**NEPA Environmental Assessment Checklist**

\[Environmental Review Guide HUD CPD 782, 24 CFR 58.40; Ref. 40 CFR
1508.8 &1508.27\]

Evaluate the significance of the effects of the proposal on the
character, features and resources of the project area. Enter relevant
base data and verifiable source documentation to support the finding.
Then enter the appropriate impact code from the following list to make a
determination of impact. **Impact Codes**: (**1)** - No impact
anticipated; (**2)** - Potentially beneficial; (**3)** - Potentially
adverse; (**4)** - Requires mitigation;

(**5)** - Requires project modification. Note names, dates of contact,
telephone numbers and page references. Attach additional material as
appropriate. Note conditions or mitigation measures required.

**Land Development Code Source or Documentation**

+-----------------------+---+-------------------------------------------+
| Conformance with      |   |                                           |
| Comprehensive Plans   |   |                                           |
|                       |   |                                           |
| and Zoning            |   |                                           |
+-----------------------+---+-------------------------------------------+
| Compatibility and     |   |                                           |
|                       |   |                                           |
| Urban Impact          |   |                                           |
+-----------------------+---+-------------------------------------------+
| Slope                 |   |                                           |
+-----------------------+---+-------------------------------------------+
| Erosion               |   |                                           |
+-----------------------+---+-------------------------------------------+
| Soil Suitability      |   |                                           |
+-----------------------+---+-------------------------------------------+
| Hazards and Nuisances |   |                                           |
|                       |   |                                           |
| including Site Safety |   |                                           |
+-----------------------+---+-------------------------------------------+
| Energy Consumption    |   |                                           |
+-----------------------+---+-------------------------------------------+

+-----------------------+---+-------------------------------------------+
| **Noise -**           |   |                                           |
| Contribution to       |   |                                           |
| Community Noise       |   |                                           |
| Levels                |   |                                           |
+-----------------------+---+-------------------------------------------+
| **Air Quality**       |   |                                           |
|                       |   |                                           |
| Effects of Ambient    |   |                                           |
| Air Quality on        |   |                                           |
|                       |   |                                           |
| Project and           |   |                                           |
| Contribution to       |   |                                           |
| Community Pollution   |   |                                           |
| Levels                |   |                                           |
+-----------------------+---+-------------------------------------------+
| **Environmental       |   |                                           |
| Design**              |   |                                           |
|                       |   |                                           |
| Visual Quality -      |   |                                           |
| Coherence, Diversity, |   |                                           |
| Compatible Use and    |   |                                           |
|                       |   |                                           |
| Scale                 |   |                                           |
+-----------------------+---+-------------------------------------------+

**Socioeconomic Code Source or Documentation**

  ----------------------- --- --------------------------------------------
  Demographic Character       
  Changes                     

  Displacement                

  Employment and Income       
  Patterns                    
  ----------------------- --- --------------------------------------------

**Community Facilities**

and Services Code Source or Documentation

+-----------------------+---+-------------------------------------------+
| Educational           |   |                                           |
| Facilities            |   |                                           |
+-----------------------+---+-------------------------------------------+
| Commercial Facilities |   |                                           |
+-----------------------+---+-------------------------------------------+
| Health Care           |   |                                           |
+-----------------------+---+-------------------------------------------+
| Social Services       |   |                                           |
+-----------------------+---+-------------------------------------------+
| Solid Waste           |   |                                           |
+-----------------------+---+-------------------------------------------+
| Waste Water           |   |                                           |
+-----------------------+---+-------------------------------------------+
| Storm Water           |   |                                           |
+-----------------------+---+-------------------------------------------+
| Water Supply          |   |                                           |
+-----------------------+---+-------------------------------------------+
| Public Safety         |   |                                           |
|                       |   |                                           |
| \- Police             |   |                                           |
+-----------------------+---+-------------------------------------------+
| \- Fire               |   |                                           |
+-----------------------+---+-------------------------------------------+
| \- Emergency Medical  |   |                                           |
+-----------------------+---+-------------------------------------------+
| Open Space and        |   |                                           |
| Recreation            |   |                                           |
|                       |   |                                           |
| \- Open Space         |   |                                           |
+-----------------------+---+-------------------------------------------+
| \- Recreation         |   |                                           |
+-----------------------+---+-------------------------------------------+
| \- Cultural           |   |                                           |
| Facilities            |   |                                           |
+-----------------------+---+-------------------------------------------+
| Transportation        |   |                                           |
+-----------------------+---+-------------------------------------------+

Natural Features Source or Documentation

  ----------------------- --- --------------------------------------------
  Water Resources             

  Surface Water               

  Unique Natural Features     
  and Agricultural Lands      

  Vegetation and Wildlife     
  ----------------------- --- --------------------------------------------

**Other Factors Source or Documentation**

+-----------------------+---+-------------------------------------------+
| Flood Disaster        |   |                                           |
| Protection Act        |   |                                           |
|                       |   |                                           |
| \[Flood Insurance\]   |   |                                           |
|                       |   |                                           |
| \[§58.6(a)\]          |   |                                           |
+-----------------------+---+-------------------------------------------+
| Coastal Barrier       |   |                                           |
| Resources Act/        |   |                                           |
|                       |   |                                           |
| Coastal Barrier       |   |                                           |
| Improvement Act       |   |                                           |
|                       |   |                                           |
| \[§58.6(c)\]          |   |                                           |
+-----------------------+---+-------------------------------------------+
| Airport Runway Clear  |   |                                           |
| Zone or Clear Zone    |   |                                           |
| Disclosure            |   |                                           |
|                       |   |                                           |
| \[§58.6(d)\]          |   |                                           |
+-----------------------+---+-------------------------------------------+
| Other Factors         |   |                                           |
+-----------------------+---+-------------------------------------------+

**Summary of Findings and Conclusions**

**ALTERNATIVES TO THE PROPOSED ACTION**

**Alternatives and Project Modifications Considered** \[24 CFR 58.40(e),
Ref. 40 CFR 1508.9\] (Identify other reasonable courses of action that
were considered and not selected, such as other sites, design
modifications, or other uses of the subject site. Describe the benefits
and adverse impacts to the human environment of each alternative and the
reasons for rejecting it.)

**No Action Alternative** \[24 CFR 58.40(e)\]

(Discuss the benefits and adverse impacts to the human environment of
not implementing the preferred alternative).

**Mitigation Measures Recommended** \[24 CFR 58.40(d), 40 CFR 1508.20\]

(Recommend feasible ways in which the proposal or its external factors
should be modified in order to minimize adverse environmental impacts
and restore or enhance environmental quality.)

## Additional Studies Performed

(Attach studies or summaries)

**List of Sources, Agencies and Persons Consulted** \[40 CFR 1508.9(b)\]

[**Environmental Assessment** **Work Sheet**]{.underline}

This worksheet provides a suggested format that may be used to complete
the Environmental Assessment process.

**[Project Name and Description]{.underline}**: (The description should
include location of the project and types of activities to be included)

**Project Name:**      

Location:      

**Activities included in the project:**      

[**Directions**:]{.underline} The Responsible Entity (RE) must make a
determination as to whether the activities affiliated with the project
will affect the resource under consideration and trigger formal
compliance consultation procedures with the appropriate oversight agency
and/or subsequent mitigation. You may consult guidance by clicking on
links in each box below which also will take you to information from
agency web sites. If the activity affects the resource, indicate (**A**)
in the Status Determination Column below. Or indicate **(B**) in that
column if the activity does not affect the resources under
consideration. The compliance documentation column should indicate what
source documentation was used to make the compliance determination and
copies of all necessary documentation should be attached to the
completed form for inclusion in the Environmental Review Record (ERR).

+--------------------------------+-------------+-----------------------+
| **Statutes, Executive Orders,  | **Status    | # Com                 |
| and Regulations listed at 24   | De          | pliance Documentation |
| CFR Sec. 58.5 and 58.6**       | termination |                       |
|                                | (A or B)**  |                       |
+--------------------------------+-------------+-----------------------+
| Wetland Protection             |             |                       |
|                                |             |                       |
| \[Executive Order 11990\]      |             |                       |
|                                |             |                       |
| *Guidance:*                    |             |                       |
+--------------------------------+-------------+-----------------------+

  -----------------------------------------------------------------------
  <http://www.hud.gov/offices/cpd/environment/review/floodplain.cfm>

  -----------------------------------------------------------------------

+--------------------------------+-------------+-----------------------+
| Coastal Zone Management        |             |                       |
|                                |             |                       |
| \[Coastal Zone Management Act, |             |                       |
| 1972, sec. 307 (c ) and (d)\]  |             |                       |
|                                |             |                       |
| *Guidance:*                    |             |                       |
+--------------------------------+-------------+-----------------------+

  -----------------------------------------------------------------------
  <http://www.hud.gov/offices/cpd/environment/review/coastal.cfm>

  -----------------------------------------------------------------------

+--------------------------------+-------------+-----------------------+
| Historic Preservation          |             |                       |
|                                |             |                       |
| \[36 CFR Part 800\]            |             |                       |
|                                |             |                       |
| *Guidance:*                    |             |                       |
+--------------------------------+-------------+-----------------------+

  ----------------------------------------------------------- -----------------------------------
  <http://www.hud.gov/offices/cpd/environment/historic.cfm>   

  ----------------------------------------------------------- -----------------------------------

+--------------------------------+-------------+-----------------------+
| Floodplain Management          |             |                       |
|                                |             |                       |
| \[Executive Order 11988; 24    |             |                       |
| CFR Part 55\]                  |             |                       |
|                                |             |                       |
| *Guidance:*                    |             |                       |
+--------------------------------+-------------+-----------------------+

  -----------------------------------------------------------------------
  <http://www.hud.gov/offices/cpd/environment/floodplain.cfm>

  -----------------------------------------------------------------------

+--------------------------------+-------------+-----------------------+
| Sole Source Aquifers           |             |                       |
|                                |             |                       |
| \[40 CFR 149\]                 |             |                       |
|                                |             |                       |
| *Guidance:*                    |             |                       |
+--------------------------------+-------------+-----------------------+

  -----------------------------------------------------------------------
  <http://www.hud.gov/offices/cpd/environment/aquifiers.cfm>

  -----------------------------------------------------------------------

+--------------------------------+-------------+-----------------------+
| Endangered Species Act         |             |                       |
|                                |             |                       |
| \[50 CFR 402\]                 |             |                       |
|                                |             |                       |
| *Guidance:*                    |             |                       |
+--------------------------------+-------------+-----------------------+

  -----------------------------------------------------------------------
  <http://www.hud.gov/offices/cpd/environment/endangeredspecies.cfm>

  -----------------------------------------------------------------------

+--------------------------------+-------------+-----------------------+
| Wild and Scenic Rivers         |             |                       |
|                                |             |                       |
| \[16 U.S.C. 1271, Sec. 7(b),   |             |                       |
| (c)                            |             |                       |
|                                |             |                       |
| *Guidance:*                    |             |                       |
+--------------------------------+-------------+-----------------------+

  ----------------------------------------------------------------------------------------------------------------------------------------------------
  [http://www.rivers.gov/wildriverslist.html](https://oasis.mcdonaldbradley.com/exchweb/bin/redir.asp?URL=http://www.rivers.gov/wildriverslist.html)

  ----------------------------------------------------------------------------------------------------------------------------------------------------

+--------------------------------+-------------+-----------------------+
| Clean Air Act                  |             |                       |
|                                |             |                       |
| \[40 CFR Parts 6, 51, 93\]     |             |                       |
|                                |             |                       |
| *Guidance:*                    |             |                       |
+--------------------------------+-------------+-----------------------+

  -----------------------------------------------------------------------
  <http://www.hud.gov/offices/cpd/environment/cleanair.cfm>

  -----------------------------------------------------------------------

+--------------------------------+-------------+-----------------------+
| Farmland Policy Act            |             |                       |
|                                |             |                       |
| \[7CFR Part 658\]              |             |                       |
|                                |             |                       |
| *Guidance:*                    |             |                       |
+--------------------------------+-------------+-----------------------+

  -----------------------------------------------------------------------
  <http://www.hud.gov/offices/cpd/environment/farmlands.cfm>

  -----------------------------------------------------------------------

+--------------------------------+-------------+-----------------------+
| Environmental Justice          |             |                       |
|                                |             |                       |
| \[Executive Order 12898\]      |             |                       |
|                                |             |                       |
| *Guidance:*                    |             |                       |
+--------------------------------+-------------+-----------------------+

  -----------------------------------------------------------------------
  <http://www.hud.gov/offices/cpd/environment/review/justice.cfm>

  -----------------------------------------------------------------------

+--------------------------------+-------------+-----------------------+
| Noise Abatement and Control    |             |                       |
|                                |             |                       |
| \[24 CFR Part 51, Subpart B\]  |             |                       |
|                                |             |                       |
| *Guidance:*                    |             |                       |
+--------------------------------+-------------+-----------------------+

  -----------------------------------------------------------------------
  <http://www.hud.gov/offices/cpd/environment/noise.cfm>

  -----------------------------------------------------------------------

+--------------------------------+-------------+-----------------------+
| Explosive and Flammable        |             |                       |
| Operations                     |             |                       |
|                                |             |                       |
| \[24 CFR Part 51 C\]           |             |                       |
|                                |             |                       |
| *Guidance:*                    |             |                       |
+--------------------------------+-------------+-----------------------+

  -----------------------------------------------------------------------
  <http://www.hud.gov/offices/cpd/environment/explosive.cfm>

  -----------------------------------------------------------------------

+--------------------------------+-------------+-----------------------+
| Toxic Chemicals and            |             |                       |
| Radioactive Materials          |             |                       |
|                                |             |                       |
| \[24 CFR Part 58, Sec          |             |                       |
| 5(i)(2)\]                      |             |                       |
|                                |             |                       |
| *Guidance:*                    |             |                       |
+--------------------------------+-------------+-----------------------+

  -----------------------------------------------------------------------
  <http://www.hud.gov/offices/cpd/environment/toxic.cfm>

  -----------------------------------------------------------------------

+--------------------------------+-------------+-----------------------+
| Airport Clear Zones and        |             |                       |
| Accident Potential Zones       |             |                       |
|                                |             |                       |
| \[24 CFR Part 51 Subpart D\]   |             |                       |
|                                |             |                       |
| *Guidance:*                    |             |                       |
+--------------------------------+-------------+-----------------------+

  -----------------------------------------------------------------------
  <http://www.hud.gov/offices/cpd/environment/airport.cfm>

  -----------------------------------------------------------------------

**Determination:** The preparers have complied with all provisions of 24
CFR Part 58, Subpart E---Environmental Review Process: Environmental
Assessments, examining alternatives to the project itself, feasible ways
to modify the project to eliminate or minimize adverse impacts, and
based on steps (a) through (f) found in the regulations, determined one
of the following:

(1) Finding of No Significant Impact (FONSI), whereby the Responsible
    Entity may proceed to Dissemination and publication of the FONSI,
    per regulations found at 24 CFR Part 58, sec.
    **[58.43(a).]{.underline}**

(2) Finding of Significant Impact whereby the Responsible Entity must
    proceed to develop an Environmental Impact Statement (EIS) in
    compliance with 24 CFR Part 58, Subparts F or G.

**PREPARER SIGNATURE:**

**DATE:**

\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_