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Home My WebLink About20210696 85 Nelson Use Variance EAF 18.Does the proposed action include construction or other activities that result in the impoundment ot' NO YE wat�r or other liquids(e.g.retention pond,waste lagoon,dam)? IfYes,explain purpuse and size: 19.Has thc site of the proposed action or an adjoining property been the location of an activ closed NO YES solid waste management facility? If Yes,describe: � 20.f las the sitc of the proposed action or an adjoining pro een the subject of remediation(ongoing or NO YES completed)for hazardous waste? / If Yes,describe: � I AFFIRM THAT THE[DIFORMATION PROVIDED ABOVE IS TRUE AND ACCURATE TO THE BEST OF MY KNO�'I.F,DGE Applicant/spflrtsor oame: Date: Sign tfe: Part 2-Impact Assessment. The Lead Agency is responsible for the completion o(Part 2. Answer all of tl�e following qucstions in Part 2 using thc informatiun containcd in Part I and othcr matcrials suhmiUcd by thc projcct sponsor or othenvise available to thc revicwer. When answering the qucstions the revicwcr should be guided by the concept"Have my responses been reasonable considering the scale and context of the proposed action'?" No,or Modcrate small to large impact impact may may occur occur 1. W ill the proposed action create a material conflict with an adopted land use plan or zuning regulations`? 2. W'ill tlic proposed action result in a change in the use or intensity of use of land? 3. W ill thc proposed action impair the character or qualiry of the existi�g community? 4. W ill the proposed action havc an impact on the environmental characteristics that cuuscd the establishment of a Critical Environmcntal Area(CI:A�'? 5. Will the propused action result in an adverse change in thc existing level oftraffic or affect existing infi'astruchtre for mass transit,biking or walkway? 6. Will the proposed action cause an increase in the use of energy and it fjils to incorporate rcasonabl available ener conservation or renewable ener o orhmities? 7. Will the proposed action impact existing: a.public/prieate water supplics'? b.public/private waste�vater treatment utilities? R. Will the proposed action imp�ir the character or quality of important historic,archaeological, architec�ural or aesthetic resources'? 9. N-'ill the proposed action result in an adverse dtange to natural resources(e.g.,wetlunds, wa�erbodics,groundwater,air qualiry,flora and fauna)'? Page 3 of 4 N�-��c;n� � ��7.1! �6��; �'(S' !'✓��s�,� ��t ��t V�,�„rE 1 � I'�i►�,� ' / �4�'r �, No,or Moderatc small to largc impact impact may may occur uccur I0. W ill the proposed action result in an increase in the potential for erosion,flooding or drainage problcros'? I I. W ill the proposed action create a hazard to environmental resources or hwnan health? Part 3-Dctermination of significance. The Lead Agency is responsible fur the completion o1'Part 3. For every qucstion in Part 2 that was answcrcd"modcratc to largc impact may occur",or if thcrc is a nccd to cxplain why a particular element of thc proposed action may or will not result in a significant adverse environmental impact,please complete Part 3. Part 3 should,in sufticient detail,identify the impact,including any measures or design clements that havc been included by the project sponsor to avoid or reduce impacts. Pah 3 shoidd also explain how Ihe lead agency deterniined that the impact may or will not bc signiticant.Each potential impact should be assessed considering its setting,probabilily of occurring, duralion,irrcvcrsibility,gcographic scopc and magnitudc. Also considcr thc potcntial for short-tcrm,long-tcrni and cumultiticc impacts. ❑ Check this box if you have determined,based on the infonnation and analysis above,and any supporting documentation, that the proposed action may resuh in one or more potentially large or signiticant adve�se impacts and an environmental impact statement is required. ❑ Check this box if you liave determi�red,6ased on the infonnation and analysis above,and any supporting documentation, .� ft� that the pro osed action will not resuh in any significant adverse environmental impacts. CanArv{�, '.)'��.k/a0 uF �;'(�L)�, �19� oF �Ar,A7�;/a ��vj�l + �Zl Juj� Name of Lead Agency � Date �� '�I�,� -r.,��, �N�� Print or Type • Responsible Officer in Lead Agency Tide of Responsible Officer Signature of Responsible Ofticer in Lead Agency Signature of Preparer(ifdifferent from Responsible Officer) Page 4 of 4 ��/�(�c;YL � �✓�� l��✓�� g� !V�-�SU �+� v `�� {'l`M_�/kr�'� � � I�Pp�r��,� � ��+��