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14. Identify the typical habitat types that occur on, or are likely to be found on the project site. Cheek all that apply: □ Shoreline 0 Forest O Agricultural/grasslands 0 Early mid-successional □Wetland 0 Urban O Suburban 15, Does ihe site of the proposed action contain any species of animal, or associated habitats, listed by the State or NO YES Federal government as threatened or endangered? ' 16, Is the project site located in the I00-year flood plan? 0 NO □ YES 17. Will the proposed action create storm water discharge, either from point or non-point sources? 0 □ NO YES If Yes, 0 □ a. Will storm water discharges flow to adjacent properties? □ □ b, Will storm water discharges be directed to established conveyance systems (runoff and stom1 drains)? If Yes, briefly describe: □□ ,' 18, Does the proposed action include construction or other activities that would result in the impoundment of water NO YES or other liquids (e.g., retention pond, waste lagoon, dam)? 0 □ If Yes, explain the purpose and size of the impoundment: ' .1.9, Has the site of the proposed action or an adjoining property been the location ofan active or closed solid waste NO YES management facility? If Yes, describe: 0 □ 20. Has the site of the proposed action or an adjoining prope1ty been the subject ofremediation (ongoing or NO YES completed) for hazardous waste? If Ycs, describe: 0 □ I CERTIFY THAT THE INFORMATION PROVIDED ABOVE IS TRUE AND ACCURATE TO THE BEST OF MY KNOWLEDGE Applicant/sponsor/name: Timothy Michaels Date: 112012026 Signature: Title:Mayor PRINT FORM Page 3 of 3