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Id. 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 Ke] Agriculturat/grasslands (TJ Early mid-successtonal
Cl wetland [Tt Urban [7] Suburban
[5. Does the site of the proposed action contain any species of animal, or associated
habitats, listed by the State or ES
Federal government as threatened or endangered?
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2X1 13) 2 |Z
LJ L
PRY RRS!
16. Is the project site located in the [00-year flood plan?
ES
ne
17, Will the proposed action create storm water discharge; either from point
or non-poin t sources?
tt]
wa
®
If Yes,
[LC
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 Yes, briefly describe:
TE. 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:
im a
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:
Bd a
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? 7 oy
(F Yes, describe: hae is a fol laer oF to? Soil that will ner bee
| fa ‘stockedl
ins
{|
I CERTIFY THAT THE INFORMATION PROVIDED ABOVE 16 TRUE AND ACCURATE TO
MY KNOWLEDGE | THE BEST OF
Date: ZL 4 [36
Two: Fetmnal, Manager
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