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A'� <br />� <br />TO BE COMPLETED BY �PPLICANT <br />3. Water <br />a. Surface: <br />� <br />1) Is chere any surface water body on or in �he immediate vicinity of �he si�e (including <br />vear—round and seasonal strcams, saliwater, laka� ponds, wedands}? [f ya, describe rype <br />and provide nama. (f appropria[e. s[ate what streaa. or river it flows into. <br />t'}o�Haf itt'f}tF. IMH�71�tCE V1Glt-�1T`{. W� �� ��n <br />lH ?N E. NOI�Tfit U2�6G-K IOl�h1 hff�f� I�I H.�! lNC I�- � <br />� �YpLa�cl�1�TI�l,�f 3 tyt.l�To'ff�t�.�U1'{�EP{�i" <br />2) Will che pro�ect raqhire any work o�er, m, or adjacent to (w�thin 200 feet) the dacribed <br />waters? lf yes, please deuribe and actach available plans. <br />�0 <br />3) Estimate the amount of fill and dredge material �hat would 6e placed in or removed <br />from surfaee wa[er or weclands and indiute che arw of the site that would be affec[ed. In- <br />dica[e the source of fill material. <br />��� . <br />4) Will the proposal require surface watcr wi[hdrawals or diversions? Give genenl da <br />seription, purpos0. and approxima[e quanci[ies if known. <br />�. � <br />5) Doet the proposal lie within :� I00—yeac floodplain° If w, note locacion on the site <br />P�a'(}-IC. l�leDY�cl. il'� ls4f'(j-tll-I 'fF'F� HO� GI..'6Ei--' l71-'I'dH�E <br />q►E.�H �U'h W{-tIGH kldU. K.EQuI12B �ct�t�i't�N <br />6) Doa the proposal involve any discharga of waste materials ta surface wa[m? !f so, <br />dacribe the type of wazte and antieipated volume af diuharge. <br />No� 1�oH6 To. �.I►�#'t�.b t��C�- UroN �11Y�-�flol-t. <br />b. Ground: <br />I) Will ground water be wichdrawn, or will water be discl:uged co ground water? Give <br />genenl dacrip�ion, purpose, and app�oximaie quantiria iC known. <br />�-}O � <br />2) Dacribe wute mncerial tha[ will be discharged into the ground from septic �anks or <br />other sourca, if any (for example: Damatic sewage; industrial, containing the following <br />chemicals ...: agricultunl: etc.). Dacribe the general size of the syseem, the number of <br />sueh syscems. �he number of houses �a bo served (if applicable), or the number of animals or <br />.iumans the syscem(s) are expected co serve. <br />�14N � . <br />EVALUATION FOR <br />�GENCY IISE ONLY <br />m <br />d <br />