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FSA-850
(06-14-02)
1. PROJECT INFORMATION
U.S. DEPARTMENT OF AGRICULTURE
Farm Service Agency
1A. PRODUCER or APPLICANT NAME
1B. PROJECT NUMBER
ENVIRONMENTAL EVALUATION CHECKLIST
2. BACKGROUND
c. Describe the surrounding land uses; indicate the directions and distances involved. The extent of the surrounding land to be considered depends on the
extent of the potential impacts of the project, its related activities, and the primary beneficiaries:
Attach adequate location maps of the project area, as well as (1) an aerial photo of the site, (2) if available, topographic map which clearly delineates the area and the location
of the project elements, (3) if available, site photos, and (4) if completed, a standard soil survey for the project. When necessary for descriptive purposes or environmental
analysis, include land use maps or other graphic information. All graphic materials shall be of high quality resolution.
3. PROTECTED RESOURCES
For the below listed land uses or environmental resources, check the appropriate answer in Column A to
indicate those that are present on the site(s) of the proposed action. Check the appropriate answer in Column
B for those resources that are within the action's area of environmental impact, such as the areas adjacent to
the proposed site(s). Check the appropriate answer in Column C for those land uses and environmental
resources that will be adversely affected by the proposed action.
Check the appropriate boxes as provided:
- If "YES" is checked in Column A or B, then Column C must be completed.
- If "YES" is checked in Column C, attach as Exhibit 3a, 3b, 3c, 3d, 3e, 3f, 3g, 3h, and 3i as applicable, a
discussion and description of all potential impacts.
a. Wetlands
An AD-1026 must be completed by all producers who request USDA program or loan benefits covered by the
FSA of 1985, as amended by the Federal Agriculture Improvement and Reform Act of 1996. If any of
questions 8 through 10 of the AD-1026 are answered ''YES,'' then a NRCS CPA-026e must be completed and
attached.
b. Floodplains - Flood Map Panel #
For projects involving construction/development in floodplains, attach applicable floodplain development
permits.
c. Sole Source Aquifer Recharge Area (Designated by Environmental Protection Agency)
The proposed action must not contaminate or contribute to the contamination of a sole source aquifer to
the extent that a significant hazard to public health is created.
d. Critical Habitat or Endangered/Threatened Species (listed or proposed)
Consult with the U.S. Fish and Wildlife to ensure that the proposed action will not jeopardize a listed
species or destroy or modify its ''critical habitat'' in accordance with the Endangered Species Act.
1C. STATE & COUNTY CODE
1D. TYPE OF PROJECT
1E. PROJECT OR DESCRIPTION 1F. GENERAL LOCATION
LOAN
CRP
ECP
OTHER
a. Describe the purpose and need for the project:
b. Describe the project site and its present use:
A
Located
on the
site of
the proposed
action
B
Located
within the
proposed
action area of
environmental
impact
C
Adversely
affected
by the
proposed
action
e. Wilderness
f. Coastal Barrier in Coastal Barrier Resources System or Approved Coastal Zone Management Area
g. Wild or Scenic River
h. Natural Landmark
i. Historical, Archeological Sites
YES YES YESNO NO NO