HomeMy WebLinkAboutExhibit 3 V2Addendum 2
NEIGHBORS AND NEIGHBORS ASSOCIATION (NANA)
CITY OF MIAMI AND MIAMI-DADE COUNTY
INFORMATION FOR ENVIRONMENTAL REVIEW FORM
Date:
Funding Source: CDBG; HOME; HOPE 3; HOMELESS; HOPWA (circle).
Name or Subrecipient/Agency:
Name of Proposed Activity:
Location (Folio Number and Address)
of Proposed Activity:
Location of Grant Recipient:
Address:
Telephone number:
Detailed Description of Project (include work program and/or scope of service):
External renovation of commercial property
Part I. Will the activity result in the following?
Yes No
Change of Use
Sub -surface alteration (i.e. excavations)
New Construction
Renovation or Demolition
Site improvements (utilities, sidewalk, landscaping, storm
Drainage, parking area, drives, etc.)
Please contact Leroy Jones at (305) 756-0605, should you have any questions regarding the
completion of this Environmental Review Form.
Osun's Village Project
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Addendum 2
NEIGHBORS AND NEIGHBORS ASSOCIATION (NANA)
CITY OF MIAMI AND MIAMI-DADE COUNTY
INFORMATION FOR ENVIRONMENTAL REVIEW FORM
Yes No
Displacement of persons, households or businesses
Increase in population working or living on site
Land acquisition
Activity in 100-year floodplain
A new non-residential use generating at least 1,375,000
gallons of water or 687,500 gallons of sewage per day
Use requiring operating peiiiiit (i.e. for hazardous waste,
pretreatment of sewage, etc.)
A sanitary landfill or hazardous waste disposal site
Tree removal or relocation
Street Improvements
The impounding of more than 10 acre feet of water (e.g.
digging in a lake) or diverting or deepening of a body of
water.
Part II Site Information
A. Land Use (please describe)
• Existing
• Proposed
NEIGHBORS AND NEIGHBORS ASSOCIATION (NANA)
Osun's Village Project
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Addendum 2
NEIGHBORS AND NEIGHBORS ASSOCIATION (NANA)
CITY OF MIAMI AND MIAMI-DADE COUNTY
INFORMATION FOR ENVIRONMENTAL REVIEW FORM
B. If the activity includes new construction, renovation or rehabilitation,
photographs must be provided on each side of the structure(s) proposed for
assistance and the buildings on abutting lots. The photographs shall be
identified by address. In addition, provide the following information:
• Existing structure(s) on site
Yes No
• Estimated age of structure(s)
C. Other Site Infoiiiiation
Flood insurance
Public water
Public sewer
Children or child under 7 years of age residing on site
(including day care facility) or relocating to it
Hazardous waste disposal facility
Storage of hazardous materials
Abandoned structure(s)
Yes No
D. If the proposed activity includes a new structure(s) or site improvements on a
site of one (1) acre or more, a site plan must be provided (attached).
Project(s) will not be environmentally reviewed without a site plan.
E. If the proposed activity includes rehabilitation or renovation of structure(s),
indicated the approximate value of the improvement.
0 to 39.9 percent of the market value of the structure(s)
40 to 49.9 percent of the market value of the structure(s)
50 to 74,9 percent of the market value of the structure(s)
75 percent or more of the market value of the structure(s)
Osun's Village Project
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Addendum 2
NEIGHBORS AND NEIGHBORS ASSOCIATION (NANA)
CITY OF MIAMI AND MIAMI-DADE COUNTY
INFORMATION FOR ENVIRONMENTAL REVIEW FORM
F. If the proposed activity involves the transfer of any property, new construction
or a secured loan for a non-residential parcel, provide a Phase I Environmental
Audit determining the likely presence of either a release or threatened release
of a hazardous substance. An audit is a review of a site and adjacent properties
that involves preparing a history of ownership, land use and zoning for the last
50 years; researching environmental records for information on hazardous
waste sites, hazardous facilities and underground storage tanks; and inspecting
the site for physical evidence of contamination such as damaged vegetation or
stains in the soil.
Yes No
If yes, copy of Phase I Environmental Audit must be submitted.
G. Environmental Health Infotniation
• Residential site
> If the site involves rehabilitation, has it been inspected for defective
paint surfaces?
Yes No
If so, please submit the results.
➢ Has any child under the age of seven at the site been tested for
elevated levels of lead in the body?
Yes No
If so, what were the results?
➢ Has chewable surfaces at the site been tested for lead -based paint?
Yes No
If so, please submit the results.
Osun's Village Project
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Addendum 2
NEIGHBORS AND NEIGHBORS ASSOCIATION (NANA)
CITY OF MIAMI AND MIAMI-DADE COUNTY
INFORMATION FOR ENVIRONMENTAL REVIEW FORM
• Residential or non-residential site
➢ If the water to the site is supplied by an individual or private system,
does it meet public health standards?
Yes No
➢ If the activity involves demolition, rehabilitation or renovation of a
structure, has the site been surveyed by a qualified asbestos, consultant?
Yes No
➢ If the site has a multi -family structure or a public or commercial
building being renovated or rehabilitated, has an operations and
maintenance plan been prepared to address asbestos issues?
Yes No
H. If the activity is in a scattered site program and involves the construction of 4 or
less dwelling units on the site, does the agency have similar activities within 2,000
feet of the site?
Part III. Certification
Yes No
I certify to the accuracy of the above information
Name
Title Date
Name of Organization or Corporation
Osun's Village Project
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