Salmon - CAMERONS DELI Site Plan App. NACE ENGINEERING, P.C.
PROJECT NARRATIVE
CAMERON'S DELI
446 DIX AVENUE
The applicants have placed an option to purchase the parcel and propose to redevelop the parcel
and construct a delicatessen with associated parking. The existing building and asphalt parking
will be completely removed prior to construction of the new building. They plan on constructing
a new 3,469 square foot building on the parcel for the deli.
The new parking area will greatly reduce the curb cuts along both Dix Avenue and Queensbury
Avenue. The entrances to the parking area will also be improved by being moved further south
and east of the traffic controlled intersection.
Stormwater from the proposed new parking area will sheet flow to the edge of the new asphalt
parking where it will be directed to shallow infiltration basins with drywells. The runoff from the
rear access delivery area will be directed to an infiltration trench. The runoff from the building
roofs will be directed to gutters and piped to infiltration trenches with infiltration chambers. All
runoff will be infiltrated into the well-drained soils on the parcel.
Municipal water will be utilized for this project. Onsite wastewater treatment will be used for the
building wastewater.
The applicant is proposing to utilize LED lighting for the site.
CAMERON'S DELI - 446 DIX AVENUE
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 forglacement 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 I original & 14 copies of the completed application package to include*
• Completed A lication pages 1-11 completed, signed & dated
• Pre-Submission Meeting Notes:, signed by staff
0 Copy of Dged
0 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 calob( ouee.;s -�°.cuo
Keith Oborne, Land Use Planner
Pam Whiting, Office Specialist 518-761-8220
Visit our website at ��u��a � r � 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
ax Parcel ID Number:er: 303 .16-1-58
Zoning District- c
Detailed Description of Project [include current&proposed use]:
cxL_NNOT. rnK r,Mr- 4, _.T CuTa f:Itut3g—rY rax- C'�.riTr 'i i rT? �r�17 rrin c 11 ;nr rr1 r r,
Location of project:
T?:T . _ u N(J'E SC)lJ I.T. ;IIASi.. CO N:::.t OF D s X: A-Vk.;NUE ANT.) OU ,Fxi:VSB3JR Y -`.'tPr.r°iCIIE
Applicant Name: JAY N Address: 451 r r)c.KHAPI b :MI ROA
LAKE GEORGE, MY
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Home P � ..................
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Work Phone „ 8 Fax
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Agent's Name: Address: o 6 9 Hr:rr..r -.cz..
N: INC LNI:.ER JN(
QU :ENS8U YYr NY 12804
one _.......... Cell: .. .............. �_____...........
Home Ph
(5:1-8) 45, 4400 c- T.
C.I.....N7.'k;R3 f ru71.. 1C)C).C'C M.C olvi:
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.�iYVner'S NamEITIT ��.....
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HomePhone---- .... � ..A..._Ce. �. ...... ................
Work Phone r a 6h _ ...... Fax -_.. .
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Town, of Queensbury Planning Office, 742 Bay Road ° Queensbury, NY 12804 ° 518-761-8220
Site Plan Review Revised June 2009
Site Development Data
Area /Type Existing sq. ft. Proposed Total sq. ft.
Addition sq.
A. Building
ft.
g footprint
3,421. 5 48 3,469.5
...... .,,...........w.e. ..... _. �.......�........ ......... ....m ....n...................................
B. Detached Garage
C._.Accessory Structur... .
e(s).-.." . _ ._...
......_ _. _... ..........____...............
D. Paved_., gravel or other hard surfaced area
11 , 879.4 8,546,65 20,5261 05
E. Porches / Decks
_ _..._
F. Other
G. Total Non-Permeable [Add A-F]
15,300.9 8, 614 .65
H. Parcel Area [43,560 sq. ft. / acre]
58, 877.71 8, 8:77 .71 8,877. 71
I. Percentage of Impermeable Area of Site [I=G/H
25.0 14 ,0 1 40 ,8
Setback Rpquirements
.. .._.._._....._. .....
Area Required Existing Proposed
Front [1]
"75 50e7 75. 1
Front [2]
75 47, 8 76,4
.................
Shoreline .......-....
..mm__M._.. . _......__.._ __ ........
Side Yard [1]
Side Yard [2] -
Rear Yard [1]
SOUTH
25 37.0 26,3
Rear Yard [2]
EAST 25 230.9 203,3
Travel Corridor
....
]
40 FT MAX35
Permeability
30. 06 746 59.26
NO. Of parking spaces 1 PER 150 SF =43 UNKNOWN 44
Town of Queensbury Planning Office- 742 Bay Road • Queensbury: NY 12804 • 518-761-8220
Site Plan Review Revised June 2009
Additional Project Information
1. Will the proposal require a Septic Variance from the Town Board of Health? No
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? YES
4. Estimated project duration: Start Date SPR 2016 End Date SUM. 2016
5. Estimated total cost of project:
6. Total area of land disturbance for project: 46.358.23 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.
g-Di_.stri_tri ct i Symbol
_ Floor Area RatioIT[FAR
C�n�n
-.__
Waterfront Residential WR 0.22
Commercial Moderate CM 0.3
...........-- _ _. _..�............
Commercial Intensive CI 0.3
A Tho nnmhinari araa of all cminrc f—f— no fir., ..+o.i. _ ,u, of nil
mpgci,rc --- -- c ---- .. -. -.. .. ..... .... .... L..
::�pciiyi
.. pr
including all floors of the structures,fres rgara'ac hacamantc nnrrl attirS with more than five (5)feet of coiling 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.
w..-.. - ....
Parcel Area 877.71 sq. ft.
Existing Floor Area _ - _ sq. ft. [see above definitionl
............. .. ._.... . __ ....
Proposed Additional Floor Area sq. ft.
.. _ ww.w —..�. . ._..... ........_........___........_....... .
Proposed Total Floor Area 6,119 sa. ft.
Total Allowable Floor Area ]r 663 .31 r
..._ w... (Aea x 3-_) [see mabove tablet
Town of Queensbury Planning Office- 742 Bay Road • Queensbury, NY 12804 • 518-761-8220 4
Revised June 2009
S 179-9-080 Reguirements for Site Pian A2proval. 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.
............ _..,..... � .. . ......_ -- -.,.,........m,
STANDARDS
w.. ... .
A. The proposed project furthers or is consistent with the policies of the Town's Comprehensive Plan,
YES
B The proposed project complies with all other � _,.including
�._...._ n
p p p 1 p ..�r 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.
YES
- encourages edestCsite plan nan activity internally and, if practicable, to and from the sito --i��
with pedestrian paths or sidewalks
connected to adjacent areas.
NA
...... _.........----.........
D. The site plan must conform to Chapter 136 Sewage and Sewage Disposal, Chapter 147 Stormwater Management Local Law, and
other applicable local laws.
SITE PLAN COMPLIES WITH CHAPTERS 136 &147.
.....
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.
YES
P proposed P _ ..... ..._.__ _
F. The establishment,maintenance and operation ofWthe.......
W roposedWuse 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.
YES
G. Off -street parking and loading facilities will be appropriately located
_._WWWWWWWWWWWWWWWW t traffic
_
p �ately 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.
OFF STREET PARKING IS PROVIDED,
vITiH, The project shall not have an undue adverse upon the natural, scenic. aesthetic, ecological, wildlife, histori ,ITe
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.
PROJECT IS AN ALLOWED USE IN A CM ZONE
_.—._........, .........Town
...of........u.ee.nSb.0 .....Pla.n.n.in........Offi.c......742...Ba.......Road ...__.. NY.....12804 . 518-7 1-822 � .................._._
Q rY 9 Y Queensbury, 6 0
..
mmRevised June
I. The provision for and arrangement of pedestrian traffic f�aaccess and circulatio_n.,...w._alk.wastructures, control el rn.ters.e
clWio
ns 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.
NA
a facilities J. Stormwater drainage will prevent� event andevelopment �>flows,a�compared increase of post dev�lo t drains cornu �
p p ... _:. g p to pre-dewelraprnent drapna"...
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.
STORMWATER CONTROLS HAVE BEEN APPROPRIATELY DESIGNED.
K DepartmentThe water up lyalth rand se age disposal and facilities will bew'rlbe adequate and will meet all applicable andcurrentrequirements set forth by
la Chapter 136 of the Town Code.
TOWN WATER IS PROVIDED AND SEPTIC SYSTEM TO BE REVIEWED &APPROVED BY NYS DOH.
plan
provide a visual _ ...u.
L. a ._._. ...._
The adequacy type and arrangement of trees, shrubs and other suitable plantings, landscaping and screening shall effectively
I 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.
LANDSCAPING HAS BEEN PROVIDED AT THE ENTRANCE.
M.
Fire lanes: emergency zones and fire hydrants will be adequate and meet the needsm anmd requirements of emergency service
providers.
ADEQUATE ACCESS IS PROVIDED.
.. .. -Ghe esi n cf structures, roadwa s and landsca in9 in areas sus eptable to pondin „ floodin3and/'or erosionen will minimize or avoid
such impacts to the maximum extent practicable.
ACCESS DRIVES HAVE BEEN ADEQUATELY SLOPED TO TO GRASSED SWALES WITH DRYWELLS.
ta
Chesife plan conforms to't'�-����"'�'��
he design standards landscaping standards and pe11 rformance starrdr=rr�:fs ral tl'uis chaptar.
S
Town of Queensbury Planning Office- 742 Bay Road • Queensbury, NY 12804 • 518-761-8220
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 Inlor-mation 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
necesSar"for an informed review under the circumstances. The Planning Board may grant such waivers on its own initiative 0
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 ml drawn at the scale that shows the relati'—
v!c �h'rn P on ship of the proposal to existing community facilities which aff�.ct 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 . P,
Survey map of the area
aYJ ^ ._........ ..._.
B The site plan" hall bed"draw,-,at scale df fciiy feet to file inch (1� =4v feet)or SUCK Ctliei scale as the Planning Board may
deem appropriate, on standard 24"x 36"sheets,with continuation on 8%"x 11"sheets as necessary for written information, S,
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�
Name
ameand ant d ndtres of ,
pp record owner,a record,developer,and
authorization shalllllbe required`erom the owneror landscape architect, If the—
applicant
hey
g'
C 7
t The locution and use or all existing and proposed structures within the property, including ail dimensions of height and floor
are 1°ext p io F er tmn ,a- .._l_. i railad jtuTe addit.i ons arI _._..._.._._r"
F The location of all resent and r.... mmmm """or .... """"
p 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 „T,.
containers shall also be shown.
G The location, height, intensity, and bulb type IT"
g ty pe (sodiuna� Incandescent, etc.) of all exterrua! lighting l"tlxtures,. The direction of
illumination and methods to eliminate glare onto adjoining properties must also be shown in compliance with§179-6-020. S P":
H.._ The location,height,size,materials,and design of all proposed srg.r._s._,
......... �:
_..._....._..... _ ............ _._.
................
l The location of ail present and proposed utility systems Including:
1. Sewage or septic system;
2. Water supply system.-
3.
ystem;3. Telephone,cable,and electrical systems; and
SPI
4, Storm drainage system including existing and proposed drain lines, culverts, catch basins, headwalls,
endwalls,hydrants,manholes,and drainage swales.
J Plains 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 SP3
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.
Existing and andtopographyproposed at two-foot contourintervals, o r such oher + nterval as the.P.l.a..nning
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 ry.c
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 Prolan showing all existing natural l'a'nd 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 SP4
watercourses,aquifers,floodp!ains, and drainage retention areas.
...........
Town of Queensbury Planning Office- 742 Bay Road • Queensbury, NY 12804 518-761-8220
Site Plan Review Revised June 2009
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. SP1
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;
sP1
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 labia containing the folkowing'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; sp
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 existin facades,showing design features and indicating the A.P.[.AC.
P 9 9 9 g type and color of materials
to be used.
Q Soil logs, water supply well and percolation test resuRs, and storm runoff calculations,as needed to determine and mitigate
project impacts, S P
pP p ._...
R Plans for disposal mof construction and demolition waste,either on-site or at an approved dis Peal facility, i... S P 3
S Plans for snow remo�waQ,including locations)of on-seta snow storage....._ JP3
p
T An Environmental Assessment Form('EAF'),as required by the SEQRA—regulations,with Part 1 com-1
pleted 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 AT,ACH
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. ATA CH
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 179-4-044
1. Tax Map ID 303 .16-1-58
2. Zoning Classification CII
3. Reason for Review: SITE PLAN r3V EW
4. Zoning Section#:
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
FAR Worksheet complete Yes No
Standards addressed /Yes No
Checklist items addressed Yes No
Environmental Form completed —YYes No
Signature Page completed Yes L'N'o
� r
7 y
r
p
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s
A-)e "� ,k„ �*�k �, d� � '�'Co v � �„ Lr rd'
',
P
i
Staff Representative;
Applicant/Agent:
Date: ';
Town of Queensbury Planning Office- 742 Bay Road • Queensbury, NY 12804• 518-761-8220 8
Short Environmental Assessment Form
Part I -Project Information
histmetimis for Completing
Part I -Project Information. The applicant or Project sponsor is responsible for the completion of Part 1. Responses
become part of the application for approval or flunding,are subajcct to public review, and may be subject to further verification.
Complete Part I 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 ail 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 I -Project and Sponsor Information
— —�_ -—--------
Name_�f Action r Project:
Project Location(describe, and attach a loc "i ...................__
on a: . —--
-------------
SOu,rHEAST CORNER OF DIX AVENUE AND QUEENSBURY AVENUE,TOWN OF QUEENSBURY,NY
...........
Brief Description of Proposed Action:
DEMOLISH EXISTING COMMERCIAL STRUCTURE AND CONSTRUCT A NEW COMMERCIAL STRUCTURE TO BE USED AS A DELI
WITH ASSOCIATED PARKING AND STORMWATER MANAGEMENT.
Name of Applicant or Sponsor: Telephone:
_Xddiess_° "....... ——--------...................
...........__ —1
City/Po: State: Zip Code:
__............ ......
1.Does the proposed actn only involve the legislative adoption of a plan,local law,ordinance, NO YES
administrative rule,crime gulation?
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 pen-nit,approval or funding from any other governmental Agency? NO YES
If Yes, list a enc (s)name and omit or roval:
TOWN OF QUEVE8C�RY SITE PLAN, ora
SYSTEM APPROVAL AND A BUILDING PERMIT, El R1
............. ... .....
mmmmmm
.a.Total acreage of the site of the proposed action? ............... acres ........
. .
............
b. Total acreage to be physically disturbed? 1.06 acres
c.Total acreage(project site and any contiguous properties')owned
or controlled by the applicant or project sponsor? 1.35 acres
.......... ..........
4. Check all land uses that occur on,adjoining and near the proposed action.
[:]Urban E:1 Rural(non-agriculture) [:]Industrial E]Commercial ®Residential(suburban)
ElForest DAgriculture El Aquatic E10ther(specify)-
ElParkland
Page 1 of 3
5. Is the proposed action, NO YES N/A
Ela.A permitted use under the zoning regulations? 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?
�_.. .._.
.............. - __... _
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 �.........._ .......... 0
8. a. Will the proposed action result in---a- substantial increase in traffic above present levels? NO YES
it/
b.Are public transportation service(s)available at or near the site of the proposed action? Eln
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 requirements,describe design features and technologies
the proposed action will exceed req.IT � ... ..... . ...
10. Will the proposed action connect to an existing public/private water supply? NO YES
If No, describe method for providing potable water: � ry
11. Will theITproposed action connect to existing wastewater utilities? NO YES
If No,describe method for providing wastewater treatment: ✓
ONSITE WASTEWATER SYSTEM PROPOSED
�. ... ...
12. a.Does the site contain a structure that is listed on either the State or National Register of Historic NO YES
Places? Z
El
b.Is the proposed action located in an archeological sensitive area?
El 9
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? i
✓
I El
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: UJ
14. Identify the typical.habi..__ ........ .... .�...��_.._.. ..��_. ._...
A,or are likely o b found on the project site. Check all that apply:
❑Shoreline ❑Forest ^or are likely to b nds ❑Early mid-successional
tat es that occur on
❑ Wetland 0 Urban ❑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? ❑✓ NO ❑YES ✓
b. Will storm water discharges be directed to established conveyance systems(runoffand storm drains)?
If Yes,'briefly describe: ❑✓ No ❑YES
Page 2 of 3
18.Does the proposed action include construction or other .._...._e...t —E
activities that result in the impoundmnt of � NO YES
water or other liquids(e.g.retention pond,waste lagoon,dam)?
If Yes, explain purpose and size:
...... ON SWALES
STORMWATEI�INFILTRATION �._. ._.- -- ..._ ._.._.��__...._.._-�.
Li
19.Has the s'�.e ro osed action or ...M..
site of the �.-... ..._.
proposed an adjoining property been the location of an active or closed NO YES
solid waste management facility?
If Yes,describe:
waste?
...�....�... _.
20.Has the site of the pro—posed d action or an ad'oinm roe been the subject of r -_
P P J � g property rtY j remediation(ongoing or NO YES
completed)for hazardous w
If Yes,describe:
NStTE FUEL OIL TA,NIC ,ASRENO -D FROM THE SITESITE ------.'..�_." EJ Z
I AFFIRM THAT THE EN>� mm A.... AND ACCURATE TO n� '�
ORMATION PROVIDED ABOVE IS TRUE AN__.-..-_
KNOWLEDGE THE BSS OF MY
PP Pname: . _ Date: .._ e r
SignatureM.........
Applicant/sponsor onsor– V�mm � A � .
..........
PRINT FORM Page 3 of 3
EAF Mapper Summary Report Monday, January 11,2016 4:59 PM
Disclaimer: The EAF Mapper is a screening tool intended to assist
project sponsors and reviewing agencies in preparing an environmental
assessment form(EAF).Not all questions asked in the EAF are
answered by the EAF Mapper.Additional information on any EAF
question can be obtained by consulting the EAF Workbooks. Although
the EAF Mapper provides the most up-to-date digital data available to
DEC,you may also need to contact local or other data sources in order
to obtain data not provided by the Mapper.Digital data is not a
substitute for agency determinations.
Taant.
R�r'IeS�tr-
;..,,..d-" I`l4V:9sd' BcUttln AfYxelr� - P..
r'r J;Ia'Pr*.
l aE.1111 4'I rd
4
r
Part 1 /Question 7 [Critical Environmental No
Area]
Part 1 /Question 12a [National Register of No
Historic Places]
Part 1 /Question 12b [Archeological Sites] Yes
Part 1 /Question 13a [Wetlands or Other No
Regulated Waterbodies]
Part 1 /Question 15 [Threatened or No
Endangered Animal]
Part 1 /Question 16 [100 Year Flood Plain] Digital mapping data are not available or are incomplete. Refer to EAF
Workbook.
Part 1 /Question 20 [Remediation Site] Yes
Short Environmental Assessment Form - EAF Mapper Summary Report 1
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: TIM HAVENS
Designates: NACE ENGTNEERINC
As agent regarding: Variance Site Plan Subdivision
For Tax Map No. 30:3.16 Section L _ Block 58 Lot
Deed Referer�e` 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:
Designates: NACE :ENG INEERING
As agent regarding. Variance C';te Plan Subdivision
For Tax Map No.: 303.16 Section 1 Block 58 Lot
Deed REa Page._ DATE Date
Book
OWNER SIGNATUeRefereli�,
_.e n
s
�� °� ✓�
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 huis.4"her'/their agerit(s) hereby authorize the Zoning Board or Planning Board and Town Staff to enter the
�.ewj�...f cliic5 IVI Lire UI vtsc vl reVMVVlll Ule application submiLLed.
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 AG'REEM.ENT TO PROVIDE DOCUMENTATION REQUIRED, I, the undersigned, have thoroughly read and understand
the instructions for subrns ssion 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.
v AJ
ig' Iatrlre [A '; ,w 1/ls/16
plicant] Print`Name [Applicant] Date signed
THOMAS CENTER, PE 1/15/16
Signature [Agent] Print Name[Agent] Date signed
Town of Queensbury Planning Office 742 Bay Road • Queensbury, NY 12804 - 518-761-8220 11