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ii. Describe how the proposed action would affect that waterbody or wetland, e.g. excavation, fill, placement of structures, or alteration of channels, banks and shorelines. Indicate extent of activities, alterations and additions in square feet or acres: _________________________________________________________________________________________________________ _________________________________________________________________________________________________________ _________________________________________________________________________________________________________ _________________________________________________________________________________________________________ iii. Will the proposed action cause or result in disturbance to bottom sediments? Yes 9 No If Yes, describe: __________________________________________________________________________________________ iv. Will the proposed action cause or result in the destruction or removal of aquatic vegetation? 9 Yes 9 No If Yes: • acres of aquatic vegetation proposed to be removed: ___________________________________________________________ • expected acreage of aquatic vegetation remaining after project completion:________________________________________ • purpose of proposed removal (e.g. beach clearing, invasive species control, boat access): ____________________________ ____________________________________________________________________________________________________ • proposed method of plant removal: ________________________________________________________________________ • if chemical/herbicide treatment will be used, specify product(s): _________________________________________________ v. Describe any proposed reclamation/mitigation following disturbance: _________________________________________________ _________________________________________________________________________________________________________ c. Will the proposed action use, or create a new demand for water? 9 Yes 9 No If Yes: i. Total anticipated water usage/demand per day: __________________________ gallons/day ii. Will the proposed action obtain water from an existing public water supply? 9 Yes 9 No If Yes: • Name of district or service area: _________________________________________________________________________ • Does the existing public water supply have capacity to serve the proposal? 9 Yes 9 No • Is the project site in the existing district? 9 Yes 9 No • Is expansion of the district needed? 9 Yes 9 No • Do existing lines serve the project site? 9 Yes 9 No iii. Will line extension within an existing district be necessary to supply the project? 9 Yes 9 No If Yes: • Describe extensions or capacity expansions proposed to serve this project: ________________________________________ ____________________________________________________________________________________________________ • Source(s) of supply for the district: ________________________________________________________________________ iv. Is a new water supply district or service area proposed to be formed to serve the project site? 9 Yes 9 No If, Yes: • Applicant/sponsor for new district: ________________________________________________________________________ • Date application submitted or anticipated: __________________________________________________________________ • Proposed source(s) of supply for new district: _______________________________________________________________ v. If a public water supply will not be used, describe plans to provide water supply for the project: ___________________________ _________________________________________________________________________________________________________ vi. If water supply will be from wells (public or private), what is the maximum pumping capacity: _______ gallons/minute. d. Will the proposed action generate liquid wastes? 9 Yes 9 No If Yes: i. Total anticipated liquid waste generation per day: _______________ gallons/day ii. Nature of liquid wastes to be generated (e.g., sanitary wastewater, industrial; if combination, describe all components and approximate volumes or proportions of each): __________________________________________________________________ _________________________________________________________________________________________________________ _________________________________________________________________________________________________________ iii. Will the proposed action use any existing public wastewater treatment facilities? 9 Yes 9 No If Yes: • Name of wastewater treatment plant to be used: _____________________________________________________________ • Name of district: ______________________________________________________________________________________ • Does the existing wastewater treatment plant have capacity to serve the project? 9 Yes 9 No • Is the project site in the existing district? 9 Yes 9 No • Is expansion of the district needed? 9 Yes 9 No Page 5 of 13 29