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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: [Shoreline [_] Forest [_] Agricultural/grasslands [] Early mid-successional [-]Wetland [_] Urban [x] Suburban 15. Does the site of the proposed action contain any species of animal, or associated habitats, listed by the State or [| [ | : bd bel bel] 3} Bs}xX )3) Bx] | Federal government as threatened or endangered? 16. Is the project site located in the 100-year flood plan? ES <i 17. Will the proposed action create storm water discharge, either from point or non-point sources? E C2) -< If Yes, CLL 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: 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: 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: iim 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: [| I CERTIFY THAT THE INFORMATION PROVIDED ABOVE IS TRUE AND ACCURATE TO THE BEST OF MY KNOWLEDGE —_ RY AD Wihac Date: T/ awn/ Q [.. WW Title: 7 i2 WW, A A PRINT FORM Page 3 of 3