ENVIRONMENTAL ASSESSMENT FORM (E.A. FORM) INSTRUCTIONS

Transcription

1 COMMONWEALTH OF PENNSYLVANIA DEPARTMENT OF ENVIRONMENTAL PROTECTION BUREAU OF WATERWAYS ENGINEERING AND WETLANDS ENVIRONMENTAL ASSESSMENT FORM (E.A. FORM) INSTRUCTIONS For more information, please visit DEP's website at

2 If you are seeking a Water Obstruction and Encroachment Permit to "build in" reservoirs, lakes, ponds, swamps, wetlands, marshes, bogs, floodways, waterways, or open waters in Pennsylvania, an Environmental Assessment must be approved by the DEP as part of the permit review process. The Environmental Assessment (E.A.) is a necessary part of a complete Chapter 105 Dam Safety and/or Water Obstruction and Encroachment (105 WO&E) Permit application. If you are completing the E.A. as part of a permit application, several maps, plans and other information requested herein may already be included as part of the overall application package and therefore do not have to be duplicated. In these instances, please reference where in the application package the information is provided on the E.A. form and any additional responses provided. However, these documents must be included with the Environmental Assessment if a permit is not required. IN THE FOLLOWING CIRCUMSTANCES, A CHAPTER 105 PERMIT IS NOT NECESSARY; HOWEVER, AN APPROVED ENVIRONMENTAL ASSESSMENT IS REQUIRED: (a)(11) - Waiver No. 11 removal of abandoned dams, water obstructions and encroachments (a)(16) - Waiver No. 16 restoration activities associated with an approved DEP Restoration Plan (b) - For structures or activities where water quality certification is required under Section 401 of the Clean Water Act (33 U.S. CA. 1341). These activities include but are not limited to Federal Nationwide Permits (NWP) and other regulated activities under Section 404 of the Clean Water Act and Section 10 of the River and Harbors Act of (a)(2) and (3) - Non-jurisdictional dams that are located in wetlands or an exceptional value water as defined in Chapter 93. The fee required for a project authorized under these permit waivers (when a Chapter 105 permit is not necessary) shall be consistent with 25 PA Code (relating to regulated activities information and fees). See (c)(2)(iv) for additional information. The Environmental Assessment is not necessary when registering the use of a General Permit. However, when applying for a 105 WO&E permit that includes project impacts that are otherwise eligible for use of a General Permit or qualify under waiver of permit requirements under (a), the structures, activities, resources and potential impacts shall be included in the E.A. Form responses. For further information regarding E.A. s, please contact the Waterways and Wetland Program in the appropriate DEP Regional Offices listed on Appendix II. Except as provided for below related to small project applications, applicants are reminded that the Chapter 105 E.A. Form will not be considered complete unless the form is filled out in its entirety, all questions answered, responses and supporting information provided in the application. THE E.A. INFORMATION SHOULD BE PRESENTED IN THE PERMIT APPLICATION USING THE OUTLINE FORMAT AND ORGANIZATIONAL IDENTIFIERS (MODULES, SECTIONS AND SUBSECTIONS) PROVIDED IN THE E.A. FORM AND E.A. INSTRUCTIONS

3 Small Project Application Submissions: The following applies to small project applications unless, if upon review, the Department determines that more information is required to determine whether a small project will have an insignificant impact on safety and protection of life, health, property or the environment, the Department may require the applicant to submit additional information and processing fees required under this chapter. A project that directly or indirectly affects wetlands is not eligible as a small project application, a standard permit application including completion of the entire E.A. Form must be submitted to the Department. APPLICATIONS FOR SMALL PROJECTS SHALL INCLUDE THE FOLLOWING INFORMATION FROM THE E.A. FORM: Module S1 - All information requested; and Module S2* - A, B, C; and Module S3*- A, B, C; and Module S4* - None. *As previously described, portions of the following Modules and Sections: S2.D; S3.D, E, F, G, H; S4.A, B, C and D may apply if deemed necessary for review of the application on a case by case basis. The information presented in the permit application should follow and be presented utilizing the outline format and organizational identifiers (module, section and subsections) provided in the E.A. Form and E.A.. DEP has developed a standardized review process and processing times for all permits or other authorizations that it issues or grants. Pursuant to its Permit Review Process and Permit Decision Guarantee Policy ( ), DEP guarantees to provide permit decisions within the published time frames, provided applicants submit complete, technically adequate applications/registrations that address all applicable regulatory and statutory requirements, in the first submission. Note: Failure to utilize the Module, Section and subsection identifiers may result in delays during the Completeness Review

4 MODULE S1: PROJECT SUMMARY This module is intended to present an overall summary of the project scope, certain key information requirements and when applicable, a comprehensive view of the overall project and related projects. These regulatory requirements and Department policies including, but not limited to, the following are applicable to this Module: Comprehensive Environmental Assessment of Proposed Project Impacts for Chapter 105 Water Obstruction and Encroachment Permit Applications (CEA Policy: Document No ); (e)(1)(iii); (e)(1)(x); (f)(4); a(a)(6); and a(b)(6). Project Description: Provide an overall project description that includes, but is not limited to, the items outlined below: 1. If the "overall" project a) requires more than one Ch. 105 permit in more than one county OR b) will be completed in more than one phase, address items S1.A.1.i iv, below; otherwise, proceed to S1.B below. i. Provide the project "Comprehensive Environmental Assessment" as described in the CEA Policy for large multi-county or multi-phase projects. i. Describe the nature and extent of the "overall" project and anticipated timeline(s) of construction. ii. Provide a list of all other additional Chapter 105 application(s) or registration(s) associated with the "overall" project that have been submitted to the Department or Chapter 105 delegated Conservation District. iii. Provide a summary table of the "overall" project's known impacts and those anticipated to occur in the future based on (ii) and (iii) above. Additional Information: Provide the information requested in the items below: 1. A detailed discussion of the project purpose and need. Applicants should reflect back to the discussion of project purpose and need as part of the alternatives analysis provided in Module S3.F below. Any supporting information that pertains to the project purpose or establishing the need for the project that facilitates the alternatives analysis should be included in this section. If an applicant anticipates the project may have an adverse effect to Exceptional Value (EV) wetlands or a significant adverse effect to Other wetlands, as described under a; the applicant should anticipate the need to address a(c) regarding the demonstration that the project is necessary to abate a substantial threat to the public health or safety and that the requirements of subsection a(b)(2) - (7) are met. 2. A statement of water dependency describing the need to be within or in close proximity to water or requires access or proximity to or siting within a wetland to fulfill the basic purposes of the project. 3. Provide a summary table of the amount and types of resources present on the project site from Module S2.B associated with the application 4. Provide a summary table of the proposed project permanent and temporary direct and indirect impacts from Module S3.A associated with the application - 3 -

5 MODULE S2: RESOURCE IDENTIFICATION AND CHARACTERIZATION This module is intended to organize information related to the identification of the resources present on the project site and to characterize those resources that may be affected by the proposed project. These regulatory requirements and Department policies including, but not limited to, the following are applicable to this Module: (e)(1)(i)(A); (e)(1)(ii); (e)(1)(iii); (e)(1)(x); (e)(2); (e)(3); (f)(4)(i); (f)(4)(iii); ; Policy for Pennsylvania Natural Diversity Inventory (PNDI) Coordination During Permit Review and Evaluation (PNDI Policy: Document No ) Standard Resource Identification Information: 1. Provide the following information for the organization(s) and person(s) performing aquatic resource identification, determination, delineation and related field work: Organization name(s), mailing addresses, first and last name of person(s), address, portions of work completed and qualifications. 2. If wetlands are not present at the site, attach a copy of the wetland determination report. Include all field data sheets, photos, sample locations, etc. that support this determination. If this information details any physical information or features not shown in the site plan, please attach additional plans which illustrate these features. Or If wetlands are present at the site, attach a copy of the wetland delineation report. Include all field data sheets, photos, sample locations, etc. and denote the size (in acres) of the wetland within project area of interest and estimated size of any areas extending outside project area. Include a brief narrative of the delineation process used and copies of any supporting materials used such as hydric soil maps, wetland maps, aerial imagery, etc. If this information details any physical information or features not shown in the site plan, please attach additional plans which illustrate these features. 3. If watercourses are present at the site, attach a copy of any report related to determining if a feature is a watercourse and the hydrologic flow status (e.g. intermittent or perennial). Include all field data sheets, photos, sample locations, etc. and denote the channel, floodway and floodplain dimensions of the watercourse in cross-section view. Include a brief narrative of the determination process used and copies of any supporting materials or cross reference to other application sections. If this information details any physical features not shown in the site plan, please attach additional plans which illustrate them. 4. If not already included in the permit application package, attach a location map or plan (e.g. 1:2400 scale or greater) that must show the location of the project, all natural features including the names and boundaries of regulated waters of this Commonwealth, natural areas, wildlife sanctuaries, natural landmarks, political boundaries, locations of public water supplies and other geographical or physical features including cultural, archeological and historical landmarks within 1 mile of the site. The features identified in S2.A.5 and all water resources identified in S2.B below shall be included

6 5. Is the site located within or adjacent to any of the following; or within 100 feet of items vii or viii? Be sure to mark either YES or NO in each column on the E.A. Form. i. National, state or local park, forest or recreation area? ii. National natural landmark? iii. National wildlife refuge, or Federal, state, local or private wildlife or plant sanctuaries? iv. State Game Lands? v. Areas identified as prime farmland? vi. Source for a public water supply? vii. A National Wild or Scenic River or the Commonwealth s Scenic Rivers System? viii. Designated Federal wilderness area? The following resources are suggested to assist in answering the above questions: U.S.G.S. quadrangle maps contain valuable information, such as wild, natural, or wilderness areas, and National wildlife refuges and sanctuaries. A current PA Recreation Guide Map locating state parks, state forests and state game lands is available from DCNR by calling PA-PARKS or from state-owned recreation areas in Pennsylvania. Prime farm land information is available from the County Conservation District Office. Contact the Bureau of Safe Drinking Water in the appropriate DEP Regional Office for information on public water supplies. A list of DEP Regional Offices can be found in Appendix II of this section. For information on waterways designated as Wild or Scenic under the Pennsylvania Scenic Rivers Act and National Wild or Scenic River corridors: Pennsylvania Scenic Rivers If your project area appears to be in a Pennsylvania scenic river corridor, contact the DCNR, Bureau of Recreation and Conservation, Partnerships Division, Scenic Rivers Program, 400 Market Street, 5 th Floor, Harrisburg, PA 17101, phone for confirmation. National Wild or Scenic Rivers If your project appears to be in a National Wild or Scenic River, contact one of the following: U.S. Forest Service Allegheny National Forest 4 Farm Colony Drive Warren, PA U.S. National Park Service NPS Wild & Scenic Rivers 200 Chestnut Street Philadelphia, PA

7 Identify all aquatic resources present that may be affected on the project site: Provide the following information when applicable: 1. Project specific unique resource identifier (e.g. W### for wetlands, R### for watercourses and L### for ponds, reservoirs, etc.) 2. Resource type: watercourse-channel (riverine), watercourse-floodway, watercourse-floodplain only, wetland or other body of water (lacustrine). For a desk analysis of the water resources which exist on the project site, refer to the United States Geological Service quadrangle maps for the project area. These maps are available for reference at the local delegated Conservation District office. Refer to the telephone directory under the County for the Conservation District. Also, these maps may be purchased from one of the retail establishments listed on the internet at and may be accessed electronically at Floodway and Floodplain information is available from the Department of Community and Economic Development, Governor s Center for Local Government Services, Keystone Building, 400 North Street, Harrisburg, PA 17120, Federal Emergency Management Agency (FEMA) maps are often available for reference at county and municipal planning offices and may be accessed electronically at or The Soil Survey for your county along with the list of hydric soils for the county are helpful office references regarding wetlands. These resources are available at the website or the Web Soil Survey website or from the Conservation District. Refer to telephone directory under the County for the Conservation District. When identifying and delineating wetlands on site, the 1987 Corps Wetland Delineation Manual, the appropriate Regional Supplements to the Corps of Engineers Wetland Delineation Manual for use in Pennsylvania and the current National Wetland Plan List for Pennsylvania Regions are essential. They may be obtained by contacting: The National Wetland Plant List U.S. Army Corps of Engineers National Wetland Plant List, version U.S. Army Corps of Engineers Engineer Research and Development Center Cold Regions Research and Engineering Laboratory, Hanover, NH The 1987 Corps Wetland Delineation Manual The US Army Corps of Engineers 3. Size of the existing resource: channel length and average width in feet; size of the watercourse floodway, floodplain, wetland or other body of water in acres (to the nearest 0.01 acre)

8 4. List any fishery designations; information on stocked waters and wild trout streams may be obtained from the Pennsylvania Fish and Boat Commission, contact the Bureau of Fisheries, Division of Fisheries Management 450 Robinson Lane, Bellefonte, PA , phone List the Title 25 Pa. Code Chapter 93 Existing or Designated use(s) of the watercourse(s) (e.g. CWF, WWF, etc.) or the Title 25 Pa. Code Chapter 105 wetland classification (e.g. O - Other or EV - Exceptional Value). Provide the analysis of whether any wetlands present are EV (related to ), when applicable. List the Special Protection water uses (e.g. High Quality - HQ or EV) of the watercourse(s) as provided for in Title 25 Pa. Code Chapter 93 whether Existing or Designated use(s). Additional information on HQ and EV waters and 25 Pa. Code Chapter 93 respectively can be found on the internet at: px; and 25 Pa. Code Chapter 93 also provides an important linkage to Exceptional Value Wetlands which are determined in 25 Pa. Code Chapter found at: Habitat for Federal threatened and endangered (T&E) plant and animal species or State T&E species or species of special concern: Coordination with the Pennsylvania Natural Heritage Program (PNHP) regarding the presence of Federal threatened and endangered (T&E) species and State T&E or species of special concern on the project site is a 25 Pa Code Chapter 105 regulatory requirement. Early coordination (prior to submission) with the appropriate jurisdictional agencies using the PA Conservation Explorer, previously known as the Pennsylvania Natural Diversity Inventory (PNDI) Environmental Review Tool (PNDI ER Tool), is the most effective means of timely permit decisions. The PA Conservation Explorer can be accessed at the website. First time users must register at the website before conducting the review. Upon completion of the review, a PNDI Receipt, valid for a period of two years from the date the search was conducted, is automatically available for printing. To provide proof of coordination with PNHP and PNDI, applicants must submit a PNDI Receipt as part of the permit application/registration. PNDI reviews can still be obtained free-of-charge for users without access to a computer using the standard process of requesting a project review directly from each jurisdictional agency PA Department of Conservation and Natural Resources (DCNR), PA Game Commission (PGC), PA Fish and Boat Commission (PFBC) and the U.S. Fish and Wildlife Service (US FWS) instead of generating a PNDI Receipt instantly through the PA Conservation Explorer. The standard PNDI review process user is responsible for securing PNDI Receipts from each jurisdictional agency DCNR, PGC, PFBC and the U.S. FWS. PNDI Receipts from each jurisdictional agency shall be included with the application/registration package. The PNDI review is not complete or satisfied unless PNDI Receipts are included from all four jurisdictional agencies listed above. Applicants are encouraged to use the PA Conservation Explorer use of this tool is the most effective means of a timely permit decision

9 1. Provide the completed Search form or Copy of PNDI search receipt(s) as part of the E.A. responses. 2. Did the PNDI search or agency coordination identify any potential conflicts? If answered YES, provide responses to the following: i. Answer the following questions related to the PNDI Policy: a. Is the applicant utilizing a sequential review of the PNDI coordination? b. Is the applicant utilizing a concurrent review of the PNDI coordination? ii. Provide unique resource identifier used in S2.B above when potential conflict is associated with an identified resource. iii. Provide the following in addition to the completed Final Search form or Copy of Final PNDI search receipt(s) as part of the E.A. responses: a. Provide evidence as part of E.A. responses that potential conflicts have been resolved, include any written recommendations provided by an appropriate resource agency(s) or reference location in application if not. b. List and cross reference any design changes or avoidance measures incorporated into design plans, construction notes, erosion and sediment control plans, narrative project description, etc. c. Any avoidance measures agreed to by the applicant that requires their signature on the PNDI Final Form, shall be signed by the applicant and not an agent on their behalf. iv. Discuss and cross reference (e.g., agency correspondence, section/page number in the Mitigation Plan) any avoidance and minimization efforts taken to resolve the potential conflict(s). Characterize all aquatic resources present that may be affected by the project: Where applicable, provide information regarding the resources that are proposed to be directly or indirectly affected by the project. If more than one resource is assessed, provide a table of the summary results including items i-iii. Include the following information and any other available relevant information: 1. Riverine Resources - Provide the following information for each riverine resource listed in S2.B above, when more than one resource is assessed, provide a table of the summary results including items i-iv: i. Unique resource identifier used in S2.B above. ii. Provide Slope Category and Watershed Size using the tables provided below. Additional information can be found in the PA Aquatic Communities Classification manual at: Gradient Class (GC) Slope Number Description 1 Low Gradient 0.5% 2 Moderate Gradient > % 3 High Gradient >2.0% - 8 -

10 Number Watershed Size (WS) Description Drainage Area 1 Headwater >0 2 mi 2 2 Small Stream >2 10 mi 2 3 Mid-reach Stream > mi 2 4 Large Stream/River >100 mi 2 iii. Summary of the results from the PA Riverine Condition Level 2 Rapid Assessment Protocol Document Number Copies of the assessment area mapping, data sheets, notes, photos and supporting information must be provided. iv. Discuss the riverine resource type(s) and condition(s) as they relate to the inherent functions including, but not limited to, those associated with hydrologic, biogeochemical and habitat attributes. Include any recreational uses when applicable. v. Describe the adjoining upstream and downstream riparian property (See S3.D.4 to assist in description purpose). 2. Wetland Resources - Provide the following information for each wetland resource listed in S2.B above, when more than one resource is assessed, provide a table of the summary results including items i-v: i. Unique resource identifier used in S2.B above. ii. Hydrogeomorphic (HGM) classification of wetlands; classification key available at: PA_HGM_Key_1.0. iii. Cowardin vegetation class(s) (e.g. Palustrine Emergent - PEM, Palustrine Scrub Shrub PSS, Palustrine Forested - PFO, etc.) iv. Palustrine Community Classification; classification key available at: PA_PCC_Key_1.0 and additional information on community classification and factsheets available at: v. Summary of the results from the PA Wetland Condition Level 2 Rapid Assessment Protocol Document Number Copies of the assessment area mapping, data sheets, worksheets, stressor checklist, notes, photos and supporting information must be provided. vi. Discuss the wetland HGM type(s) and condition(s) as they relate to the inherent functions including, but not limited to, those associated with hydrologic, biogeochemical and habitat attributes include any recreational uses when applicable. 3. Lacustrine Resources - Provide the following information for each lacustrine resource listed in S2.B above, when more than one resource is assessed, provide a table of the summary results including items i-ii: i. Unique resource identifier used in S2.B above. ii. Summary of the results from the PA Lacustrine Condition Level 2 Rapid Assessment Protocol Document Number Copies of the assessment area mapping, data sheets, notes, photos and supporting information must be provided. iii. Discuss the resource type(s) and condition(s) as they relate to the inherent functions including, but not limited to, those associated with habitat attributes. Include any recreational uses when applicable. 4. Other Environmental Factors, Special Studies, Macro-invertebrate surveys, Mussel Surveys, HGM Functional Assessment, Habitat Evaluation Models, etc. or Substitute Methods. The applicant should consult the Department early in the application development process if large impacts to resources or impacts to Special Protection waters are anticipated (e.g (e)(3)) to assist in determining if and/or which other environmental factors, special studies, surveys, etc. are necessary as part of the E.A

11 The Department may approve the use of substitute methods used in place of S2. D.1, 2 or 3 above as an alternative or substitute assessment methodology for assessing resource conditions (separate from and not contained in the applicable technical guidance) if that methodology is determined by the Department to adequately identify and assess resource conditions for the purposes of meeting regulatory requirements under Chapter 105. Complete and legally defensible supporting documentation (rationale, calculations, etc.) regarding the use of a substitute assessment methodology as it relates to the project application must be included with the application. Additional application processing time may be necessary when using an alternative methodology. For other special studies or surveys, etc. or substitute methods determined necessary by the Department, provide at a minimum the following information for each study or assessment performed: i. Unique resource identifier used in S2.B above. ii. Purpose of the study or assessment. iii. Summary of the results from the study or assessment. Copies of assessment area mapping, data sheets, notes, photos and supporting information must be provided. iv. Description of the factors, study or title of methodology used, discuss any deviations or modifications to the methodology, etc. v. Discussion of the results or findings as they related to the purpose of the study or assessment. MODULE S3: IDENTIFICATION AND DESCRIPTION OF POTENTIAL PROJECT IMPACTS This module is intended to organize and present information concerning the potential impacts or effects of the proposed project in the application. Impacts related to the "overall" project that are proposed under related but separate application(s) should be addressed as part of the CEA Policy response under S1.A.1 and included as part of each permit application. These regulatory requirements and Department policies are applicable to this Module, including, but not limited to the following: (e)(1)(ii); (e)(1)(iii); (e)(1)(viii); (e)(1)(x); (e)(3); ; a(a)(3); a(a)(6); a(b)(3); a(b)(6); Ch. 105 Subchapters B, C, D, E, F, G, H, I and J; CEA Policy; and Water Quality Antidegradation Implementation Guidance Policy (Antideg. Policy: Document No ). Provide a summary table(s) of the proposed impacts for each affected resource category (e.g. riverine, wetlands and lacustrine resources). The following information is provided to assist in categorizing impacts: Permanent Impacts are those areas affected by a water obstruction or encroachment that consist of both direct and indirect impacts that result from the placement or construction of a water obstruction or encroachment and include areas necessary for the operation and maintenance of the water obstruction or encroachment located in, along or across, or projecting into a watercourse, floodway or body of water. Temporary Impacts are those areas affected during the construction of a water obstruction or encroachment that consists of both direct and indirect impacts located in, along or across, or projecting into a watercourse, floodway or body of water that are restored upon completion of construction. This does not include areas that will be maintained as a result of the operation and maintenance of the water obstruction or encroachment located in, along or across, or projecting into a watercourse, floodway or body of water (these are considered permanent impacts). Direct Impacts consist of filling, draining or conversion of a resource to another type such as a wetland to an open body of water. Examples include placement of fill in a wetland, placement of a box culvert in a stream, placement of fill in the floodplain and/or building a dam where the impoundment area will flood resources (stream, floodplain or wetlands) with a sufficient depth as to change the existing aquatic resource to another aquatic resource type. This would include changes such as converting a riverine system to a lacustrine system, changing a palustrine wetland to a lacustrine system, etc

12 Indirect Impacts consist of altering the chemical, physical or biological components of an aquatic resource to the extent that changes to the functions of the resource results. However, indirect impacts do not result in a loss of resource acreage. Changes include such things as conversion of a forested wetland system to a non-forested state through chemical, mechanical or hydrologic manipulation that results in a maintained state of vegetation; altered hydrologic conditions (increases or decreases) such as stormwater discharges or water withdrawals that alter the chemical, physical or biological functions of the resource, areas upstream and downstream of a culvert or bridge that require periodic excavation to ensure waterway openings (e.g. bedload deposition removal), etc. 1. Provide summary of the total proposed permanent direct impacts. 2. Provide summary of the total proposed temporary direct impacts. 3. Provide summary of the total proposed permanent indirect impacts. 4. Provide summary of the total proposed temporary indirect impacts. Standard Information Responses 1. From S2.A.5: If any of these resources were checked YES, discuss any potential impacts to those resources in detail. IMPORTANT NOTE: If either item vii or viii from S2 A.5 was answered YES, the project is not eligible as a "Small Project Application" type. Complete all applicable sections of the EA form for the standard application type unless an item was otherwise waived by the Department in writing (see previous Note on waiving of information requirements). Subfacility Details Table(s): Provide a table(s) of all proposed water obstruction(s), encroachment activities, and dams (e.g. subfacility codes) including any required details. 1. Unique project Subfacility identifier (e.g. A1, SC1, C1, B1, etc.) 2. List the applicable standard subfacility code and description (i.e. CULV, BRDG, WTIM, etc.) see Appendix IV for list of codes and descriptions. 3. List the riverine, wetland, and/or lacustrine unique resource identifier from S2.B above (more than one may be listed) which the proposed subfacility affects. 4. Provide latitude and longitude coordinates for the subfacility see Appendix IV for the recommended collection of coordinate data related to the subfacility type. Note: The General Information Form: Facility Information Section should be used to record the information related to the collection method and accuracy of the locational data. 5. Provide the municipality and county in which each subfacility is located. 6. List the total permanent direct impacts for each subfacility. 7. List the total temporary direct impacts for the each subfacility. 8. List the total permanent indirect impacts for each subfacility 9. List the total temporary indirect impacts for each subfacility

13 10. Provide key details for each subfacility see Appendix V for specific information related to subfacility details by subfacility type. Resource Function Effects: Provide a description of how the proposed subfacility(s), individually and/or in combination, directly and/or indirectly impact the identified resource(s) and effects to the resource functions previously discussed in Module S2. Discuss any other environmental impacts not previously provided elsewhere. 1. Unique project Subfacility identifier 2. Discuss the types of impacts associated with the subfacility and the effect they have on the resource functions as described in Module S2. When the same type of subfacility is proposed (e.g. stream crossing utilizing a culvert and floodway fill), the description may include a general description of the effects that the subfacility type has on the resource(s) with noted exceptions related to specific locations made. The discussion should consider the following: i. Hydrologic- water quantity, streamflow, and sources, groundwater basal flows, drainage patterns, flushing characteristics, flow currents, natural recharge or source areas, storm and floodwater storage and control. ii. Biogeochemical- changes in hydrodynamics, food chain production, maintenance of water quality, Does the project degrade the water quality? Does it have an impact on water quality to the extent that the watershed s designated water use is impaired? (Refer to S2.B.4., above, regarding designated water use as indicated in Chapter 93.) iii. Habitat- general habitat provision (e.g. nesting, spawning, rearing, escape cover, feeding, migration resting); environmental study areas (e.g. sanctuaries or refuges) and T&E species or species of special concern (as identified in S2.D). Does the project impact fisheries? Will the activity impair the ability of these watercourses to continue to provide habitat for aquatic species? Special attention should be given to wild and stocked trout streams. Does the project demonstratively reduce or degrade habitat for terrestrial, aquatic and/or avian species? Is the degradation significant in a local or regional context? Will the degradation influence biodiversity? iv. Recreation- interference with the ordinary and customary use of the resource; including but not limited to such uses as hunting, fishing, wildlife observation, swimming, boating, etc. Recreational boating may also need to be considered, regardless of the official designation, where there is a documented on-going use of the watercourse for boating, canoeing or other types of recreation. 3. Discuss the effect of the subfacility on the overall regime and ecology of the watercourse or other body of water, water quality, stream flow, fish and wildlife, aquatic habitat, instream and downstream uses and other significant environmental factors. 4. Discuss any effects or changes on the property or riparian rights of owners upstream, downstream, or adjacent to the project, resulting from the subfacility. Riparian rights are those rights which are derived from the ownership of real property underlying or bordering streams and rivers. The holder of riparian rights has no property right in the water itself but only a nonexclusive right to the water. No right to divert or consume a specific quantity of water is obtained. An individual s riparian right depends upon the equal rights of other riparian holders (upstream and downstream). Historically, riparian rights have focused upon use and may be extended to the aesthetics of the watercourse for personal satisfaction or enjoyment. Riparian rights must be considered in cases where an increase or diminution of flow would result from the proposed activity and in cases where the direction of flow would be altered

14 Antidegradation Analysis: The applicant must demonstrate consistency with State antidegradation requirements. Project application information provided below in S3.E, F, G, and H may be crossreferenced. 1. Provide sufficient information such as a comparison of resources, potential impacts, other relative environmental factors, etc. to demonstrate that the project is consistent with the State antidegradation requirements including those contained in 25 Pa. Code Chapter 93, Sections 93.4a through Section 93.4c; 25 Pa. Code Chapter 102, Sections 102.2, 102.4(b)(6), and 102.8(h); 25 Pa. Code Chapter 105, Sections (c), a(a)(6) - related to EV wetlands, a(b)(6) - related to Other wetlands, and 25 Pa. Code Chapter 95, when applicable. The Applicant may summarize and use the antidegradation information from the Chapter 102 permit application submitted for the project and summarize and use the information from this Chapter 105 permit application, which addresses the requirements of Chapter 105, Sections (c), a(a)(6) and a(b)(6). Alternatives Analysis: The scope and extent of this analysis should be commensurate with the size and scope of the proposed project impacts in the application. Information provided in S3.H, below, related to avoidance and minimization efforts, may be cross-referenced in the responses. 1. Provide a description which demonstrates the unavailability of any practicable alternatives which would avoid or minimize the adverse impacts of the dam, water obstruction(s) and/or encroachment(s) proposed in the application that is not part of the responses submitted as part of the CEA Policy that addresses the overall project under S1.A.1. An alternative is considered practicable if it is available and capable of being carried out after taking into consideration construction cost, existing technology and logistics. This description should include, but not be limited to, consideration of the following: i. Alternative locations, including areas not presently owned by the applicant which could be reasonably obtained, utilized, expanded or managed to fulfill the basic purpose of the project. ii. Alternative routes or alignments iii. Alternative designs, including reduction in scope, configuration or density. 2. For the preferred alternative, provide a description of onsite avoidance efforts with supporting details. 3. For the preferred alternative, provide a description of onsite minimization efforts with supporting details. Potential Secondary Impact Evaluation: The potential secondary impact assessment is intended to identify potential permit issues and project impacts for the entire parcel of land. 1. Identify and describe the direct and indirect environmental impacts on other adjacent land and water resources associated with the construction, modification and/or operation of the dam, reservoir, water obstruction, or encroachments around the project and areas adjacent thereto. Consideration should also be given to project impacts on adjacent water resources. For example: Will the project adversely impact those resources indirectly (i.e. loss of hydrology, wildlife corridors, habitat, etc.)? 2. Identify and describe all other dams, water obstructions or encroachments, in addition to those included in this application, and their potential future impacts necessary to fulfill the project purpose. Dams, water obstructions and encroachments should be designed in consideration of future land use to assure proper adequacy for future development. The Department may require additional data relating to planning, subdivision and zoning

15 The cumulative impact of this project and other potential or existing projects on wetland resources: Identify and evaluate the potential environmental impacts of this project, other potential or existing projects like it, and the resulting impacts from numerous piece-meal changes to the wetland resource. 1. Discuss the potential for cumulative wetland impacts and the process used to identify other impacts as described in CEA Policy. 2. Identify and evaluate the potential cumulative impacts of this project and other potential or existing projects like it, and the impacts that may result through numerous piecemeal changes to the wetland resource. i. Cumulatively, do these piecemeal changes result in the impairment of the Commonwealth s exceptional value wetland resources. ii. Cumulatively, do these piecemeal changes result in a major impairment of this Commonwealth s wetland resources. MODULE S4: MITIGATION PLAN This module is intended to organize and present information concerning actions undertaken in accordance with the definition of Mitigation in Title 25 Pa. Code Chapter , , a(a)(3), a(b)(7), a, and as related to the potential impacts or effects of the proposed project in this application. Note: Impacts related to the overall project that are proposed under related but separate application(s) should be addressed as part of the CEA Policy response under S1.A.1. The following regulatory requirements and Department policies are applicable to this Module: 105.1; (e)(1)(ix); ; a(a)(3); a(a)(7); a(b)(2); a(b)(3); a(b)(7); a; ; Department s Design Criteria Wetlands Replacement/Monitoring Policy (Wetland Design Criteria Policy: Document No ). Provide a detailed response for individual proposed impact area(s) and the project as a whole for the following: 1. Identify and describe any measures taken that resulted in avoiding resource impacts. 2. Identify and describe any measures taken that resulted in minimizing unavoidable resource impacts. Provide a detailed response for individual proposed impact area(s) and for the whole project that address the following: 1. Identify and describe any repair, rehabilitation, or restorative actions taken to rectify an impacted resource. i. Provide specific details and plans outlining how impacted resources will be repaired. ii. Provide specific details and plans outlining how impacted resources will be rehabilitated. iii. Provide specific details and plans outlining how impacted resources will be restored. 2. Identify and discuss any proposed preservation and maintenance operations that will be taken to reduce or eliminate an impact during the life of the project

16 Identify and describe any actions undertaken related to the following compensatory mitigation items: 1. Does the applicant propose to utilize an approved mitigation bank to provide all or a portion of the compensation? If YES, address items listed under S4.C1.i.; otherwise proceed to S4.C.2. Note: If the applicant proposes to utilize both mitigation bank credits and conduct permittee responsible mitigation, all items in S4.C must be addressed. i. Provide a credit reservation/commitment letter from a mitigation banker approved to operate within Pennsylvania. The letter shall be from the credit provider, addressed to the applicant, and, at a minimum, include the following: a. Legal name of the credit provider (aka banker); b. Water Obstruction and Encroachment Compensation Operation Permit number; c. Contact information for the credit provider; d. Statement by credit provider attesting to credit availability or reservation (i.e. a credit may not be simultaneously represented in credit availability letters to multiple applicants); e. Specify the credit type(s) and amounts by resource type(s); and f. Specify any time limitations (e.g. expiration date) placed on the credit availability or reservation commitment. 2. Describe the proposed plans to compensate for the impacted wetland, riverine, and/or lacustrine resources with a discussion of how the affected functions identified in Module S3 will be offset by the compensation proposal. 3. Describe the proposed plans to compensate for the impacted resources including, but not limited to, the following: i. Provide detailed design plans consistent with the proposed compensation. For wetlands, specific reference is made to the Department s Wetland Design Criteria Policy. ii. For projects, which impact wetlands, provide a narrative explaining how the proposed plan: a. Replaces the wetlands at a minimum area ratio of 1:1; (2:1 for after the fact permit applications). b. Replaces the wetland functions and values that are physically and biologically the same as those that are lost at a minimum area ratio of 1:1; (2:1 for after the fact permit applications). iii. Performance standards shall be based on attributes related to the resource structure, functions, ecological condition, or other such suitable methods and/or criteria to determine if the site is achieving the proposed objectives. These standards may be incorporated into the special conditions of the permit. Monitoring Plans: When applicable, provide a plan to monitor the identified actions proposed in S4.B and/or S4.C compensatory mitigation area. The application should at a minimum reference the erosion and sediment control plan final stabilization, however, in many instances additional steps should be taken to ensure aquatic resources recover from the disturbances beyond just mere stabilization including soil segregation, resource appropriate plantings, etc. Actions taken under S4.B related to wetlands disturbances can utilize the existing USACE monitoring template: 5_Wetland_Monitoring_Report_for_Temporary_Impacts.pdf?ver=

17 Applicants should utilize the Department s Design Criteria: and the USACE s RGL to develop monitoring plans for compensatory mitigation proposals. Those plans should include, but are not limited to, the following: 1. Performance Standards - At a minimum, include the information regarding the performancestandards established previously under S4.C.3. Performance Standards shall be based on resource related functional, conditional, or other suitable assessment methods and/or criteria that can be measured to demonstrate progress towards success. 2. Recommended Monitoring Duration and Timeframes - At a minimum, include the following information: i. Expected beginning month and date of overall monitoring period, which usually consists of five (5) full-growing seasons. ii. Expected overall duration and schedule of monitoring events. Typically, monitoring events should occur twice (2) a year for first two growing season and once annually during the growing season for the final three years for a total of seven (7) site visits during a typical fiveyear monitoring period. iii. Monitoring reports should generally be submitted by December 1 of the year the monitoring even took place. Alternative schedules may be proposed or provided as a condition of the permit. 3. Monitoring Reports- At a minimum, reports should include or address the following items: i. Project overview: a. Permit Id and current monitoring event b. Responsible party conducting monitoring and dates of inspection or data collection c. Brief description of the purpose of the project, resources involved, acreages, techniques, etc. d. Written directions to site location(s), latitude and longitude coordinates, location map, etc. e. Date compensation actions were completed f. Summary of performance standard achievement g. Dates and description of any corrective actions since last report ii. Requirements: a. List of monitoring requirements b. Performance standards in permit special conditions and/or approved compensation plan c. Evaluation of whether site is achieving performance standards or is trending towards achievement (use of table(s) for comparison purposes is recommended) iii. Data Summarization: a. Provide data to substantiate progress towards achieving performance standards and conclusions reached b. Color photographs. Including date taken, photo id, and direction of photograph

18 iv. Maps and Plans: a. General location map including nearby resource features b. Photographic reference points c. Sampling locations, transects, cross sections, etc. d. Legends, clearly depicted site boundaries, habitat units, unique features, etc. v. Conclusions: a. General statement describing the conditions of the compensation project; b. If performance standards are not being met, provide a brief explanation of non-performance and specific recommendations for corrective or remedial actions including a timetable for implementation Note: Corrective or Remedial actions require prior approval unless actions are explicitly pre-approved in advance as part of a submitted Adaptive Management Plan 4. Remedial Action/Adaptive Management Plan (RAMP) - When development of an RAMP is necessary, address the flowing elements: i. Identify need for action and include description of how the problem was determined. Identify probably causes with supporting data and observations. ii. Identify the responsible party producing the RAMP. iii. The Department must approve the RAMP prior to implementation iv. Identify and describe how the implementation of the RAMP will occur including, but not limited to, implementation dates, actions, inspections, etc. v. Identify and describe specific elements addressing the monitoring of RAMP progress. vi. Implementation IMPORTANT NOTE: All or portions of this Module may apply to Small Project type applications under case specific circumstances and should be discussed during any pre-application meetings or prior to application submittal. CERTIFICATION AND FEE The completed E.A. Form will not be accepted unless the form is signed and dated. The fee required for a project authorized under certain permit waivers (when the Chapter 105 permit requirement is waived) shall be consistent with 25 PA Code (relating to regulated activities information and fees). See (c)(2)(iv) for additional information. To determine the application fee, please complete the Chapter 105 Fee(s) Calculation Worksheet (3150-PM-BWEW0553). Please provide the completed worksheet and a check for the applicable fee(s) made payable to the Commonwealth of Pennsylvania Clean Water Fund