Environmental Assessment Form (EAF)
This form is to assist the reviewers in determining whether a proposed action could cause significant natural and socioeconomic environmental effects and thus require an environmental effects report.
Department _______________________________ Division _________________________
Project Title _______________________________________________________________
Predicted Dates: Commencement _______________________________________________
Completion _____________________________ Projected Cost _____________________
A. Background Information.
(1) Give a brief description of the proposed action/project(s).
(2) Describe the geographical area(s) which will be affected by the action/project(s); specifically locate the project by using the Maryland coordinate grid system; include distinguishing natural and man-made features and a brief description of the present use of the area(s). Include a suitable location map (sketch map or copy of U.S. Geological Survey Map, etc.).
B. Assessment of Significant Environmental Effects.
(1) The following questions should be answered by placing a check in the appropriate column(s). If desirable, the "comments attached" column can be checked by itself or in combination with an answer of "yes" or "no" to provide additional information or to overcome an affirmative presumption.
(2) In answering the questions, the significant beneficial and adverse, short-term and long-term effects of the proposed action, on site and off site during construction and operation should be considered.
(3) All questions should be answered as if the agency is subject to the same requirements as a private person requesting a license or permit from the State or federal government.
|A. Land Use Considerations.|
|1. Will the action be within the 100-year flood plain?||___||___||
|2. Will the action require a permit for construction or alteration within the 50 year flood plain?||___||___||______|
|3. Will the action require a permit for dredging, filling, draining, or alteration of a wetland?||___||___||______|
|4. Will the action require a permit for the construction or operation of facilities for solid waste disposal including dredge and excavation spoil?||___||___||______|
|5. Will the action occur on slopes exceeding 15 percent?||___||___||______|
|6. Will the action require a grading plan or a sediment control permit?||___||___||______|
|7. Will the action require a mining permit for deep or surface mining?||___||___||______|
|8. Will the action require a permit for drilling a gas or oil well?||___||___||______|
|9. Will the action require a permit for airport construction?||___||___||______|
|10. Will the action require a permit for the crossing of the Potomac River by conduits, cables, or other like devices?||___||___||______|
|11. Will the action affect the use of a public recreation area, park, forest, wildlife management area, scenic river, or wildland?||___||___||______|
|12. Will the action affect the use of any natural or man-made features that are unique to the county, State, or nation?||___||___||______|
|13. Will the action affect the use of an archaeological or historical site or structure?||___||___||______|
|B. Water Use Considerations.|
|14. Will the action require a permit for the change of the course, current, or cross section of a stream or other body of water?||___||___||______|
|15. Will the action require the construction alteration, or removal of a dam, reservoir, or waterway obstruction?||___||___||______|
|16. Will the action change the overland flow of storm water or reduce the absorption capacity of the ground?||___||___||______|
|17. Will the action require a permit for the drilling of a water well?||___||___||______|
|18. Will the action require a permit for water appropriation?||___||___||______|
|19. Will the action require a permit for the construction and operation of facilities treatment or distribution of water?||___||___||______|
|20. Will the project require a permit for the construction and operation of facilities for sewage treatment or land disposal of liquid waste derivatives?||___||___||______|
|21. Will the action result in any discharge into surface or subsurface water?||___||___||______|
|22. If so, will the discharge affect ambient water quality limits or require a discharge permit?||___||___||______|
|C. Air Use Considerations.|
|23. Will the action result in any discharge into the air?||___||___||______|
|24. If so, will the discharge affect ambient air quality limits or produce a disagreeable odor?||___||___||______|
|25. Will the action generate additional noise which differs in character or level from present conditions?||___||___||______|
|26. Will the action preclude future use of related air space?||___||___||______|
|27. Will the action generate any radiological, electrical, magnetic, or light influences?||___||___||______|
|D. Plants and Animals.|
|28. Will the action cause the disturbance, reduction, or loss of any rare, unique, or valuable plant or animal?||___||___||______|
|29. Will the action result in the significant reduction or loss of any fish or wildlife habitats?||___||___||______|
|30. Will the action require a permit for the use of pesticides, herbicides, or other biological, chemical, or radiological control agents?||___||___||______|
|31. Will the action result in a preemption of division of properties or impair their economic use?||___||___||______|
|32. Will the action cause relocation of activities or structures, or result in a change in the population density or distribution?||___||___||______|
|33. Will the action alter land values?||___||___||______|
|34. Will the action affect traffic flow and volume?||___||___||______|
|35. Will the action affect the production, extraction, harvest, or potential use of a scarce or economically important resource?||___||___||______|
|36. Will the action require a license to construct a sawmill or other plant for manufacture of forest products?||___||___||______|
|37. Is the action in accord with federal, state, regional, and local comprehensive or functional plansincluding zoning?||___||___||______|
|38. Will the action affect the employment opportunities for persons in the area?||___||___||______|
|39. Will the action affect the ability of the area to attract new sources of tax revenue?||___||___||______|
|40. Will the action discourage present sources of tax revenue from remaining in the area, or affirmatively encourage them to relocate elsewhere?||___||___||______|
|41. Will the action affect the ability of the area to attract tourism?||___||___||______|
|F. Other Considerations.|
|42. Could the action endanger the public health, safety, or welfare?||___||___||______|
|43. Could the action be eliminated without deleterious effects to the public health, safety, welfare, or the natural environment?||___||___||______|
|44. Will the action be of Statewide significance?||___||___||______|
|45. Are there any other plans or actions (federal, State, county, or private) that, in conjunction with the subject action, could result in a cumulative or synergistic impact on the public health, safety, welfare, or environment?||___||___||______|
|46. Will the action require additional power generation or transmission capacity?||___||___||______|
|47. This Agency will develop a complete Environmental Effects Report on the proposed action.||___||___||______|
C. Summary of Environmental Effects Report. Attached to the front of every environmental effects report should be a one or two page summary in substantially the following form:
Letterhead of issuing agency (or: "This statement has been issued by (name of agency).")
1. Kind of action: _________________________ request for legislative appropriation, i.e., requests for capital budget items, requests for encumbrances upon special funds or trusts, and bond issues.
___________ Other legislative action, i.e., requests for proposed legislative acts and/or expansion of existing acts or agency authority, or passage of laws which will require legislative appropriation.
2. Official responsible for issuance of this statement (name, address, telephone).
3. Official responsible as a contact for questions in regard to the environmental effects report.
4. Name, location, and brief description of the action.
5. Summary of environmental effects for the following:
|A. Land ______________________________________|
|B. Water _____________________________________|
|C. Air ________________________________________|
|D. Plants _____________________________________|
|E. Animals ___________________________________|
|F. Socio-economic _____________________________|
|G. Other _____________________________________|
6. List of alternatives considered.
7. List all federal, State, and local agencies and other sources from which written comments have been requested.
8. Date statement was sent to Clearinghouse.