WI-CPA-52

ENVIRONMENTAL ASSESSMENT WORKSHEET – REFER TO HANDBOOK FOR EXPLANATION (April 20, 2001)

1. Client: / 2. Tract: / 3. Field(s): / 4. Location: T R Sec.
5. Federal Program: / Could Federal cost share become available? Yes No / 6. County:
7. Purpose and Need Statement:
8. Description of Proposed Project including a No-Action Alternative and any other Alternatives:
9. Name and Title of Person(s) Completing Worksheet and Agencies Consulted:
  • This worksheet is used to document the effects a proposed activity may have on natural, human, and cultural resources, in compliance with NEPA and NRCS NEPA Policy (General Manual 190, Section 410).
  • For Blocks 38-45-Effects are to be documented for both beneficial and adverse effects. Use “NA” if not applicable. Use “O” for neutral effects. Reference the evaluation procedure used. Attach additional sheets and narrative as necessary.
  • Onsite and offsite effects must be documented.

Special Environmental Concerns (Attach Documentation)

Proposed or Other Alternatives
10. Present / 11. Special Action Needed
YES / NO / YES / NO
12. Prime and Unique Farmland /

Other Requirements

13. Threatened and Endangered Species / 26. Project within Drainage District Yes No
14. Landscape Resource / 27. Have required permits been applied for Yes No
15. Natural Areas / 28. Mitigation required Yes No
16. Wild and ScenicRivers / 29. Public controversy about activity Yes No
17. Wetlands / 30. Landowner informed to ID known/visible hazardous/toxic material Yes No
18. Riparian Areas
19. Special Aquatic Sites / 31. Landowner informed to ID all utilities Yes No
20. Floodplain Management
21. Coastal Zone Management Area
22. Stream Channel Modification
23. Cultural Resources
24. Invasive Species
25. Migratory Birds
32. Are there effects on: / 33. No Effect / 34. Short
Term (+/-) / 35. Long
Term (+/-) / 36. Cum. Effect (+/-) / 37. Reference Notes:
38. SOIL
A. Natural soil surface
B. Soil fertility
C. Unique geologic or natural features
D. Wind or water erosion
E. Prime and Unique Farmland
F. Other
39. WATER
A. Stream channel characteristics
B. Surface water
C. Quantity and quality of ground water
D. Quantity and quality of surface water
E. Unique rivers/waters
F. Flooding
G. Wetlands
H. Other
32. Are there effects on: / 33. No Effect / 34. Short
Term (+/-) / 35. Long
Term (+/-) / 36. Cum. Effect (+/-) / 37. Reference Notes:
40. AIR
A. Air quality/odors
B. Dust or smoke
C. Other
41. PLANTS
A. Plant diversity
B. Federal T& E species
C. State T & E species
D. Native plants
E. Other
42. ANIMALS (Fish, Mammals, Birds, Reptiles, Amphibians, Invertebrates)
A. Diversity of species
B. Federal T & E species
C. State T & E species
D. Native animals
E. Existing habitat
F. Other
43. HUMAN CONSIDERATIONS
A. Noise levels
B. Present or planned land uses
C. Recreational opportunities
D. Cultural Resources
E. Visual aesthetics
F. Other
44. ECONOMICS
A. Capital
B. Labor
C. Management level
D. Risk
E. Profitability
F. Other
45. SOCIAL
A. Client well being
B. Community well being
C. Environmental Justice
D. Other

46. Findings and Recommendations

Based upon the conclusions, I find that this is not a major Federal action significantly affecting the quality of the human environment. No further environmental analysis is required. The assessment indicated work should proceed.

Further analysis is necessary, including the possible need to prepare an Environmental Impact Statement. The landowner will be informed not to proceed until further assessment is completed.

Conclusions, based upon the assessment (rational for the findings above):
Signature Title (District Conservationist)Date
Primary PlannerTitleDate