NEPSI EAF Short Environmental Assessment Ford
Part I -Project Information
Instructions for Completing
Part 1-Project Information. The applicant or project sponsor is responsible for the completion of Part 1. 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.
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§ponsor Information
Name of Action or Project:
Project Location(describe,and attach a location map):
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Brief Description of Proposed A ion: t
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Name of Applicant or Sponsor: /� Telephone: °7 .4 I t•,7 6
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Address:
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City/PO: State: Zip Code:
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1.Does the proposed action only involve t e legislative adoption of a plan,local law,ordinance, NO YES
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 governmental Agency? NO YES
If Yes,list agency(s)name and permit or approval: '51k Vk h—'WWII���t/I��L4� ❑ rV7
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3.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? �t.'7_�_acres
4. Check all land uses that occur on,adjoining and near the proposed action.
]Urban ❑Rural(non-agriculture) Industrial ❑Commercial ❑Residential(suburban)
El Forest ❑Agriculture ❑Aquatic ❑Other(specify):
❑Parkland
Page 1 of 3
5. Is the proposed action, NO YES N/A
a.A permitted use under the zoning regulations? ❑ ❑
b. Consistent with the adopted comprehensive plan? ❑ � ❑
6. Is the proposed action consistent with the predominant character of the existing built or natural NO YES
landscape? ❑
7. Is the site of the proposed action located in,or does it adjoin,a state listed Critical Environmental Area? NO YES
If Yes,identify: 7 ❑
8. a.Will the proposed action result in a substantial increase in traffic above present levels? NO YES
b.Are public transportation service(s)available at or near the site of the proposed action? K71 ❑
c.Are any pedestrian accommodations or bicycle routes available on or near site of the proposed action? � ❑
9.Does the proposed action meet or exceed the state energy code requirements? NO YES
If the proposed action will exceed re uirements,describe design features and technologies: F
❑
10. Will the proposed action connect to an existing public/private water supply? NO YES
If No,describe method for providing potable water: ❑
11.Will the proposed action connect to existing wastewater utilities? o NO YES
If No,describe method for providing wastewater treatment: FST ❑
12. a.Does the site contain a structure that is listed on either the State or National Register of Historic NO YES
Places? W] ❑
b.Is the proposed action located in an archeological sensitive area? ❑ ❑✓
13.a.Does any portion of the site of the proposed action,or lands adjoining the proposed action,contain NO YES
wetlands or other waterbodies regulated by a federal,state or local agency? ❑✓ ❑
b.Would the proposed action physically alter,or encroach into,any existing wetland or waterbody? F\A ❑
If Yes,identify the wetland or waterbody and extent of alterations in square feet or acres:
14. Identify the typical habitat types that occur on,or are likely to be found on the project site. Check all that apply:
❑Shoreline ❑Forest ❑Agricultural/grasslands ❑Early mid-successional
❑ Wetland ❑Urban ❑Suburban
15.Does the site of the proposed action contain any species of animal,or associated habitats,listed NO YES
by the State or Federal government as threatened or endangered? Z ❑
16.Is the project site located in the 100 year flood plain? NO YES
17.Will the proposed action create storm water discharge,either from point or non-point sources? NO YES
If Yes,
a.Will storm water discharges flow to adjacent properties? KA NO YES ❑
b.Will storm water discharges be directed to established conveyance systems(runoff and storm drains)?
If Yes,briefly describe: ❑NO f79YES
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Page 2 of 3
18.Does the proposed action include construction or other activities that result in the impoundment of NO YES
water or other liquids(e.g.retention pond,waste lagoon,dam)?
If Yes,explain purpose and size:
19.Has the site of the proposed action or an adjoining property been the location of an active or closed NO YES
solid waste management facility?
If Yes,describe: ❑
20.Has the site of the proposed action or an adjoining property been the subject of remediation(ongoing or NO YES
completed)for hazardous waste?
If Yes,describe: 0 ❑
I AFFIRM THAT THE INFORMATION PROVIDED ABOVE IS TRUE AND ACCURATE TO THE BEST OF MY
KNOWLEDGE
Applicant/sponsor naive: Ai SV6-j 62 Date:
Signature: - _
PRINT FORM Page 3 of 3
EAF Mapper Summary Report Monday, May 15, 2017 12:40 PM
Disclaimer: The EAF Mapper is a screening tool intended to assist
project sponsors and reviewing agencies In preparing an environmental
t assessment form(EAF).Not all questions asked in the EAF are
answered by the EAF Mapper.Additional Information on any EAF
t question can be obtained by consulting the EAF Workbooks, Although
the EAF Mapper provides the most up-to-date digital data available to
€ p DEC,you may also need to contact local or other data sources In order
i i to obtain data not provided by the Mapper,Digital data is not a
£ substitute for agency determinations.
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Part 1 /Question 7 [Critical Environmental No
Area]
Part 1 /Question 12a [National Register of �No
Historic Places]
:Part 1 /Question 12b [Archeological Sites] "Yes
_.... . __..._.._.... __..,,,..m.._._.. _ _ .
Part 1 /Question 13a [Wetlands or Other No
Regulated Waterbodles]
Part 1 /Question 15 [Threatened or No
Endangered Animal]
Part 1 /Question 16 [100 Year Flood Plain] [Digital mapping data are not available or are incomplete. Refer to EAF
Workbook.
Part 1 /Question 20 [Remediation Site] No
Short Environmental Assessment Form - EAF Mapper Summary Report