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� ' r <br /> , � TO �E COM�LETED �Y ��►(7CANT Ev�W�T70N FOII <br /> 3 �y�� � - ACCNCY {JS6 ONLY ' <br /> i. $Y�fiCG: <br /> I) Is chsre any surfaee water body on or in t6e immeditte vicinity of the site (includin� � <br /> year�rou� and sasorul strams, ultwater, lakec, ponds, wetland�)? If ya, deseribe cype <br /> and provide nama. If appropriata sute what stream or river it ttows inco. <br /> /IC <br /> 2) Will the projeet reQuiro any work over, in, or adjacent to (within 200 feec) ths daeribed <br /> waters? If ya, pleasa dacribe and atuch available plam. <br /> � <br /> 3) Fscimate the amount o( filt and dred`e macerial �hat would be plaad in or remnval <br /> from surfaa wata or wetlands and indiate the arn of the site that wauld be affccsw. lr.- <br /> diat�e.[.�6,e�!Jmurcs of fiU ma�erial. <br /> !P-�� <br /> . i <br /> 4) Will ihe propasal requirc surface wa[a wichdnwals or diversirnn? Give �eneral da � <br /> scripcion, purpcue, and approximaie quantitia if known. � <br /> � <br /> . <br /> S) Das the propatal lie within a 100-yat floodplain? If so, note london on the site <br /> plan. � . <br /> 6) Doc the propaaal involve any d'ucharge of waste materiaLs to surface wa[en? If so: <br /> dnaibe the rype of wuu and anddpated volume af dixharge. <br /> � <br /> b. Ground:• � <br /> I) Will ground water be withdnwn, o� will wata be dixharged to ground wata? Give <br /> Qeneral dnenp[ion, purpoea, and approxirtuce quantitia if knawn. <br /> � ' <br /> :) Daeribe wute material tha[ will be discharged inta the ground from septic tanks or <br /> other sourcn, if any (for example: Damanc sewage; industrial, containing che following I <br /> chemicals . . .; agncul[ural; etc.). Describe che general size of [he system, �he number of <br /> such sys�ems, the number of hou•.a to be xrved (if applicable), or the number ot animais or <br /> humam che ;yscem(s) are atrected to serve. I <br /> na�,e. <br /> l+a q I <br /> . _ . . . .. . .. _ . ... ._..._.. . .. .. . .. ' ' <br />