Site Plan Application I J
Site Plan Review Application
Review Process:
Applicant and/or agent shall meet with Zoning Administrator to determine type of review needed
Pre-submission meeting with staff is required to determine general completeness of application materials (to
be held no later than 1 week prior to deadline submittal - Call (518) 761-8220 for an appointment).
Application submittal: one (1) original application package, one (1) deed and 14 copies of the application
package with the application fee*
Determination of application completeness and placement on an agenda
Planning Board meetings are generally the third & fourth Tuesday's of each month. You will be advised in
writing as to which meeting to attend.
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. If your application
was denied your project cannot proceed as submitted.
*Fee: $100.00 (0 to 10,000 sf); $250.00 (10,001 to 30,000 sf); $500.00 (30,001 to 100,000 sf); $1,000.00
(100,000+sf)
Zoning Staff & Contact Information:
Craig Brown, Director of Planning, Zoning & Code Compliance craigb@queensbury.net
Laura Moore, Land Use Planner Imoore@queensbury.net
RECEIVED , to
JAN 14 2016 tO, tip.
TOWN OF QUEENSBURY
PLANNING OFFICE
Site Plan Review Revised March 2014
Town of Queensbury Planning Office-742 Bay Road-Queensbury, NY 12804•518-761-8220
General Information
Tax Parcel ID: 0190, 5 --I- 1-1g)
Zoning District: riD
Lot size: RH ac_
Current Use: C rrt,h l c ,rr-56 c• T rr,d.i.vu Sicuiet
Proposed Use: -TO CO3 - c s prnotau 1- ury
AIrlet
Project Location: 10 9Q rkickeS. ( t,cRPM 19tArc. N y ley
Applicant Name Address:
1.7 1 /O ] lizeAdoterA
Home Phone Cell:
1-79c 03a, 701-01,)
73
Work Phone Fax
in -OL/30 .3o1
E-Mail:
e,m;i l(A/5 m Ceiht
Agent's Name: Address:
0.1 / O 7/ del- Latets67
Home Phone Cell:
79a -0 30,6 adv vOLIO
Work Phone Fax
a60-000
E-mail
un g mrict..roac� Q a,-C
0
Owner's Name: Address
Home Phone Cell
Work Phone Fax
E-mail
Site Plan Review Revised March 2014 2
Town of Queensbury Planning Office•742 Bay Road•Queensbury,NY 12804.518-761-8220
Site Development Data
Area I Type Existing sq.ft. Proposed Total sq. ft.
Addition sq.ft.
A. Building footprint
B. Detached Garage
C. Accessory Structure(s)
D. Paved, gravel or other hard surfaced area I 00411- l ‘L./
E. Porches/Decks
F. Other (i.e. boathouse, sundeck, etc.)
G.Total Non-Permeable [Add A-F] 111-=144-27-yCr3 Hc
H. Parcel Area [43,560 sq. ft./acre]
I. Percentage of Impermeable Area of Site [l=G/H
Setback Requirements
Area Required Existing Proposed
Front[1]
Front[2]
Shoreline
Side Yard [1]
025
Side Yard [2]
Rear Yard [1]
Rear Yard [2]•
Travel Corridor
Height[max]
Permeability
No. of parking spaces
Site Plan Review Revised March 2014 3
Town of Queensbury Planning Office-742 Bay Road•Queensbury,NY 12804.518-761-8220
Additional Project Information
1. Will the proposal require a Septic Variance from the Town Board of Health? h o
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?
n,0
4. Estimated project duration: Start Date — End Date
5. Estimated total cost of project: h 6n2.
6. Total area of land disturbance for project: vow,
Floor Area Ratio Worksheet
Pi11).
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 oor Area Ratio [FAR]
Waterfront Residential WR c; 0.22
Commercial Moderate/Commercial Intensive CM/CI 0.3
Main Street ` MS 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: Operideck, 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"). j'
B. Commercial or industrial:the total area in square f et as measured from the exterior of the outside walls of a building
or structure,and when applicable,the sum totala t floor areas of the principal and accessory buildings or structures
on the project site. �/
/
A. Parcel Area �.,, sq. ft.
/ ''
B. Existing Floor Area sq. ft. [see above definition]
C. Proposed Additional Floor Area sq. ft.
D. Proposed Total Floor Area
sq.
ft.
E. Total Allowable Floor Area (Area x ) [see above table]
*if D is larger than E, a variance or revisions to your plan may be needed. Please consult
w/Staff.
Site Plan Review Revised March 2014 4
Town of Queensbury Planning Office-742 Bay Road•Queensbury, NY 12804•518-761-8220
§ 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 Town's 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.
Q2l
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.
6 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.
r, 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.
f1. 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.
6 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.
VN. 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.
6n� O. The site plan conforms to the design standards,landscaping standards and performance standards of this chapter.
Site Plan Review Revised March 2014 5
Town of Queensbury Planning Office.742 Bay Road-Queensbury, NY 12804•518-761-8220
§ 179-9-050 Application for Site Plan Review
Absent any waiver or waivers,an application for Site Plan Review shall include the following:
REQUIREMENTS 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 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 8W x 11'sheets as necessary for written information. The information
listed below shall be shown on the site plan and continuation sheets. i
C Name of the project,boundaries,date,north arrow,and scale of the plan. I
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
E The location and use of all existing and proposed structures within the property,including all dimensions of height and floor area,all
exterior entrances,and all anticipated future additions and alterations. ti
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 containers
shall also be shown. 1 ,
G The location,height,intensity,and bulb type(sodium,incandescent,etc.)of all external lighting fixtures. The direction of illumination
%JJ 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. 1 3
I The location of all present and proposed utility systems including:
1. Sewage or septic system;
2. Water supply system;
3. Telephone,cable,and electrical systems; and
1181/4-)
, ) 4. Storm drainage system including existing and proposed drain lines,culverts,catch basins,headwalls,endwalls,hydrants,
W 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 ail 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 shall be at the
1 discretion of the Planning Board as to whether a SWPPP or an erosion and control plan shall be required for site plan review project
fVw"'1 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 proposed site and within
A 5 50 feet of the proposed site where soil removal or filling Is required,showing the approximate volume in cubic yards.
V" 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 watercourses,aquifers,floodplalns,
and drainage retention areas.
M Land Use District boundaries within 500 feet of the site's perimeter shall be drawn and identified on the site plan, as well as any
Overlay Districts that apply to the property.
Site Plan Review Revised March 2014 6
Town of Queensbury Planning Office-742 Bay Road•Queensbury,NY 12804.518-761-8220
REQUIREMENTS CONTINUED Sheet#
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;
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. a.
_ 1
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;
3. Maximum seating capacity,where applicable;and
w 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(114'=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 type and color of materials to be used. I
I
Q Soil logs,water supply well and percolation test results,and storm runoff calculations,as needed to determine and mitigate project
impacts. -
t.A.) 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.
T An Environmental Assessment Form("EAP'),as required by the SEQRA regulations,with Part 1 completed by the Applicant shall be Msubmitted as part of the application. If the proposed project requires a special use permit and an EAF has been 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
i all such uses provided the proposed uses are accurately delineated on a site plan drawn pursuant to the requirements set forth
(V/ I 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.
✓ 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.
Site Plan Review Revised March 2014 7
Town of Queensbury Planning Office-742 Bay Road•Queensbury,NY 12804•518-761-8220
Pre-Submission Conference Form 1179-4-0401
1. Tax Map ID a9O, 5- /-/1'
2. Zoning Classification 111 DR (n�
3. Table of Allowed Uses A r OCB�Ure.51-r C-9 M (NaD2 is subject to Site Plan Review
4. Ordinance Section# 1.7 9— 9
5. Pre-Submission Meeting Notes;Outstanding Items To Be Addressed Include:
Deed Yes No
General Information complete ✓ Yes No
Site Development Data Complete / Yes No
Setback Requirements Complete ✓ Yes No
Additional Project Information Complete ✓,Yes No
*Coverage under DEC SWPPP Program L Yes No
FAR Worksheet complete N/A- Yes 1V)4 No
Standards addressed / Yes No
Checklist items addressed ✓ Yes No
Environmental Form completed MP Yes Niq- No
Signature Page completed ✓ Yes No
A po (tccwosec cy,ck, -e_,r e ?c(s('rc.1
FC)o( uCe S Z �Z?� s��I , (11�vSl 2WG(('� °I°
cA/1(A ( ii 1-ed-4C20/S — So Opp 1 Lecu�f r S ea I.1 2/lO
!I Ccs
D n�tt7Rc- C(c\ c,_1e`e LLet mC� C- -6�-�� Q lc� f �c -�-Z U�r� r Ath9S
Re ef
i �eoce O �(Cc �l c:� -�c �r�c_ l5 G 4-- coir
\A,()wtv7 Pc loci j •+ S tOincAcle 5
gl C. 11Gt� ..w�..., 10L,(f ati-n pkQ Z.)
*Applicant must provide office with Notice of Intent (NOl); SWPPP Acceptance Form, DEC letter issuing permit number;
Notice of Termination(NOT1
Staff Representative: LC( J a MOO
Applicant/Agent: {�I
Date: //,..3//&ll��
Site Plan Review Revised March 2014 8
Town of Queensbury Planning Office-742 Bay Road•Queensbury,NY 12804.518-761-8220
617.20
Appendix B
Short Environmental Assessment Form
Instructions for Completing
Part 1-Project Information. The applicant or project sponsor is responsible for the completion of Part L Responses
become part of the application for approval or funding,are subject to public review,and may be subject to further verification.
Complete Part 1 based on information currently available. If additional research or investigation would be needed to fully
respond to any item,please answer as thoroughly as possible based on current information.
Complete all items in Part 1. You may also provide any additional information which you believe will be needed by or useful
to the lead agency;attach additional pages as necessary to supplement any item.
Part 1-Project and Sponsor Information
5�� fo
%-E4 Y ,.. 1 r' eL & c
Name of Action or Project: pp " 1
C c�F,, L CCC 13c% S+«.
Project Location(describe,and attach a location map):
i ogcl �-11\,cQ. CILIS hsbur(1 N V Oa Li
Brief Description of Proposed ction:
�hkic � lar r� r w�u-c!1/4�ncc9 °1 t.,I,- oera4� al �ua toGe tow
slhf.F. IQ!.1S". Se gNYI- locolL. 3yg���toC�ttdQ,.
Name of Applicant or Sponsor: Telephone:
( 2..,Lt , E-Mail:erni`ler cdmilban -
Address:
1071th�7 i &.
City/PO: State: Zip Code:
G ^i M. )
1.Does the proposed action only involve the legislative adoption of a plan,local law,ordinance, NO YES
administrative rule,or regulation?
If Yes,attach a narrative description of the intent of the proposed action and the environmental resources that
may be affected in the municipality and proceed to Part 2. If no,continue to question 2.
2. Does the proposed action require a permit,approval or funding from any other governmental Agency? NO YES
If Yes,list agency(s)name and permit or approval:
t.a
3.a.Total acreage of the site of the proposed action? i o acres
b.Total acreage to be physically disturbed? acres
c.Total acreage(project site and any contiguous properties)owned
or controlled by the applicant or project sponsor? i 0 acres
4. Check all land uses that occur on,adjoining and near the proposed action.
0 Urban WRural(non-agriculture) 0 Industrial 0 Commercial e'Residential(suburban)
13/Forest 0 Agriculture 0 Aquatic ❑Other(specify): _
❑Parkland
Page 1 of 4
5. Is the proposed action, NO YES N/A
a.A permitted use under the zoning regulations?
V
b.Consistent with the adopted comprehensive plan? ✓
6. Is the proposed action consistent with the predominant character of the existing built or natural _ NO YES
landscape?
7. Is the site of the proposed action located in,or does it adjoin,a state listed Critical Environmental Area? NO YES
If Yes,identify:
8. a.Will the proposed action result in a substantial increase in traffic above present levels? NO YES
b.Are public transportation service(s)available at or near the site of the proposed action? ✓
c.Are any pedestrian accommodations or bicycle routes available on or near site of the proposed action?
9.Does the proposed action meet or exceed the state energy code requirements? NO YES
If the proposed action will exceed requirements,describe design features and technologies:
10. Will the proposed action connect to an existing public/private water supply? NO YES
If Yes,does the existing system have capacity to provide service? 0 NO 0 YES
If No,describe method for providing potable water:
11.Will the proposed action connect to existing wastewater utilities? NO YES
If Yes,does the existing system have capacity to provide service? 0 NO 0 YES
If No,describe method for providing wastewater treatment:
12. a.Does the site contain a structure that is listed on either the State or National Register of Historic NO YES
Places?
b.Is the proposed action located in an archeological sensitive area? ✓
13.a.Does any portion of the site of the proposed action,or lands adjoining the proposed action,contain NO YES
wetlands or other waterbodies regulated by a federal,state or local agency?
b.Would the proposed action physically alter,or encroach into,any existing wetland or waterbody?
If Yes,identify the wetland or waterbody and extent of alterations in square feet or acres: ✓
14. Identify the typical habitat types that occur on,or are likely to be found on the project site. Check all that apply:
0 Shoreline 0 Forest 6d`Agricultural/grasslands 0 Early mid-successional
0 Wetland 0 Urban 0 Suburban
15.Does the site of the proposed action contain any species of animal,or associated habitats,listed NO YES
by the State or Federal government as threatened or endangered? ✓
16.Is the project site located in the 100 year flood plain? NO YES
17.Will the proposed action create storm water discharge,either from point or non-point sources? NO YES
If Yes,
a.Will storm water discharges flow to adjacent properties? 0 NO 0 YES
b.Will storm water discharges be directed to established conveyance systems(runoff and storm drains)?
If Yes,briefly describe: 0 NO 0 YES
Page 2 of 4
18.Does the proposed action include construction or other activities that result in the impoundment of NO YES
water or other liquids(e.g.retention pond,waste lagoon,dam)?
If Yes,explain purpose and size:
19.Has the site of the proposed action or an adjoining property been the location of an active or closed NO YES
solid waste management facility?
If Yes,describe:
20.Has the site of the proposed action or an adjoining property been the subject of remediation(ongoing or NO YES
completed)for hazardous waste?
If Yes,describe:
I AFFIRM THAT THE INFORMATION PROVIDED ABOVE IS TRUE AND ACCURATE TO THE BEST OF MY
KNOWLEDGE
Applicant/sponsor name: C 1 i z.0n..N '(\i 1,l¢4- Date: I/3A.
Signature: 11161 '
Part 2-Impact Assessment. The Lead Agency is responsible for the completion of Part 2. Answer all of the following
questions in Part 2 using the information contained in Part 1 and other materials submitted by the project sponsor or
otherwise available to the reviewer. When answering the questions the reviewer should be guided by the concept"Have my
responses been reasonable considering the scale and context of the proposed action?"
No,or Moderate
small to large
impact impact
may may
occur occur
1. Will the proposed action create a material conflict with mitt adopted land use plan or zoning
regulations? /
2. Will the proposed action result in a change in the use or tensityof use of land?
3. Will the proposed action impair the character or quality of the existing community?
4. Will the proposed action have an impact on the environmental characteristics that caused the
establishment of a Critical Environmental Area(CEA)?
5. Will the proposed action result in an adverse change in the existing level of traffic or
affect existing infrastructure for mass transit,biking or walkway? v/
6. Will the proposed action cause an increase in the use of energy and it fails to incorporate ✓
reasonably available energy conservation or renewable energy opportunities?
7. Will the proposed action impact existing:
a.public/private water supplies?
b.public/private wastewater treatment utilities? ✓
8. Will the proposed action impair the character or quality of important historic,archaeological, ✓
architectural or aesthetic resources?
9. Will the proposed action result in an adverse change to natural resources(e.g.,wetlands,
waterbodies,groundwater,air quality,flora and fauna)?
Page 3 of 4
No,or Moderate
-
small to large
impact impact
may may
occur occur
10. Will the proposed action result in an increase in the potential for erosion,flooding or drainage
problems? ✓
11. Will the proposed action create a hazard to environmental resources or human health?
Part 3-Determination of significance. The Lead Agency is responsible for the completion of Part 3. For every
question in Part 2 that was answered"moderate to large impact may occur",or if there is a need to explain why a particular
element of the proposed action may or will not result in a significant adverse environmental impact,please complete Part 3.
Part 3 should,in sufficient detail,identify the impact,including any measures or design elements that have been included by
the project sponsor to avoid or reduce impacts. Part 3 should also explain how the lead agency determined that the impact
may or will not be significant.Each potential impact should be assessed considering its setting,probability of occurring,
duration,irreversibility,geographic scope and magnitude. Also consider the potential for short-term,long-term and
cumulative impacts.
a Check this box if you have determined,based on the information and analysis above,and any supporting documentation,
that the proposed action may result in one or more potentially large or significant adverse impacts and an
environmental impact statement is required.
4t 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.
// 19:7/6.
Name of Lead Agency ate
Print e .m f ponsible Officer in Lead Agency Title of Responsible Officer
Signature of Resp ible Officer in Lead Agency Signature of Preparer(if different from Responsible Officer)
Page 4 of 4
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: C 17 x.A .LA-41 W (sra
Designates: , —Pyitu\
As agent regarding: Variance .Site Plan Subdivision
For Tax Map No.: Section Block Lot
Deed Reference: Book Page Date
—mownOWNER SIGNATURE: I • DATE: 3
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: c, t, t
Designates: 1 \ � ..
As agent regarding: Variance Site Plan Subdivision
For Tax Map No.: Section Block Lot
Deed Reference: •_T_Book Page Date
APPLICANT SIGNATURE: C DATE: / C
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 occupancy
I have read and agree to the above.
Signature[Apps -nt] Print Name[App ant] Dat signed
V
Signature[Agent] Print Name[Agent] Date signed
Site Plan Review Revised March 2014 9
Town of Queensbury Planning Office-742 Bay Road•Queensbury,NY 12804.518-761-8220
This site plan review application is for the approval of the operation of an
existing produce stand located at 1099 Ridge Rd. in Queensbury.
I am requesting waivers for storm water, grading, lighting and landscaping.
I have included a picture of the present stand as well as a picture of the
existing sign.
I hope to operate this stand this fall to include the sale of local produce
such as pumpkins, squash, apples, etc. until October 25thth. In the Spring
would hope to reopen in May and include local fruits and vegetables with
operating hours from 10:00am until 5:00 pm. }�
V e C zck &o e e / '08
�000
' c ektiee4z Susan L Dougher, residing at 122 Sunnyside North,
0Dt Queensbury, New York 12804
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Elizabeth Miller, residing at 1071 Ridge Road, Queensbury, New York 12804
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ALL THAT CERTAIN PIECE OR PARCEL OF LAND situate, lying and being in
the Town of Queensbury, County of Warren and State of New York, more particularly bounded
and described as follows:
BEGINNING at a concrete monument found in the ground in the westerly bounds of
New York State Highway Number 9-L, also known as the Ridge Road, at the northeasterly
corner of the lands of the parties of the first part herein and the southeasterly corner of the lands
of Kenneth Sheldon and others;running from thence south 06 degrees 53 minutes west along the
westerly bounds of the said highway 222.99 feet to a fence post at the southeasterly corner of the
lands of the said parties of the first part herein; thence running north 84 degrees and 50 minutes
west along a fence and the southerly bounds of the said lands of the parties of the first part herein
651.04 feet;thence running north 84 degrees and 58 minutes west, continuing along the southerly
bounds of the lands of parties of the first part herein, and following a fence 1197.42 feet to the
center of a 16-inch and 12-inch diameter twin butternut tree at the southwesterly corner of the
lands of the parties of the first part herein; thence running north 25 degrees 46 minutes east along
the westerly bounds of the lands of the parties of the first part herein and the easterly bounds of
lands now or formerly of Howard Toomey 250.07 feet to a point for a corner;thence running
south 84 degrees 26 minutes 30 seconds east along the southerly bounds of lands of the
Sunnyside Golf Course 705.47 feet to a point at the southeasterly corner thereof;thence running
south 84 degrees 38 minutes east along the southerly bounds of the said lands of Kenneth
Sheldon and others, and following a fence a part of the way 1061.66 feet to the point and place of k
beginning. Containing 10.00 acres of land, be the same more or less.
BEING the same premises conveyed to Susan L. Dougher from Alice Kay French
a/k/a Kay French, by Warranty Deed dated July 8, 1999 and recorded in the Warren County
Clerk's Office on August 2, 1999 in Liber 1125 of Deeds at Page 263.
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Susan L. Dougher
State of New York ) SS:
County of Warren ) SS: �C
On October j , 2008, before me, a Notary Public in and for the said State,
personally appeared Susan L. Dougher, personally known to me or proved to me on
the basis of satisfactory evidence to be the individual whose name is subscribed to the
within instrument and acknowledged to me that she executed the same in her capacity,
and that by her signature on the instrument, the individual or the person on behalf of
which the individual acted, executed the instrument.
P1..
' 290.5-1-48 Page 1 of 1
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The Town of Queensbury does not warrant the correctness or accuracy of this data or assume any
responsibility for any explicit or implied uses.
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47'- '} 742 Bay Road
rfr Queensbury,NY. 12804-5902
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http://gby2svr/GIS/printdis.asp 8/4/2010