USDA Natural Resources Conservation Service AZ-CPA-52 (Rev 7/2002)

ARIZONA NRCS ENVIRONMENTAL EVALUATION WORKSHEET

Owner/Operator: / Date: / Program:
Field Office: / Conservation District:
Watershed or Channel Name/Reach: / Location:
Person(s) completing worksheet:
Purpose, Need and Scope of Proposed Action:
Alternativesto proposed action.
Briefly describe each alternative and reason(s) for selection/nonselection. This Environmental Evaluation assesses only the selected alternative.
1)Selected Alternative
2) No Action
3)

Instructions: Consider any change or alteration to resource conditions listed below that proposed action may affect. If the resource condition listed on the left is not applicable to the project site, check the appropriate box. If no effects are expected to the listed resource condition, check the appropriate box. In the “Statement of Effect” box, describe short -term and long-term effects, both adverse and beneficial, that may occur on-site or off-site for the proposed action/alternative. “Short-term” is considered the construction period. Consider cumulative effects of all practices installed on project site, multiple practices applied in area-wide plan, and the combined effects of other proposed actions in project area. Include in your statement any measures taken to avoid, offset or mitigate adverse effects. Consult “Help Sheets” found in the Field Office Technical Guide for further guidance. Attach additional sheets, photos or diagrams as needed.

RESOURCE CONDITION /

EFFECTS

I

/ SOILS:
a. / Natural soil surface (altering soil struc--ture, soil displacement/deposition, compaction, organic matter) / Not Applicable No effect
Statement of Effect:
b. / Soil Fertility / Not Applicable No effect
Statement of Effect:
c. / Unique geologic or natural physical features ( e.g. covering, modification, partial destruction, protection, etc.) / Not Applicable No effect
Statement of Effect:
d. / Wind or water erosion of soils, or soil erodibility / Not Applicable No effect
Statement of Effect:
e. / Siltation, deposition, or erosion that may impact or modify a stream, river channel, lakebed, or other waterbody / Not Applicable No effect
Statement of Effect:
f. / Exposure of people or property to geologic hazards / Not Applicable No effect
Statement of Effect:
g / Acres of Prime or unique farmland / Not Applicable No effect
Statement of Effect:

NRCS Environmental Evaluation Page 1

USDA Natural Resources Conservation Service AZ-CPA-52 (Rev 7/2002)

ARIZONA NRCS ENVIRONMENTAL EVALUATION WORKSHEET

RESOURCE CONDITION

/

EFFECTS

II

/ WATER:
a. / Stream channel dimension, pattern, and/or slope / Not Applicable No effect
Statement of Effect:
b. / Surface water infiltration rates, drainage patterns, velocities, and/or volumes / Not Applicable No effect
Statement of Effect:
c. / Discharge into surface waters, alterations of surface water quality (temperature & turbidity) / Not Applicable No effect
Statement of Effect:
d. / Wetland hydrology / Not Applicable No effect
Statement of Effect:
e. / Ground water quantity / Not Applicable No effect
Statement of Effect:
f. / Ground water quality / Not Applicable No effect
Statement of Effect:
g. / Amount of water available for public use / Not Applicable No effect
Statement of Effect:
h. / Wild & Scenic rivers or unique waters / Not Applicable No effect
Statement of Effect:
i. / Floodplains or floodplain management / Not Applicable No effect
Statement of Effect:

j.

/ Exposure of people or property to flooding / Not Applicable No effect
Statement of Effect:
III / AIR:
a. / Impacts to air quality, including dust, odors / Not Applicable No effect
Statement of Effect:
b. / Impacts to air quality, PM-10 and PM-2.5 non-attainment areas / Not Applicable No effect
Statement of Effect:
c. / Impacts to other air quality factors
(chemical drift, visibility, smoke) / Not Applicable No effect
Statement of Effect:

IV

/ PLANTS:
a. / Diversity or abundance of any species, including sensitive species recognized by BLM, FS, or Tribes and those protected by Arizona Native Plant Law / Not Applicable No effect
Statement of Effect:
b. / Threatened, Endangered, Proposed or Candidate Species / Not Applicable No effect
Statement of Effect:
c / Critical Habitat, Proposed Critical Habitat / Not Applicable No effect
Statement of Effect:
c. / Regeneration of native species / Not Applicable No effect
Statement of Effect:
e. / Opportunity for noxious weeds and/or invasive species to become established or spread / Not Applicable No effect
Statement of Effect:
f. / Functional groups (warm-cool season)
Or Structural groups (grass-shrub-tree) / Not Applicable No effect
Statement of Effect:

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USDA Natural Resources Conservation Service AZ-CPA-52 (Rev 7/2002)

ARIZONA NRCS ENVIRONMENTAL EVALUATION WORKSHEET

RESOURCE CONDITION

/

EFFECTS

V

/ ANIMALS:
a. / Diversity or abundance of any species, including sensitive species recognized by BLM, FS, or Tribes / Not Applicable No effect
Statement of Effect:
b. / Threatened, Endangered, Proposed or Candidate Species / Not Applicable No effect
Statement of Effect:
c / Critical Habitat, Proposed Critical Habitat / Not Applicable No effect
Statement of Effect:
d. / Indigenous animals (migration barriers, competition from non-natives) / Not Applicable No effect
Statement of Effect:
e. / Habitat
(nesting, calving, wintering, spawning) / Not Applicable No effect
Statement of Effect:
f. / Human activity during sensitive life stages (nesting, spawning, hibernating) / Not Applicable No effect
Statement of Effect:
VI / CULTURAL RESOURCES:
a. / Prehistoric or historical archaeological sites / Not Applicable No effect
Statement of Effect:
b. / Prehistoric or historical structures / Not Applicable No effect
Statement of Effect:
c. / Prehistoric or historical-era isolated objects / Not Applicable No effect
Statement of Effect:
d. / Known sacred uses or traditional cultural places within or adjacent to the area of potential impact / Not Applicable No effect
Statement of Effect:

VII

/ OTHER HUMAN CONSIDERATONS:
Include Environmental Justice concerns in assessment and remarks
a. / Existing noise levels / Not Applicable No effect
Statement of Effect:
b. / Present or planned land uses / Not Applicable No effect
Statement of Effect:
c. / Landscape resource, aesthetic resource, scenic value, or natural area / Not Applicable No effect
Statement of Effect:
d. / Recreational opportunities / Not Applicable No effect
Statement of Effect:
e. / Public health and safety / Not Applicable No effect
Statement of Effect:
f. / Public interest or controversy / Not Applicable No effect
Statement of Effect:
g. / Significant economic impacts to the sponsor,
Landowners, or public / Not Applicable No effect
Statement of Effect:

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USDA Natural Resources Conservation Service AZ-CPA-52 (Rev 7/2002)

ARIZONA NRCS ENVIRONMENTAL EVALUATION WORKSHEET

OTHER CONSIDERATIONS:
Is a Water Quality 401 & Army Corps of Engineers 404 permit required? Yes No
If required who will prepare?
Other state, county, tribal, & local requirements and/or permits needed:
List any permits or items needing attention.
Any mitigation planned or required?
Document communications (as appropriate) with:
Cultural Resource Specialist (NRCS, SHPO, Indian Nation, BIA):
ASLD, AGFD, FWS, FS, BLM, COE, ADEQ, ADWR, Indian Nation Natural Resource Department:
Discuss any cumulative effects (beneficial or adverse) on resource conditions, or any applicable cumulative effects analysis:
Comments or other considerations:

RECOMMENDATION (check one):

_____Proceed with action. No further environmental analysis is necessary.

_____Further analysis is recommended. A Biological Assessment, Environmental Assessment, or Environmental Impact Statement may be necessary.

_____Do not proceed. Significant adverse effects will result. Other alternatives will be explored.

CERTIFICATION

Preparer’s Signature TitleDate

Reviewed/Concurred TitleDate

Policy References:

Concerns-See "Help Sheets" / Field Office Technical Guide
Prime and Unique Farmland / 310 GM 403
Threatened or Endangered Species / 190 GM 410.22(b)
Landscape Resource / 190 GM 410.24
Invasive Species / Executive Order 13112
Coastal Zone Management Area / NRCS/ASCS/EXT 3/9/93 Letter
Natural Area / 190 GM 410.23
Wild and Scenic Rivers / FOTG Section 1
Wetland / 190 GM 410.26 FSA Manual & COE Tech Rpt Y-87-1
Riparian Area / 190 GM 411
Special Aquatic Site / EPA 404(b)(1)230.3 & 230.10, Federal Register 12/24/80
Floodplain Management / 190 GM 410.25, Executive Order 11988
Stream Channel Modification / 190 GM 410.27
Cultural Resources / 420 GM 401,601
Environmental Justice / Executive Order 12898 and USDA Regulation 5600-2

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