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14. Identify the typloal habitat types that
occur on, or are likely to be found on the project site,
Check all that apply:
[Shoreline [7] Forest (_] AgriculturaV/erasstands ["] Barly mid-suecessional
CiWetland = [“} Urban Suburban
13, Does the site of the proposed action contai
n any species of animal, or assoolated habita
Federal government as threatened or ts, listed by the Statear | NG
endangered? YES
LJ
16. ts the project site located in the | 00-ye
ar flood plan?
NO YES
A
{7, Will the proposed action create storm
water discharge; elther from point or non-p NO
f Yas, oint sources? YES
a Willi storm water discharges flow to adjacent
RCI
properties?
4
. b, Will storm water discharges be directed to
lf Yes, briefly describe: i i conveyance systems (rungff and storm drains
¢ , )?
oc Wether | | -
wil ow to 4 pale Storch
Ava ins. |
'T8, Does the proposed action include conat
raotion ov other activities that would regult
or other liquids (6.g,, retention pond, waste in the impoundment of water | NO
lagoon, dam)? YES
lf Yes, explain the purpose and size of the impoundm
ent:
x a
19. Has the site of the proposed action or an
adjoi ning property been the location of an active
management facility? or closed solid waste NO | YES |
If Yes, describe:
By O
20,Has the site of the proposed action or
an adjoining property beer the subject
completed) for hazardous waste? of remediation (ongoing or NO | YES
(f Yes, deseribe:
x 7
rt
T CERTOY THAT THE INFORMATI
ON PROVIDED ABOVE I8 TRUE AND
MY KNOWLEDGE ACCURATE TO THE BEST OF
Applicants esti ADL va 4[2o}g
Signature:
Title: EY eciiti Div eth ro
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