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' T0�lE tOM►LETED !1' �PPLIC�NT EVAWAfION FOR <br /> ' �GENCY USE ONLY ' <br /> 3. Wua <br /> �. Surf�ce: <br /> I) 1s there �ny surf�a water body on or in the immediate vicinity of the tite (includin{ � _ <br /> yar—round and sawn�l strams, saltWuer, laka, ponds, weclands)? If yes, deseribe [ype <br /> �nd piovide n�ma. If�ppropriata sute wh�t scram or river it timvs into. � <br /> NO <br /> ?) wiil the project requirc �ny work over. irt, or �djaant to (within 200 fat) the dncribed <br /> w�cen9 If y�, plaie dacribe and atuch avtilable plans. <br /> IIO I <br /> 3) F°.time�e thc tmount of fill and dred4e maierial that would be pl�ad in or rcmoved <br /> from surfaa water or wetl�nds �nd indicate the area of the site th�t would bc affxted. In• <br /> diate the wuree of fiil mueri�l. <br /> NONE <br /> 4) Will the propcxal require surface water withdrawals or divenions'! Give general de- <br /> scription, purpox, aud epproximate quanciiia if known. <br /> NO <br /> 5) Doa the propot�l lie within a IO�yur Iloodplsinl If w, note loation on the site <br /> plan. <br /> NO <br /> 6) Doa the proponl involve any disch�raa of waste materials to surface waters^ 1(so, <br /> dacribe the type of wute and anticipu� volume of discharge. <br /> NO <br /> b. Ground: <br /> 1) Will `round w�ter be withdnwn, or will w4ter be diuhrraed to ;round watm^ Give <br /> �enenl deecription, purpose, and appraximate quantitia if known. <br /> NO <br /> 2) Dacribe wute rtuleti4l that will be diuh�r4ed '+nto the around from septic unks or <br /> oiher wurca, if any (For ea�mple: Domatic uwaae; indusirial, conuinin� the followin` <br /> chemials . . .; a�riculcurtl; ete.). Deuribe [Ae `enenl siu of the system, the number of <br /> sueh syttems, the number of housa to be served (if applicable), or the number of animals or � <br /> humans the system(i) are ezpected to urve. � � <br /> NONE I <br /> I <br /> � ' <br /> 4. ; <br />