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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 _.._...._ .W. .--. .-.....�._ Cell: Home P � .................. hone .... I Work Phone „ 8 Fax ail° I _..... _. .... .. ....... _ �...... 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: ..... .�iYVner'S NamEITIT ��..... °lL!� 1:fi�/Yuu4c AddreSS � � u.l.� �i,j. l�Cd�. P.:-�YIJ1..)r)ON frALF....,S, f `� 13839 HomePhone---- .... � ..A..._Ce. �. ...... ................ Work Phone r a 6h _ ...... Fax -_.. . .. ... _ ... ------ --- 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 "` "^ 'Ped •,,�f i,r '^';,':°.,V W�uN' 'q p"^ '��w I� "...'h; N �,,,::. +•,?,.. "�°,1i" I" d t�». !IAl d""'y ,i„. f ' 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