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� �� I � <br /> � . � <br /> ;,:.n. . ' <br /> � � � <br /> 70 !E C'OM►LETED !Y APPUCAM EVALUATION FOR <br /> :. W'�tK �0[NCY USt ONLY ' <br /> a. Suriau: <br /> � 11 Is cherc any surfaa ruer bady on or in t6e immed'uu v�ctinity of t6e sim (includin� � { <br /> �� yar-round and uaion�l acrartu. ultwater. laka. pondc, weclandtl' !f yn, daaibs type <br /> y and provide mma. If�ppropnaca ata[e wha[scram or nver ii flow mw. <br /> q N � <br /> H �� <br /> �d ►�� :) Will the o <br /> pr ree rcquin any Wak over.in,or adpant ro l Wichin 200 fea) tM daerib�d <br /> � �..�.�p wattrs4 If ya, pl�us d�ibt and atuc6�wilabU plam. <br /> N <br /> � � VO <br /> HO <br /> OH <br /> �� )1 6timau the amount of fill �nd dnd�t m�cend ihai would be plaad in or remowd <br /> from suri�u W�tsr or retland� and indiau thc arn of the site tha[ would ba a(feaed. In• <br /> � y dinu the wura of flll mattri�l. <br /> H 1:'it� <br /> y�yM <br /> 00 y <br /> s) Will the propoul roquin �urfaa wata withdr�wa4 or divenfoiu? Gire {enaal de• <br /> ''�' y smption. purpae.and�pproaimtu quanridr if Icno�rn. <br /> - .„, <br /> S) Dor th� propoW lis rritkia a I00-yur floodplainl If w, nou laauon on ihs �iu <br /> ��� �� pian. nl o <br /> � � <br /> i � 1 6) Dat the propaal involw any di�ehar{� of wtu rtuariab to wrfaa raurfl !f so, <br /> draibe the cype of ruu and antieipaud valumr of di�ehar�s. <br /> i 1 �j �:u <br /> � � <br /> �,. �' b. Ground: <br /> � � I) Wiil �round waw b� �rithdnrn. ar rill w�ur b� di�eharpd to �round water? Give <br /> �a�aal deaipiion. purpoN.and app�oaimau quauutir it knarn. <br /> �� � n;o <br /> � 2) Dqeribe Wuu maurial that rill b� diuhar�ed into tht {round from �ep[ic unlu or <br /> �� ot6a wurea. if any (for wmpl�: Domrtie �s�ra�r, indu�tnal, wnwnin� the followin� <br /> ehemia� . . .; ��rieultunl: ete.). Dumb� the {menl siu of the synem, th� numbsr of <br /> sueh fyttem�. tha numba of ho�w w be fsrved (if applieahle),or the number of animau ar <br /> ' � hwnani che sy�can(s) �rc sxqa�d to urn. � <br /> M <br /> G. ( <br />