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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: OShorelinc Forest [1] Agricultural/grasslands [C] Early mid-successional wetland © Urban [J Suburban 15. Does the site of the proposed action contain any species of animal, or associated habitats, listed by the State or NO n Olé Federal government as threatened or endangered? Ow 16. Es the project site located in the 100-year or 500-year flood plain? E < a O NO 17. Will the proposed action create storm water discharge, cithcr from point or non-point < m sources?If Yes, OOO OOO a. Will storm water discharges flow to adjacent properties? b. Will storm water discharges be directed to established conveyance systems (runoff and storm drains)? if Ycs, 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)? If Yes, explain the purpose and size of the impoundment: oO 0 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: oO oO 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: 21. Is the project located within, or within 4 mile of, a disadvantaged community? Oe If No, could impacts from the project affect a disadvantaged community? CO If Yes to cither question in 21, answer the following question. a. Identify the potential pollution impacts of the project, either direct or indirect, that may occur within the disadvantaged community (e.g., wastewater discharges, air emissions, noise, odors, solid or hazardous waste generation or management): TCERTIFY THAT THE INFORMATION PROVIDED ABOVE IS TRUE AND ACCURATE TO THE BEST OF MY KNOWLEDGE Applicant/sponsor/name:_Russ Belscher Date: 10/19/26 Title, Mayor Signature: Page 3 of 3 SEAF 2026