\ US Environmental Protection Agency (W : WIFIA Program PEA Environmental Questionnaire VERSION: February 2021 WIFIA PEA SRF ENVIRONMENTAL QUESTIONNAIRE INSTRUCTION GUIDE The Programmatic Environmental Assessment (PEA) Environmental Questionnaire helps verify the applicability of the PEA for Water Infrastructure Finance and Innovation Act (WIFIA) State Revolving Fund (SRF) projects. General Guidance for the WIFIA Borrower • Completing the PEA questionnaire can be an iterative process. The document may be revised after its initial submittal to incorporate project changes or clarifying questions made by WIFIA. • The borrower should submit a completed PEA questionnaire (attached as Appendix B) including all relevant information and supporting documents listed in this checklist. • Individual projects listed in Section A of Appendix B, Environmental Questionnaire, may be replaced with different eligible projects by an SRF prospective borrower after the WIFIA Loan Agreement (WLA) has been executed, with EPA review and approval as consistent with terms outlined in the WLA. • When submitting the Environmental Questionnaire, ensure that: o All questions have been answered fully based on all available information, o All resource impacts have been evaluated and responses are filled in for each row. o All supporting documentation references and citations is provided. • Additional pages may be attached as necessary. Impact Assessment Guidance Assess anticipated impacts for each environmental resource. For each resource select either no impact, less than significant impact, or significant impact as described below and consistent the PEA. Impacts may be associated with construction and/or operation of the project. • No Impact: Select "no impact or N" if there is no potential for the project to affect a resource (e.g., the project falls outside a coastal zone). • Less Than Significant Impact: Select "less than significant impact or LS" box if the incorporation of mitigation measures will reduce an effect from "significant impact" to "LS". • Significant Impact: Select "significant impact or S" box if impacts remain significant despite the incorporation of mitigation measures, or if impacts fall outside the scope of those considered in the PEA. Select "S" for a proposed project that is likely to have significant effects or when the significance of likely effects is unknown. • Impact Overview: Provide a brief impact overview for each resource category with "LS" or "S". An overview is not required for resource categories marked with "N". Narrative descriptions may be included in the space provided or additional pages may be added. o Include a brief description of project mitigation measures, best management practices (BMPs) or standard operating procedures (SOPs) to avoid, minimize or compensate for impacts. Definitions for the Env Questionnaire • WIFIA Borrower- the entity applying to the WIFIA program • WIFIA Project- the scope of work or grouping of individual SRF projects comprising the WIFIA loan • SRF Projects- the individual SRF projects brought to the SRF by entities or sponsors that are not the WIFIA borrower WIFIA B-l ------- \ US Environmental Protection Agency (W : WIFIA Program PEA Environmental Questionnaire APPENDIX B: ENVIRONMENTAL QUESTIONNAIRE FOR WIFIA CREDIT ASSISTANCE TO SRF PROGRAMS This questionnaire, which will be completed by prospective borrowers and reviewed by the WIFIA program, supports the Programmatic Environmental Assessment (PEA) "tiering" framework, the PEA's associated preliminary Finding of No Significant Impact (FONSI), and project-specific NEPA documentation for the WIFIA program. 1. WIFIA Borrower name: Click or tap hereto enter text. 2. SRF Program Type(s): ~ Clean Water SRF ~ Drinking Water SRF 3. Provide an overview of the State Environmental Review Process (SERP). Provide a copy of the SERP or SRF Operating Agreement with EPA. Click or tap here to enter text. 4. What procedures, methodology or tools are used by the WIFIA Borrower to assess and determine the impacts of projects within the state environmental review process? Click or tap here to enter text. 5. Use the attached Section A SRF Project Impact Summary Spreadsheet to identify individual SRF projects, including project sponsor or entity, that will be included in the WIFIA loan. For each SRF project, identify any potential impacts for each resource category. This spreadsheet will provide an overview of the determinations for SRF project comprising the WIFIA project that EPA will verify as part of its environmental review. B-2 ------- Programmatic Environmental Assessment of the WIFIA Program A. SRF PROJECT IMPACT SUMMARY TABLE For each SRF borrower please identify each project name and indicate in the table below if there are significant impacts to each of the resource topics discussed above. Complete instructions can be found in the Excel version of this table. "N" indicates no impacts to a resource, "LS" indicates adverse impacts that are less than significant to a resource, "S" indicates significant impacts to a resource. Only for Resources indicated with "LS" or "S" SRF Borrower Project Name Land Use Air Quality Noise/Vibration Geological/Soil Resources Water Resources Biological Resources Cultural Resources Socioeconomics/ EJ Traffic/ Transportation Utilities/ Community Resources Hazardous and Toxic Materials and Waste Human Health and Safety Other Considerations Impact Overview Mitigation Measu res, BMPs, SOPs SRF Impact Determina tion and Date of Determina tion ¦ ¦ ¦ ¦ ¦ ¦ ¦ ¦ ¦ ¦ ¦ ¦ ¦ ¦ ¦ ¦ ¦ ¦ B-3 ------- Programmatic Environmental Assessment of the WIFIA Program B-4 ------- |