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EVALUATION FOR <br />AGENCY USE ONLY <br />2) Will the project require any work over, in, or adjacent to (within 200 feet) <br />the described waters? If yes, please describe and attach available plans. <br />There are no existing surface water bodies within 200 feet of the site. <br />3) Estimate the amount of fill and dredge material that would be placed in or <br />removed from surface water or wetlands and indicate the area of the site that <br />would be affected. Indicate the source of fill material. <br />No fill or dredge material would be placed in any surface water bodies or <br />wetlands. <br />4) Will the proposal require surface water withdrawals or diversions? Give <br />general description, purpose, and approximate quantities if known. <br />The proposed project would not involve surface water withdrawals or diversions. <br />5) Does the proposal lie within a 100-year floodplain? If so, note location on the <br />site plan. <br />The site does not lie within a 100-year floodplain. <br />6) Does the proposal involve any discharges of waste materials to surface <br />waters? If so, describe the type of waste and anticipated volume of <br />discharge. - <br />No discharge of waste materials into adjacent surface waters would occur as a <br />result of the completion of any phase of campus construction. Medical waste <br />materials are disposed of via approved methods and they are not discharged into <br />surface waters. <br />b. Ground Water: <br />1) Will groundwater be withdrawn from a well for drinking water or other <br />purposes? If so, give a general description of the well, proposed uses and <br />approximate quantities withdrawn from the well. Will water be discharged <br />to groundwater? Give general description, purpose, and approximate <br />quantities if known. <br />No groundwater withdrawal is anticipated. Water needs can and would be met <br />with existing municipal infrastructure. <br />2) Describe waste material that will be discharged into the ground from septic <br />tanks or other sources, if any (for example: Domestic sewage; industrial, <br />containing the following chemicals...; agricultural; etc.). Describe the general <br />size of the system, the number of such systems, the number of houses to be <br />served (if applicable), or the number of animals or humans the system(s) are <br />expected to serve. <br />Environmental Checklist — Providence Regional Medical Center Everett — North Site Page 9 <br />© S mC-ny <br />