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14, Identify the typical habitat types that oceus on, or are
ltkely to be found on the project site, Check all that
["{Shoreline
apply:
[|] Forest ("] Agricultural/grassiands
CT Early mid-suecessional
CT Wetland 7] Urban Suburban
(5. Does the site ofthe proposed action contal
n any species of animal, or associated habita
| Federal government as threatened or endangered? ts, listed by the State or
YES
co
16. Is the project aite located in the 100-year
flood plan?
YES
17, Will the proposed action create storm
water discharge, elther from point or non-point
If Yas, sources? VES
@ Will storm water discharges flow to adjacent
ILE
properties?
b, Will store water discharges be directed to i
Lt conveyance systems (runoff and storm drains
iY9s, brlofly describe Stocmnwaber Wi )?
A ow to abjaleh stor M
Loins.
18, Does the proposed action include const
ructi on or other activities that would result In the
or other lquids (e.g., retention pond, waste impou ndment of water “NO | YES
If Yes, explain the purpose and size of the lagoon, dat)?
im poundment:_
Dl cq
49, Has the site of the proposed action or an adjoining
management facility? property been the location of au actlve or closed
solid waste NO YES
IfYes, desoribe:
Ri a
20.Has the site of the proposed action ot an
adjoining property been the subject of remediation
completed) for hazardous waste? (ongoing or NO | YES
if Yes, desoribe:
Ki
YT CERTINY THAT THE INFORMATION
PROVIDED ABOVE IS FRUE AND ACCU
MY KNOWLEDGE RATE TO THE BEST OF
Applicant,
Signature:
esi ADC ow V4lPopg
Title: EX, uit. » Mh for
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