SDWSRF
Federal Env Cross-cutting Evaluation Checklist
Updated 12/9/2018
California Department of Public Health (CDPH)
Safe Drinking Water State Revolving Fund
Federal Cross-cutting Environmental Regulations
Applicability Evaluation Checklist for Federally Designated Agency Coordination
NOTE: This checklist will be used by the CDPH, Environmental Review Unit (ERU) to identify the Federal Agencies required for consultation.
Water System Name:
Project Name:
Water System Number:
- Farmland Protection Policy Act:
Is any portion of the proposed project site located on prime or unique farmland, or will the project result in the conversion of agricultural lands to non-agricultural use? Contact the California Department of Conservation, Division of Land Resource Protection oruse their online Farmland Mapping and Monitoring Program website to determine the land use designation. Additionally, contact your local planning department &/or assessor’s office to obtain information on allowable uses under the Williamson Act.
No. The project will not impact farmland. Description of the current land use designation (attach color map(s) and supporting documentation):
Yes. Include information on the acreage that would be converted from prime or unique farmland to other uses, &/or land cover under the Williamson Act. Attach a color map identifying the project site and the area of potential impact (APE):
- Coastal Zone Management Act:
Is any portion of the proposed project site located within a coastal zone, within the boundaries of the San Francisco Bay, or along the Bay’s nine-county shoreline? Contact the local Coastal Commission Office &/or San Francisco Bay Conservation and Development Commissionfor verification. &/or
No. Description of the project location with respect to coastal areas or Bay areas:
Yes. Describe the project location with respect to coastal or Bay areas, and the status of the coastal zone &/or San Francisco Bay Conservation and Development Commission permit(s):
- Wild and Scenic Rivers Act:
Is any portion of the proposed project site located within the watershed of a wild and scenic river? Verify the project location from the list of wild and scenic rivers maintained by the U.S. Fish & Wildlife Service. Watershed information can be obtained through the “Watershed Browser” at:
No.The project is not located within a watershed of a wild and scenic river. Description of the watershed in which the project is located:
Yes. Identify the wild and scenic river watershed and project location relative to the affected wild and scenic river (attach appropriate color map and identify APE):
- Is any portion of the proposed project site located on National Forest Lands? Check the list of California National Forests located at the U.S. Forest Service website.
No. Description of the project location with respect to National Forest Lands:
Yes. Name of the National Forest in which the project is located (attach appropriate color map and identify APE):
- Protection of Wetlands – Executive Order Numbers 11990 & 12608:
Does any portion of the proposed project area contain seasonal wet areas that should be evaluated for wetland delineation by the U.S. Army Corps of Engineers or does the project require a permit from the USACOE? Use the U.S. Fish and Wildlife Wetland Mapper to determine if any wetland areas are within the project area.
No. Provide the basis for thedetermination and attach color map from website above:
Yes. Description of any wetlands, potential wetland areas, and other surface waters, and the avoidance, minimization, and mitigation measures to reduce impacts. Provide the status of the permit and information on permit requirements:
- Flood Plain Management – Executive Order Number 11988:
Is any portion of the proposed project site located within a 100-year floodplain as depicted on a floodplain map or otherwise designated by Federal Emergency Management Agency (FEMA)? The California Department of Water Resources has prepared the preliminary 100- and 200-year maps for 32 counties and 91 cities located within the Sacramento-San Joaquin Valley watershed.
Additional maps can be found at the FEMA website:
No. Description of project location with respect to streams and potential floodplains (attach appropriate color map and identify APE):
Yes. Description of floodplain or floodplain map attached. Describe any measures and/or project design modifications that would minimize or avoid flood damage by the project:
- Federal Endangered Species Act (Section 7 and Section 10) :
Does the project involve any direct effects from construction activities, or indirect effects such as growth inducement that may affect federally listed threatened or endangered species that are known, or have a potential, to occur on-site, in the surrounding area, or in the service area? Listed species in your area may be obtained from the Department of Fish and Game California Natural Diversity Database: /or by contact the U.S. Fish and Wildlife Service.
No. There are no federally threatened, endangered, or listed species in the project area. Department of Fish & Game &/or U.S. Fish and Wildlife Service map(s) &/or biological surveys must be attached supporting the determination.
Yes. Include information on federally listed species that could potentially be affected by this project and any proposed avoidance &/or mitigation measures. The U.S. Fish and Wildlife Service and/or National Marine FisheriesServicewill be contacted by CDPH Environmental Review Unit to initiate informal or formal consultation. Attach list and associated map of all federally-listed species that could potentially be affected by the project:
- National Historic Preservation Act and Archaeological and Historic Preservation Act of 1974:
Is the project likely to affect historic properties that are included or eligible for inclusion on the National Register or any sacred lands or traditional cultural places?
The California Historical Resources Information System (CHRIS) and the Native American Heritage Commission (NAHC) must be contacted to request information on historic and cultural significant findings within the Area of Potential Effect (APE). (Note that the APE is three dimensional and includes all areas that may be affected by the project, including the surface area and extending below ground to the depth of any project excavations.)
Find the CHRIS center in your area:
The Native American Heritage Commission Request Form:
No. Arequest for a record search was conducted through the California Historical Resources Information System (CHRIS) and the Native American Heritage Commission (NAHC). Attach copies of the CHRIS & NAHC record searches,letters submitted to the Native American Contacts, any written responses from the Native American Contacts, and any additional records of communication with the Native American Tribes.
Yes. The project will require a cultural resources survey to determine the affects on cultural resources.
9. Clean Air Act:
Is the project located in an area subject to a State Implementation Plan (SIP) conformity determination? Conformity Analysis applies only to projects in a nonattainment area or an attainment area subject to a maintenance plan.If the estimated emissions from project construction are below the de minimus level for each pollutantin the nonattainment or maintenance areas, general conformity analysis is not required.
Identify the Local Air District Area name:
Air Basin Name:
Check the maps below and report if the project is located in an attainment, nonattainment or maintenance area for each criteria pollutant
or
Provide the estimated project construction and operational air emissions (in tons per year) in the chart below, and attach supporting calculations. Attach any air quality studies that may have been done for the project.
Designation Reporting and Emission Estimates
Pollutant / Status (Attainment, Nonattainment, or Unclassified) / Threshold of Significance for the Area (if applicable) / Construction Emissions (Tons/Year) / Operation Emissions (Tons/Year)Ozone (1-hour)
Ozone (8-hour)
Carbon monoxide
Nitrogen dioxide
Sulfur dioxide
PM 2.5
PM 10
No. The project is in an attainment or unclassified area. Attach supporting documentation.
No. The project is exempt from conformity determination because the project is the alteration of or addition to an already existing facility.
Yes. The project is in a nonattainment area or attainment area subject to a maintenance plan. Include information to indicate the nonattainment designation (e.g. moderate, serious, or severe), if applicable, and the pollutant de minimis level.
- Clean Water Act (Section 404) and Rivers and Harbors Act (Section 10):
Will this project include placement of dredged or fill material into waters of the U.S.? Will the project include construction of structures in, under, or over navigable waters of the U.S.? Contact one of the U.S.Army Corps of Engineersoffices for more information about your project and attach correspondence.
No. The project is not located in or near navigable waters of the U.S. There will be no modification of existing structures in or near designated navigable waters, nor will the project result in the placement of dredge or fill material into the waters of the U.S.
Yes. Please describe the type of permit the facility currently holds (General or Nationwide) from the U.S. Army Corps of Engineers. Include the permit number and the project number.
- Source Water Protection:
Is the project located within the boundaries of a Sole Source Aquifer as designated by the U.S. EPA, Region 9?
No. The project is not within the boundaries of a sole source aquifer.
Yes. The project is located within one of the designated Sole Source Aquifers. Submit a copy of the appropriate map and identify the location of the project area.
CERTIFICATION
I hereby certify that the statements furnished above and in the attached exhibits present the data and information required for this initial evaluation to the best of my ability, and that the facts, statements, and information presented are true and correct to the best of my knowledge and belief.
Name:
Position:
Signature:
Date:
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