Rural Library Attachment G

Attachment G

Environmental Questionnaire

Applicant:

Project Title:

Instructions: Complete the Environmental Questionnaire using the instructions in the Rural Library Broadband Grant Program Application Guide and below. Upload supplemental information (e.g., maps, environmental review documents) as separate attachments. Clearly label all documents as well as file names.

Any project-related activity that may adversely affect the environment must not be undertaken prior to the completion of the Rural Utilities Service environmental review process. Doing so may jeopardize consideration of your application. All of the following questions must be completed or the application will be considered incomplete. If a question is not applicable, please enter “N/A” instead of leaving the section blank.

Note: The Applicant may submit a copy of any environmental review document that has been prepared in connection with obtaining permits, approvals, or other financing for the proposed project from state, local, or other Federal agencies. Such material, to the extent relevant, may be used to meet the requirements herein. Applicants shall not reference items provided in other parts of the application package; all materials relevant to this questionnaire must be integrated herein to facilitate timely review.

1. Project Description and Location:

Describe all project-related construction activities, including, but not limited to:

1. Building construction related to installing prefabricated buildings;

2. Internal modifications, or equipment additions to buildings or other structures (e.g., relocating interior walls or adding computer facilities);

3. The construction and installation of buried cable; or

4. Installation of telecommunications transmission facilities including construction of new monopole towers or satellite dishes.

Complete descriptions and locations must be provided for each site affected by project-related construction activities.

2. Map:

Include a map for each site affected by construction (recommend U.S. Geological Survey 7.5-minute quadrangle maps at a map scale of 1:24,000; larger scale maps may be provided for site-specific proposals). USGS maps may be obtained and purchased at the following website: http://www.usgs.gov/pubprod/maps.html. All project elements, if known at the time of the application, must be clearly depicted on any map provided. If appropriate, photographs or aerial photographs of site-specific proposals may be provided.

3. Property Changes:

Describe and indicate the amount of property to be cleared, excavated, fenced, or otherwise disturbed by the project. Describe the current land use and zoning for each project site affected by construction. Document whether the proposed project is located on public land owned or managed by the federal government. For information related to federal lands see the following website – http://www.geocommunicator.gov. This website provides cadastral survey and land management information and data from the National Integrated Land System specifically the distribution of the Public Land Survey System (PLSS), other survey-based data, and federal land boundaries.

4. Buildings:

Describe buildings or other structures (i.e., transmission facilities), including dimensions, to be constructed or modified. For linear projects, state whether the project is to be located on or within previously disturbed public rights-of-way.

5. Wetlands:

Describe and indicate whether wetlands are present on or near the project site(s) affected by construction (maps of wetlands may be obtained from the U.S. Fish and Wildlife Service's National Wetland Inventory website: http://www.fws.gov/wetlands/ or from soil maps obtained from the USDA, Natural Resource Conservation Service's website: http://websoilsurvey.nrcs.usda.gov/app/HomePage.htm.

6. Threatened and Endangered Species:

Describe and indicate whether any project site(s) will directly or indirectly affect any threatened, endangered or candidate species or is within or near critical habitats. To document the analysis, applicants must provide species lists and appropriate specie accounts obtained from the U.S. Fish and Wildlife Service's website: http://ecos.fws.gov/tess_public/ for each county affected by construction of the project.

7. Floodplains:

Describe whether or not any facilities or sites are located within a 100-year floodplain. Information related to floodplains and National Flood Insurance Maps may be obtained from the Federal Emergency Management Agency's (FEMA) website:

http://msc.fema.gov/webapp/wcs/stores/servlet/FemaWelcomeView?storeId=10001&catalogId=10001&langId=-1

If any project-related construction activities are within floodplains, a copy of the FEMA, ''FIRMette'' with construction activities depicted on the map must be included. For obtaining FIRMettes review the tutorial provided by FEMA.

8. Historic Properties:

Describe any cultural resources, including historic properties, i.e., properties listed in or eligible for listing in the National Register of Historic Places, which are located in or within a one-mile radius of the project area and how they may be impacted by the project. Information related to historic properties can be obtained from the State Historic Preservation Office (SHPO) in your respective State - see the website of the National Conference of SHPO: http://www.ncshpo.org/find/index.htm.

Applicants must indicate if any portion of the project is located on tribal lands, meaning lands within the exterior boundaries of any Indian reservation and all dependent Indian communities. Information regarding historic properties located on tribal lands may be obtained from the Tribal Historic Preservation Officer (THPO) or the tribe’s official representative for historic preservation. If provided, applicants should provide any information gathered about historic properties on tribal lands, including any correspondence with an Indian tribe.

Applicants must gather information about the nature and location of historic properties from the SHPO. SHPOs should be asked the following questions:

5. Is the proposed project located on, within or adjacent to any properties listed in or eligible for listing in the National Register of Historic Places? Is the proposed project located on, within or adjacent to a National Historic Landmark? If the answer is yes, describe and indicate the geographic relationship between the project and property with maps.

6. Will the proposed project impact, use or alter a building or structure that was constructed more than 50 years ago? If so, describe the building/structure with a statement of its condition, including photographs, and document its age.

7. If provided, applicants should provide SHPO responses/information to these questions including any correspondence with the SHPO.

9. Coastal Areas:

Determine whether or not the project is within the boundaries of a coastal zone management area (CZMA). For boundary related and contact information related to CZMA, see National Oceanic and Atmospheric Administration, Office of Ocean and Coastal Resource Management's website: http://coastalmanagement.noaa.gov/consistency/welcome.html

10. Brownfields:

Determine whether the project is located within a brownfield site. Per 42 U.S.C. 9601, the term ''brownfield site'' means real property, the expansion, redevelopment, or reuse of which may be complicated by the presence or potential presence of a hazardous substance, pollutant, or contaminant. Maps and locations of sites, facilities and properties that have been contaminated by hazardous materials and are being, or have been, cleaned up under EPA's Superfund, RCRA and/or brownfields cleanup programs can be found at the following website: http://iaspub.epa.gov/Cleanups/.

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