SOW DEMO Building 3 Design Build Demo.docx

VA Butler Medical Center Butler, PA 16001 Design/Build (DB) Scope of Work DEMO Building #3 529-22-100 Construction Documents Ready by: 120 days after Notice to Proceed (NTP) issued Construction Complete by: 200 days after NTP issued Contracting Officer: Jeffrey Zbezinski Contracting Officers Representative (COR): Josh Riddle

-- Services --

· Provide all labor, materials, tools and equipment, and design-build services necessary for design and construction of a project described here in other specific tasks as further defined by this request for proposal (RFP) Project No. 529-22-100, DEMO Building #3 Design-Build. This project was designed to 100% completion under a previous contract 529-12-110 in 2016. The resultant contract of this procurement is to provide required design completion of the referenced project and perform construction of completed design work. Project shall be designed and completed in accordance with VA Criteria, EPA requirements, and VA Specifications developed for the project.

· Specifications and drawings for demolishing of Building #3 were previously completed by Harrell, Saltrick & Hopper, Pc. as part of project 529-12-110. This design/build project will update existing specifications and drawings from project 529-12-110 to bring them up to current standards. In addition, this project will provide National Environmental Policy Act (NEPA) review and Section 106 National Historic Preservation Act review.

· Building #3 has been vacant for eight years.

· This Request for Proposal (RFP) document is intended to generally define the scope and design parameters to be included in the project. It is the DB Team’s responsibility to provide a complete set of design documents in a manner consistent with VA guidelines, specifications, and design standards in order to complete construction within the 200-day schedule.

· Offeror shall be prepared for a 200-day schedule as indicated below in the Project Schedule. Offeror may propose an alternate schedule, in addition to the 200-day schedule, which will be reviewed by the VA. Schedules shall indicate the following:

o The design period and provisions for VA reviews;

o Phasing plans for coordination of any site utility relocation work;

o Construction period services including:

· Mobilization

· Demolition

· Excavation

· Enclosure

· Site utilities, roadway realignments, and other site differing conditions as encountered during construction.

· Equipment unloading, placing, inspection, testing, and reports.

PROVIDE:

Professional Design/Build (DB) and healthcare planning services to include but not limited to:

· Site investigation – architectural, civil, structural, electrical, mechanical and any other engineering services as needed, environmental studies, and materials testing.

· Contract drawings and specifications for construction.

· Construction period services for DB A/E - review of shop drawing submissions, provide recommendations regarding contractor change proposals and requests for information (RFI), DB A/E shall visit site per VA's request, add to drawings as-built conditions from contractor's record drawings; DB A/E shall respond on site within a two-hour period when requested.

· DEMO of Building #3, including all Management, Supervision, Labor, Transportation, Equipment and Materials and perform work to include demolition, general construction, alterations, mechanical and electrical work, and certain other items as required by project drawings and specifications to create a complete and useable facility.

-- Project Scope --

GENERAL:

Provide a full set of construction documents for a project that shall demo Building #3 at the Butler VA Medical Center. While the drawings and specifications provided are labeled 100% the offeror shall be prepared to conduct site investigations to verify existing conditions, all dimensions (existing and proposed) and constructability. Offeror shall be prepared to make layout changes, calculations, and provide documentation to support their design. DEMO Building #3 per the specifications and drawings approved through the Design and Project Design Team (PDT) process.

SPECIFICS:

The project to DEMO Building #3 shall include the following:

· Building removal.

· Removal and disposal of industrial waste.

· Dismantling procedures.

· Transportation and disposal of building debris and contents.

· Protection of existing structures and utilities.

· Site safety plan.

· Capping, removal, and relocation of required utilities. Separate all utilities with minimum outages.

· NEPA Environmental Assessment

· Section 106 Historical Review

· Lead based paint and asbestos monitoring and abatement

· No dead-legs, including tees

· Completely remove building foundations

· Restore site to grass

· Require General Contractor to provide COVID 19 written plan

· Require General Contractor to provide Asbestos and Lead Abatement plan

· Require General Contractor to provide experience on Section 106 and NEPA review.

· Require General Contractor to provide any Safety issues with past demo projects.

· The Contractor shall follow all federal, state, and local regulations governing the cleanup and disposal of lead paint contamination.

· Work will include preparation of all EPA documents and regulatory requirements. Including environmental checklists attachments G, H and I.

The DB A/E is responsible for providing certified industrial hygiene services to perform asbestos and Lead base paint survey investigations, bulk sampling, development of specifications and drawings, and construction period services. All designs shall be accomplished in accordance with VA guidelines and specifications, which are available on the Internet at http://www.cfm.va.gov/til/. DB A/E shall pay particular attention to NFPA, BOCA, VA Handbook 7610 space criteria and VA program guide PG-18-14. SPECIAL NOTE: Be reminded that the VA guidelines are just a guide, and the project is not bound by them. If current healthcare trends dictate a different design approach is needed, we shall follow that approach.

The DB A/E shall provide professional architectural and engineering and construction services for the project and is responsible for providing all services necessary for design of this project – i.e. mechanical, electrical, asbestos and Lead sampling and monitoring, NEPA and Section 106 Historical review.

The DB construction contractor shall provide all Management, Supervision, Labor, Transportation, Equipment and Materials and perform work to include demolition, general construction, alterations, mechanical and electrical work, and certain other items as required by project drawings and specifications complete the Building #3 demo Project.

-- Site Investigations --

EXPECTATION: The DB A/E shall make site visits as necessary to survey existing conditions.

Make site visits as required to determine existing as-built conditions affecting this project. NOTE: Information including drawings and other documentation provided to the DB A/E is used as reference only. All additional references and specifications are available in VHA’s Technical Information Library at address: http://www.cfm.va.gov/til/. AutoCAD background drawings will be provided by the VA upon request. The DB A/E shall field verify all dimensions. The DB A/E shall field verify every aspect that relates to the project. Coordinate site visits with the Contracting Officer Representative (COR) as determined after award.

-- Project Schedule --

EXPECTATION: Submit review packages so they are received on the noted day

SUBMISSIONS:

Submit review packages so they are received on the noted day (calendar days after NTP) or earlier:

Construction Documents 100 days (3 Sets of Drawings and Specifications)

Note: The issuance of the Notice to Proceed (NTP) for design will be at the first Project Design Team (PDT) Meeting. The Design-Build Team Contractor shall be required to attend and take minutes of each PDT meeting. Minutes shall be submitted electronically to the Project Manager and Contracting Officer within three calendar days of each meeting for approval and to be added to the official contract file.

-- Design Requirements/Submissions --

EXPECTATIONS: Submit complete review package in accordance with the following requirements and guidelines outlined in http://www.cfm.va.gov/til/aeDesSubReq.asp Please pay specific attention to the schematic, design and construction submission requirements. As appropriate and depending upon the complexity of the design, the DB A/E may elect to delete individual submissions where not required (i.e. Do not address Site Development, Landscaping for interior renovation projects)

DELIVER:

All design packages directly to the Contracting Officer and Project Engineer on the established dates to allow the VA to review. Include all information as follows and as outlined in the attachments for each submission. Information required for each submittal is outlined in Program Guide PG-18-15 Volume C November 2008. The manual is available at the following address: http://www.cfm.va.gov/til/aeDesSubReq.asp Area of Construction: Building #3, See Attachment A.

Design Development 65%: Attachment “B” 65% Submission Requirements

· Requirements for the 65% Design Development Documents Submission.

· Define the design elements based on the presented option and submit all information required by the PG-18-15 (65% Design Development).

· Identify Working Drawings scope within the construction budget.

· Identify all design calculations.

· Identify impact of existing asbestos.

· Identify Impact of existing Lead Base Paint

· Develop plans and marked up specifications to meet all applicable federal and state codes/requirements, including but not limited to PENDOT, OSHA, DER, EPA, NEC, NFPA 101 Life Safety Code.

· Identify all design calculations.

· Identify all existing utilities and utilities requirements.

· Identify all potential bid deduct alternatives.

· Identify all phasing requirements for construction.

· Identify all issues with NEPA review and Section 106 Historical review

Design Development 95%: Attachment “B” 95% Submission Requirements

· Requirements for the 95% Design Development Documents Submission.

· Address all comments from the 65% review.

· Define the design elements based on the presented option and submit all information required by the PG-18-15 (95% Design Development).

· Identify Working Drawings scope within the construction budget.

· Identify all design calculations.

· Identify impact of existing asbestos.

· Identify Impact of existing Lead Base Paint

· Develop plans and marked up specifications to meet all applicable federal and state codes/requirements, including but not limited to PENDOT, OSHA, DER, EPA, NEC, NFPA 101 Life Safety Code.

· Identify all design calculations.

· Identify all existing utilities and utilities requirements.

· Identify all potential bid deduct alternatives.

· Identify all phasing requirements for construction.

· Identify all issues with NEPA review and Section 106 Historical review

Design Development 100%: Attachment “C” 100% Submission Requirements

· Requirements for the 100% Design Development Documents Submission.

· Address all comments from the 95% review.

· Consolidate all necessary submittals by specification section on an Excel spreadsheet. Checklist to be utilized to track/monitor submittal process.

· Revise and update cost estimate.

· Preparation of project scope for CBD/ negotiated advertisement and account for any bid deduct alternatives developed in the 95% design submission

· Finalize all design calculations.

· Finalize all potential bid deduct alternatives.

· Finalize all phasing requirements for construction.

· Finalize impact of existing asbestos and Lead base paint Construction Documents (CD): Attachment “D” Construction Documents Submission Requirements Submit a complete set of documents of all contract requirements. The Cover Page shall be submitted for approval signatures. If necessary, update and submit until approved by the VA.

-- Construction Period Services --

Expectations: Respond to submittals and other requests in a timely manner.

PROVIDE:

· Review all shop drawing submissions and provide recommendations to the VA within five calendar days upon request.

· Make site visits on requests of the VA and prepare written reports to include agreed upon changes in design as determined necessary during the construction. Visits made based on errors and omissions in design shall be at no cost to the VA.

· Participate in partial and/or final acceptance inspections as scheduled and generate punch list items for completion. The punch list shall reference the contract documents for specific deficiencies (i.e. specification section, drawing detail, etc.)

· Prepare as-built drawings on original set with DB A/E’s stamp, based on record drawings that the contractor kept during construction. Transpose contractor’s as-built’s to AutoCAD 2019 and in PDF form and provide a set of updated as-built’s on CD within 30 days to the COR.

ATTACHMENT A

ATTACHMENT “B”

Design Development 65% Submission Requirements Deliver the following (labeled with 65% submission) and include this attachment as a checklist with your submission:

q 2 copies of a narrative report forwarding the design develop 65% submission addressing items listed in the design requirements and any additional A/E recommendations. The report should include identifying potential bid deduct alternatives, recommended construction phasing based upon discussions with the program manager, and any design calculations or analysis.

q1 set (Full Size) of all drawings updating all previous comments required by project and produced in AutoCAD 2019 and in PDF form.

q 2 copies of updated itemized cost estimate by spec section or trade (labor, material and equipment) and by VA criteria, NRM, Minor, BSER and BSEA.

q 1 copies of custom edited VA Master Specifications of sections to be used for this project and a master submittal list identifying all the submittals required to be submitted by the contractor for review.

q 1 copy of drawings in AutoCAD 2019 and in PDF form and specifications in Microsoft Word 2007 or higher on (CD)

ATTACHMENT “C”

Design Development 95% Submission Requirements

Deliver the following (labeled with 95% submission) and include this attachment as a checklist with your submission:

q 2 copies of a narrative report forwarding the design develop 95% submission addressing items listed in the design requirements and any additional A/E recommendations. The report should include identifying potential bid deduct alternatives, recommended construction phasing based upon discussions with the program manager and any design calculations or analysis.

q 1 set of (Full Size) drawings updating all previous comments required by project produced in AutoCAD 2019 and in PDF form.

q 2 copies of the proposed construction schedule.

q 2 copies of final itemized cost estimate by spec section or trade (labor, material and equipment) and also by VA criteria, NRM, Minor, BSER and BSEA.

q 2 copies of final edited VA Master Specifications of sections to be used for this project and a master submittal list identifying all the submittals required to be submitted by the contractor for review.

q 1 CD containing qAll drawings in AutoCAD 2019 and in PDF form.

qAll specifications in Microsoft Word 2007 or higher on (CD)

ATTACHMENT “D”

Expectation: Submit complete contract documents for final review prior to Notice to Proceed for Construction. Continue to submit contract documents until all changes are incorporated by the DB A/E for final signature prior to Notice to Proceed for Construction. Upon approval duplicate copies as required.

Deliver the following (labeled with Contract Documents Submission) and include this attachment as a checklist with your submission:

Contract Document Submission Requirements q1 copy of the Cover Sheet (AutoCAD) for final VA signatures.

q 2 sets of all drawings updating all previous comments required by project, produced in AutoCAD 2019 and in PDF form – for final VA review. If approved final sets to be submitted with signed off cover sheet.

\q 2 copies of final project specification (two bound;) prepared in Microsoft Word 2007 or higher. Include a master submittal list in the specifications.

q 1 CD containing qAll drawings in AutoCAD 2019 and in PDF form.

q All specifications in Microsoft Word 2007 or higher.

q Submittal Spreadsheet – identifying all the submittals required to be submitted by the contractor for review. The list shall be organized by division and specification.

q Upon signature approval, provide three (3) sets of final Contract Documents (complete with VA signed Cover Sheet). Provide two (2), half (1/2) size sets and (1) full set of final drawings. Attachment F

4/1/2010

VAMC BUTLER, PA 16001

ENVIRONMENTAL REQUIREMENTS CHECKLIST

Instructions: The Contracting Officer/Facilities Management Officer will provide this list to applicable A/E Firms and on- site contractors.

The A/E firm and the contractor must complete this checklist for any work applicable to the project scope of work.

Any checks below will require remediation and appropriate work plans prior to start of construction work and activities.

A/E Firm and Contractor will ensure all PA DEP( Requests for Determination Form) and permits and fees are properly filed prior to start of work operations.

The contracting officer will review the applicable subsections checked and ensure contractors’ scope of work includes the checked items.

Contracting and Facilities Management Staff will ensure program requirement are met prior release of contract.

The contracting officer/Facilities Management Staff will consult the Environmental Protection Specialist with any specific program requirements.

Project Name: DEMO Building #3

Work Activity

Constructing or Modifying Facilities, Equipment or Processes

Stationary Air Emission Sources onto the Site

at the Site

Operating Facilities, Equipment, or Processes

the Site

Agents

Maintaining or Repairing Facilities, Equipment, or Processes

Air Emissions Sources

WORK ACTIVITY

Planning Activities that may Break Up, Dislodge, Disturb or Block Access to

Asbestos-Containing Material

Discovered Lead

Discontinuing Use Of, or Closing Facilities, Equipment or Processes

trailers), Structures, Equipment, or Processes - General

Disturbing Soils

Purchasing of Goods and Services

that Operate Using Refrigerants, or Refrigerant Recovery or Recycling

Equip.

Spills/Rels., Fires, and Explosions; and Permit or Reg. Exceedances

Generating Waste

(Content Weights for recovery, recycling Required)

Receiving Off-site Waste, Disposing of Waste & Recycling or Reusing Materials

Sample Collection and Monitoring

Suspected Inactive Waste Sites

Attachment G

GENERAL PROJECT INFORMATION

325 New Castle Road, Butler, Pennsylvania 16001

DETERMINATION OF WHETHER AN ACTION IS CATEGORICALLY EXCLUDED FROM DEVELOPING AN ENVIRONMENTAL ASSESSMENT OR ENVIRONMENTAL IMPACT STATEMENT

Typical Classes of Action Which Normally Do Not Require an Environmental Impact Statements or Environmental Assessment. These actions are referred to as Categorical Exclusions. Does the action entail:

Yes or No

Repair, replacement, and new installation of primary or secondary electrical distribution systems.

Repair, replacement, and new installation of components such as windows, doors, roofs; and site elements such as sidewalks, patios, fences, retaining walls, curbs, water distribution lines, and sewer lines.

Routine VA grounds and facility maintenance activities.

Interior construction or renovation.

New construction of 75,000 gross square feet or less;

Development of 20 acres of land or less within an existing cemetery, or development on acquired land of five acres or less.

Examples of specific criteria associated with actions that do not normally require an Environmental Impact Statement or an Environmental Assessment:

Yes or No

Minimal or no effect on the environment.

No significant change to existing environmental conditions.

No significant cumulative environmental impact.

Similar conditions to Actions previously assessed with a finding of no significant impact.

Before responsible officials can conclude that an action is categorically excluded, extraordinary circumstances associated with actions must be considered. Answers to the questions appearing below can be used to evaluate whether there are extraordinary circumstances associated with an action.

Yes or No

Will the action be greater scope or size than normally experienced for a particular categorical exclusion.

remains, or other protected resources.

Is the action located in highly populated or congested areas.

Is there the potential for degradation, although slight, or existing poor environmental conditions.

Does the action utilize unproven technology;

Is there the potential presence of an endangered species or archeological remains or other protected resources at the action location.

Is there the potential presence of hazardous or toxic substances at the action location.

Actions Normally Require an Environmental Impact Statements :

Acquisition of land in excess of 10 acres for development of a VA medical center facility.

Acquisition of land in excess of 50 acres for development of a VA national cemetery.

Examples of specific criteria associated with actions that normally require an Environmental Impact Statement:

Yes or No

Probable significant degradation of historic or cultural resources, park lands, prime farmlands, designated wetlands or ecologically critical areas.

Probable significant impact on farmlands, designated wetlands or ecologically critical areas;

Probable significant increase in average daily vehicle traffic volume of at least impact on 20 percent on access roads to the site or the major roadway network

Probable significant conflict with Federal, State, or local environmental protection laws or requirements

Probable significant threat or hazard to the public, or the involvement of highly uncertain risks to the environment.

Probable significant conflict with, or significant effect on, local or regional zoning or comprehensive land use plans.

Similarity to previous actions that required an environmental impact statement.

If the proposed action is not Categorically Excluded or required to have an Environmental Impact Statement prepared, responsible VA official(s) are to prepare an environmental assessment. Based on the findings of the environmental assessment, the responsible official(s) shall determine whether it is necessary to prepare an Environmental Impact Statement or a finding of no significant impact (FONSI).

Typical action which normally require an environmental assessments, but not necessarily Environmental Impact Statement:

Yes or No

Acquisition of land of 10 acres or less for development of a VA medical facility.

Acquisition of land from 5 to 50 acres for development of a VA national cemetery.

New construction in excess of 75,000 gross square feet.

Examples of specific criteria associated with actions that normally require an Environmental Assessment:

Yes or No

Potential minor degradation of environmental quality.

Potential cumulative impact on environmental quality.

Presence of hazardous or toxic substances.

Potential violation of pollution abatement laws.

Potential impact on protected wildlife or vegetation.

Potential effects on designated prime farmlands, wetlands, floodplains, or ecologically critical areas.

Alteration of stormwater runoff and retention.

Potential dislocation of persons or residences

Potential increase of average daily vehicle traffic volume on access roads to the site by 10 percent or more but less than 20 percent, or which alters established traffic patterns in terms of location and direction.

Potential threat or hazard to the public, or highly uncertain risks to the environment.

Potential conflicts with Federal, State, or local environmental protection laws or requirements.

Potential conflict with, or significant impact on, official local or regional zoning or comprehensive land use plans.

Overloading of public utilities with insufficient capacity to provide reliable service and for average and peak periods.

Attachment H

ENVIRONMENTAL CHECKLIST TO EVALUATE WHETHER THE ENVIRONMENTAL ATTRIBUTES OF VETERANS HEALTH ADMINISTRATION (VHA) CONSTRUCTION, REAL PROPERTY TRANFER, ENHANCED USE AND SIMILAR PROJECTS WILL HAVE A SIGNIFICANT IMPACT ON THE ENVIRONMENT

This checklist is to be used by VA Medical Centers (VAMCs) to determine if facility-based construction projects, VHA real property transactions, enhanced use lease and similar projects will have an impact on the environment. This evaluation will, in turn, assist VHA and VAMCs in determining whether additional environmental review, including the development of detailed environmental reports and information (e.g., Environmental Assessments (EA), Environmental Impact Statements (EIS) and Phase I/Phase II Environmental Assessment) need to be developed. This checklist is not intended to substitute for activity otherwise required by the Comprehensive Environmental Response, Compensation, and Liability Act (CERCLA), the National Environmental Policy Act (NEPA), and VA and EPA regulations (Title 38 and Title 40, respectively, of the Code of Federal Regulations).

COMPLETING THE PROJECT INFORMATION TABLE ENVIRONMENTAL CHECKLIST

The Project Information Table and the Environmental Checklist should be completed by Project Coordinator and/or other staff knowledgeable of environmental requirements related to construction projects, VHA facility infrastructure and equipment, real property transactions, enhanced use lease and similar projects. If the checklist is completed by VAMC staff other than the GEMS Coordinator, the GEMS Coordinator should review and concur in the information inputted into the checklist.

Instructions for completing the Project Information Table and the Environmental Checklist follow:

1) Complete Project Information table.

2) For projects that are part of a larger project, checklist responses must take into account the ultimate environmental impact of the overall project. Responses should consider construction and operational impacts, as well as both on-site and off-site environmental impacts.

3) If the checklist response for a question listed in the “Issues” column indicates that the project may have an impact the environment, the “Impact” column must indicate whether the impact is potentially significant; less than significant providing mitigation (i.e., measures specifically designed to reduce environmental impact) is incorporated into the project; less than significant; or the environmental issue is present in project with no significant impact.

4) For answers "Less Than Significant With Mitigation Incorporated", possible mitigative measures designed to reduce otherwise significant impacts should be described in the “Comments/Supporting Documentation” column.

5) Information supporting checklist responses should be provided in the “Comments/Supporting Documentation” column. This information should be sufficiently detailed to demonstrate that the VHA facility applied environmental due diligence in its evaluation of their projects’ impact as it relates to the specific issue (question) being evaluated. A checklist response of NA (Environmental Issue Does Not Apply to Project) would require minimal explanation of why the specific environmental issue does not apply to the project.

6) Earlier environmental analysis performed for a project may be used to answer checklist questions.

7) The nature of assessing environmental impacts, including that which is required by NEPA and CERCLA, in part, calls for the evaluation of non-quantitative information in the determination of environmental impacts. In making determinations based on non-quantitative information, VHA facilities should consider whether or not there is sufficient information for a knowledgeable third party to reach the same conclusion for the particular environmental issue being considered.

8) For each of the environmental checklist issues (questions) under environmental categories (Aesthetics, Air Quality, Biological Resources, etc.), the VHA facility staff completing the checklist should indicate under the column entitled “Impact” whether the anticipated environmental impact is:

-3-

LSI/M Less Than Significant Impact Providing Mitigation is Incorporated into Project

LSI Less Than Significant Impact

NI Environmental Issue is Present in Project -- There Is No Significant Impact

NA Environmental Issue Does Not Apply to Project

GENERAL PROJECT INFORMATION

Note: Use additional sheets, if necessary.

ENVIRONMENTAL CHECKLIST ISSUES (QUESTIONS)

Issues Impact

PSI

LSI/M

LSI

NI

NA

Comments/Supporting Documentation Mitigative Measures Attach Additional Sheets If Necessary

Skip to II. AIR QUALITY if the project does not involve a new structure or the modification of an existing structure.

____ Check if you skip to II AIR QUALITY

I. AESTHETICS -- Would the project:

a) Have a substantial adverse effect on a scenic vista?

b) Substantially damage scenic resources, including, but not limited to, trees, rock outcroppings, and historic buildings within a state scenic highway?

c) Substantially degrade the existing visual character or quality of the site and its surroundings?

d) Create a new source of substantial light or glare which would adversely affect day or nighttime views in the area?

Skip to III. BIOLOGICAL RESOURCES if the project will not during construction or while operational result in 1. a new source of air pollution, 2. modification of an existing source of air pollution or 3. objectionable odor.

____ Check if you skip to III BIOLOGICAL RESOUCES

a) Conflict with or obstruct implementation of the applicable air quality plan?

b) Violate any air quality standard or contribute substantially to an existing or projected air quality violation?

c) Result in a cumulatively considerable net increase of any criteria pollutant for which the project region is non-attainment under an applicable federal or state ambient air quality standard (including releasing emissions which exceed quantitative thresholds for ozone precursors)?

d) Release toxic substances to the air in quantities that could affect human health or safety, or environmental quality?

e) Release substances for which there is a National Ambient Air Quality Standard (such as sulfur or nitrogen oxides, carbon monoxide, lead, particulates, etc.)?

f) Result in the installation of devices including an incinerator that produce air emissions that are regulated by federal, state or local requirements?

g) Create objectionable odors affecting a substantial number of people?

h) Include a fossil fuel (natural gas, gasoline, diesel fuel, coal, etc.) burning heating system with a total capacity greater than 1 million BTU/hour?

III. BIOLOGICAL RESOURCES -- Would the project:

a) Have a substantial adverse effect, either directly or through habitat modifications, on rare, threatened, or endangered species, or a critical habitat?

b) Have a substantial adverse effect on any riparian habitat or other sensitive natural community identified in local or regional plans, policies, and regulations or by the US Fish and Wildlife Service?

c) Have a substantial adverse effect on federally protected wetlands as defined by Section 404 of the Clean Water Act (including, but not limited to, marsh, vernal pool, coastal, etc.) through direct removal, filling, hydrological interruption, or other means?

d) Interfere substantially with the movement of any native resident or migratory fish or wildlife species or with established native resident or migratory wildlife corridors, or impede the use of native wildlife nursery sites?

e) Conflict with any local policies or ordinances protecting biological resources, such as a tree preservation policy or ordinance?

f) Conflict with the provisions of an adopted Habitat Conservation Plan, Natural Community Conservation Plan, or other approved local, regional, or state habitat conservation plan?

IV. CULTURAL RESOURCES -- Would the project:

Skip to V. GEOLOGY AND SOILS if the project does not involve historical, archaeological or paleontological resources or the disturbance of human remains.

____ Check if you skip to V. GEOLOGY AND SOILS

a) Cause a substantial adverse change in the significance of a historical resource?

b) Cause a substantial adverse change in the significance of an archaeological resource?

c) Directly or indirectly destroy a unique paleontological resource or site or unique geologic feature?

d) Disturb any human remains, including those interred outside of formal cemeteries?

V. GEOLOGY AND SOILS -- Would the project:

Skip to VI. HAZARDS AND HAZARDOUS MATERIALS if the project does not involve the disturbance of soil.

____ Check if you skip to VI. HAZARDS AND HAZARDOUS MATERIALS

a) Result in substantial soil erosion or the loss of topsoil?

b) Be located on a geologic unit or soil that is either unstable or would become unstable as a result of the project and potentially result in on- or off-site landslide, lateral spreading, subsidence, liquefaction or collapse?

c) Be located on expansive soil, as defined in Table 18-1-B of the Uniform Building Code (1994), creating substantial risks to life or property?

VI. HAZARDS AND HAZARDOUS MATERIALS -- Would the project:

a) Create a significant hazard to the public or the environment through the routine transport, use, or disposal of hazardous materials?

b) Create a significant hazard to the public or the environment through reasonably foreseeable release of hazardous materials to the environment?

c) Generate more than 100 kilograms of hazardous waste per month during construction or operation?

d) Be located on property that state or federal officials have identified as a hazardous or solid waste site or a CERCLA site?

e) Impair implementation of or physically interfere with an adopted emergency response plan or emergency evacuation plan?

f) Include the construction or close out of a solid waste management facility such as a landfill?

g) Involve structures that contain asbestos containing material (for demolition and renovation projects and projects involving transfer or use of structure by non-VA entity)?

h) Involve structures painted with lead-based paint (for demolition and renovation projects and projects involving transfer or use of structure by non-VA entity)?

i) Involve renovation or demolition of structure that housed laboratory or stored hazardous chemicals or hazardous waste?

j) Involve the closing out or removal of an above ground or underground storage tank?

VII. HYDROLOGY AND WATER QUALITY -- Would the project:

Skip to VII. d) HYDROLOGY AND WATER QUALITY if the project does not involve a discharge to groundwater or surface water resulting from construction or operation. ____ Check if you skip to VII. d) HYDROLOGY AND WATER QUALITY

a) Violate any water quality standards or waste discharge requirements?

b) Degrade water quality in a sole source aquifer?

c) Affect chemical quality of ground or surface waters (pH, dissolved oxygen, nutrients, dissolved solids, pesticides, etc.)?

d) Substantially deplete groundwater supplies or interfere substantially with groundwater recharge such that there would be a net reduction in aquifer volume or a lowering of the local groundwater table level.

Skip to VIII LAND USE AND PLANNING if the project does not involve construction of a new structure; changing the footprint of an existing building; or construction of new infrastructure, including, but not limited to parking lots and roads.

____ Check if you skip to VII. e) to i)HYDROLOGY AND WATER QUALITY

e) Substantially alter the existing drainage pattern of the site or area, including through the alteration of the course of a stream or river?

f) Substantially alter the existing drainage pattern of the site or area in a manner which would result in flooding on or off site?

g) Create or contribute runoff water which would exceed the capacity of existing or planned stormwater drainage systems or provide substantial additional sources of polluted runoff?

h) Place a structure within a 100-year flood hazard area as mapped on a federal Flood Hazard Boundary or Flood Insurance Rate Map or other flood hazard delineation map?

i) Expose people or structures to a significant risk of loss, injury or death involving flooding?

VIII LAND USE AND PLANNING - Would the project:

a) Conflict with any applicable land use plan, policy, or regulation of an agency that has jurisdiction over the project?

IX. NOISE -- Would the project result in:

a) Exposure of persons to or generation of noise levels in excess of standards established in the local general plan or noise ordinance, or applicable regulations and standards?

b) Exposure of persons to or the generation of excessive groundborne vibration or groundborne noise levels?

c) A substantial temporary or permanent increase in ambient noise levels in the project vicinity above levels existing without the project?

X. POPULATION AND HOUSING -- Would the project:

a) Induce substantial population growth in an area, either directly or indirectly?

b) Displace substantial numbers of existing housing or persons, necessitating the construction of replacement housing elsewhere?

XI. PUBLIC SERVICES

a) Would the project result in substantial adverse impacts associated with changes in infrastructure needed to maintain acceptable levels of public service associated with:

Fire protection?

Police protection?

Schools?

Parks?

Other public facilities?

(Specify)

XII. TRANSPORTATION / TRAFFIC -- Would the project:

a) Cause an increase in traffic which is substantial when compared to the existing traffic load and capacity of the street?

XIII. UTILITIES AND SERVICE SYSTEMS -- Would the project:

a) Have soils incapable of adequately supporting the use of septic tanks or alternative wastewater disposal systems where sewers are not available?

b) Exceed wastewater treatment requirements or capacity of the applicable state, regional or local water pollution agency?

c) Result in the construction of new water or wastewater treatment facilities or the expansion of existing facilities that could result in significant environmental impacts?

d) Result in the discharge of industrial waste to wastewater treatment facilities?

e) Require or result in the construction of new storm water drainage facilities or the expansion of existing facilities, the construction of which could cause significant environmental effects?

f) Be able to obtain sufficient drinking water from existing sources and entitlements?

g) Require the installation or removal of above ground or underground storage tanks?

h) Be served by a landfill or other solid waste disposal facility with sufficient permitted capacity to accommodate the project’s solid waste disposal needs?

i) Result in the disturbance of > 1 acre and need to obtain storm water discharge permit?

Skip to XV. – ENVIRONMENTAL PERMITTING if the project does not involve real property transfer or an enhanced use lease..

____ Check here if you skip to XV. – ENVIRONMENTAL PERMITTING

a) What has been the use of the property at question in the past::

_____Health care?

_____Industrial?

_____Residential?

_____Commercial (e.g., Office/Store)?

_____Other (specify)?

_____Unknown?

b) Has past use of property involved storing, handling or use of hazardous materials, or the release of hazardous material to the environment?

c) Has a Phase I Environmental Assessment (EA) been performed in accordance with ASTM specification 1527?

d) Has a Phase I EA been expanded to cover asbestos containing material and lead-based paint?

e) Does the Phase I EA conclude that there are environmental conditions that need to be further addressed?

f) Has a Phase II EA (or its equivalent) been prepared to address environmental conditions identified in either the Phase I EA or other environmental review?

g) Has Phase I EA and Phase II EA and other project data been reviewed to both determine if remedial action is needed and assess possible future VA environmental liabilities associated with the project?

XV – Environmental Permitting – Does the project involve

a) Installation or modification of new equipment or infrastructure that would require a federal, state or local environmental permit. This would include equipment or infrastructure that produces air emissions (e.g., boiler or incinerator); wastewater, industrial wastewater or stormwater discharge; solid or hazardous waste; or otherwise impacts on environmental media?

ENVIRONMENTAL FACTORS THAT WILL POTENTIALLY HAVE A SIGNIFICANT IMPACT ON THE ENVIRONMENT

VAMC staff that completed the checklist should complete the table below, consulting with other staff, as necessary. If it is determined that any of the checklist responses under Aesthetics, Air Quality, Biological Resources, etc. indicate a “Potentially Significant Impact”, the appropriate category should be checked. This individual should also sign and date this information.

Aesthetics

Air Quality

Biological Resources

Cultural Resources

Hazards & Hazardous Materials

Hydrology / Water Quality

Land Use / Planning

Mineral Resources

Noise

Population / Housing

Public Services

Transportation/Traffic

Utilities / Service Systems

Recreation

Real Property Transfer

Name of VAMC or Other VHA Staff Completing the Environmental Checklist

Title Date

DETERMINATION OF WHETHER THE PROJECT IN ITS ENTIRETY WILL HAVE A SIGNIFICANT IMPACT ON THE ENVIRONMENT

In accordance with VHA policy and guidance, a senior VHA facility manager is to determine if the project taken in its entirety will have a significant impact on the environment. This official is note their determination in the below table and sign and date the table

WILL NOT have a significant effect on the environment.

MAY HAVE a significant effect on the environment. HOWEVER, revisions to the project have been made to mitigate perceived significant environmental impacts.

MAY HAVE a significant effect on the environment, and an Environmental Assessment or Environmental Impact Statement is required.

Name of VAMC or Other VHA Facility Senior Manager Making Determination

Title Date image1.emf image2.emf