EXHIBIT IV-I

ENVIRONMENTAL ASSESSMENT CHECKLIST

Requires Modification

Needs Mitigation

Potentially Adverse Requires

More Study

Potentially Beneficial

No Impact Anticipated

IMPACT CATEGORIES

Potentially Adverse Requires

Documentation

Project Name & Identification No.:

SOURCE OF DOCUMENTATION
(Note date of contact or page reference).
Additional material may be attached.

Land Development
Conformance with
Comprehensive Plans &
Zoning
Compatibility & Urban
Impact
Slope
Erosion
Soil Suitability
Hazards & Nuisances,
Including Site Safety
(See Exhibit IV-J-2)
Energy Consumption

Noise
Effects of Ambient Noise
on Project &
Contribution to
Community Noise Levels
(See Exhibit IV-J-3)

IV-I-1
(Revised 4/01)

EXHIBIT IV-I, Cont.

ENVIRONMENTAL ASSESSMENT CHECKLIST

Requires Modification

Needs Mitigation

Potentially Adverse Requires

More Study

Potentially Beneficial

No Impact Anticipated

IMPACT CATEGORIES

Potentially Adverse Requires

Documentation

Project Name & Identification No.:

SOURCE OF DOCUMENTATION
(Note date of contact or page reference).
Additional material may be attached.

Air Quality
Effects of Ambient Air
Quality on Project &
Contribution to
Community Pollution
(See Exhibit IV-C-5)
Environmental Design & Historic Values
Visual QualityCoherence, Diversity,
Compatible Use, &
Scale
Historical, Cultural, &
Archaeological
Resources
(See Exhibit IV-C-1)
Socioeconomic
Demographic /
Character Changes
Displacement
Employment & Income
Patterns
Community Facilities & Services
Educational Facilities
Commercial Facilities
Health Care
Social Services

IV-I-2
(Revised 4/01)

EXHIBIT IV-I, Cont.

ENVIRONMENTAL ASSESSMENT CHECKLIST

Requires Modification

Needs Mitigation

Potentially Adverse Requires

More Study

Potentially Beneficial

No Impact Anticipated

IMPACT CATEGORIES

Potentially Adverse Requires

Documentation

Project Name & Identification No.:

SOURCE OF DOCUMENTATION
(Note date of contact or page reference).
Additional material may be attached.

Community Facilities & Services (Continued)

Solid Waste
Waste Water
Storm Water
Water Supply
Public Safety - Police

Public Safety - Fire

Public Safety Emergency Medical
Open Space
Recreation
Cultural Facilities
Transportation

IV-I-3
(Revised 4/01)

EXHIBIT IV-I, Cont.

ENVIRONMENTAL ASSESSMENT CHECKLIST

Requires Modification

Needs Mitigation

Potentially Adverse Requires

More Study

Potentially Beneficial

No Impact Anticipated

IMPACT CATEGORIES

Potentially Adverse Requires

Documentation

Project Name & Identification No.:

SOURCE OF DOCUMENTATION
(Note date of contact or page reference).
Additional material may be attached.

Natural Resources
Water Resources
Surface Water
Floodplain
(See Exhibit IV-C-2)
Wetlands
(See Exhibit IV-C-2)
Unique Natural
Features & Agricultural
Lands
(Exhibit IV-C-6)
Vegetation & Wildlife
(See Exhibit IV-C-4)
Environmental Justice

IV-I-4
(Revised 4/01)

EXHIBIT IV-I, Cont.

ENVIRONMENTAL ASSESSMENT CHECKLIST
Continued - Page 5

Summary of Findings and Conclusions:

Summary of Environmental Conditions:

Project Modifications and Alternatives Considered:

IV-I-5
(Revised 4/01)

EXHIBIT IV-I, Cont.

ENVIRONMENTAL ASSESSMENT CHECKLIST
Continued - Page 6

Additional Studies Performed (Attach Study or Summary):

Mitigation Measures Needed:

1.

Is the project in compliance with applicable laws and regulations?

2.

A Finding of No Significant Impact can be made. Project will not significantly affect the quality of the
human environment.
Yes
No

3.

Is an EIS required?

Yes

Yes

No

No

________________________________________
Prepared by

_________________________________________________
Certifying Official: (Include Title)

_______________________
Date

IV-I-6
(Revised 4/01)