HomeMy WebLinkAbout20200229 Neumann Building Verizon Wireless EAF 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 fu11y 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 fu11y develop that information.
Applicants/sponsors must complete a11 items in Sections A&B. In Sections C,D&E,most items contain an initial question that
must be answered either"�es"or"No". If the answer to the initial question is"�es",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 1 is accurate and complete.
A.Project and Sponsor lnformation.
Name of Action or Project:
Verizan Wireless-Oklahama Track-Unmanned Wireless Cammunicatian Facility
Project Location{describe,and attach a generallocation map):
233 Lake Rvenue,City af Sarataga Springs,Sarataga Caunty,New Yark 12866
Brief Description of Proposed Action{include purpose or need):
Cellca Partnership,dlbla Verizan Wireless("Verizan Wireless"ar the"RpplicanY')prapases the installatian af an unmanned wireless cammunicatians
facility lacated an the existing praperty.Said praperty being lacated an Lake Rvenue appraximately 0.06 miles east af Excelsiar Springs Rvenue.Rccess ta
the prapased facility will ariginate fram Lake Rvenue utilizing the existing paved access raad.
In general,the installatian will cansist af the fallawing:twelve(12)antennas ta be maunted ta the penthause walls af the existing 42.6'±tall building at a
center-line height af 47',twa(2)equipment cabinets and related utility and RF equipment maunted ta the penthause walls,and all related caaxial cabling
and utility services(pawer and telephane).
Name of Applicant/Sponsor: Telephone:t�g�����_�q,��
Cellca Partnership,dlbla Verizan Wireless E-Mail:
Kathy.Pampania@Verizan Wireless.cam
Address:�275 Jahn Street,Suite#100
City/PO:�est Henrietta State: Zip Code:
New Yark 14586
Project Contact{if not same as sponsor;give name and title/role): Telephone:�������g_��gg
David C. Brennan,Esq.,YaunglSammer LLC E-Mail:DBrennan@yaungsammer.cam
Address:
Executive Waads, Five Palisades Drive
City/PO: State: Zip Code:
Rlbany New Yark 12205
Property Owner {if not same as sponsor): Telephone:
Neumann Building LLC E-Mail:
Address:
18 Divisian St Ste 401
City/PO: State: Zip Code:
Sarataga Springs NY 12866
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B.Government Approvals
B.Government Approvals,Funding,or Sponsorship. {"Funding"includes grants,loans,tax relief,and any other forms of fmancial
assistance.)
Government Entity If Yes: Identify Agency and Approval{s) Application Date
Required {Actual or projected)
a.City Council,Town Board, ❑�es�No
or Village Board of Trustees
b.City,Town or Village �Yes❑No Planning Baard-Special Use Permit TBD
Planning Board or Commission
c.City Council,Town or ❑�es�No
Village Zoning Board of Appeals
d.Other 1oca1 agencies �Yes❑No Building Department-Building Permit TBD
Design Review Cammissian-Rrchitectural Review
e.County agencies �Yes❑No Caunty Planning Baard-239-m referral TBD
£Regional agencies ❑�es�No
g. State agencies ❑�es�No
h.Federal agencies ❑�es�No
i. Coastal Resources.
i. Is the project site within a Coastal Area,or the waterfront area of a Designated Inland Waterway? ❑�es�No
ii. Is the project site located in a community with an approved Loca1 Waterfront Revitalization Program? ❑�es�No
iii. Is the project site within a Coastal Erosion I�azard Area? ❑�es�No
C.Planning and Zoning
C.1.Planning and zoning actions.
Wi11 administrative or legislative adoption,or amendment of a p1an,1oca11aw,ordinance,rule or regulation be the ❑�es�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 a11 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 ��es❑No
where the proposed action would be located?
If�es,does the comprehensive plan include specific recommendations for the site where the proposed action ❑�es�No
would be located?
b.Is the site of the proposed action within any 1oca1 or regional special planning district{for example: Greenway ��es❑No
Brownfield Opportunity Area{BOA);designated State or Federal heritage area;watershed management p1an;
or other?)
If�es,identify the plan{s):
NYS Majar Basins:U�per Susquehanna
c. Is the proposed action located whol]y or partially within an area]isted in an adopted municipa] open space p1an, ❑Yes�No
or an adopted municipa] farmland protection plan?
If I�es,identify the plan{s):
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C.3. Zoning
a. Is the site of the proposed action located in a municipality with an adopted zoning 1aw or ordinance. ��es❑No
If�es,what is the zoning classification{s) including any applicable overlay district?
UR-1 -Urban Residential-1
b. Is the use permitted or allowed by a special or conditional use permit? ��es❑No
c.Is a zoning change requested as part of the proposed action? ❑�es�No
If�es,
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? Sarataqa Sprinqs City Schaal District
b.What police or other public protection forces serve the project site?
Sarataga Springs Palice Department
c.Which fire protection and emergency medical services serve the project site?
Sarataga Springs Fire Department
d.What parks serve the project site?
East Side Recreatianal Park
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 a11
components)? Unmanned public utilitylpersonal wireless service facility
b.a.Tota1 acreage of the site of the proposed action? 11,27 acres
b.Tota1 acreage to be physically disturbed? p acres
c.Tota1 acreage{project site and any contiguous properties)owned
or controlled by the applicant or project sponsor? 0 acres
c.Is the proposed action an expansion of an existing project or use? ❑�es�No
i. If�es,what is the approximate percentage of the proposed expansion and identify the units{e.g.,acres,miles,housing units,
square feet)? °lo Units:
d.Is the proposed action a subdivision,or does it include a subdivision? ❑�es�No
If�es,
i. Purpose or type of subdivision?{e.g.,residential,industrial,commercial; if mixed,specify types)
ii. Is a cluster/conservation layout proposed? ❑�es❑No
iii. Number of lots proposed?
iv. Minimum and maximum proposed 1ot sizes? Minimum Maximum
e.Wi11 proposed action be constructed in multiple phases? ❑�es�No
i. If No,anticipated period of construction: 2 months
ii. If�es:
• Tota1 number of phases anticipated
• Anticipated commencement date of phase 1 {including demolition) month year
• Anticipated completion date of fmal 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 af 13
£Does the project include new residential uses? ❑�es�No
If Yes,show numbers of units proposed.
One Familv Two Familv Three Familv Mu1ti 1e Familv four or more
Initial Phase
At completion
of a11 phases
g.Does the proposed action include new non-residential construction{including expansions)? ��es❑No
If�es,
i.Tota1 number of structures 12
ii. Dimensions{in feet)of largest proposed structure: 8' height; �'width; and length
iii. Approximate extent of building space to be heated or cooled: 0 square feet
h.Does the proposed action include construction or other activities that wi11 result in the impoundment of any ❑�es�No
liquids,such as creation of a water supply,reservoir,pond,1ake,waste lagoon or other storage?
If�es,
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 fi11,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 a11 excavated
materials wi11 remain onsite)
If�es:
i.What is the purpose of the excavation or dredging?
ii. I�ow 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 excauated or dredged,and plans to use,manage or dispose of them.
iv. Wi11 there be onsite dewatering or processing of excauated materials? ��es�No
If yes,describe.
v. What is the total area to be dredged or excauated? 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. Wi11 the excavation require blasting? ��es�No
ix. Summarize site reclamation goals and p1an:
b.Wou1d�he proposed action cause or result in alteration of,increase or decrease in size of,or encroachment �I�es�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):
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ii. Describe how the proposed action would affect that waterbody or wetland,e.g.excavation,fi11,placement of structures,or
alteration of channels,banks and shorelines. Indicate extent of activities,alterations and additions in square feet or acres:
iii. Wi11 proposed action cause or result in disturbance to bottom sediments? ❑�es❑No
If�es,describe:
iv. Wi11 proposed action cause or result in the destruction or removal of aquatic vegetation? ❑�es❑No
If�es:
• acres of aquatic vegetation proposed to be removed:
• expected acreage of aquatic vegetation remaining after project completion:
• purpose of proposed removal{e.g.beach clearing,invasive species control,boat access):
• proposed method of plant removal:
• if chemical/herbicide treatment wi11 be used,specify product(s):
v.Describe any proposed reclamation/mitigation following disturbance:
c.Wi11 the proposed action use,or create a new demand for water? ❑�es�IVo
If�es:
i. Tota1 anticipated water usage/demand per day: gallons/day
ii. Wi11 the proposed action obtain water from an existing public water supply? ❑�es❑[Vo
If�es:
• Name of district or service area:
• Does the existing public water supply have capacity to serve the proposal? ❑�es❑No
• Is the project site in the existing district? ❑�es❑No
• Is expansion of the district needed? ❑�es❑No
• Do existing lines serve the project site? ❑�es❑No
iii. Wi111ine extension within an existing district be necessary to supply the project? ❑�es❑[Vo
If�es:
• Describe extensions or capacity expansions proposed to serve this project:
• Source(s)of supply for the district:
iv. Is a new water supply district or service area proposed to be formed to serve the project site? ❑ �es❑No
If,�es:
• Applicant/sponsor for new district:
• Date application submitted or anticipated:
• Proposed source(s)of supply for new district:
v. If a public water supply wi11 not be used,describe plans to provide water supply for the project:
vi.If water supply wi11 be from we11s{public or private),maximum pumping capacity: gallons/minute.
d.W i11 the proposed action generate liquid wastes? ❑�es�No
If�es:
i. Tota1 anticipated liquid waste generation per day: gallons/day
ii. Nature of liquid wastes to be generated{e.g.,sanitary wastewater,industrial; if combination,describe a11 components and
approximate volumes or proportions of each):
iii. Wi11 the proposed action use any existing public wastewater treafiment facilities? ❑�es❑No
If Yes:
• Name of wastewater treatment plant to be used:
• Name of district:
• Does the existing wastewater treatment plant haue capacity to serve the project? ❑�es❑No
• Is the project site in the existing district? ❑�es❑No
• Is expansion of the district needed? ❑�es❑No
Page 5 af 13
• Do existing sewer lines serve the project site? ❑�es❑No
• Wi111ine extension within an existing district be necessary to serve the project? ❑�es❑No
If�es:
• Describe extensions or capacity expansions proposed to serve this project:
iv. Wi11 a new wastewater{sewage)treatment district be formed to serve the project site? ❑�es❑No
If�es:
• Applicant/sponsor for new district:
• Date application submitted or anticipated:
• What is the receiving water for the wastewater discharge?
v. If public facilities wi11 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.Wi11 the proposed action disturb more than one acre and create stormwater runoff,either from new point ❑�es�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�es:
i.I�ow much impervious surface wi11 the project create in relation to total size of project parcel?
Square feet or acres{impervious surface)
Square feet or acres{parcel size)
ii. Describe types of new point sources.
iii. Where wi11 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:
• Wi11 stormwater runoff flow to adjacent properties? ❑�es❑No
iv. Does proposed plan minimize impervious surfaces,use pervious materials or collect and re-use stormwater? ❑�es❑No
£ Does the proposed action include,or wi11 it use on-site,one or more sources of air emissions,including fuel ��es❑No
combustion,waste incineration,or other processes or operations?
If�es,identify:
i.Mobile sources during project operations{e.g.,heauy equipment,fleet or delivery vehicles)
Canstructian Equipment
ii. Stationary sources during construction{e.g.,power generation,structural heating,batch plant,crushers)
NiR
iii. Stationary sources during operations{e.g.,process emissions,large boilers,electric generation)
NiR
g.Wi11 any air emission sources named in D.2.f{above),require a N�State Air Registration,Air Facility Permit, ❑�es�No
or Federal C1ean Air Act Tit1e IV or Tit1e V Permit?
If�es:
i. Is�he project site located in an Air quality non-attainment area? {Area routinely or periodically fails to meet ❑�es❑No
ambient air quality standards for a11 or some parts of the year)
ii. In addition to emissions as calculated in�he application,the project wi11 generate:
• Tons/year{short tons)of Carbon Dioxide{COz)
• Tons/year{short tons)of Nitrous Oxide{Nz0)
• Tons/year{short tons)of Perfluorocarbons{PFCs)
• Tons/year{short tons)of Sulfur I�exafluoride{SF6)
• Tons/year{short tons)of Carbon Dioxide equivalent of I Iydroflourocarbons{HFCs)
• Tons/year{short tons)of I�azardous Air Pollutants{HAPs)
Page 6 af 13
h.Wi11 the proposed action generate or emit methane{including,but not limited to,sewage treatment plants, ❑�es�No
landfills,composting facilities)?
If�es:
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.W i11 the proposed action result in the release of air pollutants from open-air operations or processes,such as ❑�es�No
quarry or landfill operations?
If�es:Describe operations and nature of emissions{e.g.,diesel exhaust,rock particulates/dust):
j.Wi11 the proposed action result in a substantial increase in traffic above present 1evels or generate substantial ��es�No
new demand for transportation facilities or services?
If�es:
i. When is the peak traffic expected{Check a11 that apply): ❑Morning ❑Evening ❑Weekend
❑Randomly between hours of to
ii. For commercial activities on1y,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? ��es�No
v. If the proposed action includes any modification of existing roads,creation of new roads or change in existing access,describe:
vi. Are public/private transportation service{s)or facilities available within`l2 mile of the proposed site? ��es�No
vii W i11 the proposed action include access to public transportation or accommodations for use of hybrid,electric ❑�es❑No
or other alternative fueled vehicles?
viii.Wi11 the proposed action include plans for pedestrian or bicycle accommodations for connections to existing ❑�es❑No
pedestrian or bicycle routes?
k.Wi11 the proposed action{for commercial or industrial projects only)generate new or additional demand ❑�es�No
for energy?
If�es:
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/1oca1 utility,or
other):
iii. Wi11 the proposed action require a new,or an upgrade to,an existing substation? ❑�es❑No
L I�ours of operation. Answer a11 items which apply.
i.During Construction: ii. During Operations:
• Monday-Friday: 8-5 • Monday-Friday: 2a no��rs
• Saturday: • Saturday: 24 haurs
• Sunday: • Sunday: 24 haurs
• �Iolidays: • �Iolidays: 24 haurs
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m.Wi11 the proposed action produce noise that wi11 exceed existing ambient noise 1evels during construction, ��es❑No
operation,or both?
If yes:
i. Provide details including sources,time of day and duration:
During canstructian,naise assaciated with the aperatian af canstructian equipment.
ii. Wi11 proposed action remove existing natural barriers that could act as a noise barrier or screen? ❑�es�No
Describe:
n.. Wi11 the proposed action have outdoor lighting? m�es❑No
If yes:
i. Describe source{s),location{s),height of fixture{s),direction/aim,and proximity to nearest occupied structures:
One(1)switch aperated LED wark liqht with timer,desiqned ta illuminate the area araund the equipment cabinets anly.
ii. W i11 proposed action remove existing natural barriers that could act as a light barrier or screen? ❑�es�No
Describe:
o.Does the proposed action haue the potential to produce odors for more than one hour per day? ❑�es�No
If�es,describe possible sources,potential frequency and duration of odor emissions,and proximity to nearest
occupied structures:
p.Wi11 the proposed action include any bulk storage of petroleum{combined capacity of over 1,100 gallons) ❑�es mNo
or chemical products 185 gallons in above ground storage or any amount in underground storage?
If�es:
i. Product{s)to be stored
ii. Volume{s) per unit time {e.g.,month,year)
iii. Generally describe proposed storage facilities:
q.Wi11 the proposed action{commercial,industrial and recreational projects only)use pesticides{i.e.,herbicides, ❑�es mNo
insecticides)during construction or operation?
If�es:
i. Describe proposed treatment(s):
ii. Wi11 the ro osed action use Inte ated Pest Mana ement Practices? ❑ �es ❑No
r.Wi11 the proposed action{commercial or industrial projects only)involve or require the management or disposal ❑ �es mNo
of solid waste{excluding hazardous materials)?
If�es:
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 af 13
s.Does the proposed action include construction or modification of a solid waste management facility? ❑ �es� No
If�es:
i. Type of management or handling of waste proposed for the site{e.g.,recycling or transfer station,composting,landfill,or
other disposal activities):
ii. Anticipated rate of disposal/processing:
• Tons/month,if transfer or other non-combustion/thermal treatment,or
• Tons/hour,if combustion or thermal treatment
iii. If landfill,anticipated site 1ife: years
t.Wi11 proposed action at the site involve the commercial generation,treafiment,storage,or disposal of hazardous ❑�es�No
waste?
If�es:
i. Name{s)of a11 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. Wi11 any hazardous wastes be disposed at an existing offsite hazardous waste facility? ❑�es❑No
If�es:provide name and location of facility:
If No: describe proposed management of any hazardous wastes which wi11 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 a11 uses that occur on,adjoining and near the project site.
❑ Urban ❑ Industrial ❑ Commercial � Residential{suburban) ❑ Rura1{non-farm)
� Forest ❑ Agriculture ❑ Aquatic � Other{specify):Reliqious, Park
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 4.17 4.17 0.0
• Forested 6.10 6.10 0.0
• Meadows,grasslands or brushlands{non-
agricultural,including abandoned agricultural) �.00 1.00 0.0
• Agricultural
{includes active orchards,field,greenhouse etc.)
• Surface water features
{lakes,ponds,s�reams,rivers,etc.)
• Wetlands{freshwater or tidal)
• Non-vegetated{bare rock,earth or fi11)
• Other
Describe:
Page 9 af 13
c.Is the project site presently used by members of the community for public recreation? ❑�es✓❑No
i. If�es: explain:
d.Are there any facilities serving children,the elderly,people with disabilities{e.g.,schools,hospitals,licensed ��es❑No
day care centers,or group homes)within 1500 feet of the project site?
If�es,
i. Identify Facilities:
St.Clements Regianal Cathalic Schaal
e.Does the project site contain an existing dam? ❑�es�No
If�es:
i. Dimensions of the dam and impoundment:
• Dam height: feet
• Dam length: feet
• Surface area: acres
• Volume impounded: gallons OR acre-feet
ii. Dam's existing hazard classification:
iii.Provide date and summarize results of last inspection:
£I�as the project site ever been used as a municipal,commercial or industrial solid waste management facility, ❑�es�No
or does the project site adjoin property which is now,or was at one time,used as a solid waste management facility?
If�es:
i. I�as the facility been formally closed? ❑�es❑ 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.I�aue hazardous wastes been generated,treated and/or disposed of at the site,or does the project site adjoin ❑�es�No
property which is now or was at one time used to commercially treat,store and/or dispose of hazardous waste?
If�es:
i.Describe waste(s)handled and waste management activities,including approximate time when activities occurred:
h. Potential contamination history. I�as there been a reported spi11 at the proposed project site,or haue any ❑�es� No
remedial actions been conducted at or adjacent to the proposed site?
If�es:
i. Is any portion of the site listed on the N�SDEC Spi11s Incidents database or Environmental Site ❑�es❑No
Remediation database? Check a11 that apply:
❑ �es—Spi11s Incidents database Provide DEC ID number{s):
❑ �es—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�he project wi�hin 2000 feet of any site in�he NI�SDEC Environmental Site Remediation database? ❑I�es�No
If yes,provide DEC ID number{s):
iv. If yes to{i),{ii)or{iii)above,describe current status of site(s):
Page 14 af 13
v. Is the project site subject to an institutional controllimiting property uses? ❑�es❑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:
• Wi11 the project affect the institutional or engineering controls in place? ❑�es❑No
• Explain:
E.2. Natural Resources On or Near Project Site
a.What is the average depth to bedrock on the project site? >7 feet
b.Are there bedrock outcroppings on the project site? ❑�es�No
If Yes,what proportion of the site is comprised of bedrock outcroppings? °lo
C.PPBt�OYT11T1a21t S011 t�8{S�pP8S821t 021 pP0�8Ct SltB: VitnA-Win�isnr I namv San�i 100 �Io
°Jo
°Jo
d.What is the auerage depth to the water table on the project site? Average: ,� feet
e.Drainage status of project site soils:� We11 Drained: �nn°lo of site
❑ Moderately We11 Drained: °lo of site
❑ Poorly Drained °lo of site
£Approximate proportion of proposed action site with slopes: � 0-10°l0: �oo °lo of site
❑ 10-15°l0: °lo of site
❑ 15°l0 or greater: °lo of site
g.Are there any unique geologic features on the project site? ❑�es�No
If�es,describe:
h. Surface water features.
i.Does any portion of the project site contain wetlands or other waterbodies{including streams,rivers, ��es❑No
ponds or lakes)?
ii. Do any wetlands or other waterbodies adjoin the project site? ��es❑No
If�es 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, ��es❑No
state or 1oca1 agency?
iv.For each identified regulated wetland and waterbody on the project site,provide the following information:
• Streams: Name Classification
� Lakes or Ponds: Name Classification
• Wetlands: Name NYS Wetland, Federal Waters Approximate Size NYS Wetland
• Wetland No.{if regulated by DEC) 5-14
v. Are any of the above water bodies listed in the most recent compilation of N�S water quality-impaired ❑�es�[Vo
waterbodies?
If yes,name of impaired water body/bodies and basis for listing as impaired:
i.Is the project site in a designated Floodway? ❑�es�No
j.Is the project site in the 100 year Floodplain? ❑I�es�No
k.Is the project site in the 500 year Floodplain? ❑�es�No
1.Is the project site located over,or immediately adjoining,a primary,principal or sole source aquifer? ❑�es�No
If Yes:
i. Name of aquifer:
Page 11 af 13
m. Identify the predominant wildlife species that occupy or use the project site:
Sauirrels t7nn�cci imc Raccaans
Rir�ic Chiomunks Faxes
n.Does the project site contain a designated significant natural community? ❑�es�No
If�es:
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 N�S as ❑�es�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 N�S as rare,or as a species of ❑�es�No
special concern?
q.Is the project site or adjoining area currently used for hunting,trapping,fishing or she11 fishing? ❑�es�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 ❑�es�No
Agriculture and Markets Law,Article 25-AA,Section 303 and 304?
If�es, provide county plus district name/number:
b.Are agriculturallands consisting of highly productive soils present? ❑�es�No
i. If�es: acreage(s)on project site?
ii. Source{s)of soil rating{s):
c. Does the project site contain a11 or part of,or is it substantially contiguous to,a registered National ❑�es�No
Natural Landmark?
If�es:
i. Nature of the naturallandmark: ❑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? ❑�es�No
If Yes:
i. CEA name:
ii. Basis for designation:
iii. Designating agency and date:
Page 12 af 13
e.Does the project site contain,or is it substantially contiguous to,a building,archaeological site,or district ❑�es�No
which is listed on,or has been nominated by the N�S Board of I�istoric Preservation for inclusion on,the
State or National Register of I�istoric Places?
If�es:
i. Nature of historic/archaeological resource: ❑Archaeological Site ❑I�istoric Building or District
ii. Name:
iii.Brief description of attributes on which listing is based:
£Is the project site,or any portion of it,located in or adjacent to an area designated as sensitive for ❑�es�No
archaeological sites on the N�State I�istoric Preservation Office{SI�PO)archaeological site inventory?
g.I�aue additional archaeological or historic site{s)or resources been identified on the project site? ❑�es�No
If�es:
i.Describe possible resource{s):
ii. Basis for identification:
h.Is the project site within fives miles of any officially designated and publicly accessible federal,state,or 1oca1 ❑�es�No
scenic or aesthetic resource?
If�es:
i. Identify resource:
ii. Nature of,or basis for,designation{e.g.,established highway overlook,state or 1oca1 park,state historic trail or scenic byway,
etc.):
iii.Distance between project and resource: miles.
i. Is the project site located within a designated river corridor under the Wi1d,Scenic and Recreational Rivers ❑�es�No
Program 6 NYCRR 666?
If�es:
i. Identify the name of the river and its designation:
ii. Is the activity consistent with development restrictions contained in 6N�CRR Part 666? ❑�es❑No
F.Additional Information
Attach any additional information which may be needed to clarify your project.
If you have identified any adverse impacts which could be associated with your proposal,please describe those impacts plus any
measures which you propose to avoid or minimize them.
G. Verification
I certify that the information provided is true to the best of my knowledge.
Applicant/Sponsor Name Steven Matthews,Rgent an behalf af applicant Date 112120
�/
Signature I �` �r Title Manager af Engineering,Tectanic Engineering
PRINT FORM Page 13 af 13
Agency Use Only[If applicable]
Full Environmental Assessment Form Pro�e�t:
Part 2-Identi�cation o_f'Potential Project Impacts �ate:
Part 2 is to be completed by the lead agency. Part 2 is designed to help the lead agency inventory a11 potential resources that could
be affected by a proposed project or action. We recognize that the lead agency's reviewer{s)wi11 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 wi11 provide the information needed to answer the Part 2 question. When Part 2 is completed,the
lead agency wi11 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 a11 of the information provided in Part 1.
• Review any application,maps,supporting materials and the Fu11 EAF Workbook.
• Answer each of the 18 questions in Part 2.
• If you answer"Yes"to a numbered question,please complete a11 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 a11 components of the proposed activity,that is,the"whole action".
• Consider the possibility for long-term and cumulative impacts as we11 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)
� "Yes", answer uestions a- '. � "No; move on to Section 2.
Relevant No,or Moderate
Part 1 small to large
Question{s) impact impact may
ma occur occur
a.The proposed action may involve construction on land where depth to water table is E2d � �
less than 3 feet.
b.The proposed action may involve construction on slopes of 15°l0 or greater. E2f ❑ ❑
c.The proposed action may involve construction on land where bedrock is exposed,or E2a � ❑
generally within 5 feet of existing ground surface.
d.The proposed action may involve the excavation and removal of more than 1,000 tons D2a � �
of natural material.
e.The proposed action may involve construction that continues for more than one year D 1e ❑ ❑
or in multiple phases.
£The proposed action may result in increased erosion,whether from physical D2e,D2q ❑ ❑
disturbance or vegetation removal{including from�reatment by herbicides).
g.The proposed action is,or may be,located within a Coastal Erosion hazard area. B 1 i � �
h.Other impacts: ❑ ❑
Page 1 af 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)
� "Yes", answer uestions a-c. � "No; move on to Section 3.
Relevant No,or Moderate
Part 1 small to large
Question{s) impact impact may
ma occur occur
a.Identify the specific land form{s)attached: E2g ❑ ❑
b.The proposed action may affect or is adjacent to a geological feature listed as a E3c ❑ ❑
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)
� "Yes", answer uestions a- l. � "No; move on to Section 4.
Relevant No,or Moderate
Part 1 small to large
Question{s) impact impact may
ma occur occur
a.The proposed action may create a new water body. D2b,D1h ❑ ❑
b.The proposed action may result in an increase or decrease of over 10°l0 or more than a D2b ❑ ❑
10 acre increase or decrease in the surface area of any body of water.
c.The proposed action may involve dredging more than 100 cubic yards of material D2a ❑ ❑
from a wetland or water body.
d.The proposed action may involve construction within or adjoining a freshwater or E2h ❑ ❑
tidal wetland,or in the bed or banks of any other water body.
e.The proposed action may create turbidity in a waterbody,either from upland erosion, D2a,D2h ❑ ❑
runoff or by disturbing bottom sediments.
£The proposed action may include construction of one or more intake(s)for withdrawal D2c ❑ ❑
of water from surface water.
g.The proposed action may include construction of one or more outfall{s)for discharge D2d ❑ ❑
of wastewater to surface water{s).
h.The proposed action may cause soil erosion,or otherwise create a source of D2e ❑ ❑
stormwater discharge that may lead to siltation or o�her degradation of receiving
water bodies.
i.The proposed action may affect the water quality of any water bodies within or E2h ❑ ❑
downstream of�he site of the proposed action.
j.The proposed action may involve the application of pesticides or herbicides in or D2q,E2h ❑ ❑
around any water body.
k.The proposed action may require the construction of new,or expansion of existing, Dla,D2d ❑ ❑
wastewater treatment facilities.
Page 2 af 10
1.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)
�f"Yes", answer questions a-h. �f"No", move on to Section S.
Relevant No,or Moderate
Part 1 small to large
Question{s) impact impact may
ma occur occur
a.The proposed action may require new water supply we11s,or create additional demand D2c ❑ ❑
on supplies from existing water supply we11s.
b.Water supply demand from the proposed action may exceed safe and sustainable D2c � ❑
withdrawal capacity rate of the 1oca1 supply or aquifer.
Cite Source:
c.The proposed action may a11ow or result in residential uses in areas without water and D 1a,D2c ❑ �
sewer services.
d.The proposed action may include or require wastewater discharged to groundwater. D2d,E21 � �
e.The proposed action may result in the construction of water supply we11s in locations D2c,E1 f, ❑ ❑
where groundwater is,or is suspected to be,contaminated. E1g,E1h
£The proposed action may require the bulk storage of petroleum or chemical products D2p,E21 ❑ ❑
over ground water or an aquifer.
g.The proposed action may involve the commercial application of pesticides within 100 E2h,D2q, ❑ ❑
feet of potable drinking water or irrigation sources. E21,D2c
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)
� "Yes", answer uestions a- . � "No", move on to Section 6.
Relevant No,or Moderate
Part 1 small to large
Question{s) impact impact may
ma occur occur
a.The proposed action may result in development in a designated floodway. E2i ❑ ❑
b.The proposed action may result in development within a 100 year floodplain. E2j ❑ ❑
c.The proposed action may result in development within a 500 year floodplain. E2k ❑ ❑
d.The proposed action may result in,or require,modification of existing drainage D2b,D2e ❑ ❑
patterns.
e.The proposed action may change flood water flows that contribute to flooding. D2b,E2i, ❑ ❑
E2',E2k
£If�here is a dam located on�he site of the proposed action,is the dam in need of repair, E1e ❑ ❑
or upgrade?
Page 3 af 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)
�f"Yes", answer questions a-f. �f"No; move on to Section 7.
Relevant No,or Moderate
Part 1 small to large
Question{s) impact impact may
ma 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 1evels:
i. More than 1000 tons/year of carbon dioxide{COz) D2g ❑ ❑
ii. More than 3.5 tons/year of nitrous oxide{Nz0) D2g ❑ ❑
iii.More than 1000 tons/year of carbon equivalent of perfluorocarbons{PFCs) D2g ❑ ❑
iv.More than.045 tons/year of sulfur hexafluoride{SF6) D2g � �
v. More than 1000 tons/year of carbon dioxide equivalent of D2g � �
hydrochloroflourocarbons{IIE'Cs)emissions
vi.43 tons/year or more of inethane D2h ❑ ❑
b.The proposed action may generate 10 tons/year or more of any one designated D2g ❑ ❑
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 1bs.per hour,or may include a heat
source capable of producing more than 10 million BTU's per hour.
d.The proposed action may reach 50°l0 of any of the thresholds in"a"through"c", D2g ❑ ❑
above.
e.The proposed action may result in the combustion or thermal treatment of more than 1 D2s ❑ ❑
ton of refuse per hour.
£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
� "Yes", answer uestions a- '. � "No; move on to Section 8.
Relevant No,or Moderate
Part 1 small to large
Question{s) impact impact may
ma occur occur
a.The proposed action may cause reduction in population or loss of individuals of any E2o � ❑
threatened or endangered species,as listed by New�ork State or the Federal
government,that use the site,or are found on,over,or near the site.
b.The proposed action may result in a reduction or degradation of any habitat used by E2o ❑ ❑
any rare,threatened or endangered species,as listed by New�ork State or the federal
government.
c.The proposed action may cause reduction in population,or loss of individuals,of any E2p ❑ ❑
species of special concern or conservation need,as listed by New�ork State or the
Federal government,�hat use�he site,or are found on,over,or near the site.
d.The proposed action may result in a reduction or degradation of any habitat used by E2p ❑ ❑
any species of special concern and conservation need,as listed by New�ork State or
the Federal government.
Page 4 af 10
e.The proposed action may diminish the capacity of a registered National Natural E3c ❑ ❑
Landmark to support the biological community it was established to protect.
£The proposed action may result in the removal of,or ground disturbance in,any E2n ❑ ❑
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 1oca11y important habitat.
I�abitat type&information source:
i.Proposed action{commercial,industrial or recreational projects,only) involves use of D2q ❑ ❑
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
� "Yes", answer uestions a-h. � "No", move on to Section 9.
Relevant No,or Moderate
Part 1 small to large
Question{s) impact impact may
ma occur occur
a.The proposed action may impact soil classified within soil group 1 through 4 of the E2c,E3b ❑ ❑
N�S Land Classification S stem.
b.The proposed action may sever,cross or otherwise limit access to agriculturalland E 1 a,E1b ❑ ❑
{includes cropland,hayfields,pasture,vineyard,orchard,etc).
c.The proposed action may result in the excavation or compaction of the soil profile of E3b ❑ ❑
active agriculturalland.
d.The proposed action may irreversibly convert agriculturalland to non-agricultural E1b,E3a ❑ ❑
uses,either more than 2.5 acres if located in an Agricultural District,or more than 10
acres if not within an Agricultural District.
e.The proposed action may disrupt or prevent installation of an agriculturalland E1 a,E1b ❑ ❑
management system.
£The proposed action may result,directly or indirectly,in increased development C2c,C3, ❑ ❑
potential or pressure on farmland. D2c,D2d
g.The proposed project is not consistent with the adopted municipal Farmland C2c ❑ ❑
Protection P1an.
h.Other impacts: ❑ ❑
Page 5 af 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.l.a, E.l.b, E.3.h.)
� "Yes; answer uestions a- . � "No; o to Section 10.
Relevant No,or Moderate
Part 1 small to large
Question{s) impact impact may
ma occur occur
a.Proposed action may be visible from any officially designated federal,state,or 1oca1 E3h ❑ ❑
scenic or aesthetic resource.
b.The proposed action may result in the obstruction,elimination or significant E3h,C2b ❑ ❑
screening of one or more officially designated scenic views.
c.The proposed action may be visible from publicly accessible vantage points: E3h
i. Seasonally{e.g.,screened by summer foliage,but visible during other seasons) ❑ ❑
ii.�ear round ❑ ❑
d.The situation or activity in which viewers are engaged while viewing the proposed E3h
action is:
i. Routine travel by residents,including travel to and from work E2q'
Elc � �
ii.Recreational or tourism based activities � �
e.The proposed action may cause a diminishment of the public enjoyment and E3h ❑ ❑
appreciation of the designated aesthetic resource.
£ There are similar projects visible within the following distance of the proposed D1a,E1a, ❑ ❑
project: D1f,D1g
0-1/2 mile
'/z-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.)
�f"Yes", answer questions a-e. �f"No; go to Section 11.
Relevant No,or Moderate
Part 1 small to large
Question{s) impact impact may
ma occur occur
a.The proposed action may occur wholly or partially within,or substantially contiguous E3e ❑ ❑
to,any buildings,archaeological site or district which is listed on or has been
nominated by the N�S Board of I�istoric Preservation for inclusion on the State or
National Register of I�istoric Places.
b.The proposed action may occur whol]y or partial]y within,or substantial]y contiguous E3f ❑ ❑
to,an area designated as sensitive for archaeological sites on the N�State I�istoric
Preservation Office{SI�PO)archaeological site inventory.
c.The proposed action may occur wholly or partial]y within,or substantially contiguous E3g ❑ ❑
to,an archaeological site not included on the N�SI�PO inventory.
Source:
Page 6 af 10
d.Other impacts: ❑ ❑
If any of the above{a-d)are answered"Moderate to large impact may
�• occur",continue with the following questions to help support conclusions in Part 3:
i. The proposed action may result in the destruction or alteration of a11 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,E 1 a,
Elb
iii. The proposed action may result in the introduction of visual elements which E3e,E3f, � �
are out of character with the site or property,or may alter its setting. E3g,E3h,
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.l.c., E.2.q.)
� "Yes", answer uestions a-e. � "No; o to Section 12.
Relevant No,or Moderate
Part 1 small to large
Question{s) impact impact may
ma occur occur
a.The proposed action may result in an impairment of natural functions,or"ecosystem D2e,E1b ❑ ❑
services",provided by an undeveloped area,including but not limited to stormwater E2h,
storage,nutrient cycling,wildlife habitat. E2m,E2o,
E2n,E2
b.The proposed action may result in the loss of a current or future recreational resource. C2a,E1c, ❑ ❑
C2c,E2
c.The proposed action may eliminate open space or recreational resource in an area C2a,C2c ❑ ❑
with few such resources. E1c,E2q
d.The proposed action may result in loss of an area now used informally by the C2c,E1c ❑ �
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)
� "Yes", answer uestions a-c. � "No; o to Section 13.
Relevant No,or Moderate
Part 1 small to large
Question{s) impact impact may
ma occur occur
a.The proposed action may result in a reduction in the quantity of the resource or E3d � ❑
characteristic which was the basis for designation of the CEA.
b.The proposed action may result in a reduction in the quality of the resource or E3d ❑ ❑
characteristic which was the basis for designation of the CEA.
c.Other impacts: ❑ ❑
Page 7 af 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)
� "Yes", answer uestions a- . � "No", o to Section 14.
Relevant No,or Moderate
Part 1 small to large
Question{s) impact impact may
ma occur occur
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 D2j ❑ ❑
more vehicles.
c.The proposed action wi11 degrade existing transit access. D2j ❑ ❑
d.The proposed action wi11 degrade existing pedestrian or bicycle accommodations. D2j ❑ ❑
e.The proposed action may alter the present pattern of movement of people or goods. D2j ❑ ❑
£ 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)
� "Yes", answer uestions a-e. � "No; o to Section IS.
Relevant No,or Moderate
Part 1 small to large
Question{s) impact impact may
ma occur occur
a.The ro osed action wi11 re uire a new,or an u rade to an existin ,substation. D2k ❑ ❑
b.The proposed action wi11 require the creation or extension of an energy transmission D 1 f, ❑ ❑
or supply system to serve more than 50 single or two-family residences or to serve a D 1q,D2k
commercial or industrial use.
c.The proposed action may utilize more than 2,500 MWhrs per year of electricity. D2k ❑ ❑
d.The proposed action may involve heating and/or cooling of more than 100,000 square Dlg ❑ ❑
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.)
� "Yes", answer uestions a- . � "No", o to Section 16.
Relevant No,or Moderate
Part 1 small to large
Question{s) impact impact may
ma occur occur
a.The proposed action may produce sound above noise 1evels established by 1oca1 D2m � �
regulation.
b.The proposed action may result in blasting within 1,500 feet of any residence, D2m,E1d ❑ ❑
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 ❑ ❑
Page 8 af 10
d.The proposed action may result in light shining onto adjoining properties. D2n ❑ ❑
e.The proposed action may result in lighting creating sky-glow brighter than existing D2n,E1a ❑ ❑
area conditions.
£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.)
� "Yes", answer uestions a-m. � "No; o to Section 17.
Relevant No,or Moderate
Part 1 small to large
Question{s) impact impact may
ma cccur occur
a.The proposed action is located within 1500 feet of a school,hospital,licensed day E1d ❑ ❑
care center, rou home,nursin home or retirement communit�.
b.The site of the proposed action is currently undergoing remediation. E1g,E1h ❑ ❑
c.There is a completed emergency spi11 remediation,or a crnnpleted environmental site E1g,E1h ❑ ❑
remediation on,or adjacent to,the site of the proposed action.
d.The site of the action is subject to an institutional controllimiting the use of the E1g,E1h ❑ ❑
property{e.g.,easement or deed restriction).
e.The proposed action may affect institutional control measures that were put in place E1g,E1h ❑ ❑
to ensure that the site remains protective of the environment and human health.
£The proposed action has adequate control measures in place to ensure that future D2t � ❑
generation,treatment and/or disposal of hazardous wastes wi11 be protective of the
environment and human health.
g.The proposed action involves construction or modification of a solid waste D2q,Elf ❑ ❑
management facility.
h.The proposed action may result in the unearthing of solid or hazardous waste. D2q,E1 f ❑ ❑
i.The proposed action may result in an increase in the rate of disposal,or processing,of D2r,D2s ❑ ❑
solid waste.
j.The proposed action may result in excavation or other disturbance within 2000 feet of E1f,E1g ❑ ❑
a site used for the disposal of solid or hazardous waste. E1h
k.The proposed action may result in the migration of explosive gases from a landfill E1f,E1g ❑ ❑
site to adjacent off site structures.
1.The proposed action may result in the release of contaminated leachate from the D2s,E 1 f, ❑ ❑
project site. D2r
m.Other impacts: � �
Page 9 af 10
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.)
�f"Yes", answer questions a-h. �f"No", go to Section I8.
Relevant No,or Moderate
Part 1 small to large
Question{s) impact impact may
ma occur occur
a.The proposed action's land use components may be different from,or in sharp C2,C3,D1a ❑ ❑
contrast to,current surrounding land use pattern{s). Ela,Elb
b.The proposed action wi11 cause the permanent population of the city,town or village C2 ❑ ❑
in which the project is located to grow by more than 5°l0.
c.The proposed action is inconsistent with 1oca11and use plans or zoning regulations. C2,C2,C3 ❑ ❑
d.The proposed action is inconsistent with any County plans,or other regionalland use C2,C2 ❑ ❑
plans.
e.The proposed action may cause a change in the density of development that is not C3,D 1 c, ❑ ❑
supported by existing infrastructure or is distant from existing infrastructure. Dld,Dlf,
Dld,E1b
£The proposed action is located in an area characterized by 1ow density development C4,D2c,D2d ❑ ❑
that wi11 require new or expanded public infrastructure. D2j
g.The proposed action may induce secondary development impacts{e.g.,residential or C2a ❑ ❑
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)
� "Yes", answer uestions a- . � "No; roceed to Part 3.
Relevant No,or Moderate
Part 1 small to Iarge
Question{s) impact impact may
ma occur occur
a.The proposed action may replace or eliminate existing facilities,structures,or areas E3e,E3f,E3g ❑ ❑
of historic importance to the community.
b.The proposed action may create a demand for additional community services{e.g. C4 ❑ ❑
schools,police and fire)
c.The proposed action may displace affordable or 1ow-income housing in an area where C2,C3,D 1 f ❑ ❑
there is a shortage of such housing. D1g,E1a
d.The proposed action may interfere with the use or enjoyment of officially recognized C2,E3 ❑ ❑
or designated public resources.
e.The proposed action is inconsistent wi�h�he predominant architectural scale and C2,C3 ❑ ❑
character.
£Proposed action is inconsistent with the character of the existing naturallandscape. C2,C3 ❑ ❑
Ela,Elb
E2 ,E2h
g.Other impacts: ❑ ❑
Page 10 af 10
Agency Use Only [IfApplicable]
Project:
Date:
Full Environmental Assessment Form
Part 3 -Evaluation o.f'the�Vlagnitude and Importance o.f'Project Impacts
and
Determination o.f'Signi�cance
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 wi11 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 wi11 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 wi11 not,or may,result in a significant adverse
environmental impact.
• Provide the reason{s)why the impact may,or wi11 not,result in a significant adverse environmental impact
• For Conditional Negative Declarations identify the specific condition{s)imposed that wi11 modify the proposed action so that
no significant adverse environmental impacts wi11 result.
• Attach additional sheets,as needed.
Determination of Significance- Type l 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 wi11 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 wi11 be avoided or
substantially mitigated because of the following conditions which wi11 be required by the lead agency:
There wi11,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 N�CRR 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:
Tit1e of Responsible Officer:
Signature of Responsible Officer in Lead Agency: Date:
Signature of Preparer{if different from Responsible Officer) Date:
For Further lnformation:
Contact Person:
Address:
Telephone Number:
�mai1:
For Type 1 Actions and Conditioned Negative Declarations,a copy of this Notice is sent to:
Chief Executive Officer of�he political subdivision in which�he action wi11 be principally located{e.g.,Town/City/Village of�
O�her involved agencies{if any)
Applicant{if any)
Environmental Notice Bulletin: http://www.dec.ny�;ov/enb/enb.html
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