Application 169 Haviland Road
Queensbury, NY 12804
Hutchins Engineering Phone: (518) 745-0307
Fax: (518) 745-0308
September 13, 2013
Town of Queensbury Planning Board
742 Bay Road
Queensbury NY 12804
Re: Swordfish Realty, LLC
Town of Queensbury. Warren County, New York
Dunhams Bay Lodge Property Parcel ID# 252.00-1-75.1
Dear Planning Board Members:
This office represents Swordfish Realty, LLC with respect to the enclosed application. Attached
please find application, plans. and supporting information describing the applicant's proposal to
construct a 40' x 60' office/storage building to be located in the footprint of an existing storage
shed.
On behalf of the applicant, Swordfish Realty, LLC, we respectfully request to be placed on the
Planning Boards meeting schedule for October 2013. We look forward to discussing this project
at one of your October meetings.
Please contact if you require additional information.
Regards,
114
G. Thomas Hutchins, P.E.
Hutchins Engineering
Cc. w/ application
Rich Gordon
Jon Lapper
Tom Albrecht
G.Thomas Hutchins. P.E.
Site Plan Review Revised June 2009
Site Plan Review Application
REVIEW PROCESS:
1. Required Pre-submission meeting with staff to determine general completeness to be held no
later than 1 week prior to deadline day. Call (518) 761-8220 for an appointment
2. Submittal of complete application: 1 original and 14 copies of the application package by monthly
deadline.
3. Determination of application completeness. All necessary information must be provided and
appropriate fee(s) paid for consideration for placement on an agenda for that month.
4. Incomplete applications will not be considered for placement on any agenda until all missing
information has been submitted.
5. Submittal to Warren County Planning, if applicable.
6. Planning Board meeting, generally the third & fourth Tuesday of each month. You will be advised
in writing as to which meeting to attend.
7. Following the meeting you will be provided with a copy of the resolution stating the Board's
decision on your application. If your application was approved, the next likely step is a Building
Permit. Final drawings must be provided for the next phase of review. If your application was
denied your project cannot proceed as submitted.
DOCUMENTATION REQUIREMENTS:
Please submit 1 original & 14 copies of the completed application package to include
• Completed Application: pages 1-11 completed, signed & dated
• Pre-Submission Meeting Notes: signed by staff
• Copy of Deed
• New: Checklist & Plot Plan
• Fee 0 - 10,000 sf = $100
10,001- 30,000 sf = $250
30,001- 100,000 sf= $500
100,000 + sf = $1000
ZONING STAFF & CONTACT INFORMATION:
Craig Brown. Zoning Administrator crag bC g.eensbury.net
Keith Oborne, Land Use Planner keithoqueensbury.net
Pam Whiting. Office Specialist 518-761-8220 pamwgqueersbury.net
Visit our website at Nww.queensbury.ne: for further information and forms
Town of Queensbury Planning Office 742 Bay Road Queensbury. NY 12804 • 518-761-8220 1
Site Plan Review Revised June 2009
General Information
Tax Parcel ID Number: 252.00-1-75 . 1
Zoning District: WR (WATERFRONT RESIDENTIAL)
Detailed Description of Project [include current& proposed use]:
CONSTRUCT A 40 'x60 ' BUILDING, WITH 4 GARAGE BAYS IN LOWER LEVEL AND OFFICE
SPACE IN THE UPPER FLOOR TO SERVE THE DUNHAM'S BAY LAKE GEORGE RESORT FACILITY.
Location of project:
2999 STATE ROUTE 9L
Applicant Name: Address: 2999 STATE ROUTE 9L
SWORDFISH REALTY, LLC
QUEENSBURY NY 12804
Home Phone Cell:
Work Phone ' Fax
E-Mail:
Agent's Name: Address: 169 HAVILAND ROAD
HUTCHINS ENGINEERING
QUEENSBURY, NY 12804
Home Phone Cell:
JON LAPPER, ESQ. - BPSR 1 WASHINGTON ST -12801
Work Phone Fax
(518) 745-0307
(518) 745-0308
E-mail THUTCHINS @HUTCHINSENGINEERING.COM
Owner's Name Address
SAME AS APPLICANT
Home Phone Cell
Work Phone Fax
E-mail
Town of Queensbury Planning Office- 742 Bay Road - Queensbury, NY 12804 518-761-8220 2
Site Plan Review Revised June 2009
Site Development Data
Area /Type Existing sq.ft Proposed Total sq.ft.
Addition sq.
ft.
A. Building footprint 11,708 SF - 11,708 SF
B. Detached Garage
C. Accessory Structure(s)
(BARN & SHED) 2210 SF 290 SF 2500 SF
D. Paved, gravel or other hard surfaced area
(DRIVES,WALKS,SHUFFLEBOARD,TENNIS,WALLS ) 86, 790 SF 3435 SF 90,225 SF
E. Porches / Decks
F. Other
17,845 SF - 17, 845 SF
(GUEST CABINS, BLOCK BLDG)
G. Total Non-Permeable [Add A-F]
118,553 SF 3725 SF 122,278 SF
H. Parcel Area [43,560 sq. ft. /acre]
589, 890 SF 589,890 SF 589, 890 SF
I
I. Percentage of Impermeable Area of Site [I=G/H]
20.1% 0.6% 20.7%
Setback Requirements
Area Required Existing Proposed
Front [1] 30 ' 0 ' (NORTHEAST HSE) 465 .9 ' (NEW BLDG)
(RT 9L)
Front [2] 30 ' 89.8 ' (608SF CABIN) 489.5 ' (NEW BLDG)
Shoreline
Side Yard [1] 25' 133.9' (BARN) 125.4 ' (NEW BLDG)
(EAST)
Side Yard [2]
Rear Yard [1] 30 ' 35.8 ' (NEAST HSE) 76.0' (NEW BLDG)
(EAST, OPP. ALEXY)
Rear Yard [2] 30 ' 154.6 ' (1450SF CAB) 737.3 ' (NEW BLDG)
(OPP. RT 9L)
Travel Corridor
Height [max]
28' VARIES 27.95 '
Permeability
75% 79.9% 79.3%
No. of parking spaces 7 (NEW BLDG) VARIES 8 (NEW BLDG)
Town of Queensbury Planning Office. 742 Bay Road • Queensbury, NY 12804 - 518-761-8220 3
Site Plan Review Revised June 2009
Additional Project Information
1. Will the proposal require a Septic Variance from the Town Board of Health? rro
2. If the parcel has previous approvals, list application number(s):
3. Does this project require coverage under the NYS DEC Stormwater Pollution Prevention
Program? NO
4. Estimated project duration: Start Date FALL 2013 End Date 5/2014
5. Estimated total cost of project: $200, 000
6. Total area of land disturbance for project: 29, 000 SF
Floor Area Ratio Worksheet
FLOOR AREA RATIO (FAR) -- The relationship of building size to lot size, derived by dividing the total
building floor area by the lot size in square feet, yielding a percentage.
Zoning District Symbol Floor Area Ratio [FAR]
Waterfront Residential WR 0.22
Commercial Moderate CM 0.3
Commercial Intensive CI 0.3
A. The combined area of all square footage, as measure from exterior walls of all structures on the property,
including all floors of the structures, garages, basements and attics with more than five (5) feet of ceiling height
and covered porches. Building square footage does not include: Open deck, docks and that portion of covered
docks extending over water and one storage shed of one hundred twenty (120) square feet or less. Any
additional sheds will be included. (See "FLOOR AREA RATIO").
B. Commercial or industrial: the total area in square feet as measured from the exterior of the outside walls of a
building or structure, and when applicable, the sum total of all floor areas of the principal and accessory
buildings or structures on the project site.
Parcel Area 589,890 SF sq. ft.
Existing Floor Area 55, 080 sq. ft. [see above definition]
Proposed Additional Floor Area 2690 (290+2400 2ND FLR) sq. ft.
Proposed Total Floor Area 57, 770 sq. ft.
Total Allowable Floor Area 129,776 (Area x 0.22 ) [see above table]
Town of Queensbury Planning Office- 742 Bay Road - Queensbury. NY 12804 518-761-8220 4
Site Plan Review Revised June 2009
§ 179-9-080 Requirements for Site Plan Approval. The Planning Board shall not approve a Site Plan
unless it first determines that such site plan meets the following Standards. Please prepare responses to each of
the following topics.
STANDARDS
A. The proposed project furthers or is consistent with the policies of the Towns Comprehensive Plan.
B. The proposed project complies with all other requirements of this Chapter. including the site plan review standards as set forth in
Paragraph F of this section. the dimensional. bulk, and density regulations of the zoning district in which it is proposed to be located
(Article 3 and Table 1). the applicable requirements of all other Articles that apply.
C. The site plan encourages pedestrian activity internally and. if practicable. to and from the site with pedestrian paths or sidewalks
connected to adjacent areas.
D. The site plan must conform to Chapter 136 Sewage and Sewage Disposal. Chapter 147 Stormwater Management Local Law. and
other applicable local laws.
E. the proposed use shall be in harmony with the general purpose or intent of this Chapter. specifically taking into account the location.
character and size of the proposed use and the description and purpose of the district in which such use is proposed. the nature and
intensity of the activities to be involved in or conducted in connection with the proposed use and the nature and rate of any increase in
the burden on supporting public services and facilities which will follow the approval of the proposed use.
F The establishment. maintenance and operation of the proposed use will not create public hazards from traffic. traffic congestion or the
parking of vehicles and/or equipment or be otherwise detrimental to the health. safety or general welfare of persons residing or
working in the neighborhood or to the general welfare of the town. Traffic access and circulation road intersections, road and
driveway widths. and traffic controls will be adequate.
G Off-street parking and loading facilities will be appropriately located and arranged and sufficient to meet traffic anticipated to be
generated by the new use The establishment of vehicle links between parking areas of adjacent properties are provided where
feasible. This furthers the Town's goal of reducing curb cuts and reducing congestion. A twenty-foot wide connection is required. If
adjacent properties are either undeveloped or previously developed without having made provision for future linkage. then a future
connection must be identified and provided for in the site plan under review for such future linkage when the time arises. The
Planning Board may require proof that the applicant has made contact with adjacent property owners for purposes of coordinating
•
• linkages with adjacent properties.
H. The project shall not have an undue adverse impact upon the natural. scenic. aesthetic. ecological. wildlife. historic. recreational or
open space resources of the town or the Adirondack Park or upon the adequate provision of supporting facilities and services made
necessary by the project.taking into account the commercial. industrial residential. recreational or other benefits that might be derived
from the project. In making the determination hereunder. the Planning Board shall consider those factors pertinent to the project
contained in the development considerations set forth herein under§ 179-9-080 of this chapter. and in so doing. the Planning Board
shall make a net overall evaluation of the project in relation to the development objectives and general guidelines set forth in§ 179-9-
080 of this Article.
I. The provision for and arrangement of pedestrian traffic access and circulation. walkway structures. control of intersections with
vehicular traffic and overall pedestrian convenience shall be safe and adequate for pedestrian movement. Pedestrian connections
between adjacent sites shall be provided to encourage pedestrian use.
J. Stormwater drainage facilities will prevent an increase of post development drainage flows as compared to pre-development drainage
flows. Drainage of the site shall recharge ground water to the extent practical. Surface waters flowing off-site shall not degrade any
streams or adversely affect drainage on adjacent properties or public roads. Facilities shall be in conformance with the drainage
standards of Chapter 147 of the Town Code and the Town of Queensbury Subdivision Regulations where applicable.
K. The water supply and sewage disposal facilities will be adequate and will meet all applicable and current requirements set forth by
Department of Health regulations and Chapter 136 of the Town Code.
L. The adequacy. type and arrangement of trees. shrubs and other suitable plantings, landscaping and screening shall effectively
provide a visual and/or noise buffer between the applicants and adjoining lands. including the maximum retention of existing
vegetation and maintenance. including replacement of dead or deceased plants.
M. Fire lanes, emergency zones and fire hydrants will be adequate and meet the needs and requirements of emergency service
providers.
N The design of structures. roadways and landscaping in areas susceptible to ponding, flooding and/or erosion will minimize or avoid
such impacts to the maximum extent practicable.
O The site plan conforms to the des:gn standards, landscaping standards and performance standards of this chapter.
Town of Queensbury Planning Office 742 Bay Road Queensbury. NY 12804 518-761-8220 5
179-9-080 Responses to standards questions A-O
A. This site involves a resort/restaurant use, which is an allowable use in this
zone: the proposed building will support this operation.
B. The proposed project as presented is believed to be in compliance with
applicable code parameters.
C. The proposed project has been designed to allow internal pedestrian
activities as necessary and applicable to this type of use.
D. The proposed project has been designed to be in compliance with Chapters
136 and 147 as applicable.
E. The proposed project has been designed to be in harmony with the general
purpose or intent of this Chapter.
F. The proposed project has been designed to be in compliance with principles
of good site access. traffic flow. and safety and general welfare of the
neighborhood.
G. The proposed project has been designed with the intent to provide safe.
adequate, and functional off-street parking and loading facilities.
H. The proposed project has been designed to not impact natural. scenic,
aesthetic ecological. wildlife. historic. recreational or open space resources of
the Town.
The proposed use is located in a rural setting. in which the pedestrian use is
within the facility, not adjacent parcels.
J The proposed project has been designed to be in compliance with Chapter
147 as applicable.
K. The proposed project has been designed to be in compliance with Chapter
136 as applicable. Water supply will be from the existing facility's private
water district.
L. The proposed project has been designed to maintain the existing vegetation
and landscaping as feasible.
M. The project has been designed in effort to meet the needs of emergency
service providers adequately.
N. The site grading and drainage provisions have been developed with the intent
of avoiding flooding and ponding with the exception of areas required for
stormwater controls.
O. The site has been designed with the intent of maintaining the existing
vegetation and landscaping as feasible.
Site Plan Review Revised June 2009
§ 179-9-050 Application for Site Plan Review
Application for site plan approval shall be made to the Planning Board using forms supplied by the Board. Application materials
and the site plan shall include sufficient information for the Board to make its findings under § 179-9-070 and 179-9-080 below.
In determining the content of the site plan and supporting documentation. the Planning Board may waive certain requirements if
the Planning Board deems such requirements or information unnecessary for the type of project proposed. Any such waiver
shall be made in writing, and shall contain statements of the reasons why the waived information requirements are not
necessary for an informed review under the circumstances. The Planning Board may grant such waivers on its own initiative or
at the written request of an applicant. Such request shall set forth the specific requirements that are requested to be waived and
the reasons for the requested waiver. Absent any waiver or waivers, an application for Site Plan Review shall include the
following:
Shown
REQUIREMENTS on Sheet
A A vicinity map drawn at the scale that shows the relationship of the proposal to existing community facilities which affect or
serve it, such as roads. shopping areas. schools. etc. The map shall also show all properties. identify owners. subdivisions.
streets, and easements within 500 feet of the property. Such a sketch may be superimposed on a United States Geological S3
Survey map of the area.
B The site plan shall be drawn at a scale of forty feet to the inch (1"=40 feet) or such other scale as the Planning Board may
deem appropriate. on standard 24"x 36"sheets. with continuation on 81/2 x 11"sheets as necessary for written information. S3,54
The information listed below shall be shown on the site plan and continuation sheets.
C Name of the project, boundaries. date. north arrow. and scale of the plan. f ALL
D Name and address of the owner of record. developer and seal of the engineer.architect. or landscape architect. If the
applicant is not the record owner. a letter of authorization shall be required from the owner ALL
E The location and use of all existing and proposed structures within the property. all dimensions of height and floor
area all exterior entrances. and all anticipated future additions and alterations. 52,S3
F The location of all present and proposed public and private ways. off-street parking areas. driveways. outdoor storage areas.
sidewalks. ramps, curbs. paths. landscaping. walls. and fences. Location, type. and screening details for all waste disposal
52 S3
containers shall also be shown.
G The location. height. intensity and bulb type (sodium incandescent. etc.) of all external lighting fixtures. The direction of
illumination and methods to eliminate glare onto adjoining properties must also be shown in compliance with§179-6-020.
H The location. height,size. materials. and design of all proposed signs.
I The location of all present and proposed utility systems including:
1. Sewage or septic system:
2. Water supply system:
S3 ,S4
3. Telephone.cable, and electrical systems: and
4. Storm drainage system including existing and proposed drain lines. culverts. catch basins. headwalls.
endwalls. hydrants manholes. and drainage swales.
j Plans to prevent the pollution of surface or groundwater, erosion of soil both during and after construction. excessive runoff.
and flooding of other properties. as applicable. A Stormwater Pollution Prevention Plan (SWPPP) for all land development
activities (excluding agricultural activities) on the site that results in land disturbance of 1-acre or more. A SWPPP shall
comply with the requirements of the DEC SPDES MS-4 General Permit and Chapter 147 of the Town of Queensbury Code It S3,S4
shall be at the discretion of the Planning Board as to whether a SWPPP or an erosion and control plan shall be required for a
site plan review project land disturbance of less than 1-acre.
K Existing and proposed topography at two-foot contour intervals. or such other contour interval as the Planning Board shall
allow. All elevations shall refer to the nearest United States Coastal and Geodetic Bench Mark. If any portion of the parcel is
within the 100-year floodplain. the area will be shown, and base flood elevations given. Areas shall be indicated within the S3, S4
proposed site and within 50 feet of the proposed site where soil removal or filling is required.showing the approximate volume
in cubic yards.
L A landscape plan showing all existing natural land features that may influence the design of the proposed use such as rock
outcrops. stands of trees. single trees eight or more inches in diameter. forest cover. and water sources. and all proposed
changes to these features including sizes and types of plants. Water sources include ponds. lakes. wetlands and WAIV
watercourses. aquifers.floodplains. and drainage retention areas.
Town of Queensbury Planning Office. 742 Bay Road - Queensbury. NY 12804 518-761-8220 6
Site Plan Review Revised June 2009
to Land Use District boundaries within 500 feet of the site's perimeter shall be drawn and identified on the site plan. as well as 1
any Overlay Districts that apply to the property. S2
N Traffic flow patterns within the site.entrances and exits. and loading and unloading areas,as well as curb cuts on the site and
within 100 feet of the site. The Planning Board may, at its discretion. require a detailed traffic study for large developments or
for those in heavy traffic areas.which shall include:
1.The projected number of motor vehicle trips to enter or leave the site. estimated for weekly and annual peak hour
traffic levels:
S 1,S 2
2.The projected traffic flow pattern including vehicular movements at all major intersections likely to be affected by the
proposed use of the site
3.The impact of this traffic on levels of service on abutting public streets and at affected intersections Existing and
proposed weekly and annual peak hour traffic levels and road capacity levels shall also be given.
O For new construction or alterations to any structure. a table containing the following information shall be included:
1. Estimated area of structure to be used for particular purposes such as retail operation. office. storage. etc
2. Estimated maximum number of employees; S2,S3
3. Maximum seating capacity.where applicable-and
4. Number of parking spaces existing and required for the intended use.
p 1. Floor Plans.
2. Elevations at a scale of one-quarter inch equals one foot(1/4"= 1 foot)for all exterior facades of the proposed structure(s)
and/or alterations to or expansions of existing facades. showing design features and indicating the a and color of materials A�'A2
P 9 9 9 9= type
be used
Q Soil logs. water supply well and percolation test results, and storm runoff calculations. as needed to determine and mitigate
project impacts,
S4
R Plans for disposal of construction and demolition waste,either on-site or at an approved disposal facility.
S Plans for snow removal, including location(s)of on-site snow storage. S4
T An Environmental Assessment Form ('`EAF'). as required by the SEQRA regulations. with Part 1 completed by the Applicant
shall be submitted as part of the application. If the proposed project requires a special use permit and an EAF has been ATT.
submitted in conjunction with a special use permit application. a duplicate EAF is not required for the site plan application.
U If an application is for a parcel or parcels on which more than one use is proposed. the applicant may submit a single
application for all such uses provided the proposed uses are accurately delineated on a site plan drawn pursuant to the
requirements set forth above. The Planning Board may grant the application with respect to some proposed uses and not
others. For purposes of reviewing an application and for SEQRA compliance) all proposed uses on a single parcel or on
• contiguous parcels shall be considered together
V A brief narrative statement on how the project proposed for review furthers or is consistent with the vision. goals and policies
in the Town s Comprehensive Plan. ATT.
Town of Queensbury Planning Office- 742 Bay Road Queensbury. NY 12804 518-761-8220 7
Site Plan Review Revised June 2009
Pre-Submission Conference Form 1179-4-0401
1. Tax Map ID 252.00-1-75.1
2. Zoning Classification WR (WATERFRONT RESIDENTIAL;
3. Reason for Review: e( _; (-c,l 1<'1.A S fec (, tt i c_)i.e%-- c<03' &
4. Zoning Section#: (7 �3—C
5. Pre-Submission Meeting Notes; Outstanding Items To Be Addressed Include:
Deed Yes No
General Information complete y Yes No
Site Development Data Complete ✓Yes No?(<- "-'
Setback Requirements Complete /Yes Nox v 1e, ,'.-..ec 1
Additional Project Information Complete ,/ Yes No
FAR Worksheet complete ,/Yes No
Standards addressed V.Yes No OM elc• r:.,
Checklist items addressed ✓ Yes No
—Environmental Form completed ,-/ Yes
o
Signature Page completed Yes No
-y0 �rc�U,S `y()Abo 02 ,s41;'L4 ),\cjc43
' c -r-CL.(.2°1 INV,, .'1 C.'1 Gi t7 c-f. , ' - Q "i C Q i, .c '
7
4n ('en-1( -- @f -4L'.y7 S-}01u(, -C pi)]f bGc-n
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Staff Representative: l-c' ' c <= 0•`'0C_P
Applicant/Agent: I
Date: /i (O /C
Tow of Queensbury Planning Office 742 Bay Road - Queensbury. NY 12804 • 518-761-8220 8
Site Plan Review Revised June 2009
14-164 i111951—Text 12
PROJECT I.D.NUMBER 617.20 SEOR
Appendix C
State Environmental Quality Review
SHORT ENVIRONMENTAL ASSESSMENT FORM
For UNLISTED ACTIONS Only
PART —PROJECT INFORMATION (To be completed by Applicant or Project sponsorl
1. APPLICANT;SPONSOR I 2. PROJECT NAME
SWORDFISH REALTY, LLC DUNHAM'S BAY LAKE GEORGE RESORT
3. PROJECT LOCATION:
Municipality QUEENSBURY County WARREN
A. PRECISE LOCATION(Street address and road intersections.prominent landmarks,etc.,or prorde map)
2999 STATE RT 9L
5. IS PROPOSED ACTION:
0 New tJ Expansion 0 Modification/alteration
6. DESCRIBE PROJECT BRIEFLY:
CONSTRUCT A 40'x60' 2-STORY BUILDING, WITH 4 GARAGE BAYS IN LOWER LEVEL AND
OFFICE SPACE IN SECOND FLOOR TO SERVE THE DUNHAM'S BAY LAKE GEORGE RESORT
FACILITY.
7. AMOUNT OF LAND AFFECTED:
Initially. 0'67 acres Ultimately 0.67 acres
8. WILL PROPOSED ACTION COMPLY WITH EXISTING ZONING OR OTHER EXISTING LAND USE RESTRICTIONS?
LLJ Yes 0 No If No,describe briefly
9. WHAT IS PRESENT LAND USE IN VICINITY OF PROJECT?
El Residential Olnduatrial El Commercial 0 Agriculture 0 Park/Forest/Open space 0 Other
Describe:
RURAL RESIDENTIAL, MARINAS, BOAT LAUNCHES, LAKEFRONT RESIDENTIAL
10. DOES ACTION INVOLVE A PERMIT APPROVAL OR FUNDING,NOW OR ULTIMATELY FROM ANY OTHER GOVERNMENTAL AGENCY(FEDERAL,
STATE OR LOCAL)?El No It yes,list agency(s)and permit/approvals
11. DOES ANY ASPECT OF THE ACTION HAVE A CURRENTLY VALID PERMIT OR APPROVAL?
0 Yes El No If yea,list agency name and permitapproval
12. AS A RESULT OF PROPOSED ACTION WILL EXISTING PERMIT/APPROVAL REQUIRE MODIFICATION?
❑Yes CI No
i CERTIFY THAT THE INFORMATION PROVIDED ABOVE IS TRUE TO THE BEST OF MY KNOWLEDGE
Applicant/sponsor name: / Date:
Slgnatute: , �(17
If the action is in the Coastal Area, and you are a state agency, complete the
Coastal Assessment Form before proceeding with this assessment
OVER
Town of Queensbury Planning Office- 742 Bay Road • Queensbury, NY 12804 • 518-761-8220 9
Site Plan Review Revised June 2009
• PART II—ENVIRONMENTAL ASSESSMENT(To be completed by Agency)
A. DOES ACTION EXCEED ANY TYPE i THRESHOLD IN 6 NYCRR PART 617.4? If yes,coordinate the review process aria use the FULL EAF.
❑Yes ❑No
B. WILL ACTION RECEIVE COORDINATED REVIEW AS PROVIDED FOR UNLISTED ACTIONS IN 6 NYCRR,PART 617.6? If No.a negative declaration
T.ay be superseded by another involved agency.
❑Yes ❑No
C. COULD ACTION RESULT IN ANY ADVERSE EFFECTS ASSOCIATED WITH THE FOLLOWING:(Answers may be handwritten,it,egiblel
C1. Existing air quality. surface or groundwater quality or quantity, noise levels, existing traffic patterns. solid waste Production or disposal.
potential for erosion•drainage or flooding problems?Explain briefly:
C2. Aesthetic agricultural.archaeoiogicai,historic,or other natural or cultural resources:or community or neighborhood character?Explain briefly:
03. Vegetation or fauna.fish,shellfish or wildrife species,significant habitats.or threatened or endangered species?Explain briefly:
C4- A community's existing plans or goals as officially adopted,or a change in use or intensity of use of and or other natural resources?Explain briefly
C5. Growth,subsequent development,or related activities likely to.be induced by the proposed action?Explain briefly.
06. Long term,short term.cumulative.or other effects not identified in Cl-05?Explain briefly.
C7. Other impacts(including changes in use of either quantity or type of energy)?Explain bnefly.
D. WILL THE PROJECT HAVE AN IMPACT ON THE ENVIRONMENTAL CHARACTERISTICS THAT CAUSED THE ESTABLISHMENT OF A CEA?
❑Yes No
E IS THERE,OR IS THERE UKELY TO BE CONTROVERSY RELATED TO POTENTIAL ADVERSE ENVIRONMENTAL IMPACTS?
❑Yes ❑No If Yes,explain briefly
PART III—DETERMINATION OF SIGNIFICANCE(To be completed by Agency)
INSTRUCTIONS: For each adverse effect identified above,determine whether it is substantial,large,important or otherwise significant.
Each effect should be assessed in connection with its (a) setting (i.e. urban or rural); (b) probability of occurring; (c)duration;(d)
irreversibility:(e)geographic scope;and(f)magnitude.If necessary,add attachments or reference supporting materials.Ensure that
explanations contain sufficient detail to show that all relevant adverse impacts have been identified and adequately addressed. If
question D of Part It was checked yes,the determination and significance must evaluate the potential impact of the proposed action
on the environmental characteristics of the CEA.
❑ Check this box if you have identified one or more potentially large or significant adverse impacts which MAY
occur. Then proceed directly to the FULL EAF and/or prepare a positive declaration.
❑ Check this box if you have determined, based on the information and analysis above and any supporting
documentation, that the proposed action WILL NOT result in any significant adverse environmental impacts
AND provide on attachments as necessary, the reasons supporting this determination:
• Name of Lead Allencv
Print or Type Name of Responsible Officer in Lead Agency Thtle or Responsible Officer
•ignature or Responsible Officer:n lead♦gency Signature of Preoarer',11 different from responsible officers
Date
2
Town of Queensbury Planning Office- 742 Bay Road •Queensbury,NY 12804 • 518-761-8220 10
Site Plan Review Revised June 2009
Signature Page
This page includes the 1.)Authorization to Act as Agent Form: 2.) Engineering Fee Disclosure; 3.)Authorization for
Site Visits: 4.) Other Permit Responsibilities; 5.) Official Meeting Disclosure and 6.) Agreement to provide
documentation required.
OWNER'S AGENT FORM:
Complete the following if the OWNER of the property is not the same as the applicant
Owner:
Designates:
As agent regarding: Variance Site Plan Subdivision
For Tax Map No.: 252.CG Section 1 Block 75.1 Lot
Deed Reference: Book Page Date
OWNER SIGNATURE: DATE:
APPLICANT'S AGENT FORM:
Complete the following if the APPLICANT is unable to attend the meeting or wishes to be represented by another
party:
Owner: SWORDFISH REALTY, LLC
Designates: HUTCHINS ENGINEERING & BPSR
As agent regarding: Variance J Site Plan Subdivision
For Tax Map No.: 252.06 Section 1 Block 75.1 Lot
Deed Reference: Book Page Date
OWNER SIGNATURE: DATE:
2.) ENGINEERING FEE DISCLOSURE: Applications may be referred to the Town consulting engineer for review of septic
design, storm drainage. etc. as determined by the Zoning or Planning Department. Fees for engineering review services will be
charged directly to the applicant. Fees for engineering review will not exceed$ 1,000 without notification to the applicant.
3.) AUTHORIZATION FOR SITE VISITS: By signing this page and submitting the application materials attached herein, the
Owner, Applicant, and his/her/their agent(s) hereby authorize the Zoning Board or Planning Board and Town Staff to enter the
subject properties for the purpose of reviewing the application submitted.
4.) OTHER PERMIT RESPONSIBILITIES: Other permits may be required for construction or alteration activity subsequent to
approval by the Zoning Board or Planning Board. It is the applicant's responsibility to obtain any additional permits_
5.) OFFICIAL MEETING MINUTES DISCLOSURE: It is the practice of the Community Development Department to have a
designated stenographer tape record the proceedings of meetings resulting from application, and minutes transcribed from
those tapes constitutes the official record of all proceedings.
6.) AGREEMENT TO PROVIDE DOCUMENTATION REQUIRED: I. the undersigned, have thoroughly read and understand
the instructions for submission and agree to the submission requirements, I acknowledge no construction activities shall be
commenced prior to issuance of a valid permit I certify that the application, plans and supporting materials are a true and
complete statement/description of the existing conditions and the work proposed, and that all work will be performed in
accordance with the approved plans and in conformance with local zoning regulations. I acknowledge that prior to occupying
the facilities proposed, I or my agents, will obtain a certificate of occupancy as necessary. I also understand that I/we may be
required to provide an as-built survey by a licensed land surveyor of all newly constructed facilities prior to issuance of a
certificate of occupan,y
I have r- nd -• to the above.
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Town of Queensbury Planning Office- 742 Bay Road • Queensbury, NY 12804• 518-761-8220 11