØ×ØéÓÈ×ìÐÛÎÖÍÊîÍÊÈÔÅÛÃé×ÐÖéÈÍÊÛÕ× Project Location (describe, and attach a location map): ùÛÊ×ÃêÍÛØëÇ××ÎÉÚÇÊÃîã Brief Description of Proposed Action: ûÌÌÐÓÙÛÎÈÌÊÍÌÍÉ×ÉÈÍÏÍØÓÖÃÈÔ×ÍÊÓÕÓÎÛÐÐÃÛÌÌÊÍÆ×ØÉÓÈ×ÌÐÛÎÖÊÍÏ ÈÍÓÎÙÐÇØ×ÙÐ×ÛÊÓÎÕÍÖ×ÄÓÉÈÓÎÕÅÍÍØ×ØÛÊ×ÛÛÐÍÎÕÈÔ×ÖÊÍÎÈÃÛÊØÐÓÎ×ÛÎØÙÊ×ÛÈ× ÛÐÛÅÎÛÎØÐÛÎØÉÙÛÌ×ØÛÊ×Û Name of Applicant or Sponsor: Telephone: îÍÊÈÔÅÛÃé×ÐÖéÈÍÊÛÕ×ððù E-Mail: ÕÌÐÈØÇÉüÃÛÔÍÍÙÍÏ Address: îÍÊÈÔÅÛÃðÛÎ× City/PO:State:Zip Code: ëÇ××ÎÉÚÇÊÃ îã 1.Does the proposed action only involve the legislative adoption of a plan, local law, ordinance, NOYES administrative rule, or regulation? If Yes, attach a narrative description of the intent of the proposed action and the environmental resources that may be affected in the municipality and proceed to Part 2. If no, continue to question 2. 2.Does the proposed action require a permit, approval or funding from any other government Agency? NOYES If Yes, list agency(s) name and permit or approval: èÍÅÎÍÖëÇ××ÎÉÚÇÊÃìÐÛÎÎÓÎÕúÍÛÊØ 3.a. Total acreage of the site of the proposed action? __________ acres b.Total acreage to be physically disturbed? __________ acres c.Total acreage (project siteand any contiguous properties) owned or controlled by the applicant or project sponsor? __________ acres Check all land uses that occur on,adjoining near the proposed actio Rural(non-agriculture)ndustrialCommercialResidential(suburban) ForestAgriculture Parkland Page 1 of 3 5.Is the proposed action,NOYESN/A a.A permitted use under the zoning regulations? b.Consistent with the adopted comprehensive plan? NOYES 6.Is the proposed action consistent with the predominant character of the existing built or natural landscape? 7.Is the site of the proposed action located in, or does it adjoin, a state listed Critical Environmental Area? NOYES If Yes, identify: ________________________________________________________________________________ NOYES a.Will the proposed action result in a substantial increasein traffic above present levels? Are public transportationservices available at or near the site of the proposed action? Are any pedestrian accommodations or bicycle routesavailable on or nearsite of the proposed action? 9.Does the proposed action meet or exceed the state energy code requirements? NOYES If the proposed action will exceed requirements, describe design features and technologies: _____________________________________________________________________________________________ _____________________________________________________________________________________________ 10.Will the proposed action connect toan existingpublic/privatewater supply? NOYES If No, describe method for providing potable: _________________________________________ _____________________________________________________________________________________________ 11.Will the proposed action connect to existing wastewater utilities? NOYES If No, describe method for providing wastewater treatment: ______________________________________ åÛÉÈ×ÅÛÈ×ÊÓÉÎÍÈÎ××Ø×ØÖÍÊÈÔÓÉÌÊÍÌÍÉÛÐ _____________________________________________________________________________________________ NOYES . Does any portion of thesite of the proposed action, orlands adjoining the proposed action, contain NOYES wetlands or otherwaterbodies regulated byafederal, state or local agency? Would the proposed actionphysically alter, or encroach into, any existing wetland orwaterbody? If Yes, identify the wetland or waterbody and extent of alterations in square feet or acres: _____________________ _____________________________________________________________________________________________ _____________________________________________________________________________________________ Page 2 of 3 Identify the typicalhabitat types that occur on, or are likelyto be found on the project site. Check all that apply: ShorelineForestAgricultural/grasslands Early mid-successional WetlandUrban Suburban 15.Does the site of the proposed action contain any species of animal, or associated habitats, listed by the State or NOYES Federal government as threatened or endangered? 16.Is the project site located in theloodplan? NOYES NOYES 17.Will the proposed action create storm water discharge, either from point or non-point sources? If Yes, a.Will storm water discharges flow to adjacent properties? b.Will storm water discharges be directed to established conveyance systems (runoff and storm drains)? If Yes, briefly describe: _____________________________________________________________________________________________ _____________________________________________________________________________________________ 18.Does the proposed action include construction or other activities thatresult in the impoundment ofwater NOYES other liquids(e.g. retention pond,waste lagoon, dam)? or If Yes, explainpurpose and size ____________________________________________________________________________________________ _ 19.Has the site of the proposed action or an adjoining property been the location of an active or closed solid waste NOYES management facility? If Yes, describe: _______________________________________________________________________________ _____________________________________________________________________________________________ 20.Has thesite of the proposed action or an adjoining property beensubject of remediation (ongoing NOYES for hazardouswaste? completed) If Yes, describe: _______________________________________________________________________________ _____________________________________________________________________________________________ I THAT THEINFORMATION PROVIDED ABOVE IS TRUEAND ACCURATE TO THE BEST OF MYKNOWLEDGE ûÇÕÇÉÈ øúÊÓ×ÎêÛÕÍÎ× Applicant/sponsorname:______________________ Date:_______________________________________________ ðÛÎØÉÙÛÌ×ûÊÙÔÓÈ×ÙÈðû Signature: _____________________________________________________ ìêóîèöíêï Page 3 of 3 ÛßÚ Ó¿°°»® Í«³³¿®§ Î»°±®¬ ïÍÎØÛÃûÇÕÇÉÈ ìï øÓÉÙÐÛÓÏ×Ê èÔ×÷ûöïÛÌÌ×ÊÓÉÛÉÙÊ××ÎÓÎÕÈÍÍÐÓÎÈ×ÎØ×ØÈÍÛÉÉÓÉÈ ÌÊÍÒ×ÙÈÉÌÍÎÉÍÊÉÛÎØÊ×ÆÓ×ÅÓÎÕÛÕ×ÎÙÓ×ÉÓÎÌÊ×ÌÛÊÓÎÕÛÎ×ÎÆÓÊÍÎÏ×ÎÈÛÐ ÛÉÉ×ÉÉÏ×ÎÈÖÍÊÏ÷ûöîÍÈÛÐÐËÇ×ÉÈÓÍÎÉÛÉÑ×ØÓÎÈÔ×÷ûöÛÊ× ÛÎÉÅ×Ê×ØÚÃÈÔ×÷ûöïÛÌÌ×ÊûØØÓÈÓÍÎÛÐÓÎÖÍÊÏÛÈÓÍÎÍÎÛÎÃ÷ûö ËÇ×ÉÈÓÍÎÙÛÎÚ×ÍÚÈÛÓÎ×ØÚÃÙÍÎÉÇÐÈÓÎÕÈÔ×÷ûöåÍÊÑÚÍÍÑÉûÐÈÔÍÇÕÔ ÈÔ×÷ûöïÛÌÌ×ÊÌÊÍÆÓØ×ÉÈÔ×ÏÍÉÈÇÌÈÍØÛÈ×ØÓÕÓÈÛÐØÛÈÛÛÆÛÓÐÛÚÐ×ÈÍ ø÷ùÃÍÇÏÛÃÛÐÉÍÎ××ØÈÍÙÍÎÈÛÙÈÐÍÙÛÐÍÊÍÈÔ×ÊØÛÈÛÉÍÇÊÙ×ÉÓÎÍÊØ×Ê ÈÍÍÚÈÛÓÎØÛÈÛÎÍÈÌÊÍÆÓØ×ØÚÃÈÔ×ïÛÌÌ×ÊøÓÕÓÈÛÐØÛÈÛÓÉÎÍÈÛ ÉÇÚÉÈÓÈÇÈ×ÖÍÊÛÕ×ÎÙÃØ×È×ÊÏÓÎÛÈÓÍÎÉ ìÛÊÈ ëÇ×ÉÈÓÍÎáùÊÓÈÓÙÛÐ÷ÎÆÓÊÍÎÏ×ÎÈÛÐîÍ ûÊ×Ûß ìÛÊÈ ëÇ×ÉÈÓÍÎ îÍ ê×ÕÓÉÈ×ÊÍÖôÓÉÈÍÊÓÙìÐÛÙ×ÉÍÊéÈÛÈ×÷ÐÓÕÓÚÐ× éÓÈ×Éß ìÛÊÈ ëÇ×ÉÈÓÍÎ ã×É ìÛÊÈ ëÇ×ÉÈÓÍÎ Ûáå×ÈÐÛÎØÉÍÊíÈÔ×ÊîÍ ê×ÕÇÐÛÈ×ØåÛÈ×ÊÚÍØÓ×Éß ìÛÊÈ ëÇ×ÉÈÓÍÎ áèÔÊ×ÛÈ×Î×ØÍÊîÍ ÷ÎØÛÎÕ×Ê×ØûÎÓÏÛÐß ìÛÊÈ ëÇ×ÉÈÓÍÎ á ã×ÛÊöÐÍÍØìÐÛÓÎßøÓÕÓÈÛÐÏÛÌÌÓÎÕØÛÈÛÛÊ×ÎÍÈÛÆÛÓÐÛÚÐ×ÍÊÛÊ×ÓÎÙÍÏÌÐ×È×ê×Ö×ÊÈÍ÷ûö åÍÊÑÚÍÍÑ ìÛÊÈ ëÇ×ÉÈÓÍÎ îÍ éÔÍÊÈ÷ÎÆÓÊÍÎÏ×ÎÈÛÐûÉÉ×ÉÉÏ×ÎÈöÍÊÏ÷ûöïÛÌÌ×ÊéÇÏÏÛÊÃê×ÌÍÊÈ [[2414,3217,2464,3255][8][B,I,][Times New Roman]]1