Environmental Checklist

U.S. DEPARTMENT OF AGRICULTURE RURAL DEVELOPMENT
3/21/23

ENVIRONMENTAL INFORMATION
This document is used to collect information to determine what level of environmental review is
necessary. The Agency may request additional information if needed. All answers need to be
supported by appropriate documentation when applicable. Potentially helpful links are
provided in blue, though not exhaustive or a comprehensive list of resources. A complete NEPA
review is required prior to award. Construction may jeopardize completion of NEPA do not begin construction until the Agency has confirmed a complete NEPA review.
1. APPLICANT NAME:

Yes

No

2. ADDRESS: Physical location of the project (includes specifics such as longitude & latitude and
legal description).

3. PHOTOS & MAP: Please provide recent project site photos as well as an aerial map
showing the building/lot/exact location of the project. Please indicate in detail on
map any potential trenching or other ground disturbance, electrical connections, or
other relevant information.

Attach

Photos &
Map:

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 (indicate project square feet of existing and new ground disturbance).

6. Will the project involve construction without any ground disturbance? (i.e.
roof mounted solar)

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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).

7. What is the zoning for the project location?

8. What is the age/year built, of the building where the project will be located in/on?
9. Will the project be located within the viewshed of a building that is a least
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50+ years old?
10. Use the link below. Is the building or project site listed on the State/
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National Register of Historic Places?
National Register: https://www.nps.gov/nr/research/
Attach NPS Findings:

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11. If building is over 50 yrs old or yes to # 9 or 10, has approval or concurrence
been obtained from State Historic Preservation Office?

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Attach letters sent to and responses
obtained from SHPO, if applicable:

12. Have any Tribes or Tribal Historic Preservation Officers been contacted?
Note-Some Tribes require government to government contact therefore
consultation with the local RD State Office is recommended.

Attach letters to and responses obtained from
Tribal contact TDAT: https://egis.hud.gov/tdat
Tribes or THPO, if applicable:
Tribal Lands: https://nationalmap.gov/small_scale/mld/indlanp.html

12a. Summarize SHPO, Tribes, and THPO responses below:

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

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Attach Hist Dist.
Correspondence:

14. Use the link below to pull an IPAC report. Are there threatened or
endangered species or critical habitats within the project area? If present
describe below the impact your project will have on these resources:

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Attach

IPAC
Report:

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) Discuss relevant construction timeline below as needed.

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16. Use one of the links below. Is the project located in or could the project
affect a wetland?
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

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Attach
Wetland Map:

16a. If yes to 16, has an Army Corps or other permit been issued for the
Attach permit(s), if
project site?
applicable:

17. Use one of the links below. Is the project located in or could the project
affect a Floodplain(100 or 500 year floodplains)?

FEMA: http://msc.fema.gov/portal
WSS: https://websoilsurvey.sc.egov.usda.gov/App/HomePage.htm
18. Use one of the links below. 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.?

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Attach
FEMA Map:

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Attach
Land Map:

USGS: https://nationalmap.gov/small_scale/mld/fedlanp.html
USGS: https://nationalmap.gov/small_scale/printable/fedlands.html
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/ecological-services/habitatconservation/cbra/Maps/Mapper.html
CZMA - https://coast.noaa.gov/czm/mystate/
20. Use the web soil survey link below. Is the proposal located on prime,
important, unique or of local Importance Farmland?
20a. If yes, 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.

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If on coast,
attach Coastal
Map:

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Attach Web
Soil Survey:

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Attach NRCS letter:

22. Has a Phase 1 ESA been prepared for this site? A Phase I is not the
same as a NEPA review. The Phase I is generally needed for all
projects over $100,000 when loan funds are requested and the agency will take a
security interest in real estate.
22a. If prepared, is Phase I ESA attached?

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

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

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

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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.

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27. For projects involving new construction, will the project affect any Water
Resources (Sole Source Aquifers, Well-head protection areas, Watershed
Protection Areas, etc.)? If yes, explain.

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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. Use EPA link to pull an environmental justice map. 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

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Attach EJ Map:

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

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

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32. Use links below. 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?

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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