Updated 3/17/2015
Site Specific Environmental Review Checklist
This checklist is for categorically excluded housing activities as listed in the unspecified site strategy.
Address of Site: _____________________________________________________________________________________
Signature of Person Who Inspected Site: _________________________________________________________________
Approving Signature: ________________________________________________________________________________
Date of Completed Review: __________________________________ Grant Number: ____________________________
If there are more than 4 new construction units together, this form cannot be used. Refer to 24 CFR Part 58.35(a)(4).
Develop the Site Specific Review checklist which contains only the items that could not document compliance on the
Broad Review per 24 CFR Part 58.15. Attach the scope of work and pictures for the project.
What is the estimated cost of rehabilitation or renovation? ______________
Indicate the estimated value of the improvement(s)
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0 to 39.9% of the market value of the structure
40 to 49.9% of the market value of the structure
50 to 74.9% of the market value of the structure *
75%+ (and above) of the market value of the structure *
Please note that when the rehabilitation costs meet or exceed 50% of the market value of the structure, a Statutory
Worksheet (with supporting documentation) must be completed for each unit.
1.
Historic Preservation:
Is the structure on the site or structure adjacent to the site more than 50 years old? (Attach a copy of the property
appraiser’s report). ____ yes, ____ no
______ age of structure on the site
______ age of structure on the adjacent site
______ age of structure on the adjacent site
Is the site in a historic district? ____ yes ____ no
If you are disturbing the soil, contact the Tribal Historic Preservation Office(s) located in the Tribal Directory Assessment
Tool (http://egis.hud.gov/tdat/Tribal.aspx). Include photocopies of all correspondence.
Does your site have the potential to contain archeological properties? ____ yes ____ no
If yes to any of the above, then contact the State Historic Preservation Office (SHPO) to determine if the property is
eligible for the National Register of Historic Places. Attach a photocopy of the SHPO document.
2.
Floodplain Management: (Executive Order 11989 and 24 CFR Part 55)
Check the Flood Insurance Rate Map (FIRM) to determine if the site is in the Floodplain (Attach a copy of the FIRM map):
500 year for critical actions
____ yes ____ no
100 year for all other activities ____ yes ____ no
If yes to the above and the site involves new construction or substantial improvement as defined in 24 CFR Part 55.2
(b)(8), then the eight step decision making process is required as described at 24 CFR Part 55.20. Or,
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If yes to the above and the site involves minor repairs or improvements to single family properties, then the decision
making process as described in 24 CFR Part 55.20 is not applicable based on 24 CFR Part 55.12(b)(2). Documentation must
be provided.
If yes, Flood insurance is required. Attach proof of Flood insurance and a photocopy of the FIRM map that indicates the
site is in the floodplain.
3.
Wetlands: (Executive Order 11990 and 24 CFR Part 55)
According to the U.S. Fish and Wildlife Service National Wetland Inventory website (http://www.fws.gov/wetlands/), is
the site in a wetland: ____ yes ____ no
Attach a photocopy of the Wetland map to include the site location.
If no, proceed to #4.
Will the project involve impacts to on-site or off-site wetlands? ____ yes ____ no
If yes to the above questions, complete the 8-step process if the site is located in a wetland and involves new construction
as defined in Executive Order 11990. The restriction regarding increasing the footprint for the rehabilitation of a one to
four family dwelling in a floodplain or wetland was removed effective 12/15/2013.
4.
Noise: (24 CFR Part 51)
a. Based on the information provided below, the Noise policy will not apply to any action or emergency assistance for
actions under Disaster Recovery grants as described in 24 CFR Part 51.101(a)(3).
Will the project use funds from a Disaster Recovery grant? ____ yes ____ no
If no, proceed to 4(b). If yes, then continue.
Will the project involve the use of additional funding sources other than the Disaster Recovery grant? ____ yes ____ no
If yes, provide the funding sources in the scope of work and proceed to 4(b). If no, proceed to #5.
b. Is the project for rehabilitation? ____ yes ____ no; If yes, consideration of noise is required. Proceed to “C” below
and complete the questions to determine if a noise assessment must be completed. If no, then continue.
Is the project new construction? ____ yes ____no; If yes, complete the questions in “c” below. Mitigation is required
when a project exceeds the average day night level of 65 decibels (dB).
c. Is there a Rail Road within 3,000 feet
Is there is Highway within 1,000 feet
Is there a: civilian airport within 5 miles
military airport within 15 miles
____ yes ____ no
____ yes ____ no
____ yes ____ no
____ yes ____ no
If yes to the above, conduct and attach a copy of the Day/Night noise level calculator using the website:
https://www.hudexchange.info/resource/2830/day-night-noise-level-assessment-tool/ with assistance from the HUD
Noise Guidebook. If the noise exceeds the acceptable levels, reject the site or mitigate to achieve acceptable or normally
acceptable Noise levels.
5.
Explosive & Flammable Operations (per 24 CFR Part 51 Subpart C)
Is the project for rehabilitation? ____ yes ____ no
Will the number of individuals subjected to a potential hazard increase? ____ yes ____ no
Is the project new construction? ____ yes ____ no
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If no to the above questions, then proceed to section #6. If yes to either question, then continue below.
Are there any stationary above ground storage tanks of more than 100 gallons within 1 mile of the site that contain
explosive or flammable liquids? ____ yes ____ no
If yes, use the Acceptable Separation Distance (ASD) Assessment Tool available at
http://www.hud.gov/offices/cpd/environment/asdcalculator.cfm and refer to pages 51 and 52 in the HUD Hazard
Guidebook. Collect information about the size and contents of the storage tank and determine if the tank is under
pressure.
A site located less than the Acceptable Separation Distance will require mitigation or it will be rejected. For example,
mitigation would be required if the separation distance is 150 feet but the site is located at 125 feet. If mitigation is not
obtained, the site will be rejected.
Attach the ASD calculation report, photos and a map with the project site location and the location of the above ground
storage tank(s).
6.
Toxics
a. Observe the site for any evidence that a toxic material could be present on the site such as: distressed vegetation,
vent or fill pipes, storage tanks, pits, ponds or lagoons, stained soil or pavement, pungent, foul or noxious odors, or past
uses of the site. _____ yes _____ no
Reject any site that has a presence of Toxics or require cleanup prior to purchasing the site.
Use the U.S. Environmental Protection Agency NEPAssist website (http://nepassisttool.epa.gov/nepassist/entry.aspx) to
determine:
Are there EPA facilities within 3,000 feet of the site? ____ yes ____ no
If yes, are there Brownfield or Superfund facilities?
documentation requirements.
____ yes ____ no; if yes, contact DEO for additional
Attach a photocopy of the NEPAssist report and the ECHO reports of the facilities found within 3,000 feet of the project
site.
b. Lead-Base Paint (LBP):
Was the structure built prior to 1978? ____ yes ____ no; if no, continue to #7. If yes, then continue below.
For the following questions, refer to the U.S. Department of Housing and Urban Development “Guidelines for the
Evaluation and Control of Lead-Based Paint Hazards in Housing”
(http://portal.hud.gov/hudportal/HUD?src=/program_offices/healthy_homes/lbp/hudguidelines) and the “Lead Safe
Housing Rule” under 24 CFR Parts 35, Subparts B through M.
Is the structure exempt from LBP testing? ____ yes ____ no; if yes, provide documentation and proceed to #7. If no,
then continue.
Is a LBP test required? ____ yes ____ no; if yes, include photocopies of the LBP report and LBP inspector’s qualifications.
Is the LPB test results positive? ____ yes ____ no; if yes, include the Notice of Evaluation or Presumption. Submit the
Notice of Hazard Reduction Activity and the clearance exam(s) at the completion of the hazard reduction work.
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7. Airport Clear Zone/Runway Protection Zone
Is the project located within 2,500 feet of a civilian runway?
____ yes ____ no
Is the project located within 15,000 feet of a military runway? ____ yes ____ no
If no, attach a map of the site location and the Runway Protection Zone(s).
If yes, continue below:
Will the site involve minor rehabilitation or down-payment assistance? ____ yes ____ no
If yes, was the applicable notice provided to the homeowner? (see the website: https://www.onecpd.info/environmentalreview/airport-hazards/) ____ yes ____ no
Does the site involve major rehabilitation or new construction? ____ yes ____ no
If yes, the site should be rejected unless it will not be frequented by people and/or is approved by the airport operator.
8. Endangered Species Act
Use the Florida Fish and Wildlife Conservation Commission (FFWCC) Eagle Nest Locator website
(http://myfwc.com/wildlifehabitats/managed/bald-eagle/), to check for bald eagles nest within a one mile radius of the
project location. A visual inspection should also be conducted within a one mile radius of the project site. Include a copy
of the Bald Eagle Nest Data Search Results, clearance documentation and permit(s) as required.
a. Is a bald eagle nest(s) located on the FFWCC website within a one mile radius of the project site? ____ yes ____ no;
b. Was a bald eagle nest(s) located during a visual inspection within one mile of the project? ____ yes ____ no;
c. Is a bald eagle nest(s) located within 660 feet of the project location? ____ yes ____ no;
If yes to “c” above, contact Michelle van Deventer, Bald Eagle Plan Coordinator with the FFWCC at (941) 894-6675 or (850)
296-4153. Include clearance documentation and permit (if required) in the review.
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