Source: http://plattsburghpd.net/FormCenter/Building-Inspector-5/Full-Environmental-Assessment-Form-Part--46
Timestamp: 2017-11-19 04:37:42
Document Index: 417970318

Matched Legal Cases: ['art 1', 'art 1', 'art 1', 'art 1', 'art 1', 'art 1', 'art 666']

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 base 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 1 is accurate and complete.
A. Project and Sponsor Information
Project Location (Describe, and attach a general location map)
Brief Description of Proposed Action (Include purpose or need)
City/ PO
Project Contact (If not same as sponsor, give name and title/role)
City / PO
Property Owner (If not same as sponsor)
B. Government Approvals
B. Government Approvals, Funding, or Sponsorship. ("Funding" includes grants, loads, tax relief, and any other forms of financial assistance.)
If yes: Identify Agency and Approval(s) Required
Application Date (Actual or Projected)
City Council, Town Board, or Village Board of Trustees
Agency and Approval(s) Required
City, Town, or Village Planning Board or Commission
Is the project site within a Coastal Area, or the waterfront area of a Designated Inland Waterway?
Is the project site located in a community with an approved Local Waterfront Revitalization Program?
Is the project site within a Coastal Erosion Hazard Area?
Will administrative or legislative adoption, or amendment of a plan, local law, ordinance, rule or regulation be the 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
Do any municipally - adopted (City, Town, Village, or County) comprehensive land use plan(s) include the site where the proposed action would be located?
Is the site of the proposed action within any local or regional special planning district (for example: Greenway Brownfield Opportunity Area (BOA); Designated State or Federal Heritage area; watershed management plan; or other?)
If yes, Identify the plan(s)
Is the proposed action located wholly or partially within an area listed in an adopted municipal open space plan, or an adopted municipal farmland protection plan?
C.3 Zoning
Is the site of the proposed action located in a municipality with an adopted zoning law or ordinance?
If yes, What is the zoning classification(s) including any applicable overlay district?
Is the use permitted or allowed by a special or conditional use permit?
Is a zoning change requested as part of the proposed action?
If yes, What is the proposed new zoning for the site?
C.4. Existing Community services
In what school district is the project site located?
What police or other public protection forces serve the project site?
Which fire protection and emergency medical services serve the project site?
Which parks serve the project site?
D. Project Details
D.1. Proposed and Potential Development
What is the general nature of the proposed action (e.g., residential, industrial, commercial, recreational; if mixed, include all components)?
Total acreage of the site of the proposed action?
Total acreage to be physically disturbed?
Total acreage (Project site and any contiguous properties) owned or controlled by the applicant or project sponsor?
Is the proposed action an expansion of an existing project or use?
If yes, what is the approximate percentage of the proposed expansion and identify the units (e.g. acres, miles, housing units, square feet)?
Is the proposed action a subdivision, or does it include a subdivision?
Purpose or type of subdivision? (e.g., residential, industrial, commercial; If mixed specify types)
Is a cluster/conservation layout proposed?
Number of Lots Proposed
Maximum proposed lot size
Minimum proposed lot size
Will proposed action be constructed in multiple phases?
If no, anticipated period of construction in months
If yes, Total number of phases anticipated
Anticipated completion date of final phase
Anticipated commencement date of phase 1 (including demolition)
Generally describe connections or relationships among phases, including any contingencies where progress of one phase may determine timing or duration of future phases
Does the project include new residential uses?
If yes, show numbers of units proposed
One Family at Initial Phase
Two Family at Initial Phase
Three Family at Initial Phase
Multiple Family (four or more) at Initial Phase
One Family at Completion of all Phases
Two Family at Completion of all Phases
Three Family at Completion of all Phases
Multiple Family (four or more) at Completion of all Phases
Does the proposed action include new non-residential construction (Including expansions)?
If yes, Total number of structures
Dimensions (in feet) of largest proposed structure Height
Approximate extent of building space to be heated or cooled in square feet
Does the proposed action include construction or other activities that will result in the impoundment of any liquids, such as creation of a water supply, reservoir, pond, lake, waste lagoon, or other storage?
If yes, Purpose of the impoundment
If a water impoundment, the principal source of the water:
If other than water, Identify the type of impounded/contained Liquids and their source.
Approximate size of the proposed impoundment
Volume in Millions of Gallons
Surface Area in Acres
Dimensions of the proposed dam or impounding structure in height and length
Construction Method/Materials for the proposed dam or impounding structure (e.g., earth fill, rock, wood, concrete):
D.2. Project Operations
Does the proposed action include any excavation, mining, or dredging, during construction, operations, or both? (Not including general site preparation, grading, or installation of utilities or foundations where all excavated materials will remain onsite)
If yes, what is the purpose of the excavation or dredging?
How much material (including rock, earth, sediments, etc) is proposed to be removed from the site in volume (Specify tons or cubic yards)
Over what duration of time?
Describe nature and characteristics of materials to be excavated or dredged, and plans to use, manage, or dispose of them?
Will there be onsite dewatering or processing of excavated materials?
What is the total area to be dredged or excavated in acres?
What is the maximum area to be worked on at any one time in acres?
What would the maximum depth of excavation or dredging in feet?
Will the excavation require blasting?
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 into any existing wetland, waterbody, shoreline, beach, or adjacent area?
If yes, Identify the wetland or waterbody which would be affected (by name, water index number, wetland map number or geographic description):
ii. Describe how the proposed action would affect that waterbody or wetland, e.g. excavation, fill, placement of structures, or alteration of channels, banks or 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?
iv. Will proposed action cause or result in the destruction or removal or aquatic vegetation?
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 will be used specify product(s):
v. Describe any reclamation/mitigation following disturbance:
c. Will the proposed action use, or create a new demand for water?
If yes, total anticipated water usage/demand per day in gallons/day:
Will the proposed action obtain water from an existing public water supply?
If yes, name of district or service area:
Does the existing public water supply have the capacity to serve the proposal?
Is the project site in the existing district?
Is expansion of the district needed?
Do existing lines serve the project site?
Will line extension within an existing district be necessary to supply the project?
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 or service area proposed to be formed to serve the project site?
If yes, Applicant/sponsor for new district:
Date application submitted or anticipated:
Proposed source(s) of supply for new district:
If a public water supply will not be used, describe plans to provide water supply for the project:
If water supply will be from wells (Public or Private), Maximum pumping capacity in gallons/minute:
Will the proposed action generate liquid wastes?
If yes, total anticipated liquid waste generation per day in gallons/day:
Nature of liquid wastes to be generated (e.g. sanitary, wastewater, industrial; if combination, describe all components and approximate volumes or proportions of each):
Will the proposed action use any existing public wastewater treatment facilities?
If yes, Name of wastewater treatment plant to be used:
Does the existing wastewater treatment plant have capacity to serve the project?
Do existing sewer lines serve the project site?
Will line extension within an existing district be necessary to serve the project?
Will a new wastewater (sewage) treatment district be formed to serve the project site?
What is the receiving water for the wastewater discharge?
If public facilities will not be used, describe plans to provide wastewater treatment for the project, including specifying propsed receiving water (name and classification if surface discharge, or describe subsurface disposal plans):
Describe any plans or designs to capture, recycle, or reuse liquid waste:
Will the proposed action disturb more than on acre and create stormwater runoff, either from new point 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, how much impervious surface will the project create in relation to total size of project parcel? (in square feet or acres) Please include impervious surface and parcel size:
Describe types of new point sources
Where will the stormwater runoff be directed (i.e. on-site stormwater management facility/structures, adjacent properties, groundwater, onsite surface water or off site surface waters)?
If to surface waters, identify receiving water bodies or wetlands:
Will stormwater runoff flow to adjacent properties?
Does proposed plan minimize impervious surfaces, use pervious materials or collect and re-use stormwater?
f. Does the proposed action include or will it use on-site, one or more sources of air emissions, including fuel combustion, waste incineration, or other processes or operations?
Mobile sources during project operations (e.g., heavy equipment, fleet or delivery vehicles)
Stationary sources during construction (e.g., power generation, structural heating, batch plant, crushers)
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, or Federal Clean Air Act Title IV or Title V Permit?
If yes, is the project site located in an Air quality non-attainment area? (Area routinely or periodically fails to meet ambient air quality standards for all or some parts of the year)
In addition to emissions as calculated in the application, the project will generate:
Tons/Year (Short Tons) of Carbon Dioxide (CO2)
Tons/Year (Short Tons) of Nitrous Oxide (N2O)
Tons/Year (Short Tons) of Perfluorocarbons (PFCs)
Tons/Year (Short Tons) of Sulfur Hexafluoride (SF6)
Tons/Year (Short Tons) of Carbon Dioxide equivalent of Hydrofluorocarbons (HFCs)
Tons/Year (Short Tons) of Hazardous Air Pollutants (HAPs)
Will the proposed action generate or emit methane (including, but not limited to, sewage treatment plants, landfills, composting facilities)?
If yes, Estimate methane generation in tons/year (Metric):
Describe any methane capture, control, or elimination measures included in project design (e.g., Combustion to generate heat or electricity, flaring):
Will the proposed action result in the release of air pollutants from open-air operations or processes, such as quarry or landfill operations?
If yes, Describe operations and nature of emissions (e.g., Diesel exhaust, rock particulates/dust):
Will the proposed action result in a substantial increase in traffic above present levels or generate substantial new demand for transportation facilities or services?
If yes, When is the peak traffic expected (Check all that apply)
Random between hours or _____ to _____
For commercial activities only, projected number of semi trailer truck trips/day: (Net increase/decrease)
Parking spaces existing:
Parking spaces proposed:
Does the proposed action include any shared use parking?
If the proposed action includes any modification of existing roads, creation of new roads or change in existing access, describe:
Are public/private transportation services(s) or facilities available within half mile of the proposed site?
Will the proposed action include access to public transportation or accommodations for use of hybrid, electric, or other alternative fueled vehicles?
Will the proposed action include plans for pedestrian or bicycle accommodations for connections to existing pedestrian or bicycle routes?
Will the proposed action (for commercial or industrial projects only) generate mew or additional demand for energy?
Estimate annual electricity demand during operation of the proposed action:
Anticipated sources/suppliers of electricity for the project (e.g. on-site combustion, on-site renewable, via grid/local utility, or other):
Will the proposed action require a new, or an upgrade to, an existing substation?
Hours of Operation. Answer all items which apply.
During Operations:
Will the proposed action produce noise that will exceed existing ambient noise levels during construction, operation, or both?
If yes, provide details including sources, time of day and duration:
Will proposed action remove existing natural barriers that could act as a noise barrier or screen?
Will the proposed action have outdoor lighting?
If yes, Describe source(s), location(s), height of fixture(s), direction/aim, and proximity to nearest occupied structures:
Will proposed action remove existing natural barriers that could act as a light barrier or screen?
Does the proposed action have the potential to produce odors for more than one hour per day?
If yes, describe possible sources, potential frequency and duration of odor emissions, and proximity to nearest occupied structures:
Will the proposed action include any bulk storage of petroleum (combined capacity of over 1,100 gallons) or chemical products 185 gallons in above ground storage or any amount in underground storage?
If yes, products to be stored
Per unit time (e.g. month, year)
Generally describe proposed storage facilities:
Will the proposed action (commercial, industrial, and recreational projects only) use pesticides (i.e., herbicides, insecticides) during construction or operation?
If yes, Describe proposed treatment(s):
Will the proposed action use Integrated Pest Management Practices?
Will the proposed action (commercial or industrial projects only) involve or require the management or disposal of solid waste (excluding hazardous materials)?
If yes, describe any solid waste(s) to be generated during construction or operation of the facility (Tons per unit of time)
Describe any proposals for on-site minimization, recycling, or reuse of materials to avoid disposal as solid waste during construction:
Describe any proposals for on-site minimalization, recycling, or reuse of materials to avoid disposal as solid waste during operation:
Proposed disposal methods/facilities for solid waste generated on site during construction:
Proposed disposal methods/facilities for solid waste generated on-site during operation:
Does the proposed action include construction or modification of a solid waste management facility?
If yes, type of management or handling of waste proposed for the site (e.g. recycling or transfer station, composting, landfill, or other disposal activities):
Tons/month, if transfer or other non-combustion/thermal treatment, or
Tons/hour, if combustion or thermal treatment
If landfill, anticipated site life in years:
Will proposed action at the site involve the commercial generation, treatment, storage, or disposal of hazardous waste?
If yes, name(s) of all hazardous wastes or constituents to be generated, handled, or managed at facility:
Generally describe processes or activities involving hazardous wastes or constituents:
Specify amount to be handled or generated in tons/month
Describe any proposals for on-site minimization, recycling or reuse of hazardous constituents:
Will any hazardous wastes be disposed of at an existing offsite hazardous waste facility?
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
Existing land uses. Check all uses that occur on, adjoining and near the project site.
Residential (suburban)
Rural (Non-farm)
If mix of uses, generally describe:
Land Uses and covertypes on the project site.
Land use of covertype
Acreage After Project Completion
Change (Acres +/-)
Roads, buildings, and other paved or impervious surfaces
Meadows, grasslands, or brushlands (non-agricultural, including abandoned agricultural)
Agricultural (includes active orchards, field, greenhouse etc)
Surface water features (lakes, pondsm streams, rivers, etc)
Wetlands (freshwater or tidal)
Non-vegetated (bare rock, earth, or fill)
Is the project site presently used by members of the community for public recreation?
Are there any facilities serving children, the elderly, people with disabilities (e.g., Schools, Hospitals, Licensed Day Care Centers, or Group Homes) within 1500 feet of the project site?
If yes, Identify Facilities:
Does the project site contain an existing dam?
If yes, please list the dimensions of the dam and impoundement:
Dam height in feet:
Dam length in feet:
Surface area in acres:
Volume impounded in gallons or acre-feet
Dam's existing hazard classification:
Provide date and summarize results of last inspection:
Has the project site ever been used as a municipal, commercial or industrial solid waste management facility, or does the project site adjoin property which is now or was at one time, used as a solid waste management facility?
If yes, has the facility been formally closed?
If yes, cite sources/documentation:
Describe the location of the project site relative to the boundaries of the solid waste management facility:
Describe any development constraints due the prior solid waste activities:
Have hazardous wastes been generated, treated, and/or disposed of at the site, or does the project site adjoin property which is now or was at one time used to commercially treat, store, and/or dispose of hazardous waste?
If yes, describe waste(s) handled and waste management activities, including approximate time when activities occured:
Potential contamination history. Has there been a reported still at the proposed project site or have any remedial actions been conducted at or adjacent to the proposed site?
If yes, Is any portion of the site listed on the NYSDEC Spills Incidents database or Enviormental Site Remediation database?
Yes - Spills Incidents database
Yes - Enviormental Site Remediation database
Neither database
Provide DEC ID number(s)
If site has been subject of RCRA corrective activities, describe control measures:
Is the project within 2000 feet of any site in the NYSDEC Enviormental Site Remediation Database?
If yes, provide DEC ID number(s):
If yes to questions above, describe current status of site(s):
Is the project site subject to an institutional control limiting property uses?
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?
E.2. Natural Resources On or Near Project Site
What is the average depth to bedrock on the project site in feet?
Are there bedrock outcroppings on the project site?
If yes, what proportion of the site in comprised of bedrock outcroppings (in %)?
Predominant soil type(s) present on project site (include name and %):
What is the average depth to the water table on the project site (in feet)?
Drainage status of project site soils (in %)
Approximate proportion of proposed action site with slopes:
% of site
Are there any unique geologic features on the project site?
Surface water features.
i. Does any portion of the project site contain wetlands or other waterbodies (including streams, rivers, ponds, or lakes?
ii. Do any wetlands or other waterbodies adjoin the project site?
If yes to either i or ii, continue. If no, skip to E.2.i.
Are any of the wetlands or waterbodies within or adjoining the project site regulated by any federal, state, or local agency?
For each identified regulated wetland and waterbody on the project site, provide the following information:
Wetland Number (if regulated by DEC)
Are any of the above waterbodies listen in the most recent compilation of NYS water quality-impaired watebodies?
If yes, name of impaired water body/bodies and basis for listing as impaired:
Is the project site in the 100 year Floodplain?
Is the project site in a designated Floodway?
Is the project in the 500 year Floodplain?
Is the project site located over, or immediately adjoining, a primary, principal or sole source aquifer?
If yes, name of aquifer:
Identify the predominant wildlife species that occupy or use the project site:
Does the project site contain a designated significant natural community?
If yes, describe the habitat/community (composition, function, and basis for designation):
Source(s) of description or evaluation:
Extent of community/habitat:
Currently in acres:
Following completion of project as proposed in acres:
Gain or Loss (indicate + or - ):
Does the project site contain any species of plant or animal that is listed by the federal government or NYS as endangered or threatened, or does it contain any areas indentified as habitat for an endangered or threated species?
Does the project site contain any species of plant or animal that is listed by NYS as rare or as a species of special concern?
Is the project site or adjoining area currently used for hunting, trapping, fishing, or shell fishing?
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
Is the project site, or any portion of it, located in a designated agricultural district certified pursuant to Agriculture and Markets Law, Article 25-AA, Section 303 and 304?
If yes, provide county plus district name/number:
Are agricultural lands consisting of highly productive soils present?
If yes, acreage(s) on project site?
Source(s) of soil rating(s):
Does the project site contain all or part of, or is it substantially contiguous to, a registered National Natural Landmark?
Nature of the natural landmark:
Provide brief description of landmark, including values behind designation and approximate size/extent:
Is the project site located in or does it adjoin a state listed Critical Enviormental Area?
CEA name:
Designating agency and date:
Does the project site contain, or is it substantially contiguous to, a building, 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?
Nature of historic/archaeological resource:
Historic Building or District
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 archaeological sites on the NY State Historic Preservation Office (SHPO) archaeological site inventory?
Have additional archaeological or historic site(s) or resources been identified on the project site?
Describe possible resource(s):
Basis for identification:
Is the project site within five miles of any offically designated and publicly accessible federal, state, or local scenic or aesthetic resource?
Identify resource:
Nature of, or basis for, designation (e.g. established highway overlook, state or local park, state historic trail or scenic byway, etc):
Distance between project and resource in miles:
Is the project site located within a designated river corridor under the Wild, Scenic, and Recreational Rivers Program 6 NYCRR 666?
Identify the name of the river and its designation:
Is the activity consistent with the development restrictions contained in 6NYCRR Part 666?
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