ECOPAC – REGION 1 - New York State Department of ...



ENVIRONMENTAL COMMITMENTS & OBLIGATIONS PACKAGE FOR CONSTRUCTION (ECOPAC)

Current as of May 4, 2006 Edited by J. Farina | |

|Project:       |Project Manager:       |

| | |

|PIN:       |Design Environmental Contact:       |

| | |

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

| | |

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

| |

|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 the 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. |

| |

|Exact construction/repair locations have not been identified for this Project (IE. Where and When). As sites are identified, they will be screened for any environmental concerns, reviews or permits. A |

|separate ECOPAC will be developed for each site. [Only include page one of this document for PS&E] |

| |

|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) |

|Non-Compliance Rank Definitions |

|Rank N1 = Imminent substantial threat to public health or 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 Manager (in consultation with LA/Environmental Coordinator) completes the left side of the |Engineer-in-Charge in consultation with the CEC completes right side of ECOPAC form (pages 1 -11) and |

|ECOPAC form (pages 1 – 11) prior to filing the PS & E package. |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 |

| |

|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 included |48 | All work done as per plan with no major | Not in Compliance |

|All phases and proposed work included in this project and/or |in Design Approval Document | |project changes |(Rank N______)# |

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

|processed under and with SEQR compliance. ECL Article 8, and |SEQR completed for all work shown| | | |

|6NYCRR Part 15. |in contract documents or for work added|48 |All additional work processed as per SEQR |Not in Compliance |

| |after Design Approval | |Regulations, for additional work RLA/EM was |(Rank N______)# |

| | | |contacted, SEQR completed | |

| |SEQR shall be completed for all work | | | |

| |added during construction | | | |

| | |48 |SEQR not completed for all work added during |Not in Compliance |

| | | |construction:~) |(Rank N______)# |

| | | | | |

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

|All phases and proposed work included in this project and/or |contract documents | |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 work shown in |N/A |All additional work processed as per NEPA |Not in Compliance |

|Federal Funding or Federal Permits. |contract documents or for work added | |Regulations, RLA/EM was contacted, NEPA completed |(Rank N______)# |

|No Federal Funding |after Design Approval | | | |

|No Federal Permits Required | | |NEPA not completed for all work added during | |

| | | |construction : |Not in Compliance |

| | | | |(Rank N______)# |

| | | | | |

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

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

|construction, grading, filling, excavating, clearing, | | | | |

|stockpiling, storing, staging, or other activity in a wetland. | | |Complied with APA Permit Requirements | |

|Activities within 100 feet (30 meters) of a state wetland are |APA Wetlands Permit |20 | |Not in Compliance |

|also regulated. Any wetland impacts incurred during | | |Complied with DEC Section 401 Water Quality |(Rank N______)# |

|construction, such as those associated with off-site disposal, |DEC Section 401 Water Quality |49 |Certificate |Not in Compliance |

|may require a separate permit. |Certificate | | |(Rank N______)# |

| | | |Complied with Section 404 Individual permit | |

|***There is a potential that regulated wetlands exist within |COE Section 404 Individual permit |N/A | |Not in Compliance |

|the project limits. Due to the nature of the work these | | |Submitted NWP Compliance Certificate and |(Rank N______)# |

|wetlands may not be shown in the contract documents. Any work,|COE Section 404 Nationwide permits | |Post-Construction Report (if required) | |

|storage or placement of materials and/or field offices needs to|List NWP#       |N/A | |Not in Compliance |

|be reviewed for any wetlands or other environmental factors. | | |Built as submitted for EO 11990 |(Rank N______)# |

| |FHWA Executive Order 11990 | | | |

| | |NA | |Not in Compliance |

| |Mitigation Plan Required | |Mitigation Plan Implemented |(Rank N______)# |

| | | | | |

| | |NA |Wetlands were not encountered during construction |Not in Compliance |

|Based on investigations during design, wetlands will not be | | | |(Rank N______)# |

|impacted by this project. | | | | |

|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 prevent |DEC Article 15 Memorandum of |23 |Complied with conditions imposed by DEC (such as date|Not in Compliance |

|damage, pollution and sedimentation in or near the water. In |Understanding coordination | |restrictions for in-water work) |(Rank N______)# |

|water work must not occur during restricted time periods if | | |Complied with DEC Section 401 Blanket Water Quality | |

|imposed by DEC. Erosion prevention and sediment controls must |DEC Section 401 Water Quality |49 |Certification |Not in Compliance |

|be employed as shown in the Contract Documents. Limit the |Certification. Blanket Certification | | |(Rank N______)# |

|amount of bare soil exposed at any one time to minimize |DEC Section 401 Water Quality | |Complied with DEC Section 401 Individual Water | |

|potential water quality impacts, if applicable. |Certification. Individual Water Quality|49 |Quality Certification |Not in Compliance |

|***There is a potential that surface waters exist within the |Certification | | |(Rank N______)# |

|project limits. Due to the nature of the work, these waters |COE Section 404 Individual permit | | | |

|may not be shown in the contract documents. Any work, storage | | |Complied with Section 404 Individual Permit | |

|or placements of materials and or field offices needs to be |COE Section 404 Nationwide permit List|N/A | |Not in Compliance |

|reviewed for any waters and other environmental factors. |NWP#       | |Submitted NWP Compliance Certificate and |(Rank N______)# |

| | | |Post-Construction Report (if required) | |

|Based on investigations performed during design, surface waters| |N/A | |Not in Compliance |

|will not be impacted by this project. | | |Surface Waters were not encountered during | |

| | | |construction | |

| | | | | |

| | | | | |

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

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

|obstruct or alter navigable waters (including filling and |COE Section 10 Nationwide permit List | | | |

|dredging). Limit the amount of ground disturbed at any one |NWP#       |N/A |Complied with COE Section 10 NWP |Not in Compliance |

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

| |USCG Section 9 Permit | | | |

|Based on investigations performed during design, navigable | |N/A |Complied with USCG Section 9 |Not in Compliance |

|waters will not be impacted by this |USCG Section 9 Notification | | | |

|project. | |N/A |Complied with USCG Section 9 Notification |Not in Compliance |

| | | | | |

| | | |Navigable Waters were not encountered 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 | | |Complied with conditions imposed by EPA | |

|materials in aquifer areas. |EPA Section 1424(e) |N/A | |Not in Compliance |

| |consultation F5 | |All erosion prevention and sediment control measures | |

|Based on investigations performed during design, sole source | | |were in place as required | |

|aquifers are not impacted by this project. |Project is located over a Sole | | |Not in Compliance |

| |Source Aquifer, no additional | | | |

| |measures, except erosion | | | |

| |prevention and sediment | | | |

| |control plans are required | | | |

|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 (CBRS) |FCAF completed |N/A |Complied with FCAF |Not in Compliance |

|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 approval |53 |Complied with DEC Article 15-0503 approval |Not in Compliance |

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

|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 on flood |Not in Compliance |

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

|land and changes landscape features; destroys vegetation; adds | | | | |

|gutter, sidewalks, driveways, parking lots or parking spaces; | |54B |Complied with DEC Part 501 for operation of motor |Not in Compliance |

|or involves outdoor lighting, utilities or operation of a motor| | |vehicles on flood control lands |(Rank N______)# |

|vehicle. | | | | |

| | | | | |

|Based on investigations performed during design, DEC flood | | | | |

|control lands will not be impacted by this project | | | | |

| | | | | |

|DEC PHASE II SPDES CONSTRUCTION PERMIT |DEC Article 17, Titles 3, 7, and 8 |58B |Complied with DEC Phase II SPDES Storm Water |Not in Compliance |

|A DEC Phase II SPDES Construction Permit is required on all | | |Pollution Prevention Plan and completed all |(Rank N______)# |

|projects were there is a soil disturbance of one acre or more | | |inspections and reports as per the SPDES General | |

|on any individual parcel of property. This disturbance of soil | | |Permit 02-01 and/or the MOU with the NYS DEC. | |

|is a result of Permanent or Temporary impacts. Defined areas of| | | | |

|disturbance have been included in the SWPPP and NOI. |SPDES Notice of Intent [NOI] filed | |SPDES Notice of Termination [NOT] filed at the | |

| |before construction begins. | |conclusion of the project. |Not in Compliance |

|Based on the design and areas computed by the designer, there | | | | |

|will be less than one acre of disturbance on any single parcel | | | | |

|affected by this project. A SPDES Construction Permit for this | | | | |

|project is not required. | | | | |

|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 removal | | | |(Rank N______)# |

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

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

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

| |FWS Section 7 consultation | |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 Wildlife |Not in Compliance |

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

|beaver) that become a nuisance, are destructive to public or | | | | |

|private property, or are a threat to public health and welfare.|DEC Article 24 permit |20 |Complied with DEC Article 24 Wetland Permit |Not in Compliance |

|A wetland permit may also be needed to modify or remove beaver | | | |(Rank N______)# |

|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 permit |40 |Complied with DEC Article 15, Title 27 permit |Not in Compliance |

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

|construction activities within designated state or federal |APA concurrence with Article 17 | |Complied with APA conditions | |

|Wild, Scenic and Recreational River corridors. | |40 | |Not in Compliance |

| |NPS coordination (P.L. 95-625) | | | |

|Based on investigations performed during design, Wild, Scenic | | |Complied with conditions imposed by National Park | |

|and Recreational Rivers are not within the project area or | |N/A |Service |Not in Compliance |

|within the regulated distances. | | | | |

| | | | | |

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

|Independent compliance air monitoring may be required during | | |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. | | | | |

|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 |Air quality analyses were properly performed (Note: |Not in Compliance |

|An air quality analysis may be required during design for | | |Air quality analyses is required during construction | |

|projects changing horizontal or vertical alignment, or changing|EPA 40 CFR Part 93 |N/A |if substantial re-design of alignments, signals | |

|operating conditions (e.g. installation of traffic signals at | | |and/or lanes becomes necessary). | |

|previously unsignalized intersections, addition of travel/queue|EPA 40 CFR Parts 6, 51 and 93 |N/A | | |

|lanes). | | | | |

| |Air Quality Analysis was not | |Project Air Quality Analysis completed during | |

|Air quality analyses were not required for this project. |completed / documented in the Design | |construction and is in compliance with SEQR / NEPA |Not in Compliance |

| |Approval Document | |requirements | |

| | | | | |

| | | | | |

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

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

|using DOL-certified personnel. The DOL and EPA must be |EPA 29 CFR 1926.1101 requirements | | | |

|notified before starting any asbestos abatement work. | |N/A |Compliance air monitoring was performed |Not in Compliance |

|Independent compliance air monitoring is required. |EPA 40 CFR Part 61 Subpart M | | | |

| |requirements | | | |

|Based on investigations performed during design, asbestos | |N/A |EPA and/or DOL were properly notified |Not in Compliance |

|materials will not be impacted/generated by this project. | | | | |

| | | | | |

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

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

|by a permitted hauler (with a Part 364 permit) and disposed in |DEC 6 NYCRR Part 360 requirements | | | |

|an approved asbestos waste facility. Non-friable ACM may be | |50A |An authorized ACM disposal facility was |Not in Compliance |

|disposed at an approved C&D site. | | |used for friable asbestos materials |(Rank N_______)# |

| | | | | |

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

|materials are not impacted/generated by this project. | | | | |

|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 | | | | |

|Removal of lead paint will require compliance with hazardous |Expected and included in the | |Lead paint waste (hazardous waste) was properly |Not in Compliance |

|waste and air quality requirements. Independent compliance air|construction plans and documents. | |removed, stored, transported and disposed | |

|monitoring may also be required. Refer to the “Hazardous Waste|Includes minor areas for steel | | | |

|Storage”, “Hazardous Waste Transportation and Disposal” and |cutting and demolition. | |Compliance air monitoring was properly performed (if| |

|“Compliance Air Monitoring” sections of the ECOPAC for specific| | |required) |Not in Compliance |

|requirements. | | | | |

| | | | | |

| | | | | |

| | | | | |

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

|wastes (lead paint waste) will not be impacted/generated by | | | | |

|this project. | | | | |

| | | | | |

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

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

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

|the project generates more than 220 pounds (100 kilograms) of |DEC 6 NYCRR Part 373-3.9 and 373-1.1 | |Complied with all hazardous waste storage | |

|hazardous waste per month, an EPA Identification Number must be|(d)(1)iii or (d)iv requirements |31 |requirements |Not in Compliance |

|obtained. An annual report must be completed if more than 2200| | | |(Rank N_______)# |

|pounds (1000 kilograms) of hazardous waste is generated in any |DEC 6 NYCRR Part 372 requirements | |Hazardous waste was disposed of within the designated| |

|single month. | | |time frames |Not in Compliance |

| | |31 | |(Rank N_______)# |

| | | | | |

| | | |Annual generator reports were completed by the | |

| | |32 |Regional Construction Office |Not in Compliance |

| | | | |(Rank N_______)# |

|Based on investigations performed during design, hazardous | | |Hazardous Waste was not encountered during | |

|wastes will not be impacted/generated by this project. | | |construction | |

|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 370- 374 |31 |An authorized Hazardous Waste Disposal Facility was |Not in Compliance |

|Hazardous waste must be transported by licensed waste |requirements | |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 requirements |28 |A licensed Hazardous Waste Transporter was used |Not in Compliance |

|transportation and disposal of hazardous waste. It should be | | | |(Rank N_______)# |

|confirmed that the disposal facility is authorized to accept | | |Manifests were properly completed and filed | |

|hazardous | |33 | |Not in Compliance |

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

| | | | | |

| | | |Hazardous Waste Transportation and Disposal was not | |

|Based on investigations performed during design, hazardous | | |required during construction | |

|wastes will not be impacted/generated by this project. | | | | |

| | | | | |

|PETROLEUM CONTAMINATED MATERIAL |DEC 6 NYCRR Parts 360, 364 |50A |Petroleum contaminated materials were properly |Not in Compliance |

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

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

|as industrial solid waste at permitted facilities or handled as| | |Petroleum contaminated materials found during | |

|per a DEC approved method. Material storage prior to disposal |DEC Spill Technology and Remediation | |construction, NYDES Spills Hot Line, and Construction|Not in Compliance |

|must not exceed 30 days unless approved by EIC. Quantities |Series (STARS) | |Supervisor called and actions were consistent with | |

|greater than 500 pounds (227 kilograms) must be transported by | | |directionof the Spill Officer. Part 360 and Part 364| |

|a licensed waste hauler. | | |Requirements followed | |

| | | | | |

|Note: NYS DEC Spills Hotline needs to be called within 2 hours | | |Petroleum-Contaminated Materials or tanks were | |

|of finding any previously undocumented tank or spill during |DEC 6 NYCRR Part 613 requirements | |encountered during construction, and NYS DEC was | |

|construction at 1-800-457-7362 | | |contacted within 2 hours |Not in Compliance |

| | | | | |

| | | |Petroleum-Contaminated Materials were not encountered| |

| | | |during construction | |

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

|contaminated soils are not expected to be impacted/generated by| | | | |

|this project. No action is expected to be required during | | | | |

|construction. | | | | |

|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 requirements |26 |A certified commercial applicator was used |Not in Compliance |

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

|commercial applicators. Only products registered with DEC may |DEC 6 NYCRR Part 326 requirements | |All pesticides were registered with DEC | |

|be used, and all products must be applied in accordance with | |25A | |Not in Compliance |

|label instructions. A DEC permit is required if pesticides and|DEC Article 24 wetlands permit | | |(Rank N_______)# |

|herbicides are to be applied within 100 feet (30 meters) of a | | |Complied w/ DEC Article 24 Wetland Permit | |

|state-regulated wetland or in non-isolated waters. |DEC Part 327 permit |20 | |Not in Compliance |

| | | |Complied with DEC Aquatic Pesticide (Part 327) Permit|(Rank N_______)# |

| | | | | |

| | |27 |Pesticides and Herbicides were not used during |Not in Compliance |

| | | |construction |(Rank N_______)# |

|Based on investigations performed during design, the use of | | | | |

|pesticides and herbicides will not be necessary for this | | | | |

|project. | | | | |

| | | | | |

|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. | | | | |

|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 requirements |48 |Complied with noise reduction requirements and noise |Not in Compliance |

|Noise issues must be fully considered in the design of the | | |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 analyses and noise abatement measures are not required | | |Noise abatement measures were not required for this | |

|for this project. | | |project | |

| | | | | |

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

|No construction, grading, filling, excavating, clearing, |the National Register of Historic | |during construction without first obtaining SHPO | |

|stockpiling, storing, staging, tree removal or other related |Places occur within the project area | |approval | |

|activities are allowed in or near historic or prehistoric | | | | |

|resources without first consulting with the SHPO and/or THPO. |SHPO effect determination with | | | |

|The FHWA must also be consulted if the project includes federal|conditions | | | |

|funds. | |48 |Complied with conditions imposed by SHPO |Not in Compliance |

| |THPO effect determination with | | | |

| |conditions | |Complied with conditions imposed by THPO | |

| | |48 | |Not in Compliance |

| |FHWA effect determination with | |Complied with conditions imposed by FHWA | |

| |conditions | | | |

| | |48 |Complied with the conditions imposed in the |Not in Compliance |

| |DOT/FHWA/SHPO project-specific | |DOT/FHWA/SHPO Memorandum of Agreement | |

| |Memorandum of Agreement | | | |

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

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

| |for Canal Bridges | | | |

| | | |Projects scope of work changed in construction, work | |

| |Project work changed or added after |48 |recycled through the RLA/ES Unit, SHPO approved |Not in Compliance, |

| |Determination of Effect, changes | | | |

| |recycled through (1409, 106, 4(f), or| | | |

| |6(f) process | | | |

| | |48 | |Not in Compliance |

| | | | | |

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

|resources will not be impacted by this 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 single|Filed a Notice of Intent with the NYS|48 |Complied with conditions imposed by the NYS |Not in Compliance |

|farm or more than 10 acres (4 hectares) in an Agricultural |Department of Agriculture and Markets| |Department of Agriculture and Markets | |

|District must complete a Notice of Intent process. Any |in compliance with 1 NYCRR Part 371 | | | |

|federally funded project that impacts prime/unique farmland | | | | |

|requires the filing of Form AD 1006 with the NRCS. Note: |Filed Form AD 1006 with NRCS in | | | |

|These approvals are activity-specific. Any impacts incurred |compliance with 7CFR Parts 657 & 658 | |Complied with conditions imposed by the Natural | |

|during construction, such as using farmland for off-site | |N/A |Resource Conservation Service |Not in Compliance |

|borrow/disposal areas may require separate approvals. | | | | |

| | | | | |

| | | | | |

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

|districts and prime/unique soils are not impacted by this | | |Agricultural Districts and Prime/Unique Soils were | |

|project. | | |not encountered during construction | |

| | |

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

|Contact to List here: | |

| | |

|1.       |1.       |

| | |

|2.       |2.       |

| | |

|3.       |3.       |

| | |

|4.       |4.       |

| | |

|5.       |5.       |

| | |

|DESIGNER STOPS COMPLETING ECOPAC AT THIS POINT ( | |

| |EIC TO CONTINUE COMPLETING ECOPAC ON FOLLOWING PAGES |

| | |

| |

|ENVIRONMENTAL COMMITMENTS & OBLIGATIONS PACKAGE FOR CONSTRUCTION (ECOPAC) |

|*** 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 exempt |DEC 6 NYCRR Part 360-1.2; DEC 6 |50B |Contractor properly disposed of all exempt, |Not in Compliance |

|from landfill requirements and can be spoiled on-site or off-site |NYCRR Part 360-1.15; and DEC 6 | |recognizable C & D waste |(Rank N_______)# |

|during daylight hours if no fee is involved: uncontaminated soil, |NYCRR Part 360-7 requirements | | | |

|rock, concrete and concrete products, asphalt pavement, brick and | | | | |

|glass. Land clearing and yard 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 requirements |48B |All staging and spoil areas were properly sited and |Not in Compliance |

|on-site or off-site locations. Uncontaminated excavated material | | |no environmentally-sensitive resources were impacted | |

|may be spoiled at suitable on-site locations and off-site | | | | |

|locations. Do not stage or spoil material in wetlands, waters, | | |All staging and spoil areas were properly | |

|floodplains, farmland, historic sites, visually sensitive areas or| | |reclaimed/restored |Not in Compliance |

|other environmentally sensitive 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 | | |No staging areas or spoil areas were required for | |

|wasted and/or equipment is stored/staged. | | |this project | |

|BORROW AREAS | | | | |

|A DEC mining permit is required if more than 1000 tons (910 metric|DEC 6 NYCRR Parts 420-426 |44 |Contractor had (or obtained) a valid DEC mining |Not in Compliance |

|tons) or 750 cubic yards (573 cubic meters) of minerals are |requirements | |permit |(Rank N_______)# |

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

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

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

|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 possible.|FHWA 23 CFR Part 772 requirements |48 |Contractor complied with work hour restrictions |Not in Compliance |

|All equipment must have the correct mufflers and other factory | | |and/or contract requirements | |

|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. | | | | |

| |

|ENVIRONMENTAL COMMITMENTS & OBLIGATIONS PACKAGE FOR CONSTRUCTION (ECOPAC) |

|*** 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 requirements |56A |Petroleum spill(s) were properly reported |Not in Compliance |

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

|hazardous substance spills must be reported to the DEC Spills Unit|DEC 6 NYCRR Part 595 requirements | | | |

|within 2 hours of discovery. Any releases or leaks from tanks | |51A |Hazardous substance spill(s) were properly reported |Not in Compliance |

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

| |DEC 6 NYCRR Part 613 requirements | | | |

|Tanks discovered in project excavation must be reported to the NYS| | |Found Tanks were properly reported | |

|DEC Spills Hotline at 1-800-457-7362 with in 2 hours of | |56A | |Not in Compliance |

|discovery. Tanks are to be treated as a spill and receive a NYS | | | |(Rank N_______)# |

|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 & 613 |56 |Petroleum tanks were properly registered or a waiver |Not in Compliance |

|Bulk petroleum storage tanks exceeding 1100 gallons (4165 liters) |requirements | |was obtained from DEC |(Rank N_______)# |

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

|substances that are brought on site must be registered with DEC. | |56C |Petroleum bulk storage fees were paid |Not in Compliance |

|Valid registration must be maintained until tanks are removed from|DEC 6 NYCRR Part 596 requirements | | |(Rank N_______)# |

|the site – unless registration is waived by DEC. Appropriate bulk| | | | |

|storage fees must be paid to DEC. | |51 |Chemical tanks were properly registered or a waiver |Not in Compliance |

| | | |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, 481, and |31B |Hazardous waste generator fees were paid by Regional |Not in Compliance |

|Annual regulatory fees must be paid for projects generating more |485 requirements | |Construction Office |(Rank N_______)# |

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

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

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

| | | | | |

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

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

| | | | | |

| | | | | |

| | | |Payment of Regulatory Fees was not required during | |

| | | |construction | |

| | | | | |

| |

|ENVIRONMENTAL COMMITMENTS & OBLIGATIONS PACKAGE FOR CONSTRUCTION (ECOPAC) |

| |

|*** 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 permit and |Not in Compliance |

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

|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 requirements |7 |Contractor complied with Part 211 requirements |Not in Compliance |

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

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

|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 217.3 |5C |Contractor complied with Part 217.3 requirements for |Not in Compliance |

|All diesel vehicle exhaust must be clear and must not include |requirements | |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 hazardous waste and |Not in Compliance |

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

|solid and hazardous waste generated during construction, to 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 |

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