———— SENECA NATION ————
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ALLEGANY TERRITORY
90 OHI:YO’ WAY
SALAMANCA, NY 14779
(716) 945-1790
———— SENECA NATION ————
CATTARAUGUS TERRITORY
12837 ROUTE 438
IRVING, NY 14081
(716) 532-4900
ENVIRONMENTAL PROTECTION DEPARTMENT
Environmental Impact Assessment Form
To Be Completed by Applicant or Designee
Purpose: The Environmental Impact Assessment procedure is designed to help applicants and the
Nation determine whether the impact a project creates may be significant. It is our duty to protect our
Earth so that successive generations will continue to receive sustenance from her in the same way we
have. This procedure encourages this commitment and concern about how our actions today impact
upon the future of our world environment. Often this impact is subjective or immeasurable. However,
this procedure is intended to provide a method that identifies a range of possible impacts to be
addressed.
Instructions: Complete the form and return to the Environmental Protection Department at
epd@sni.org. Please also send any relevant project plans and/or maps and diagrams.
Project & Applicant Information
Applicant Name, Title, &
Agency
Applicant/Agency Address &
Phone:
1. Project Location:
Seneca Nation Territory:
Precise location (address, nearest
intersection, landmarks, etc.) Please
include map if available:
2. Is proposed project:
New
Expansion
Modification
3. Check any of the following which apply:
The project is maintenance or repair involving no substantial changed to an existing
structure or facility
The project is the replacement of a facility in-kind on the same site
The project is the repair or construction of a minor necessary structure, such as
sheds or fencing, not changing land use
The project is maintenance of existing landscaping or natural growth
The project involves information and data collection, surveys, or other studies
4. Describe the project briefly:
5. Physical Dimensions and Scale of Project
Total contiguous acreage owned or controlled by project sponsor:
Project acreage to be developed:
Initially:
Ultimately:
Project acreage to remain undeveloped:
Length of project, in miles:
If the project is an expansion, indicate the percent of expansion proposed:
Number of off-street parking spaces:
Existing:
Proposed:
Maximum vehicular trips generated per hour, upon completion:
If residential, number and type of housing
One Family:
units, initially/proposed:
Dimensions of the largest purposed structure (length, width, height):
Linear feet of frontage along a public thoroughfare:
Multi Family:
6. If the project is a single-phase project, what is the anticipated period of construction?
7. If the project is a multi-phased project:
Total number of anticipated phases
Anticipated date of commencement of phase
one
Approximate date of completion of final phase
Is phase one functionally dependent on
subsequent phases?
8. Number of jobs:
Generated during project:
Generated upon completion of project:
Eliminated by proposed project:
9. Will the project require the relocation of any existing projects or facilities?
YES
NO
If yes, please explain:
10. Will blasting occur during construction?
YES
NO
Project Permit Information
1. Amount of land affected by project, in acres:
Initially:
Ultimately:
2. What is the present land use in the vicinity of the project?
Residential
Industrial
Commercial
Agricultural
Park/Forest/Open Space
Other (please describe):
3. Does any aspect of this project currently have a valid permit or approval?
YES
NO
If yes, list department or agency, type of permit, and date of issuance:
4. Will this project require any modification of any existing valid permit?
YES
NO
If yes, please explain:
5. Was there a public comment period or other community review?
YES
NO
6. Is the site/area served by existing public utilities?
YES
NO
If yes, does sufficient capacity exist to allow connections?
YES
NO
Will improvements be necessary to allow connections?
YES
NO
7. Has the site ever been used for the disposal of solid or hazardous waste?
YES
NO
If yes, please explain:
8. Is the project within a non-attainment area for criteria pollutants such as ozone, VOCs, a
Prevention of Significant Deterioration area, or either a 10-mile radius designated Class 1
(Pristine) area?
YES
If yes, please explain:
NO
9. Could this project result in any adverse effects associated with the following areas of concern?
Existing air quality, surface or
groundwater quality or quantity, noise
levels, existing traffic pattern, solid waste
production or disposal, potential for
erosion, drainage or flooding problems,
or any other ground disturbing activity
Aesthetic, agricultural, archaeological,
historic or other natural or cultural
resources, or community or
neighborhood character
Vegetation or fauna, fish or wildlife
species or their habitat
YES
NO
If Yes, please explain:
Existing plans or surrounding community
balance or a change in community use of
land or other natural resources
Growth or subsequent development
induced by the proposed action
Other short term, long term, or
cumulative effects
Changes in use of quantity or type of
energy
10. Is there, or is there likely to be, controversy related to potential adverse environmental impacts
which prohibits or infringes on other individuals’ way of life?
Project Environmental Impact Information
1.
What is the total acreage of the project area?
2. What is the approximate breakdown of acreage, by percentage?
Current
Proposed
Meadow or Brush land, nonagricultural
Forested
Agricultural (orchards, croplands,
pastures, etc.)
Wetland
Water Surface Area
Unvegetated (rock, earth, fill)
Buildings, roads, or other paved
surfaces
Other:
3. Predominant soil type in project area:
a. Soil Drainage type, by percentage:
Well Drained:
Moderately Drained:
Poorly Drained:
b. If agricultural land, how many acres of soil are classified as Prime Farmland or hydric
soils, per USDA soil survey:
4. Are there bedrock outcroppings within project area?
YES
NO
If yes, what is the depth to bedrock, in feet?
5. Are there any unique or unusual land forms (cliffs, geological formations, etc.) within project
area?
YES
If yes, please explain:
NO
6. Approximate percentage of proposed project area with slopes:
0-10%
11-15%
16% or greater
7. What is the depth of the water table, in feet?
8. Is the project area located over a primary, principle, or sole source aquifer?
YES
NO
9. Are there streams within or contiguous with the project area?
YES
NO
Name of stream:
River, which stream is a tributary to:
10. Are there lakes, ponds, or wetland areas within or contiguous to the project area?
YES
NO
If yes, what is the size of the lake, pond, or wetland, in acres?
11. Does the project area contain any species of plant or animal that is identified as threatened or
endangered?
YES
NO
Which species is/are threatened or endangered?
Which agency lists the species as threatened or endangered?
12. Does hunting, fishing, or plant gathering occur within the project area?
YES
NO
13. Does the project area include natural or cultural sites known to be important to the community?
YES
NO
14. Is the project area substantially contiguous to, or contain any building, site, or district which is
listed on the Tribal or National registers of historic places?
YES
NO
15. Is the project area currently used by the community as an open space or recreation area?
YES
NO
If yes, please explain:
16. Material Removal:
How much natural material (rock, earth, etc.) will be removed from the
project area?
How many acres of vegetation (trees, shrubs, ground cover, etc.) will
be removed from site?
Will any mature forest (over 100 years old) or other locallyimportant plant life be removed from this site?
17. Will disturbed areas be reclaimed?
YES
NO
If yes, what is the intended purpose of reclaimed
materials:
Will topsoil be stockpiled for reclamation?
Will upper subsoil be stockpiled for reclamation?
How much fill material will be added to the site?
18. Is surface liquid waste disposal involved?
YES
NO
If yes, indicate type of waste (sewage, industrial, etc.) and
amount:
Name of water body into which effluent will be discharged:
How will stormwater runoff be managed:
19. Is subsurface liquid waste disposal involved?
YES
NO
YES
NO
20. Will the project generate solid waste?
YES
NO
If yes,
How much solid waste will be generated per
month?
Will any waste NOT go into a sewage disposal
system or into a sanitary landfill?
Where will this waste be disposed of?
What is the anticipate rate of disposal?
What is the anticipated site life of this waste?
21. Will the project generate any hazardous waste or involve storage/use of hazardous material?
YES
NO
If yes,
What waste product or material?
How much will be generated?
How will it be stored?
How will it be disposed of?
22. Will surface area of existing water bodies increase or decrease due to project?
YES
NO
If yes, please explain:
23. Is the project area or any portion of the project area located within a 100-year flood plain?
YES
NO
24. Water Use
What is the total anticipated water use, in gallons per day?
If water supply is from a well, indicate pumping capacity, in gallons per minute:
25. Will the project require the use of herbicides or pesticides?
YES
NO
26. Is open burning anticipated during or after completion of the project?
YES
NO
If yes, please explain:
27. Will the project result in air pollution emissions?
YES
NO
If yes, please explain:
28. Will the project routinely produce odors (more than one hour per day)?
YES
NO
29. How will fugitive dust created during the project be controlled?
30. Will the project produce operating noise exceeding the local ambient noise level?
YES
NO
31. Will the project result in an increase in energy use?
YES
NO
If yes, indicate type:
32. Does the project involve local, state, federal, or tribal funding?
YES
If yes, please explain:
NO
Applicant Acknowledgement: The above provided information is correct to the best of my knowledge. I
understand that the Seneca Nation of Indians and their associated departments may request more
information or provide approval with contingent requirements.
Signature:
Print Name and Title:
Date:
This is a copy of a public record, reproduced as it was published. It is not legal advice, and it may not be the version a court would rely on. Check the official source before you cite it.