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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 [JWetland [-] Urban J Suburban 15. Does the site of the proposed action contain any species of animal, or associated habitats, listed by the State or O | YES Z Federal government as threatened or endangered? 7 ] NY ac n J 16. Is the project site located in the 100-year flood plan? YES oO Z YES 17. Will the proposed action create storm water discharge, either from point or non-point sources? Z ) If Yes, a. Will storm water discharges flow to adjacent properties? Ao 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 YES oO > or other liquids (e.g., retention pond, waste lagoon, dam)? If Yes, explain the purpose and size of the impoundment: LN \ 19. Has the site of the proposed action or an adjoining property been the location of an active or closed solid waste : management facility? If Yes, describe: N 20.Has the site of the proposed action or an adjoining property been the subject of remediation (ongoing or op) Z O - completed) for hazardous waste? If Yes, describe: N I CERTIFY THAT THE INFORMATION PROVIDED ABOVE IS TRUE AND ACCURATE TO THE BEST OF Applicant/sponsor/name: ha 4 cr Crise _ jira Wy] L/ IN Date: o> /, Zoe PRINT FORM Page 3 0f3