Facility: _______________________________________ Date: __________________

Prepared by: _______________________________________ Phone:__________________

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Section 1. Proposed Project Description

Describe the proposed project. Include general information identifying procedure(s) and/or airspace action(s) to be implemented and/or amended. Identify the associated airports and/or facilities.

1.1. Describe the operational and/or environmental benefits that may result if the proposed action is implemented.

1.1.1. Is a reduction of fuel cost and/or energy consumption anticipated as a result of the proposed action?
☐ Yes ☐ No ☐ N/A

1.1.1.a. If so, can it be quantified, and how?
☐ Yes ☐ No

1.1.1.b. If not quantifiable, describe the approximate anticipated benefits in lay terms.

1.1.2. Describe any additional operational and/or environmental benefits that may result from the proposed action.

1.2. Describe the existing procedure(s) (the no action alternative) in full detail. Provide the necessary chart(s) depicting the current procedure(s). Describe the typical fleet mix, including (if possible) the number and types of aircraft on the route (both annually and average day) and depict their altitude(s) along the route.

1.3. Describe the proposed action, providing the necessary chart(s) depicting changes. Describe anticipated changes to the fleet mix, numbers of aircraft on the new routes and their altitude(s), if any.

1.3.1. Has airspace modeling been conducted using Sector Design Analysis Tool (SDAT), Aviation Environmental Screening Tool (AEST), Terminal Area Route Generation, Evaluation, and Traffic Simulation (TARGETS), or another airspace/air traffic design tool?
☐ Yes. Model: __________________ ☐ No
If yes, provide a summary of the output from the modeling.

1.3.2. Will there be actions affecting changes in aircraft flights between the hours of 10 p.m. - 7 a.m. local?
☐ Yes ☐ No
Describe:

1.3.3. Are any noise abatement programs presently in effect for the affected airport(s), formal or informal?
☐ Yes ☐ No
Describe:

1.3.4. Will airport preferential runway configuration use change as a result of the proposed action?
☐ Yes ☐ No
Explain:

1.3.5. Is the proposed action primarily designed for Visual Flight Rules (VFR), Instrument Flight Rules (IFR) operations, or both?
☐ VFR ☐ IFR ☐ Both
If the proposed action specifically involves a charted visual approach (CVA) procedure, provide a detailed local map indicating the route of the CVA, along with a discussion of the rationale for how the route was chosen.

1.3.6. Will there be a change in takeoff power requirements?
☐ Yes ☐ No
If so, what types of aircraft are involved, i.e., general aviation propeller-driven versus large air carrier jets?

1.3.7. Will all changes occur over 3,000 feet above ground level (AGL)?
☐ Yes ☐ No

1.3.8. What is the lowest altitude on newly proposed routes or on existing routes that will receive an increase in operations?

1.3.9. Will there be actions involving civil jet aircraft arrival procedures between 3,000-7,000 feet AGL or departures between 3,000-10,000 feet AGL?
☐ Yes ☐ No

Section 2. Purpose and Need

2.1. Describe the purpose and need for the proposed action. Present the problem being addressed and describe what the FAA is trying to achieve with the proposed action. The purpose and need for the proposed action must be clearly explained and stated in terms that are understandable to individuals who are not familiar with aviation or commercial aerospace activities. If detailed background information is available, summarize here and provide a copy as an attachment to this review.

2.1.1. Is the proposed action the result of a user or community request or regulatory mandate?
☐ Community Request ☐ Regulatory Mandate ☐ User Request

2.1.2. If not, describe what necessitates this proposed action:

Section 3. Alternatives

3.1. Are there alternatives to the proposed action?
☐ Yes ☐ No
If yes, describe any alternatives to the proposed action.

3.2. Please provide a summary description of eliminated alternatives and the reasons for their elimination.

Section 4. Environmental Review and Evaluation

The determination of whether a proposed action may have a significant environmental effect is made by considering requirements applicable to the specific environmental impact categories discussed below (see FAA Order 1050.1, appendix B).

4.1. Describe the Affected Environment

4.1.1. Describe the existing land use, including noise sensitive areas (if any) in the vicinity of the proposed action.

4.1.2. Will the proposed action introduce air traffic over noise sensitive areas not currently affected?
☐ Yes ☐ No
Describe:

4.2. Environmental Consequences

As stated in FAA Order 1050.1, paragraph 5-2. b., extraordinary circumstances exist when a proposed action meets both of the following criteria:

4.2.a. Involves any of the following circumstances below; and

4.2.b. May have a significant impact (see 40 CFR 1508.4).

4.2.1. Air Quality
Has research been conducted to identify areas of concern or communication with air quality regulatory agencies to determine if the affected area is a non-attainment area (an area which exceeds the Clean Air Act (CAA) National Ambient Air Quality Standards (NAAQS) for the following criteria air pollutants: ozone, carbon monoxide, lead, particulate matter, sulfur dioxide, or nitrogen dioxide) or maintenance area (an area which was in non-attainment but subsequently upgraded to an attainment area) concerning air quality?
☐ Yes ☐ No
Comment:

Evaluation: Will implementation of proposed action result in an impact on air quality or a violation of local, state, tribal, or federal air quality standards under the Clean Air Act amendments of 1990? (See FAA Order 1050.1, paragraph 5-2. b. (8), the Air Quality Handbook, and 1050.1 Desk Reference, chapter 1, for details on how to make the determination.)
☐ Yes ☐ No
Comment:

4.2.2. Biological Resources (including Marine Mammals; Wildlife and Waterfowl; Endangered/Threatened Species; Critical Habitat)

4.2.2.1. Are wildlife and/or waterfowl refuge/management areas, protected or critical habitats within the affected area of the proposed action?
☐ Yes ☐ No
Identify:

4.2.2.2. If so, has there been any communication with the appropriate wildlife management regulatory agencies (federal or state) agencies to determine if endangered or protected species inhabit the area?
☐ Yes ☐ No
If yes, identify endangered or protected species.

4.2.2.3. At what altitude would aircraft overfly these habitats?

4.2.2.4. During what times of the day would operations be more/less frequent?

Evaluation: Will implementation of the proposed action result in an impact on natural, ecological or biological resources of federal, tribal, state, or local significance (for example, federally listed or proposed endangered, threatened, or candidate species or proposed or designated critical habitat under the Endangered Species Act)? (See FAA Order 1050.1, paragraph 5-2. b. (3), and 1050.1 Desk Reference, chapter 2, for details on how to make the determination.)

4.2.2.a. ☐ Yes
Comment:

4.2.2.b. ☐ No. An impact to biological resources is not anticipated.

4.2.3. Climate

4.2.4. Coastal Resources

4.2.4.1. Are there designated coastal resources in the affected area?
☐ Yes ☐ No
Identify:

4.2.4.2. Will implementation of the proposed action result in any construction or development or any physical disturbances of the ground with the potential to affect coastal resources?
☐ Yes ☐ No

Evaluation: Will implementation of the proposed action result in an impact in to coastal resources? (See FAA Order 1050.1, paragraph 5-2. b. (4), and 1050.1 Desk Reference, chapter 4, for details on how to make the determination.)

¹ Draft NEPA Guidance on Consideration of the Effects of Climate Change and Greenhouse Emissions, CEQ (2010).
http://ceq.hss.doe.gov/nepa/regs/Consideration_of_Effects_ofGHG_Draft_NEPA_Guidance_FINAL_02182010.pdf

4.2.4.a. ☐ Yes
Comment:

4.2.4.b. ☐ No. An impact to coastal resources is not anticipated.

4.2.5. Department of Transportation Act, Section 4(f)

4.2.5.1. Are there cultural or scenic resources, of national, state, or local significance, such as national parks, publicly owned parks, recreational areas, and public and private historic sites in the affected area?
☐ Yes ☐ No
Identify:

4.2.5.2. If so, during what time(s) of the day would operations occur that may impact these areas?

Evaluation: Will implementation of the proposed action result in an impact to properties protected under Section 4(f) of the Department of Transportation Act? (See FAA Order 1050.1, paragraph 5-2. b. (2), and 1050.1 Desk Reference, chapter 5, for details on how to make the determination.)

4.2.5.a. ☐ Yes
Comment:

4.2.5.b. ☐ No. Section 4(f) impacts are not anticipated.

4.2.6. Farmlands
Are the following resources present: National Resources Conservation designated prime and unique farmlands or, state, or locally important farmlands including pastureland, cropland, and forest?
☐ Yes ☐ No
Identify:

Evaluation: Will the implementation of the proposed action involve the development of land regardless of use, or have the potential to convert any farmland to non-agricultural uses? (See FAA Order 1050.1, paragraph 5-2. b. (4), and the 1050.1 Desk Reference, chapter 6, for details on how to make the determination.)

4.2.6.a. ☐ Yes
Comment:

4.2.6.b. ☐ No. An impact to farmland resources is not anticipated.

4.2.7. Hazardous Material, Solid Waste, and Pollution Prevention
Will implementation of the proposed action result in any construction or development or any physical disturbances of the ground in an area known to contain hazardous materials, hazardous waste, solid waste, or other forms of pollution or contamination?
☐ Yes ☐ No

Evaluation: Is implementation of the proposed action likely to cause contamination by hazardous materials, hazardous waste, or likely to disturb existing hazardous materials, hazardous waste site, or other area of contamination? (See FAA Order 1050.1, paragraph 5-2. b. (12), and the 1050.1 Desk Reference, chapter 7, for details on how to make the determination.)

4.2.7.a. ☐ Yes
Comment:

4.2.7.b. ☐ No. An impact to existing areas of hazardous material, hazardous or solid waste, or pollution prevention activities, is not anticipated; and implementation of the proposed action is not anticipated to result in the production of hazardous material, hazardous or solid waste. .

4.2.8. National Historic Preservation Act of 1966 (NHPA)

4.2.8.1. Are there historic resources protected under Section 106 of the NHPA in the study area of the proposed action ?
☐ Yes ☐ No
Identify:

4.2.8.2. Will the proposed action include removal or alteration of historic resources (direct effect)?
☐ Yes ☐ No

4.2.8.3. Do any of the historic resources identified have quiet as a generally recognized feature or attribute?
☐ Yes ☐ No
If yes, explain:

4.2.8.4. Will the proposed action substantially interfere with the use or character of the resource (indirect effect)?
☐ Yes ☐ No
Explain:

Evaluation: Will the proposed action result in an adverse effect on resources protected under the National Historic Preservation Act of 1966, as amended? (See FAA Order 1050.1, paragraph 5-2. b. (1), and the 1050.1 Desk Reference, chapter 8, for details on how to make the determination.)

4.2.8.a. ☐ Yes
Comment:

4.2.8.b. ☐ No. An impact to resources subject to Section 106 review is not anticipated.

4.2.9. Land Use
The compatibility of existing and planned land uses with an aviation or aerospace proposal is usually associated with noise impacts. In addition to the impacts of noise on land use compatibility, other potential impacts of FAA actions may affect land use compatibility. The impact on land use, if any, should be analyzed and described under the appropriate impact category.

Evaluation: The determination that significant impacts exist in the Land Use impact category is normally dependent on the significance of other impacts. (See 1050.1 Desk Reference, chapter 9, for details on how to make the determination.)

4.2.10. National Resources and Energy Supply

Will the proposed action have the potential to cause demand or strain on a natural resource(s) or material(s) that exceeds current or future availability of these resources? (See FAA Order 1050.1, paragraph 5-2. b. (4).)
☐ Yes ☐ No
If yes, explain:

Evaluation: Will implementation of the proposed action result in an impact in relation to natural resources and energy supply?

4.2.10.a. ☐ Yes
Comment:

4.2.10.b. ☐ No. An impact to natural resources and materials and/or energy supply is not anticipated.

4.2.11. Noise and Noise-Compatible Land Use
The significance threshold for noise is whether the proposed action would increase noise by Day-night average sound level (DNL) 1.5 dB or more for a noise sensitive area that is exposed to noise at or above the DNL 65 dB noise exposure level; or that will be exposed at or above the DNL 65 dB level due to a DNL 1.5 dB increase, when compared to the No Action alternative for the same timeframe.

Noise compatibility or non-compatibility of land use is determined by comparing the proposed action DNL values to the values in the 14 CFR part 150, Appendix A, Table 1, Land-Use Compatibility guidelines. (See FAA Order 1050.1 and the 1050.1 Desk Reference, section 11.)

4.2.11.1.1.Will the proposed action introduce air traffic over noise sensitive areas not currently affected?
☐ Yes ☐ No
Comment:

4.2.11.1.2.Do the results of the noise analysis indicate that the proposed action would result in an increase in noise exposure by DNL 1.5 dB or more for a noise sensitive area that is exposed to noise at or above the DNL 65 dB noise exposure level?
☐ Yes ☐ No

4.2.11.1.3.If yes, are the results of the noise analysis incompatible with one or more of the Land Use Compatibility categories? (See FAA Order 1050.1, Desk Reference Exhibit 11-3.)
☐ Yes ☐ No
If yes, explain:

4.2.11.1.4.Do the results of the noise analysis indicate a threshold of significance over noise sensitive areas not listed under the Land Use Compatibility categories (for example, national parks, wildlife/waterfowl refuges)?
☐ Yes ☐ No
If yes, explain:

4.2.11.2. Do the results of the noise analysis indicate a change in noise meeting threshold criteria considered “reportable”?

i. For DNL 60 dB to <65 dB: + 3 dB ☐ Yes ☐ No

ii. For DNL 45 dB to <60 dB: + 5 dB ☐ Yes ☐ No

Evaluation:

4.2.11.a. Will the proposed action result in a significant noise impact over noise sensitive land use? (See FAA Order 1050.1, paragraph 5-2. b. (7), and the 1050.1 Desk Reference, chapter 11, for details on how to make the determination.)
☐ Yes
If yes, explain:

4.2.11.b. ☐ No. The results of the noise analysis indicate that no significance threshold noise criteria are reached as a result of the implementation of the proposed action.

4.2.11.c. Will the proposed action result in a significant noise impact over noise sensitive areas? (See FAA Order 1050.1, paragraph 5-2. b. (7), and the 1050.1 Desk Reference, chapter 8, for details on how to make the determination.)
☐ Yes
If yes, explain:

4.2.11.d. ☐ No. The results of the noise analysis indicate that no reportable noise impacts are expected to result from the implementation of the proposed action.

4.2.12.Socioeconomics, Environmental Justice, and Children's Environmental Health and Safety Risk

4.2.12.1. Socioeconomics
4.2.12.1.a. Will the proposed action result in a division or disruption of an established community; a disruption of orderly, planned development; or an inconsistency with plans or goals that have been adopted by the community in which the proposed action is located? (See FAA Order 1050.1, paragraph 5-2. b. (5).)
☐ Yes ☐ No

4.2.12.1.b. Will the proposed action result in an increase in congestion from surface transportation, by causing a decrease in the Level of Service below the acceptable level determined by the appropriate transportation agency? (i.e., a highway agency) [See FAA Order 1050.1, paragraph 5-2 b. (6).)
☐ Yes ☐ No

Evaluation: Will implementation of the proposed action result in an impact to socioeconomics? (See the 1050.1 Desk Reference, chapter 12, for details on how to make the determination.)

4.2.12.a. ☐ Yes
Comment:

4.2.12.b. ☐ No. The proposed action is not anticipated to involve acquisition of real estate, relocation of residence or community business, disruption of local traffic patterns, loss of community tax base, or changes to the fabric of the community.

4.2.12.2.Environmental Justice

Evaluation: Will the proposed action have the potential to lead to a disproportionally high and adverse impact to an environmental justice population, (i.e., a low income or minority population) due to significant impacts in other environmental impact categories or impacts on the physical or natural environment that affect an environmental justice population in a way that the FAA determines are unique to the environmental justice population and significant to that population? (See the 1050.1 Desk Reference, chapter 12, for details on how to make the determination.)

4.2.12.2.a. ☐ Yes
Comment:

4.2.12.2.b. ☐ No. An impact related to environmental justice is not anticipated.

4.2.12.3.Children's Environmental Health and Safety Risk

Evaluation: Will the proposed action have the potential to lead to a disproportionate health or safety risk to children due to significant impacts in other environmental impact categories? (See the 1050.1 Desk Reference, chapter 12, for details on how to make the determination.)

4.2.12.3.a. ☐ Yes
Comment:

4.2.12.3.b. ☐ No. An impact related to children's environmental health and safety is not anticipated.

4.2.13.Visual Effects

4.2.13.1. Will implementation of the proposed action create annoyance or interfere with normal activities from light emissions?
☐ Yes ☐ No
Explain:

4.2.13.2. Will implementation of the proposed action affect the visual character of the area including the importance, uniqueness, and aesthetic value of the affected visual resources?
☐ Yes ☐ No
Explain:

Evaluation: Will the proposed action result in an impact to visual resources? (See FAA Order 1050.1, paragraph 5-2. b. (5), and 1050.1 Desk Reference, chapter 13, for details on how to make the determination.)

4.2.13.a. ☐ Yes
Comment:

4.2.13.b. ☐ No. The proposed action is not anticipated to interfere or have an effect on the visual resources.

4.2.14.Water Resources (including Wetlands, Flood Plains, Surface Waters, Groundwater, and Wild and Scenic Rivers)

4.2.14.1. Are there wetlands, flood plains, and/or Wild and Scenic Rivers in the proposed action study area?
☐ Yes ☐ No

4.2.14.2. Are there reservoirs or other public water supply systems in the affected area?
☐ Yes ☐ No

4.2.14.3. Will implementation of the proposed action result in any construction or development or any physical disturbances of the ground?
☐ Yes ☐ No

4.2.14.4. Will implementation of the proposed action result in any changes to existing discharges to water bodies, create a new discharge that would result in impacts to water quality, or modify a water body?
☐ Yes ☐ No
If yes, is there a potential for an impact to water quality, sole source aquifers, a public water supply system, federal, state or tribal water quality standards established under the Clean Water Act and the Safe Drinking Water Act?
☐ Yes ☐ No

Evaluation: Will the proposed action result in an impact to water resources? (See FAA Order 1050.1, paragraph 5-2. b. (9), and 1050.1 Desk Reference, chapter 14, for details on how to make the determination.)

4.2.14.a. ☐ Yes
Comment:

4.2.14.b. ☐ No. The potential for impact to water resources is not anticipated.

4.2.15.Effects on the Quality of the Human Environment that are Likely to be Highly Controversial on Environmental Grounds.

4.2.15.1. Will implementation of the proposed action result in the likelihood of an inconsistency with any federal, state, tribal, or local law relating to the environmental aspects of the proposed action. (See FAA Order 1050.1, paragraph 5-2. b. (11).)
☐ Yes ☐ No
If yes, explain:

Evaluation: Is there likelihood for the proposed action to be highly controversial based on environmental grounds?

4.2.15.a. ☐ Yes
Comment:

4.2.15.b. ☐ No. The potential for controversy is not anticipated.

Section 5. Mitigation

Are there measures which can be implemented that might mitigate any of the potential impacts, i.e., GPS/FMS plans, NAVAIDS, etc.?
☐ Yes ☐ No ☐ N/A
Describe:

Section 6. Cumulative Impacts

What other projects (FAA, non-FAA, or non-aviation) are known, planned, have been previously implemented, or are ongoing in the affected area that would contribute to the proposed project's environmental impact?

Section 7. Community Involvement

Community involvement is the process of engaging in dialog and collaboration with communities affected by FAA actions. The appropriate level of community involvement and public engagement will vary to some degree depending on the project scope and affected communities. (See FAA Order JO 7400.2, appendices 10 and 11, and the Community Involvement Performance Based Navigation Desk Guide, and/or AEE's Community Involvement Manual, or other available Community Involvement guidance for further information.)

7.1. Are the airport proprietor and/or users providing general support for the proposed action?
☐ Yes ☐ No ☐ N/A

7.2. Are local community leaders or groups who could have an interest in FAA activity (i.e., aviation roundtables, historical preservation society, etc) due to their location or by their function in the community been notified, consulted, or otherwise informed of this proposed action?
☐ Yes ☐ No ☐ Not Known

7.2.1. Are any ☐ opposed to or ☐ supporting it? ☐ Not Known

7.2.2. Identify the parties and indicate whether they are in opposition or in support of the proposed action.

7.2.3. If they are opposed, what is the basis of their opposition?

7.3. Are local citizens aware of the proposed action?
☐ Yes ☐ No ☐ Not Known

7.3.1. Are any ☐ opposed to or ☐ supporting it? ☐ Not Known

7.3.2. Identify the parties and indicate whether they are in opposition or in support of the proposed action.

7.3.3. If they are opposed, what is the basis of their opposition?

7.4. Has the FAA received one or more comments objecting to the proposed project on environmental grounds from local citizens or elected officials?
☐ Yes ☐ No

7.4.1. If so, state the nature of the comment and how the FAA was notified (for example, resolution, Congressional, Public meeting/workshop, etc.).

7.4.2. How is the comment(s) being responded to? Can the comment(s) be mitigated through changes in design?

7.5. Is the proposed project consistent with local plans and development efforts?
☐ Yes ☐ No

7.6. Has there been any previous aircraft-related environmental or noise analysis, including a FAR Part 150 Study, conducted at this location?
☐ Yes ☐ No

7.6.1. If so, was the study reviewed as a part of this initial review?
☐ Yes ☐ No ☐ N/A

Section 8. References/Correspondence

Attach written correspondence, summarized phone contacts using Memorandums for the File, etc.

Section 9. Additional Preparers

The person(s) listed below, in addition to the preparer indicated on page 1, are responsible for all or part of the information and representations contained herein:

Name: ______________________________________

Title: _______________________________________
Facility: ______________________________________

Telephone Number: _____________________________

Specific Area of Responsibility: ____________________

Section 10. Facility/Service Area Conclusions

☐ This initial review and analysis indicates that no extraordinary circumstances or other reasons exist that would cause the responsible federal official to believe that the proposed action might have the potential for causing significant environmental impacts. The undersigned have determined that the proposed action qualifies as a categorically excluded action in accordance with FAA Order 1050.1, and on this basis, recommend that further environmental review need not be conducted before the proposed project is implemented.
☐ The undersigned have determined that the proposed action may not qualify as a categorically excluded action in accordance with FAA Order 1050.1, and on this basis, recommend that further environmental review be conducted before the proposed action is implemented.
The undersigned recommend that the proposed action be submitted for environmental funding for preparation of an ☐ EA ☐ EIS ☐ Not sure - more analysis is needed.

Facility Manager Review/Concurrence

Signature: _______________________________________ Date: __________________
Name: _______________________________________
Title: _______________________________________
Address: _______________________________________
Phone: _______________________________________ Email: __________________

Service Area Environmental Specialist Review/Concurrence

Signature: _______________________________________ Date: __________________
Name: _______________________________________
Title: _______________________________________
Address: _______________________________________
Phone: _______________________________________ Email: __________________

Service Area Director Review/Concurrence, if necessary

Signature: _______________________________________ Date: __________________
Name: _______________________________________
Title: _______________________________________
Address: _______________________________________
Phone: _______________________________________ Email: __________________