Complete Trombley PB Submission 3.15.16 169 Haviland Road
Queensbury, NY 12804
Hutchins Engineering Phone: (518)745-0307
Fax: (518)745-0308
March 15, 2016
Town of Queensbury Planning Board & Zoning Board
742 Bay Road
Queensbury NY 12804
Re: Michael & Cindy Trombley, 2-Lot Subdivision
80 Ellsworth Lane, Tax Map ID: 265.-1-16
Dear Board Members:
This office represents Michael & Cindy Trombley with respect to a proposed 2-lot subdivision of
their 6.97-acre parcel, which contains their single-family home. As you may recall, a kennel
project was approved upon this parcel under a Special Use Permit in 2008, however this project
never materialized. Now it is the applicants' desire to subdivide the southerly half of their parcel
to create a new building lot.
Due to the existing parcel's geometry and limited amount of road frontage on Ellsworth Lane, the
400-foot requirements for lot width and road frontage upon a public road cannot be met for either
lot, therefore area variance relief is requested from these two zoning requirements. In addition,
for Lot 1 which contains the applicant's existing home, area variance relief is requested to maintain
an existing second utility garage. The applicant's home was constructed in 2002 and the utility
garage was constructed in 2006; both of these structures meet the previous RR-3A setbacks
under the 2002 zoning code.
As the detailed house design has not been completed for the new building lot, waivers are
requested from the typical detailed site plan requirements (topography, grading, wastewater, and
stormwater). If the project receives the necessary approvals, a detailed site plan will be prepared
as part of the building permit application.
We respectfully request that this application be placed upon the Boards' agendas for the April
meetings. Please contact this office if you have any questions or if you require additional
information.
Best Regards,
Lucas W. Dobie, EIT
Cc: Michael & Cindy Trombley
G.Thomas Hutchins,P.E. thutchins@hutchinsengineering.com
Preliminary Stage Revised April 2010
Subdivision Review Application
Preliminary Stage
REVIEW PROCESS:
1) Required Pre-submission meeting with staff to determine general completeness to be held no later
than 1 week riot to deadline da 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 for placement on any agenda until all missing
information has been submitted.
5) Planning Board meeting, generally the third & fourth Tuesday of each month. You will be advised in
writing as to which meeting to attend.
6) 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 denied your project cannot proceed as submitted.
DOCUMENTATION REQUIREMENTS:
1) Please submit 1 original, & 14 copies of the completed application package to include:
Completed Applicatiom signed & dated
Pre-Submission Meefin Notes: signed by staff
Copy of Deed: 1
Survey
Fee: $50.00
ZONING STAFF & CONTACT INFORMATION:
• Craig Brown, Zoning Administratorrai b ueenLbu .r t
• Laura Moore, Land Use Planner Lm ore ensbury net
• Pam Whiting, Office Specialist 518-761-8220 pmw ue nsbur .rrl�Lt
Visit our website at www. uquegeiisb tit for further information and forms
Town of Queensbury Planning Office- 742 Bay Road • Queensbury, NY 12804• 518-761-8220 0
Preliminary Stage Revised April 2010
General Information
Tax Parcel ID Number'. 265.4-16
Zoning District- RURAL RESIDENTIAL 3 ACRE
AMlication StaUe lcheck cine l:
Sketch Plan Stage
Preliminary Stage V
Final Stage
Indicate the follovving:
Number of lots proposed 2
Residential or Commercial RESIDENTIAL
Total Lot acreage 6.97 ACRES
Proposed lot sizes LOT 1:3.74 AC/LOT 2:3.2 AC
Project location 80 ELLSWORTH LANE
Detailed Description of Project [include current& proposed use]'
2-LOT RESIDENTIAL SUBDIVISION;LOT 1 TO RETAIN OWNER/APPLICANT RESIDENCE;LOT 2 TO BECOME NEW,VACANT,
BUILDING LOT
Applicant Name: MICHAEL&CINDY TROMBLEY Address- 80 ELLSWORTH LANE
LAKE GEORGE NY 12845
Home Phone (518)743-0338 Cell-
Work Phone . Fax
E-Mail-
............
Agent's Name: HUTCHINS ENGINEERING re ss: 169 HAVILAND ROAD
QUEENSBURY NY 12804
Home Phone Cell:.
Work Phone (518)745-0307 Fax (518)792-8511
E-mail THUTCHINSPHUTCHINSENGINEERIN(.COM
'
Owners Name (SAME AS APPLICANT) Address
Home Phone Cell
Work Phone Fax
E-mail
Town Gf Queensbury Planning Office, 742 Bay Road - Queensbury, NY 12804 - 518-761-8220
Telimirary Stage Revised April 2C 10
ITEMS TO BE IDENTIFIED BY STAFF DURING PRE-SUBMISSION MEETING. You shouA use ths page for
guidance wher drafting your application; hop,-eller itvibe completed by a staff member. Submitta- of a preliminary
not
ad below. Failure to nc'ude all reclix,ed
pat depicting exist;rg and proposed ccncliticir-�_, ten
}s the les -as , -
inforrinat:on may result in a determination of ncomp=eteness and a cle%ay in the processing orf your appl-catlon
§ A183-13. Plat details and requirements.
The a-,nplic3rt is required to submit one
11 ori� hml and 14 cogies of the prelir:-inary plai application, Such appi-cation
sha" include the fojov,,ng d0CL1MentS ar)dll'or nfom-atior:
APRELIMINARY PLAT. The prelimirary p at __znall be laid out b'j a ceeilsed professon.3 engineer anther a
licensed professional lard suro_i�Clr Nith .3 ciroperly executed Nevv York State Educat;on Department
sha I be prepared at a sc-
-inar ale of one rch equals 50 feet zero inches. clear
xernot on N_ Such ore'ir v pla
shovving:
1 1 The locatiar of all ey�stinq ard praposed p-noerty lines buildings, -,�.,atercours4nd otner mrntant
T e
atures.
2, and p-0,pGSeC1 C011tOUrs shovving elevwicns at two-foot comov lnterl.als_ and extend ng at ieas-,
-3C
3r Te location_ namn-1 %Jft
es seed of al existing aJ proposed streets, easer-erts and nd Ludding 1.ne..3
ard septic L
ic tanks and 'ields and mini la-facts regarding proce-, r.- —&-itely adiacen- o, oppo_3re the
P-00OSaell SUbdi-iis on
i A loczncr map shn-tving:
in
-m -i TS lard to ;_-e suLdi, dalc s -ca-&d- and
a� The -on dist,ict dist-ict._:� P.,,# c,
ba -he prop&rtm:/ i n Cl u d ec, in the p-ap Cs-ec sz_i Ld 1 i s ic�I and a I I ccr ti Cg_1 COUS IQ FC'per7i eS of the p ro 0 rused
zubdivszon and all p-cosrtes tvithir 500 feet r e-am direction from the brjsird- 3�.y line of t pr -, -d
L
1 71 e C
SUbdi-ilS on alorg an-,: cort.quous st-eet or h Ah p-operties shall oe oy, iot and Cl
-i u m ta e r a n d n a m es a f a hers.
tvate� r-airs culverLs ana 1rair p,pes- a-ectr _ -eiephone
Tim �ocatiion ard size of ary existilig severs, u
an-1 cable -,:e,e,.. sicn ires and prop,csed se-.vers_ -tvater n-,a ns, cu e--.-t---; and drain pipes on tl�e proper-ty o-
i m n 19 d i a t e I v -4 d.i a c a r t to tree p r ocp e rty to be s u b d i 4-1 d e d.
I Tne proposed ar-argel-ert and approximate area. e�,i&h and iength of st7eet frontage anc, se-back
req-a=re= erts of each Ic,
t for the Durposte of demonstrating to the P anr•ng Sward ti-at the proposed location, -
o- streets akes possible a la-v-out o�1--rs in accordance ,klith the requ-mmerns of the Tc.vn of Queensbrjry
7r.j,-1
ing avw for the d's-rct or
dst--icts 'n xnich the SUbdiv,sion is located.
411l arcels
osed to be dedicated --- the pube:c use
oiof larid pre*
8! Tie date. Norti, arrcw; and scale.
T`ie title --inder avhicr) :he proposed subdivision s o be recorded. wit tne _'}ap-es ,D- te o'Lt.,,r--r ard the
enig,ree�or ant -.%,ho prepared the Drelm-,inary, pat: the cerse rurriber and sea! ic` the eng roe,,
�j 11 &
C,r land surveyor shall 'b—ami: To trie cravoing-
LAYOUT PLANS. -ayo--it olars shail be crepa-ed by -9 p-'D�sssicnal licensec engineer or pr-ofessi;Dral licensed
La L
land surb'eycr P;-- 1- a prooe-ler executec New Y��r� Mate Education Department Exernoton V Such la',-iout
p ans Sn-'all 'Ce ircoirperated on the prelimirary plat a!-id shal shci•,N the follo irg-
�rw,x✓� „. 1I T-ie exact ard c;'n-ensicns of p-aposec streets. nc udirg stat:on ng aild t e-ir to the celeerdine
d'sn lcl ot�lmr ocints. 1s. r qr. ,
�ar ces o'Exist rg etre e s vd-h morium� Ls il a r-
7
Preliminar%d Stage Revised AprO _2C 13
21Tge locatior and widths of all streets, pavements, c-urbs, s,de,.,v3lks, easements, parks and other ooe
-
spaces.
39 The proposed names of all streets. and the r3dl;p of aV' curies in the street
The location of a'! proposed utilit es, includ�nq the proposed -.Aiater supply, san7tary ma
sewe,s. storni' te-
dra rage .s stern 1-.-4rd any other proposed underground utifties
5 D i , roposed lot lines.
E.Ii T� e -date. North arria,�v and scale,
7) The tItle under ..vnich the proposed subdi-vis.on is to be recorded vv rh the names of the owrer and
err ree—or land sur-I-evor "Pih,,:) p-epared the avow planus; the licerse number anc sea of the engineer r.-
land sur,evo- snall be affixed to the Jra,v ng
C_ CONSMUCTION D TAILS Const-uction details shall be prepared b-,., a licensed orofessional eIC Ise, C�3
ficensed profes-3 on kind su-,,e,icrr a riroperiv executec Nev.- 'Y'orx StateEdUCI-tio-I Depq-u ert
Exempt on N_ S4ich details shall r c °.ide:
L
1) The proposed sar�tasev4er s". stem nc uding pipe s zes beddii,g and prof�ies.
T°ie proposed storrr, drains sy-ster-, rcluding pipe sizes bedd7-ig c.ratch g-q_Sk- anc r-arn-le det�- -,3
vcfiles and method o'disposal of collected storn-water,
TrIe pr-oposed vater scop y system-
,fin-, -other croposed `ender groan, rt Pties
-al cross section of thee -oaI-vay. nc�udyng 'Ilre right-of—ay; Piidtn. paeme-it wict ai-d cep-t
A t vp i i
pavernent materia s and subbase, the -ocatIon of Afizies. cnoq-ac�---r a-id dimensiors of curlbs and
side tvalks ard side s ope grading-
t�) =Irofies, the on,
qir�al avound surfics ano finished str�-__,t surface. at cemer lines of allst,-Se-ts
percentage of grades of streets. stationing and e.evationts of ai' points oP c;Jr-i'3-ur_e ocairts of inte_-sect on
poin-,.s of tangent and of -proposed sewelrS, drairs, cu�%,.rts manholes and other features.
e evations ard slopes of sety-e-s and drains and both surface and in -ert elevaticrs of manholes sria I be
indicated. OrafOes snarl be drawr to the scale of four feet to the ir& iertical and 11� --et to the nch
-igir, -
hwzortal. -ne sr�-ationing sha;� Shoo` accurate centei-hne distarce's The ele%,-at ons of te o! .al ground
surface shall oe to the nearest tenth of a foot and at fixed points-to the neares-, humd-edth of a foot.
71 Tae locatior-. and elevation of all �woposed rrOrUment locat ons,
The date and scale.
Tr-,e title under which the pr000sed sub&visior -s to be recorr 1. wqn the narnes of the cviner and
led
engree- oihsa prepared the construction cleta,"s: the ;:cense n-imber and seal of the er-Lgineer sriall be
affixed to the drav4ng.
PK EIL) LANDSCAPE PLAN A Lirdscace clan shall be prepared b-..- a licensed andsc-acie a-chi+ rt f -,d -
or suL, kisiorls
a7e:ater thoon 'C lots, Sw& :andscape plan sha,. include:
I Tne kwatior ands pecies of street trees if retained ixithin t�'ne right-of,vay or p;raocsev; to tis plariteo a,, te
subdiv-der.
!-)etails of r•ethocls of tree protect on ard tree plant-erg
ovin J ri 7-"arr i-1� Olfr,,CS- 742 5,3V RC a", Lleens:Dur-i. N Y '-4.3 Ca - -82-,C
Preliminary Stage Revised Apr! 20'10
3) Plans and details of any site n-pro-,?ernerits re�ated to pat or recreation p.anring. nc°uding 'ayou,
grading, panting and details of any improvements.
4.I Plans and details of any other public an-er-ties provided in the subdi-,,sion-
61 The date and scale.
6) The tie number which the proposes' subdivis;or is to be recorded. w1h the rames, of the o-,,vrer and
landscape architect jvto preparey-l' the ancscacne Alar; the licerse number and seal of the andscaoe aFchitc-cT
shale be alixed to the Jra-song.
tom:: L - A c earng On SON be prepai-ed a- a scale of one inch ecua s 55C fee� ze-o inche-,:-�, S--ich
p'an sha<: show the `olzowrg detaiis:
I j Exzjng uregemlon pror Us ary waing of the site V site invest ga&r purposes,
Ic
3f$ -e-oyac -rcr7- tale s.te �t_ niestgatior. ouraxmsesn
,
TJ 1� bcsion w- ro:.icvays- arm
do or ur
lit ot in roadwayrs- iiairs of qrading,. proposeJ
staill4�-I Cand WMAQ11 SePAC tWP a ells anC dri,,elwiys and any other inip,meniants. whch nigh".
Jj Areas-4are Slopes are greatertnar 2C%. as per§.A183-t0'
r-is of proposed c earmg o"mas.
Measures m be taken to protect rernatning irees- nciud rg deWs
GRAUINGAND ERC)SI(IN CONTROL PLANS, A gradag pun and evosion conuol Oai snall be prepaimcl at 3
scale c7 ore h ecua I 5C hot zerc. inches Such p-an sha sho-,: the falloveirg:
I.i A gemeralizec givding ana drainage p,:an 4dcjes not mquire spot gmdes or shoe des gnat w I.
2) Any phashg oftree -e--oval ard,,-cr car--str-icton
7 ,lU MENIAL SEPQR1. A ong an jmn—eNa assessment 'o-rn shall be prepared :n accordance with
the State Er,-irorr--ertQuahty Re ie,N Act desc-lbing the potertia: environmental impact of the proposed
subdNAon.
9TATEMENT W INTENT A sntmmewit of htwt sha:i be. submitted by the applicam- Such, statenien- stall
include.
I i ProoF of ownership J the land to be Kibd�vidled. In a form approved by the T-own At-orney
2) The natum and e.,,aent of proposs,d street rnprove9:`ents-
3� The nature and exte,it of any -ecreatioral features- parks, play'g'ound;s, vater suciply. sav;erage -and
dra,rage and emementn rommiar ba les anc other land to be ded cated to pulb-c use and tl'e
corditions urde-at zK dedoat on Y lese,features, is lo be n-,aae to the oton.
A) IN slaternent that Me apd1mix 0; iristaii all irn p roie—ants in accordance with the standards orescrbed by
,he dapartmem.s of the T- un ha Jng jurisdWar. and set all n-,-onumenns as shown on the f na peat !hereof in
Such manner as the Board may ces'griate.
A ST()RMWATEE, MAL4AGEMENT PLAN ard 3 STORMWATER N-JILLUTICiti PREVENTIC'M PLAN
j IN x, W—F&SI-ent w1h the -smikements of ChaMe, 117
=wvirg Wce- 742 Bay Rcac Queensoo, W '2804 - TSWAW
Preliminar,.,, Stage Reiised Apr!; 4-1010
J. FEES.
1;e The application for preliminary plat approva' shall be accompanied by a fee listed on the c---irrent sche, we
of fees for the To-jvn of Queensbury posted in the Planning Off--,ce-
I
2,i in add^tion to the fee listed on the schedu,r- of fees. the Planning Boxc may charg"a fee to de,ic-opens o'
P-o,,ects requiring legal and technica' reiie&. prnidtd that the 'ee cha,,-,led re'le,cts the lCtUal cost of the legal
and techrical assistance to the Planning Board
< WAIVERS. 14 the Plann ng Board finds that -arlli of the informatior -equirements as set forth- above are
Jriappe%or at cv Biot:rscessar,",to curldUrt, 31-, infill,rmed revie--�v- it ma-y- warie such inforn-ation requ`rements as
it d aporolpr ate- A��,,, such �xaiver shall be ,,,ade in bo;ritqg ar,.d shy!! contain statements of the reasons
:My *h rpt nief1,,, or an onforn ed under the circumstances
�nfcrn ittca c�'flrem ire jc*. necessary f
l Board g7qx-,t sich its -3,ewn intiafior at the pa,itten request ithat sets forth the
I
sprr,64ic equirsrnent-,-� :1-at are requested t.: L.e ..,aived and the -easons for the requested Qwai,ier", of an
applicant,
§ A183-14. Submission and Review procedure-Subdivision Sign Posting Requirements
D. Notice. The svubdll-der snall ulispla,,, prom:r-ently on the subject prope-rty. for IC days prscaiing the date of the
P,-&is rieorirg. at least ore s en. feer by three feet in size and Pcarr--jing a legerd prescribed oy the T�a�,'in
uil pubiic Je,& from the street cavennenr laqnirg Board- annourc,rg ti�.e public et The sqn shall be in f . ,
and shall be legible fron- the :street. 1the property is bounded by more than one s-reet, a s^gr shal be placed
on e-ach street that bounds the property,
Sav Rcac, -ueeroi--�ury, h,Y —PM4 -7F
4�
T-4- -
Preliminary Stage ReJsed Apra 1010
Pre-Submission Conference Forni,
I Tax Map ID: 265.4-16
Zoning classification: RR 3A
CCti
3, Reason for Revle,,v: I_X
4Ord,nance Section
5. Pre-Submission rvleetng Notes: Outstand'rg Items To Be Addressed IMclude:
I 6/V_3 Deed N G
G --a inlormation ""JO
ene
�7
Preliminary at Nc
ayout Pans! Yes No
2V
Corstr_iction Detail s NG,
1 and cape P[ar Ve No
7. Clea-ing P�an e-S
ITLN-
61- Grading & Erosion C'onfrol Yes N ct.
En,vironmenta Repor7
1 Ij Statement of Intent Yes 'N c
11 Stom-piater Plar ' S'A'P13P -IVPS No
�:eqs eS
1I, 'A'a,vers °`e-3
14 Subdivtscon S,gr Pos-ing
15' Eignature P-ice 14 n'
2
(4c,
--hIL
'Ak
..........
Staff Representati�ie;
Applicant `Agen-:
Da%:
_2r4::`a; ri-g Cffce- �4-_Ela;; Ruad - Ni 1 - 5 �i- :"1-8 G F.
617.20
Appendix A
State Environmental Quality Review
Full Environmental Assessment Form
Purpose: The Full Environmental Assessment Form(EAF)provides an orderly and
comprehensive means for evaluating the potential environmental significance of a proposed
action. The question of whether an action may be significant is not always easy to answer.
Frequently, there are aspects of a project that are subjective or unmeasurable. It is also
understood that those who determine significance may have little or no formal knowledge of the
environment or may not be technically expert in environmental analysis. In addition,many who
have knowledge in one particular area may not be aware of the broader concerns affecting the
question of significance. The lead agency must use the Full EAF for Type I actions and may use
it for Unlisted actions.
The Full EAF consists of three parts and when completed it will serve as the determination of
significance:
Part 1 -Is completed by the project sponsor. Part 1 provides basic information including a
description of the proposed action, proposed site location and its environmental resources. The
information provided in Part 1 is later used by the reviewing agency to complete Parts 2 and 3.
The questions in Part 1 are grouped in sections A-G:
• Section A gathers information that identifies the project sponsor,the proposed action, and the
proposed action's location.
• Section B requests information about government approvals or funding.
• Section C requests information about planning, zoning and community services.
• Section D requests information about the proposed action.
• Section E requests information about resources on or adjacent to the proposed site.
• Section F provides the project sponsor the opportunity for supplying additional information
including project elements that may avoid or reduce impacts.
• Section G is where the certifying signature of the preparer is provided.
Part 2 -Is completed by the lead agency. Part 2 is designed to help the lead agency inventory all
potential resources that could be affected by a proposed action and to determine the potential size
of the impact by providing a series of questions that can be answered using the information
found in Part 1. To further assist the lead agency in completing Part 2, the form identifies the
most relevant questions in Part 1 that will provide the information needed to answer the Part 2
question. Part 2 is designed to help a reviewer identify any element of a proposed project that
may have a potentially significant adverse impact on the environment.
Part 3 -Is completed by the lead agency. Part 2 questions where the impact has been identified
as potentially moderate to large or where there is a need to explain why a particular element of
the proposed action will not, or may, result in a significant adverse environmental impact should
be explored in a series of written,well reasoned statements_in Part 3. The discussion of impacts
in Part 3 will serve as the supporting documentation for the determination of significance.
Full Environmental Assessment Form
Part 1 -Project and Setting
Instructions for Completing Part 1
Part 1 is to be completed by the applicant or project sponsor. Responses become part of the application for approval or funding,
are subject to public review,and may be subject to further verification.
Complete Part 1 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;indicate whether missing information does not exist,
or is not reasonably available to the sponsor;and,when possible,generally describe work or studies which would be necessary to
update or fully develop that information.
Applicants/sponsors must complete all items in Sections A&B. In Sections C,D&E,most items contain an initial question that
must be answered either"Yes"or"No". If the answer to the initial question is"Yes",complete the sub-questions that follow. If the
answer to the initial question is"No",proceed to the next question. Section F allows the project sponsor to identify and attach any
additional information. Section G requires the name and signature of the project sponsor to verify that the information contained in
Part 1 is accurate and complete.
A.Project and Sponsor Information.
Name of Action or Project:
TROMBLEY SUBDIVISION
......... ................................._....-
Project Location(describe,and attach a general location map):
80 ELLSWORTH LANE,TOWN OF QUEENSBURY,WARREN COUNTY
Brief Description of Proposed Action(include purpose or need):
2-LOT RESIDENTIAL SUBDIVISION;LOT 1 TO RETAIN OWNER/APPLICANT'S RESIDENCE;LOT 2 TO BECOME ANEW,VACANT,
BUILDING LOT
--- .......--.. _. ..................
Name of Applicant/Sponsor: Telephone: (518)743-0338
MICHAEL&CINDY TROMBLEY E-Mail:
Address„
80 ELLSWORTH LANE
...............................
City/PO: LAKE GEORGE State: NY Zip Code: 12845
Project Contact(if not same as sponsor;give name and title/role): Telephone: (518)745-0307
_._._.. ._............................................................
HUTCHINS ENGINEERING(AGENT) E-Mail:THUTCHINSOHUTCHINSENGINEERING.COM
_._....... .....................
__
Address:
169 HAVILAND ROAD
...................._....................................�.............................................................�........- _. .
City/PO: State: Zip Code:
QUEENSBURY NY 12804
Property Owner (if not same as sponsor): Telephone
(SAME AS APPLICANT) E-Mail:
..................
Address:
............_._._._.___�
City/PO: State: Zip Code:
Page 1 of 13
B. Government Approvals
B. Government Approvals Funding,or Sponsorship. ("Funding includes grants,loans,tax relief,and any other forms of financial
assistance.)
Government Entity If Yes: Identify Agency and Approval(s) Application Date
Required (Actual or projected)
a. City Council,Town Board, ❑Yes®No
or Village Board of Trustees
b. City,Town or Village ®Yes❑No TOWN OF QUEENSBURY PLANNING BOARD FEBRUARY 2016
Planning Board or Commission FOR SUBDIVISION
c. City Council,Town or ®Yes❑No TOWN OF QUEENSBURY ZONING BOARD
FEBRUARY 2016
Village Zoning Board of Appeals OF APPEALS FOR AREA VARIANCE
d.Other local agencies ❑Yes®No
e. County agencies . ❑Yes®No
f. Regional agencies ❑Yes®No
g. State agencies ®Yes❑No ADIRONDACK PARK AGENCY FEBRUARY 2016
JURISDICTIONAL INOUIRY
h.Federal agencies ❑Yes®No
i. Coastal Resources.
i. Is the project site within a Coastal Area,or the waterfront area of a Designated Inland Waterway? ❑Yes®No
If Yes,
ii. Is the project site located in a community with an approved Local Waterfront Revitalization Program? ❑Yes®No
iii. Is the project site within a Coastal Erosion Hazard Area? ❑Yes[Z]No
C.Planning and Zoning
C.I.Planning and zoning actions.
Will administrative or legislative adoption,or amendment of a plan,local law,ordinance,rule or regulation be the ❑Yes®No
only approval(s)which must be granted to enable the proposed action to proceed?
• If Yes,complete sections C,F and G.
• If No,proceed to question C.2 and complete all remaining sections and questions in Part 1
C.2.Adopted land use plans.
a.Do any municipally-adopted (city,town,village or county)comprehensive land use plan(s)include the site ®YesONo
where the proposed action would be located?
If Yes,does the comprehensive plan include specific recommendations for the site where the proposed action ❑Yes®No
would be located?
b.Is the site of the proposed action within any local or regional special planning district(for example: Greenway ❑Yes®No
Brownfield Opportunity Area(BOA);designated State or Federal heritage area;watershed management plan;
or other?)
If Yes,identify the plan(s):
c. Is the proposed action located wholly or partially within an area listed in an adopted municipal open space plan, ❑Yes®No
or an adopted municipal farmland protection plan?
If Yes,identify the plan(s):
Page 2 of 13
C.3. Zoning
a. Is the site of the proposed action located in a municipality with an adopted zoning law or ordinance. ®Yes❑No
If Yes,what is the zoning classification(s)including any applicable overlay district?
b. Is the use permitted or allowed by a special or conditional use permit? ®Yes❑No
c.Is a zoning change requested as part of the proposed action? ❑Yes®No
If Yes,
i. What is the proposed new zoning for the site?
CA.Existing community services.
a.In what school district is the project site located? LAKE GEORGE CENTRAL SCHOOL DISTRICT
b.What police or other public protection forces serve the project site?
WARREN COUNTY SHERIFF
c.Which fire protection and emergency medical services serve the project site?
BAY RIDGE FIRE DEPARTMENT AND EMS
d.What parks serve the project site?
JENKINSVILLE
D.Project Details
D.1.Proposed and Potential Development
a.What is the general nature of the proposed action(e.g.,residential,industrial,commercial,recreational;if mixed,include all
components)?
RURAL RESIDENTIAL
b.a.Total acreage of the site of the proposed action? 6.97 acres
........
b.Total acreage to be physically disturbed? 0.45 acres
c.Total acreage(project site and any contiguous properties)owned
or controlled by the applicant or project sponsor? 6.97 _ acres
c.Is the proposed action an expansion of an existing project or use? ❑Yes®No
i. If Yes,what is the approximate percentage of the proposed expansion and identify the units(e.g.,acres,miles,housing units,
squarefeet)? %. ..................................................................................... Units:........w...11.11......... _
d.Is the proposed action a subdivision,or does it include a subdivision? ®Yes❑No
If Yes,
i. Purpose or type of subdivision?(e.g.,residential,industrial,commercial;if mixed,specify types)
RESIDENTIAL
Y proposed?- .........
ii. Is a cluster/conservation layout ❑Ye s®No
iii. Number of lots proposed? 2
iv. Minimum and maximum proposed lot sizes? Minimum 3.22 Maximum 3.74
e.Will proposed action be constructed in multiple phases? ❑Yes®No
i. If No,anticipated period of construction: _.....8 months
ii. If Yes:
• Total number of phases anticipated
• Anticipated commencement date of phase 1 (including demolition) month year
• Anticipated completion date of final phase month year
• Generally describe connections or relationships among phases,including any contingencies where progress of one phase may
determine timing or duration of future phases„
Page 3 of 13
f.Does the project include new residential uses? ®Yes❑No
If Yes,show numbers of units proposed.
One Family Two Family Three Family Mtrlti11 Family four or more
Initial Phase 1
At completion
of all phases
g.Does the proposed action include new non-residential construction(including expansions)? ❑Yes®No
If Yes,
i.Total number of structures
ia. Dimensions(in feet)of largeproposed t p p osed
structure: height; width; and length
iii. Approximate extent of building space to be heated or cooled: square feet
h. Does the proposed action include construction or other activities that will result in the impoundment of any ❑Yes®No
liquids,such as creation of a water supply,reservoir,pond,lake,waste lagoon or other storage?
If Yes,
i. Purpose of the impoundment: ❑__ _ . ............. --- --------.
ii. If a water impoundment the principal source o th
f the water: Ground water❑Surface water streams❑Other specify:
iii. If other... --- ----- ---... - —- ........_
than water,identify the type of impounded/contained liquids and their source.
_..-.-.- -.-.-.-.---------------------
iv. Approximate ...... proposed — - ........ -....._ _ ----------------
—
size of the ro osed impoundment. Volume: million gallons, surface area: acres
v. Dimensions of the proposed dam or impounding structure: height; length
vi. Construction method/materials for the proposed dam or impounding structure(e.g.,earth fill,rock,wood,concrete):
D.2. Project Operations
a.Does the proposed action include any excavation,mining,or dredging,during construction,operations,or both? Yes No
(Not including general site preparation,grading or installation of utilities or foundations where all excavated
materials will remain onsite)
If Yes:
i.What is the purpose of the excavation or dredging?
ii. How much material(including rock earth sediments,etc.)is proposed to be re
( g moved from the site?
• Volume(specify tons or cubic yards):
• Over what duration of time?
iii. Describe nature and characteristics of materials to be excavated or dredged,and plans to use,manage or dispose of them.
iv. Will there be onsite dewatering or processingof excavated materials?
.
Yes No
If yes,describe.
v. What is the total area to be dredged or excavated? acres
vi. What is the maximum area to be worked at any one time? .. acres
vii. What would be the maximum depth of excavation or dredging. feet
viii. Will the excavation require blasting? ❑Yes❑No
ix. Summarize site reclamation goals and plan: _
b.Would the proposed action cause or result in alteration of,increase or decrease in size of,or encroachment Yes No
into any existing wetland,waterbody,shoreline,beach or adjacent area?
If Yes:
L Identify the wetland or waterbody which would be affected(by name,water index number,wetland map number or geographic
description):
Page 4 of 13
ii. Describe how the proposed action would affect that waterbody or wetland,e.g. excavation,fill,placement of structures,or
alteration of channels,banks and shorelines. Indicate extent of activities,alterations and additions in square feet or acres:
p p - ,.. —_. ---- — ... ._._--------
iii. Will ro osed action cause or result in disturbance to bottom sediments. Yes No
If Yes,describe: _ ____
iv. Will proposed action cause or result in the destruction or removal of aquatic vegetation? ❑
Yes❑No
If Yes:
• acres of aquatic vegetation proposed to be removed:
o .
• expected acreage of aquatic vegetation remaining after project completion:
• purpose of proposed removal(e.g.beach clearing,invasive species control,boat access): _
• proposed .. _
method of plant removal
• if chemical/herbicide treatment will be used,specify product(s):
v. Describe any proposed reclamation/mitigation following disturbance:
c.Will the proposed action use,or create a new demand for water? ®Yes X10
If Yes:
i. Total anticipated water usage/demand per day: 330 gallons/day
ii. Will the proposed action obtain water from an existing public water supply? ❑Yes Flo
If Yes:
• Name of district or service area:
. ...
• Does the existing public water supply have capacity to serve the proposal? ❑�
Yes[--]No
• Is the project site in the existing district? ❑Yes❑No
• Is expansion of the district needed? ❑Yes❑No
• Do existing lines serve the project site? ❑Yes❑No
iii. Will line extension within an existing district be necessary to supply the project? ❑Yes❑No
If Yes:
• Describe extensions or capacity expansions proposed to serve this project
• Source(s)..of supply for t..... . ....... _
he district
iv. Is a new water supply district or service area proposed to be formed to serve the project site? ❑Yes❑No
If,Yes:
• Applicant/sponsor for new district:
• Date application submitted or anticipated:
• Proposed source(s)of supply for new district:
v. If a public water supply will not be used,describe plans to provide water supply for the project: ON-SITE WELL
vi. If water supply will be from wells(public or private),maximum pumping capacity:... _________
P g .. g --------------------
vi.
--- -- -
....
10 gallons/minute,
d.Will the proposed action generate liquid wastes? ®Yes❑No
If Yes:
i. Total anticipated liquid waste generation per day„ 330 gallons/day
q g ( g.,sanitary wastewater,ii. Nature of liquid wastes to be generated e. water,industrial; if combination,describe all components and
approximate volumes or proportions of each): SANITARY WASTEWATER
iii. Will the proposed action use any existing public wastewater treatment facilities? ❑Yes®No
If Yes:
• —
Name of wastewater treatment plant to be use
• Name of district:
plant have capacity to serve the project? — ❑Y �...
• Does the existing wastewatertreatment 1 ..
tre es o
❑N
• Is the project site in the existing district? ❑Yes❑No
• Is expansion of the district needed? ❑Yes❑No
Page 5 of 13
• Do existing sewer lines serve the project site?
Will line extension within an existing district be necessary to serve the project? ❑Yes❑No
• If Yes: ❑Yes❑No
• Describe extensions or capacity expansions proposed to serve this project:
iv. Will s new wastewater(sewage)treatment d
. istnct be formed to serve the project site?If ❑No
• Applicant/sponsor for new district:
Date application submitted or anticipated:
• What is the receiving
not be used, or t e wastewater
to
p e and a used,d e vast water discharge'?
eervrn'T wafer for the �
v. If public facilities�vl' provide wastewater treatment for the project, irttltlding specifyiang pmposed
receiving water(nam tion if surface discharge,or describe subsurface disposal plans):
vi. Describe an designs to capture,plans recycle
or reussee liquid waste:
_ . —... ..
e. Will the proposed action disturb more than one acre and create stormwater runoff,either from new point ❑YesoNo
sources(i.e.ditches,pipes,swales,curbs,gutters or other concentrated flows of stormwater)or non-point
source(i,e, sheet flow)during construction or post construction?
If Yes:
i. How much impervious surface will the project create in relation to total size of project parcel?
Square feet or acres(impervious surface)
Square feet or acres(parcel size)
ii. Describe types of new point sources.
iii. Where will the stormwater - g ructures,adacent ro e _
groundwater,on-site surface water or t i•e. on-site st
off-site surface waters)?water,mans eme —�
runoff be nt facility/st � p p rties,
• If to surface waters identifyreceiving water bodies or wetlands:
iv. Does proposed plan minimize
P ilpl
stormwater runoff flow
impervious surfaces use pervious materials or collect and re-use__. _..
❑ . . . _
adjacent p p Yes❑No
, se stormwater? Yes[]No
f. Does the proposed action include,or will it use on-site,one or more sources of air emissions,including fuel OYes❑No
combustion,waste incineration,or other processes or operations?
If Yes,identify:
i.Mobile sources during project operations(e.g.,heavy equipment,fleet or delivery vehicles)
EQUIPMENT FOR SITE WORK
ii. Stationary sources during construction(e.g.,power
generation structural heating,batch plant,crushers) w
iii. Stationary sources during operations(e.g.,process emissions large boilers,electric generation)
g or Federal Clean Air Act Title IV
in le 2 ir ...._.., ._..,
Will an air emission sources n D,2.f(above),require a NY State Air Registration,Air
FacilityPermit, ^ � � ...
V or Tit Permit.
If Yes;
i. Is the project site located in an Air quality non-attainment area? (Area routinely or periodically fails to meet ❑Yes❑No
ambient air quality standards for all or some parts of the year)
h. In addition to emissions as calculated in the application,the project will generate:
__„Tons/year(short tons)of Carbon Dioxide(CO2)
• _ Tons/year(short tons)of Nitrous Oxide(N2O)
•
,.—.,-Tons/year(short tons)of Perfluorocarbons(PFCs)
• Tons/year(short tons)of Sulfur Hexafluoride(SF6)
• Tons/year(short tons)of Carbon Dioxide equivalent of Hydroflourocarbons(HFCs)
• Tons/year(short tons)of Hazardous Air Pollutants(HAPS)
Page 6 of 13
h. Will the proposed action generate or emit methane(including,but not limited to,sewage treatment plants, Yes No
landfills,composting facilities)?
If Yes:
L Estimate methane generation in tons/year(metric):
ii. Describe any methane capture,control or elimination measures included in project design(e.g.,combustion tog enerate heat or
electricity,flaring):
i.Will the proposed action result in the release of air pollutants from open-air operations or processes,such as ❑Yes®No
quarry or landfill operations?
If Yes:Describe operations and nature of emissions(e.g.,diesel exhaust,rock particulates/dust):
j.Will the proposed action result in a substantial increase in traffic above present levels or generate substantial ❑Yes®No
new demand for transportation facilities or services?
If Yes:
i. When is the peak traffic expected(Check all that apply): ❑Morning ❑Evening ❑Weekend
❑Randomly between hours of to
ii. For commercial activities only,projected number of semi-trailer truck trips/day
iii. Parking spaces: Existing__ __ Proposed Net increase/decrease
iv. Does the proposed action include any shared use parking? ❑Yes❑No
v. If the proposed action includes any modification of existing roads,creation of new roads or change in existing access,describe:
Vi. Are ublic/ rivate transportation service(s)or facilities available within 1/2 mile of the proposed site? ❑Yes❑No
vii Will the proposed action include access to public transportation or accommodations for use of hybrid,electric ❑Yes❑No
or other alternative fueled vehicles?
viii. Will the proposed action include plans for pedestrian or bicycle accommodations for connections to existing ❑Yes❑No
pedestrian or bicycle routes?
k.Will the proposed action(for commercial or industrial projects only)generate new or additional demand ❑Yes❑No
for energy?
If Yes:
i. Estimate annual electricity demand during operation of the proposed action:
.... .. . . ty _..... ------------------------------
ii. Anticipated s urces/Sulirs oflectricthe project(e.g.,on-site combustion,on-site renewable,via grid/local utility,ty,or
other):
iii. Will the proposed action require a new,or an upgrade to an existing
' e ,p p q pg substation? QYcs[]No
1.Hours of operation. Answer all items which apply.
L During Construction: ii. During Operations:
a Monday-Friday: 7 00 A.M.TO 5:00 P.M. • MondayFriday:
.........---— - Y m .........................................................................................................................
• Saturday: • Saturday:
* Sunda • Sunday: ... mm... ....
* Holidays: • Holidays:
Page 7 of 13
m. Will the proposed action produce noise that will exceed existing ambient noise levels during construction, m Yes❑No
operation,or both?
If yes:
i. Provide details including sources,time of day and duration:
HOUSE CONSTRUCTION
Will proposed
aa. action remove existing natural barriers that could act as a noise barrier or screen? O Yes❑No
Describe: CLEARINGFOR HOUSE SITE
n.. Will the proposed action have outdoor lighting? m Yes❑No
If yes:
i. Describe source(s),location(s),height of fixture(s),direction/aim,and proximity to nearest occupied structures::
HOUSE-MOUNTED LIGHTING AT ENTRANCES
-- -- — -
ii. Will proposed action remove existing natural barriers that could act as a light barrier or screen? m Yes❑No
Describe:CLEARING FOR HOUSE SITE
o. Does the proposed action have the potential to produce odors for more than one hour per day? ❑Yes ONo
If Yes,describe possible sources,potential frequency and duration of odor emissions,and proximity to nearest
occupied structures:
p. Will the proposed action include any bulk storage of petroleum(combined capacity of over 1,100 gallons) ❑Yes❑No
or chemical products 185 gallons in above ground storage or any amount in underground storage?
If Yes:
i. Product(s)to be stored
ii. Volume(s) per unit time (e.g. month year),...
iii. Generally describe proposed storage facilities:
q. Will the proposed action(commercial,industrial and recreational projects only)use pesticides(i.e.,herbicides, ❑Yes [:]No
insecticides)during construction or operation?
If Yes:
i. Describe proposed treatment(s):
.......-. m
.................. --------
..
ii. Will the proposed action use Integrated Pest Management Practices? � ❑
Yes []No
r.Will the proposed action(commercial or industrial projects only)involve or require the management or disposal ❑Yes ❑No
of solid waste(excluding hazardous materials)?
If Yes:
i. Describe any solid waste(s)to be generated during construction or operation of the facility:
• Construction: tons per ... (unit of time)
• Operation: tons per (unit of time)
ii. Describe any proposals for on-site minimization,recycling or reuse of materials to avoid disposal as solid waste:
• Construction:
-....
• Operation:
...........
........... .......................
iii. Proposed disposal methods/facilities for solid waste generated on-site:
• Construction:
......._ .........
• Operation
Page 8 of 13
s. Does the proposed action include construction or modification of a solid waste management facility? ❑ Yes® No
If Yes:
i. Type of management or handling of waste proposed for the site(e.g.,recycling or transfer station,composting,landfill,or
other disposal activities) _
ii. Anticipated rate of disposal/processing:
p
• Tons/month,if transfer or other non-combustion/thermal treatment,or
• Tons/hour,if combustion or thermal treatment
iii. If landfill,anticipated site life: .....__.........______............_._...............................................................................years
t. Will proposed action at the site involve the commercial generation,treatment,storage,or disposal of hazardous ❑Yes®No
waste?
If Yes:
i. Name(s)of all hazardous wastes or constituents to be generated,handled or managed at facility:
ii. Generally describe processes or activities involving hazardous wastes or constituents:
iii. Specify amount to be handled or generated tons/month
iv. Describe any proposals for on-site minimization,recycling or reuse of hazardous constituents:
V. Will a hazardous wastes be dis disposed at an existing offsite hazardous
........... _
any p g waste facility? Yes�No
If Yes:provide name and location of facility:
If No:describe proposed management of an hazardous wastes which will not be sent to a hazardous was
p p g y to facility:
E.Site and Setting of Proposed Action
E.1.Land uses on and surrounding the project site
._.........
a. Existing land uses.
i. Check all uses that occur on,adjoining and near the project site.
❑ Urban ❑ Industrial ❑ Commercial ® Residential(suburban) ® Rural(non-farm)
® Forest ❑ Agriculture ❑ Aquatic ❑ Other(specify);
ii. If mix of uses,generally describe:
...................
b. Land uses and covertypes on the project site.
Land use or Current Acreage After Change
Covertype Acreage Project Completion (Acres+/-)
_...... _ .. ...................._...._.._._.
• Roads,buildings,and other paved or impervious
surfaces 0.17 0.37 0.20
_, ...............................
• Forested 5.80 5.35 -0.45
__ _.. .... ........
• Meadows,grasslands or brushlands(non- 0.80 1.05 0.25
agricultural,including abandoned agricultural)
• Agricultural
(includes active orchards,field,greenhouse etc.)
• Surface water features 0.20 0.20 0.00
(lakes,ponds,streams,rivers,etc.)
• Wetlands(freshwater or tidal)
........
_WWW. ...........
• Non-vegetated(bare rock,earth or fill)
............
• Other
Describe:
Page 9 of 13
.. _................�... _
c. Is the project site presently used by members of the community for public recreation? ❑Yes®No
i. If Yes:explain: ................. ----.-.......
d.Are there any facilities
serving children,the elderly, � J. .................................................. ..... ....
g people with disabilities(e.g.,schools,hospitals,licensed ❑Yes®No
day care centers,or group homes)within 1500 feet of the project site?
If Yes,
i. Identify Facilities:
. ......._.... .._...._........._........................................................__....................... ........_............ . . . m,.mm.. _.
e.Does the project site contain an existing dam? ❑Yes®No
If Yes:
i. Dimensions of the dam and impoundment:
• Dam height: feet
Dam length: feet
0 Surface area: acres
• Volume impounded: gallons OR acre-feet
ii. Dam's existing hazard1 ifi ti n•
c ass ca o .
iii. Provide date and summarize results of last inspection:
............
f.Has the project site ever been used as a municipal,commercial or industrial solid waste management facility, ❑Yes®No
or does the project site adjoin property which is now,or was at one time,used as a solid waste management facility?
If Yes:
i. Has the facility been formally closed? []Yes[--] No
• If yes,cite sources/documentation
ii. Describe the location of the project site relative to the
boundaries of the solid waste management facility:
be any d constraints due to the prior
.
iii. Describe development co solid waste activities:
______................_........... .--_.-._. ._.._.._.._..............----
g.Have hazardous wastes been generated,treated and/or disposed of at the site,or does the project site adjoin ❑Yes®No
property which is now or was at one time used to commercially treat,store and/or dispose of hazardous waste?
If Yes:
i. Describe waste(s)handled and waste management activities,including approximate time when activities occurred:
h. Potential contamination history. Has there been a reported spill at the proposed project site,or have any ❑Yes® No
remedial actions been conducted at or adjacent to the proposed site?
If Yes:
i. Is any portion of the site listed on the NYSDEC Spills Incidents database or Environmental Site ❑Yes❑No
Remediation database? Check all that apply:
❑ Yes—Spills Incidents database Provide DEC ID number(s):
❑ Yes—Environmental Site Remediation database Provide DEC ID number(s)
❑ Neither database
ii. If site has been subject of RCRA corrective activities,describe control measures:
iii. Is the project within 2000 feet of any site in the NYSDEC Environmental Site Remediation database? ❑Yes❑No
If yes,provide DEC ID number(s):
iv. If yes to(i),(ii)or(iii)above,describe current status of site(s):
Page 10 of 13
..._ _..... ........ ..........�
v. Is the project site subject to an institutional control limiting property uses? ❑Yes❑No
• If yes,DEC site ID number:
- ...... ......... . -----
— .........
• Describe the type of institutional control(e.g.,deed restriction or easement)
• Describe any use limitations:
• Describe any engineering controls:
• Will theroject affect the institutional or engineering p J g Bring controls in place? ❑Yes❑No
• Explain:
E.2. Natural Resources On or Near Project Site _....___ .
a.What is the average depth to bedrock on .. feet
the project site? 5+ feet
b.Are there bedrock outcroppings on the project site? _ ❑Yes®No
If Yes,what proportion of the site is comprised of bedrock outcroppings?
... _.._..... .....
c.Predominant soil typ type(s)present on project site: BKE WOODSTOCK 100 /
...._ 7 _ ........
d.What is the average depth to the water table on the ro'ect site. Avera e: 5+ feet
g P p J g __..
e.Drainage status of project site soils:® Well Drained: 97%of site
❑ Moderately Well Drained: %of site
® Poorly Drained3%of site
_. ._. ......
_----------
f.Approximate proportion of proposed action site with slopes: ® 0-10%: 80 %of site
0 10-15%: 15 %of site
0 15%or greater: 5 %of site
............................. .................._.
g.Are there any unique geologic features on the project site? Yes[Z]No
If Yes,describe:
............ _....... ........... .............
h. Surface water features.
i. Does any portion of the project site contain wetlands or other waterbodies(including streams,rivers, ®Yes❑No
ponds or lakes)?
ii. Do any wetlands or other waterbodies adjoin the project site? ❑Yes®No
If Yes to either i or ii,continue. If No,skip to E.2.i.
iii. Are any of the wetlands or waterbodies within or adjoining the project site regulated by any federal, ❑Yes®No
state or local agency?
iv. For each identified regulated wetland and waterbody on the project site,provide the following information:
• Streams: Name Classification
........ -----. ....... -------
Lakes or Ponds: Name Classification
• Wetlands: Name Approximate Size
*' Wetland No.(if regulated by DEC)
v. Are any of the above water bodies listed in the
most recent compilation of NYS water quality-impaired El Yes®No
waterbodies?
If yes,name of impaired water body/bodies and basis for listing as impaired:_—
_._. _. ......
i. Is the project site in a designated Floodway? ❑Yes®No
... ...
j.Is the project site in the 100 year Floodplain? ❑Yes[Z]No
..._......... __ ............
k.Is the project site in the 500 year Floodplain? ❑Yes®No
.............................................. ............. ....................
1. Is the project site located over,or immediately adjoining,a primary,principal or sole source aquifer? ❑Yes®No
If Yes:
i. Name of aquifer:
Page 11 of 13
in. Identify the predominant wildlife species that occupy or use the project site:
SQUIRRELS DEER
n. Does the project site contain a designated significant natural community? ❑YesONo
If Yes:
i. Describe the habitat/community(composition,function,and basis for designation): ——
—_
ii. Source(s)of description or evaluation
W. Extent of community/habitat:
• Currently acres
• Following completion of project as proposed. _ acres
• Gain or loss(indicate+or-): acres
o.Does project site contain any species of plant or animal that is listed by the federal government or NYS as ❑Yes[Z]No
endangered or threatened,or does it contain any areas identified as habitat for an endangered or threatened species?
p. Does the project site contain any species of plant or animal that is listed by NYS as rare,or as a species of Yes®No
special concern?
...............
�
q.Is the project site or adjoining area currently used for hunting,trapping,fishing or shell fishing? ❑Yes®No
If yes,give a brief description of how the proposed action may affect that use
E.3. Designated Public Resources On or Near Project Site
......................... ............_.........
....................
a. Is the project site,or any portion of it,located in a designated agricultural district certified pursuant to ❑Yes®No
Agriculture and Markets Law,Article 25-AA,Section 303 and 304?
If Yes, provide county plus district name/number:
b.Are agricultural lands consisting of highly productive soils present? ❑Yes®No
i. If Yes: acreage(s)on project site?
---
ii. Source(s)of soil rating(s): ._..
.........................ww --.. . ..._....._................._....... .___..____............_____........................
c. Does the project site contain all or part of,or is it substantially contiguous to,a registered National ❑Yes®No
Natural Landmark?
If Yes:
i. Nature of the natural landmark: ❑Biological Community ❑ Geological Feature
ii. Provide brief description of landmark,including values behind designation and approximate size/extent:
d.Is the project site located in or does it adjoin a state listed Critical Environmental Area? ❑Yes®No
If Yes:
i. CEA name:
H. Basis for designation:
...
iii. Designating agency and date„ _ _
Page 12 of 13
�.�.....�m.. ..........
e.Does the project site contain,or is it substantially contiguous to,a building,archaeological site,or district ❑Yes®No
which is listed on,or has been nominated by the NYS Board of Historic Preservation for inclusion on,the
State or National Register of Historic Places?
If Yes:
i. Nature of historic/archaeological resource: El Archaeological Site ❑Historic Building or District
ii. Name: _
iii. Brief description of attributes on which listing
is based.
....... ..
f. Is the project site,or any portion of it,located in or adjacent to an area designated as sensitive for ❑Yes®No
archaeological sites on the NY State Historic Preservation Office(SHPO)archaeological site inventory?
_................................
_.._... _.
g.Have additional archaeological or historic site(s)or resources been identified on the project site? ❑Yes®No
If Yes:
i.Describe possible resource(s):
ii. Basis for identification:
__.. ...... .......
h. Is the project site within fives miles of any officially designated and publicly accessible federal,state,or local ®Yes❑No
scenic or aesthetic resource?
If Yes:
i. Identify resource LAKE GEORGE GLEN LAKE __ _
ii. Nature of,or basis for,designation e. established highway overlook state or local
gn ( g., park,state historic trail or scenic byway,
etc.)„ LAKES..... ....... ------------------------- ------------
iii. Distance between project and resource; „ / 7,0 miles,
..... _ ...._.. ._........ _...._ .......... _
i. Is the project site located within a designated river corridor under the Wild,Scenic and Recreational Rivers ❑Yes®No
Program 6 NYCRR 666?
If Yes:
i. Identify the name of the river and its designation: __ _
ii. Is the activity consistent with development restrictions contained in 6
NYCRR Part 666? ❑Yes❑No
F.Additional Information
Attach any additional information which may be needed to clarify your project.
If you have identified any adverse impacts which could be associated with your proposal,please describe those impacts plus any
measures which you propose to avoid or minimize them.
G. Verification
I certify that the information provided is true to the best of my knowledge.
B 2/2016
Applicant/Sponsor N° IC.i4,S W DOME,EIT Date ._
Signature.... _. Title AGENT
PRINT FORM J Page 13 of 13
Full Environmental Assessment Form
Part 2-Identification of Potential Project Impacts
Part 2 is to be completed by the lead agency. Part 2 is designed to help the lead agency inventory all potential resources that could
be affected by a proposed project or action. We recognize that the lead agency's reviewer(s)will not necessarily be environmental
professionals. So,the questions are designed to walk a reviewer through the assessment process by providing a series of questions that
can be answered using the information found in Part 1. To further assist the lead agency in completing Part 2,the form identifies the
most relevant questions in Part I that will provide the information needed to answer the Part 2 question. When Part 2 is completed,the
lead agency will have identified the relevant environmental areas that may be impacted by the proposed activity.
If the lead agency is a state agency and the action is in any Coastal Area,complete the Coastal Assessment Form before proceeding
with this assessment.
Tips for completing Part 2:
• Review all of the information provided in Part 1.
• Review any application,maps,supporting materials and the Full EAF Workbook.
• Answer each of the 18 questions in Part 2.
• If you answer"Yes"to a numbered question,please complete all the questions that follow in that section.
• If you answer"No"to a numbered question,move on to the next numbered question.
• Check appropriate column to indicate the anticipated size of the impact.
• Proposed projects that would exceed a numeric threshold contained in a question should result in the reviewing agency
checking the box"Moderate to large impact may occur."
• The reviewer is not expected to be an expert in environmental analysis.
• If you are not sure or undecided about the size of an impact,it may help to review the sub-questions for the general
question and consult the workbook.
• When answering a question consider all components of the proposed activity,that is,the"whole action".
• Consider the possibility for long-term and cumulative impacts as well as direct impacts.
• Answer the question in a reasonable manner considering the scale and context of the project.
Impact
action involve construction on or physical a....._........ � -
Proposed n _ i alteration 1. Im act n Land
y on of ❑NO ❑YES
the land surface of the proposed site. (See Part 1. D.1)
If"Yes", answer questions a-i. If"No", move on to Section 2.
Relevant No,or Moderate
Part I small to large
Question(s) impact impact may
may occur occur
a.The proposed action may involve construction on land where depth to water table is E2d ] ❑
less than 3 feet.
b.The proposed action may involve construction on slopes of 15%or greater„ E2f Q �]
c.The proposed action may involve construction on land where bedrock is exposed,or E2a
generally within 5 feet of existing ground surface.
d.The proposed action may involve the excavation and removal of more than 1,000 tons D2a ❑
of natural material.
e.The proposed action may involve construction that continues for more than one year Dle El ❑
or in multiple phases.
£The proposed action may result in increased erosion,whether from physical D2e,D2q ®, ❑
disturbance or vegetation removal(including from treatment by herbicides)„
g.The proposed action is,or may be,located within a Coastal Erosion hazard area. B 1 i ( ]'
h.Other impacts: ......— — --.....--- 1:11
Page 1 of 10
......._......... ....................... ._._. .
2. Impact on Geological Features
The proposed action may result in the modification or destruction of,or inhibit
access to, any unique or unusual land forms on the site(e.g.,cliffs, dunes, ❑NO ❑YES
minerals, fossils,caves). (See Part 1. E.2.g)
If"Yes", answer questions a-c. If`No", move on to Section 3.
Relevant No,or Moderate
Part I small to large
Question(s) impact impact may
may occur occur
a.Identify the specific land form(s)attached: ..........
Egg 0 ❑
b.The proposed action may affect or is adjacent to a geological feature listed as a E3c
registered National Natural Landmark.
Specific featured
c. Other impacts: .... .............. ....._ -.-.- _ ----
.... ........... _ ...
3. Impacts is on Surface Water
The proposed action may affect one or more wetlands or other surface water ❑NO ❑YES
bodies(e.g., streams,rivers,ponds or lakes). (See Part 1. D.2, E.2.h)
If"Yes", answer questions a- 1. 1f"No", move on to Section 4.
Relevant No,or Moderate
Part I small to large
Question(s) impact impact may
may occur occur
a.The proposed action may create a new water body. D2b,Dlh Q
.............. ..........
b.The proposed action may result in an increase or decrease of over 10%or more than a D2b ❑
10 acre increase or decrease in the surface area of any body of water.
c.The proposed action may involve dredging more than 100 cubic yards of material D2a ❑
from a wetland or water body.
... .._. .... _...._ ...................._..__.._..... _.. vw..... .__-__...........
d.The proposed action may involve construction within or adjoining a freshwater or E2h 11 0
tidal wetland,or in the bed or banks of any other water body.
e.The proposed action may create turbidity in a waterbody,either from upland erosion, D2a,D2h ❑ ❑
runoff or by disturbing bottom sediments.
f.The proposed action may include construction of one or more intake(s)for withdrawal D2c ❑ ❑
of water from surface water.
g.The proposed action may include construction of one or more outfall(s)for discharge D2d '
of wastewater to surface water(s).
h.The proposed action may cause soil erosion,or otherwise create a source of D2e ❑
stormwater discharge that may lead to siltation or other degradation of receiving
water bodies.
........ ........
i.The proposed action may affect the water quality of any water bodies within or E2h ❑ ❑
downstream of the site of the proposed action.
j.The proposed action may involve the application of pesticides or herbicides in or D2q,E2h D 0
around any water body.
k.The proposed action may require the construction of new,or expansion of existing, D 1 a,D2d [ 0
wastewater treatment facilities.
Page 2 of 10
1. Other impacts: . .... . ........ .......-----—-------- ......
--------------------------------------—------ ..............................
...................
..........—.................... .........................
4. Impact on groundwater
The proposed action may result in new or additional use of ground water,or [:]NO YES
may have the potential to introduce contaminants to ground water or an aquifer,
(See Part 1. D.2.a,D.2.c, D.2.d,D.2.p,D.2.q,D.2.t)
If"Yes", answer questions a-h. If"No", move on to Section S.
Relevant No,or Moderate
Part I small to large
Question(s) impact impact may
may occur occur
.............. ................... .............
a. The proposed action may require new water supply wells,or create additional demand D2c 13
on supplies from existing water supply wells.
b. Water supply demand from the proposed action may exceed safe and sustainable D2c n
withdrawal capacity rate of the local supply or aquifer.
Cite Source:
...........
c. The proposed action may allow or result in residential uses in areas without water and Dla,D2c El
sewer services.
d.The proposed action may include or require wastewater discharged to groundwater. D2d,E21
................................ ..... ..........
e. The proposed action may result in the construction of water supply wells in locations D2c,Elf,
where groundwater is,or is suspected to be,contaminated. E1g,Elh
........................ -.-......................... ...................-.— .............
f. The proposed action may require the bulk storage of petroleum or chemical products D2p,E21 Cl El
over groundwater or an aquifer.
g.The proposed action may involve the commercial application of pesticides within 100 E2h,D2q, 0 0
feet of potable drinking water or irrigation sources. E21,D2c
........ ............
h. Other impacts: -—- ---------111-11................. 0
—---------------- ......... ........... ......... ...........
5. Impact on Flooding
The proposed action may result in development on lands subject to flooding. ❑NO ❑YES
(See Part 1. E.2)
If"Yes", answer questions a-Q. If"No", move on to Section 6.
Relevant No,or Moderate
Part I small to large
Question(s) impact impact may
may occur occur
... .......-.................................... .....................
a.The proposed action may result in development in a designated floodway. E2i
b.The proposed action may result in development within a 100 year floodplain. E2j ❑ El
c.The proposed action may result in development within a 500 year floodplain. E2k El
d. The proposed action may result in,or require,modification of existing drainage D2b,D2e 0
patterns.
...................
e.The proposed action may change flood water flows that contribute to flooding. D2b,E2i, El 0
E2J,E2k ......
...................... .....................
f. If there is a dam located on the site of the proposed action,is the dam in need of repair, Ele 0
or upgrade?
Page 3 of 10
.........�..,
[j'-61-h—erimp acts; ❑ ❑
_ W ...............
6. Impacts on Air
The proposed action may include a state regulated air emission source. [:]NO []YES
(See Part 1. D.2.£,D,2,h,D.2.g)
If"Yes", answer questions a-f If"No",...move on to Section 7.
Relevant No,or Moderate
Part I small to large
Question(s) impact impact may
may occur occur
a. If the proposed action requires federal or state air emission permits,the action may
also emit one or more greenhouse gases at or above the following levels:
i. More than 1000 tons/year of carbon dioxide(CO2) D2g ❑ ❑
ii. More than 3.5 tons/year of nitrous oxide(N20) D2g ❑ ❑
iii.More than 1000 tons/year of carbon equivalent of perfluorocarbons(PFCs) D2g ❑ ❑
iv.More than.045 tons/year of sulfur hexafluoride(SF6) D2g
v. More than 1000 tons/year of carbon dioxide equivalent of D2g
hydrochloroflourocarbons(HFCs)emissions
vi.43 tons/year or more of methane D2h ❑ ❑
b.The proposed action may generate 10 tons/year or more of any one designated D2g ❑
hazardous air pollutant,or 25 tons/year or more of any combination of such hazardous
air pollutants.
c.The proposed action may require a state air registration,or may produce an emissions D2f,D2g [ ❑
rate of total contaminants that may exceed 5 lbs.per hour,or may include a heat
source capable of producing more than 10 million BTU's per hour.
d.The proposed action may reach 50%of any of the thresholds in"a"through"c", D2g ❑
above.
e.The proposed action may result in the combustion or thermal treatment of more than 1 D2s ❑
ton of refuse per hour,.
f.Other impacts; _ 0 0
................. ......... .....
7. Impact on Plants and Animals
The proposed action may result in a loss of flora or fauna. (See Part 1. E.2. m.-q.) NO ❑YES
If"Yes", answer questions a-i. If"No", move on to Section 8.
Relevant No,or Moderate
Part I small to large
Question(s) impact impact may
may occuroccur
any Ego ❑
a.The proposed action may cause reduction in population or loss of individuals of ❑
threatened or endangered species,as listed by New York State or the Federal
government,that use the site,or are found on,over,or near the site.
b.The proposed action may result in a reduction or degradation of any habitat used by Ego ❑
any rare,threatened or endangered species,as listed by New York State or the federal
........................ F -1................
government.
c.The proposed action may cause reduction in population,or loss of individuals,of any E2p ]', ❑
species of special concern or conservation need,as listed by New York State or the
Federal government,that use the site,or are found on,over,or near the site.
d.The proposed action may result in a reduction or degradation of any habitat used by E2p ❑
any species of special concern and conservation need,as listed by New York State or
the Federal government.
Page 4 of 10
.......... .._.._......._�...... ........
e.The proposed action may diminish the capacity of a registered National Natural ER ❑ ®'
Landmark to support the biological community it was established to protect.
f.The proposed action may result in the removal of,or ground disturbance in,any E2n ❑ ❑
portion of a designated significant natural community.
Source:
g.The proposed action may substantially interfere with nesting/breeding,foraging,or Elm ❑ ❑
over-wintering habitat for the predominant species that occupy or use the project site.
...................- ......
h.The proposed action requires the conversion of more than 10 acres of forest, Elb ❑ ❑
grassland or any other regionally or locally important habitat.
Habitat type&information source:
i.Proposed action(commercial,industrial or recreational projects,only)involves use of D2q ❑ 0
herbicides or pesticides.
.Other impacts: ❑
8. Impact on Agricultural Resources
The proposed action may impact agricultural
ic
ultural resources. (See Part 1. E.3.a. and b.) [:]NO ❑YES
If"Yes". answer questions a-h. If"No", move on to Section 9.
Relevant No,or Moderate
Part I small to large
Question(s) impact impact may
may occur occur
a.The proposed action may impact soil classified within soil group 1 through 4 of the Etc,E3b rl ❑
NYS Land Classification System.
b.The proposed action may sever,cross or otherwise limit access to agricultural land Ela,Elb ❑ El
...... (includes cropland,hayfields,pasture,vineyard,orchard,etc).
_ ... _........
c.The proposed action may result in the excavation or compaction of the soil profile of E3b ❑ ❑
active agricultural land.
d.The proposed action may irreversibly convert agricultural land to non-agricultural Elb,E3a ❑ ❑
uses,either more than 2.5 acres if located in an Agricultural District,or more than 10
acres if not within an Agricultural District.
e.The proposed action may disrupt or prevent installation of an agricultural land El a,Elb ❑ ❑
management system.
f. The proposed action may result,directly or indirectly,in increased development C2c,C3, ❑ ❑
potential or pressure on farmland. D2c,D2d
F_
g.The proposed project is not consistent with the adopted municipal Farmland C2c 0
Protection Plan.
h.Other impacts:.. _ - --------
Page 5 of 10
. . __.............
9, Impact on Aesthetic Resources
The land use of the proposed action are obviously different from, or are in ❑NO ❑YES
sharp contrast to, current land use patterns between the proposed project and
a scenic or aesthetic resource. (Part 1. E.La, E.Lb,E.31.)
If"Yes", answer questions a-z If"No", go to Section 10.
............
Relevant No,or Moderate
Part I small to large
Question(s) impact impact may
may occur occur
a.Proposed action may be visible from any officially designated federal,state,or local E3h 0
scenic or aesthetic resource.
b.The proposed action may result in the obstruction,elimination or significant E3h,C2b 0
screening of one or more officially designated scenic views.
c.The proposed action may be visible from publicly accessible vantage points: E3h
i. Seasonally(e.g.,screened by summer foliage,but visible during other seasons) ❑' ❑
ii.Year round ❑' ❑
d.The situation or activity in which viewers are engaged while viewing the proposed E3h
action is:
i. Routine travel by residents,including travel to and from work E2q,
0 11
ii.Recreational or tourism based activities
Elc
e.The proposed action may cause a diminishment of the public enjoyment and E3h ❑'
appreciation of the designated aesthetic resource.
£ There are similar projects visible within the following distance of the proposed Dla,Ela, Q'
project: Dlf,Dlg
0-1/2 mile
'/2-3 mile
3-5 mile
5+ mile
.. ........ ......... ...
g.Other impacts: ❑ ❑
10. Impact on Historic and Archeological Resources
The proposed action may occur in or adjacent to a historic or archaeological [:]NO ❑YES
resource. (Part 1. E.3.e,f. and g.)
If"Yes", answer questions a-e. If`No", go to Section 11.
Relevant No,or Moderate
Part I small to large
Question(s) impact impact may
may occur occur
a.The proposed action may occur wholly or partially within,or substantially contiguous E3e ❑ n
to,any buildings,archaeological site or district which is listed on or has been
nominated by the NYS Board of Historic Preservation for inclusion on the State or
National Register of Historic Places.
b.The proposed action may occur wholly or partially within,or substantially contiguous E3f
to,an area designated as sensitive for archaeological sites on the NY State Historic
Preservation Office(SHPO)archaeological site inventory.
........ ................. -
c.The proposed action may occur wholly or partially within,or substantially contiguous E 0
to,an archaeological site not included on the NY SHPO inventory.
Source:
Page 6 of 10
d. Other impacts;_.-. _...... .__ _.... ❑ ❑
.......
e. If any of the above(a-d)are answered"Yes",continue with the following questions
to help support conclusions in Part 3:
i. The proposed action may result in the destruction or alteration of all or part E3e,E3g, ❑ ❑
of the site or property. E3f
ii. The proposed action may result in the alteration of the property's setting or De,E3f,
integrity. E3g,E 1 a,
Elb
iii. The proposed action may result in the introduction of visual elements which Be,E3f,
are out of character with the site or property,or may alter its setting. E3g,E3h,
C2.C3
....--- ..........
11. Impact on Open Space and Recreation
The proposed action may result in a loss of recreational opportunities or a ❑NO YES
reduction of an open space resource as designated in any adopted
municipal open space plan.
(See Part 1. C.2.c,E.l.c.,E.2.q.)
If"Yes", answer questions a- e. If"No",go to Section 12.
.... ..�._ ....... ......... ___...........
Relevant No,or Moderate
Part I small to large
Question(s) impact impact may
may occur occur
a.The proposed action may result in an impairment of natural functions,or"ecosystem D2e,Elb ❑
services",provided by an undeveloped area,including but not limited to stormwater E2h,
storage,nutrient cycling,wildlife habitat. Elm,E2o,
E2n,E2r)
b. The proposed action may result in the loss of a current or future recreational resource. C2a,Elc, ® ❑',
C2c,E2q
c. The proposed action may eliminate open space or recreational resource in an area C2a,C2c El
with few such resources. Elc,E2q
d. The proposed action may result in loss of an area now used informally by the C2c,Elc ❑, El
community as an open space resource.
e. Other impacts:... ❑
.............
12. Impact on Critical Environmental Areas
The proposed action may be located within or adjacent to a critical NO YES
environmental area(CEA). (See Part 1. E.3.d)
If"Yes", answer questions a-c. If`No", go to Section 13.
Relevant No,or Moderate
Part I small to large
Question(s) impact impact may
may occur occur
a. The proposed action may result in a reduction in the quantity of the resource or E3d n
characteristic which was the basis for designation of the CEA.
b.The proposed action may result in a reduction in the quality of the resource or E3d n
characteristic which was the basis for designation of the CEA.
c. Other impacts:-. ❑
Page 7 of 10
........................................... .................._.. ........ ....................
13. Impact on Transportation
The proposed action may result in a change to existing transportation systems. ❑NO ❑YES
(See Part 1. D.2.j)
If"Yes", answer auestions a-L7. If`No". _eo to Section 14.
Relevant No,or Moderate
Part I small to large
Question(s) impact impact may
............ _.�. _......�.. ....
may occur occur
a.Projected traffic increase may exceed capacity of existing road network. D2j ❑ ❑
b. The proposed action may result in the construction of paved parking area for 500 or D2j ❑ ❑
more vehicles.
c. The proposed action will degrade existing transit access. D2j ❑ ❑
d.The proposed action will degrade existing pedestrian or bicycle accommodations. D2j ❑ El
e.The proposed action may alter the present pattern of movement of people or goods. D2j
£ Other impacts:...... rl
............................... _.-._._.._..._...___..
14. Impact on Energy
The proposed action may cause an increase in the use of any form of energy, NO []YES
(See Part 1.D.21)
If"Yes", answer questions a- e. If`No", go to Section 15.
Relevant No,or Moderate
Part I small to large
Question(s) impact impact may
may occur occur
a. The proposed action will require a new,or an upgrade to an existing,substation. D2k ❑ ❑
b.The proposed action will require the creation or extension of an energy transmission Dlf, ❑
or supply system to serve more than 50 single or two-family residences or to serve a Dlq,D2k
commercial or industrial use.
c. The proposed action may utilize more than 2,500 MWhrs per year of electricity. D2k
d.The proposed action may involve heating and/or cooling of more than 100,000 square Dlg ❑ ❑
feet of building area when completed.
....
e.Other Impacts: ❑
..........---.-�.._____
15. Impact on Noise,Odor, and Light
The proposed action may result in an increase in noise,odors,or outdoor lighting. [:]NO ❑YES
(See Part 1.D.2.m.,n., and o.)
If"Yes", answer questions a-f. If`No", go to Section 16.
Relevant No,or Moderate
Part I small to large
Question(s) impact impact may
occur
... .........
may occur occ
a.The pro ... _. ..... ._._.. �........
posed action may produce sound above noise levels established by local D2m
regulation.
b.The proposed action may result in blasting within 1,500 feet of any residence, D2m,Eld [� ❑
hospital,school,licensed day care center,or nursing home.
c.The proposed action may result in routine odors for more than one hour per day, D2o ❑ ❑
Page 8 of 10
d.The proposed action may result in light shining onto adjoining properties. 132n �] ❑
e.The proposed action may result in lighting creating sky-glow brighter than existing 132n,Ela ❑ El
area conditions.
f.Other impacts:........... ... ❑
-------------------------
..�....._ __._._._ ..........
16. Impact on Human Health
The proposed action may have an impact on human health from exposure ❑NO DYES
to new or existing sources of contaminants. (See Part 1.13.2.q., E.1. d. f. g. and h.)
If"Yes", answer questions a-m. If"No", go to Section 17.
Relevant No,or Moderate
Part I small to large
Question(s) impact impact may
may cccur occur
a.The proposed action is located within 1500 feet of a school,hospital,licensed day Eld El ❑
care center,group home,nursing home or retirement community.
b.The site of the proposed action is currently undergoing remediation. Elg,Elh El
c.There is a completed emergency spill remediation,or a completed environmental site Elg,Elh ® ❑
remediation on,or adjacent to,the site of the proposed action.
d.The site of the action is subject to an institutional control limiting the use of the Elg,Elh ❑
property(e.g.,easement or deed restriction).
e.The proposed action may affect institutional control measures that were put in place Elg,Elh ❑
to ensure that the site remains protective of the environment and human health.
f.The proposed action has adequate control measures in place to ensure that future 132t
generation,treatment and/or disposal of hazardous wastes will be protective of the
environment and human health.
g.The proposed action involves construction or modification of a solid waste D2q,E 1 f ❑ ❑
management facility.
h.The proposed action may result in the unearthing of solid or hazardous waste. 132q,Elf ❑ ❑
....... .------
i.The proposed action may result in an increase in the rate of disposal,or processing,of D2r,D2s
solid waste.
j.The proposed action may result in excavation or other disturbance within 2000 feet of Elf,Elg FI ❑
a site used for the disposal of solid or hazardous waste. Elh
k.The proposed action may result in the migration of explosive gases from a landfill Elf,Elg ❑ El
site to adjacent off site structures.
1.The proposed action may result in the release of contaminated leachate from the 132s,Elf, 0 ❑
project site. 132r
in. Other impacts:.. -------------------------------- ❑ rl
Page 9 of 10
................................. ............._. ........
17. Consistency with Community Plans
The proposed action is not consistent with adopted land use plans. []NO DYES
(See Part 1. C.1, C.2. and C.3.)
If"Yes", answer questions a-h. If"No", go to Section I8.
_._... .......... ...............
Relevant No,or Moderate
Part I small to large
Question(s) impact impact may
may occur occur
a.The proposed action's land use components may be different from,or in sharp C2,C3,Dla 1:1 ❑
contrast to,current surrounding land use pattern(s). Ela,Elb
.............__ _ ❑ .__._-
b.The proposed action will cause the permanent population of the city,town or village C2
in which the project is located to grow by more than 5%. _
c.The proposed action is inconsistent with local land use plans or zoning regulations. C2,C2,C3 ❑ ...
d.The proposed action is inconsistent with any County plans,or other regional land use C2,C2 ❑ _.__._.❑
plans.
e.The proposed action may cause a change in the density of development that is not C3,Dlc, ❑ ❑
supported by existing infrastructure or is distant from existing infrastructure. Dld,Dlf,
Dld,Elb
f.The proposed action is located in an area characterized by low density development C4,D2c,D2d ❑'
that will require new or expanded public infrastructure. D2j
....... ....... ........
g.The proposed action may induce secondary development impacts(e.g.,residential or C2a ❑
commercial development not included in the proposed action)
h. Other: ❑''.
18. Consistency with Community Character
The proposed project is inconsistent with the existing community character. [:]NO YES
(See Part 1. C.2, C.3,D.2, E.3)
If"Yes", answer questions a-g. If"No", proceed to Part 3.
..............................
Relevant No,or Moderate
Part I small to large
Question(s) impact impact may
may occur occur
a. The proposed action may replace or eliminate existing facilities,structures,or areas E3e,E3f,E3g 0 ❑
of historic importance to the community„
b.The proposed action may create a demand for additional community services(e.g. C4 ❑ 11
schools,police and fire) _
W
c. The proposed action may displace affordable or low-income housing in an area where C2,C3,Dl f l ❑
there is ashortage of such housing. D 1 g,E 1 a
W
d.The proposed action may interfere with the use or enjoyment of officially recognized C2,E3 Q ❑
or designated public resources.
....
e.WThe proposed action... ...�.... .........................................
. ............
p p is inconsistent with the predominant architectural scale and C2 C3 ❑ ❑
character.
f.Proposed action is inconsistent with the._....
character of the existing natural landscape. C2,C3 ❑ ❑
Ela,Elb
E2g,E2h
,g, Other impacts. .......... ❑ ❑
PRINT.FULL FORM
Page 10 of 10
Full Environmental Assessment Form
Part 3 -Evaluation of the Magnitude and Importance of Project Impacts
and
Determination of Significance
Part 3 provides the reasons in support of the determination of significance. The lead agency must complete Part 3 for every question
in Part 2 where the impact has been identified as potentially moderate to large or where there is a need to explain why a particular
element of the proposed action will not,or may,result in a significant adverse environmental impact.
Based on the analysis in Part 3,the lead agency must decide whether to require an environmental impact statement to further assess
the proposed action or whether available information is sufficient for the lead agency to conclude that the proposed action will not
have a significant adverse environmental impact. By completing the certification on the next page,the lead agency can complete its
determination of significance.
Reasons Supporting This Determination:
To complete this section:
• Identify the impact based on the Part 2 responses and describe its magnitude. Magnitude considers factors such as severity,
size or extent of an impact.
• Assess the importance of the impact. Importance relates to the geographic scope,duration,probability of the impact
occurring,number of people affected by the impact and any additional environmental consequences if the impact were to
occur.
• The assessment should take into consideration any design element or project changes.
• Repeat this process for each Part 2 question where the impact has been identified as potentially moderate to large or where
there is a need to explain why a particular element of the proposed action will not,or may,result in a significant adverse
environmental impact.
• Provide the reason(s)why the impact may,or will not,result in a significant adverse environmental impact
• For Conditional Negative Declarations identify the specific condition(s)imposed that will modify the proposed action so that
no significant adverse environmental impacts will result.
• Attach additional sheets,as needed.
Determination of Significance-Type 1 and Unlisted Actions
.................. ......... ..
SEQR Status: ❑ Type 1 ❑Unlisted
Identify portions of EAF completed for this Project: ❑Part 1 ❑Part 2 ❑Part 3
..................
Upon review of the information recorded on this EAF,as noted,plus this additional support information
and considering both the magnitude and importance of each identified potential impact,it is the conclusion of the
as lead agency that:
❑ A. This project will result in no significant adverse impacts on the environment,and,therefore,an environmental impact
statement need not be prepared. Accordingly,this negative declaration is issued.
❑ B. Although this project could have a significant adverse impact on the environment,that impact will be avoided or
substantially mitigated because of the following conditions which will be required by the lead agency:
There will,therefore,be no significant adverse impacts from the project as conditioned,and,therefore,this conditioned negative
declaration is issued. A conditioned negative declaration may be used only for UNLISTED actions(see 6 NYCRR 617A).
❑ C. This Project may result in one or more significant adverse impacts on the environment,and an environmental impact
statement must be prepared to further assess the impact(s)and possible mitigation and to explore alternatives to avoid or reduce those
impacts. Accordingly,this positive declaration is issued.
Name of Action:
........
Name of Lead Agency:
__...............
Name of Responsible Officer in Lead Agency:
Title of Responsible Officer:
Signature of Responsible Officer in Lead Agency: BUILDING LOT Date:
Signature of Preparer(if different from Responsible Officer) Date:
For Further Information:
Contact Person: (518)743-0338
Address:
Telephone Number:
E-mail:
For Type 1 Actions and Conditioned Negative Declarations,a copy of this Notice is sent to:
Chief Executive Officer of the political subdivision in which the action will be principally located(e.g.,Town/City/Village of)
Other involved agencies(if any)
Applicant(if any)
Environmental Notice Bulletintffl p,B/v yin +µt3��ruy � vdt r;lla��c�lI tml
Preliminary Stage Revised April 2010
Signature Page
This page includes: 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:
Designates
As agent regarding: Variance Site Plan _______ Subdivision
For Tax Map No.: Section Block Lot
Deed Reference: 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: MICHAEL&CINDY TROMBLEY
Designates HUTCHINS ENGINEERING
As agent regarding: ✓ _Variance � Site Plan ✓ Subdivision
For Tax Iia No 265,, Section 1 Block 16 Lot
page 7/22/02 Date
OWNER S,GNATURER— w kk1r;r #2 Book 255 P " DATE: 2 2 20#
a
2,1 ENGIN_ERINO FEE I to 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 S 1.000 without notification to the applicant-
3j, AUTHORIZATION ORIZATION FOR IT # IT : By signing this page and submitting the application materials attached herein, the
Owner, Applicant, and his/herftheir agent(s) hereby authorize the Zoning BOard or Planning Board and Town Staff to enter the
subject properties for the purpose of reviewing the application submitted.
4. O" PIER 'PERMIT ESpt)NS.BILITIES: 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.
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
6j AQRf EI4 NT Ta") pRftVl E Giga_ MENT TIC'aN REt"U!IF ft: I, the undersigned, have thoroughly read and understand the
instructions for submission and agree to the submission requirements, I acknowledge no construction activities shall be commenced
prior to issuance of a valid permit. I certify that the application, plans and supporting materials are a true and complete
state ment/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 Ihae 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
e r.cud Ud ��agr e to the above.
��
MICHAEL[Applicant]
LPR OMB Y 2/2/2016 _
SiL jaa4vr� W grant Print Name A licant Date signed
LUCAS.W.DOBIE,EIT _ 2/2/2016
4f�jnaure Print Name [Agent] Date signed
Town of Queensbury Planning Office- 742 Bay Road • Queensbury; NY 12804• 518-761-3220 7
LANDS NOW OR FORMERLY OF
ANDREW T. & LINDA A. DOBROSKI
BK. 951, PG. 174
IRON
ROD
FOUND
LANDS NOW OR FORMERLY OF IRON p
RODS O e- S 81`26'00" E IRON
JESSE JENKINS FOUND 315.95'
ROD
`- STONE WALL ....•...............•.....• S 81`38'00" E 233.17' \` FOUND
8K. 1277, PG. 94 •
CRUSHED STONE
o
E o STONE WALL
GRAVEL oR,
Ay
TURN ;
` 00METAL d p`
1 AROUND +i GARAGE Z
I � �
Z 1
TURN AROUND EASEMENT •••
STONE +< TO THE TOWN OF QUEENSBURY a
MASONRY I \ AS NOTED ON MAP REFERENCE NO. 1
WALL
T o / 6" MAPLE
GARAGE
V)
IRON
x
ROD U*) -----
_
FOUND ' f77 SEPTIC I N
TANK x�
END OF
ASPHALT SURFACE I M
D.BOX
0 1H0 HOUSE £i 36" W. OAK
LOT 1
END OF TOWN ROAD ® x
3,75 ACRES± I LANDS NOW OR FORMERLY OF
AS SHOWN ON M o ' co
aD LAURA A. MABEY & JOHN G. FEDOROWICZ
MAP REFERENCE NO.1 104.2' LEACH cV x
f FIELD BK. 1278, PG. 240
POND z
LANDS NOW OR FORMERLY OF 50.0'
JEFFREY M. JENKINS WELLTBACKED SE ` \ / x
BK. 1277, PG. 251
NOTES
1) FIELD SURVEY UPDATED TO SHOW THE METAL GARAGE
x ON LOT 1 IN MARCH, 2016.
LANDS OF MICHAEL S. & CINDY LYNN MARIE TROMBLEY 6" OAK 2) SUBJECT TO ALL RIGHTS THAT THE PUBLIC SERVICE UTILITY
COMPANIES MAY HAVE IN AND TO THE PREMISES.
x
3) THIS MAP WAS PREPARED WITHOUT BENEFIT OF AN UP-TO-DATE
— _ o TITLE REPORT OR ABSTRACT OF TITLE AND IS THEREFORE SUBJECT
M TO WHATEVER FACTS MAY BE REVEALED BY THESE SAID DOCUMENTS.
IRON (n ' �p
ROD
FOUND S 81'21'33" E 557.87' p
N V)
I`
O
Lo
r-
B.. X X-ar X—X, WIRE FENCE % jt IRON
utS X —X—X—X—X—X—X— X—X— ROD
16" MAPLEFOUND
18" W. OAK 10" OAK
41
LANDS NOW OR FORMERLY OF o o LOT O
CHARLES & SHIRLEY STEVENSON o O
BK. 448, PG. 591 0 Lo W 0 0 D E D 3,22 ACRES±
z 3
� � o
to
n N
JEDGE OF Wp0D5
.A.
OF A PROPOSED TWO LOT SUBDIVISION
LANDS OF
FIELD �,/
1CHAEL S. 7ROMBLEY
IRON
AND
I IRON O ROD CINDY LYNN MARIE 7ROMELEY
ROD N 8121'33" W 565.07' FOUND
FOUND
SI TUA TED IN
MAP REFERENCES DEED REFERENCE T014N OF QUEENSEURY, WARREN COUNTY NEW YORK
z 1) "MAP OF A SURVEY MADE FOR LANDS NOW OR FORMERLY OF ��� '� g®� �R "s ®16
0 MICHAEL S . TROMBLEY", MADE BY NICKOLE M. & TRACY B. STEVENSON JESSE L. JENKINS
z_ VAN DUSEN & STEVES, LAND SURVEYORS, TO
z DATED SEPTEMBER 12, 2001, REVISED BK. 1139, PG. 155
FEBRUARY 20, 2002 AND FILED IN THE MICHAEL S. TROMBLEY & SURVEY & MAP BY
WARREN COUNTY CLERK'S OFFICE ON CINDY LYNN MARIE TROMBLEY ®� SUR1oEYlNf�, LLC
MARCH 28, 2002 IN PLAT CAB. B, SLIDE 193. DTD. JULY 22, 2002 r �
ONLY COPIES MADE FROM THE ORIGINAL OF THIS o s
SURVEY MAP WHICH ARE MARKED WITH AN ORIGINAL pin
RCD. JULY 26, 2002 ry i i DONALD L. PIDGEON, Jr.
uj
OF THE LAND SURVEYORS EMBOSSED SEAL AND m BK. 1277, PG. 255
BEARING THE SURVEYORS ORIGINAL SIGNATURE IN } 2) "MAP SHOWING EXISTING SITE IMPROVEMENTS PROFESSIONAL LAND SURVEYOR
RED INK, SHALL BE CONSIDERED TO BE VALID m LANDS OF MICHAEL S. TROMBLEY AND
AND TRUE COPIES. N.Y.S. LICENSE NO. 50372
o " TAX MAP REFERENCE
w CINDY LYNN MARIE TROMBLEY", MADE BY F ��
UNAUTHORIZED ALTERATION OR ADDITION DONALD L. PIDGEON, Jr., LAND SURVEYOR, , t 16 MICHAEL ROAD
TO A SURVEY MAP BEARING A LICENSED IRONSECTION: 265.00, BLOCK: 1, PARCEL: 16
LAND SURVEYORS SEAL IS A VIOLATION ROD DATED DECEMBER 19> 2002. , FORT EDWARD, NEW YORK 12828
OF SECTION SUBDIVISION 2, OF (518) 792-4146
THE NEW YORKK STATE EDUCATION LAW. FOUND ��,>,.,, .._.-
Q-129-1-SD
/ / `✓�/ //F � �,1 ` ._.3� `�` 1, `3� .,,, ��u a��
l C._•�
IRON
ROD �
FOUND I / /,/-,—
`�
IRON '
RODS S 81-26'00"
E
FOUND � �� _ -�% — r`,=-- �-,1 A\����` ���1����A'/ ���,�ti�l � � ( �� � ,I �� a � �;' •, ti
STONE
I 315 95 / IRON
WALL \ S 81°38'
00 E -'�— r /lr,� ♦ �� J1i
......... 7-nH
, -
.............. � 233.17' ROD s
FOUND
r } °
k
CRUSHED STONE - "- ��,•, �,:��_ =-)� � � `:��'\1� r l r�, ��I ' ', 1 �z< <U �, �
\ EI / STONE WALL O- 4 -/�" - w ! ,� . „ K \ a
dr
77r
GRAVEL \ -a
�r,
1 Y 357.9
.r
TURN -�• �3�ESETBACK
•• ( 1} ,. ,� ��.."p �, t �yV�'ry '�` I. �� .....7 i � L�-.r' �I I�t �'�� ��} iil ��. p
2002 ZONING) � � � � � � � 11a �� � �� / � ,/ �� l,t .A�fl .. ,Ca
I o ` METAL /
I : � � r' (X1443 V , t.,.. . �- . � lF�.'1 - ``�'��i�� 'Ir '�J 4 . . , i I x• ....,._._ "
AROUND oo : GARAGE
I � / I ry�°�✓�� %. - '`} ��.�� ',:�,/',���1 �i..r'J�f�f � i.��i 1��,% y i t ' �, � , ` ,I Golf I,
t
' . }
ry
STONE I / / z , - r`J) \ ` !i"� ! '� �> `j]I� '' ? i' ,', ) 1
MASONRYX75 SIDE SETBACK
WALL
(PRESENT ZONING) '
I 0000 I ij
/ to
TURN AROUND ASEMENT / /
GARAGE / /
,
t0 ;/ o
IRON LO TO THE TOWN tF QUEENSBU�RY ti x
ROD 1 AS NOTED ON AP REFERENCE o o cn � -
/ rn
N0. 1. / f11 m z z -�
.�
FOUND 1 I / / I oo N 1
la
END OF AN K / / A ro
`f
I ASPHALT SURF�CE 01
'
�U� _
403.4 � � + �> n_ too° � l �ZEt
z
_00 NI � D.BOX �
00 0 0 / 0 1 STORY / LOT / I �Ik�
0 oh / HOUSE o I / SITE LOCATION LOCATION MAP
x i
END OF TOWN Ro D /97 8' //III ; 3,75 ACRES± / I � � ' ' ZONING REQUIREMENTS DENSITY CALCULATION
AS SHOWN ON . PATIOS, I I,
MAP REFERENCE IN 0.1 104.2' o WALKS&I I I 1 I LEACH / I I nC ADIRONDACK PARK AGENCY ZONE- LOW INTENSITY TOTAL ACREAGE = 6.97-AC= 303,575 SF
T PLANTINGSEDS I I I I FIELD /
TOWN OF QUEENSBURY ZONE- POND AREA = 8600 SF
rn 0 50%INIPERV.
z z I \ I RR-3A (RURAL RESIDENTIAL, 3-ACRE) USABLE ACREAGE FOR DENSITY= 294,975 SF
I o m �/ I I / I // x w TOTAL ACREAGE IN RR-3A: 6.97-ACRES MINIMUM LOT SIZE = 3-AC = 130,680 SF
a 11 I I / POND // w MINIMUM LOT SIZE- 3-ACRES NUMBER OF ALLOWABLE LOTS =
50.0'
LL FRONT SETBACK- 100 294,975 SF 1130,680 SF= 2.26
I D R I L I�D 100 I / 6 . g 7 ACRES± I �I' x w SIDE SETBACKS - 75' 2 - LOTS PROPOSED
WEL� I SETBAC / � REAR SETBACK- 100'
/ LANDS OF MICHAEL S. & // I AVERAGE LOT WIDTH - 400'
It CINDY LYNN MARIE TROMBLEY / x ROAD FRONTAGE- 400'
i
75'SIDE SETBACK / / I MAXIMUM BUILDING HEIGHT- 35'
(PRESENT ZONING) �
MINIMUM PERCENT PERMEABLE- 75%
C;
I� I SITE SETBACKS - LOT 1 SITE SETBACKS - LOT 2
I j LANDS OF MICHAEL S. & CINDIY LYNN MARIE TROMBLEY
2002 ZONING CURRENT EXISTING REQUIRED FOR PROPOSED
I RR-3A ZONE RR-3A ZONING RR-3A ZONE
l 30'SIDE SETBACK _
T (2002 ZONING) x
FRONT 50' 100' 97.8' - PORCH FRONT 100' 186'±
Q
� I / \ \ \ // o NORTH SIDE 30' 75' 30'- METAL
NORTH SIDE 75' 90'±
IRON � PROPOSED P.L.
ROD � � ><■ � � � � � � � � � � � co
I / S 81°21'33" E 557.87' - SOUTH SIDE 75' 95'±
FOUND Q I I O SOUTH SIDE 30 75 129.3 HOUSE
I I 357.9' - METAL GARAGE REAR 100' 317'±
�\ REAR 30' 100' 403.4' - HOUSE
i
/ \ o NOTE: HOUSE WAS CONSTRUCTED IN 2002, METAL GARAGE WAS CONSTRUCTED IN 2006±
LO
I I \\ H
' SITE DEVELOPMENT DATA - LOT 1 SITE DEVELOPMENT DATA - LOT 2
PROP. LOT AREA: 163,210 SF = 3.75-AC PROP. LOT AREA: 140,365 SF = 3.22-AC
I �' ESETBACK - - X X X X X WIRE FENCE / /` IRON
> — — — — r� — -�- — — — — — — — X X X ROD EXISTING TOTAL PROPOSED TOTAL
I PT-1 P ' \ X X FOUND
186 t IMPERVIOUS AREAS IMPERVIOUS AREAS
J I I \i I I HOUSE&ATTACHED GARAGE 2345 SF
I o I HOUSE 3500 SF
y I lU I I METAL GARAGE 470 SF DRIVE 5500 SF
I rI
I in � L O T 2 o I DRIVE 7640 SF
I n
I nI 0 at
v \ I PORCH & DECK 445 SF
w I ��� Iy�JI \ m I _ o
. Q \ 3.22 A C R E S f y o TOTAL IMPERVIOUS 9000 SF
0 1-1 I oo - PATIO & WALKS 2340 SF
0 o c N PERCENT IMPERVIOUS 6.4%
00o I 0 \ \ I II � o
O N 1
Q- -� \ I I Cn TOTAL IMPERVIOUS 13,240 SF
z \
11 PROP. 317'± II PERCENT IMPERVIOUS 8.1% TAX MAP ID: 265.-l-16
Q) \ ® WELL I I ALTERATION OF THIS DOCUMENT EXCEPT BY A LICENSED
L I I PROFESSIONAL ENGINEER IS A VIOLATION OF NYS EDUCATION LAW.
7 D SETBACK
" J
J SITE SOILS DATA AREA VARIANCE REQUESTS
TEST PIT I §179-3-040 A.(2) (b) X61 - LOT WIDTH - LOTS 1 &2 (400'REQD)
�V H TP-1 - 1/4/08 BY: T.HU6/NS, P.E. - 303.8'- PROP. LOT 1 - 96.2'OF RELIEF REQUESTED \ 1 ISSUED FOR PRELIMINARY SUBDIVISION & AREA VARIANCES 3/15/16
LO WITNESSED BY DAN RYAN, f .E. - TOWN ENGINEER FOR QBY
\ 0) 0-6" MEDIUM BROWN SANDY TOPSOIL - 250'- PROP. LOT 2 - 150'OF RELIEF REQUESTED \ 0 ISSUED FOR TO APA FOR JURISDICTIONAL INQUIRY 2/3/16
\ 6-16" MEDIUM BROWN FINE SANDY LOAM
\ � No. Revisions Date
\ 16-36" LIGHT BROWN FINEI SANDY LOAM, SOME COBBLES \�
\ 36-88" LIGHT BROWN FINEI SANDY LOAM, 5090 BOULDERS §179-3-040 A.(2) (b) X71 - ROAD FRONTAGE- LOTS 1 & 2 (400'REQ'D) 190 SUBDIVISION PLAN
\\ ROOTS TO 60" I - 108.7'- PROP. LOT 1 - 291.3'OF RELIEF REQUESTED MAP REFERENCE
1 DRY ENTIRE DEPTH - 250'- PROP. LOT 2 - 150'OF RELIEF REQUESTED BOUNDARY INFORMATION TAKEN FROM MAP prepared for
1 NO SEASONAL HIGH GROUNDWATER EVIDENCE I IRON SHOWING EXISTING SITE IMPROVEMENTS LANDS Michael & Cindy Trombley
11� 565.07' FOUDOF MICHAEL S.ND MARIE TROMBLEY" PREPARED BYLEY AND NDY DONALDNL. SO Ellsworth Lane
N 81°21'33" W PERCOLATION TEST §179-5-020 D - GARAGES PIDGEON, JR. LICENSED LAND SURVEYOR Town of Queensbury Warren County New York
IRON
I ROD I PTi1 - 1/4/08 BY. T HUTCHINS, P.E. - ONLY 1 GARAGE PERMITTED PER DWELLING '
DATED DECEMBER 19, 2002.
FOUND II SUBDIVISION PLAN STABILIZED PERCOLATION RATE: 7 MINUTES PER INCH - RELIEF REQUESTED TO MAINTAIN EXISTING METAL GARAGE, Drawn: LWD Checked: GTH Scale: 1"=30' Date: 1/28/16
CONSTRUCTED IN 2006, UNDER PREVIOUS ZONING TOPOGRAPHY TAKEN FROM USGS DATA 169 Hovilond Rood
SCALE: 1"=30' 0 Queensbury, NY 12804
FINAL SURVEY PLAT TO BE PREPARED BY (518) 745-0307 Phone 29997-01 -S2
Ln LICENSED LAND SURVEYOR PRIOR TO FILING Hutchins Engineering (518) 745-0308 Fox
z WARREN COUNTY CLERK
RECORDING COVER SHEET
EMP. 111ITIALS _ IttSTRMNT 9 Is
No. of,PAGES �_ TYPE OF DOC. +
ADDTL,.FEE TOWN
ADDTL. NAMES
TRANSFER TAX AHT. * MORTGAGE A_MT. —
* T
* MORTGAGE TAX C
TRANSFER TAX STAMP * MORTGAGE TAX STAMP 1
RECEIVED
REALESTATE
lei
A JUL z 6 zooz
w
w TRANSFER TAX
WARREN COUNTY
***hA hhh A A A h*h*A*AA****A*h**A*A******A***h***AA*********A****►.********i.**********f*
Please fill in blanks below before submitting for recording.
PARTY OF THE FIRST PART JESSE L. JENKTNS
PARTY OF, THE SECOND PART MICHAEL S. TROMBLEY AND CINDY LYNN MARIE TROMBLEY
RECORDED 8Y: lycP➢nil t xss
RETURN T0: Joseph &CcB*Neilli, s Escy /
/ RECORDING STA.*LD
P.O. Dor. 1391 / R
South Glans Falls. ity 12803 / / ",
� t
/ O2 Jug 4b F11 4: 0
/ R
Upon recording, this page becomes a part of the /
docuaent (43.00) /
/ RECORDED
/
y
G�
4'
NY DEED-WARRANTY Wah Lim Cmn
eru I
THIS INDENTURE,Made the 22nd day of July,2002
BETWEEN
JESSE L.JENKINS,residing at 91 Ellsworth Lane,Lake George,NY 12845,
Party of(lie first part,
and
MICHAEL S.TROMBLEY and CINDY LYNN MARIE TROMBLEY,
husband and wife both residing at 91 Elisworth Lane,Lake George,NY 12845
Party of the second part,
:j WITNESSETH that the Party of the first part,in consideration of ONE DOLLAR($1.00)lawful
money of the United Slates,and other good and valuable consideration paid by the Party of the
second part,does hereby grant and release unto the Party of the second part,its heirs,successors
Ut and assigns forever,
07
80 Ellsworth Lane a
Town of Queensbury,County of Warren
Tax Map 4 265-1-16
(Property more fully described in Schedule A annexed hereto)
TOGETHER with the appurtenances and all of the estate and rights of the Party of the first part
in and to said premises,
TO HAVE AND TO HOLD the premises herein granted unto the Party of the second part,its
Successors and assigns forever,
AND said Party of the first part covenant as follows:
FIRST,That(lie Party of the second part shall quietly enjoy the said premises;
SECOND,That said Party of the first part will forever WARRANT and defend the title
to said premises.
THIRD,That in compliance with Section 13 of the Lien Law,the grantor will receive the
consideration for this conveyance and will hold the right to receive such consideration as a trust
fund to be applied first for the purpose of paying the cost of the improvements and will apply the
same first to the payment of the cost of the improvements before using any part of the total of the
some for any other purpose.
Z
4 X.
IN WITNESS WHEREOF,the Party ofthc first part has executed this Deed on the day
and year First nbove written. I"
dA'SF.L.JENKINe—
a
I
m
T
�P
STATE OF NEW YORK
COUNTY Or
firs tile„a' 'lay of t�r. _ 2002,before me,the undcrsigned,a Na
Notary Public itt and for said State,leers nally appcared JESSE L.JEN 'INS,personally known CA
to ntc or proved to me on the basis ofsatist`actory evidence to be the individual whose name is
subscribed to the within instrument and acknowledged to me that he/she executed the same in
hiAcr capacity and that fay his/her signature on the instrument,the individual,or the person on
behalf of which the individual acted,executed the instrument,.
t
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mL
Cary ublic
JosmWkWitups
HaWy PLWStz 0& kw YA
-AW�t
It&R to: dMtl rwrr � /
Joseph W. McPhillips,Attorney
11.0.Dox 1391
South Glens Palls,NY 12803
p�
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I
i
2
4
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u
All that certain piece or parcel of land situate,lying and being in the Town of
Queensbury,County of Warren and State of New York,more particularly bounded and described
as follows:
Beginning at a point in the easterly bounds of Ellsworth Lane at the northwest corner of
land conveyed to Nicole N,Stevenson and Tmcey B.Stevenson by deed dated October 18,1999,
recorded in Book 1139 of deeds at page 155;running thence North 08 degrees 00 minutes 00
seconds East,along the easterly side of said Ellsworth Lane,a distance of 358.76 feet to the
northeasterly corner of said Ellsworth Lane;thence continuing North 08 degrees 00 minutes 00
seconds East a distance of 195.12 feet to a point in the southerly bounds of lands now or
formerly of Andrew and Linda Dobroski;thence running along said lands as defined by a stone
wall the following two courses and distances:
(1) South 81 degrees 26 minutes 00 seconds East a distance of 315,95 feet;
(2) South 81 degrees 38 minutes 00 seconds East a distance of 233.17 feet to the
northwest comer of lands now or formerly of Byron and Judy Rist;thence running
m along the same following two courses and distances:
n (1) South 06 degrees l6 minutes 30 seconds West a distance of 361.23 feet;
Ab (2) South 06 degrees 23 minutes 00 seconds West a distance of 174.86 feet to the
northeast corner of said lands of Stevenson;thence running North 83 degrees 21 t
minutes 33 seconds West along the northerly bounds thereof a distance of 565.07
feet to the point and place of beginning. Containing 6.97 acres of land be the
same more or less.
Bearings given in the above description refer to magnetic North.
Subject to casements of record.
Subject also to a turn around easement granted to the Town of Queensbury at the
northerly end of said Ellsworth Lane.
Being the same premises described in a deed from Janet Jenkins to Jesse L.Jenkins dated
September 10,1988 and recorded in the Warren County Clerk's Office September l5, 1988 in
Book 724 at Page 245.
Schedule A(Description)
3