11.01.08.08

.08 Forms.

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 _________________________

Other _______________________________________________________________________

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.

  Yes No Comments
Attached
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? ___ ___ ______
E. Socio-Economic.      
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 plans—including 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? ___ ___ ______
G. Conclusion.      
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:

Comments None Adverse Beneficial
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.