ENVIRONMENTAL COMMITMENTS & OBLIGATIONS …



ENVIRONMENTAL COMMITMENTS & OBLIGATIONS PACKAGE FOR CONSTRUCTION (ECOPAC) – REGION 1

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|Project: |Project Designer: |

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|PIN: |Design LA/Environmental Project Manager: |

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|Letting Date: |Construction Environmental Coordinator (CEC): |

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|Contract Number (D#): |Engineer-in-Charge (EIC): |

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|Summary of ECOPAC Instructions: |

|The Project Designer (in consultation with the LA/Environmental Project Manager) completes the left side of the ECOPAC form (pages 1 through 11 only) before PS&E to highlight the environmental |

|issues and permits/approvals obtained for the project. The Project Designer and LA/Environmental Project Manager sign the ECOPAC form, and at this time all applicable environmental permits are |

|then transferred to the Construction Environmental Coordinator. A copy of the signed ECOPAC form must also be attached to ht PS&E transmittal memo submitted to Main Office Construction. |

| |

|The Construction Environmental Coordinator reviews the ECOPAC form and permits with the Engineer-in-Charge prior to the construction. The EIC refers to the ECOPAC form throughout construction to|

|ensure compliance with environmental regulations. If a previously unidentified environmental issue is encountered during construction, the EIC fills out the applicable boxes on the left side of |

|the ECOPAC form and initials the applicable boxes. At the conclusion of the project (or for multi-year projects – at the end of each state fiscal year) the EIC completes the right side of the |

|ECOPAC form (pages 1 through 11) and fully completes pages 12 through 14. If a Non-Compliance event occurred, the EIC contacts the Construction Environmental Coordinator for assistance in |

|assigning a Non-Compliance Rank. The EIC provides a copy of the ECOPAC form to the Construction Environmental Coordinator and retains a copy in the construction project file. The Construction |

|Environmental Coordinator reviews the ECOPAC form for completeness and reports the appropriate Non-compliance events as part of the annual State Agency Environmental Audit. |

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|State Agency New York State Department of Environmental Conservation (DEC) Federal Agency United States Army Corps of Engineers (COE) |

|Abbreviations New York State Department of State (DOS) Abbreviations United States Coast Guard (USCG) |

|New York State Department of Labor (DOL) United States National Park Service (NPS) |

|New York State Department of Health (DOH) United States Fish & Wildlife Service (FWS) |

|New York State Department of Agriculture and Markets United States Environmental Protection Agency (EPA) |

|State Historic Preservation Officer (SHPO) Federal Highway Administration (FHWA) |

|Tribal Historic Preservation Officer (THPO) United States Department of Transportation (USDOT) |

|Natural Resource Conservation Service (NRCS) |

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|Non-Compliance Rank Definitions |

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|Rank N1 = Imminent substantial threat to public health of environment. |

|Rank N2 = Substantial threat to public health or environment. |

|Rank N3 = Discernible but not substantial threat to public health or environment. |

|Rank N4 = No evidence of discernible threat to public health of environment. |

| |

|If a Non-Compliance event occurs, immediately contact the ECOPAC Coordinator for assistance in assigning a Non-Compliance Rank. |

|Project Designer (in consultation with LA/Environmental Coordinator) completes the left side of |Engineer-in-Charge in consultation with the CEC completes right side of ECOPAC form (pages 1 -11)|

|the ECOPAC form (pages 1 – 11) prior to filing the PS & E package. |and pages 12 – 14 at conclusion of the state’s fiscal year. |

|Project Manager |EIC |

|Date |Date |

|Signature |Signature |

|Env. Contact |CEC |

|Date |Date |

|Signature |Signature |

Page 1 of 14

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|ENVIRONMENTAL COMMITMENTS & OBLIGATIONS PACKAGE FOR CONSTRUCTION (ECOPAC) – REGION 1 |

|LEFT SIDE TO BE COMPLETED BY PROJECT DESIGNER BEFORE PS&E |RIGHT SIDE TO BE COMPLETED BY EIC |

|Environmental Issue |Permit / Approval Obtained |Audit |Compliance Requirements |Noncompliance |

| | |Reg. No. | |(Rank)# |

|SEQR |□ SEQR Completed for all work |48 |□ All work done as per plan with no major | |

|All phases and proposed work included in this project and/or|shown included in Design | |project changes |□ Not in Compliance |

|any additional work to be completed has been reviewed and |Approval Document | | |(Rank N______)# |

|processed under and with SEQR completed. ECL Article 8, and| | | | |

|6NYCRR Part 15. |□ SEQR completed for all work |48 |□ All additional work processed as per SEQR | |

| |shown in contract documents or for work| |Regulations, for additional work RLA/EM was |□ Not in Compliance |

| |added after Design Approval | |contacted, SEQR completed |(Rank N______)# |

| | | | | |

| |□ SEQR Completed for all additional | | | |

| |project work added during construction|48 |□ SEQR completed for all work :~) | |

| |not included in Design Approval | | |□ Not in Compliance |

| |Document | | |(Rank N______)# |

| | | | | |

|NEPA |□ NEPA Completed for all work |N/A |□ All work done as per plan or approved as |□ Not in Compliance |

|All phases and proposed work included in this project and/or|shown in contract documents | |per NEPA Regulations |(Rank N______)# |

|any additional work to be completed has been reviewed and | | | | |

|processed under and with NEPA completed. For projects with |□ NEPA completed for all | |□ All additional work processed as per NEPA |□ Not in Compliance |

|Federal Funding of Federal Permits. |work shown in contract | |Regulations, RLA/EM was contacted, |(Rank N______)# |

| |documents or for work added | |NEPA completed | |

|□ No Federal Funding of Federal |after Design Approval | | | |

|Permits Required | | |□ NEPA completed for all work :~) |□ Not in Compliance |

| | | | |(Rank N______)# |

| | | | | |

|WETLANDS |□ DEC Article 24 permits |20 |□ All work completed as per contract |□ Not in Compliance |

|A DEC, APA, and/or US ACOE permit is required for any | | |documents and previously obtained |(Rank N______)# |

|construction, grading, filling, excavating, clearing, |□ APA Wetlands Permit |20 |permits / approvals | |

|stockpiling, storing, staging, or other activity in a | | | |□ Not in Compliance |

|wetland. Activities within 100 feet (30 meters) of a state |□ DEC Section 401 Water Quality |49 |□ Complied with APA Permit Requirements |(Rank N______)# |

|wetland are also regulated. Any wetland impacts incurred |Certificate | | | |

|during construction, such as those associated with off-site | | |□ Complied with DEC Section 401 Water |□ Not in Compliance |

|disposal, may require a separate permit. |□ COE Section 404 Individual |N/A |Quality Certificate |(Rank N______)# |

| |permit | | | |

|***There is a potential that regulated wetlands exist within| | |□ Complied with Section 404 Individual |□ Not in Compliance |

|the project limits. Do to the nature of the work these |□ COE Section 404 Nationwide |N/A |permit |(Rank N______)# |

|wetlands may not be shown in the contract documents. Any |permits List NWP#_______ | | | |

|work, storage of placements of materials and or field | | |□ Submitted NWP Compliance Certificate |□ Not in Compliance |

|offices needs to be reviewed for any wetlands or other |□ FHWA Executive Order 11990 |N/A |and Post-Construction Report (if required) |(Rank N______)# |

|environmental factors. | | | | |

|□ Based on investigations during design, wetlands will |□ Mitigation Plan Required | |□ Mitigation Plan Implemented |□ Not in Compliance |

|not be impacted by this project. | | | |(Rank N______)# |

| | | |□ Wetlands were not encountered during | |

| | | |construction | |

Page 2 of 14

|LEFT SIDE TO BE COMPLETED BY PROJECT DESIGNER BEFORE PS&E |RIGHT SIDE TO BE COMPLETED BY EIC |

|Environmental Issue |Permit / Approval Obtained |Audit |Compliance Requirements |Noncompliance |

| | |Reg. No. | |(Rank)# |

| | | | | |

|Surface Waters | | | | |

|Construction activities in or near surface waters must |□ DEC Article 15 Memorandum |23 |□ Complied with conditions imposed by DEC |□ Not in Compliance |

|prevent damage, pollution and sedimentation in or near the |of Understanding coordination | |(such as date restrictions for in-water work) |(Rank N______)# |

|water. In water work must not occur during restricted time | | | | |

|periods if imposed by DEC. Erosion prevention and se3diment|□ DEC Section 401 Water |49 |□ Complied with DEC Section 401 Water |□ Not in Compliance |

|controls must be employed as shown in the Contract |Quality Certification | |Quality Certification |(Rank N______)# |

|Documents. Limit the amount of bare soil exposed at any one| | | | |

|time to minimize potential water quality impacts, if |□ DEC SPDES Stormwater |58B |□ Complied with SPDES General Permit |□ Not in Compliance |

|applicable. A SPDES and/or NPDES Notice of Intent (NOI) |General Permit for | | |(Rank N______)# |

|must be filed before construction begins. A SPDES and/or |Construction | | | |

|NPDES Notice of Termination (NOT) must be filed at the | |58B |□ Complied with SPDES General Permit and |□ Not in Compliance |

|conclusion of the project. | | |filed Notice of Termination |(Rank N______)# |

| | | | | |

|***There is a potential that surface waters exist within the|□ COE Section 404 Individual |N/A |□ Complied with Section 404 Individual |□ Not in Compliance |

|project limits. Do to the nature of the work, these waters |permit | |Permit | |

|may not be shown in the contract documents. Any work, | | | | |

|storage or placements of materials and or field offices |□ COE Section 404 Nationwide |N/A |□ Submitted NWP Compliance Certificate |□ Not in Compliance |

|needs to be reviewed for any waters and other environmental |permit List NWP#_______ | |and Post-Construction Report (if required) | |

|factors. | | | | |

| | | | | |

|□ Based on investigations performed during design, surface | | |□ Surface Waters were not encountered | |

|waters will not be impacted by this project. | | |during construction | |

| | | | | |

|NAVIGABLE WATERS |□ COE Section 10 permit |N/A |□ Complied with COE Section 10 permit |□ Not in Compliance |

|A USCG and/or COE permit is required for any activities that| | | | |

|obstruct or alter navigable waters (including filling and |□ USCG Section 9 permit |N/A |□ Complied with USCG Section 9 permit |□ Not in Compliance |

|dredging). Limit the amount of ground disturbed at any one |Bridge Permit | | | |

|time to minimize potential water quality impacts. |Notification | | | |

| | | | | |

|□ Based on investigations performed during design, | | |□ Navigable Waters were not encountered | |

|navigable waters will not be impacted by this project. | | |during construction | |

| | | | | |

|AQUIFERS |□ DEC consultation |N/A |□ Complied with conditions imposed by DEC |□ Not in Compliance |

|Erosion prevention and sediment control and stormwater |(TOGS 2.1.3) | | | |

|management practices must be implemented in aquifer areas. | | | | |

|Avoid refueling equipment and the storage of tanks/hazardous|□ EPA Section 1424(e) |N/A |□ Complied with conditions imposed by EPA |□ Not in Compliance |

|materials in aquifer areas. |consultation F5 | | | |

| | | | | |

|□ Based on investigations performed during design, sole |□ Project is located over a Sole | |□ All erosion prevention and sediment control |□ Not in Compliance |

|source aquifers are not impacted by this project. |Source Aquifer, no additional | |measures were in place as required | |

| |measures, except erosion | | | |

| |prevention and sediment | | | |

| |control plans are required | | | |

Page 3 of 14

|LEFT SIDE TO BE COMPLETED BY PROJECT DESIGNER BEFORE PS&E |RIGHT SIDE TO BE COMPLETED BY EIC |

|Environmental Issue |Permit / Approval Obtained |Audit |Compliance Requirements | Noncompliance |

| | |Reg. No. | |(Rank)# |

| | | | | |

|COASTAL ZONE AREAS |□ FAN completed |52 |□ Complied with FAN |□ Not in Compliance |

|A DEC permit and/or DOS approval is required for any work in| | | |(Rank N______)# |

|coastal erosion hazard areas, coastal zone management areas,| | | | |

|inland waterways, and Coastal Barriers Resources System |□ FCAF completed |N/A |□ Complied with FCAF |□ Not in Compliance |

|(CBRS) areas. | | | | |

| |□ CAF completed |N/A |□ Complied with CAF |□ Not in Compliance |

|□ Based on investigations performed during design, | | | | |

|coastal zone areas are not impacted by this project. | | | | |

| | | | | |

|DAMS AND IMPOUNDMENTS |□ DEC Article 15-0503 written |53 |□ Complied with DEC Article 15-0503 |□ Not in Compliance |

|Approval from DEC is required if constructing, |approval | |approval |(Rank N______)# |

|reconstructing or repairing a dam or impoundment structure | | | | |

|with a height greater than 10 feet (3 meters), with a | | | | |

|storage capacity greater than 1 million gallons (3.785 | | | | |

|million liters), or with a drainage area greater than 1 | | | | |

|square mile (259 hectares). | | | | |

| | | | | |

|□ Based on investigations performed during design, | | | | |

|dams and impoundments will not be encountered | | | | |

|by this project. | | | | |

| | | | | |

|DEC FLOOD CONTROL LANDS |□ DEC Part 501 |54 |□ Complied with DEC Part 502 for activities |□ Not in Compliance |

|A DEC permit is required if the project occupies flood | | |on flood control lands |(Rank N______)# |

|control land and changes landscape features; destroys | | | | |

|vegetation; adds gutter, sidewalks, driveways, parking lots | |54B |□ Complied with DEC Part 501 for operation |□ Not in Compliance |

|or parking spaces; or involves outdoor lighting, utilities | | |of motor vehicles on flood control lands |(Rank N______)# |

|or operation of a motor vehicle. | | | | |

| | | | | |

|□ Based on investigations performed during design, | | | | |

|DEC flood control lands will not be impacted by | | | | |

|this project. | | | | |

Page 4 of 14

|LEFT SIDE TO BE COMPLETED BY PROJECT DESIGNER BEFORE PS&E |RIGHT SIDE TO BE COMPLETED BY EIC |

|Environmental Issue |Permit / Approval Obtained |Audit |Compliance Requirements |Noncompliance |

| | |Reg. No. | |(Rank)# |

| | | | | |

|ENDANGERED SPECIES |□ DEC Article 9 consultation |37A |□ No rare plants were taken/destroyed |□ Not in Compliance |

|The taking, possession, transportation, destruction or | | | |(Rank N______)# |

|removal of any state or federal endangered/threatened plant,| | | | |

|fish, shellfish, crustacean, or wildlife species is |□ DEC Article 11 consultation |22 |□ No endangered or threatened, fish, wildlife, |□ Not in Compliance |

|prohibited. | | |shellfish, or crustacean were taken, |(Rank N______)# |

| |□ FWS Section 7 consultation | |transported, possessed or sold | |

| | | | | |

|□ Based on investigations performed during design, | | | | |

|endangered species are not impacted by this project. | | | | |

| | | | | |

|DESTRUCTIVE WILDLIFE |□ DEC Article 11 permit |18 |□ Complied with DEC Article 11 Destructive |□ Not in Compliance |

|A DEC permit is required to take protected wildlife | | |Wildlife Permit |(Rank N______)# |

|(including beaver) that become a nuisance, are destructive | | | | |

|to public or private property, or are a threat to public |□ DEC Article 24 permit |20 |□ Complied with DEC Article 24 Wetland |□ Not in Compliance |

|health and welfare. A wetland permit may also be needed to | | |Permit |(Rank N______)# |

|modify or remove beaver dams. | | | | |

| | | | | |

|□ Based on investigations performed during design, | | | | |

|protected wildlife species are not impacted by this | | | | |

|project. | | | | |

| | | | | |

|WILD, SCENIC AND RECREATIONAL RIVERS |□ DEC Article 15, Title 27 |40 |□ Complied with DEC Article 15, Title 27 |□ Not in Compliance |

|A DEC permit and/or NPS approval is required for any |permit | |permit |(Rank N______)# |

|construction activities within designated state or federal | | | | |

|Wild, Scenic and Recreational River corridors. |□ APA concurrence with |40 |□ Complied with APA conditions |□ Not in Compliance |

| |Article 17 | | | |

|□ Based on investigations performed during design, | | | | |

|Wild, Scenic and Recreational Rivers are not |□ NPS coordination |N/A |□ Complied with conditions imposed by |□ Not in Compliance |

|within the project area or within the regulated |(P.L. 95-625) | |National Park Service | |

|distances. | | | | |

| | | | | |

|COMPLIANCE AIR MONITORING |□ Agreements with DEC/DOH |N/A |□ Compliance air monitoring was properly |□ Not in Compliance |

|Independent compliance air monitoring may be required during| | |performed during construction (if required). | |

|construction for public and/or worker health and safety | | | | |

|purposes (asbestos abatement, lead paint removal, etc.). | | | | |

| | | | | |

|□ Based on investigations performed during design, | | | | |

|this project does not include work operations that | | | | |

|will require compliance air monitoring. | | | | |

Page 5 of 14

|LEFT SIDE TO BE COMPLETED BY PROJECT DESIGNER BEFORE PS&E |RIGHT SIDE TO BE COMPLETED BY EIC |

|Environmental Issue |Permit / Approval Obtained |Audit |Compliance Requirements |Noncompliance |

| | |Reg. No. | |(Rank)# |

| | | | | |

|AIR QUALITY ANALYSIS |□ DEC 6 NYCRR Part 240 |48 SEQR |□ Air quality analyses were properly |□ Not in Compliance |

|An air quality analysis may be required during design for | | |performed (Note: Air quality analyses | |

|projects changing horizontal or vertical alignment, or |□ EPA 40 CFR Part 93 | |is required during construction | |

|changing operating conditions (e.g. installation of traffic | | |if substantial re-design of alignments, | |

|signals at previously unsignalized intersections, addition |□ EPA 40 CFR Parts 6, 51 and | |signals and/or lanes becomes necessary). | |

|of travel/queue lanes). |93 | | | |

| | | | | |

|□ Air quality analyses were not required for this |□ Air Quality Analysis was not | |□ Project Air Quality Analysis completed during |□ Not in Compliance |

|project. |completed / documented in the | |construction and is in compliance with | |

| |Design Approval Document | |SEQR / NEPA requirements | |

| | | | | |

| | | | | |

|ASBESTOS ABATEMENT |□ DOL 12 NYCRR Part 56 |N/A |□ DOL-licensed company and DOL-certified |□ Not in Compliance |

|Asbestos abatement must be performed by a DOL-licensed |requirements | |personnel performed work | |

|company using DOL-certified personnel. The DOL and EPA must| | | | |

|be notified before starting any asbestos abatement work. |□ EPA 29 CFR 1926.1101 |N/A |□ Compliance air monitoring was performed |□ Not in Compliance |

|Independent compliance air monitoring is required. |requirements | | | |

| | | | | |

|□ Based on investigations performed during design, |□ EPA 40 CFR Part 61 |N/A |□ EPA and/or DOL were properly notified |□ Not in Compliance |

|asbestos materials will not be impacted/generated |Subpart M requirements | | | |

|by this project. | | | | |

| | | | | |

|ASBESTOS MATERIAL TRANSPORT & DISPOSAL |□ DEC 6 NYCRR Part 364 |28 |□ A licensed ACM transporter was used for |□ Not in Compliance |

|Friable asbestos-containing materials (ACM) must be |requirements | |asbestos materials |(Rank N_______)# |

|transported by a permitted hauler (with a Part 364 permit) | | | | |

|and disposed in an approved asbestos waste facility. |□ DEC 6 NYCRR Part 360 |50A |□ An authorized ACM disposal facility was |□ Not in Compliance |

|Non-friable ACM may be disposed at an approved C&D site. |requirements | |used for friable asbestos materials |(Rank N_______)# |

| | | | | |

|□ Based on investigations performed during design, | | | | |

|asbestos materials are not impacted/generated by | | | | |

|this project. | | | | |

Page 6 of 14

|LEFT SIDE TO BE COMPLETED BY PROJECT DESIGNER BEFORE PS&E |RIGHT SIDE TO BE COMPLETED BY EIC |

|Environmental Issue |Permit / Approval Obtained |Audit |Compliance Requirements |Noncompliance |

| | |Reg. No. | |(Rank)# |

| | | | | |

|LEAD PAINT | |31 |□ Lead paint waste (hazardous waste) was |□ Not in Compliance |

|Removal of lead paint will require compliance with hazardous| | |properly removed, stored, transported and | |

|waste and air quality requirements. Independent compliance | | |disposed | |

|air monitoring may also be required. Refer to the | | | | |

|“Hazardous Waste Storage”, “Hazardous Waste Transportation | | |□ Compliance air monitoring was properly |□ Not in Compliance |

|and Disposal” and “Compliance Air Monitoring” sections of | | |performed (if required) | |

|the ECOPAC for specific requirements. | | | | |

| | | | | |

| | | | | |

| | | | | |

|□ Based on investigations performed during design, | | | | |

|hazardous wastes will not be impacted/generated | | | | |

|by this project. | | | | |

| | | | | |

|HAZARDOUS WASTE STORAGE |□ DEC 6 NYCRR Part 372 |31 |□ Lead paint waste (hazardous waste) was |□ Not in Compliance |

|All hazardous waste containers must be properly labeled, |requirements | |properly removed, stored, transported and |(Rank N_______)# |

|stored, inspected weekly and disposed of within 45 days. If| | |disposed | |

|the project generates more than 220 pounds (100 kilograms) | | | | |

|of hazardous waste per month, an EPA Identification Number |□ DEC 6 NYCRR Part 373-3.9 |31 |□ Complied with all hazardous waste storage |□ Not in Compliance |

|must be obtained. An annual report must be completed if |and 373-1.1 (d) (1) iii or (d) | |requirements |(Rank N_______)# |

|more than 2200 pounds (1000 kilograms) of hazardous waste is|iv requirements | | | |

|generated in any single month. | | |□ Hazardous waste was disposed of within |□ Not in Compliance |

| |□ DEC 6 NYCRR Part 372 |31 |the designated time frames |(Rank N_______)# |

| |requirements | | | |

| | | |□ Annual generator reports were completed |□ Not in Compliance |

| | |32 |by the Regional Construction Office |(Rank N_______)# |

|□ Based on investigations performed during design, | | | | |

|hazardous wastes will not be impacted/generated | | | | |

|by this project. | | | | |

| | | |□ Hazardous Waste was not encountered | |

| | | |during construction | |

Page 7 of 14

|LEFT SIDE TO BE COMPLETED BY PROJECT DESIGNER BEFORE PS&E |RIGHT SIDE TO BE COMPLETED BY EIC |

|Environmental Issue |Permit / Approval Obtained |Audit |Compliance Requirements |Noncompliance |

| | |Reg. No. | |(Rank)# |

| | | | | |

|HAZARDOUS WASTE TRANSPORTATION & DISPOSAL |□ DEC 6 NYCRR Parts |31 |□ An authorized Hazardous Waste Disposal |□ Not in Compliance |

|Hazardous waste must be transported by licensed waste |370- 374 requirements | |Facility was used |(Rank N_______)# |

|transporters. A copy of the transporter’s Part 364 permit | | | | |

|should be obtained. Manifests must be used to track the |□ USDOT 49 CFR 172-173 |28 |□ A licensed Hazardous Waste Transporter |□ Not in Compliance |

|transportation and disposal of hazardous waste. It should |requirements | |was used |(Rank N_______)# |

|be confirmed that the disposal facility is authorized to | | | | |

|accept hazardous | |33 |□ Manifests were properly completed and |□ Not in Compliance |

|waste and that it has adequate capacity. | | |filed |(Rank N_______)# |

| | | | | |

| | | | | |

|□ Based on investigations performed during design, | | | | |

|hazardous wastes will not be impacted/generated | | |□ Hazardous Waste Transportation and | |

|by this project. | | |Disposal was not required during | |

| | | |construction | |

| | | | | |

|PETROLEUM CONTAMINATED MATERIAL |□ DEC 6 NYCRR Parts 360, |56A |□ Petroleum contaminated materials were |□ Not in Compliance |

|Materials/soils contaminated with petroleum products (at |364 requirements | |properly handled, stored, transported and |(Rank N_______)# |

|non-hazardous waste levels) must be identified and disposed | | |disposed | |

|of as industrial solid waste at permitted facilities or | | | | |

|handled as per a DEC approved method. Material storage |□ DEC Spill Technology and |56A |□ Petroleum contaminated materials found |□ Not in Compliance |

|prior to disposal must not exceed 30 days unless approved by|Remediation Series | |during construction, NYDES Spills Hot | |

|EIC. Quantities greater than 500 pounds (227 kilograms) |(STARS) | |Line, and Construction Supervisor called | |

|must be transported by a licensed waste hauler. | | |and actions were consistent with direction | |

| | | |of the Spill Officer. Part 360 and Part 364 | |

| | | |Requirements followed | |

| | | | | |

|□ Based on investigations performed during design, | | | | |

|petroleum contaminated soils are not expected to | | | | |

|be impacted/generated by this project. No action | | |□ Petroleum-Contaminated Materials were | |

|is expected to be required during construction. | | |not encountered during construction | |

Page 8 of 14

|LEFT SIDE TO BE COMPLETED BY PROJECT DESIGNER BEFORE PS&E |RIGHT SIDE TO BE COMPLETED BY EIC |

|Environmental Issue |Permit / Approval Obtained |Audit |Compliance Requirements |Noncompliance |

| | |Reg. No. | |(Rank)# |

| | | | | |

|PESTICIDE AND HERBICIDE APPLICATION |□ DEC 6 NYCRR Part 325 |26 |□ A certified commercial applicator was used |□ Not in Compliance |

|Pesticides and herbicides must only be applied by certified |requirements | | |(Rank N_______)# |

|commercial applicators. Only products registered with DEC | | | | |

|may be used, and all products must be applied in accordance |□ DEC 6 NYCRR Part 326 |25A |□ All pesticides were registered with DEC |□ Not in Compliance |

|with label instructions. A DEC permit is required if |requirements | | |(Rank N_______)# |

|pesticides and herbicides are to be applied within 100 feet | | | | |

|(30 meters) of a state-regulated wetland or in non-isolated |□ DEC Article 24 wetlands |20 |□ Complied w/ DEC Article 24 Wetland |□ Not in Compliance |

|waters. |permit | |Permit |(Rank N_______)# |

| | | | | |

| |□ DEC Part 327 permit |27 |□ Complied with DEC Aquatic Pesticide |□ Not in Compliance |

| | | |(Part 327) Permit |(Rank N_______)# |

|□ Based on investigations performed during design, | | | | |

|the use of pesticides and herbicides will not be | | | | |

|necessary for this project. | | | | |

| | | |□ Pesticides and Herbicides were not used | |

| | | |during construction | |

| | | | | |

|STATE LANDS |□ DEC Article 9-0105 permit |39 |□ Complied with Use of State Land permit |□ Not in Compliance |

|A DEC permit is required for the use of land under the | | | |(Rank N_______)# |

|jurisdiction of DEC | | | | |

|(such as Forest Preserve Lands). | | | | |

| | | | | |

| | | | | |

| | | | | |

| | | | | |

|□ Based on investigations performed during design, | | | | |

|DEC lands will not be used/impacted by this | | | | |

|project. | | | | |

Page 9 of 14

|LEFT SIDE TO BE COMPLETED BY PROJECT DESIGNER BEFORE PS&E |RIGHT SIDE TO BE COMPLETED BY EIC |

|Environmental Issue |Permit / Approval Obtained |Audit |Compliance Requirements |Noncompliance |

| | |Reg. No. | |(Rank)# |

| | | | | |

|NOISE ABATEMENT |□ FHWA 23 CFR Part 772 |48 |□ Complied with noise reduction requirements and |□ Not in Compliance |

|Noise issues must be fully considered in the design of the |requirements | |noise abatement measures were properly installed | |

|project (i.e. – night time construction; local noise | | | | |

|ordinance restrictions; noise sensitive receptors; equipment| | | | |

|compliance; operations that generate significant noise). | | | | |

|Noise abatement measures (such as sound walls) should be | | | | |

|installed as early as possible to assist in the abatement of| | | | |

|construction noise. | | | | |

| | | | | |

| | | |□ Noise abatement measures were not | |

|□ Noise analyses and noise abatement measures are | | |required for this project | |

|not required for this project. | | | | |

| | | | | |

|CULTURAL RESOURCES |□ Properties listed on or |48 |□ No design changes occurred near these |□ Not in Compliance |

|No construction, grading, filling, excavating, clearing, |eligible for the National | |properties during construction without first | |

|stockpiling, storing, staging, tree removal or other related|Register of Historic Places | |obtaining SHPO approval | |

|activities are allowed in or near historic or prehistoric |occur within the project area | | | |

|resources without first consulting with the SHPO and/or | | | | |

|THPO. The FHWA must also be consulted if the project |□ SHPO effect determination |48 |□ Complied with conditions imposed by |□ Not in Compliance |

|includes federal funds. |with conditions | |SHPO | |

| | | | | |

| |□ THPO effect determination |48 |□ Complied with conditions imposed by |□ Not in Compliance |

| |with conditions | |THPO | |

| | | | | |

| |□ FHWA effect determination |48 |□ Complied with conditions imposed by |□ Not in Compliance |

| |with conditions | |FHWA | |

| | | | | |

| |□ DOT/FHWA/SHPO project- |48 |□ Complied with the conditions imposed in |□ Not in Compliance |

| |specific Memorandum of | |the DOT/FHWA/SHPO Memorandum of | |

| |Agreement | |Agreement | |

| | | | | |

| |□ DOT/SHPO Memorandum |48 |□ Complied with the conditions imposed in |□ Not in Compliance, |

| |of Understanding for Canal | |the DOT/SHPO Memorandum of | |

| |Bridges | |Understanding for Canal Bridges | |

| | | | | |

| |□ Project work changed or |48 |□ Projects scope of work changed in |□ Not in Compliance |

| |added after Determination | |construction, work recycled through the | |

| |of Effect, changes recycled | |RLA/ES Unit, SHPO approved | |

|□ Based on investigations performed during design, |through (1409, 106, 4(f), or | | | |

|cultural resources will not be impacted by this |6(f) process | | | |

|project. | | | | |

| | | | | |

| | | | | |

Page 10 of 14

|LEFT SIDE TO BE COMPLETED BY PROJECT DESIGNER BEFORE PS&E |RIGHT SIDE TO BE COMPLETED BY EIC |

|Environmental Issue |Permit / Approval Obtained |Audit |Compliance Requirements |Noncompliance |

| | |Reg. No. | |(Rank)# |

| | | | | |

|AGRICULTURE | | | | |

|Projects impacting more than 1 acre (0.4 hectare) from a |□ Filed a Notice of Intent with |48 |□ Complied with conditions imposed by the |□ Not in Compliance |

|single farm or more than 10 acres (4 hectares) in an |the NYS Department of | |NYS Department of Agriculture and | |

|Agricultural District must complete a Notice of Intent |Agriculture and Markets in | |Markets | |

|process. Any federally funded project that impacts |compliance with 1 NYCRR | | | |

|prime/unique farmland requires the filing of Form AD 1006 |Part 371 | | | |

|with the NRCS. Note: These approvals are | | | | |

|activity-specific. Any impacts incurred during |□ Filed Form AD 1006 with |48 |□ Complied with conditions imposed by the |□ Not in Compliance |

|construction, such as using farmland for off-site |NRCS in compliance with 7 | |Natural Resource Conservation Service | |

|borrow/disposal areas may require separate approvals. |CFR Parts 657 & 658 | | | |

| | | | | |

| | | | | |

|□ Based on investigations performed during design, | | | | |

|agricultural districts and prime/unique soils are | | |□ Agricultural Districts and Prime/Unique | |

|not impacted by this project. | | |Soils were not encountered during | |

| | | |construction | |

| | |

|Special Conditions or permits that have an effect on the project. Project Manager or |Jobs is in compliance with these added factors after review with the LA/ES Unit: |

|Environmental Contact to List here: | |

| | |

|1. |1. |

| | |

|2. |2. |

| | |

|3. |3. |

| | |

|4. |4. |

| | |

|5. |5. |

| | |

| | |

| | |

| | |

| | |

| | |

| | |

| | |

| | |

| | |

| | |

|( DESIGNER STOPS COMPLETING ECOPAC AT THIS POINT ( | |

Page 11 or 14

| |

|ENVIRONMENTAL COMMITMENTS & OBLIGATIONS PACKAGE FOR CONSTRUCTION (ECOPAC) – REGION 1 |

|*** CONSTRUCTION-SPECIFIC ISSUES – THIS PAGE TO BE COMPLETED BY EIC ONLY *** |

|CONSTRUCTION ISSUE |APPLICABLE PERMITS |AUDIT |COMPLIANCE REQUIREMENTS |NONCOMPLIANCE |

| |/ APPROVALS |REG. NO. | |(RANK)# |

|C & D WASTE | | | | |

|The following Construction & Demolition (C & D) wastes are |□ DEC 6 NYCRR Part 360- |50B |□ Contractor properly disposed of all exempt, |□ Not in Compliance |

|exempt from landfill requirements and can be spoiled on-site |1.2; DEC 6 NYCRR Part | |recognizable C & D waste |(Rank N_______)# |

|or off-site during daylight hours if no fee is involved: |360-1.15; and DEC 6 | | | |

|uncontaminated soil, rock, concrete and concrete products, |NYCRR Part 360-7 | | | |

|asphalt pavement, brick and glass. Land clearing and yard |requirements | | | |

|debris (trees, stumps, yard waste, wood chips) are also exempt| | | | |

|if disposal occurs on property owned by or under the control | | | | |

|of DOT. Excess or other C & D wastes must be sent to a C & D | | | | |

|or solid waste disposal facility. | | |□ No C & D waste was generated or disposed | |

| | | |of during construction | |

|STAGING AND SPOIL AREAS | | | | |

|Equipment and construction material may be staged at suitable |□ DEC 6 NYCRR Part 360 |50B |□ All staging and spoil areas were properly |□ Not in Compliance |

|on-site or off-site locations. Uncontaminated excavated |requirements | |sited and no environmentally-sensitive | |

|material may be spoiled at suitable on-site locations and | | |resources were impacted | |

|off-site locations. Do not stage or spoil material in | | | | |

|wetlands, waters, floodplains, farmland, historic sites, | | |□ All staging and spoil areas were properly |□ Not in Compliance |

|visually sensitive areas or other environmentally sensitive | | |reclaimed/restored | |

|locations. Do not store fuel tanks and/or drums of hazardous | | | | |

|materials where spills could enter waterways or other | | | | |

|sensitive resources. Erosion control and site reclamation | | | | |

|plans must be completed before any materials are wasted and/or| | |□ No staging areas or spoil areas were | |

|equipment is stored/staged. | | |required for this project | |

|BORROW AREAS | | | | |

|A DEC mining permit is required if more than 1000 tons (910 |□ DEC 6 NYCRR Parts |44 |□ Contractor had (or obtained) a valid DEC |□ Not in Compliance |

|metric tons) or 750 cubic yards (573 cubic meters) of minerals|420-426 requirements | |mining permit |(Rank N_______)# |

|are removed from a borrow area within 12 successive months. | | | | |

|Excavation integral to construction (e.g. roadbed excavation) |□ DEC/DOT 1977 MOUS1 |44 |□ All borrow/mining areas were properly |□ Not in Compliance |

|is excluded. Erosion control and site reclamation must be | | |reclaimed/restored |(Rank N_______)# |

|completed in borrow areas. Note: If material is being | | | | |

|obtained from a commercial source which has a valid mining | | | | |

|permit, the DOT/Contractor does not need to obtain a separate | | | | |

|permit. Plans showing grading and restoration must be | | | | |

|approved by EIC before these operations may start. | | |□ No borrow areas or mining permits were | |

| | | |required for this project | |

|CONSTRUCTION NOISE | | | | |

|Construction noise must be reduced to the fullest extent |□ FHWA 23 CFR Part 772 |48 |□ Contractor complied with work hour |□ Not in Compliance |

|possible. All equipment must have the correct mufflers and |requirements | |restrictions and/or contract requirements | |

|other factory compliant parts. Contractor must comply with | | | | |

|all work hour restrictions if imposed. Public should be | | | | |

|notified in advance of operations generating significant | | | | |

|construction noise (such as blasting, pile driving, deck | | | | |

|demolition). Notices, bulletins, message boards and other | | | | |

|media avenues should be used to alert the community of loud | | | | |

|construction activities. | | | | |

Page 12 of 14

| |

|ENVIRONMENTAL COMMITMENTS & OBLIGATIONS PACKAGE FOR CONSTRUCTION (ECOPAC) – REGION 1 |

|*** CONSTRUCTION-SPECIFIC ISSUES – THIS PAGE TO BE COMPLETED BY EIC ONLY *** |

|CONSTRUCTION ISSUE |APPLICABLE PERMITS / APPROVALS |AUDIT |COMPLIANCE REQUIREMENTS |NONCOMPLIANCE |

| | |REG. NO. | |(RANK)# |

| | | | | |

|SPILLS REPORTING |□ DEC 6 NYCRR Part 613 |56A |□ Petroleum spill(s) were properly reported |□ Not in Compliance |

|All petroleum spills (gasoline, diesel, fuels, waste oil) and |requirements | | |(Rank N_______)# |

|hazardous substance spills must be reported to the DEC Spills | | | | |

|Unit within 2 hours of discovery. Any releases or leaks from |□ DEC 6 NYCRR Part 595 |51A |□ Hazardous substance spill(s) were properly |□ Not in Compliance |

|tanks must also be reported to the DEC |requirements | |reported |(Rank N_______)# |

| | | | | |

|Tanks discovered in project excavation must be reported to the| | | | |

|NYS DEC Spills Hotline at 1-800-457-7362 with|□ DEC 6 NYCRR Part 613 |56A |□ Found Tanks were properly reported |□ Not in Compliance |

|in 2 hours of discovery. Tanks are to be treated as a spill |requirements | | |(Rank N_______)# |

|and receive a NYS DEC Spill Number. | | | | |

| | | |□ No tanks, petroleum or hazardous substance spills | |

| | | |occurred or were encountered during construction | |

| | | | | |

|BULK PETROLEUM AND CHEMICAL STORAGE |□ DEC 6 NYCRR Part 612 |56 |□ Petroleum tanks were properly registered or |□ Not in Compliance |

|Bulk petroleum storage tanks exceeding 1100 gallons (4165 |& 613 requirements | |a waiver was obtained from DEC |(Rank N_______)# |

|liters) (combined total) and all chemical tanks containing | | | | |

|hazardous substances that are brought on site must be | |56C |□ Petroleum bulk storage fees were paid |□ Not in Compliance |

|registered with DEC. Valid registration must be maintained |□ DEC 6 NYCRR Part 596 | | |(Rank N_______)# |

|until tanks are removed from the site – unless registration is|requirements | | | |

|waived by DEC. Appropriate bulk storage fees must be paid to | |51 |□ Chemical tanks were properly registered or |□ Not in Compliance |

|DEC. | | |a waiver was obtained from DEC |(Rank N_______)# |

| | | | | |

| | |51C |□ Chemical bulk storage fees were paid |□ Not in Compliance |

| | | | |(Rank N_______)# |

| | | | | |

| | | |□ Bulk petroleum and/or chemical storage | |

| | | |tanks were not required during construction | |

| | | | | |

|ENVIRONMENTAL REGULATORY FEES |□ DEC 6 NYCRR Parts 480, |31B |□ Hazardous waste generator fees were paid |□ Not in Compliance |

|Annual regulatory fees must be paid for projects generating |481, and 485 requirements | |by Regional Construction Office |(Rank N_______)# |

|more than 15 tons (13.6 metric tons) of hazardous waste, | | | | |

|projects with SPDES permits, and projects with Mined Land | |58A |□ SPDES permit fees were paid by Regional |□ Not in Compliance |

|Reclamation permits (for DOT/contractor mining permits). | | |Construction Office |(Rank N_______)# |

| | | | | |

| | |44A |□ Mined Land Reclamation fees were paid by |□ Not in Compliance |

| | | |Regional Construction Office |(Rank N_______)# |

| | | | | |

| | | | | |

| | | |□ Payment of Regulatory Fees was not | |

| | | |required during construction | |

| | | | | |

| | | | | |

| | | | | |

Page 13 of 14

| |

|ENVIRONMENTAL COMMITMENTS & OBLIGATIONS PACKAGE FOR CONSTRUCTION (ECOPAC) – REGION 1 |

| |

|*** CONSTRUCTION-SPECIFIC ISSUES – THIS PAGE TO BE COMPLETED BY EIC ONLY *** |

|Construction Issue |Applicable Permits |Audit |Compliance Requirements |Noncompliance |

| |/ Approvals |Reg. No. | |(Rank)# |

| | | | | |

|OPEN BURNING |□ DEC Part 215 permit |13 |□ Contractor obtained Part 215 Open Fires |□ Not in Compliance |

|The current DOT policy is to avoid open burning. A DEC Open | | |permit and burned only proper materials |(Rank N_______)# |

|Fires permit is required for burning conducted on-site or at a| | | | |

|designated burn site. Only materials generated during land | | | | |

|clearing (tree trimmings, leaves, brush) and/or wood generated| | | | |

|during demolition may be burned. Burning of other materials | | | | |

|is not allowed. | | | | |

| | | | | |

|GENERAL NUISANCE |□ DEC 6 NYCRR Part 211 |7 |□ Contractor complied with Part 211 |□ Not in Compliance |

|Project activities must not cause or allow emissions or air |requirements | |requirements regarding nuisance air |(Rank N_______)# |

|contaminants (including asphalt emissions and dust) into the | | |emissions | |

|atmosphere of such quantity, characteristic or duration which | | | | |

|are injurious to humans, plants, animals, property, or which | | | | |

|unreasonably interfere with the comfortable enjoyment of life | | | | |

|or property. | | | | |

| | | | | |

|DIESEL ENGINE EMISSIONS |□ DEC 6 NYCRR Part |5C |□ Contractor complied with Part 217.3 |□ Not in Compliance |

|All diesel vehicle exhaust must be clear and must not include |217.3 requirements | |requirements for diesel engine emissions |(Rank N_______)# |

|dense smoke. Diesel vehicles must not idle for more than 5 | | | | |

|continuous minutes except when necessary for operator comfort,| | | | |

|when the vehicle must remain motionless for more than 2 hours | | | | |

|at temperatures less than 25°F (-4°C), or when the vehicle is | | | | |

|being used to provide power for an additional purpose – such | | | | |

|as another construction operation. | | | | |

| | | | | |

|HAZARDOUS WASTE AND SOLID WASTE REDUCTION |Environmental Conservation Law |70 & 71 |□ Contractor implemented effective |□ Not in Compliance |

|The current DOT policy is to reduce the amount and toxicity of|27-0106 requirements | |hazardous waste and solid waste reduction |(Rank N_______)# |

|solid and hazardous waste generated during construction, to | | |techniques | |

|reuse or recycle material, and to select disposal methods that| | | | |

|minimize future environmental impacts. Techniques include | | | | |

|substituting a hazardous material with a less hazardous | | | | |

|material; segregating wastes; reusing wastes; and recycling. | | | | |

| |

|END OF ECOPAC |

|Current as of Friday, December 31, 2004 by CPS |

Page 14 of 14

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