Preliminary Environmental Information Survey Checklist_508.pdf

U.S. DEPARTMENT OF AGRICULTURE RURAL DEVELOPMENT

PRELIMINARY ENVIRONMENTAL INFORMATION SURVEY

The purpose of this document is to assist RD staff in collecting adequate information to determine what level of environmental review is necessary. Depending on the information provided, the Agency may request additional information. All answers need to be supported by appropriate documentation, check marks are not sufficient support. Potentially helpful links are provided in blue, these are not an exhaustive or comprehensive list of resources. Yes No

1. APPLICANT NAME:

2 . ADDRESS: Physical location of the property (include legal description if farmland):

3. MAP. Please provide an aerial map showing the building /lot/exact location for all project types, please indicate on map any potential trenching or other ground disturbance. Is map attached?

4. DETAILED PROJECT DESCRIPTION (Describe how proposed funds will be used. If project involves construction, whether interior or exterior or renovations, please describe in detail. For renewable energy systems such as solar panels be specific on type of system (fixed tilt, tracking, mounting & structure, i.e. ballasted, 3" pile driven, concrete, screws, etc.):

5. SIZE OF THE PROJECT & SITE: Please indicate the size (acres) of your project and how the project will impact the site including roads, right of ways, utilities, or other impacts. Example:

Renewable energy solar project should include sq. ft, linear ft, number of installed units/panels/buildings, and details regarding any trenching or ground disturbance to be completed.

6. Will the project involve construction without any ground disturbance? (i.e.

roof mounted solar)

6a. If no ground disturbance, please provide land use, land ownership, & description (i.e.

industrial, residential, wooded, grasslands, etc.).

6b. If ground disturbance is expected, provide descriptive info, including if the project site was previously disturbed (i.e. previous structure, excavation, cultivation).

Rev 06/10/2022

7. What is the zoning for the project location?

8. Will the project be located in/on a building that is more than 50 years old? ☐ ☐

9. Will the project be located within the viewshed of a building that is a least 50+ years old?

10. Is the building or project site listed on the State/National Register of Historic Places?

National Register: https://npgallery.nps.gov/NRHP/

11. If yes to # 8, 9 or 10, has approval or concurrence been obtained from State Historic Preservation Office?

12. Have any Tribes or Tribal Historic Preservation Officers’ been contacted? ☐ ☐ 12a. If so, when?

12b. Were any responses received and if yes, provide details of responses.

Tribal contact TDAT: https://egis.hud.gov/tdat Tribal Lands: https://biamaps.doi.gov/indianlands/

13. Will the project be located within a Historic District? If yes, please provide review/comments/approval from the local town historic district.

14. Are there threatened or endangered species or critical habitats within the project area? If present describe impact (IPAC report should be included):

14a. Is IPAC report attached? ☐ ☐

IPAC Official Species List: https://ecos.fws.gov/ipac/

15. Will the project involve cutting trees or trimming trees? If yes explain in detail below: how many, how large, tree type, etc.

15a. If yes to 15, can the applicant / project refrain from cutting, clearing, or trimming trees during habitat critical time frames? (Ex. 6/1 - 7/31 for long-eared bat)

16. Is the project located in or could the project effect a wetland? ☐ ☐ 16a. Is Wetland map attached? ☐ ☐

NWI:- https://www.fws.gov/wetlands/data/Mapper.html WSS: https://websoilsurvey.sc.egov.usda.gov/App/HomePage.htm NEPA Assist: https://www.epa.gov/nepa/nepassist

16b. If yes to 16, has an Army Corps or other permit been issued for the project site?

17. Is the project located in or could project affect a Floodplain(100 or 500 year floodplains)? If yes provide a FEMA map.

17a. Is FEMA map attached? ☐ ☐

FEMA: http://msc.fema.gov/portal WSS: https://websoilsurvey.sc.egov.usda.gov/App/HomePage.htm

18. Is the project site on or in the vicinity of classified land, such as State/Federal Parks, Monuments, Natural Landmarks, Wilderness Areas, Wild and Scenic Rivers, State Lands, National Forest, etc.?

USGS: https://maps.usgs.gov/padus/ NEPA Assist: https://www.epa.gov/nepa/nepassist

18a. If yes explain and indicate if the land managing agency has been contacted.

19. Does project affect Coastal Resources (including Great Lake area) including impact to a coral reef (Coastal Barrier Resources System or Coastal Zone Management Areas)? If your project is not located on the coast, you will likely check no.

CBRS - https://www.fws.gov/program/coastal-barrier-resources-act/maps-and-data/ CZMA - https://coast.noaa.gov/czm/mystate/

20. Is the proposal located on prime, important, unique or of local Importance Farmland?

20a. Has NRCS completed a LESA? ☐ ☐

WSS: https://websoilsurvey.sc.egov.usda.gov/App/HomePage.htm FPPA guidance available from NRCS:

https://www.nrcs.usda.gov/wps/portal/nrcs/main/national/landuse/fppa/ 20b. If yes to 20, is the project expected to benefit by saving or offsetting energy for a farm or agricultural producer?

21. Is the project expected to house, store, reclaim, recycle or involve the handling of hazardous materials, e.g. waste storage, disposal recovery, incineration or waste treatment actions? If yes explain.

22. Has a Phase 1 ESA been prepared for this site? Generally needed for all projects over $100,000 in which the agency takes a security interest in the property.

22a. If prepared, is Phase I ESA attached? ☐ ☐

23. Does the property contain any areas where regulated hazardous substances or petroleum products appear to have been released? If yes explain.

24. Does the property contain an underground storage tank (UST)? If yes explain and include: type, size, age, date of last state certification.

25. Does the property contain any aboveground storage tanks (AST)? If yes, are the ASTs in secondary containment?

26. Will or could the project have any emissions or cause uncontrolled or unpermitted releases of hazardous substances, pollutants, contaminants, petroleum or natural gas products? If yes explain.

27. Will the project affect any Water Resources (Sole Source Aquifers, Well-head protection areas, Watershed Protection Areas, etc.)? If yes, explain.

NEPA Assist: https://www.epa.gov/nepa/nepassist EPA Sole Source Aquafers:

https://epa.maps.arcgis.com/apps/webappviewer/index.html?id=9ebb047ba3ec41ada1 877155fe31356b

28. Is there any controversy that you are aware of or about the project for environmental reason? If yes, explain.

29. Does the proposal have any concerns or disproportionately high and or adverse human health or environmental effects on minority populations or low-income populations? If yes, explain.

USDA policy: https://www.rd.usda.gov/files/1970e.pdf EJ Screen: https://www.epa.gov/ejscreen

30. Is the subject business facility connected to a municipal wastewater system?

If no, describe the existing on-site system, including capacity.

31. Is the subject business facility connected to a municipal water system? If no, describe the existing on-site system, including capacity.

32. Is the project located in a county that has been designated by EPA as a Non- Attainment or Maintenance for any of the National Ambient Air Quality Standards?

NEPA Assist: https://www.epa.gov/nepa/nepassist EPA Greenbook: https://www3.epa.gov/airquality/greenbook/anayo_ak.html

33. SIGNATURE, DATE, & TITLE OF PREPARER

Signature Title Date