DORMITORY AUTHORITY — STATE of NEW YORK
OFFICE of ENVIRONMENTAL AFFAIRS
Full Environmental Assessment Form - Part I
STATE ENVIRONMENTAL QUALITY REVIEW
ENVIRONMENTAL ASSESSMENT FORM
PART I — PROJECT INFORMATION
(Prepared by Project Sponsor)
Name of action_____________________________________________________________________
Location of action (Include street address, Municipality and County)
__________________________________________________________________________________
__________________________________________________________________________________
Name of Applicant/Sponsor (and contact person)
__________________________________________________________________________________
Business Telephone______________________
Address___________________________________________________________________________
City/PO_________________________________
State___________________________________
Zip Code________________________________
Name of Owner (if different)____________________________________________________________
Business Telephone______________________
Address___________________________________________________________________________
City/PO_________________________________
State___________________________________
Zip Code________________________________
Description of Action and proposed project
__________________________________________________________________________________
__________________________________________________________________________________
Please Complete Each Question—Indicate N/A if Not Applicable
BACKGROUND INFORMATION
Please Complete Each Question—Indicate N/A if Not ApplicableBACKGROUND
INFORMATION
1. The predominant facility type (use) existing on the site is____________________ . The number of separate buildings existing on the site is____________________ . The total square footage of existing structures is____________________ . The total number of structures to be demolished is ____________________. The total square footage of buildings to be demolished is____________________ .
2. The total number and stories of new additions will be__________ and__________ , respectively. The use of the newly constructed additions is____________________ . The total square footage of new additions is__________.
3. The total number and stories of separate new buildings will be__________ and__________ , respectively. The use of each newly constructed building is____________________ . The total square footage of each new building is__________.
4. The uses of buildings or areas proposed for renovations are____________________ . The total square footage of renovations is__________. The date(s) of construction of the building(s) to be renovated are____________________.
5. The number of separate project sites is__________ . The size of each site in acres is__________ . The site is in the o Village o Town or o City of____________________ which has a population of__________ . The total size of the project site will increase by__________ acres or decrease by __________acres as a result of the proposed project.
6. The total construction cost for the proposed project is __________. The total number of dwelling units or beds will change from__________ to__________ upon project completion.
7. List the project architect’s name, company, address, and telephone
number:
__________________________________________________________________________________
__________________________________________________________________________________
8. List the general contractor’s or construction manager’s name,
company, address, and telephone number:
__________________________________________________________________________________
__________________________________________________________________________________
9. List the environmental consultant’s name, company, address, and telephone
number:
__________________________________________________________________________________
__________________________________________________________________________________
10. Identify the specific Dormitory Authority program and funding amount for
which this application has been made:
__________________________________________________________________________________
__________________________________________________________________________________
A. SITE DESCRIPTION
1. Attach a project location map (e.g., appropriate portion U.S. Geological Survey quadrangle map or equivalent) indicating existing property boundaries and dimensions, topography, roads, and major structures.
2. Present land use(s) of project sponsor’s site:
a. __Urban __Suburban __Rural
b. __Residential __Institutional __Commercial __Industrial __ Agricultural
__Forest __Parkland __Manufacturing __Other: Specify __________________________________________
c. Specific uses now on project site are (e.g., hospital with separate parking
garage)
__________________________________________________________________________________
__________________________________________________________________________________
d. Site has been used as above since_______________ (year)
3. Past land use(s) of project sponsor’s site (if known):
__________________________________________________________________________________
__________________________________________________________________________________
4. Indicate below how the project sponsor’s site will change as a result of the action proposed.
| APPROXIMATE ACREAGE | CURRENTLY (acres) | AFTER COMPLETION (acres) |
| Meadow or Brushland (Non-agricultural) | ||
| Forested | ||
| Agricultural (includes orchards, cropland, pasture, etc.) | ||
| Wetland (Freshwater or Tidal as per Articles 24, 25, or ECL) | ||
| Water Surface Area | ||
| Unvegetated (rock, earth or fill) | ||
| Roads, and other paved surfaces | ||
| Buildings (ground floor coverage) | ||
| Other (indicate type) | ||
| Totals |
5. Attach a neighborhood map showing major land uses within a one-mile radius of the project site. The map should identify roads, transportation facilities, institutions (including military bases), residential areas (and their character), parks and recreational facilities, major commercial areas, industrial/manufacturing facilities (including factories, energy production plants, public or private landfills, incinerators, gas stations, waste treatment facilities).
a. The uses of the properties directly adjoining and across the street from
the proposed project site are:
__________________________________________________________________________________
__________________________________________________________________________________
6. Is project substantially contiguous to, or contain, a building, site,
or district, listed on the State or the National Registers of Historic Places?
__Yes __No. If yes, describe the condition that applies:
__________________________________________________________________________________
__________________________________________________________________________________
7. Is project substantially contiguous to, or contain a site listed on the
Register of National Natural Landmarks?
__Yes __No. If yes, describe the condition that applies:
__________________________________________________________________________________
__________________________________________________________________________________
8. What is predominant soil type(s) on the project site?________________________________________
a. Soil drainage:
__ Well drained ( _____% of site);
__Moderately well drained ( _____% of site);
__Poorly drained ( _____% of site).
b. Has the project site been significantly filled?
__Yes __No. If yes, what are the nature and origins of the fill materials?____________________________
c. If any agricultural land is involved, how many acres of soil are classified
within soil group 1 through 4 of the NYS Land Classification System? _________acres.
(See NYCRR 370).
9. Are there bedrock outcroppings on project site?
__Yes __No
a. What is depth to bedrock? _________(in feet).
10. Approximate percentage of proposed site with slopes: 0-10%_____%; 10-15%_____%; 15% or greater_____%
11. What is the depth of the water table? _____(in feet)
Source of information:___________________________________________________________________
12. Is site located over a primary, principal, or sole source aquifer (as
designated by the U.S. Environmental Protection Agency)?
__Yes __No.
Identify:______________________________________________________________________________
13. Do hunting, fishing, or shell fishing opportunities currently exist in
the project area?
__Yes __No
14. Does project site contain any species of plant or animal life that is
identified as threatened or endangered?
__Yes __No. According to:_______________________________________________________
Identify each species:___________________________________________________________
15. Is there any visible evidence of possible groundwater or soil contamination
on the proposed or any adjacent sites (e.g., stressed vegetation, stained
soil, discolored surface water, foul odors, leaking containers)?
__Yes __No. If yes, describe:______________________________________________________________
16. Are there any aboveground or underground tanks for storage of fuel or
liquid waste products currently on the site?
__Yes __No.
If yes, describe storage capacity and product stored for each tank and attach
the NYSDEC Bulk Storage Registration Certificate (if applicable) in accordance
with 6 NYCRR Part 612:
__________________________________________________________________________________
__________________________________________________________________________________
17. Are any new aboveground and/or underground storage tanks proposed?
__Yes __No. If yes, describe storage capacity and products to be stored for
each new tank:
__________________________________________________________________________________
__________________________________________________________________________________
18. Are there any unique or unusual land forms on the project site (i.e.,
cliffs, dunes, other geological formations)
__Yes __No. If yes, describe:
__________________________________________________________________________________
__________________________________________________________________________________
19. Is the project site currently used by the community or neighborhood as
an open space or recreation area?
__Yes __No. If yes, describe:
__________________________________________________________________________________
__________________________________________________________________________________
20. Does the project site include scenic views known to be important to the
community?
__Yes __No. If yes, describe view and identify character of view or vista:
__________________________________________________________________________________
__________________________________________________________________________________
21. Streams within or contiguous to project area:
__________________________________________________________________________________
a. Name of stream and name of river to which it is tributary:
__________________________________________________________________________________
22. Are any lakes, ponds, wetland areas within or contiguous to project area?
__Yes __No.
a. Name ___________________________________________________________________________
b. Size_____(in acres)
23. Is site served by existing public utilities? __Yes __No.
a. Which will be used to service this project?
__Electricity __Gas __Water __Steam __Storm sewer __Sanitary sewer __Other
(Describe):
__________________________________________________________________________________
b. Attach name, address and telephone numbers for each utility company or
authority to service proposed project.
c. Will public or private improvements be required to allow connections? __Yes
__No.
24. Will any utilities necessary to support the project be provided exclusively on-site; or will any public utilities be supported by on-site facilities (e.g., sanitary sewage treatment facility, stormwater retention basin, cogeneration plant, etc.)? __Yes __No.
25. Is the site located in an agricultural district certified pursuant to
Agriculture and Markets Law, Article 25-AA Sections 303 and 304?
__Yes __No. If yes, describe:
__________________________________________________________________________________
26. Is the site located in or substantially contiguous to a Critical Environmental
Area designated pursuant to Article 8 of the ECL and 6 NYCRR 617? (Contact
regional NYSDEC office to verify).
__Yes __No. If yes, describe:
__________________________________________________________________________________
27. Has the project site or any sites within a _-mile radius of the project
site ever been used for storage or disposal of solid or hazardous waste? (Contact
regional NYSDEC office to verify).
__Yes __No. If yes, identify:
__________________________________________________________________________________
28. Is the site located in a coastal area as defined in 19 NYCRR Part 600
(Waterfront Revitalization and Coastal Resources Policies and Procedures)?
__Yes __No. If yes, identify:
__________________________________________________________________________________
B. PROJECT DESCRIPTION
1. Attach a site plan of proposed new site development and/or renovation
which indicates proposed new site boundaries, topography, structures, buildings
to be altered, dimensions and heights, new roads and parking, power or incineration
structures, storm drainage structures, utilities, etc.
2. Total contiguous acreage owned or controlled by project sponsor:_____acres.
3. Project acreage to be developed:_____acres initially; _____acres ultimately.
4. Project acreage to remain undeveloped:_____acres.
5. Project will occupy _____ linear feet of frontage along a public thoroughfare.
Name of thoroughfare:
__________________________________________________________________________________
6. Will the proposed action result in the generation of traffic significantly
above present levels?
__Yes __No. Maximum numbers of trips generated by proposed action in A.M.
and P.M. peak hours, respectively:
__________________________________________________________________________________
7. If yes, is the existing road network adequate to handle the additional traffic? __Yes __No.
8. Will the proposed project result in a demand for additional parking? __Yes __No.
9. The number of off-street parking spaces existing:_____ ; proposed:_____
10. The number of loading (service and delivery) berths existing is_____ ; proposed:_____
11. Will the project require any state or local permits for curb cuts or
traffic signalization?
__Yes __No. If yes, describe:
__________________________________________________________________________________
12. Has a traffic or parking study been done? __Yes __No. (If yes, submit a copy with this SEQR application.)
13. If residential, number and type of housing units:
| One-Family | Two-Family | Multiple-Family | |
| Existing | |||
| Proposed |
If hospital, health-related, or nursing facility, the number of beds existing_____ ; proposed_____
14. Dimension (in feet) of largest proposed structure _____height; _____width; ____length
15. How much natural material (i.e., rock, earth, etc.) will be removed from
the site? _______________tons/cubic yards.
How much fill will be imported onto the site? _______________tons/cubic yards.
Origin_____________________________________________________________________________
16. Will disturbed areas be reclaimed? __Yes __No __N/A.
a. If yes, for what intended purpose is the site being reclaimed?
__________________________________________________________________________________
b. Will topsoil be stockpiled for reclamation? __Yes __No.
c. Will upper subsoil be stockpiled for reclamation? __Yes __No.
17. How many acres of vegetation (trees, shrubs, ground cover) will be removed from site? _____acres.
18. Will any mature forest (over 100 years old) or other locally-important
vegetation be removed by this project?
__Yes __No. Identify:
__________________________________________________________________________________
19. The anticipated period of construction (including demolition):
months _________ Starting date__________; completion date__________
20. If multi-phased:
a. Total number of phases anticipated_____
b. Anticipated date of commencement Phase I: _____month _____year
c. Approximate completion date of final phase: _____month _____year
d. Is Phase I functionally necessary to subsequent phases? __Yes __No.
e. What work will be completed in each phase?
__________________________________________________________________________________
21. Will blasting occur during construction? __Yes __No.
22. Number of jobs generated: during construction_____ ; after project is complete_____ .
23. Number of jobs eliminated by this project:_____ .
24. Will project require relocation of any people, businesses, or facilities?
__Yes __No. If yes, explain:
__________________________________________________________________________________
25. What types and amounts of liquid waste will be discharged as a result
of the operation of the proposed project?
__Sanitary sewage; _____gpd; _Industrial waste; _____gpd.
a. For each type that will not go into a permitted municipal system, indicate
whether effluent will be discharged into surface or groundwaters. If surface,
name water body into which it will be discharged: Sanitary Sewage______________
Industrial Waste
b. Indicate status of any discharge permits required for liquid waste disposal
or attach permits:
__________________________________________________________________________________
26. Will the surface area of an existing water body increase or decrease
as a result of the proposed?
__Yes __No. If yes, explain:
__________________________________________________________________________________
27. Is project or any portion of project located in a 100-year floodplain? __Yes __No. In a coastal high hazard area? __Yes __No.
28. What are the components of the proposed stormwater disposal system and
their locations:
__________________________________________________________________________________
a.What are the design criteria used?
__________________________________________________________________________________
b. Who administers stormwater management requirements in your locality?
__________________________________________________________________________________
29. Will the project generate solid waste? _Yes _No.
a. If yes, what is the amount generated per month? _____tons.
b. Identify the name and location of the solid waste facility to be used:
__________________________________________________________________________________
c. Will any wastes not go into a sewage disposal system or into a sanitary
landfill? __Yes __No.
If yes, explain:
__________________________________________________________________________________
d. Will the project generate any solid waste due to demolition of existing
structures? __Yes __No. If yes, what is the approximate amount to be taken
off-site?________________________________
30. Will the project involve disposal of solid waste? __Yes __No.
a. If yes, what is the anticipated rate of disposal? _____tons/month.
b. If yes, what is the anticipated site life? _____years.
31. Will the project generate any hazardous, toxic or infectious waste either
during construction or operation of facility? __Yes __No.
a. If yes, what types (e.g., PCBs, asbestos, radiological, medical, infectious,
etc.)?
__________________________________________________________________________________
b. If yes, what is the anticipated rate of disposal? _____tons/month.
c. Is the applicant operating an on-site incinerator? __Yes __No.
d. For applicants utilizing an off-site incineration facility, identify final
disposal location:
__________________________________________________________________________________
32. Will project use herbicides or pesticides?
__Yes __No. If yes, identify:
__________________________________________________________________________________
33. Will project routinely produce odors (more than one hour per day)? __Yes __No.
34. Will project contain any new stationary sources of air emissions (e.g.,
boiler, laboratory vents, etc.)?
__Yes __No. If yes, describe:
__________________________________________________________________________________
35. Will project produce operating noise exceeding the local ambient noise
levels? __Yes __No.
36. Will project result in an increase in energy use?
__Yes __No. If yes, indicate type(s) and percentage (%) increase over existing
use in the applicable service area:
__________________________________________________________________________________
37. If water supply is from wells, indicate pumping capacity __________gallons/minute.
38. Total anticipated water usage per day: __________gallons/day.
39. Does the project sponsor have knowledge of any environmental liens or
government notifications relating to past or current violations of environmental
laws with respect to the proposed project site or any facility on it?
__Yes __No. If yes, explain:
__________________________________________________________________________________
40. Does project involve any local, state or federal funding other than the
Dormitory Authority?
__Yes __No. If yes, explain sources and amounts:
__________________________________________________________________________________
41. Approvals/Permits Required. (Attach Copies of Approvals/Permits Received
or Applications submitted. Please be sure to include environmental permits
for: underground and aboveground storage tanks, waste haulers, wetlands, stream
disturbance, SPDES, etc.):
| Permit/Approval Type | Submittal/ Approval Dates | Specific Agency | |
| City, Town, Village | |||
| City, Town, Village Planning Board | |||
| City, Town Zoning Board | |||
| City, County Health Department. | |||
| Other Local Agencies | |||
| Regional Agencies | |||
| State Agencies | |||
| Federal Agencies |
IMPORTANT: For each agency approval needed or received, attach a list of
the full agency name, address, telephone number and contact person.
C. ZONING AND PLANNING INFORMATION
1. Please attach a local zoning map showing zoning districts in the project
area and environs and a copy of the zoning regulations (or applicable portion)
pertaining to the proposed project site.
2. Does proposed action involve a planning or zoning decision? __Yes __No.
If yes, indicate specific decision required:
__zoning amendment;
__zoning variance;
__special use permit;
__subdivision;
__site plan;
__new/revision of master plan;
__resource management plan;
__other (identify):
__________________________________________________________________________________
3. What is the present zoning classification(s) of the site? ______________________________________
Indicate block and lot numbers: __________________________________________________________
4. What is the maximum potential development of the site if developed as
permitted by the present zoning?
Units and/or floor area:_________________________________________________________________
5. What is the proposed zoning of the site?__________________________________________________
6. What is the maximum potential development of the site if developed as
permitted by the proposed zoning?
Units and/or floor area:_________________________________________________________________
7. Is the proposed action consistent with the recommended uses in adopted local land use plans? __Yes __No.
8. If zoning variance is required, specify reason:
__height, __density, __bulk, __setback, __parking, or __other.
9. What are the predominant land use(s) and zoning classifications within
a 1/4 mile radius of proposed action?
__________________________________________________________________________________
10. Is the proposed action compatible with adjoining, surrounding land uses within a 1/4 mile radius? __Yes __No.
11. If the proposed action requires the subdivision of land, how many lots
are proposed?__________
What are the lot sizes proposed?__________
12. Will proposed action require any authorization(s) for the formation or
extension of sewer or water districts?
__Yes __No. Identify district:
__________________________________________________________________________________
13. Will the proposed action create an increased demand for any community
provided services (recreation, education, police, fire protection)?
__Yes __No. If yes, which services:
__________________________________________________________________________________
a. If yes, is existing capacity sufficient to handle projected demand? __Yes
__No.
b. If capacity insufficient, explain how increased demand will be met:
__________________________________________________________________________________
14. Do you know of any public controversy related to potential adverse environmental
impacts associated with your proposal?
__Yes __No. If yes, describe:
__________________________________________________________________________________
Identify any groups or organizations opposed to project based on potential
adverse environmental impacts grounds:
__________________________________________________________________________________
D. INFORMATIONAL DETAILS
Attach any additional information as needed to clarify your project. If there
are or may be any adverse impacts associated with your proposal, please discuss
such impacts and the measures which you propose to mitigate or avoid them.
a. If an environmental determination has been made previously in conjunction
with an approval by another government agency, submit for review all materials
related to that determination: the written determination (i.e., Negative Declaration,
Conditional Negative Declaration, or Positive Declaration), any Draft or Final
Environmental Impact Statement, Findings Statement, environmental audit report,
or permit application(s).
b. Attach appropriate portion of applicable Federal Emergency Management Agency
(FEMA) "Flood Insurance Rate Map (FIRM)" with the project boundaries
located on that map.
c. Attach any cultural resources impact determination made so far by, or evidence
of prior consultation with, the New York State Office of Parks, Recreation
& Historic Preservation (OPRHP). If a project review impact determination
letter has been previously issued by the OPRHP include a copy of that letter
with this EAF. (A project review impact determination letter is required
for all projects wholly or partially funded or undertaken by the Dormitory
Authority in accordance with the State Historic Preservation Act of 1980.)
E. VERIFICATION
I certify that the information provided above is true to the best of my knowledge.
Applicant/Project Sponsor Name _____________________________________________
Authorized Representative’s Name_____________________________________________
Representative’s Title_____________________________________________
Signature of Applicant or Authorized Representative_____________________________________________
Date_____________________________________________
If the action is in the Coastal Area, the Dormitory Authority will complete
a Coastal Assessment Form before proceeding with its assessment of the project.