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�� 5 <br /> O �x <br /> C 1-� <br /> �Hf/� <br /> K� � P . � 'S <br /> Ij'.O p T — 1 2 �- B 9 W E D 1 2 _ 5 '3 W ? C T E C H S E ci T T L E <br /> ��� <br /> Vl H <br /> � H� <br /> OH <br /> �1-��� TO BE COMPLETED BY APPLICANT <br /> �z H��� 4) Will the proposal requuTe Selfand aiproximato �uentities�ot? Give <br /> M y qenerel deacription, p Po p q <br /> g N H xnovn. <br /> C1 ti <br /> � ConsEructiit �end�dischergingsittto wetlandsl collect run-of , <br /> y��"j Ceteining , <br /> HOrn <br /> 5) poee tho proposel lie witY�in a 1o0-yenr lloodplain? l.f so, note <br /> loce►tiun on the site plen. <br /> No. <br /> 6) papg the proposal involve any discharge �otWWastamandrials to <br /> surlace watere? I! so, deecriba the type <br /> antiaipated of discherg�. <br /> No. <br /> '�, p, Groundweter: <br /> 1j Will ground water be witt�dravn, or will WBuiI bo/di�naha�pp�oximet� <br /> ��' qround watar? Giva general d�ocription, p po <br /> '�' quentitiee if known• <br /> t ' No. <br /> « Z) Daeeribe waste material thnt will bdischergef r�exnmhlo rD mostic <br /> � � from s�ptic tenks or other gaurcee, ii any ( P <br /> � , s�veget induatriel, containing tha following chemicels. . . : <br /> � egricult;iral; etc. ) . Desct'iba tho gmneral eiz• of the systemr th� <br /> �1 nusbaT' at mu�orethe�number of�enimnle or�humansbthee ystem(s) er� <br /> �� applicable) , <br /> � axpeat�d to serve. <br /> ' I Nan�. <br /> � c. Wster Runo!! (including atorm veter) : <br /> � 1� pegcriW Lhe source ot runoff (includlnq gtarm wntor) and method <br /> �� of collection end dieposal, if eny (include quantities, i! <br /> � �o�,r�� . Whare will this vat�r flow? Will thia weter flow into <br /> � other wetera7 If eo, deucriba. <br /> d16Chnrq it�totnavlyycreateCawetlandaolloct trie run-ofi and <br /> 5 <br />