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( <br />TO 6E COMPLETED Bl' APPUCAf.'T <br />3. WafK <br />a. Surfac:: <br />EVALUATION FOR <br />AGENCY VSE ONLY <br />1) ls there any surfacc water body on or in the immedioie vicinity of the site (including <br />year—round and seasonal stroams, saltwater, laku, ponds, wetlands)1 If yu, describe type <br />and provide namcs. If appropriate, state what stream or river it ilows into. <br />f�l� �'�/ <br />2) Will thc project require any work over, in, or adjacen[ to (within 200 fcet) the dacribed <br />waters? 1( yes, plwse describe and attach availablc plans. <br />� <br />3) Esiimate the amount of fill and dredgc material that would be piaced in or removed <br />from surface water or wetlands and indicate the area of the sitc that would be aFfecced. In- <br />dicate the source of lill material. <br />�%i <br />4) Will the proposal require sur(ace water withdrawals or diversions? Give general de- <br />uription, purpose, and approximatc quantiiia if know n. <br />�io <br />S) Does the proposal lie within a 100—year (loodplain? If so, note loca'`on cn the site <br />plan. <br />1`i� I i 1'iw �t'i � Aic i" I' <br />6) Daa the proposal involve any diuharga of waste materials to surface waten? If so, <br />dacribe the type of waste and anticipated volume o( diuharge. <br />N� <br />b. Ground: <br />1) Will ground water be withdrawn, or will water be discharged to graund water? Give <br />grneral dacription, purpose, and approximate quantities if known. <br />N� <br />2) Dcscribe wascc material that will be discharged into the ground (rom septic tanks or <br />other sourca, if any (for ezample: Domestic sewage; industrial, containing the (ollowing <br />chemicals ...; agricultural; etc.). Describe the general size o( the system, the number of <br />such systems, the number of houses to be served (if applicable), or the number of animals or <br />humans the system(s) are expected to serve. <br />4, <br />