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SEQRA form 14-,6-2 (2!87)-7c SECIR 817.21 Appendix A State Environmental Quality Review FULL ENVIRONMENTAL ASSESSMENT FORM Purpose: The full EAF is designed to help applicant: and agencies determine, in an orderly manner, whether a project or action may be significant. The question of whether an action may be significant is not always easy to answer. Frequent- ly, there are aspects of a project that are subjective or unmeasureabie. It is also understood that those who determine significance may have little or no formal knowledge of the environment or may be technically expert in environmental analysis. In addition, many who have knowledge in one particular area may not be aware of the broader concerns affecting the question of significance. The full EAF is intended to provide a method whereby applicants and agencies can be assured that the determination process has been orderly, comprehensive in nature, yet flexible to allow introduction of information to fit a project or action Full EAF Components: The full EAF is comprised of three parts: Part 1: Provides objective data and information about a given project and its site. By identifying basic project data, it assists a reviewer in the analysis that takes place in Parts 2 and 3. Part 2: Focuses on identifying the range of possible impacts that may occur from a project or action. It provides guidance as to whether an impact is likely to be considered small to moderate or whether it is a Potentially- large impact. The form also identifies whether an impact can be mitigated or reduced. Part 3: If any impact in Part 2 is identified as potentially-large, then Part 3 is used to evaluate whether or not the impact is actually important. DETERMINATION OF SIGNIFICANCE—Type 1 and Unlisted Actions Identify the Portions of EAF completed for this project: ❑ Part 1 ❑ Part 2 ❑Part 3 Upon review of the information recorded on this EAF (Parts 1 and 2 and 3 if appropriate), and any other supporting information, and considering both the magitude and importance of each impact, it is reasonably determined by the lead agency that ❑ A. The project will not result in any large and important impact(s) and, therefore, is one which will not have a significant impact on the environment, therefore a negative declaration will be prepared. ❑ B. Although the project could have a significant effect on the environment, there will not be a significant effect for this Unlisted Action because the mitigation measures described in PART 3 have been required, therefore a CONDITIONED negative declaration will be prepared.* ❑ C. The project may result in one or more large and important impacts that may have a significant impact on the environment, therefore a positive declaration will be prepared. • A Conditioned Negative Declaration Is only valid for Unlisted Actions Name of Action Name of Lead Agency Print or Type Name of Responsible Officer in Lead Agency Title of Responsible Officer Signature of Responsible Officer in Lead Agency Signature of Preparer(If different from responsible officer) r Dark t PART 1—PROJECT INFORMATION Prepared by Project Sponsor NOTICE: This document is designed to assist in determining whether the action proposed may have a significant effect on the environment. Please complete the entire form, Parts A through E. Answers to these questions will be considered a$ part of the application for approval and may be subject to further verification and public review. Provide any additional information you believe will be needed to complete Parts 2 and 3. It is expected that completion of the full EAF will be dependent on information currently available and will not involve new studies, research or investigation. If information requiring such additional work is unavailable, so indicate and specify each instance. NAME OF ACTION � IGK LOCATION OF ACTION (include Street Addrelm Municipality and County) W r[F1Ltr� erLeM LAkE Roan 0r� NAME OF APPLICANTISPONSOR BUSINESS TILEPHONE E is 7 74-77 S- 11MV ADDRESS RQI i PO STATE ZIP CORE cmlL.prKE NY 129�3 L GEORQE NAME OF OWNER Of dlffennt) BUSINESS TELEPHONE f 1 ADDRESS CrT'rlPO STATE ZIP CODE OESCRIPT)ON OF ACTION GDIJS?KvG1LOr/ dF SIN" '*Mi'll RIEgID&J(Z- SOto"Will V"Wkfia "%W — hulk VhRI Adco. Please Complete Each Question—Indicate N.A. if not applicable A. Site Description Physical setting of overall project, both developed and undeveloped areas 1. Present land use: ❑Urban ❑Industrial OCommercial i�Residential (suburban) ❑Rural (non-farm) ❑Forest ❑Agriculture 00ther 2. Total acreage of project area: s 40 — acres. APPROXIMATE ACREAGE PRESENTLY AFTER COMPLETION Meadow or Brushland (Non•agnculturail -- - - ----- — ac"` Forested acres acres Agricultural (Includes orchards, cropland, pasture, etc.) acres acres .Wetland (Freshwater or tidal as per Articles 24, 25 of ECL) acres acres Water Surface Area acres acres Unvegetated (Rock, earth or fill) acres acres Roads. buildings and other paved surfaces •0 I acres • (Z- acres Other (Indicate type) acres acres 3. What is predominant soil type(s) on project site? a. Soil drainage: hKVell drained J� % of !Ute VIttoderatety well drained _*112— % of site ❑Poorly drained % of site b. if any agricultural land Is Involved, how many acres of soil are classified within soil group 1 through 4 of the NYS Land Classification System? acres. (See 1 NYCRR��3/770). 4. Are there bedrock outcroppings an project site? Oyes 1QNo a. What Is depth to bedrock? (in feet) 2 --- -� T�FIICp 3IOvSE E"4ST s� fb�SlPEIe kt STAvk�lr�- W 5. App•oximate percentage of proposed project site with slopes: vv0.10% 14" 56 ❑10-15% % 015% or greater % 6. Is Qiroject substantially contiguous to, or co ain a building, site, or district, listed on the State or the National Resisters of Historic Places? Dyes IWO e,/N 7 Isprojett substantially contiguous to a site listed on the Register of National Natural Landmarks? ❑Yes �No a. Wilat is the depth of the water table? 4% (in feet) 9. Is Site located over a primary, principal, or sole source aquifer? ees ❑No 10. V0 hunting, fishing or shell fishing opportunities presently exist in the project area? LO�es ❑No 11. Voes project site contain any species of plant or animal life that is identified as threatened or endangered? ❑Yes MIKO According to Identify each species 12 Ar_ there any unique or unusual land forms on the project site? (i.e., cliffs, dunes, other geological formations) [Dyes Vo" Describe 1,3. Is the project site presently used by the community or neighborhood as an open space or recreation area? ❑Yes N Rio If yes, explain 14 Does the present site include scenic views known to be important to the community? []Yes SAO 15. Streams within or contiguous to project area: NONE a Name of Stream and name of River to which it is tributary 16. Lakes, ponds, wetland areas within or contiguous to project area: a. Name G�N a� b. Size (in acres) 17 Is the site served by existing public utilities? ❑Yes ?elo a) If Yes, does sufficient capacity exist to allow connection? ❑Yes ❑No b) If Yes, will improvements be necessary to allow connection? ❑Yes ❑No 18. Is the site located in an agricultural district certified pursuant to Agriculture and Markets Law, Article 25-AA, Section 303 and 304? ❑Yes M14o 19. Is tjte site located in or substantially contiguous to a Critical Environmental Area designated pursuant to Article 8 of{ne ECL, and 6 NYCRR 617? 11'fe9 ❑No �� 20, Hes the site ever been used for the disposal of solid or hazardous wastes? ❑Yes ❑ 0 B. Project Description 1. physical dimensions and scale of project (fill in dimensions as appropriate) a. Total contiguous acreage owned or controlled by project sponsor acres. b. Project acreage to be developed: OIZAacres initially; r�Z acres ultimately. c. Project acreage to remain undeveloped #7oll — acres. d. Length of project, in miles: 09 (If appropriate) e. If the project is an expansion, indicate percent of expansion proposed f. Number of off-street parking spaces existing Z ; proposed . Maximum vehicular trips generated per hour (upon completion of project)? Ji- If residential: Number and type of housing units: On; Family Two Family Multiple Family Condominium Initially 1 Ultimately I. Dimensions (in feet) of largest proposed structure 3g_- height; _11 _width; tillig length. j. Linear feet of frontage along a public thoroughfare project will occupy is? jT ft 3 2. How much natural material (i.e.. rock, `a�rth, etc.) will be removed from the site? NGIUIS tons/cubic yards 3. Will disturbed areas be reclaimed? 19Yes QNo ❑NIA a. If yes, for what inten&� purpose is the site being reclaimed? LAW hk ptftV' b. Will topsoil be stockpiled for reclamation? Imes QNo c. Will upper subsoil be stockpiled for reclamation? 1 Kes ONo 4. How many acres of vegetation (trees, shrubs, ground covers) will be removed from site? •01 acres. 5. Will anv mature fpprest (over 100 years old) or other locally important vegetation be removed by this project? ❑Yes 6No 6. If single phase project: Anticipated period of construction 69 months, (including demolition). 7. If multi phased: a. Total number of phases anticipated (number). b. Anticipated date of commencement phase 1 month year, (including demolition). c Approximate completion date of final phase month year. d Is phase 1 functionally dependent on subsequent phases? ❑Yes ONo a. 11Vil blasting occur during construction? ❑Yes WN0 9. Nw fiber of jobs generated: during construction I ; after project is complete t7 10 Number of jobs eliminated by this project CP III, Will project require relocation of any projects or facilities? ❑Yes BA0 If yes, explain 12. Is surface liquid waste disposal involved? OYes 81V0 a. If yes, indicate type of waste (sewage, industrial, etc.) and amount In. Name of water body into which effluent will be discharged 13, Is subsurface liquid waste disposal involved? ❑Yes MKo Type 14. WIII surface area of an existing water body increase or decrease by proposal? Oyes Wa 10 Explain 15 Is project or any portion of project located in a 100 year flood plain? OYes M<O 16. WIII the project generate solid waste? ees ONo a. If yes, what Is the amount per month •I tons b. If yes, will an existing solid waste facility be used? RKes ❑No c. If yes, give name ; location d. Will any wastes not go into a sewage disposal system or into a sanitary landfill? Oyes 111114c, e. If Yes, explain 17. Will the project involve the disposal of solid waste? OYes B440 a. If yes, what is the anticipated rate of disposal? tons/month. b. If yes, what is the anticipated site life? years. 1k Will project use herbicides or pesticides? Oyes Mf4o A Will project routinely produce odors (more than one hour per day)? OYes 1!1KO 26. Will project produce operating noise exceeding the local ambient noise levels? ❑Yes 19410 211, Will project result in an increase in ener�r use? ees ONo If yes , indicate type(s) E.L'F'C 1 "1 C (T%f %I If water supply is from wells, indicate pumping capacity .s� gallons/minute. 'Sp Total anticipated water usage per day 1500 gallonslday. 14 Does project involve Local. State or Federal funding? ❑Yes 9?0 If Yes, explain 4 25. Approvals Required: Submittal Type Date City, Town, Village Board ❑Yes t-N0 City, Town, Village Planning Board ❑Yes Oki City, Town Zoning Board rYes GNoIf City, County Health Department ❑Yes '61No Other Local Agencies ZYes ❑No � (A��dt•�c� tT n'u't� Other Regional Agencies Dyes ANO State Agencies ❑Yes tNo Federal Agencies Oyes ifNo C. Zoning and Planning Information 1 Does proposed action involve a planning or zoning decision? �JYes CJNo If Yes, indicate decision required: ❑zoning amendment Ezoning variance ❑special use permit ❑subdivision ❑site plan ❑new/revision of master plan ❑resource management plan ❑other 2. What is the zoning classification(s)of the site? �IATcz-F-4zt-r Rai DEA DTI p'V I 3. What is the maximum potential development of the site if developed as permitted by the present zoning? 0"V_ 5r/JE7Lf_ r-o ry I Ott ��1 DEa t�i Alr a. What is the proposed zoning of the site? `x - 5. What is the maximum potential development of the site if developed as permitted by the proposed zoning? 6 Is the proposed action consistent with the recommended uses in adopted local land use plans? ,*es ❑No 7. What are the predominant land uses) and zoning classifications within a 1/4 mile radius of proposed action? U) L - Ifc a is the proposed action compatible with adjoin ing/surrounding land uses within a 1/4 mile? ,e,7res ❑No 9. If the proposed action is the subdivision of land, how many lots are proposed? Vk' a. What is the minimum lot size proposed? � '75 10. Will proposed action require any authorization(s) for the formation of sewer or water districts? ❑Yes o 11 , Will the proposed action create a demand for any community provided services (recreation, education, police, fire protection)? ❑Yes kINo a,� a. If yes, is existing capacity sufficient to handle projected demand? I ' ❑Yes ❑No 12. Will the proposed action result in the generation of traffic significantly above present levels? ❑Yes 1V0 a. If yes, is the existing road network adequate to handle the additional traffic?r. . CYes ❑No D. Informational Details Attach any additional information as may be needed to clarify your project If there are or may be any adverse impacts associated with your proposal, please discuss such impacts and the measures which you propose to mitigate or avoid them. I_ Verification I certify that the Information provided above is true to the best of my knowledge. Applicant/Spons0 a e S fr., Date IZ'2i Signature - Titlei a' If the action is in the Coastal Area, and you are a state agency, complete the Coastal Assessment Form before proceeding with this ausmwncnt. 5 Part 2—PROJECT IMPACTS AND THEIR MAGNITUDE Responsibility of Lead Agency General Information (Read Carefully) • In completing the form the reviewer should be guided by the question: Have my responses and determinations been reasonable? The reviewer is not expected to be an expert environmental analyst. • Identifying that an impact will be potentially large (column Z) does not mean that it is also necessarily significant. Any large impact must be evaluated in PART 3 to determine significance. Identifying an impact in column 2 simply asks that it be looked at further. • The Examples provided are to assist the reviewer by showing types of impacts and wherever possible the threshold of magnitude that would trigger a response in column 2. The examples are generally applicable throughout the State and for most situations. But, for any specific project or site other examples and/or lower thresholds may be appropriate for a Potential Large Impact response, thus requiring evaluation in Part 3. • The impacts of each project, on each site, in each locality, will vary. Therefore. the examples are illustrative and have been offered as guidance.They do not constitute an exhaustive list of impacts and thresholds to answer each question • The number of examples per question does not indicate the importance of each question. • In identifying impacts, consider long term, short term and cumlative effects. Instructions (Read carefully) a. Answer each of the 19 questions in PART 2. Answer Yes if there will be any impact. b. Maybe answers should be considered as Yes answers. c. If answering Yes to a question then check the appropriate box (column 1 or 2) to indicate the potential size of the impact. If impact threshold equals or exceeds any example provided, check column 2. If impact will occur but threshold is lower than example, check column 1. d. If reviewer has doubt about size of the impact then consider the impact as potentially large and proceed to PART 3. e. If a potentially large impact checked In column 2 can be mitigated by chanill in the project to a small to moderate impact also check the Yes box in column 3. A No response indicates that such a reduction is not possible. This must be explained in Part 3. 1 2 3 Small to Potential Can Impact Be Moderate Large Mitigated By IMPACT ON LAND Impact Impact Project Change 1 . Will the proposed action result in a physical change to the project site? ONO OYES Examples that would apply to column 2 • Any construction on slopes of 15% or greater, (15 foot rise per 100 ❑ ❑ ❑Yes ONo foot of length), or where the general slopes in the project area exceed 10%. • Construction on land where the depth to the water table is less than ❑ ❑ ❑Yes ❑No 3 feet, • Construction of paved parking area for 1,000 or more vehicles. ❑ ❑ 1)Yes ONo • Construction on land where bedrock is exposed or generally within ❑ ❑ []Yes ❑No 3 feet of existing ground surface. • Construction that will continue for more than 1 year or involve more ❑ ❑ ❑Yes ❑No than one phase or stage. • Excavation for mining purposes that would remove more than 1,000 ❑ ❑ Dyes ONO tons of natural material (i.e., rock or soil) per year. • Construction or expansion of a sanitary landfill. ❑ ❑ ❑Yes ONo • Construction In a designated floodway. ❑ ❑ OYes ❑No • Other impacts ❑ ❑ ❑Yes ❑No 2. Will there bean effect M _.iy unique or unusual land forms found on the site?(i.e.. cliffs, dunes, geological formations, etc.)❑NO ❑YES • Specific land forms: ❑ ❑ OYes ONo - - --- - .