Month 20XX PIN XXXX.XX

Social, Economic and Environmental ResourcesChecklist
PIN: / TYPE FUNDING:
DESCRIPTION: / DATE:
REVISION DATE:
TOWN: COUNTY: / NEPA CLASS:
FORM COMPLETED BY: / SEQRA TYPE:
SOCIAL, ECONOMIC AND ENVIRONMENTAL CONSIDERATIONS / PRESENCE OR ANALYSIS NEEDED? / IMPACT OR ISSUE?
YES / NO / YES / NO
Social
1. Land Use
2. Neighborhoods and Community Cohesion
3. General Social Groups
4. School Districts, Recreation Areas & Places of Worship
5. Pedestrian & Bicycle Facilities/Accommodations
Economic
6. Regional and Local Economies
7. Business Districts
8. Specific Business Impacts
Environmental
9. Wetlands
10. Surface Waterbodies and Watercourses
11. Wild, Scenic, and Recreational Rivers
12. Navigable Waters
13. Floodplains
14. Coastal Resources
15. Aquifers, Wells, and Reservoirs
16. Stormwater Management
17. General Ecology and Wildlife Resources
18. Critical Environmental Areas
19. Historic and Cultural Resources
20. Parks and Recreational Resources
21. Visual Resources
22. Farmlands
23. Air Quality Analysis
24. Energy Analysis
25. Noise Analysis
26. Asbestos
27. Contaminated and Hazardous Materials
28. Canal System
29. Unique Boundary Lands
30.
Construction Effects
Indirect (Secondary) Effects
Cumulative Effects
ANTICIPATED PERMITS & APPROVALS
[list all permits and approvals anticipated for the project]
NYSDEC State Pollutant Discharge Elimination System (SPDES) General Permit (#16)
NYSDEC or APA, Article 24Freshwater Wetlands Permit (Individual or General Permit) (#9)
NYSDEC or APA Article 15 Title 27 Wild, Scenic & Recreational Rivers Permit (#11)
NYSDEC Section 401Water Quality Certification (Blanket or Individual Permit) (#9, #10)
NYSDEC Art 15/24 MOU Coordination (#9, #10)
NYSDEC State Forest Preserve Lands Temporary Revocable Permit (#20)
APA Section 814 Order New Land Use and Development (#29)
U.S. Coast Guard Section 9 Permit (#12)
U.S. Army Corps of Engineers, Section 404 / 10 Nationwide Permit – PCN needed? yes no
(#9, #10)
U.S. Army Corps of Engineers, Section 404 / 10 Individual Permit (#9, #10)
Coastal Zone Consistency Certification Statement (#14)
FHWA Executive Order 11990 Wetlands Findings (#9)
NYCDEP Watershed Coordination (#29)
NYSDOS Coastal Consistency Coordination (#14)
NYS Canals Temporary Occupancy Permit (#28)
Lake George Park Commission Coordination (#29)
National Park Service Wild & Scenic Rivers Consultation (#11)
US Fish & Wildlife Service Endangered & Threatened Species Section 7 Consultation (#17)

Instructions:

Use this checklist to document the evaluation of social, economic and environmental issues for Maintenance and Simple projects.

  1. Whenever the evaluation indicates the presence of a resource or the need for further investigation into the presence of a resource, check the YES checkbox in the “Presence or Analysis Needed” column and document the issue in the DAD(Design Approval Document), such as IPP/FDR or PSR/FDR. This documentation must indicate the location, extent and a full description of the resource appropriate to determine any impacts or effects.
  1. Once enough information is available, the “Impact or Issue” checkboxes must be checked either YES or NO. For any YES answer, appropriate documentation must be included in the report (IPP/FDR, PSR/FDR) section that documented the presence of the resource under #1 above. This documentation must include the nature and size or extent of an impact; measures taken to avoid or minimize impacts; and any mitigation being provided.Documentation for each issue should clearly note any necessary approvals and/or expected permits.

Prior to seeking approval (“design approval”) of the DAD, this checklist and the appropriate sections of the DAD should be reviewed to ensure checkmarks and statements are valid and also for consistency between the checklist and DAD sections.