1970B Exhibit D Categorical Exclusion with Instructions.docx
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1970B Exhibit D Categorical Exclusion
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RD Instruction 1970-B Exhibit D
Categorical Exclusion Form with Instructions
U.S. DEPARTMENT OF AGRICULTURE RURAL DEVELOPMENT
ENVIRONMENTAL CHECKLIST FOR CATEGORICAL EXCLUSIONS
1. APPLICANT NAME:
2. NAME OF PROPOSAL (provide brief description):
3. ADDRESS OR GENERAL LOCATION OF PROPOSAL:
| 4. FEDERAL ACTION: |
| Loan |_| |
| Grant |_| |
| Guarantee |_| |
| Construction Work Plan or Loan/System Design |
| |_| |
5. APPLICABLE RD PROGRAM:
6. THIS PROPOSAL QUALIFIES AS A CATEGORICAL EXCLUSION IN ACCORDANCE WITH § 1970.53 ______ OR § 1970.54 _______
7. * ENVIRONMENTAL REPORT PREPARED FOR RD: YES |_| NO |_|
*This form can be used to document the consideration and incorporation by reference of environmental information from any source
8. S. 106 Findings: No Potential to Affect |_| No Historic Properties Affected |_| No Adverse Effect to Historic Properties |_|
9. Endangered Species Act, Section 7 Findings: Species/Habitat - Not Present |_| Species/Habitat Present - No Effect |_| Species/Habitat Present - May Affect, Not Likely To Adversely Affect |_|
10. IF PREPARED, ATTACH ENVIRONMENTAL REPORT (SEE EXHIBIT C)
For the items listed below, indicate either a “Yes” or “No” in the appropriate columns. If the answer is ”Yes” in the “Adversely Affected” column for any listed resources, then an extraordinary circumstance exists and the proposed action is not eligible for a Categorical Exclusion.
(04-01-16) SPECIAL PN
Table (Con.)
| Resources |
| Resources Present |
| Effects to Resources |
| Yes |
| No |
| No Effect |
| Affected |
| Adversely Affected |
| a. Historic Properties/Cultural Resources (Historic Properties listed or eligible for listing in the National Register of Historic Places, sites of cultural or religious significance to tribes) |
| |_| |
| |_| |
| |_| |
| |_| |
| |_| |
| b. Threatened or Endangered Species, Critical Habitat, State Listed Species |
| |_| |
| |_| |
| |_| |
| |_| |
| |_| |
| c. Wetlands |
| |_| |
| |_| |
| |_| |
| |_| |
| |_| |
| d. Floodplains (100 or 500 year floodplains) |
| |_| |
| |_| |
| |_| |
| |_| |
| |_| |
| e. Formally Classified Lands (State/Federal Parks, Monuments, Natural Landmarks, Wilderness Areas, Wild and Scenic Rivers, National Forest System Lands, other Federal or State Lands, etc.) |
| |_| |
| |_| |
| |_| |
| |_| |
| |_| |
| f. Water Resources (Sole Source Aquifers, Well-head protection areas, Watershed Protection Areas, etc.) |
| |_| |
| |_| |
| |_| |
| |_| |
| |_| |
| g. Coastal Resources (Coastal Barrier Resources System or Coastal Zone Management Areas) |
| |_| |
| |_| |
| |_| |
| |_| |
| |_| |
| h. Coral Reefs or Protected aquatic habitats (Only applies to American Samoa, Florida, Guam, Hawaii, Northern Marianna Islands, Puerto Rico, U.S. Virgin Islands) |
| |_| |
| |_| |
| |_| |
| |_| |
| |_| |
| Questions |
| Yes |
| No |
| i. Is the proposal located on Important Farmland (Prime Farmland, Unique Farmland, Farmland of Statewide Importance, Farmland of Local Importance) and if so, has Form AD-1006 been completed? |
| |_| |
| |_| |
| j. Does the project threaten a violation of local, state, or federal statutory, regulatory, or permitting requirements and have all necessary permits been identified? |
| |_| |
| |_| |
| k. Is the proposal located within EPA-designated Non-Attainment or Maintenance Areas for Air Quality Criteria Pollutants? |
| |_| |
| |_| |
| l. Does the proposal result in the production of unpermitted hazardous materials or waste, or consist of construction of a new RCRA hazardous materials handling facility? |
| |_| |
| |_| |
Table (Con.)
| m. Does the proposal have any Environmental Justice concerns or disproportionately high and adverse human health or environmental effects on minority populations or low-income populations? |
| |_| |
| |_| |
| n. Is the proposal controversial for environmental reasons? If so, attach a summary of the controversy(ies) and any actions taken and resolutions necessary to respond to the concerns. |
| |_| |
| |_| |
| o. Is the proposal controversial for other than environmental reasons? If so, attach a summary of the controversy(ies) and any actions taken and resolutions necessary to respond to the concerns. |
| |_| |
| |_| |
11. FINDING:
I find that the proposal meets the criteria established in 7 CFR §§1970.53, “Categorical Exclusions Involving No or Minimal Disturbance,” or 1970.54 (c), “Categorical Exclusions Involving Small-scale Development.” Upon review of the proposal’s description or the Environmental Report I find that the proposal is consistent with 40 CFR §1508.4, “Categorical Exclusion" and does not have any extraordinary circumstances or that the proposal individually or cumulatively does not have a significant effect on the human environment and, therefore, neither an Environmental Assessment nor an Environmental Impact Statement is required.
(04-01-16) SPECIAL PN
RD Instruction 1970-B
12. SIGNATURES:
12a. SIGNATURE OF PREPARER
DATE
NAME OF PREPARER
TITLE
12b. SIGNATURE OF STATE ENVIRONMENTAL COORDINATOR OR NATIONAL ENVIRONMENTAL STAFF
DATE
NAME OF STATE ENVIRONMENTAL COORDINATOR OR NATIONAL ENVIRONMENTAL STAFF
TITLE
12c. SIGNATURE OF APPROVING OFFICIAL
DATE
NAME OF APPROVING OFFICIAL
TITLE
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