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Preliminary Subdivision Application with deed 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 project sponsor to verify that the information contained in Part 1is accurate and complete. A. Project and 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: ZipCode: Property Owner (if not same as sponsor): Telephone: E-Mail: Address: City/PO:State: ZipCode: Page 1 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) Application Date Required (Actual or projected) a. City Council, Town Board, Yes No or Village Board of Trustees b. City, Town or Village Yes No Planning Board or Commission c. City Council, Town or Yes No Village Zoning Board of Appeals d. Other local agencies Yes No e. County agencies Yes No f. Regional agencies Yes No g. State agencies Yes No h. Federal agencies Yes No i. Coastal Resources. i. Is the project site within a Coastal Area, or the waterfront area of a Designated Inland Waterway? Yes No If Yes, ii. Is the project site located in a community with an approved Local Waterfront Revitalization Program? Yes No iii. Is the project site within a Coastal Erosion Hazard Area? Yes 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 Yes 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 Yes No where the proposed action would be located? If Yes, does the comprehensive plan include specific recommendations for the site where the proposed action Yes No would be located? b. Is the site of the proposed action within any local or regional special planning district (for example: Greenway Yes 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, Yes No or an adopted municipal farmland protection plan? If Yes, identify the plan(s): ________________________________________________________________________________________________________ ________________________________________________________________________________________________________ ________________________________________________________________________________________________________ Page 2 of 13 C.3. Zoning a. Is the site of the proposed action located in a municipality with an adopted zoning law or ordinance. Yes 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? Yes No c. Is a zoning change requested as part of the proposed action? Yes 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? Yes 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? Yes 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? Yes No iii. Number of lots proposed? ________ iv. Minimum and maximum proposed lot sizes? Minimum __________ Maximum __________ e. Will proposed action be constructed in multiple phases? Yes No i. If No, anticipated period of construction: _____ months ii. If Yes: Total number of phases anticipated _____ Anticipated commencement date of phase 1 (including demolition) _____ month _____ year 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 3 of 13 f. Does the project include new residential uses? YesNo 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)? Yes 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 Yes 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: Ground water Surface water streams 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? Yes 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? Yes 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? Yes 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 Yes 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 4 of 13 ii.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: _________________________________________________________________________________________________________ _________________________________________________________________________________________________________ _________________________________________________________________________________________________________ _________________________________________________________________________________________________________ iii.Will proposed action cause or result in disturbance to bottom sediments? Yes No If Yes, describe: __________________________________________________________________________________________ iv.Will proposed action cause or result in the destruction or removal of aquatic vegetation? Yes No If Yes: proposedto be removed ___________________________________________________________ a ofvegetation acreageof 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? Yes 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? Yes No If Yes: Name of district or service area: _________________________________________________________________________ Does the existing public water supply have capacity to serve the proposal? Yes No Is the project site in the existing district? Yes No Is expansion of the district needed? Yes No Do existing lines serve the project site? Yes No iii.Will line extension within an existing district be necessary to supply the project? Yes 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 orservice area proposed to be formed to serve the project site? Yes 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), maximum pumping capacity: _______ gallons/minute. d. Will the proposed action generate liquid wastes? Yes 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? Yes 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? Yes No Is the project site in the existing district? Yes No Is expansion of the district needed? Yes No Page 5 of 13 Do existing sewer lines serve the project site? Yes No Will line extension within an existing district be necessary to serve the project? Yes 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? Yes 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 Yes 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.Howmuch impervious surface will the project create in relation to total size of project parcel? _____ Square feetor _____ 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? Yes No iv.Doesproposed plan minimize impervious surfaces, use pervious materials or collect and re-use stormwater? Yes No f.Does the proposed action include, or will it use on-site, one or more sources of air emissions, including fuel Yes 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, Yes 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 Yes 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 ()of CarbonDioxide (CO) 2 ___________Tons/year() of NitrousOxide (N) 2 ____ _______Tons/year() of Perfluorocarbons (PFCs) ___________Tons/year() of Sulfur Hexafluoride (SF) 6 ___________Tons/year ()of CarbonDioxide equivalent ofHydroflorocarbons (H) ___________Tons/year ()ofHazardous Air Pollutants (HAPs) Page 6 of 13 h.Will the proposed action generate or emit methane (including, but not limited to, sewage treatment plants, Yes 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 Yes 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 Yes 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 semi-trailer truck trips/day: _______________________ iii.Parking spaces: Existing _____________ Proposed ___________ Net increase/decrease _____________ iv.Does the proposed action include any shared use parking? Yes No v.If the proposed action includes any modification of existing roads, creation of new roads or change in existing access, describe: ________________________________________________________________________________________________________ ________________________________________________________________________________________________________ ________________________________________________________________________________________________________ vi.Arepublic/private transportation service(s) or facilities available within ½ mile of the proposed site? Yes No vii Will the proposed action include access to public transportation or accommodations for use of hybrid, electric Yes No or other alternative fueled vehicles? No viii.Will the proposed action include plans for pedestrian or bicycle accommodations for connections to existing Yes pedestrian or bicycle routes? k.Will the proposed action (for commercial or industrial projects only) generate new or additional demand Yes 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? Yes 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: ___________________________________ Page 7 of 13 m.Will the proposed action produce noise that will exceed existing ambient noise levels during construction, Yes No operation, or both? If yes: i.Provide details including sources, time of day and duration: _______________________________________________________________________________________________________ _______________________________________________________________________________________________________ ii.Will proposed action remove existing natural barriers that could act as a noise barrier or screen? Yes No Describe: _________________________________________________________________________________________________ _________________________________________________________________________________________________________ n.. Will the proposed action have outdoor lighting? Yes No If yes: Describe source(s), location(s), height of fixture(s), direction/aim, and proximity to nearest occupied structures: i. _________________________________________________________________________________________________________ _________________________________________________________________________________________________________ ii.Will proposed action remove existing natural barriers that could act as a light barrier or screen? Yes No Describe: _________________________________________________________________________________________________ _________________________________________________________________________________________________________ o.Does the proposed action have the potential to produce odors for more than one hour per day? Yes No If Yes, describe possible sources, potential frequency and duration of odor emissions, and proximity to nearest occupied structures: ______________________________________________________________________________________ ________________________________________________________________________________________________________ ________________________________________________________________________________________________________ p.Will theproposed action include any bulkstorageof petroleum (over1,100gallons) Yes No or chemical products? If Yes: i.Product(s) to be stored ______________________________________________________________________________________ ii.Volume(s) ______ per unit time ___________ (e.g., month, year) iii.Generally describeproposed storagefacilities ___________________________________________________________________ ________________________________________________________________________________________________________ q.Will the proposed action (commercial, industrial and recreational projects only) use pesticides (i.e., herbicides, Yes No insecticides) during construction or operation? If Yes: Describe proposed treatment(s): i. ________________________________________________________________________________________________________ ________________________________________________________________________________________________________ ________________________________________________________________________________________________________ ________________________________________________________________________________________________________ ii.Will the proposed action use Integrated Pest Management Practices? Yes No r.Will the proposed action (commercial or industrial projects only) involve or require the management or disposal Yes 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 8 of 13 s.Does the proposed action include construction or modification of a solid waste management facility? Yes No If Yes: Type of management or handling of waste proposed for the site (e.g., recycling or transfer station, composting, landfill, or i. 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 proposed action at the site involve the commercial generation, treatment, storage, or disposal of hazardous Yes 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? Yes 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. Urban Industrial Commercial Residential (suburban) Rural (non-farm) Forest Agriculture Aquatic Other (specify): ____________________________________ ii.If mix of uses, generally describe: __________________________________________________________________________________________________________ __________________________________________________________________________________________________________ b.Land uses and covertypes on the project site. Land use or Current Acreage After Change Covertype Acreage Project Completion (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 9 of 13 c.Is the project site presently used by members of the community for public recreation? Yes No i.If Yes: explain: __________________________________________________________________________________________ d.Are there any facilities serving children, the elderly, people with disabilities (e.g., schools, hospitals, licensed Yes 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? Yes 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.Dams 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, Yes 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? Yes 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 Yes 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 Yes 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 Yes No Remediation database? Check all that apply: Yes – Spills Incidents database Provide DEC ID number(s): ________________________________ Yes – Environmental Site Remediation database Provide DEC ID number(s): ________________________________ 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? Yes No If yes, provide DEC ID number(s): ______________________________________________________________________________ iv.If yes to (i), (ii) or (iii) above, describe current status of site(s): _______________________________________________________________________________________________________ _______________________________________________________________________________________________________ Page 10 of 13 v.Is the project site subject to an institutional control limiting property uses? Yes 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? Yes 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? Yes 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: Well Drained:_____%ofite Moderately Well Drained: _____% of site Poorly Drained _____%ofite f.Approximate proportion of proposed action site with slopes: 0-10%:_____% of site 10-15%: _____% of site 15% or greater: _____% of site g.Are there any unique geologic features on the project site? Yes No If Yes, describe: _____________________________________________________________________________________________ ________________________________________________________________________________________________________ h.Surface water features. i.Does any portion of the project site contain wetlands or other waterbodies (including streams, rivers, Yes No ponds or lakes)? ii.Do any wetlands or other waterbodies adjoin the project site? Yes 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, Yes No state or local agency? iv.For each identifiedwetland and waterbody on theproject site, providethefollowing information Streams:Name ____________________________________________Classification _______________________ Lakesor Ponds:Name ____________________________________________Classification_______________________ Wetlands:Name ____________________________________________Approximate Size ___________________ Wetland No. (if regulatedbyDEC) _____________________________ v.Are any of the above water bodies listed in the most recent compilation of NYS water quality-impaired Yes No waterbodies? If yes, name of impaired water body/bodies and basis for listing as impaired: _____________________________________________ ___________________________________________________________________________________________________________ i.Is the project site in a designated Floodway? Yes No j.Is the project site in the 100 year Floodplain? Yes No k.Is the project site in the 500 year Floodplain? Yes No l.Is the project site located over, or immediately adjoining, a primary, principal or sole source aquifer? Yes No If Yes: i.Name of aquifer: _________________________________________________________________________________________ Page 11 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? Yes 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 Yes 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 Yes No special concern? q.Is the project site or adjoining area currently used for hunting, trapping, fishing or shell fishing? Yes 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 Yes 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? Yes 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 Yes No Natural Landmark? If Yes: i.Nature of the natural landmark: Biological Community 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? Yes No If Yes: i.CEA name: _____________________________________________________________________________________________ ii.Basis for designation: _____________________________________________________________________________________ iii.Designating agency and date: ______________________________________________________________________________ Page 12 of 13 Full Environmental Assessment Form Part 2 - Identification of Potential Project Impacts Part 2 is to be completed by the lead agency. Part 2 is designed to help the lead agency inventory all potential resources that could be affected by a proposed project or action. We recognize that the lead agencys reviewer(s) will not necessarily be environmental professionals. So, the questions are designed to walk a reviewer through the assessment process by providing a series of questions that can be answered using the information found in Part 1. To further assist the lead agency in completing Part 2, the form identifies the most relevant questions in Part 1 that will provide the information needed to answer the Part 2 question. When Part 2 is completed, the lead agency will have identified the relevant environmental areas that may be impacted by the proposed activity. If the lead agency is a state agency and the action is in any Coastal Area, complete the Coastal Assessment Form before proceeding with this assessment. Tips for completing Part 2: Review all of the information provided in Part 1. Review any application, maps, supporting materials and the Full EAF Workbook. Answer each of the 18 questions in Part 2. If you answer “Yes” to a numbered question, please complete all the questions that follow in that section. If you answer “No” to a numbered question,move on to the next numbered question. Check appropriate column to indicate the anticipated size of the impact. Proposed projects that would exceed a numeric threshold contained in a question should result in the reviewing agency checking the box “Moderate to large impact may occur.” The reviewer is not expected to be an expert in environmental analysis. If you are not sure or undecided about the size of an impact, it may help to review the sub-questions for the general question and consult the workbook. When answering a question consider all components of the proposed activity, that is, the whole action. Consider the possibility for long-term and cumulative impacts as well as direct impacts. Answer the question in a reasonable manner considering the scale and context of the project. 1.Impact on Land Proposed action may involve construction on, or physical alteration of, NO YES the land surface of the proposed site. (See Part 1. D.1) If “Yes”, answer questions a - j. If “No”, move on to Section 2. Relevant No, or Moderate Part I small to large Question(s) impact impact may may occur occur a. The proposed action may involve construction on land where depth to water table is E2d less than 3 feet. E2f b. The proposed action may involve construction on slopes of 15% or greater. E2a c. The proposed action may involve construction on land where bedrock is exposed, or generally within 5 feet of existing ground surface. D2a d. The proposed action may involve the excavation and removal of more than 1,000 tons of natural material. D1e e. The proposed action may involve construction that continues for more than one year or in multiple phases. D2e, D2q f. The proposed action may result in increased erosion, whether from physical disturbance or vegetation removal (including from treatment by herbicides). B1i g. The proposed action is, or may be, located within a Coastal Erosion hazard area. h. Other impacts: _______________________________________________________ ___________________________________________________________________ Page1 of 10 2.Impact on Geological Features The proposed action may result in the modification or destruction of, or inhibit access to, any unique or unusual land forms on the site (e.g., cliffs, dunes, NO YES minerals, fossils, caves). (See Part 1. E.2.g) If “Yes”, answer questions a - c. If “No”, move on to Section 3. Relevant No, or Moderate Part I small to large Question(s) impact impact may may occur occur E2g a. Identify the specific land form(s) attached: ________________________________ ___________________________________________________________________ E3c b. The proposed action may affect or is adjacent to a geological feature listed as a registered National Natural Landmark. Specific feature: _____________________________________________________ c. Other impacts: ______________________________________________________ ___________________________________________________________________ 3.Impacts on Surface Water The proposed action may affect one or more wetlands or other surface water NO YES bodies (e.g., streams, rivers, ponds or lakes). (See Part 1. D.2, E.2.h) If “Yes”, answer questions a - l. If “No”, move on to Section 4. Relevant No, or Moderate Part I small to large Question(s) impact impact may may occur occur D2b, D1h a. The proposed action may create a new water body. D2b b. The proposed action may result in an increase or decrease of over 10% or more than a 10 acre increase or decrease in the surface area of any body of water. D2a c. The proposed action may involve dredging more than 100 cubic yards of material from a wetland or water body. E2h d. The proposed action may involve construction within or adjoining a freshwater or tidal wetland, or in the bed or banks of any other water body. D2a, D2h e. The proposed action may create turbidity in a waterbody, either from upland erosion, runoff or by disturbing bottom sediments. D2c f. The proposed action may include construction of one or more intake(s) for withdrawal of water from surface water. D2d g. The proposed action may include construction of one or more outfall(s) for discharge of wastewater to surface water(s). D2e h. The proposed action may cause soil erosion, or otherwise create a source of stormwater discharge that may lead to siltation or other degradation of receiving water bodies. E2h i. The proposed action may affect the water quality of any water bodies within or downstream of the site of the proposed action. D2q, E2h j. The proposed action may involve the application of pesticides or herbicides in or around any water body. k. The proposed action may require the construction of new, or expansion of existing, D1a, D2d wastewater treatment facilities. Page2 of 10 l.Other impacts: _______________________________________________________ ___________________________________________________________________ 4.Impact on groundwater The proposed action may result in new or additional use of ground water, or NO YES may have the potential to introduce contaminants to ground water or an aquifer. (See Part 1. D.2.a, D.2.c, D.2.d, D.2.p, D.2.q, D.2.t) If “Yes”, answer questions a - h. If “No”, move on to Section 5. Relevant No, or Moderate Part I small to large Question(s) impact impact may may occur occur D2c a.The proposed action may require new water supply wells, or create additional demand on supplies from existing water supply wells. D2c b.Water supply demand from the proposed action may exceed safe and sustainable withdrawal capacity rate of the local supply or aquifer. Cite Source: ________________________________________________________ c.The proposed action may allow or result in residential uses in areas without water andD1a, D2c sewer services. D2d, E2l d.The proposed action may include or require wastewater discharged to groundwater. e.The proposed action may result in the construction of water supply wells in locationsD2c, E1f, where groundwater is, or is suspected to be, contaminated.E1g, E1h D2p, E2l f.The proposed action may require the bulk storage of petroleum or chemical products over ground water or an aquifer. E2h, D2q, g.The proposed action may involve the commercial application of pesticides within 100 E2l, D2c feet of potable drinking water or irrigation sources. h.Other impacts: ______________________________________________________ __________________________________________________________________ 5.Impact on Flooding The proposed action may result in development on lands subject to flooding. NO YES (See Part 1. E.2) If “Yes”, answer questions a - g. If “No”, move on to Section 6. Relevant No, or Moderate Part I small to large Question(s) impact impact may may occur occur E2i a.The proposed action may result in development in a designated floodway. E2j b.The proposed action may result in development within a 100 year floodplain. E2k c.The proposed action may result in development within a 500 year floodplain. D2b, D2e d.The proposed action may result in, or require, modification of existing drainage patterns. D2b, E2i, e.The proposed action may change flood water flows that contribute to flooding. E2j, E2k E1e f.If there is adam locatedon thesiteof theproposed action, dam Page3 of 10 g.Other impacts: ______________________________________________________ ___________________________________________________________________ 6.Impacts on Air The proposed action may include a state regulated air emission source. NO YES (See Part 1. D.2.f., D,2,h, D.2.g) If “Yes”, answer questions a - f. If “No”, move on to Section 7. Relevant No, or Moderate Part I small to large Question(s) impact impact may may occur occur a.If the proposed action requires federal or state air emission permits, the action may also emit one or more greenhouse gases at or above the following levels: D2g i.More than 1000 tons/year of carbon dioxide (CO) 2 D2g ii.More than 3.5 tons/year ofnitrousoxide (N) 2 D2g iii.More than 1000 tons/year of carbon equivalent of perfluorocarbons (PFCs) D2g iv.More than .045 tons/year of sulfur hexafluoride (SF) 6 D2g v.More than 1000 tons/year of carbon dioxide equivalent of hydrochloroflurocarbons (HFCs)emissions D2h vi.43 tons/year or more of methane D2g b.The proposed action may generate 10 tons/year or more of any one designated hazardous air pollutant, or 25 tons/year or more of any combination of such hazardous air pollutants. c.The proposed action may require a state air registration, or may produce an emissions D2f, D2g rate of total contaminants that may exceed 5 lbs. per hour, or may include a heat source capable of producing more than 10 million BTUs per hour. D d.Theproposedaction may reach 50%of any of the thresholds in “a”through “c”, above. D2s e.The proposed action may result in the combustion or thermal treatment of more than 1 ton of refuse per hour. f.Other impacts: ______________________________________________________ __________________________________________________________________ 7.Impact on Plants and Animals The proposed action may result in a loss of flora or fauna. (See Part 1. E.2. m.-q.) NO YES If “Yes”, answer questions a - j. If “No”, move on to Section 8. Relevant No, or Moderate Part I small to large Question(s) impact impact may may occur occur E2o a.The proposed action may cause reduction in population or loss of individuals of any threatened or endangered species, as listed by New York State or the Federal government, that use the site, or are found on, over, or near the site. E2o b.The proposed action may result in a reduction or degradation of any habitat used by any rare, threatened or endangered species, as listed by New York State or the federal government. E2p c.The proposed action may cause reduction in population, or loss of individuals, of any species of special concern or conservation need, as listed by New York State or the Federal government, that use the site, or are found on, over, or near the site. E2p d.The proposed action may result in a reduction or degradation of any habitat used by any species of special concern and conservation need, as listed by New York State or the Federal government. Page4 of 10 E3c e. The proposed action may diminish the capacity of a registered National Natural Landmark to support the biological community it was established to protect. E2n f. The proposed action may result in the removal of, or ground disturbance in, any portion of a designated significant natural community. Source: ____________________________________________________________ g. The proposed action may substantially interfere with nesting/breeding, foraging, or E2m over-wintering habitat for the predominant species that occupy or use the project site. h. The proposed action requires the conversion of more than 10 acres of forest, E1b grassland or any other regionally or locally important habitat. Habitat type & information source: ______________________________________ __________________________________________________________________ D2q i. Proposed action (commercial, industrial or recreational projects, only) involves use of herbicides or pesticides. j. Other impacts: ______________________________________________________ __________________________________________________________________ 8.Impact on Agricultural Resources The proposed action may impact agricultural resources. (See Part 1. E.3.a. and b.) NO YES If “Yes”, answer questions a - h. If “No”, move on to Section 9. Relevant No, or Moderate Part I small to large Question(s) impact impact may may occur occur a. The proposed action may impact soil classified within soil group 1 through 4 of the E2c, E3b NYS Land Classification System. E1a, Elb b. The proposed action may sever, cross or otherwise limit access to agricultural land (includes cropland, hayfields, pasture, vineyard, orchard, etc). E3b c. The proposed action may result in the excavation or compaction of the soil profile of active agricultural land. E1b, E3a d. The proposed action may irreversibly convert agricultural land to non-agricultural uses, either more than 2.5 acres if located in an Agricultural District, or more than 10 acres if not within an Agricultural District. El a, E1b e. The proposed action may disrupt or prevent installation of an agricultural land management system. C2c, C3, f. The proposed action may result, directly or indirectly, in increased development D2c, D2d potential or pressure on farmland. C2c g. The proposed project is not consistent with the adopted municipal Farmland Protection Plan. h. Other impacts: ________________________________________________________ Page5 of 10 9. Impact on Aesthetic Resources The land use of the proposed action are obviously different from, or are in NO YES sharp contrast to, current land use patterns between the proposed project and a scenic or aesthetic resource. (Part 1. E.1.a, E.1.b, E.3.h.) If “Yes”, answer questions a - g. If “No”, go to Section 10. Relevant No, or Moderate Part I small to large Question(s) impact impact may may occur occur E3h a. Proposed action may be visible from any officially designated federal, state, or local scenic or aesthetic resource. E3h, C2b b. The proposed action may result in the obstruction, elimination or significant screening of one or more officially designated scenic views. E3h c. The proposed action may be visible from publicly accessible vantage points: i. Seasonally (e.g., screened by summer foliage, but visible during other seasons) ii. Year round E3h d. The situation or activity in which viewers are engaged while viewing the proposed action is: E2q, i. Routine travel by residents, including travel to and from work E1c ii. Recreational or tourism based activities E3h e. The proposed action may cause a diminishment of the public enjoyment and appreciation of the designated aesthetic resource. D1a, E1a, f. There are similar projects visible within the following distance of the proposed D1f, D1g project: 0-1/2 mile ½ -3 mile 3-5 mile 5+ mile g. Other impacts: ______________________________________________________ __________________________________________________________________ 10. Impact on Historic and Archeological Resources The proposed action may occur in or adjacent to a historic or archaeological NO YES resource. (Part 1. E.3.e, f. and g.) If “Yes”, answer questions a - e. If “No”, go to Section 11. Relevant No, or Moderate Part I small to large Question(s) impact impact may may occur occur E3e a. The proposed action may occur wholly or partially within, or substantially contiguous to, any buildings, archaeological site or district which is listed on or has been nominated by the NYS Board of Historic Preservation for inclusion on the State or National Register of Historic Places. E3f b. The proposed action may occur wholly or partially within, or substantially contiguous to, an area designated as sensitive for archaeological sites on the NY State Historic Preservation Office (SHPO) archaeological site inventory. E3g c. The proposed action may occur wholly or partially within, or substantially contiguous to, an archaeological site not included on the NY SHPO inventory. Source: ____________________________________________________________ Page6 of 10 d.Other impacts: ______________________________________________________ __________________________________________________________________ e.If any of the above (a-d) are answered “Yes”, continue with the following questions to help support conclusions in Part 3: i.The proposed action may result in the destruction or alteration of all or part E3e, E3g, of the site or property. E3f ii.The proposed action may result in the alteration of the property’s setting or E3e, E3f, integrity. E3g, E1a, E1b E3e, E3f, iii.The proposed action may result in the introduction of visual elements which E3g, E3h, are out of character with the site or property, or may alter its setting. C2, C3 11.Impact on Open Space and Recreation The proposed action may result in a loss of recreational opportunities or a NO YES reduction of an open space resource as designated in any adopted municipal open space plan. (See Part 1. C.2.c, E.1.c., E.2.q.) If “Yes”, answer questions a - e. If “No”, go to Section 12. Relevant No, or Moderate Part I small to large Question(s) impact impact may may occur occur D2e, E1b a.The proposed action may result in an impairment of natural functions, or “ecosystem E2h, services”, provided by an undeveloped area, including but not limited to stormwater E2m, E2o, storage, nutrient cycling, wildlife habitat. E2n, E2p C2a, E1c, b.The proposed action may result in the loss of a current or future recreational resource. C2c, E2q C2a, C2c c.The proposed action may eliminate open space or recreational resource in an area E1c, E2q with few such resources. C2c, E1c d.The proposed action may result in loss of an area now used informally by the community as an open space resource. e.Other impacts: _____________________________________________________ _________________________________________________________________ 12.Impact on Critical Environmental Areas The proposed action may be located within or adjacent to a critical NO YES environmental area (CEA). (See Part 1. E.3.d) If “Yes”, answer questions a - c. If “No”, go to Section 13. Relevant No, or Moderate Part I small to large Question(s) impact impact may may occur occur E3d a.The proposed action may result in a reduction in the quantity of the resource or characteristic which was the basis for designation of the CEA. E3d b.The proposed action may result in a reduction in the quality of the resource or characteristic which was the basis for designation of the CEA. c.Other impacts: ______________________________________________________ __________________________________________________________________ Page7 of 10 13.Impact on Transportation The proposed action may result in a change to existing transportation systems. NO YES (See Part 1. D.2.j) If “Yes”, answer questions a - g. If “No”, go to Section 14. Relevant No, or Moderate Part I small to large Question(s) impact impact may may occur occur D2j a.Projected traffic increase may exceed capacity of existing road network. D2j b.The proposed action may result in the construction of paved parking area for 500 or more vehicles. D2j c.The proposed action will degrade existing transit access. D2j d.The proposed action will degrade existing pedestrian or bicycle accommodations. D2j .The proposed action may alter the present pattern of movement of people or goods. .Other impacts: ______________________________________________________ __________________________________________________________________ 14.Impact on Energy The proposed action may cause an increase in the use of any form of energy. NO YES (See Part 1. D.2.k) If “Yes”, answer questions a - e. If “No”, go to Section 15. Relevant No, or Moderate Part I small to large Question(s) impact impact may may occur occur a.The proposed action will require a new, or an upgrade to an existing, substation.D2k b.The proposed action will require the creation or extension of an energy transmission D1f, or supply system to serve more than 50 single or two-family residences or to serve aD1q, D2k commercial or industrial use. D2k c.The proposed action may utilize more than 2,500 MWhrs per year of electricity. D1g d.The proposed action may involve heating and/or cooling of more than 100,000 square feet of building area when completed. e.Other Impacts: ________________________________________________________ ____________________________________________________________________ 15.Impact on Noise, Odor, and Light The proposed action may result in an increase in noise, odors, or outdoor lighting. NO YES (See Part 1. D.2.m., n., and o.) If “Yes”, answer questions a - f. If “No”, go to Section 16. Relevant No, or Moderate Part I small to large Question(s) impact impact may may occur occur D2m a.The proposed action may produce sound above noise levels established by local regulation. D2m, E1d b.The proposed action may result in blasting within 1,500 feet of any residence, hospital, school, licensed day care center, or nursing home. c.The proposed action may result in routine odors for more than one hour per day.D2o Page8 of 10 D2n d.The proposed action may result in light shining onto adjoining properties. D2n, E1a e.The proposed action may result in lighting creating sky-glow brighter than existing area conditions. f.Other impacts: ______________________________________________________ __________________________________________________________________ 16.Impact on Human Health The proposed action may have an impact on human health from exposure NO YES to new or existing sources of contaminants. (See Part 1.D.2.q., E.1. d. f. g. and h.) If “Yes”, answer questions a - m. If “No”, go to Section 17. Relevant No,or Moderate Part I small to large Question(s) impact impact may may cccur occur a.The proposed action is located within 1500 feet of a school, hospital, licensed dayE1d care center, group home, nursing home or retirement community. E1g, E1h b.The site of the proposed action is currently undergoing remediation. E1g, E1h c.There is a completed emergency spill remediation, or a completed environmental site remediation on, or adjacent to, the site of the proposed action. E1g, E1h d.The site of the actionissubjectto an institutionalcontrol limiting the use of the property (e.g.easementdeedrestriction) E1g, E1h e.The proposed action may affect institutional control measures that were put in place to ensure that the site remains protective of the environment and human health. D2t f.The proposed action has adequate control measures in place to ensure that future generation, treatment and/or disposal of hazardous wastes will be protective of the environment and human health. D2q, E1f g.The proposed action involves construction or modification of a solid waste management facility. D2q, E1f h.The proposed action may result in the unearthing of solid or hazardous waste. D2r, D2s i.The proposed action may result in an increase in the rate of disposal, or processing, of solid waste. E1f, E1g j.The proposed action may result in excavation or other disturbance within 2000 feet of E1h a site used for the disposal of solid or hazardous waste. E1f, E1g k.The proposed action may result in the migration of explosive gases from a landfill site to adjacent off site structures. D2s, E1f, l.The proposed action may result in the release of contaminated leachate from the D2r project site. m.Other impacts: ______________________________________________________ __________________________________________________________________ Page9 of 10 Full Environmental Assessment Form Part 3 - Evaluation of the Magnitude and Importance of Project Impacts and Determination of Significance Part 3 provides the reasons in support of the determination of significance. The lead agency must complete Part 3 for every question in Part 2 where the impact has been identified as potentially moderate to large or where there is a need to explain why a particular element of the proposed action will not, or may, result in a significant adverse environmental impact. Based on the analysis in Part 3, the lead agency must decide whether to require an environmental impact statement to further assess the proposed action or whether available information is sufficient for the lead agency to conclude that the proposed action will not have a significant adverse environmental impact. By completing the certification on the next page, the lead agency can complete its determination of significance. Reasons Supporting This Determination: To complete this section: Identify the impact based on the Part 2 responses and describe its magnitude. Magnitude considers factors such as severity, size or extent of an impact. Assess the importance of the impact. Importance relates to the geographic scope, duration, probability of the impact occurring, number of people affected by the impact and any additional environmental consequences if the impact were to occur. The assessment should take into consideration any design element or project changes. Repeat this process for each Part 2 question where the impact has been identified as potentially moderate to large or where there is a need to explain why a particular element of the proposed action will not, or may, result in a significant adverse environmental impact. Provide the reason(s) why the impact may, or will not, result in a significant adverse environmental impact For Conditional Negative Declarations identify the specific condition(s) imposed that will modify the proposed action so that no significant adverse environmental impacts will result. Attach additional sheets, as needed. Determination of Significance - Type 1 and Unlisted Actions SEQR Status: Type 1 Unlisted Identify portions of EAF completed for this Project: Part 1 Part 2 Part 3 Upon review of the information recorded on this EAF, as noted, plus this additional support information and considering both the magnitude and importance of each identified potential impact, it is the conclusion of the as lead agency that: A. This project will result in no significant adverse impacts on the environment, and, therefore, an environmental impact statement need not be prepared. Accordingly, this negative declaration is issued. B. Although this project could have a significant adverse impact on the environment, that impact will be avoided or substantially mitigated because of the following conditions which will be required by the lead agency: There will, therefore, be no significant adverse impacts from the project as conditioned, and, therefore, this conditioned negative declaration is issued. A conditioned negative declaration may be used only for UNLISTED actions (see 6 NYCRR 617.d). C. This Project may result in one or more significant adverse impacts on the environment, and an environmental impact statement must be prepared to further assess the impact(s) and possible mitigation and to explore alternatives to avoid or reduce those impacts. Accordingly, this positive declaration is issued. Name of Action: Name of Lead Agency: Name of Responsible Officer in Lead Agency: Title of Responsible Officer: Signature of Responsible Officer in Lead Agency: Date: Signature of Preparer (if different from Responsible Officer) Date: For Further Information: Contact Person: 518-932-1750 Address: Telephone Number: E-mail: For Type 1 Actions and Conditioned Negative Declarations, a copy of this Notice is sent to: Chief Executive Officer of the political subdivision in which the action will be principally located (e.g., Town / City / Village of) Other involved agencies (if any) Applicant (if any) Environmental Notice Bulletin: http://www.dec.ny.gov/enb/enb.html 17. Consistency with Community Plans The proposed action is not consistent with adopted land use plans. NO YES (See Part 1. C.1, C.2. and C.3.) If “Yes”, answer questions a - h. If “No”, go to Section 18. Relevant No, or Moderate Part I small to large Question(s) impact impact may may occur occur C2, C3, D1a a. The proposed action’s land use components may be different from, or in sharp E1a, E1b contrast to, current surrounding land use pattern(s). C2 b. The proposed action will cause the permanent population of the city, town or village in which the project is located to grow by more than 5%. C2, C2, C3 c. The proposed action is inconsistent with local land use plans or zoning regulations. C2, C2 d. The proposed action is inconsistent with any County plans, or other regional land use plans. C3, D1c, e. The proposed action may cause a change in the density of development that is not D1d, D1f, supported by existing infrastructure or is distant from existing infrastructure. D1d, Elb C4, D2c, D2d f. The proposed action is located in an area characterized by low density development D2j that will require new or expanded public infrastructure. C2a g. The proposed action may induce secondary development impacts (e.g., residential or commercial development not included in the proposed action) h. Other: _____________________________________________________________ __________________________________________________________________ 18. Consistency with Community Character The proposed project is inconsistent with the existing community character. NO YES (See Part 1. C.2, C.3, D.2, E.3) If “Yes”, answer questions a - g. If “No”, proceed to Part 3. Relevant No, or Moderate Part I small to large Question(s) impact impact may may occur occur E3e, E3f, E3g a. The proposed action may replace or eliminate existing facilities, structures, or areas of historic importance to the community. C4 b. The proposed action may create a demand for additional community services (e.g. schools, police and fire) C2, C3, D1f c. The proposed action may displace affordable or low-income housing in an area where D1g, E1a there is a shortage of such housing. C2, E3 d. The proposed action may interfere with the use or enjoyment of officially recognized or designated public resources. C2, C3 e. The proposed action is inconsistent with the predominant architectural scale and character. C2, C3 f. Proposed action is inconsistent with the character of the existing natural landscape. E1a, E1b E2g, E2h g. Other impacts: ______________________________________________________ __________________________________________________________________ PRINTFULLFORM Page10 of 10