10500 EVERGREEN WAY 2018-01-02 MF Import

tn _ 4 _ tE COM►LETED SY APPLICANT EVALUATION FOR 3 W�� AGENCY USE ONLY� a. Surface: I) Is there any surface water body an or in the immedialc vicinily uf the sitc (including �� ycar-round and seasonal strcams, saltwatcr, lakcs, ponds, wcllands)? I( ycs, dcscribc typc and provide nama. If appropri•rle, statc what strcam or rivcr it Ilows into. None 2) Will thc project rcyuirc any work uvcr, in,or adjaccm to (Within 200 fcct) ihc dcxcribcJ w�lcrs? If y�. plca� Jcscribc and :ulach ;iv;�ilablc pl;ins. No 3) flstimatc the rmount uf fiU and dredge matcri�l thut would bc placcd in ur rcmovcd from surfaee w•ater or wetlands and india�te the are� uf lhc sitc that would bc afPectcd. In- dicate the source o(fill matcrial. None 4) Will the proposal require sur(ace water withdrawals or Jivcrsions? Give gcneral de- scription, purpose,and approximate quantitics if known. No 5) Does the proposal lie within a 100-year Ooodplain? If so, nutr location on thc si�c plan. No 6) Dues the proposal invulve any Jischarges of waste matcrialx to sur(acc waters? If so, dc�cribc the type uf waste and anticipate� volume o(dischargc. No b. Ground: I) �ill ground water be withdrawn, or will water be discharged to g �,und water? Gi�c dV� +�j �6_Z�-�� general deuription, purpose, and approximatc quantities if known. � No 2) Describe waste material that will be dischorged intu thc graund from scptic tanks or other sources, if any (for example: Domcstic sewage; industrial, c��ntaining lhe following chcmicals . . .; agriculwr�l; cicJ. Describc thc gcneral si�c uf the systcm, the numbcr of such systems, Ihe number of houses to bc scrvcJ (if applic:iblc). or the numbcr of animals or humans the systcm(s) are cxpcctcd to serve. None . - .. �� )