FEMA Form FF-104-FY-22-246, Environmental and Historic Preservation Addendum

D EPARTMENT OF HOMELAND SECURITY

Federal Emergency Management Agency

ENVIRONMENTAL AND HISTORIC PRESERVATION INFORMATION ADDENDUM

Disposal of Demolition Debris or Other Material or Disposal of Construction Debris or Other Materials¹

What type of debris? Please select all that apply.

☐ Construction and demolition

☐ Hazardous materials

☐ Large appliances or white goods

☐ Electronics

☐ Sand, mud, silt, gravel, rocks, or boulders

☐ Other. Please describe:      

How was [will] the debris be collected and transported to disposal site? ² Please describe:      

What is the location of the final disposal location(s)?

☐ Commercial. Please provide name of vendor(s) and address or GPS coordinates:      

☐ Municipal. Please provide the address or GPS coordinates:      

☐ Private. Please provide the address or GPS coordinates:      

☐ Other. Please describe and provide the address or GPS coordinates:      

Who is the hauler to the final disposal location?      

Fill or Borrow Material³

What was the quantity of fill?       Unit of measure:       (Cubic Yards, Tons)

What type of fill?

☐ Gravel

☐ Rock

☐ Sand

☐ Soil

☐ Other material. Please describe:      

What was the source and location of the fill and borrow material?

☐ Commercial. Please provide name of vendor(s) and address or GPS:      

☐ Municipal. Please provide the GPS coordinates:      

☐ Private. Please provide the GPS coordinates:      

☐ Other. Please describe and provide the GPS coordinates:      

Ground Disturbance⁴

Did [will] the ground disturbance occur on previously undisturbed areas or outside of an existing footprint or right of way?⁵

☐ No

☐ Yes. What are [will be] the dimensions of the ground disturbance? Length:       Width:       Depth:      

Did [will] the ground disturbance involve the removal of any existing [non-debris] trees, rootballs, stumps, or other vegetation?

☐ No

☐ Yes. Please provide the GPS coordinates for each location: Latitude:       Longitude:      

Hazardous Materials⁶

What type of hazardous materials?

☐ Asbestos containing products (sealants, insulation, tile, etc.)⁷

☐ Chemical or fuel storage tanks (above or below ground)⁸

☐ Glycol or antifreeze

☐ Lead based paints, solder, flashing

☐ Mercury containing waste (mercury switches, fluorescent bulbs, thermostats, etc.)

☐ Oil, fuel (gasoline, diesel, kerosene, propane), or hydraulics

☐ Polychlorinated Biphenyl (PCB) containing materials (transformers, caulking, etc.)⁹

☐ Pesticides

☐ Solvents (thinners, cleaners, varnishes, and adhesives)

☐ Swimming pool maintenance supplies (chlorine products, muriatic acid, etc.)

☐ Transformers

☐ Treated utility poles

☐ Other hazardous materials. Please describe:      

Did [will] the Applicant dispose of the hazardous materials?

☐ No. Please describe why the Applicant did not dispose of the hazardous materials:      

☐ Yes. Please upload applicable permits, waste manifests, notification of proper storage, and any required facility-specific Emergency Response Plans for spills, safety, and proper handling. [required]

Please provide the name of the vendor or organization that transported the material:      

Please provide the GPS coordinates of the final disposal site(s):      

Did any oil or hazardous material releases occur at this site?

☐ No

☐ Yes. Did the Applicant report the release[s] to state environmental agencies under spill or cleanup requirements?

☐ No. Please explain:      

☐ Yes.¹⁰ Please upload documentation of permits or correspondence with the environmental agency. [required] Please include the case or site number:      

In an Invasive Species Quarantine Area¹¹

What is the name of the quarantine area?      

Was [will] the debris [be] disposed of according to quarantine requirements?¹²

☐ No. Please explain why quarantine requirements were not met:      

☐ Yes

Where was [will] the debris [be] disposed of?      

How was the debris transported?      

In or Within 200 feet of a Waterway, Body of Water, Floodway, or Wetland¹³

Has there been coordination with a Federal, State, Tribal, or Territorial regulatory agency?

☐ No

☐ Yes. Please upload all applicable permits or documentation of correspondence with the regulatory agencies.¹⁴ [required]

☐ Unsure

Did [will] the work involve placing any equipment (e.g., machinery or vehicles) in water and/or wetlands?

☐ No

☐ Yes. Did [will] the work involve dredging?

☐ No

☐ Yes. Please provide the area dimensions (L/W/D)       and the GPS coordinates of the dredging boundaries:      

Dredging method:

☐ Barge

☐ Flotation device

☐ Land

☐ Other. Please describe the dredging method:      

Did [will] the work involve discharge of fill materials into a waterway, body of water, floodway, or wetland?

☐ No

☐ Yes. What type of fill?

☐ Gravel

☐ Rock

☐ Sand

☐ Soil

☐ Other material. Please describe:      

Near Threatened Species, Endangered Species, or Designated Critical Habitat¹⁵

Are there threatened or endangered species or designated critical habitat in or near the work site?

☐ No

☐ Yes

Has there been coordination with a Federal, State, Tribal, or Territorial regulatory agency?

☐ No

☐ Yes. Please upload all applicable permits or documentation of correspondence with the regulatory agencies. ¹⁶ [required]

☐ Unsure

☐Unsure

On a Beach or Coastal Facility¹⁷

Has there been coordination with a Federal, State, Tribal, or Territorial regulatory agency?

☐ No

☐ Yes. Please upload all applicable permits or documentation of correspondence with the regulatory agencies.¹⁸ [required]

☐ Unsure

On or Adjacent to a Facility: Constructed 45 or More Years Ago; Listed on a Local, State, Tribal, Territorial, or National Register; or that is a Locally Registered Landmark.

Has there been coordination with a Federal, State, Tribal, or Territorial regulatory agency?

☐ No

☐ Yes. Please upload all applicable permits or documentation of correspondence with the regulatory agencies.¹⁹ [required]

☐ Unsure

Did [will] the work include any cleaning or mold remediation?

☐ No

☐ Yes.

What surface did [will] the Applicant treat?

Please describe the mold remediation activities:

Did [will] the Applicant use:

☐ Chemical cleansers

☐ No

☐ Yes. What chemicals did the Applicant use:      

☐ Power washing

☐ No

☐ Yes. Please list the pounds per square inch (PSI) used:     

Were there any previous extensive renovations to the exterior or interior?²⁰

☐ No

☐ Yes. Please list the date(s) of any previous renovations:      

Temporary access road construction²¹

Please describe the work in detail including quantities      , dimensions      , and material types used      . Please upload sketches, design plans, maps, aerial images, and photos.²² [optional]

Temporary Staging of Equipment or Materials²³

Is the staging area within an existing right-of-way?

☐ No²⁴

☐ Yes

Please select the type of surface for each staging area site²⁵

☐ Grass field

☐ Gravel

☐ Paved (asphalt or concrete)

☐ Other. Please d☐scribe:      

1 Functionality: Trigger if selected on the Impact List or the Simple Approach. Only for Emergency Protective Measure and Infrastructure Restoration Project Applications.

2 (Help text) Method of removal may include hand tools, deredging, or heavy equipment such as excavator, surf rake, or litter picker.

3 Functionality: Trigger if selected on the Impact List or the Simple Approach

4 Functionality: Trigger if selected on the Impact List or the Simple Approach

5 (Help text) Agricultural fields are considered previously undisturbed.

6 (Help text) See the Hazardous Materials section in the the Public Assistance Program and Policy Guide (PAPPG) for more information. Functionality: Trigger if selected on the Impact List or the Simple Approach

7 (Help text) See EPA’s asbestos website for more information on on asbestos, including information on the federal requirements for the renovation and demolition of buildings that contain asbestos.

8 (Help text) EPA’s Underground Storage Tanks website contains information on preventing, detecting, and cleaning up releases.

9 (Help text) EPA’s website contains PCB management and other information including PCB-containing disaster debris guidance.

10 Functionality: Documentation required prior to submitting the project application.

11 Functionality: Trigger if selected on the Impact List or the Simple Approach. Only trigger for Debris Removal Project Application.

12 (Help text) If unsure, please contact the State, local, Tribal, or Territorial emergency management office to determine prior to submitting the Project Application.

13 Functionality: Trigger if selected on the Impact List or the Simple Approach

14 Functionality: Applicable permits or correspondence required before Applicant can submit its Project Application.

15 (Help text) Endangered Species Act: The Endangered Species Act (ESA) requires Federal agencies to use their authorities to conserve federally listed threatened and endangered species (listed species) and critical habitats. FEMA must also consult with the U.S. Fish and Wildlife Service (USFWS) and the National Oceanic and Atmospheric Administration’s (NOAA’s) National Marine Fisheries Service (NMFS), also known as NOAA Fisheries, to ensure that proposed projects will not jeopardize the continued existence of any listed species or result in the destruction or adverse modification of critical habitat for listed species. See 16 U.S.C. § 1536, Endangered Species Act Section 7 for additional information. Bald and Golden Eagle Protection Act: The Bald and Golden Eagle Protection Act prohibits any person from pursuing, capturing, killing, wounding, disturbing, or otherwise taking bald eagles or golden eagles, including their parts (e.g., feathers), nests, or eggs, unless authorized by a permit from the USFWS. The prohibition on disturbance applies to nests and previously used nest sites when eagles are not present if, were an eagle to return, such alterations would lead to injury, death or nest abandonment. Functionality: Trigger if selected on the Impact List or the Simple Approach

16 Functionality: Applicable permits or correspondence required before Applicant can submit its project application.

17 Functionality: Trigger if selected on the Impact List or the Simple Approach

18 Functionality: Applicable permits or correspondence required before Applicant can submit its project application.

19 Functionality: Applicable permits or correspondence required before Applicant can submit its project application.

20 (Help text) If unsure, please contact the State, local, Tribal, or Territorial emergency management office to determine prior to submitting the Project Application. Functionality: Only ask on Emergency Protective Measure and Infrastructure Restoration Project Applications.

21 Functionality: Trigger this in the Environmental and Historic Preservation Addendum if selected on the project application.

22 Functionality: Documentation requested, not required.

23 Functionality: Trigger if selected on the project application.

24 (Help text) FEMA may need to conduct a more extensive environmental and historic preservation review.

25 (Help text) The type of surface impacts the extent of environmental and historic preservation review.

FEMA Form FF-104-FY-22-246 2