ࡱ > bjbj 4 { t g 4 1% 4 $ "$ "$ "$ "$ "$ "$ )& ( Z "$ "$ $ z $ $ 6H[ $ % 0 1% %) %) J %) L "$ "$ 1% %) : D e t e r m i n a t i o n o f S e c t i o n 4 ( f ) D e M i n i m i s U s e
N O T E : D e m i n i m i s i m p a c t s a r e d e f i n e d a s t h o s e t h a t d o n o t a d v e r s e l y a f f e c t t h e a c t i v i t i e s , f e a t u r e s , a n d a t t r i b u t e s o f t h e S e c t i o n 4 ( f ) r e s o u r c e . T h e a g e n c y i n r e q u e s t i n g d e m i n i m i s n e e d s t o r i g o r o u s l y e x a m i n e the activities, features, and attributes of the Section 4(f) resource and assess the adversity of the effects of the proposed action. This sheet is used to document the analysis of impacts to a Section 4(f) property and to determine if de minimis is appropriate. Only one Section 4(f) property is documented per form; if more than one property is impacted, separate forms will be used for each property.
Project Sponsor:
FORMTEXT P r o j e c t C o n t a c t ( i n c l u d e N a m e , A d d r e s s , a n d P h o n e ) :
F O R M T E X T P r o j e c t N o . :
F O R M T E X T C o n t r o l N o . :
F O R M T E X T P r o j e c t N a m e a n d L o c a t i o n ( A t t a c h l o c a t i o n m a p . I n c l u d e c o u n t y , m u n i c i p a l i t y , e t c . ) :
F O R M T E X T N a m e a n d T i t l e o f O f f i c i a l w i t h J u r i s d i c t i o n o v e r S e c t i o n 4 ( f ) P r o p e r t y :
F O R M T E X T F O R M C H E C K B O X E I S F O R M C H E C K B O X E A F O R M C H E C K B O X C E I d e n t i f i c a t i o n o f S e c t i o n 4 ( f ) P r o p e r t y ( s ) :
F O R M T E X T B r i e f D e s c r i p t i o n o f P r o j e c t S c o p e :
F O R M T E X T S u m m a r y o f P r o j e c t P u r p o s e a n d N e e d :
F O R M T E X T D e s c r i b e t h e p r o p o s e d u s e o f t h e 4 ( f ) p r o p e r t y :
F O R M T E X T D e M i n i m i s U s e D e t e r m i n a t i o n f o r P u b l i c P a r k s , R e c r e a t i o n A r e a s , W i l d l i f e , a n d / o r W a t e r f o w l R e f u g e s :
F O R M T E X T I s a s a i d p r o p e r t y t y p e b e i n g a n a l y z e d f o r d e m i n i m i s ?
F O R M C H E C K B O X Y e s F O R M C H E C K B O X N o ( i f N o , s k i p t o h i s t o r i c p r o p e r t i e s a n d l e a v e t h i s s e c t i o n b l a n k ) D e s c r i b e t h e e x i s t i n g a c t i v i t i e s , f e a t u r e s , a n d a t t r i b u t e s o f t h e S e c t i o n 4 (f) resource (the no build). In describing the Section 4(f) resource, the following content is expected to be provided.
Attach a detailed map or drawing of sufficient scale to identify the relationship of the alternatives to the Section 4(f) property (include sidewalks and roadway design features, etc.)
Function of or available activities on the property (walking trail, ball playing, etc.)
Access (pedestrian, vehicular) and usage (approximate number of users/visitors, and where they are coming from, etc.).
R e l a t i o n s h i p t o o t h e r s i m i l a r l y u s e d l a n d s i n t h e v i c i n i t y .
P r i m a r y u s e o f t h e p r o p e r t y .
F O R M T E X T D o e s t h e p r o j e c t i n v o l v e a m i n o r t a k e o f l a n d f r o m t h e S e c t i o n 4 ( f ) p r o p e r t y ? F O R M C H E C K B O X Y e s F O R M C H E C K B O X N o I d e n t i f y t h e t o t a l a c r e a g e o f t h e p r o p e r t y : F O R M T E X T I n c l u d e m a p s o r o t h e r e x h i b i t s s u c h a s p h o t o g r a p h s , s k e t c h e s , e t c . i d e n t i f y i n g t h e a f f e c t e d S e c t i o n 4 ( f ) p r o p e r t y . D e s c r i b e t h e u s e o f l a n d f r o m t h e p r o p e r t y ( i d e n t i f y a m o u n t o f t h e p r o p e r t y t o b e u s e d , i n c l u d i n g t e m p o r a r y a n d p e r m a n e n t a c q u i s i t i o n ) :
F O R M T E X T A r e t h e r e a p p l i c a b l e c l a u s e s a f f e c t i n g t h e o w n e r s h i p , s u c h a s l e a s e , e a s e m e n t , c o v e n a n t s , r e s t r i c t i o n s , o r c o n d i t i o n s , i n c l u d i n g f o r f e i t u r e .
I f Y e s , d e s c r i b e .
F O R M T E X T D o e s t h e p r o j e c t a d v e r s e l y a f f e c t t h e q u a l i t i e s , a c t i v i t i e s , f e a t u r e s , o r a t t r i b u t e s o f t h e r e s o u r c e t h a t q u a l i f y i t f o r p r o t e c t i o n u n d e r S e c t i o n 4 ( f ) ? F O R M C H E C K B O X Y e s F O R M C H E C K B O X N o D e s c r i b e t h e a f f e c t t o t h e q u a l i t i e s , a c t i v i t i e s , f e a t u r e s , o r a t t r i b u t e s o f t h e r e s o u r c e t h a t q u a l i f y i t f o r p r o t e c t i o n :
F O R M T E X T D e M i n i m i s D e t e r m i n a t i o n f o r H i s t o r i c P r o p e r t i e s :
I f a n h i s t o r i c p r o p e r t y b e i n g a n a l y z e d f o r d e m i n i m i s ?
F O R M C H E C K B O X Y e s F O R M C H E C K B O X N o ( i f n o , l e a v e t h i s s e c t i o n b l a n k ) C r i t e r i o n f o r E l i g i b i l i t y : F O R M C H E C K B O X a F O R M C H E C K B O X b F O R M C H E C K B O X c F O R M C H E C K B O X d E f f e c t D e t e r m i n a t i o n : F O R M T E X T D e s c r i b e t h e e x i s t i n g a c t i v i t i e s , f e a t u r e s , a n d a t t r i b u t e s o f t h e S e c t i o n 4 ( f ) r e s o u r c e ( t h e n o b u i l d ) . A t t a c h a d e t a i l e d m a p o r d r a w i n g o f s u f f i c i e n t s c a l e t o i d e n t i f y t h e r e l a t i o n s h i p o f t h e a l t e r n a t i v e s t o t h e h i s t o r i c S e c t i o n 4 ( f ) p r o p e r t y . F O R M T E X T A l t e r n a t i v e s A n a l y s i s A f t e r c o m p a r i n g t h e m a g n i t u d e o f i m p a c t s , e x p l a i n w h y i t i s s e n s i b l e t o u s e t h e S e c t i o n 4 ( f ) p r o p e r t y ( i n d i c a t e t h o s e t h a t a p p l y a n d d e s c r i b e a s a p p r o p r i a t e ) : F O R M C H E C K B O X I m p a c t s t o o t h e r e n v i r o n m e n t a l / c u l t u r a l / s o c i a l r e s o u r c e s w o u l d o c c u r .
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E x p l a i n : F O R M T E X T F O R M C H E C K B O X O t h e r .
E x p l a i n : F O R M T E X T S u m m a r i z e t h e m e a s u r e s t a k e n t o m i n i m i z e h a r m . T h i s w o u l d i n c l u d e , i f a p p l i c a b l e , d e s i g n s h i f t s t o m i n i m i z e i m p a c t s , u s e o f r e t a i n i n g w a l l s , a n d o t h e r m i t i g a t i o n m e a s u r e s .
F O R M T E X T S u m m a r i z e t h e i m p a c t s t o o t h e r r e s o u r c e s t h a t w o u l d o c c u r i f t h e u s e o f t h e p u b l i c p a r k , r e c r e a t i o n a r e a , w i l d l i f e o r w a t e r f o w l r e f u g e , o r h i s t o r i c s i t e w a s a v o i d e d . O t h e r r e s o u r c e s i n c l u d e t h e f o l l o w i n g :
1 ) r e s i d e n t i a l a n d n e i g h b o r h o o d c h a r a c t e r a n d l o c a t i o n , 2 ) c o n s e r v a t i o n i n c l u d i n g a i r , e r o s i o n , s e d i m e n t a t i o n , w i l d l i f e , a n d g e n e r a l e c o l o g y o f a r e a , 3 ) n o i s e , a n d a i r a n d w a t e r p o l l u t i o n , 4 ) m u l t i p l e u s e o f s p a c e , 5 ) r e p l a c e m e n t h o u s i n g , 6 ) d i s p l a c e m e n t o f f a m i l i e s a n d b u s i n e s s , 7 ) a e s t h e t i c s , 8 ) p u b l i c h e a l t h a n d s a f e t y , 9 ) f a s t , s a f e , a n d e f f i c i e n t t r a n s p o r t a t i o n , 1 0 ) c i v i l d e f e n s e s , 1 1 ) e c o n o m i c a c t i v i t y , 1 2 ) e m p l o y m e n t , 1 3 ) f i r e p r o t e c t i o n , 1 4 ) p u b l i c u t i l i t i e s , 1 5 ) r e l i g i o u s i n s t i t u t i o n s , 1 6 ) c o n d u c t a n d f i n a n c i n g o f g o v e r n m e n t , i n c l u d i n g t h e e f f e c t o n t h e l o c a l t a x b a s e a n d s o c i a l s e r v i c e c o s t s , 1 7 ) p r o p e r t y v a l u e s , 1 8 ) e d u c a t i o n , i n c l u d i n g t h e d i s r u p t i o n o f s c h o o l d i s t r i c t o p e r a t i o n s , 1 9 ) e n g i n e e r i n g , r i g h t - o f - w a y , a n d c o n s t r u c t i o n c o s t s o f t h e p r o j e c t a n d r e l a t e d f a c i l i t i e s , 2 0 ) m a i n t e n a n c e a n d o p e r a t i n g c o s t s o f t h e p r o j e c t a n d r e l a t e d f a c i l i t i e s , a n d 2 1 ) o p e r a t i o n a n d u s e o f e x i s t i n g t r a n s p o r t a t i o n r o u t e s a n d p r o g r a m s d u r i n g c o n s t r u c t i o n a n d a f t e r c o m p l e t i o n .
F O R M T E X T H a s t h e o f f i c i a l w i t h j u r i s d i c t i o n o v e r t h e p r o p e r t y c o n c u r r e d i n w r i t i n g w i t h t h e F H W A s a n d / o r N D O R d e t e r m i n a t i o n t h a t t h e p r o j e c t w i l l n o t a d v e r s e l y a f f e c t t h e p r o p e r t y ?
I f Y e s , i d e n t i f y t h e o f f i c i a l w i t h j u r i s d i c t i o n a n d d a t e o f c o n c u r r e n c e a n d a t t a c h w r i t t e n c o n c u r r e n c e : F O R M T E X T F O R M C H E C K B O X Y e s F O R M C H E C K B O X N o H a s t h e o f f i c i a l w i t h j u r i s d i c t i o n o v e r t h e p r o p e r t y b e e n i n f o r m e d o f F H W A s a n d / o r N D O R s i n t e n t t o m a k e a d e m i n i m i s u s e f i n d i n g ?
I f Y e s , a t t a c h c o r r e s p o n d e n c e . F O R M T E X T F O R M C H E C K B O X Y e s F O R M C H E C K B O X N o H a s t h e p u b l i c b e e n a f f o r d e d a n o p p o r t u n i t y t o r e v i e w a n d c o m m e n t o n t h e e f f e c t s o f t h e p r o j e c t o n t h e p r o t e c t e d a c t i v i t i e s , f e a t u r e s , a n d a t t r i b u t e s o f t h e S e c t i o n 4 ( f ) r e s o u r c e ?
I d e n t i f y o p p o r t u n i t y f o r p u b l i c c o m m e n t : F O R M T E X T F O R M C H E C K B O X Y e s F O R M C H E C K B O X N o
F O R M C H E C K B O X N / A
S u m m a r y a n d D e t e r m i n a t i o n T h e p r o j e c t i n v o l v e s a d e m i n i m i s u s e o n t h e S e c t i o n 4 ( f ) p r o p e r t y a s e v i d e n c e d t h r o u g h t h e m i n i m i z a t i o n o f h a r m t o a p a r k , r e c r e a t i o n l a n d , o r w i l d l i f e a n d w a t e r f o w l r e f u g e a s a r e s u l t o f m i t i g a t i o n t o o r a v o i d a n c e o f i m p a c t s t o t h e q u a l i f y i n g c h a r a c t e r i s t i c s a n d / o r t h e f u n c t i o n s o f t h e r e s o u r c e . B a s e d o n t h e s c o p e o f t h e u n d e r t a k i n g ; t h e f a c t t h a t t h e u n d e r t a k i n g d o e s n o t a d v e r s e l y a f f e c t t h e f u n c t i o n / q u a l i t i e s o f t h e S e c t i o n 4 ( f ) p r o p e r t y o n a p e r m a n e n t o r t e m p o r a r y b a s i s ; a n d w i t h a g r e e m e n t f r o m t h e o f f i c i a l w i t h j u r i s d i c t i o n , t h e p r o p o s e d a c t i o n c o n s t i t u t e s a d e m i n i m i s u s e a n d t h e a l t e r n a t i v e s a n a l y s i s i s c o n s i d e r e d s a t i s f i e d . N a m e a n d O r g a n i z a t i o n o f P r e p a r e r : D a t e : N D O R E n v i r o n m e n t a l M a n a g e r : D a t e : F H W A : D a t e : P l e a s e e n t e r a n y a d d i t i o n a l i n f o r m a t i o n i n t h e f o l l o w i n g a r e a :
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