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Cumberland Farms Site Plan Application M S L REV/Fto 26/4 Qen er-dlufom at!on Y ,4F Ti ax Parcel ID N umber; Zoning District'. Detafl'ed De cripdon of Project [Includes cumene&pro used ars ]: zze U, MPivofi"41 P Location, of project, ZL6 M22LL 517 ,Applicant'Name. C0177 23z--R T—R—"7D, Address: Home Phone � CeII:; Agent" use. dr :� K � Ad ��,3� � ��' SSR 22190 16 ' Home PhoneCell: Vork Phone � Fax E4I. 4 0- ChAMIW4Wame AL Hom,e Phone ill Mork Phone E-mall Town of Queens,bury„Zoning Office-742 Saar Road Queensbuiry, NY 12 0'a 518-761-8238 � Side Develol2ment Geta V/ 11 Area Type Exisfing seq.ft. Proposed Total sq W Additlicm s M. A. Building footprint 3?16 B. Detached Garage C. Acwssory Structure(s) D, Paved, gravel or otter hard awfaced area N 9 . Other G. Total a -Perrneab [Ad's!A-171 3 „ H. Parcel Area [4MM sq.[4M ft. 1 acres Erurruraige lrnperrnur [I-CUM V 06 �45 Setback Reguiremitnts Area Required ExIst[ Proposed Front[21 (- /v Shoreline ` /V )q' Side Yard [11, Side Yard (21 Rear Yard [I] M) I Rear Yard [ Travel Corridor Height[maxj Permeability eability �� No. of parking spaces Town of QueensbuTy Zoning Office 742 Bay Road; Queensbury,NY 1,2004 4 98-7 1-8238 Additional Pro[egt Information 1. Will the proposal require a Septic Variance from the Town Board Of Health? M`2 2. It the Parcel Ihas previous approvals, list application inumber(s). 9 31. Does this,project,require coverage under,the NYS DEC Stormwater Pollution Prevention Program?, -AL 62- 4., Esfimated project duration. Start Date--e!2:26Z-P End Date J 5. Estimated total cost of project; E. Total area of'land disbirbance for projeCt' Floor Area io Worksheet FLOOR AREA RATIO (FAR), -- The relationship lot building Size to lot size,, dbrived by dividing the totalbuilding floor area by the lot size in square feet:,y1elding a percentage. Zoning Dis,tNet Symboll Floor Area Ratio [FAR] WaterfrontResidenti I a WR 0.22 Commercial Moderate�Commercial Intens-ive ' CM/C1 0.3 MS 7 Main Street 0.3 "I-= A. The comblned area of all square footage, as measure from, exterior walls of all structures on the property, inaluding all floors of the structures, garages:, basements and attics with more than five (5) feet cf ceiling height and covered poirches. Building square footage, does not lnclude„ Open deck, docks and that, portion of' covered docks extending over water and one, storage shoed, of one hundred twentj1 0) square feet or less, Any additional sheds will be included. (See"'FLOOR AREA RATIO"), K Cornmeroial or Industflal, the total area In square feet as measured from the exterior of the outside wails; of a building or structure,and when applicable, the sum total of all floor areas of,the pr[nolpall and accessory buildings orstructures on the project site. A. Parcel A,rea 4 IL S. E)datl ng Floor Area sq. it: [see above definition] C. Proposed Additional Floqir Am sq. ft. D. Prop mad Total Floor Area sq. ft. _E1.1 Total Alpo able, Floor Area (Area x I[see above table *1f, D Is larger than IE, a variance or revisions to your plan may be needed. Please consult wistaff. Site Plan Revie!w Reals W Mairch 2014, Town ofQueensIbury Planning Office-742 ISay Road-QuisensbuTy. ,,NY 12804-518-761-8220 4, § ,179-9-080 Reguirementa for,gifte, Plan &-p–r—Oval. The Planning'Board shall not approve a Site Plan unless it first determines that,such, sitel meets the VIOWIng Standards. Peas pmpl responses to each of ttle t0flowing SfARBA09 A, The proposed project furthers or is tonsistent with the policies of the TwWs Comprehensive B. The,lamposed project tornpl$es Wilh all other requirements of lhl Chapter,iumoiu thng the sil�e plan review stain4ards as= form in Paral r of this section,the dimensianal,,bulk and,density regulations of the zorting distr'iot In which,kJ Is propoW to be located,(Article 3 and Tatoe 1). the al requirements of allotlhar Articles tKal spi C, The she plan encourages pedestrian aolMly Infernally and,II pmatIcable,to and-from,the gie;WM pedestrian paths or Sidleviiialks conril 10 adjacentareas. D. The site plan must cont li to Chapter 136 Sewage and Sewage Disposal, Chaplet 147 Ctoll r Marragemeryt Local Low, and ether applicable local laws. E. the proposed use shall be tirl hairml with the general purpose or Intent of this Chapter,speolficalFkalilng Into account thekmr;on,,charaotar and size of the proposed use and the descripftin and,purpose of the district in Wh1uh such use Is piroplasedthe nature and intensity of the aolivifts to be Inwolved In or conducted in connection with the proposed use anti'the nature and gals of,any fricTease In the burden an m*foortiriq plublio serVi facIll vifich wfil Wow the approval of the piciposed use. P. The establishment.maintenance ani operation ol:the proposed use will naT create public hei;d—s from traft.traffic congestion or the pai of vehicles,andlor equipment cr be offierw[se datftental to ane health, safety, or general welfare of persons mialling or woTkkg In the nalghboulhood or to the general welfare of the tovillim Trallia access and tttloviallon,,mad,fintewsecllions,road and driveway wi and[raffia conte ts will be adequate, 0, Off-street parldri and,loading faclEfes wIM be appropriately 1.located and arranged-amci suffici 10 meat traffic anOcipated to be generated by the now use. The:establIshni of vehicle 110s,between parklng areas of adjacent propeAlas are p where teal Ttils,furthers the Town's goal of reducing curb cum and TedUGIODcongesilan. acv twenty-footw0a,connection Is; required. 11 adjacent propadlas am,either Undeveloped or previously developed without hsvnq made pmvislon for future linkage, then a, future oommcklon must ble Wentlilled and provided for in the site plan tvnder ravlaw for such ftftris Ini when the throve edse& The Planning Boot may require proof that'the applicant has made contact vAth adi property owners for purposes of coardinaling linkages with adjacent properli'm H. The project shallnot have an undue adverse hpact Zp;n_UWnall sceftic,aesthetic,acdoi MOW,Wsloi reofeal.Tomal,Or Open space resources of the ti cN the Adirondack Park or upon the adequate provision of supporting faculties and sWiffas made necessary by the protect, taking kft account the commemil industrial, re:sWeNbk recreational or other benalfts that rnight be dwl from the,prof, In making the deftnirrilhatlon hereunder,the Plarmilog Board small cal those factors pertinent to the project contained In the development considerations set forth herein under§179-9-OW of this ichapterr.and In so dolng,the Planni BoW oll make a net overall evalluation of the project In relation lo,dna developrem obgectives and general guidelines sat forth In 17980 of this A113OW, L The provision for and arrangement or padiesill trail acum and aircufaklon,vilaftay structures,corArd!of WGrG;WVS with,vehOular_kmffic and ousiall,pedestrian cormentence shelf be safe and adequate for p8dWOM MDVeTl Pedestrian connections between adjacent sites shall be ptoyWed to ancoutaVe,pedestrian,use. J. Slormwater dreAnage facilities will prevent W,Increase of post demelopment drainage flowis ji Z;;;arad to pie-development drainage Ucw& Drainage of the site,shall rechl giround water to the extent Practical, Surface walleris IllowIngi off-slite shall,not,dagFade:any F&aams or advafse!y all act drainage on adjacent piropeffias or publio roads. Fac011es shall be In conformance with the drainage standard$of Chapter 1147 olthe Town Code and the'Town at Queensbury ftibd[.YWm RegulaUlans'Where applicable., K The walersupoly and si crigposal fies will;be adequate au Will meet all &gblejQ;RTFaW requilwernents set Full by Deparbnent of Health reVetions and Chapter 130 of the'Town Code. L Th c;y. type and arrangement Wheal shrubs and other sultable plarttings. lim";;F50 and SUfflarOng ORWA effeOVe1y'pMVk1ff 2 visual aniftT nolle buffer behiveen the applicai and adjulningi hands, Including the maArnum, retention of exisfirkg vei and makftnano%Including replacement of dead,or deceased plants. M. Fire lanes,emergency zones,;Q R-0 !am, N The:design of strucluras, roadways and landsicapIng,In areas susceptible to perndirmg,, IfoodIng andWor erenaion will minini or,an olki such Impacts 0 the meAraurn extent pi,cable. 0, The site plain confanns;to,thedesIgn standards,landscaping starijawdi and ftm,ance,standards of,ftschapitar. Site Plan Review Revised March 2014 Town of'Queenabury Planning Office-742 Bay Ri-Queensbury, NY 12804-61 -761-8220 179-9-050 Application for. ,it Mn,Re a Absent ny,wai�ver or waivers, an application for Site Plan Review haft inc�lude the follcWng. REQUIREMENTS shoal 0 A vidnity map drawn at the scale Thai shows;the relationship,of the ptWosal T6 exisling community ladlWas which affect or serve It, such as roads, shopping areas,schools,, etc. The map shall also sbow all icropgrU100, Identify owners, subdiwis,Wns, streets,, and easements wAhin 500 legit oFlhe ip"rly. Such a sketch may be:superimposed on a United States Geotagical umay map of the -rho site plan WWI be,drawn at a soWe of lody feet to the irkuh(I"�40 feet)or sAich other scale as the PlarknN Board may doom appropriate,un slandEffd 244®x 36"spheels,vft continualicn on OW x 1,V sheells as necessary forwritten Inlormalion. Ue inforrnation listed befow shall be shom on the site&n atw fconi]nuallon sheets. Name ofthe project.bDundayies,date,noffth arrow,and woe of,the plan,. Narne and address of the,owner of record,dewreWl per,and seat 01 the engineer,archileat,or IaTWISCaps archiled. It the oppll=t Is not the record owner,a letter of authadzeilton shall be requited frown the omar E The localion and use of all existing and proposed slnjdturer,vAlinIn lie prop"'.Including all dimensions ol height and floor area,all eNler5v and alp antl4ated l'uture addl0ons,and aftenatlans. F The location of alt present and proposed public and' pitivate we", off-streat parking areas, drivewam, ot4door storage areas, sidewalks,iramps,curbs,paths,landscaping,Walls,and len,. Lonflani,type.and screening details lar all waste disposel oontalners shell also be sham. The rocalian,height,tatenaf y.and biulb,type,,ociciturn,Incandescent,elm)int all extemat lighting fixtures. The dilrection,04 Ilhiminallon and malhoft to eliminate glare onto adjohning properties mustalso be shown,k%compliancewith§1 79-6-020� H The location,height,size,materials,and design of all proPOSsid SIOTIS, The locallon of all pfesent and proposed ulffity systems lndWinq� 1, sewage of sepoo syatem" 2, Water Supply system, 3Telephone,cable,and electrical systems~„ and 4. tarm drainage system Including existing and pmpused drain lines, c�uWvds,oWcb basIns,headwalls. endwaft,h"ranAs, marthotas,and drWnaga swaWs. Frons to pfavant the poltudon of ourface or groundwater, erosion of:q6t both during and after consInxelion, excessive runaill. and Hooding of cdher pruperfles, as apoicabls. A Sllormwamr Poll0lbri Prevention F9an (SVPPP) for all land dMIOPMOM activitles fentuding agriquitural acilvilies) on ft sNe That results In land disturbance of I-acre or more., A,SWPPP OW comply With we (equIrements of the DEG SIRDS MS-4 General Permit and ChRpter W of:the Tmvn of, Oveemsbury Code. It shall be at the: discretion of the,Manning'guard as to whether,a SWPPP or an arosion and oonUd plan&WI be;required for a SAO plan review project land atsturbatca of lass than I-acia. K Exisift and proposed topography at Two-fact conbcw Wervals,or such otbar contour interval as the Flanning Board shaft abew, All elevatlons shall refer to the nearest United States Coastal and Geodetic Bench MarK if any poillon of the pard Is WWn the 1f0D- 'year lfoodplaln,tha area v(41 basbown,and base flood elevallonsgivem Areas shelf be indicated%Whin the proposed site and w0to SD feet of the proposed site whom soil removal or filling It required,thowing,the approximate volluma In cubic y8ids-, L A landscape plan showing all existing natural land features that may Influence the cfesigq of line proposed use such as rock outcrops,, stands of trees, single,tress eight or more Inches On diameter,f cover, and vmW sources, and all,proposed obianges to these LfeatLues Including Was amd types of plants. Mier sourm,InciWe ponds,lakes,watlands and watercourses,aquifers,flaccipjains, and drainage retention areas, Land Use District boundafto Within 500 feet of,the slWs perimeter shall be dram and Idenfifled an the site p4an, as;waflas any Overlay Districts that apply to tins property. Site Plan Review Revised March 2014 Town oll`Qtjeanabury Planning Office-742 Bay Road'-Queensbury,NY 12804-518-7611-8220, "0 19,/V o&742 F- X I, SE�OUIREMENTS CGNMNUED Sheet# N Tfafllo flow,patterns within the,slte,entrances and,exit%and leading and urfloadingi areae„as W04 or,Oufb cuts ran the sila and vyithTn. 100 foot,of lhe site, The:P'lan,nN Board may,at ft dscreflon,re:quire a dela iled fraffic;study for large,deveippments or for those In heavy tralfic areas,vyhkh shall,bldude,. T. The projected number,of motor webicle trips to entat or leave the site,estimated for we0ty and annual peak hoUr Irallin levels, 2, The projected traffio flow pattem Woludlog vehicular rrinvarnanis at all major intersections Illy 10 r e y a proposed tMe 01''the SRO; 3. The Ernpact of this traffic on 1 of seroice on,abutting publib streets and at aff—ecled lbtersertlans. 'lin Wing and proposed Weekly anti annual peak hour traffic levels and road capa$jty levels shall also,be given. 7'6 For new construction or afteralons to any structure,a labia oontaining the faflowing Wormation shall be[noluded. t. atimaled area of structure,to be used for parflodar purposes sLmh as relaid apetation,,office,,storage,dc.; 2. EsOrn aled maArnum number of ernooyees; 3. Maxknurn emoting capoity,where aWMcOle,and 4, Number at parking spaces exlsl'ng snd required for the latended ves. P' 1. Floor Frans. z Elevagons at a Scale of on"vader Inch eqpWk one foot(11W,=1 foot)for all exterior Noodles of Om proposed struchae(e)andkw alterations lo,or,expanslons of @YJ:sllng facades,showing design features,and jndaiinq lhe type and color of maledats to be us , SO logs.water supply w-elt and percolation test results,and storm runoff ciftulations,or.needed to determine and MWgiate, projeot Impact& R Kans for,ftposal of construotion.and olarnOlition waste,elther on-sile or at an approved dbposW facility. S Plans for swo rernovW.Including leca,Uon(s)of on-site snow s$=ge. T An Environmental Assessment Form CF-An,as requIred by,the SECIRA,regulations,WWI,Post I mplated by the Appillicant shall be submitted as part at the applicalJon. If the proposed pTojacl:reqVires a spec3at use permit and an F has been, submitted In conjunclIon with a special use permit application,a dupliawa EAF Is,not requIred,for the SRO plan appMeallon.. U it an application W for a parcel or,parcels on wbichi more than,one use Is proposed,the applkara may suibm,It a,single appOcation for all zu0h, uses;Provided the proposed uses are accurately dlefineated on a cite plan dram pursuant to the (eqViremen%set forth above. Tfie,Planning SoaM may grant theapplicagon wM respect to some proposed uses and not olherc For purposes of revlWrg an application (and! for SECIRA compMance) all proposed, uses on a slrge parcel or on conligonus,parcels shelf be Considemd tqgelhar. A brief narralWestaternent an how the project proposed frog saviewIudbers or Is consl9tent with the VISWn,goats and policiffs In the Town's ComprehensW Plan. Site Plan Review ReAsed March 2014 Town of Cluee,,nsloury Planning Office.742 Say Road-QueensbuTy.,NY 12804-618-781-MO P'Eg-aubmf§sion Coofe"o -Farm r17941--M 4. Tax Map M �w q! 2, Zoning Massificaflon �NA Q�� an 3. Re:ason for Review. L--d�sb 4, Zoning Section A: q0 S. Pro-Submizalon Meeting NOW$;Out"� ndirvg Items To Be Addreased tbclude: Deed 6".',�Yes —No Genaml Infatmofion compWte -=I-'Yes No m Re Development Data Complete 49:�Ye's 140 1, r� 6r Satbar*Requirements CompleW Yes No Compliance Wth,Sign OnRnance L "Yes No Checklist fterns aftessed yes No EiMronmergrm at Focomp,16ted 11 y e3 No Signature Piga completed Yes No A r. 1-ki 1 4, a klo -T ecc C,:L irl, r r Cot III W I- f3c,A ,ARC- ---c"Vtt.�L-4A S L/I ck�taff RepresentatNe�. 44 se Applicant I Agent. b4..OL Date: S� \V&— JI frV, Town of Oueens- buiy-Zanft Office*742 Day Road-Onae jwbury; NY 12804.518.7 1 2W 6 /V40 VIS qj Signature Page This page includes the 1.)Authorization,to Act as Agent Form 2.) Engineering Fee Discl,osurs; 3.) Authorization for Site Visits; 4.) Other Permit Responsibilities, 5.) Official Meeting Disclosure and 6.) Agreement to, provide documentation requlredM OWNER's AGENT,FoRim Complete this following R the OWNER of the property Is not the,,sarne as the appitcam 1-19AID i=19 Owner- 0'v ln'8'k;-pz. , x Designates: 191&"� ...... As agent:regarding, Var'lance Site Plan Subdivision For Tax Map No.: .F0Section Bliock, Lot Dead Reference. ;:E�_zBook Page m04,0 e-0 Ik 3 OWNER SIGNATURE.- 2, DATE: APPLICANT'S AGEw FoRm Complete the following I the APPLICANTis Unabba to,attend the meeting or wishes to be represented by another party Owner. Designates; As agent regarding-, -Variance-Site Plan-Subdivision For Tax Map No.: Section -Block -Lot Deed Reference. Book -Page -Date APPLICANT SIGNATURE: DATE: Z) 5NGIN �QIISC�LQSURE, Applicaflons,may be referred to the Town coi englneer'lor review of si design, storm drainage, etc. as determined by the honing or Planning Departrinairic Fees for angIneefling review services will be charged directly to the opplicant, Fees for engfneerfol;l reVlaw will not exceed$ 1.()Oo w-Ithout w0iji;.ation to the 4pplicant. 3.) AUTHORIZATION FPB_Ujf.Y1§JTS- By signing this page and submitting the applioation materials aftached hereln,the Omer, AppHicant and hisolheritheir agenti hereby authodze the Zoning Board or Manning Board and Town, Staff to enter the subject properties for the purpose of reviewing the application subirn,itted. 4.) OjdgQNAL(W Other permits may be required for construction or,afteration activity subsequent,to approi by the Zoning Board or Planning,BDard. It Is the appricarift responsibility to oblimin any additional permits. 6.) OFFICIAL MEETING LWNjjjggMSL0S gE_CIt is The Comm practice of the unity Development Department to have a desIgnated , ,U , stenographer tape record the proceedings of meetings resulling from appliloation.and minutes transcribed[torn thoso tapes constitutes the officlial record of,all proceedings. &) A0gEtytENT'T0 PRIOVIID : REQUIRED: 1, the undersigned, Ihave thoroughly read and tinderstand the Instructions for sobimission and agree to the subirnission requ[rernanls, I acknowledge no constrxiftri,activities shMI be commenced prior to issuance of a valid permit I cerUly that the application, plans and supporting materials are a true and complete, statemenlidesctiption of the existing condillons and the work proposed, and that all work Will be performed In accotdance with tbe, approved plans,and in cantonnance with lioc;a!zoning regutallons. I acknowledge that prior to occupying the fficIlwas proposed„I or my agents,V411 In a coafficate of occupanuyas necessary,,, I also understand ft,t Vwe may be required to provide all as-buift survey by a licensed land survelmr of all ny constructed facliffies,prior to,Issuance of a certificate of occupancy I have read and agree to the above. 3� Batesigned Patu re VATic 'q� Print NAme [Applicant] d Y"209-)e %nat Ure 1- gent] Print Name [Ageni Date signed Site Plan Revie:w Revised Marruh 2014 9 Town of Queensbury Planning Office-742 Say Road-Queensbury.W 12804-518-761-8220 T Appendix Short ort Environmental'Ass sinew,Form J_P§trucfioHLfor C2MRIeting Part I-Project Iun or®adem. The applicant our project sponsor is responsible for the enrnpletion of Part]. Responses become par of lie application,for approval or 16bnrding,are subject to public review,and may he subject to furtherverification. Complete, rt i based an infoation currently available. If additional research or investigation would be needed .fWl�y respond to any ftern,pleas answer as thoroughly as possible based an cuuu nt information. Complete all items:in batt L You may also provide any additional information which you believe will be needed by or usefid tow the lead agency;attach addM anal pales as,necessary tosupplement any it6m. Part I. Project and Sponsor Irri'eruruatirrrr Name of Action orProject: Project Location(describe,and attach a location map): 1� V G Brief Description,of edAction: R,C- 0 Vx5 P 70 A NOT,=otApplicant or Sponsor Phone. address: g i /po, ate, Zia Code, 101)R— A 91-67 122 . I.Does the proposed action only involve the legislative adoption of a pian,local iaw,ordinance, N administrative rule,or regulation? If Yes,attach a narrative dewriptio n owi"t'he intent oftbe proposed,action and,the environmentalresources that may be affected in the municipality and puraaceed,ta,p"art 2. If no,continue for question 2. 2. Does the proposed action require a penni't,,approval our funding from any other goverrrrruental Agency? ' N O YES If Yes,lust agency(s)nam e and permit or approval: ` � 3.a.Total image of site of the Proposed action? acres b.Total acmage to be physically distuurbed a' acres c.Total acreage(project site acrd airy crane gturrns properties)owned r controlled by the applicant or pTrcrject sper=r? acres 4, Check all land uses that occur uur o n,.adjiouiniAg and alar the pmpor actim Rural(Ron-agriculture) o Industrialcrarrumer-cidi Residential(sbirusbaq) Forest a Agriouhure Q,Arndt 0 Mar(specify'); Parkland Page ) of 4 5'. is the proposed action, NO YES NIA a.A permitted arse under the zoning regulations? .Consistent with the adopted comprehensive plan? . is the proposed action,consistent with the predoriraam character of the existing builtor natural. NO YES landscaape9 7,. is the site ort the proposed action located in,or dares it adjoain,aa,state listed,Critical Environmental Area? NO YES ➢fYes,identify: �r a�Will the proposed.action result in a sunbstantigi increase in traffic above present levels? NO YES b.Are public transportation service(s)available at or near the site of the proposed,action? c�Are aruy pedestrian accommodations or bicycle routes available on or near site ouf the propobsed action' .fomes the proposed,action meet obr exceed the state energy code requirements? If[be proposed action will exceed requirements,describe desi,gna features and,tecbnolckgies. i 111. 'dill th,e proposed action cannect tc an existing pabbliciprivate water supply? NO YES, if Yes,does the existing system have capacity to,provide service? 13 NO Cl YES If'No,describe method for providing poatable water: H.. ill the proposed action connect to existing wastewater utilities? SES If Yes,domes the existing system havecapacity to provide servled? 13 NO Cl 1f No,describe amethod fir orvi>dngwastewater treaatment,:,._.. 1 , a.Domes the site contain a structure that is listed on either the State or Nal anal Register obfBistcnric 'yf places? b.is the proposed a tion located in an archeological sensitive area" I 13. a.lobes any portion of the site of the,proposed action,our lands adjoining the proposed actioin,contain NO YES' wetlands,or other waterbodies regulated by as federal,state or local agency? b.Would the proposed action physically alter;o r eraommch into,any existing wetland or waterboo y? IfYes,identify the wetland or uaraterbody and extent of alterations in square feet or acres. l4. identify the typical,habitat types that occur on,or are likely to be found on the project site. Check all that apply. 0 Shoreline 0 Forest lel Agricultural/grasslands 13 Early Mid-sunceessional Wetland 0 Urban ❑I Suburban /�&IV ld;DDes the site of the proposed actim contain any species of animal,or tissoaci.ated habitats,listed NO YES by the Mata 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 attionereate storm water discharge,eitther from point or na n-pairnt sources? NO VES If Yes, a.Will storm water discharges flow to adjacent Properties? 13 NO 13 YES b.Will stonn water discharges be directed to established conveyance systarnas(runoff and.sterna drains , If Yes,briefly describe, I®NO 13 YES i Page 18.Does the proposed action include construction or other activides that result in the impoundment of NO YES water or other liquids(e.g.retention pond,,waste lagoon,d=)? If Yes,explain purpose and size: X 19.Has the site of'the:proposed action or an 4oining,property been the location of an active for closed kN() i YES solid,,waste management facility? IfYes,describe. 20Has the site of the proposed action or an adjoining property been the wbject of remediation(ongoing or NO YES com leted)for hazardous waste? if Yes,describer, I AFFIRM THAT THE INFORMATION PROVIDED ABOVE IS TRUE AND ACCURATE TO THE BEST OF MY KNOWLEDGE tJs 9 9, PkApplicanp or um0 Date. $ Signature. L-L 21,Ar L A 2 Part 2-Impact Assessment. 'The Lead Agency is responsible fdr the,completion of Part 2. Answer all ofthe following qpestions in,Part 2 usinthe inforination contained in Part I and other materials submined by the pro*t sponsor or otherwis,e available to the re:vie+ er. When,answering the questions the,reviewfrsbauld beguided by the concept"Have my responses been reasonable considering the scale and context of the proposed action?" NQ,or Moderate small to targe Impact Impact way May occur occur I. Will the:proposed actmn create as material conflict with an adopted land use plan or zoning rogulations? 2. Will the proposed action result in a ch"a in the use or intensity of use of land? 3, Will the proposed action irapair the character or quality of the existing community? 4. Will the proposed action have an impact on the environmental characteristics that ritused the esW ishment of a Critical Environmental Area,(CEA)? 5. Will the proposed action result in a,n adverse than in t'he existing level of traffic or affbct existing inftutructure for mass translt;,biking or walkway? 6. Will die proposed action cause an increase in the use of energy and it fails to incorporate reasonably available eneM conservation or renewable energyapportunitics? 7. Will the proposed action impact existing- a.public/private water supplies? b.,public,I private,wastewater treatment utilities? 9, Will the proposed action impair the character or quality of importanthistoric,archaeological, architectural or acsthetlC resources? 1 9. Will the proposed action result in an adverse change to natural resources(e.g.,wetlands,, I waterbodiM groundwater,air quality,flora and,fauna)? Page.3 of 4 No,or Moderate small to large Impo'cl impact may may occur o"ur ..................... 10,. Will the proposed action result in an increase in the potential for erosion,flooding,or drainage problems? 1,1 'Wil I the proposed action create,a hazard to environmental resourocs or human,health? Part 3-Determination of significa nee. The Lead Agency is responsible for the completion of Part 3. For every question in Part'z that was, answered"moderate to large impact may,occu',or if there is a need to explain by a particular element,of the proposed action mayor will not result in a significant adverse environmenial impact,please coTaplOe Part 3. Part 3 should,in sufficient detail,idenflfy the impact,,including,any measures or design,elements that have:been included by the project sponsor to avoid or reduce impacts. Part 3 sbould also w,plain how the leadagency determined that the impact may or will not be significant,Each potential impact should be assessed considering its setting,probability of occurning, duration,irreversibility,geographic scope and magnitude. Also consider the potential for short-term,long-terin and cumulative impacts. F], Check this box if you have deterinined,based on the infonna6un and analysis above,and any sqpporting documentation, that.the proposed action may result in one or more potentially large or significant adverse unpactland an environmental impact statement is required. a Check this box if you have determined,based on the information and analysis above,and any supporting documentation, that the:proposed action will not result in my significant adverse environmental impacts. Name of Lead Agency Date Print or Type Name:of Responsible Officer in Lead Agency Title of Responsible Officer Signature of Responsible Officer In Lead Agency Signature of Prepamr,(if different fmm Responsible officer), Paof 4 Caro0 n Parker From. Craig Brown <Craig Wqueensbury.net> Sent: Monday, February 29, 2016&49 AM Tor rolyn! Parker, Subject: RE-CF -Smark Pay Proram - NY PT Only The Town of Queensbw-yin code does note allow for any LED/ E[ectronic dlq)lays. Thank you, Craig Brown Dinnior, P'llanning/zoning Town rata eenSbUry 742 Bay Road Queensbury, NY 128:04 Ph. 5,18-761-8218 Pax 5,18-745-443,7 From: Carolyn Parker nPqrj�,epi nsultinc.0 ,�ftCaro� 11 Co _L,,.qrD] J Sent, Monday, February 29, 2016 8:23 AM, To: Craig, Brown Subject: FW: CF- Smart Pay Program - NY FT Only Craig, Cu rn berland Farni,s is at the,andof their'Srnart Pay P roject G111,d wanted me to 0 baok to all the Towns that did not allow LED. Dur haat er-nail vv a8 back In 20'1- , Do, your hyla wsstill prolijbit LED,?? Let me kri,ow Carolyn From: Carolyn Parker[_mp1JJq,,Qp nsij n veri�zo. 0- _a P_et], Senb Wednesday, May 22, 2013 8:58 AM Tot. 'Craig Brown,' SubJectm, RE: CF-SMart Play Program- NY PT Only Thank,you— 11 wa,5 i u,sti"e,chaQking since the pr og ram is atan[ng, u p sc�rt Carolyn ,& Parker Consulting 3 Loriori Avenue Worcester, MA 01606 (5 8)853-11 7 Qff ice phone (508) Ba3-1176 f8x (774) 239-2781 cell pls&�&consid"n th,,enviralwent ILSafore printing this e-iiia!I, From: Craig Brow, ftiajtq�.Cra�, U'@rz,&15 wt] qjLL Sent: Wednesday, May 22, 2013 8.5,5 AM Tom Carai[Vn Parker 0 Subject: RE., CF- Smart Pay Progiram,- NY PT'Only Carolyn, Adiscussed' previous[y, LED sign:s are prat b[ted in the Town,Of QUeensbury Sign Code, YOUr "alternator" proposal cornpounds the issue as flashIng or changirig copy sigm are also prohibited. PUMp Toppers LED - NO Purnp Toppers LED with Altemator - INIO Than you for your inquiry. Craig Brown Zoning Administrator Town of Queensbury 742 Bay Road Queensbury, NY '12.8,04 Ph. 518-76'11-8 18 FaIx 518-745-4437 From: Carolyn Parker j_n, -t Sent-.Tuesday, May 21, 2013 7:12 PM TW CraigBrown, Sukect: CF- Smart Pay Program -NY PT Only Craig, CUMbarland Farrn8 i.5 undergoing the addition of a Srnart Pay program, whIth 011 allow rnernbers to get t1jefi-gasoline at lower,rate than a rion-membar, All their locations,will! sign installed on the pylon sign, 8116S aSO iIaS Manual PUITIp toppers, Cumberland Farrns,wishes to 0stall LED Pump toppers over the-dispensers- see attacl�ied'deftdl. They would also like to Install the "afteMat0r"'W the,PLIMP tQ,pl')Prs wh[ch will Silow the pump toppars,to alternate betwean the smart pay i"nernber price and ther-ton-mernber price,, Ple�ase aee the attached'videoPip �be9 5[L[),' �9,�WLU Let me know separD:tLqy orj 417o [)jjfjjL4 7 LIED Yes or No with Afternator Yes of NO Also is allowed do we nae(j an eleph,lc go install tIlle new Any questions ca[I nie aI 774-239-2781, thank you in advance for your,firnQ, C�arolyn 2 �P,"ASIVA t. 143 7 UN' Wuh "i . ............ .. CIL, fi .0 C.5 w ur CA: CO Pf KT PC') a ✓ ✓u °>.. /�h�'. ��a 6,u�+I rarx➢ru�PVa �J11 M0 Lis Z It kip Mr �4� I .�� ru �✓�i d � � a � �ub •w p ��t��, /r/ tai ll��J , r y✓ 1 r � Pd a�`J,�� I �" /i� �✓ fir( "� � �rri�" els'�rp�Y`l,�!r^ `��,�¢ u� �1� I u 'o JY' ry, �/n� � � �; ✓t rr�l; , r� r f� w� w n,�w. �Y ✓ u��ql�Airi��Y�"^ !� l!1�� "� 4 TI a o �q��^,��rr�"; '�/ �} /� a !k- �j"�"JiN flu✓w JI W JII G�,� n„'rjr�;j i��l .� � �i i F�/ � v (lJfl�� 'v��✓'6J""I Ff J YuIH b,✓Jw �! ,,,, r, �4� r�%��' >✓ 0 1. r ,M5� VaUs VA , p ,. X916 I 1p ° -w zo a. - -Ju' n MNMS awoj Ids, ca ck Piz Af 900 09901 1.2 Al VN IMATI90 ......... ........ (I vo, x W w ea ' ��' �� lie! U. 1"i l 111 0 , lollia . � MINI If fill 11 file �, 1 w u RO N; LI p. f u3n yY� m i par ��._ ... . �,.. .._. .. � '. .nw-amm o,4 � Cumbedand Quff Gmup of Companift ff "0 *Fra ham, www q L mm 1,2014 F hr and, to its ' a Cumberlmd ff, �' Products COMMONWEALTH MASSACHUSETTS, Middlesex,sa. Much 1, 2016 On this day befog igned notary public,personally Ronald J. S ; nor,proved to,me through satisfhetory,evidence o id -cation,wbich pemonally known to nay;,to b' erse'n whosename:is signed on the preceding or niched and acknowkdgcd to ane that he signed,it,voluntarily for its stated purpose. Nam Public- Pamela A. 'Sett My Commdssion Exp .2/9/2018 .,