WIFIA PEA Questionnaire and Supporting Document Checklist February 2021

\ US Environmental Protection Agency

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**'* PEA Environmental Questionnaire

WIFIA PEA QUESTIONNAIRE AND SUPPORTING
DOCUMENT CHECKLIST

VERSION: February 2021

The Programmatic Environmental Assessment (PEA) Environmental Questionnaire helps verify the
applicability of the PEA for a Water Infrastructure Finance and Innovation Act (WIFIA)-funded project.
Compliance with other federal and state environmental laws and regulations is required, as appropriate
and applicable. These could include, for example, those requiring site-specific consultations with other
federal, state, Tribal governments and agencies (such as consultation under the Endangered Species Act
(ESA) or National Historic Preservation Act (NHPA)); completing National Environmental Policy Act
(NEPA)-like requirements of the state; or complying with certain state requirements for water and
wastewater systems.

Completing the PEA questionnaire can be an iterative process. The document may be revised after its
initial submittal following project changes or clarifying questions made by EPA.

The borrower should submit a completed PEA questionnaire (attached as Appendix A) including all
relevant information and supporting documents listed in this checklist.

Appendix A

Question

Checklist Item or Instructions

Included

General

• All questions have been answered fully based on all available information.

Guidance

• All resource impacts have been evaluated and check boxes are filled in for

each row.

• All supporting documentation is referenced and attached.

• Additional pages are attached as necessary.

Question 3:

• Describe each project component or subproiect outlined in the WIFIA

Application Section E.

Project

o Note if components are new, replacements, or rehabilitations.

Description

o Provide size of construction site footprint, length of right(s)-of-way,

specific volumes/capacities.

o Indicate if the project or components are still in the early phases of design

and if specific details are not yet available.

• Note project phases (if applicable).

Question 4:

• Provide location descriptions for each project component or subproiect

outlined in the WIFIA Application Section E.

Project

o Provide Street address or nearest intersection.

Location

o Note if located at a new or existing site.

o Note if located within existing, adjacent to existing or new right(s)-of

way.

o Note any previous site disturbances or current usage.

o Note existing land cover/vegetation.

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Appendix A
Question

Checklist Item or Instructions

Included

o Provide Site coordinates.

• Provide project overview map, showing all project components in one map.

• Provide maps of each project component, including:

o Additional maps for clarity.

o Maps labeled appropriately, with relevant streets and roadways.

o Map surroundings should be visible.

o Provide ArcGIS Project Shapefiles of project components, as

appropriate.

Sections A
through M:

Impact
Assessment

Assess anticipated impacts for each environmental resource. For each resource check the
appropriate box if there are no impacts, less than significant impacts, or potentially
significant impact as described in each resource section in the PEA.

• No Impact: Mark the "no impact" box 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: Mark the "less than significant impact" box if the
incorporation of mitigation measures will reduce an effect from "potentially significant
impact" to "less than significant impact'.

• Potentially Significant Impact: Mark the "potentially significant impact" box if impacts
remain significant despite the incorporation of mitigation measures, or if impacts fall
outside the scope of those considered in the PEA. Check this box for a proposed action that
is likely to have significant effects or when the significance of the effects is unknown.

• Narrative Description: Provide a narrative for each box checked "less than significant
impact" or "potentially significant impact". A narrative is not required for boxes checked
"no impact". Narrative description may be included in the space provided or additional
pages may be added.

o Include a description of the impact(s) (both construction and operational impacts),
o Include a description of associated mitigation measures, Best Management Practices
(BMPs), and/or Standard Operating Procedures (SOPs) to avoid, minimize or
compensate for impacts,
o Provide adeauate supporting references and citations for impact and mitigation
assessments.

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APPENDIX A: ENVIRONMENTAL QUESTIONNAIRE FOR
WIFIA CREDIT ASSISTANCE PROJECTS

This questionnaire will be used for most WIFIA funded projects and supports the PEA "tiering"
framework, the PEA's associated preliminary Finding of No Significant Impact (FONSI), and project
specific NEPA documentation for the WIFIA program. WIFIA credit assistance to Clean Water and
Drinking Water State Revolving Fund (SRF) programs should use the questionnaire in Appendix B.

1.	WIFIA Project name:

Click or tap here to enter text.

2.	WIFIA Borrower:

Click or tap here to enter text.

3.	Project Description: Describe each project component or subcomponent outlined in the WIFIA
Application Section E.

Component: Click or tap here to enter text.

Description: Click or tap here to enter text.

Component is: ~ New ~ Replacements ~ Rehabilitation
Stage of design: Click or tap here to enter text.

Component: Click or tap here to enter text.

Description: Click or tap here to enter text.

Component is: ~ New ~ Replacements ~ Rehabilitation
Stage of design: Click or tap here to enter text.

*Note: Create additional tables for all components

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4. Project Location: Answer the questions below about project location for each component or
subproject. Attach or provide project maps of the entire project, each project component and
ArcGIS project shapefiles, as applicable.

Click or tap here to enter text.

Provide a location for each project component or subcomponent outlined in the WIFIA
Application Section E.

Select the checkbox(es) that best describe the project:

~ Within an existing facility, easement or right(s)-of-way.

~ Outside of an existing facility, easement or right(s)-of-way.

~ Site previously undisturbed ~ Site previously disturbed

Describe the current site use, landcover, and/or vegetation:

Click or tap here to enter text.

Street address or nearest intersection:

Click or tap here to enter text.

Site coordinates (Latitude/Longitude, or Decimal Degrees):

Click or tap here to enter text.

*Note: Create additional tables for all components

5. Project type: (Check all that apply):

Identify if any of the following apply to the project:

~ Program of projects: Projects that consist of a common type of work within a similar
construction time frame (up to 5 years) that may have unknown project locations within a
general geographic area (e.g., pipe repair and manhole replacement projects over several
years).

~ Combination of projects: A group of projects with a common purpose that have defined
locations and similar construction schedules.

~ Not Applicable (N/A)

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Identify which project type(s) best describe the project:

~

Wastewater Projects

~

Drinking Water Projects

~

Energy Efficiency Enhancement Projects

~

Repair, Rehabilitation, and Replacement Projects

~

Brackish or Seawater Desalination Projects

~

Drought Prevention, Reduction, or Mitigation Projects

~

Acquisition of Real Property Projects

~

Combination Wastewater or Drinking Water Projects

~

Other [Please explain]

6. Describe any environmental permits or approvals needed for the project (e.g., federal, state,
local) and the status of any permit:

Click or tap here to enter text.



Issuing



Date

Permit/Authorization

agency

Status

Issued/Anticipated





~ Received



Clean Water Act 404



~ Application Submitted



Click or tap here to enter text.

USACE

~ To Be Submitted







~ Received



Clean Water Act 401



~ Application Submitted



Click or tap here to enter text.



~ To Be Submitted







~ Received



Coastal Zone Management



~ Application Submitted



Click or tap here to enter text.



~ To Be Submitted







~ Received



Fish and Wildlife Service



~ Application Submitted



Click or tap here to enter text.



~ To Be Submitted







~ Received



National Marine and Fisheries Service



~ Application Submitted



Click or tap here to enter text.



~ To Be Submitted







~ Received



State Historic Preservation Office



~ Application Submitted



Click or tap here to enter text.



~ To Be Submitted







~ Received







~ Application Submitted



Click or tap here to enter text.



~ To Be Submitted







~ Received







~ Application Submitted



Click or tap here to enter text.



~ To Be Submitted



*Note: Additional rows may be added as necessary

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IMPACT ANTICIPATED

A. LAND USE:

NO IMPACT

LESS THAN
SIGNIFICANT
IMPACT

POTENTIALLY
SIGNIFICANT
IMPACT

1. Conversions of Prime Farmland, Unique
Farmland, or Farmland of Statewide
Importance (Farmland), to non-agricultural
use as defined under the Farmland
Protection Act 7 U.S.C. 4201 et seq.

2. Conflicts with any applicable land use plan,
policy, act, or regulation of an agency with
jurisdiction over the project (including, but
not limited to, the general plan, habitat
conservation plan, specific plan, local plan,
or zoning ordinance).

PEA EXAMPLES TO REDUCE LAND USE IMPACTS:

NOT
APPLICABLE

NOT
INCORPORATED

INCORPORATED

1. Compatibility with state and local
government and private programs and
policies.

2. Measures agreed upon in coordination
with stakeholders.

NARRATIVE DESCRIPTION: Please provide a narrative description of the impacts (including construction
and operation impacts) associated with any items with checked boxes in the less than significant impact
or potentially significant impact columns. Identify and describe any mitigation measures, BMPs and/or
SOPs that may avoid, minimize or compensate for the impacts, including those that reduce impacts to
less than significant. Examples that were considered within the PEA are listed in, but not limited to, the
table above. References to existing supporting documentation (document name, section, page number)
may be included as well as a summary of the relevant information.

Click or tap here to enter text.

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IMPACT ANTICIPATED

B. AIR QUALITY:

NO IMPACT

LESS THAN
SIGNIFICANT
IMPACT

POTENTIALLY
SIGNIFICANT
IMPACT

1. Conflicts with or delays in implementation of
any applicable federal, state, or local air
quality plan.

2. Violations of any federal air quality standards
or contributions to an existing or projected air
quality violation (including protected areas
designated as mandatory Federal "Class 1").

3. Increases in any criteria pollutant for which
the project region is in non-attainment under
an applicable federal or state ambient air
quality standard (including releasing emissions
which exceed quantitative thresholds for
ozone precursors).

4. Releases of objectionable odors, such as
hydrogen sulfide.

PEA EXAMPLES TO REDUCE AIR QUALITY IMPACTS:

NOT
APPLICABLE

NOT
INCORPORATED

INCORPORATED

1. Odor minimizing facility design or emission
control devices.

2. Use of energy efficient technologies, such
as anti-idling measures for construction
vehicles.

3. Use of dust suppression techniques, such as
water for dust suppression, reducing vehicle
speeds, cover truck loads during transit,
rumble strips, truck washing stations during
construction.

Click or tap here to enter text.

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IMPACT ANTICIPATED

C. NOISE AND VIBRATION:

NO IMPACT

LESS THAN
SIGNIFICANT
IMPACT

POTENTIALLY
SIGNIFICANT
IMPACT

1. Generation of noise levels in excess of
standards established in the local general
plan or noise ordinance, or applicable
standards of other agencies; or generation of
noise resulting in public health impacts.

~

~

~

2. Permanent increases in ambient noise levels
in the project vicinity above levels existing
without the project.

~

~

~

3. Temporary or periodic increases in ambient
noise levels in the project vicinity above
levels existing without the project.

~

~

~

4. Generation of vibration that could increase
the risk of structural damage.

~

~

~

PEA EXAMPLES TO REDUCE NOISE IMPACTS:

NOT
APPLICABLE

NOT
INCORPORATED

INCORPORATED

1. Compliance with local ordinances and land
use designations.

~

~

~

2. Placing intakes and exhausts facing away
from sensitive receivers.

~

~

~

3. Attenuation of fan noise and pump and
motor noise.

~

~

~

4. Use of general noise reduction measures.

~

~

~

NARRATIVE DESCRIPTION: Please provide a narrative description of the impacts (including construction
and operation impacts) associated with any items with checked boxes in the less than significant impact
or potentially significant impact columns. Identify and describe any mitigation measures, BMPs and/or
SOPs that may avoid, minimize or compensate for the impacts, including those that reduce impacts to
less than significant. Examples that were considered within the PEA are listed in, but not limited to, the
table above. References to existing supporting documentation (document name, section, page number)
may be included as well as a summary of the relevant information.

Click or tap here to enter text.

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IMPACT ANTICIPATED

D. GEOLOGY AND SOILS:

NO IMPACT

LESS THAN
SIGNIFICANT
IMPACT

POTENTIALLY
SIGNIFICANT
IMPACT

1. Exposure of people or structures to hazards
from unstable soils, landslide, lateral
spreading, subsidence, liquefaction or
collapse.

2. Increase in soil erosion or loss of topsoil.

3. Loss of economic viable mineral deposits,
scientifically significant paleontological
resources, or unique geological features.

PEA EXAMPLES TO REDUCE IMPACTS TO GEOLOGY
AND SOIL:

NOT
APPLICABLE

NOT
INCORPORATED

INCORPORATED

1. Use of erosion control and site
stabilization BMPs.

2. Implementation of a stormwater
pollution prevention plan and fugitive
dust control plan.

3. Implementation of effective site selection
and design.

Click or tap here to enter text.

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IMPACT ANTICIPATED

E. WATER RESOURCES:

NO
IMPACT

LESS THAN
SIGNIFICANT
IMPACT

POTENTIALLY
SIGNIFICANT
IMPACT

1. Violations of any federal water quality

standards or waste discharge requirements,
including degradation of water quality.

~

~

~

2. Depletion or contamination of groundwater
supplies (including sole-source aquifers) or
negatively interfere with groundwater
recharge.

~

~

~

3. Alteration of the drainage pattern of a water
resource that would result in an increase in
erosion or flooding on- or off-site.

~

~

~

4. Soil erosion or stormwater runoff that
increases sediment, pollutants, or
contaminates into streams, rivers, or other
water resources.

~

~

~

5. Floodplain modification, development within,
or redirection, as defined by Executive Order
11988.

~

~

~

6. Increase in flood risk affecting loss on human
safety, health, and welfare.

~

~

~

7. Loss, degradation, or destruction of wetlands
and waterbodies through direct removal,
filling, hydrological interruption, or other
means.

~

~

~

8. Alteration of wild and scenic rivers as defined
by the Wild and Scenic River Act 16 U.S.C. 1271
et seq.

~

~

~

9. Conflicts with the Rivers and Harbors Act, 33
U.S.C. 403.

~

~

~

10. Conflicts with the Coastal Barrier Resources
Act, 16 U.S.C. 3501 et seq.

~

~

~

11. Conflicts with the enforceable policies of a
state's federally approved coastal
management program (the Coastal Zone
Management Act, 16 U.S.C. 1451 et seq.).

~

~

~

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PEA EXAMPLES TO REDUCE IMPACTS TO
WATER RESOURCES:

NOT
APPLICABLE

NOT

INCORPORATED

INCORPORATED

1. Use of appropriate erosion and

sediment control measures, BMPs, and
site stabilization.

~

~

~

2. Implementation of effective site
selection and design.

~

~

~

3. Use of appropriate erosion and

sediment control measures, BMPs, and
site stabilization.

~

~

~

4. Implementation of effective site
selection and design.

~

~

~

NARRATIVE DESCRIPTION: Please provide a narrative description of the impacts (including construction
and operation impacts) associated with any items with checked boxes in the less than significant impact
or potentially significant impact columns. Identify and describe any mitigation measures, BMPs and/or
SOPs that may avoid, minimize or compensate for the impacts, including those that reduce impacts to
less than significant. Examples that were considered within the PEA are listed in, but not limited to, the
table above. References to existing supporting documentation (document name, section, page number)
may be included as well as a summary of the relevant information.

Click or tap here to enter text.

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IMPACT ANTICIPATED

F. BIOLOGICAL RESOURCES:

NO
IMPACT

LESS THAN
SIGNIFICANT
IMPACT

POTENTIALLY
SIGNIFICANT
IMPACT

1. Jeopardizes the continued existence of any
federally threatened or endangered species as
identified by the U.S. Fish and Wildlife Service
(USFWS) or National Marines Fisheries Service
(NMFS) in the Endangered Species Act 16
U.S.C. Ch. 35 § 1531 et seq.

~

~

~

2. Adversely modify, fragment, or degrade of
critical habitat by the USFWS or NMFS.

~

~

~

3. Modification, fragmentation, or degradation of
biological sensitive areas other than
designated critical habitat.

~

~

~

4. Harm to fauna, including mammals, birds,
reptiles, amphibians, fish, and invertebrates.

~

~

~

5. Changes in vegetation type (native to the
region), particularly if the vegetation type in
the region is already highly fragmented
because of human activity.

~

~

~

6. Potential to injure or disturb marine mammals
in U.S. waters as protected under Marine
Mammal Protection Act as defined under 16
U.S.C 1361-1407.

~

~

~

7. Reduction in the quality or quantity of Essential
Fish Habitat as designated in accordance with
the Magnuson Stevens Fisheries Conservation
and Management Act.

~

~

~

8. Disturbances to Bald or Golden Eagles as
defined under 16 U.S.C. 668 et seq.

~

~

~

9. Disturbances to migratory birds as defined
under 16 U.S.C. 703-712 as amended.

~

~

~

10. Conflicts with the provisions of an adopted
Habitat Conservation Plan as approved under
section 10 (a) (1) (B) of the ESA or other federal
habitat conservation plan.

~

~

~

11. Introduction or spread of invasive species as
identified under Executive Order 13112.

~

~

~

12. Loss of or damage to wildlife resources due to
the control or modification of any stream or
other body of water protected by the Fish and
Wildlife Coordination Act 16 U.S.C. 661-667e

~

~

~

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PEA EXAMPLES TO REDUCE IMPACTS TO
BIOLOGICAL RESOURCES:

NOT
APPLICABLE

NOT

INCORPORATED

INCORPORATED

1. Implementation of avoidance and
minimization measures, and BMPs.

~

~

~

2. Adoption of recommendations and
conservation measures from USFWS,
NMFS and/or the National Oceanic and
Atmospheric Administration.

~

~

~

3. Prevention of spills and leaks from
vehicles and equipment.

~

~

~

4. Implementation of measures to minimize
soil compaction and the transportation of
noxious, invasive and pest species.

~

~



NARRATIVE DESCRIPTION: Please provide a narrative description of the impacts (including construction
and operation impacts) associated with any items with checked boxes in the less than significant impact
or potentially significant impact columns. Identify and describe any mitigation measures, BMPs and/or
SOPs that may avoid, minimize or compensate for the impacts, including those that reduce impacts to
less than significant. Examples that were considered within the PEA are listed in, but not limited to, the
table above. References to existing supporting documentation (document name, section, page number)
may be included as well as a summary of the relevant information.

Click or tap here to enter text.

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IMPACT ANTICIPATED

G. CULTURAL RESOURCES:

NO IMPACT

LESS THAN
SIGNIFICANT
IMPACT

POTENTIALLY
SIGNIFICANT
IMPACT

1. Potential adverse effects to federally listed
and eligible historical properties, including
prehistoric and historic sites, historic
districts and traditional cultural properties,
as defined in 36 CFR part 800.

~

~

~

2. Modification of unique paleontological
resources or site or unique geologic
features.

~

~

~

3. Disturbance of human remains, including
those interred outside of formal cemeteries.

~

~

~

4. Conflicts with Native American Graves
Protection and Repatriation Act, as defined
in 25 U.S.C. § 3001 et seq.

~

~

~

5. Conflicts with the Archaeological Resources
Protection Act, as defined in 16 U.S.C. §§
470AA-MM

~

~

~

PEA EXAMPLES TO REDUCE IMPACTS TO CULTURAL
RESOURCES:

NOT
APPLICABLE

NOT
INCORPORATED

INCORPORATED

1. Implementation of effective site selection
and design.

~

~

~

2. Implementation of avoidance and
minimization measures identified in
consultation with the State Historic
Preservation (SHPO) and/or Tribal Historic
Preservation Officer (THPO).

~

~

~



~

~

~

3. Conduct surveys prior to construction.







4. Development of an unanticipated
discoveries plan.

~

~

~

NARRATIVE DESCRIPTION: Please provide a narrative description of the impacts (including construction
and operation impacts) associated with any items with checked boxes in the less than significant impact
or potentially significant impact columns. Identify and describe any mitigation measures, BMPs and/or
SOPs that may avoid, minimize or compensate for the impacts, including those that reduce impacts to
less than significant. Examples that were considered within the PEA are listed in, but not limited to, the
table above. References to existing supporting documentation (document name, section, page number)
may be included as well as a summary of the relevant information.

Click or tap here to enter text.

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IMPACT ANTICIPATED

H. SOCIOECONOMIC AND ENVIRONMENTAL
JUSTICE:

NO IMPACT

LESS THAN
SIGNIFICANT
IMPACT

POTENTIALLY
SIGNIFICANT
IMPACT

1. Changes to the demographics around project
location, such as population growth.

~

~

~

2. Modifications to economic factors such as
per capita income, unemployment rate, or
poverty.

~

~

~

3. Alterations to social assets, such as housing
or public services.

~

~

~

4. Disproportionate high and adverse human
health environmental effects on minority
population and low-income populations as
defined under Executive Order 12898.

~

~

~

PEA EXAMPLES TO REDUCE SOCIOECONMIC AND
ENVIRONMENTAL JUSTICE IMPACTS:

NOT
APPLICABLE

NOT
INCORPORATED

INCORPORATED

1. Implementation of construction mitigation
measures.

~

~

~

2. Measures identified as a result of conducting
meaningful public engagement to
environmental justice communities.

~

~

~

NARRATIVE DESCRIPTION: Please provide a narrative description of the impacts (including construction
and operation impacts) associated with any items with checked boxes in the less than significant impact
or potentially significant impact columns. Identify and describe any mitigation measures, BMPs and/or
SOPs that may avoid, minimize or compensate for the impacts, including those that reduce impacts to
less than significant. Examples that were considered within the PEA are listed in, but not limited to, the
table above. References to existing supporting documentation (document name, section, page number)
may be included as well as a summary of the relevant information.

Click or tap here to enter text.

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IMPACT ANTICIPATED

1. TRANSPORTATION AND TRAFFIC:

NO IMPACT

LESS THAN
SIGNIFICANT
IMPACT

POTENTIALLY
SIGNIFICANT
IMPACT

1. Changes to traffic patterns around the
project area including, but not limited to,
the arrival and departure of construction
workers, vehicles hauling equipment and
materials to the site, road closures or
detours, and slower movement and larger
turning radii of truck going to project site.

PEA EXAMPLES TO REDUCE TRANSPORATION AND
TRAFFIC IMPACTS:

NOT
APPLICABLE

NOT
INCORPORATED

INCORPORATED

1. Mitigation measures identified in
coordination with local agencies.

2. Use of warning signage, flag persons.

3. Use of lane closures and detours as
necessary.

Click or tap here to enter text.

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IMPACT ANTICIPATED

J. UTILITIES AND COMMUNITY SERVICES:

NO
IMPACT

LESS THAN
SIGNIFICANT
IMPACT

POTENTIALLY
SIGNIFICANT
IMPACT

1. Changes to electric, cable, gas, sewer,
water, stormwater, and other existing
utility services.

2. Changes to community services, such as
open space, recreational and cultural
facilities.

PEA EXAMPLES TO REDUCE IMPACTS TO UTILTIES
AND COMMUNITY SERVICES:

NOT
APPLICABLE

NOT INCORPORATED

INCORPORATED

1. Identification and avoidance of utilities.

2. Coordination with service providers and
minimization of service interruption.

3. Mitigation measures identified in

coordination with park and recreational
resource managers/agencies.

Click or tap here to enter text.

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IMPACT ANTICIPATED

K. HAZARDOUS AND TOXIC MATERIALS
AND WASTE:

NO IMPACT

LESS THAN
SIGNIFICANT
IMPACT

POTENTIALLY
SIGNIFICANT
IMPACT

1. Accidental releases, spills, or
improper storage and disposal of
hazardous materials.

~

~

~

2. Conflicts with Comprehensive
Environmental Response,
Compensation, and Liability Act
(CERCLA), Resource Conservation and
Recovery Act (RCRA), Solid Waste
Disposal Act, Toxic Substances
Control Act, and Emergency Planning
and Community Right-to-Know Act.

~

~

~

3. Generation or increase in the amount
of sewage sludge that is not in
compliance with EPA standards for
the use or disposal of sewage sludge.

~

~

~

PEA EXAMPLES TO REDUCE HAZARDOUS AND
TOXIC MAERIALS AND WASTE IMPACTS:

NOT
APPLICABLE

NOT
INCORPORATED

INCORPORATED

1. Mitigation measures identified
through compliance with applicable
hazardous and toxic materials laws
and regulations.

~

~

~

2. Implementation of environmental
protection measures, BMPs, and
Standard Operating Procedures
(SOPs).

~

~

~

3. Development or Adoption of an

Emergency Plan/Emergency Response
Plan (or similar).

~

~

~

NARRATIVE DESCRIPTION: Please provide a narrative description of the impacts (including construction
and operation impacts) associated with any items with checked boxes in the less than significant impact
or potentially significant impact columns. Identify and describe any mitigation measures, BMPs and/or
SOPs that may avoid, minimize or compensate for the impacts, including those that reduce impacts to
less than significant. Examples that were considered within the PEA are listed in, but not limited to, the
table above. References to existing supporting documentation (document name, section, page number)
may be included as well as a summary of the relevant information.

Click or tap here to enter text.

A-18

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	\ US Environmental Protection Agency

(W : WIFIA Program

**'*	PEA Environmental Questionnaire





IMPACT ANTICIPATED

L. HUMAN HEALTH AND SAFETY:

NO
IMPACT

LESS THAN
SIGNIFICANT
IMPACT

POTENTIALLY
SIGNIFICANT
IMPACT

1. Creating occupational health hazards for
workers during construction or operation.

~

~

~

2. Creating or contributing to environmental
health or public health risks and safety risks
that may disproportionately affect children,
consistent with Executive Order 13045.

~

~

~

3. Creating or contributing to public health risk
of immediate injury or long-term health
hazards.

~

~

~

PEA EXAMPLES TO REDUCE HUMAN HEALTH AND
SAFETY IMPACTS:

NOT
APPLICABLE

NOT
INCORPORATED

INCORPORATED

1. Implementation of a health and safety plan.

~

~

~

2. Limiting site access to authorized personnel
only.

~

~

~

3. Implementation of fugitive dust minimization
measures.

~

~

~

NARRATIVE DESCRIPTION: Please provide a narrative description of the impacts (including construction
and operation impacts) associated with any items with checked boxes in the less than significant impact
or potentially significant impact columns. Identify and describe any mitigation measures, BMPs and/or
SOPs that may avoid, minimize or compensate for the impacts, including those that reduce impacts to
less than significant. Examples that were considered within the PEA are listed in, but not limited to, the
table above. References to existing supporting documentation (document name, section, page number)
may be included as well as a summary of the relevant information.

Click or tap here to enter text.

A-19

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y	\ US Environmental Protection Agency

:w : WIFIA Program

PEA Environmental Questionnaire





IMPACT ANTICIPATED





LESS THAN

POTENTIALLY



NO

SIGNIFICANT

SIGNIFICANT

M. OTHER ENVIRONMENTAL EFFECTS

IMPACT

IMPACT

IMPACT

1. Click or tap hereto enter text.

~

~

~

2. Click or tap hereto enter text.

~

~

~

3. Click or tap hereto enter text.

~

~

~

4. Click or tap hereto enter text.

~

~

~

5. Click or tap hereto enter text.

~

~

~

*Note: Additional rows may be added as necessary

NARRATIVE DESCRIPTON: Please identify and describe any other reasonably foreseeable environmental
effects from the proposed action not previously identified in Tables AtoL that may have less than
significant impacts or potentially significant impacts. These effects may include effects that are later in
time or farther removed in distance from the proposed action. Identify and describe any mitigation
measures, BMPs, and/or SOPs that may avoid, minimize or compensate for the impacts, including those
that reduce impacts to less than significant. In addition, provide all mitigation measures, BMPs, and/or
SOPs not identified previously in the document that will be included in the project. References to existing
supporting documentation (document name, section, page number) may be included as well as a
summary of the relevant information.

Click or tap here to enter text.

A-20

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