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14. Identify the typical habitat types that occur on, or are likely to be found on the project site. Check all that apply: Shoreline [7] Forest [7] Agricuttural/grasslands [7] Early mid-successional Wetland [7] Urban Suburban 15. Does the 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? CO 16. Is the project site located in the 100-year flood plan? NO | YES L . , : a at . : NO | YES 17, Will the proposed action create storm water discharge, either from point or non-point sources? If Yes, L] a. Will storm water discharges flow to adjacent properties? im L] b. Will storm water discharges be directed to established conveyance systems (runoff and storm drains)? C] CT] 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 (¢.g., retention pond, waste lagoon, dam)? If Yes, explain the purpose and size of the impoundment: 19. Has the site of the proposed action or an adjoining property been the location of an active or closed solid waste | NO | YES management facility? If Yes, describe: 20.Has the site of the proposed action or an adjoining property been the subject of remediation (ongoing or NO | YES completed) for hazardous waste? If Yes, describe: 1 CERTIFY THAT THE INFORMATION PROVIDED ABOVE IS TRUE AND ACCURATE TO THE BEST OF MY KNOWLEDGE Applicant/sponsor/name: Timothy Michaels Date: 9/16/2026 Signature: Title; Mayer PRINT FORM Page 3 of 3