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l. Other impacts: _______________________________________________________ 9 ✔ 9 ___________________________________________________________________ 4. Impact on groundwater The proposed action may result in new or additional use of ground water, or ✔ NO YES may have the potential to introduce contaminants to ground water or an aquifer. (See Part 1. D.2.a, D.2.c, D.2.d, D.2.p, D.2.q, D.2.t) If “Yes”, answer questions a - h. If “No”, move on to Section 5. Relevant No, or Moderate Part I small to large Question(s) impact impact may may occur occur a. The proposed action may require new water supply wells, or create additional demand D2c 9 9 on supplies from existing water supply wells. b. Water supply demand from the proposed action may exceed safe and sustainable D2c 9 9 withdrawal capacity rate of the local supply or aquifer. Cite Source: ________________________________________________________ c. The proposed action may allow or result in residential uses in areas without water and D1a, D2c 9 9 sewer services. d. The proposed action may include or require wastewater discharged to groundwater. D2d, E2l 9 9 e. The proposed action may result in the construction of water supply wells in locations D2c, E1f, 9 9 where groundwater is, or is suspected to be, contaminated. E1g, E1h f. The proposed action may require the bulk storage of petroleum or chemical products D2p, E2l 9 9 over ground water or an aquifer. g. The proposed action may involve the commercial application of pesticides within 100 E2h, D2q, 9 9 feet of potable drinking water or irrigation sources. E2l, D2c h. Other impacts: ______________________________________________________ 9 9 __________________________________________________________________ 5. Impact on Flooding The proposed action may result in development on lands subject to flooding. NO ✔ YES (See Part 1. E.2) If “Yes”, answer questions a - g. If “No”, move on to Section 6. Relevant No, or Moderate Part I small to large Question(s) impact impact may may occur occur a. The proposed action may result in development in a designated floodway. E2i 9 9 b. The proposed action may result in development within a 100 year floodplain. E2j 9 9 c. The proposed action may result in development within a 500 year floodplain. E2k 9 9 d. The proposed action may result in, or require, modification of existing drainage D2b, D2e 9 9 patterns. e. The proposed action may change flood water flows that contribute to flooding. D2b, E2i, 9 9 E2j, E2k f. If there is a dam located on the site of the proposed action, is the dam in need of repair, E1e 9 9 or upgrade? Page 3 of 10