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• Do existing sewer lines serve the project site? 9 Yes 9 No • Will a line extension within an existing district be necessary to serve the project? 9 Yes 9 No If Yes: • Describe extensions or capacity expansions proposed to serve this project: ____________________________________ ____________________________________________________________________________________________________ ____________________________________________________________________________________________________ iv. Will a new wastewater (sewage) treatment district be formed to serve the project site? 9 Yes 9 No If Yes: • Applicant/sponsor for new district: ____________________________________________________________________ • Date application submitted or anticipated: _______________________________________________________________ • What is the receiving water for the wastewater discharge? __________________________________________________ v. If public facilities will not be used, describe plans to provide wastewater treatment for the project, including specifying proposed receiving water (name and classification if surface discharge or describe subsurface disposal plans): ________________________________________________________________________________________________________ ________________________________________________________________________________________________________ vi. Describe any plans or designs to capture, recycle or reuse liquid waste: _______________________________________________ ________________________________________________________________________________________________________ ________________________________________________________________________________________________________ e. Will the proposed action disturb more than one acre and create stormwater runoff, either from new point 9 Yes 9 No sources (i.e. ditches, pipes, swales, curbs, gutters or other concentrated flows of stormwater) or non-point source (i.e. sheet flow) during construction or post construction? If Yes: i. How much impervious surface will the project create in relation to total size of project parcel? _____ Square feet or _____ acres (impervious surface) _____ Square feet or _____ acres (parcel size) ii. Describe types of new point sources. __________________________________________________________________________ _________________________________________________________________________________________________________ iii. Where will the stormwater runoff be directed (i.e. on-site stormwater management facility/structures, adjacent properties, groundwater, on-site surface water or off-site surface waters)? ________________________________________________________________________________________________________ ________________________________________________________________________________________________________ • If to surface waters, identify receiving water bodies or wetlands: ________________________________________________ ____________________________________________________________________________________________________ ____________________________________________________________________________________________________ • Will stormwater runoff flow to adjacent properties? 9 Yes 9 No iv. Does the proposed plan minimize impervious surfaces, use pervious materials or collect and re-use stormwater? 9 Yes 9 No f. Does the proposed action include, or will it use on-site, one or more sources of air emissions, including fuel 9 Yes 9 No combustion, waste incineration, or other processes or operations? If Yes, identify: i. Mobile sources during project operations (e.g., heavy equipment, fleet or delivery vehicles) _________________________________________________________________________________________________________ ii. Stationary sources during construction (e.g., power generation, structural heating, batch plant, crushers) ________________________________________________________________________________________________________ iii. Stationary sources during operations (e.g., process emissions, large boilers, electric generation) ________________________________________________________________________________________________________ g. Will any air emission sources named in D.2.f (above), require a NY State Air Registration, Air Facility Permit, 9 Yes 9 No or Federal Clean Air Act Title IV or Title V Permit? If Yes: i. Is the project site located in an Air quality non-attainment area? (Area routinely or periodically fails to meet 9 Yes 9 No ambient air quality standards for all or some parts of the year) ii. In addition to emissions as calculated in the application, the project will generate: • ___________Tons/year (short tons) of Carbon Dioxide (CO2) • ___________Tons/year (short tons) of Nitrous Oxide (N2O) • ___________Tons/year (short tons) of Perfluorocarbons (PFCs) • ___________Tons/year (short tons) of Sulfur Hexafluoride (SF6) • ___________Tons/year (short tons) of Carbon Dioxide equivalent of Hydroflourocarbons (HFCs) • ___________Tons/year (short tons) of Hazardous Air Pollutants (HAPs) Page 6 of 13 39