Site Plan Application a
Site Plan Review Application
,applicant and/or agent shall meet with Zoning Administrator to determine type of review needed
Pre-submission meeting with staff"is required to determine general completeness of application materials(to
be held no later than 1 week prior to deadline submittal•Cull(51 8) 761-8220 for an appointment).
ppilcation submittal, one (1) original application package, one (1) deed and 14 copies of the application
package with the application fear
Determination of application completeness and placement on an agenda
Planning Board meetings are generally the third & fourth Tuesday's of each month. You will be advised in
writing as to which meting to attend.
Following the meting you will be provided with a copy of the resolution stating the Board's declsion on your
application, it your applicatton was approved, the next likely step is a Building Permit. if your application
was denied your project cannot proceed as submitted..
*Fee: $100.00 (0 to 10,000 sf), $260.00 (10,001 to 30,000 sQ; $500.00 (30,001 to 100,000 ); $1,000.00
(100,000+of
c of
Craig Brown, Director of Planning,Zoning&Code Compliance cralabOquegenshyMEeA
Laura Deere, land Use Planner IMggLq2.queansburv.net
Pam Whiting, Office Specialist (618-761-8220) oaraw 0 Qu stau .ne
RECEIVED
FEB 12 2016
.i OWNI Ol Ota EC SB i "
� i tFI :E.....
Site Fera Review Revised March 20114
Town of Queensbury Planning Office-742 Fay Road*Queensbury,NY 12604.518-7 61-8220
General Inf arri tig
Tac Parcel iii: a',
Zoning District:
Lot size: ac_r
Current Use:
Proposed Use:
Applicant ratansddrs
� M 1:11 �
Home Phone Call:
�IV57rk Ph ;'OFax
E-Mail
Agent's dame: Address:
Home Phone ell:
Work Phone
iff.rrreiN
------------
ow ner's Name: �� Address
Hams Phone Cell
Work Phone Fax
E-mail
Town of Queensbury PlanWng Office."4 Say Road-Queensbury,NY 12804 w 518-761-8220
a
Area
"type I ting sq.ft. Proposed Total sq.ft.
A. Building footprint Addlltl2aln ,ft.
. Act Vary tr ura(
U. paved,gravel or othar hard surfaced area "4 SIX
E. Por fa s/ ecks
771:—* Other i, .boathouse,aunda , atr.. � .,
�.
tom.Tot l 9 n•Parmaabi [�1dd .� �.
H. Pari—Area-----—(43,560sq.ft.I gra
T. Par anttage Of Mrrrparrrrea le Area of Site
Area Required Existing PrOPOSed
Front C1)
Front i )
SShoreline
Aida Yard Cts
`Yard i
/`
F r Yard 1j
Aear Yard i2
`rr ,vl�carr'Pdrar
Raiht rad
Peraa fflty
--------------
No. of parking spaces
.fits PtOn Review Revised March 2014
TOWn Or Otteensbury i tsnr►irrg C »742 Say Rosa•Queensbury,Nor 12804.618-761.0220
1, Will the proposal require a Septlo Variance from the Town Board ofHealth?
w if the parcel has Previous approvals, list application number(s):
. Doe's this project require coverage under the NYS DEC Storrmwwater Pollution PreventionProgram?
4,. Estimated project duration:. Start mate End Date
w. Estimated tort cost of project:
. Total area of land disturbance for project:
FLOOR AREA RATIO(FAR) --'the reiatfonship of buiidfng size to lot size,derived by dividing the total bWldtn
floor area by the lot size In square feet,yielding a percentage.
tonin iietrllt yrrlboi Pioorwrea igatit 1 aid
Waterfront Residential
0.22
Commercial moderate/Cornrnerclal intensive Z lM Ci 6.3
Main street �.�
----------------------
A,. The combined area of all square footage, as measure from a terlor walls of all structures on the property, Including all
floors of the structures, garages, basements and attlos width more than five ( ) fest of calling 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 AREA RATIO"),
BCommercial 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 prInclpsl and accessory buildings or structures
on the project site,
A. Parcel
. iietfrr Pioor Area s w ft. see abovedefinition
C. Pro used lddltionai Pioor Area a
D. Prop used Total Floor Area s . ft.
E. 'dotal Allowable Floor Area (urea � see above table
*if D Is larger than E, a Variance or revisions to your plan may be needed. Please oc�rtault
` /Staff
of Queensbury Planning Office-742 Bay Road~Queensbury,W 12804518-761-8220
pm'
w
�"�'�'- "-t�af� _t' �t� 'I The Planning Boardshall not approve S SUO Pisaunless It
first detwsftmine$ that such site Ilam nifeets tyle folloWng Standards. ptease prepare responses to each of the following
tal►rcs,
B1 AhlfaAFtDS
T'toa pro Scd proleot turthare or 4ha poitolas
It "s C omprohensfva tan
D. The proposed project compltas wtbr all otlrar raqulrams of tfafs pias,Trot the alta plan ravraw Ards as set oaf in ph r
of this section,the dimensional,bull,and density regutailrns of the zoning dfalrict In which a is proposed to be located(A rttcls 3 and Table 1).
the appliteablis requirements of ail other Articles that apply.
rte. Ifwa sits pian anon padeatrlan activity t sari,It prao le,to and from the sits with pedastrlsn paltry or sidevralkcs orae d to
adfacent areae.
l7. The site,plan must cordorm to C waptar 136 swags and t evrage Disposal,Chaplet 147" Btonsweter Management Loa^aI t wv,and o f
applicable local laws,
11. the proposed rasa S a be lra harmoc14 wltw qra Behest purpose or Infantof thls Chapters specifically to Into account bra loo »ohaasolar
and size of proposed'Van and the dsscrlp"tfon end purpose of district to whfoh such use Is pmpoSad,the n WIO, ,and Intensity of the
activlles to be involved In or conducted In connection with the proposed vas end the nature and rate of any Increase In the burden on
supporiii publi services,and laclilles wlhkh Will frill the et of the Dead use.
ITM. The est shrnent,maintenance and operat1i ct the propos use will not create publro hazards trona Urattto.Ira to congestion or the park erg
of vehlotas and/or equipment or be otherwise detrimental to the health, safety or general ICsra Of parson$ melding, or workdng In the
nerg rhood car to the general welfare of the „"Traffic accese and circulation,road rseotlo a,road and d as widths,and traffic
controls VAR be adequate.
. Cuff-stcaat pa 6111 and foacttng o as will be spproprfata' I arranged and lard to msrwt tra o a Ipataed tct tap ganerstted y
the now use. The establishment of vehicle Ands between parking areas of adjacent properties are provided where faas'lbtaa, "This furMlrare the
Town's goat of(educing curb outs and redualtg c ngastlom A my-toot wide connection Is rsrtufreda It adjacent properties are either
undeveloped Or previously developed vAlrout having made provtslon for future arrieli then a Mute connection must be Identified and
providserf for in the site plan under review for Such future finkags when the flan arises. The planning Board may require proof that the
applicant has maria contact with adlaoard property owners for purposes of coordrialirrg linkages with 4014osnt propari
lass pr act shelf not twava an tondos a sea Irrpaot upon lha natural,s to,aaa og al»wild a, Ispor »raoraart Dna or opera Spaoe
resouoes of the lawn or the Adirondack parks or upon the adequate paovtalan of supporting feolitlas and services measle necessary by the
project,taking into account the ommeloW.industrial, reeldenllal,recterritunal or other boneftfe that might be darived from the protect, In
snaking the delorminadon hereunder,the Planning Dowd slualt 0000WOr those lectors perdnant to tM prOlsot contalned In the devvlopMent
constderations Set forth horeln under J 1704000 of this chapter,and In to tiring,,the Planning Board shall(ARM a net overaa avoluatlon of
the project In rolation to the development objectives and ganaral guldetines set forth In 6179.9M080 oI thfa Argota,
t "Thep stun for and arranganraent of pedaslr an RK aooaes and ofrculatfon,wolKway structures,conlrof of Intarsaot Dna wrrttln vahiculir traffto
and overall pedestrian cerrventence shall be eats and adequate fear pedestrian movement Pedestrian connections between adjacent sites
draft be provided to encourage clan use.
J» SIormwatsr dratnaga Naoiltlae wi6 pravan't an ina:rsasa of poet dsvalopment rainaga flours ae Dom to Ira dsysloprnent lar s 11
Drainage of the site shalt mcharits ground water to the extent pmodoaL Surface,Waters Rowing aft-slits shall not degrade any streams or
adversely effect drainage on ad;acent proponlss or pubilo roads. Faciutgaas shalt be in conformance with the drainage standards of C rsplar
117 of Che"Town Code and The Town of queembury Subdivision Regulations whets applicable.
K,. "Thewater S ty and sawwaga dispose taaaifillss wilt tea adaguale and wilt roast all applicable and current negu arnents seat:.forth by Department
Of tlsatdr reqUisitons and Ch&Wr 1rf of the"Town C:
L adequacy,typo and arrang ent of trees,shrubs arrd others bIa planhrngs,tarada Ing crud ssning shall atfsctivv'a protide a
visual o or nolea buffer be an the applicants and sdlolnlng lands, inctuding d1a rassrlmum ratantlon of anrlaling vsgatatlorr and
maintenance,Including replacement of dears or docassed plants.
m. Fos i , ,emergency zonas, lira tr rartla will be adequate and meet" needs and raqulremants o emarga y Sans oa prov dare.
N. The design :111 structures,roadways and landscaping In areas susceptible toponding» flooding andfor aros'icn wvitt min fze or ovod such
Imparts to the MOWUM extant prao bla.
r . The s to plan c„oruforms to the design standards, aping stand sandperformancestandards of Ws chapter.
Site Plan RevRevised March 2014 �
"own of Queonsbury Plenrdng Oft! -742 Se,'Road•Queensbury,NY 12814.618-761-8220
179-9-060 PalkadO tgLM,fta BE
Absent ar waiver or watvors,an applIcation for Site Plan Review shall Include the tall omno:
REQUIREMENTS Shoot#
A7
A vIdnity,map drawn at the scale that shows the relationship of the proposal t6 e*flno community faciltles which affect or Serve It, 4Z
such as reads,shopping areas,aftols. etc. IU map shad also show all properties,Identlify comers, subdivistons,streets, and
easements wMIn$00 feet of the property. Such a sketch May be superimposed on a Untied states dootogical Survey map of the
area.
B The site plan shag be drawn at a scale of"feet to the Inch(11'w 40 feaq or such other saws as the Planning Board may doom
appropriate,on standard W x 6"abets,vdih continuation on OW x 11 I sheets as necessary for written Irk n, Its Irdbrnoallon
Itsted below shall be shown on the site plan and continuation sheets.
-hisme of the project boundaries,date,north arrow,and to of the plan.
IT Name and address of the owner of record,developer,and ssal of the engineer,archtlect,or landscape architect, If"OPPI10ant Is not
the record owner,a letter of atabodzerfen shall be required from the owner
E The locatlors and use of all mdatin and proposed structures within the property.Including all cilmensrom of tWght and floor otrea,al
axledor entrances,and all arrIMpated future additions and afterafts.
The location of al'I present and proposed pubito and Private ways, off-street parlOa
ng areas. driveways. outdoor storage reas,
sidwalks,romps,numbs,paths,landscaping,walls,and fences. Location.We,and screening details for go waste dtsposal container$ v 7
shall also be shown.
G The location,helght,Intensity.and bulb typs.(sodium,Incandescent,eta.)of all external ilightinil 0%jums. The dkeown of Harnination
and methods to elimfnats glare onto'adjolft properties mug also be show In compliance with§170.6-020.1?
The location,height st?e,matedals,end design of all proposed signs.
The location or all present end proposed utility systems including: r Via- rO
1. $ewatio,or sept io system;
2. Misr supply systam; 0A, " 0 �-t, ll e'q^I
3. Telephone,cable,and electrical systems-, and
4. Storm drainage system tricludino existing and proposed dtaln Ones,mdverts,catch basirks,headwalls, endwalls,hydrante,
manholes,and drainage awates.
J Plans to prevent the polkillork of surface or groundwater, arostan of soil both during and after construttlon,excessive runoff,and
Iloodfng at other properties,as sppflczblo. A Sloromalar pollution Prevention Plan(SWPPP) to all land development aclWWas
(SX01VdIng agricultural ammOss)on the olle that resells In land disturbance of 1-acre or more, A SWPPP shall comply with the
requirements of the DEC SPD ES MS-4 General Permit and Chapter 147 of Vis Town of Quoonsbury Code. It shag be at the
discretion of the Planning Board as to whether a SWPPP or an woslon and control on shall be receilred for a sits pfam review ptoidet
land disturbance of less than Vaors.
K exf8ttng and proposed IoMrapby at tft.rcot contour Intervals,or such other contour Interval as the Planning Board shall allow. All
elevations she$refer to the newest United States Coastal and Geodetto Dench Mak It:any portion of the parcel Is within ft 100.
year Modplaln,the area wit be shown,and bass ftod el ll given. Areas shall be indloated within the proposed oft and wfthln
60 feet of the proposed sits where soll removal or WAS Is required,showling the approximate volumo In cuble yards.
L A landscape plans all exisling inatural"features that may Influence the doefort of the Proposed use such as rock outcrops,
stands of trees,single tress eight or Moto Inches In diameter,forest cover,and water sources,and all proposed changes to these
features IrmludIng sims and types of plants. Water sources Inoluds ponds,lakes,wedands and watercourses,aquilem,floodplatne,
and d roge(etentlonavess.
Land Use DWVot bourldarles within 500 feet of the s3Ws perimeter shall be drawn and Identilled on the este plan,as well as any
Overlay Districts that apply to 010 prop".
Sile Plan RWew Revised March 2014
Town of Queensbury Planning Office.742 Bay Road-Oueenebury,NY 12804-518-761-8220
ReOUIREMENTS CONICINU110 t hostff
N "Traffifo flow pattems within the site,ants arwd obits,end loading and unl ing sraas,as woo as corb cuts on the site and within
toil feet of the alte. The Planotng Board may,at Ilrr d" rellon,require a detailed traffic agcy for large developments or for those In
heavy traffic SMIAS,which Shall Include.
1. The projeOled number of raotor vehiote Irlps to anter or leave the alta,astlmated for weekly and anrwuat peak hour traffic
levels,
p. lbo prrrjected traffic flower pattern Including vehicular amemenis at all major Interseolions Iifwaly to be affected by the
proposed use of the silex,
.. The Impact of this trafflo on farvals of service on abutting public streate and at aftecAed lrdetsecgorm CAsting and proposed
weekly and annual peals hour traffic levels and road capacity levels shalt also be given.
For now construeflonor afterations to any siruofure,a table conlaWng the fo trig[alormallM Shall be Incl
1. C-stimated area of structure to be mod for parlicahr purposes such as retail Opera ,office,90rage,
Z Esilroated maxtraurn number of employees;
Maximum seaf capactly,w hereapplicablel end �r� �� V f III.
4. Number of panting spaces extating and required for the Intended me.
P 1. Docs'plans. '4
p. plew alions at aw scale of one-quader Inch equals one foot(114`=1 two for all exterior facades of the proposed structuae(s)arrdfor
alleraliens to or expansions of existing facades,showltV design features and Indicating line type and color of materials to be used,
VF1
s.water arapply R and porcolatlon test results,and stoma ru calculations,as needed to detemtlrwe and mlligat�a project
.
for possl of oonslr ,tl'on and demolition uresis,atUtar on-she or at an aper disposal facility. �.
for snowy re l,. wxgng localfonja)of on-afte s -storage. d�.w
vironmental Assessment Porro VEAF).as required by the BPA regutatlons,wwlth Part 1 completed by the Applicant shall be reO,
ted as part of the appflcatfon, It the pro d project requires a ctal use permit and ars EAF hoe baen submitted In r,4. Aic w ction with a;special use permit applloatforr,ar duplicate EAP Is not required for the elle plan applfos lran..
pplfcallon Is for a parcel or parosts on vrhlch mora than one use Is propose!,the applicant may submit a alogia spplloatfort for
ch uses provided the proposed rases are saoourately delineated on a site plan drawn pursuant to the requirements set forth wt
above.The Planning Hoard may grand the applIcagon wvllh respect to sorra proposed uses and not others. For purposes of reviewing
an application(and for SSQRA compliance) ail proposed uses on a single parcel or on conitguous parcels shell be consWeaed
logegher.
V A brisf narrative statement on how the pr000t proposed for ravlewv fwurthers or is consistent with the vlslon.WAIs and policies In the I '
"Town's Cormprehanstvo plan.
. a .
Site plan Review Revised March 2014 �
Town of Queensbury Planning Office-742 Say Toad.Queensbury,fwlY 12804.818-781-8 ytl
t`. Tax Map ID ��� � � 4, 2,
2. Zoning Classification
3. Table of Allowed Uses subject to Site Plan Review
4. Ordinance Section if
S. Pre-Submission Meeting Note Outstanding Items To Be,addressed include:
Dead Zyes No
General Information complete bs � o
Site Development Data Complete Yes i ,i,
Setback k i�equIrements Complete �Yes .._. NNo
o
Additional Project information Complete �Yes NO
Mmatifund
s Yes .. NO
FAR V1lcmftheet complete Yes No
Standards addressed Yes VNo
Checklist items addressed ,Yes No
Environmental Form completed Yes Kira
Signature Page completed es �No
Cc.
' a r
7b
..
0.1 LJ
�. e1" C, _I Q I
t i
QLC
res pl it PiP4c E it rM
0
Stall Representative: �.
Applicant l Agent:
mate:
Site Pian Review Revised Match 2014
Town of Queensbury Planning Office-742 Say Road.Queensbury,NY 12 «518-761-8220
61 Z20
AppendIx
MortNnYtronmentalAssessment Farm
(riff oy Co vietine
Part I-Project Information. Fire applicant or project sponsor is responsible for the completion of Fart I. Rx.spao
nm
become part Of the application for approval or funding„are subject to public review,and may be subject to further verification.
Complete part I based an Informationcurrently avaitablo. If additional research or investigation would be needed to flully
respond to any item,plem answer as thoroughly as possible based on currant Information.
Complete all[term In part 1. You may also provide any additional Inibmation which you believe will be needed by or useful
to the lead agency;attach additional paws as necessary to supplement gay item.
Part I-Preot and Sponsor Information
Markle of Asti n car Project:
project Looati sn(describe,�dattaalova on rnap ;
k.
flrlafDasoription of—Proposed ActionIW7 7—a
,� `r°
Name of locant or Sponsor. Telephoner7 �-? "
-Mails
Address,
c
7
city/Ft ; � state. � dip ;Y�S '
1.D Cho proposed actio-n only involve the legislative adoption of a plan,local lave,ordinance,. O
administrative rule,or regulation?
IfYes,attach a narrative description ofthe Intent of the proposed action and the environmental resources that «'
may be amcted in the municipality and proceed to part 2. If no,continue,to question 2.
. noes tho proposed action require a permit,approval or funding from any other governmental,agency? o YES
It yes,list agency(s)name and permit or approval;
1-4 � A a 73,7
.a.Total noroage Of site;766"j roposed action? acres
b.Total acroage to be physically disturbed" aures
c.Total acreage(project site and any contiguous properties)owned'
or controlled by the applicant or project sponsor? -4L,2C acres
4. Chaoh all land uses that occur on,adjoining and near the proposed action.
rt Urban 0 Rural(non-agriculture) to Industrial wCornmercial Wkesidentlal(suburban)
cr Forest D Agriculture 0A quatic ca other(specify):
to parkland
,Page 1of 4
S. Is the proposed action,
a. itted use under the coning regulations? ��� �
bd consistent with than ado taf
p prehensi've plan? »
6. is the proposed action consistent with flee pradomluant ultaracter of the existing built or,natural
landscape? + "SMS
7. is a-Its of'tlaa propuaerl action Ioacated In,or does it atoln,a state I'Iaritical gnvironrnaIvrea? l
ff des,Identify: C
Fproposed action rasrslt in a substantial ince .e in traff"to abovent ll '? YI!ic transportation servicefs available at or near the alta ofthe proposed action /striae
rnmodatlons or bicycle routes available on or near all of the proposed action?
p.]does fleePrOI 1us1d'aotlon meet or exceed the state energy e requirement P
if flee proposed action witl exuaed requirements,describe design features and technologies. NO
f
I�. "ilC Haas prb ed autiun count to an.aswiatiag polalieJprivata water supply?
ifs"ass,dues flus satiating systarn have capacity to vide seervlea? ' 'IP`°
if lµio,describe method for prvlding potable w
X I.1 111 the p ed action connect to earlsting Was water utultleal
if "es,does the existing systemhave capacity to provide service? ON00YES YES
If desorlba method for providing wautawatar treatment: s
12, a.boas the alae contain a structure that is N
places? Wed on either the Mate or''Nationai iteg 'Historic o R VIS
b,is the proposed action located In an areheologloal sensitive area"
I .a, ea any portion of Cha site
wettlands or othof the proposed action,or lands ar olnin,g the proposed action,contain N
er waterbo
sit-
wetlands regulated by a fbd al,state or local Agency? YES
b.Would the proposed action physically alter,or encroach Into,any existing wetland or waterbody?
If' es,Identify,the wetland or waterbody and extent of alterations In square feet or acres:
1 , identif�r the typical habitat types that occur ors,or era Iiltely to ba found on the project site, heck all that� apply:horelirao l frorest I"i grloulturallgrssslands M Early rnid»s ssional
f" VV'etlattd �IJ`rban u"�urban
1 . s the alta oftlto proposed action oo in any species ofaniMal,or 10=0018ted habitats,listed
by the Mate or ped*ral government as threatened or endangered?
i .is the project site located In flee IAf1 year flood plain
YES
17.will deo proposed action crate s water dlsuharge,either from point or,non-point sources?'
If Yes, NO Ygs
M Will stone water discharges flow to adjacent properties? dNO 0 YES V,'
b.Will stOrrn water discharges be directed to established conveyance Systems t tun ff and storm drains)?
If Yes,briefly describe:
0 YES
Page 2 of
1 .
I)oes the pro PMOd action Include construction or other aptiwltles that result in the Impoundment of
%Vater or other liquids(e.g.retention pond,waste Iggocr4 dam)"
YES
It yes,explain purpose and size:
19-Has the site Of the Proposed action or an adjoiningO
$OtId waste management facility?
PrOPsrtY been the location of an active or closed NYES
If Yes,describe:
20.HAS the site Of the proposed action or an adjoining property been the subject ofro
ediation(ongoing or –go—
lf Yes,describe: r hazardous
waste? In(ongoing or ....
I AFF THAT�TRR�����=�NPRO�7D -------
I]KNOWLEDGE 'R To i7URFUEST OF My
A ppli 01/3 n�
c po se
a
pplicant/sponsor name:
Sl t 6 e, /C
SignaturC e2
Part 2-Impact Assessment. The Lead A96110Y Is msPonsible for the completion of part 2. Answer all ofthefollowt"it
questions In Pon 2 using,the Information contained In Part I and Other materials submitted by the project sponsor or
otherwise available to the mvlewer. When answering the questions the reviewer should be guided by the concept ,Have my
responses been reasonable considering the scale and context of the proposed cotton?"
r o
No, Roderate
'qo'0"
small to large
Impact impact
may may
occur
I. Will is proposed action create a material Tc01AdFwI1h an adopted'land useplan_o_T_�6o zoning occur
regulations?
12, Will the proposed action result In a change in the use or intensity of use of land?
3. Will the proposed action Impair the character or quality of the existing oommunio
4. Will the proposed action have On impact on the environmental characteristics that caused the
establishment ofa,Critical Environmental Area(CRA)?
5, Will(Im proposed action result in an adverse change In the"Wing level oftrafflo or
aftet existing Itirrastrupture for mass transit,biking or walkwayl
6, Wilt the proposed action cause an Increase In the use of energy and it ffits to incorporate
reasonably available enaV&conservatlon or renewable ene.
rtunitiass
7. Will the proposed action impact exisdnit..
It.Public I private water supplies?
_b,public/private wastowaux treatment utilities?
8. Will the proposed action impalr the character orqualk of important historic,archaeological,
architectural or aesthetic resourcesi
9. Will the proposed action result In an adverse change to Astund resources(o g.,wvtlends,
watatbodfcs,groundwater,air quality,Ilom and fauna)?
Page 3 of 4
No,or Niod6roa
small to large
Impact impact
may may
occur occur
10- ilproblarrr posed action result In an lnor a In the potential for lon,flooding or drain
lee
1.1. Will the proposed action create a hazard to environmental re3ources or human health'
Part 3-Determination of significance. The Lead agency Is responsible for the completion of Part 3. For every
question to Part 2 that was answered'I'moderate to large Impact mayue,,or If there Is a need to explainshy a particular
olemerat of the proposedaction or w�Iil not result in a significant ria environmental impact,please complete Dart 3,
Dart 3 should,In sufflclent detail,i t*the Impact,including any measures or design elemenu that have been Inraluded by
the project sponsor to avoid or reduce Impacts. Part 3 should also explain how the lead agency determined that the lamp
act
may or wilt not be signIfioant.Each potential Impact should be assessed considering Its setting,probability of occurring,
duration,irreversibility,geographic scope and magnitude. also consider the potential for short-term,long-term and
cumulative impacts.
Check this bot if you have determined,leased on the information and analysis above,and any supportln documentation,
that the proposed action may result in one or mora potentially lame or significant adverse impacts and an
onvironrnestal impact statement Is required..
Check this boar If you have determined,based on the Information and analysis above,wW any supporting,documentation,
that the proposed notion will not result In any significant adverse environmental Impacts,
Name of Load Agency bate
Print orI*ype blame of Responsible t f icer in'LeadAgency Title of V csponsihle officer
Signature ofnsible C-friar In lead
lm -Agcy
ySignature of'proparar(ifdu"f1`arent Erose Responsible! fflcer)
Page 4o
Signature Page
TWe page Includes the 1.)Authorization to Aot as Agent Form:2.) Engineering Fee Disclosure; 3.)Authorization for Site
Visits; 4.) Other Permit Responsibilities; 6.) Official Meeting Disclosure and 6.) Agreement to provide documentation
required.
Ow"En's AGENT FORM:
Complete the following It the OWNIER of The property Is not the same as the applicant
Owner:
Designates:
As agent regarding., —Variance Site Plan_Subdivision
For Tax Map No.: —Section Block Lot
Deed Reference: Sook Page Date
OWNER SIGNATUKI!:--.' DATE:
AP'pucANT's AeENT Fow.
Complete the following 9 the APPUCANT Is unable to attend the meeting or wishes to be represented by another party
Owner.
Designates*
As agent regarding- _Variance_Site Plan_Subdivision
For Tax Map No.: —Section —Block —Lot
—
Dead Reference: —Book —Page- Date
APPLICANT SIGNATURE: DATE:
Applications maybe rolorrad to the Town consulting enifInser for review of septic design,
storm dmlnago* ate. as determined by the Zoning or planning Department. Fees for engineering WAsw services will be charged
directly to the applicant. Foos for onginseting review will not exceed$1,000 without rcolUrcation to the applicant,
3.) AU-TWEIZATION?-Q8 SITLYI%M By signing this page and submItUng the application materials aftchad heroin,the Owns(,
Applicant, and hlethefteir agant(s) hereby authorize the Zoning Board or Planning Board and Town Staff to enter the subject
propertlas for the purpose of wlewtng the application submitted.
4.) Other permits may be required for construction or alteration activity subsequent to approval
by the Zoning Board or Planning Board. It Is the applicenra responsibility to obtain any additional permits.
�I� I � ';';': 1 1!!!�ii
6.) EFJQAL=JJAQ !111:11ii"IJI l.;";iLQ69gkQJ= It Is the practice of the Community Development Department to have a design
stenographer tape recoid the prooesclings of meetings resulting from application,and minutes transcribed from those tapes constftutes
the offlolat record of all proceedings.
6.) AGABF-MEW' DEDQgLJNgNJAJIQfJ ElEgUI13ffl) 1, the undersigned, haw thoroughly read and understand the
Instructlons for submission and agree to the submission requirements, I acknowledge no construction activitles Shall be commenced
prior to Issuance of a valid permit. I certify that the application, plans and supporting Materials are a true and complate
statementidesorlption of the oxIstMg conditions and the work propossd, 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 Ificliftles proposed,I or may
agents,will obtain a cart ficate of occupancy as necessary. I also understand that We may be required to provide an a's-built survey by
a Hoensed land surveyor of all newly constructed facilities prior to Issuance of a certificate of occupancy
I have read and agree to ab 0.
-/T/ :-"/r, T) re,I
dig titre Appii Print Name(Applicant) Date signed
Signature[Ageilt) erPrint Name(AMrdl Cc,-OALI/7,1—Date signed
Site Plan Review Revised March 2014 9
Town of Queensbury Planning Office-742 Bay Road-Oueensbury,W 12804.618-761-8220
Requirements for site plan review
, .The proposed project is consistent with town policy.
B.The proposed project is in compliance with requirements of all articles
that apply.
C.There is pedestrian walkways ie paths leading to the docks and to our
house for restrooms.Most of our boaters have cruisers with bathrooms,
and Lake G:eo Boat Co. has agreed to pump them out as needed. (see copy
of agreement)
D.There is no sewage disposal on this site.Boaters use Lk Geo Boat Co for
pumpouts and the house bathroom if needed.
E.We are not changing the size or use of this dock project. We are shucking
the docks a little to avoid a nasty rock, but other than that the docks will be
rebuilt exactly in the same size format and they were rental docks, so no
change there.The whole bay is rental docks other than a couple of private
docks, so there is nothing to hurt the look of anything.
F.There is adequate parking for all on the property.The area is kept mowed
short and has no hazard to local traffic. We are very remote and private.
G.The parking area has appropriate setbacks from adjacent properties and
rarely do more than a couple vehicles show up at the same time.Our
boaters know where they can have friends park on our parking area by the
Cleverdale Post Office so the extra vehicles would not create any
congestion.
H.The area proposed for docks and parking are the same use approved
before the board in the past. We do not seek to change the use.
I.The path to the docks is well established and safe. On the rare occasion
someone might come to the house, the road is rural and safe to walk on.
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J.We are not changing anything that would affect stormwater drainage.
K.The boat 0rs will use Lk Geo Boat Co for any pumpout needs.A copy of
that agreement is included.The house is available for the rare need of
another toilet.
L.We are not changing the landscape in any wayAt is heavily forest/trees
rural land and will stay that way.
M.We are emergency service workers, and Ray is also with the Fire Co. Our
location is accessable to both and they all know where we are.
N.We aren't changing the landscape and the only structure is the 2 docks.
O. he design meets the standards for docks, Ray is a builder for over 45
years.
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