Site Plan Application1
gt(leT)1&-_ et)le(.0
cDs5RJ A(1
Curtis D. Dybas, RA
19 Deer Run . ! r EIVEp
Lake George, NY 12845 /,}•�
P_•
14 U15
October 28, 2015 10
TOWN OF QUEENSBURY
Chairman Chris Hunsinger ZONING OFF E
Planning Board
Town of Queensbury
742 Bay Road
Queensbury,NY 12804
Re: Proposed breezeway at the DiMartino residence
97 Birdsall Road
Dear Chairman Hunsinger,
The proposed scope of work involves the construction of a roof to provide an open breezeway t
between the existing detached garage and residence. The floor elevation of the breezeway would
be raised to eliminate steps at both doors, which would comply with the Code requirement to
provide a landing on both sides of an outswing door. The residence is used on a temporary basis,
and when unoccupied, in winter, snow and ice accumulate on the concrete platform creating a
safety hazard and at times prevent opening of the outswing door. Another serious safety hazard
and Code violation is the total lack of guardrails at numerous platform and stair locations.
The current site was developed beyond the Town's current criteria regarding impervious surface
and FAR prior to the DiMartinos' purchase in 1996. A deed survey,prepared by VanDusen&
Steves in 1996 is not sealed and signed, a requirement from which a waiver is requested. Side
yard setbacks are noted and the proposed breezeway will not encroach on the 12'-0 current side
yard requirements
Mr. & Mrs. DiMartino are aware of the developed status of the property, therefore, are seeking
minimal additional relief to correct an ongoing safety issue. Your consideration of the outlined
facts would be appreciated.
It is the intent of the owners to commence work as soon as weather permits.
Sincerely,
0,...&6 0.60.04A
Curtis D. Dybas, RA
General Information
Tax Parcel ID: -
Zoning District: \A• IA
Lot size: 18,In 4ir (*) i 4
Current Use: 4i U F, fr LV`(; ad->r wiri4
Oar& ( Ar Vie.
Proposed Use: SI LJ ( rAli.viik,-r* j i i.i I j f 0
Project Location: 1-1 S VO #`-
I Applicant Name I Aulzile3 0.6.WAI Address: I tot MU. iaXt . I
IL4.6ea 1.11d1264 I
I Home Phone I6.1,7, 6616 . 5G i Cell• 5,s 64-14
I -Work Phone Fax
i
Agents Name: Address:
Home Phone Cell:
Work Phone f Fax ( I
E-mail
Owner's Name: ,0 1 eF Address S3 G 12`( AL. eat/Sal PO
144114 Lel HA-4i 4.4 i-4021C;44e-`-`74 1J47" 11155
Home Phone 1 I 816 - Oda A Cell T 511 11
X31 �. > - 4102.
Work Phone Fax
E-mail ,YrIA moi°l l-tUal)1.10 ti`n^: 6 1-144-41=►COV'
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 I Existing sq.ft. 1 Proposed Total sq.ft. I
f Addition sq.ft.
A. Building footprint � f ,., i
Ii B. Detached Garage f I
17n� CIO ---m d rco
n or, Structr rc o • 1� ...�aw 2960 Accessory�vu uv�w�.�u�
j D. Paved,gravel or other hard surfaced area illbg <18 2. S+Q61
1E. Porches i Decks 244 j I 1244
IF. Other(i.e.boathouse,sundeck, etc.)
rG.TotelN0flPrneable [Add A-F] 6961 -----
41';"7� f
IH. Parcel Area [43,560 sq.ft./acre] ( 7$00 , I 7gce,
II. Percentage of Impermeable Area of Site [I=G/H] I 17% I 710°1®
I i
Setback Requirements
Area + Required I Existing I Proposed
Front[1] Li/A I
Front[2] I zJ/' I
Shoreline I r:,I Ii4.1 I 0, 04.,,,,....L... ..,.....
Side Yard[11 9.' c i vi4; diet. { .
Side Yard[2] t 5.641
Pear Yard[1] 30+ j 611 I uio e.
Rear Yard[21 ijI
I
Travel Corridor WA I
Height[max] l
q , I z1 r I Ua G &e
Permeability 4%% (23e (24�O e- i
•
No. of parking spacese2. ( 00 GthL1C
Site Plan Review Revised March 2014 3
Town of Queensbury Planning Office.742 Bay Road•Queensbury,NY 12804.518-761-8220
•
§ 179-9-080 Requirements for Site Plan Approval. The Planning Board shall not approve a Site Plan unless it
first rletermines that such site plan meets the following Standards. Please prepare responses to each of the following
topics.
STA C7RG
A. The proposed project furthers or is consistent with the policies of the Town's Comprehensive Plan.1.77 A
ti
B. e proposed project complies with all other r-• irem is of,is apter,including t -s e p an review standards as set forth in Paragraph F
of this section.the dimensional,bulk,and density regulations of the zoning district in which it is proposed to be located(Article 3 and Table 1),
'fie apptica a reMenVill other A cies t t CC* e. �6%matwig ,� .
•
v. :
he site plan encourages 1.C,wc ia^activity'internally and,if practicable,ticatie,it7 end from the site with pedestrian paths or sidewalks connected to ,
adiacent areas.
4705 M�,,,,�1�__,i� 4. " � ail _. D.l�
D. The site plan must conform to Chapter 136 Sewage and Sewage Dispose!, Chapter 147 Stormwater Management Local Law,
and other 'I
fpplicable Coca!laps. i _. �$;3 ..:-� ':_ .e. .ate f� 0t t! f ' tt1,,,74 ...t
E. the proposed uses all be n harmon with t - general pu hose or intent o this Chapter,specifically taking into account the • -lion,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
su porting public services and facilities which rill follow the pr val of the proposed use. it
t I oma.
F. a establishment,maintenance arid operation of the proposed use will'not create public,hazards from traffic,traffic congestion or the parking
!!! otherwise- t to heelth, ,foty or „ora! welfare of persons residing nr working in the
O: Jpwiit�e5 an.�lsr .:���Ya}w� or_._-1a!„r..ro:�.�'-4�Rtriri32nfrn the Wet: �^
neighborhood or to the general welfare of the town.Traffic access and circulation,road intersections,road and driveway widths,and traffic
cc trpis will be adequate. L� jj b� ! , (&J FJ P, �
'�u, W �.� C ed and
G. Off-street parking and loading facilities will be appropriately lo�ted and arranged and sufficient to meet traffic anticipated to be generated by
the new use. The esia'ulia'crniuot vabinie rinks 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
anvil.^art hRF.msde;;rntnct with.nitaoeer-t property owners for_ pt"poses of coordinatjng h'rtkages with adjacent properties.
PAgiadet 19 A A CD+-f •`f'4/r1W 7 fuc7.
H. The project shall not have an undue adverse Impact upon the natural,scenic,aesthetic,ecological,wildlife,historic,recreational or open space
resources of me 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§179-8-080 of this chapter,and in so doing,the Planning Board shall make a net overall evaluation of
I - rojert in refetin n to the development obisctives ar• •neve!a'it.alines sat forth in§ 79-9-080 of this Article, -
i. a provisi• or and arrangement of.-destrian traffic:' ess and circulation, • of intersections with vehicular traffic
and overall pedestrian convenience shall be safe and adequate for pedestrian movement. Pedestrian connections between adjacett sites
s
a be rovided to ncoura ed e.
f. mwat - s,.. er� ge ze mu -tolow. - __la
! � J. Sttormwater drainage facilitres will ant an increase of post vel m t drama flows as compared to pre-development drainage lbws.
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 Chaplet
14:7 of the Towp Code amend the Tow not Quteensb ury f u ikon,•R!egutations�yh ap ti bleA,
.� �d .,..,
K. e water supply and sewage disposal facili'ti'es will be dequate and will meet all applicable and current requirements set forth by Department
pf ith a lattgns and Chaot 1 6 t _Tonnn�de. '�` ,nC;� „pa
{ 111 q� / &Mos s rrid to plantings, g ging effectively
L. The adequacy, pe and arrangement trees,s oth r sutfab p►antin is soaping and screening shall effectiv provide a
V@goal and/or nolee huffar between the applicants and adtolelep lands, including the maximum retention of existing vegetation and
in
at ce, luding re.lacement of dead•r d- eased•tants.
w_ _ ��' .`. ♦.
M. I-ire lanes mer en z n and due aranis 1 adeq 'a nit pie t `ta needs d qutrerre of ens'sery iders.
-g Qe " t3 P► FSU , �.t `€31.100LID '2�'�� � " iD-
N. The design of structures, roadways and landscaping In areas suscepti a to ponding, flooding a or erosion will minimize avoid such
impacts to the wx,, imum extent1206 .
r��cab „,
tttpian conforms o me, Zraping s_3 �Fe.rds eirforreerica^tandarLsof thleohopter.
-
Site Plan Review Revised March 2014 5
Town of Queensbury Planning Office.742 Bay Road•Queensbury,NY 12804.518-761-8220
y 179-9-050 Application for Site Plan Review
Absent any waiver or waivers, an application for Site Plan Review shall include the following:
1 ncntitREMENTS I sheet# I
A t A vinioiry map drawn at tile scale.that shows the relationship of the proposal to existing community facilities which affect or serve it, 1 a i
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 ,rw. ` „
B area.
f, The din,:.r,!an - be 'a or forty f.^-. ,.thr nh(1'!40 tan tl or oh otherasscale the Planning Board may deem e. lle.✓
appropriate,on standard 24 x 36 sheets,with continuation on 81e 11'sheets as necessary for written information. The informationbra ""
nstprt below shall be shown on the site plan and cnntinnatinn sheets. M•Pt I
C 1 Name of the project,boundaries,date,north arrow,and scale of the plan. pubs 1 42
D Name and address of the owner of record,developer,and seal of the engineer,architect,or landscape architect. If the applicant is not Est`'
the record owner,a letter of authorization shall be required from the owner
E IThe location and use of all existing and proposed structures within the property,including all dimensions of height and floor area,all 21
exterior entrances.and all anticipated future additions and alterations.
F I The location of all present and proposed public and private ways, off-street parking areas driveways outdoor storage areas, low I
sidewalks,ramps,auras,paths,i ndsc.apir,g,wails,and fenct.xs. Loca.. ,type,and screening details fur ail w disposal coritainets
Ishall also be shown. I 1 E
• The location,height,intensity,and bulb type.(sodium,incandescent,etc.)of au external lighting fixtures. The direction of illumination elgiorg fol
and methods to eliminate glare onto adjoining properties must also be shown in compliance with§179-6-020. tekitgal
H ( The location,height,size,materials,and design of all proposed signs. Lihia
l - i.-
- � - � I IIC.iVlydtiVif or ail present alit jarvprvs8v utility ays..-.e....,including: �jy
1. Sewage or septic system; E7(ryy,11
4 w•
12. Water supply system; t_3. Telephone,cable,and electrical systems; and 16).0.1 1 4l.
4. Storm drainage system including existing and proposed drain lines,culverts,catch basins,headwalls,endwails,hydrants, j
manholes,and drainage swales. f
J Plans to prevent the pollution of surface or groundwater, erosion of soil both during and after construction, excessive runoff, and Iwo 41/
flooding of other grcoerticc as applicable A Rtormwater Pnf utlon Prevention Plan (SWPPP) for all land development activities ord it,
(excluding agriculturai activities) on thesitethat results in land disturbance of 1-acre or more. A SWPPP shall comply with the
f/moi -10'
requirements of the DEC SPDES MS-4 General Permit and Chapter 147 of the Town of Queensbury Code. It shall be at the
discretion of the Planning Board as to whether a SWPPP or an erosion and control plan snail be requires tor a site pars review project t
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 I Fre)
elevations shall refer to the nearest United States Coastal and Geodetic Bench Mark. If any portion of the parcel is within the 100- ; y
I year floodplain,the area will be shown,and base flood elevations given.-Areas shall be indicated within the proposed site and within i
50 feet of the proposed site where soil removal or filling is required,showing the approximate volume in cubic yards.
L I A landscape plan showing all existing natural land features that may influence the design of the proposed use such as rock outcrops, 1%014
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,floodplains, +!
I
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 ")slag
I
Overlay Districts thatapply to the property• ,1-14?
t f
site t•'lan I-(eview f(evusea March 2014 6
Town of Queensbury Planning Office-742 Bay Road•Queensbury,NY 12804.518-7661-8220
I
1 REQUIREMENTS CONTINUED + Sheet# I
I
"MNyn IV la i iiv's'r p a cr,i5 ro•vi I ,c iib,VA fOr.irvw u:.",wi.,'w, :.,,,an 4,, ,...... ^.'y-i--S,a_:^ !f„...e rlKt.,
` ,_ ..
� . _7.,..!•_,A_.;,rt r;ai'.7_,,,..t!!r,. . •
100 feet of the site. The Planning Board may,at its discretion,require a detailed traffic study for large developments or for those in
.__f•- r�as which. tl incl.,
1. The projected number of motor vehicle trips to enter or leave the site,estimated for weekly and annual peak hour traffic ,
IIII{{ levels;
2. The projected traffic flow pattern including vehicular movements at all major intersections likely to be affected by the ( 1
3. The impact of this traffic on levels of service on abutting public streets and at affected intersections. Existing and proposed I
weekly and annual peak hour traffic mels and road capacity levels shell also be Given.
0 For new construction or alterations to any structure,a table containing the following information shall be included: jVgj
1. Estimated area of structure to be used for particular purposes such as retail operation,office,storage,etc.;
2. Estimated maximum number of employees; f f
I
3. Maximum seating capacity,where applicable;and
A ra,,mhpr of r srkIno e errs m istino and r ired for the intended use. � u�
1 P 11. Floor Plans. IgeolrS 1
f 2. Elevations at a scale of one-quarter inch equals one foot(1/4"=1 foot)for all exterior facades or the proposed structure(s)and/or 24 6
alterations to or expansions of existing facades,showing design features and indicating the type and color of materials to be used.
IQ ISoil logs,water supply well and percolation test results,and storm runoff calculations,as needed to determine and mitigate project 1‘41144e2.1ipacts.
R Plans for disposal of construction and demolition waste,either on-site or at an approved disposal facility. •
Wk.
Plans for snow removal,including location(s)of on-site snow storage. iil„�
T .".r rivirrr° �t A.,,,,,,,,,,..—..t ;
Pre-Submission Conference Form 1179-4-0401
1= Tax Map ID n . 11 _ ! - 3''
7nnina c ssific tii_ n we I A ,c .i1( .
3- Table of Allowed Uses t. pc, i o nc r" tt>zv OI1 )r 0111/4 I is subject to Site Plan Review
4. Ordinance Section;*
11 1 --b 0
5. Pre-Submission Meeting Notes;Outstanding items To Re Addressed Include:
Deed Yes No
General Information complete L.,"---7 Yes No
Site Development Data Complete ✓Yes No
Setback Requirements Complete ..Yes No
Additional Project Information Complete Yes No
*Coverage under DEC SWPPP Program J.J/A Yes No
FAR WiNrkchaat enmplAte L-/".v.s No
p Standards addressed Yes • No
Checklist items addressed No
Environmental Form completed AM Yes No
Signature Page completed _JZ Yes No
1:ccrvk- 0v, Cont i7oc. )r t .9C) 9 4 ' e76--<,1r l
e n Q cry e- c,,.>f'� Se, r 4- 07�id 1 ,c , , (-1:)‘(,-ET,
i. loC4. (n"c t52tc EA - q„.,6;oe, � �t � c - �-S, t' cr? rc�./�
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Ittalt ot`�itO t mw Pcr' ,00 T S ' c.r"' i vu vc-C I c ('IC j -
A ' , ! \t c • tel/ \I< r ( i AO, Gz 1 <v Ste)r(Jec,/ )f' ) ;'1%fr i 1
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5t4,611)1 vlSeic(c� c 0 cya c dncltd ans-,AJ -e r q60 sore
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we. c,k .v,42) (n'l c-,4•0,/‘./ rde .priVI Ckd c6. 2.01Vr'tt `�f
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44)--c- ceUveLk.) ctect riOntr�A \eoPr J
*Applicant must 3r^vivo office with Notice of intent
(NOD: SWPPP Acceptance Form. DEC letter issuing permit number;
Notice of Termination(NOT)
Staff Representative: .4C cJ i t- c
(
.) C
Applicant/Agent:
Date: ID/Zf3(r( L"
Site Plan Review Revised March 2014 8
Town of Queensbury Planning Office.742 Bay Road•Queensbury,NY 12804.518-761-8220
' 10/26/2015 Authorization Forth pg
6iggnatur e 1-'-'age
This page inncii.iues ute'i.j AiiututtLaiiuin iu"tel.1:25 Ayerr t i-oriii: 24 ci igineeiing Fee Disciosure; 3.)Authorization for Site
Visits; 4.) Other Permit Responsibilities; 5.) Official Meeting Disclosure and 6.) Agreement to provide documentation
e cituii ZC:.
i Complete the feiiio inc if the OWNER ra the property is not the sane.est e epp:if-ent
rr
1 Owner. clo)- 11-hcz 4 4LE Oi ° I
--'"i ••'-''. C.—C.-tel`✓ i I. i..Pi i`.71-.1`1-2
• 1 As agent regarding: X Variance X Site Plan Subdivision
ilrTex Map't\k}• /fa,n Irnn__ _ ^lr,:tr —'ct l
DeedReference: 4 /� Book Page Date ., 1
I - ( /1 L J,. A 10 ,9,etlf 17,4411 IA,f1V i
7 s f .... c - i t-
OWNER SIGNATURE n'� %� �- " V" DATE: ieftJ/] 1
1 APPLICANT'S AGENT FORM:
I
Complete the following if the APP iCAN T is unable to attend the meeting or.'Ashes to be represented by another party: 1
Owner
usaigr:aies:
As agent regarding: Variance Site Plan Subdivision
Deed Reference: Book Page Date
1 APPLICANT SIGNATURE: _ _ _._- DATE: 1
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 iu ilee eppiiceriL Fees fur engineering review wiii not exceeo$1,UOU without notification to uie applicant.
g,) AUTHORIZATION FOR SITE VLSITS: By si.^.ninu this pane and suhmit:inn the application trete ia!s al ached en the O ;ne.-
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 7nnirr,RoP,rd or PtnnnintYt Dogma. It is the applir anfq responsibility to obtain any additional permits.
5.) OFFICIAL MEETING MINUTES DISCLOSURE: It is the practice of the Community Development Department to have a designated
stenograpner tape record tree 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
phut- iu iasuau e ui a vait1 peunii. i cattily ii'iai 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
eppreeed pie.__. _. ...a. .._. . ...... ._.. ........�. ..._.. . .:p�v c,_upsi:y'.>-
,, ,,,v Fi+sjsysvu,i.,:rilji
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 certifirrte of occupancy
I have read and agree to the above.
....y, L..t..t,+..v.n. o E•''i-'l'""- ''i t>~Sjas
Signature[Agent] Print Name[Agent] Date signed
Area Variance Revised March 2014 /
Town of Queensbury s Zoning Qitice•tee bay itoau•Queensbury,NY 12604•b iii-cell-dLJo
hltpsJlmaiLanoole.com/ /srs/mail-stafip/ fis/k=rgmail.rmain.en.r_Cv! )Xnfltm-mi,titlam=Pit eSM.ntu, curZnhcLv 77i fXaTe2cPi 3rmaGSvAPf... 1/1
Warren County Parcel Viewer Page 1 of 1
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htto://gis-2.warreneountvnv.gov/wanencountvgis/ 10/26/2015
617.20
Appendix B
Short Environmental Assessment Form
Instructions for Completing,
Part d-Project Information. Ti 2 applicant or project sponsor 5S responsible for the completion of Part 1. Responses
become part of the application for approval or funding,are subject to public review,and may be subject to further verification.
Complete Part t based on information currently available. If auditio„$i 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 ac necessary to supplement any item.
Part 1-Project and Sponsor Information
Name of Action or Project:
Project Location(describe,and attach a location map):
n•, oe .a��•,�+, , p i,fit . es.. .r, I t ► 1 P., ?v r Jr' !
4410, CilW4411 cdf *XV'
Brief negeription of Proposed Action_:
612-JoTizoar 124,0P /64.1 egAggh...1a, V41.44.
Name of Applicant or Sponsor:_ 1 Telephone: 1 �C`9 �
�� ✓i i✓ E-Mail:4 ,reyy,". , cowl
Address: •,
City/PO: State: •I Zip Code:, /
a m� ids' ,1
1,Does the proposed action only involve the legislative adoption of a plan,local law,ordinance, 1 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:
Total of t, action? t i. acres
3.a. acreage the site ofui+',proposed v Ion=_ �
b.Total acreage to be physically disturbed? .• 0• acres
c.Total acreage(project site and any contiguous properties)owned
or controlled by the applicant or project sponsor? ® acres j
4. Check all land uses that occur on,adjoining and near the proposed action.
o Urban )(Rural(non-agriculture) ❑Industrial ❑Commercial )(Residential(suburban)
o Forest o Agriculture • 0 Aquatic 0 Other(specify):
❑Parkland
Page 1 of 4
1 5. Is the proposed action, I NO YES N/A
a.A permitted use under the zoning regulations? X.
I
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? X
' 7. Is the site of the proposed action located in,or does it adjoin,a state listed Critical Environmental Area? YES
Yes,identify: L• (,/1.1 s olz i I I x
8. a.Will the proposed action result in a substantial increase in traffic above present levels? I NO YES I
X
b.Are public transportation services)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? I NO YES
If the proposed action will exceed requirements,describe design features and technologies.
Ul../iat( ? 'Teti) 4Z. I I X
10. Will the proposed action connect to an existing public/private water supply? I NO YES 1
If Yes,does the existing system have capacity to provide service? 0 NO 0 YES
If No,describe method for providing potable water:
1.1.Will the proposed action connect to existing wastewater utilities? . NO YES
If Yes,does the existing system have capacity to provide service? O NO 0 YES x
If No,describe method for providing wastewater treatment:
State or National Registerof Historic I NO YES
12. a.Does the site contain a structure that is listed on either the j
Places? i1
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 I NO YES
wetlands or other waterbodies regulated by a federal,state or local agency? 1
b.Would the proposed action physically alter,or encroach into,any existing wetland or waterbody? i
IfYes,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:
I PIC Shoreline 0 Forest 0 Agricultural/grasslands 0 Early mid-successional
0 Wetland 0 Urban 0 Suburban
NO YES
115 .Does the site of the proposed action contain any species of animal,or associated habitats,listed j
by the State or Federal government as threatened or endangered-? jo
16.Is the project ro ect site located in the 100 year flood plain? 1 NO YES
17.Will the proposed action create storm water discharge,either from point or non-point sources? NO ; YES
IIf Yes, v X
Ia.Will storm water discharges flow to adjacent properties? 0 NO 0 FES
b.Will storm water discharges be directed to established conveyance systems(runoff and storm drains)?
If Yes,briefly describe: 0 NO O YES �.
i
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1 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)? i
If Yes,explain purpose and size; 1
( 19.Has the site of the proposed action or an adjoining property been the location of an active or closed ( NO
YES I
!� solid waste E nanogement facility:
if Yes,describe:
I I I
20.Has the site of the proposed action or an adjoining property been the subject of remediation(ongoing or NO YES
i completed)for hazardous waste? I 1
I e-,I If Yes,describe: ++ {I
IT AFFIRM THAT THE INFORMATION PROVIDED ABOVE IS TRUE ANTI}A CCUUR ATE TO THE REST OF MV i
IKNOWLEDGE —
Apptl itf&3viSu ac: ., ' J I7d . Date: ILJILf/ 1`J
Signature: s4I2V.4Le ./) .� �.AC,0Pw i:�
I
/'q 7
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 toe information contained in Part i and other materials suomined by the project sponsor or
otherwise available to the reviewer. When answering the questions the reviewer should be guided by the concept"Have my
resi....,a been reasonable considering tate scale and context of the proposed action?"
No,or Moderate I
small to large
impact I impact
may may
occur occur .
1 {1. Will the proposed action create a material conflict with an adopted land use plan or zonine I I
I regulations? eI I
' 2. Will the proposed action result in a change in the use or intensity of use ofland.' j
..' 3. Will the proposed action impair the character or quality of the existing community?
!j
14. Will the proposed action have all impact on the environmental characteristics that caused to 1I I
•
establishment of a Critical Environmental Area(CEA)? it
Willaffect the proposedinfrastructure action resultfor mass in an adverse changebitting or in thewalkexistingway? levet of traffic or
existing transit, I
I 5. I
16. Will the proposed action cause an increase in the use of energy and it fails to incorporate 1I I
reasenaoty available energy .OnSe:,load: renewable energy opportunities?
7. Will the proposed action impact existing:
I a.public f private water supplies I
b.public/private wastewater treatment utilities?
—t
iI
8. Will the proposed action impair the character or quality of important historic,archaeological, ��t arch ectu al or aesthetic.ea..urres% I I
19. Will the proposed action result in an adverse change to natural resources(e.g.,wetlands,
I
waterbodies,groundwater,air quality,bora.and .unaj i i i
Page 3 of 4