3.04 3.4
TRANSIENTSTinpire State Tovvnig at Great Escape—APPROVE-5-2-16
RESOLUTION APPROVING EMPIRE STATE TOWING AND RECOVERY
ASSOCIATION'S APPLICATION FOR PROPOSED
TRANSIENT MERCHANT/TRANSIENT MERCHANT MARKET
AT GREAT ESCAPE THEME PARK
RESOLUTION NO.: ,2016
INTRODUCED BY:
WHO MOVED ITS ADOPTION
SECONDED BY:
WHEREAS, the Empire State Towing and Recovery Association has submitted an application
to the Queensbury Town Board for a Transient Merchant/Transient Merchant Market License to
conduct a transient merchant market from June 3rd through June 5dr, 2016 for the sale of flatbed trucks
and trailers, truck parts, towing items and other items at the Great Escape Theme Park, 1172 State
Route 9, Queensbury in accordance with the provisions of Town Code Chapter 160, and
WHEREAS, the application is essentially identical to the application submitted by the applicant
and approved by the Town Board in 2015, and since the Queensbury Planning Board conducted site
plan review of various projects at the Great Escape Theme Park, the Town Board does not deem it
necessary to refer this application to the Planning Board for site plan review,
NOW, THEREFORE, BE IT
RESOLVED, that in accordance with the requirements set forth in Queensbury Town Code
§160-8, the Queensbury Town Board hereby grants a Transient Merchant/Transient Merchant Market
License to the Empire State Towing and Recovery Association (Empire) to conduct a transient
merchant market for the sale of flatbed trucks and trailers, truck parts, towing items and other
items at the Great Escape Theme Park, 1172 State Route 9 Queensbury, subject to the following:
1. Empire must pay all fees as required by Town Code Chapter 160;
2. Empire must submit a bond in the amount of$10,000 as required by Chapter 160;
3. Empire must submit proof of authorization to do business in New York and authorization
of agent to receive service of summons or other legal process in New York;
4. The License shall be valid only from June 3rd through June 5th, 2016 from 2:00-6:00 p.m.
on June 3rd, from 9:00 a.m. to 5:00 p.m. on June 0, and from 9:00 a.m. to 3:00 p.m. on
June 5th, and the license shall expire immediately thereafter;
5. Empire shall add parking lot attendants to the "additional vendors" and "beauty pageant"
lots as necessary;
6. Empire shall coordinate the inspection and approval of the tents/canopies with the Town of
Queensbury's Fire Marshal prior to any occupancy thereof,
7. The Transient Merchant License shall not be assignable; and
8. Empire must comply with all regulations specified in Town Code §160-8.
Duly adopted this 2nd day of May, 2016, by the following vote:
AYES
NOES
ABSENT:
TrArsierifMerc,hentirrar*OtisApfahatit Woken Revited June.2009
TOWN OF 04.fEaNS8URY.T.OW.14.150ARD APPOCATPN
TRAN*ENT.MEROHANTi TRANIENT MERCHANT MARKET
Submit 15 Oopies.10;-the TOO Oferk $1.c.440.01icatfon...rep 044 appticable Town:.Clerk
fees
DATE: St.20-1(P.
,,. •
APPLICANT'S NAMEi; . . a‘lVattlat
iD.PRE4S:
.•
.01101;'!,4
1. ,F6c10011Drt.
2. NY State..40eS Ta5s . • I. 114, 4; if
• • • 1
. tooataslIC
3iO0 MeOcet sik.. l'.
4. ..bet00 Hrotgol:YrOperat$Qm Sp, J • . •
.peacriptien,ofbocle.wares,•Cornmacgties or Services to be offered tor sale or to be used for• -
• ,o stifro• ' set cea
* Mt' HA )01-'5 ill,.•,11.1*,• • lit 4 a, tuft
6_ Other.informOorttb I30...Provi4ed;
A. If AppitcKiort.:JSAiod by 00Non,t;:i ,..:rorpti,of.thefirptor.pprsor(reprosentqOandweitten
aPtIrr#09.4b-Y1114:4ko-P00:00xikf the
E3; .•Aothodteflori otelp.AgPit to.romi*,:7Seiviiles.of.Sprnropps...
.0, A.planar -4#)ow.fhg:thelooEition. oflhe.pr.pposed maric't prosimity..tg. property
bour.)0000.0nd Or*°other tempoi*...or perm#606:t•stmotorw.pn the !qt, the plan or MOP
.020'49o:10*tho::foolibrtpfthwvetldpfs...Within the morket tike.prqvisions.fOr dedicated
.Pari514gIVOhJetiatAtVees.t9 from the xbrifhg.4114-tritg fri whioh.the market Is to
tie**ed protlilops forlketersitp*..eho:seW.ege •
siODA.Nri*OrAPPOehti., ,
i•Zatw.
Signature of Agent: COMMA M. A Le2A Date: 411/11,9"4
•
RECEIVEri
Town of-pudehSbunip!orptio Office r 7480 Rcia0.:!:Qv:00W%NY 42804 1 ret 220 A'11-/In aisBuR:
' 3 2016
LER(te
'S OFFICE
/277'1*
Site Plan Review Revised June 2009
General Information
Tax Parcel 2.c15, %7 t.- 3_____
Zoning District: i
fily -E-►v w 4 1-1144A-6 Current Use: f)aykc
Proposed Use:
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Location of project: ( c1," ' ,
Applicant Name E'.S •T D -A Address:
a D � iyl/� n 1, 1` �'1 Cell: b � ��'tl O
Home Phone C f151 - 514,.1 V- i
Work Phone l!!�� `"1�`Vut Fax
1-ng— I5- FSTOA
E-Mail: Mnatow@ op 6t ll,e,, 1 nG
Agent's Name: Address:
Home Phone Cell:
Work Phone Fax
E-mail
Owner's Name: -fro
6'eic1, Esuf( " ;ei Uas
rtfG 4
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Home Phone cJ CeIL
V) �-lqL U 2
ify �ri t 4 tZ^.--�CeZ-S I
Work Phone g � Vt h Fax 6 a D -NS S _ 6 q(Pg
E-mail pC Ai e��C!-„ �m,
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Town of Queensbury Planning Office.742 Bay Road•Queensbury,NY 12804 • 518-781-8220 2
Site Plan Review Revised June 2009
Site Development Data
Area/Type Existing sq.ft. Proposed Total sq.ft.
Addition sq.ft.
A. Building footprint
B. Detached Garage
C. Accessory Structure(s)
D. Paved, gravel or other hard surfaced area
E. Porches/ Decks
F. Other
G. Total Non-Permeable [Add A-F]
H. Parcel Area [43,560 sq.ft. /acre]
I. Percentage of Impermeable Area of Site [I=G/H]
Setback Requirements
Area Required Existing Proposed
Front[1]
Front[2]
Shoreline
Side Yard [1]
Side Yard [2]
Rear Yard [1]
Rear Yard [2]
Travel Corridor
Height[max]
Permeability
No. of parking spaces
Town of Queensbury Planning Office.742 Bay Road• Queensbury,NY 12804• 518-761-8220 3
Site Plan Review Revised June 2009
Additional Protect Information /�\
1. Will the proposal require a Septic Variance from the Town Board of Health? C.)
2. If the parcel has previous approvals, list application number(s):
3. Does this project require coverage under the NYS DEC Stormwater Pollution Prevention Program?
4. Estimated project duration: Start Date End Date
5. Estimated total cost of project:
6. Total area of land disturbance for project: - "
Floor Area Ratio Worksheet
FLOOR AREA RATIO (FAR)--The relationship of building size to lot size, derived by dividing the total building
floor area by the lot size in square feet, yielding a percentage.
Zoning District Symbol Floor Area Ratio [FAR]
Waterfront Residential WR 0.22
Commercial Moderate CM 0.3
Commercial Intensive CI 0.3
A. The combined area of all square footage, as measure from exterior walls of all structures on the property, including all
floors of the structures, garages, basements and attics with more than five (5) feet of ceiling height and covered
porches. Building square footage does not include: Open deck, docks and that portion of covered docks extending
over water and one storage shed of one hundred twenty (120) square feet or less. Any additional sheds will be
included. (See"FLOOR AREA RATIO").
B. Commercial or industrial:the total area in square feet as measured from the exterior of the outside walls of a building
or structure, and when applicable,the sum total of all floor areas of the principal and accessory buildings or structures
on the project site.
Parcel Area sq.ft.
Existing Floor Area sq.ft. [see above definition]
Proposed Additional Floor Area sq.ft.
Proposed Total Floor Area sq.ft.
Total Allowable Floor Area (Area x )[see above table]
Town of Queensbury Planning Office.742 Bay Road•Queensbury,NY 12804.518-761-8220 4
rtrhv rS Ir. Site Plan Review Revised June 2009
§ 179-9-080 Requirements for Site Plan Approval. The Planning Board shall not approve a Site Plan unless it
first determines that such site plan meets the following Standards. Please prepare responses to each of the following
topics.
STANDARDS
A. The proposed project furthers or is consistent with the policies of the Town's Comprehensive Plan.
B. The proposed project complies with all other requirements of this Chapter,including the site plan review standards as set forth in Paragraph F
of this section,the dimensional,bulk,and density regulations of the zoning district In which It Is proposed to be located(Article 3 and Table 1),
the applicable requirements of all other Articles that apply.
C. The site plan encourages pedestrian activity internally and,if practicable,to and from the site with pedestrian paths or sidewalks connected to
adjacent areas.
D. The site plan must conform to Chapter 136 Sewage and Sewage Disposal, Chapter 147 Stormwater Management Local Law, and other
applicable local laws.
E. the proposed use shall be In harmony with the general purpose or Intent of this Chapter,specifically taking into account the location,character
and size of the proposed use and the description and purpose of the district in which such use is proposed,the nature and Intensity of the
activities to be involved In or conducted in connection with the proposed use and the nature and rate of any increase In the burden on
supporting public services and facilities which will follow the approval of the proposed use.
F. The establishment,maintenance and operation of the proposed use will not create public hazards from traffic,traffic congestion or the parking
of vehicles and/or equipment or be otherwise detrimental to the health, safety or general welfare of persons residing or working in the
neighborhood or to the general welfare of the town.Traffic access and circulation, road intersections,road and driveway widths,and traffic
controls will be adequate.
G. Off-street parking and loading facilities will be appropriately located and arranged and sufficient to meet traffic anticipated to be generated by
the new use. The establishment of vehicle links between parking areas of adjacent properties are provided where feasible. This furthers the
Town's goal of reducing curb cuts and reducing congestion. A twenty-foot wide connection is required. If adjacent properties are either
undeveloped or previously developed without having made provision for future linkage, then a future connection must be identified and
provided for in the site plan under review for such future linkage when the time arises. The Planning Board may require proof that the
applicant has made contact with adjacent property owners for purposes of coordinating linkages with adjacent properties.
H. The project shall not have an undue adverse impact upon the natural,scenic,aesthetic,ecological,wildlife,historic,recreational or open space
resources of the town or the Adirondack Park or upon the adequate provision of supporting facilities and services made necessary by the
project, taking into account the commercial, industrial, residential, recreational or other benefits that might be derived from the project. In
making the determination hereunder, the Planning Board shall consider those factors pertinent to the project contained in the development
considerations set forth herein under§179-9.080 of this chapter,and in so doing,the Planning Board shall make a net overall evaluation of
the project in relation to the development objectives and general guidelines set forth in§179-9-080 of this Article.
I. The provision for and arrangement of pedestrian traffic access and circulation,walkway structures,control of intersections with vehicular traffic
and overall pedestrian convenience shall be safe and adequate for pedestrian movement. Pedestrian connections between adjacent sites
shall be provided to encourage pedestrian use.
J. Stormwater drainage facilities will prevent an increase of post development drainage flows as compared to pre-development drainage flows.
Drainage of the site shall recharge ground water to the extent practical. Surface waters flowing off-site shall not degrade any streams or
adversely affect drainage on adjacent properties or public roads. Facilities shall be in conformance with the drainage standards of Chapter
147 of the Town Code and the Town of Queensbury Subdivision Regulations where applicable.
K. The water supply and sewage disposal facilities will be adequate and will meet all applicable and current requirements set forth by Department
of Health regulations and Chapter 136 of the Town Code.
L. The adequacy, type and arrangement of trees, shrubs and other suitable plantings, landscaping and screening shall effectively provide a
visual and/or noise buffer between the applicants and adjoining lands, including the maximum retention of existing vegetation and
maintenance,Including replacement of dead or deceased plants.
M. Fire lanes,emergency zones,and fire hydrants will be adequate and meet the needs and requirements of emergency service providers.
N. The design of structures, roadways and landscaping in areas susceptible to ponding, flooding and/or erosion will minimize or avoid such
impacts to the maximum extent practicable.
0. The site plan conforms to the design standards,landscaping standards and performance standards of this chapter.
Town of Queensbury Planning Office.742 Bay Road• Queensbury, NY 12804-518-761-8220 5
.
Site Plan Review Revised June 2009
§ 179-9-050 Application for Site Plan Review
Application for site plan approval shall be made to the Planning Board using forms supplied by the Board.Application materials and the
site plan shall include sufficient information for the Board to make its findings under§ 179-9-070 and 179-9-080 below, In determining
the content of the site plan and supporting documentation, the Planning Board may waive certain requirements if the Planning Board
deems such requirements or information unnecessary for the type of project proposed. Any such waiver shall be made in writing, and
shall contain statements of the reasons why the waived information requirements are not necessary for an informed review under the
circumstances. The Planning Board may grant such waivers on its own initiative or at the written request of an applicant.Such request
shall set forth the specific requirements that are requested to be waived and the reasons for the requested waiver. Absent any waiver
or waivers, an application for Site Plan Review shall include the following:
Shown
REQUIREMENTS on Sheet
#
A A vicinity map drawn at the scale that shows the relationship of the proposal to existing community facilities which affect or serve it,
such as roads, shopping areas, schools, etc. The map shall also show all properties, identify owners,subdivisions, streets, and
easements within 500 feet of the property. Such a sketch may be superimposed on a United States Geological Survey map of the
area.
B The site plan shall be drawn at a scale of forty feet to the Inch(1"=40 feet)or such other scale as the Planning Board may deem
appropriate, on standard 24" x 38" sheets, with continuation on SW' x 11" sheets as necessary for written information. The
information listed below shall be shown on the site plan and continuation sheets.
C Name of the project,boundaries,date,north arrow,and scale of the plan.
D Name and address of the owner of record,developer,and seal of the engineer,architect,or landscape architect. If the applicant is
not the record owner,a letter of authorization shall be required from the owner
E The location and use of all existing and proposed structures within the property,including all dimensions of height and floor area,all
exterior entrances,and all anticipated future additions and alterations.
F The location of all present and proposed public and private ways, off-street parking areas, driveways, outdoor storage areas,
sidewalks, ramps, curbs, paths, landscaping, walls, and fences. Location, type, and screening details for all waste disposal
containers shall also be shown.
G The location,height,intensity,and bulb type(sodium,Incandescent,etc.)of all external lighting fixtures. The direction of illumination
and methods to eliminate glare onto adjoining properties must also be shown In compliance with§179.6-020.
H The location,height,size,materials,and design of all proposed signs.
I The location of all present and proposed utility systems including:
1. Sewage or septic system;
2. Water supply system;
3. Telephone,cable,and electrical systems; and
4. Storm drainage system including existing and proposed drain lines,culverts,catch basins,headwalls,endwalls, hydrants,
manholes,and drainage swales.
J Plans to prevent the pollution of surface or groundwater, erosion of soil both during and after construction, excessive runoff, and
flooding of other properties, as applicable. A Stormwater Pollution Prevention Plan (SWPPP) for all land development activities
(excluding agricultural activities) on the site that results in land disturbance of 1-acre or more. A SWPPP shall comply with the
requirements of the DEC SPDES MS-4 General Permit and Chapter 147 of the Town of Queensbury Code. It shall be at the
discretion of the Planning Board as to whether a SWPPP or an erosion and control plan shall be required for a site plan review project
land disturbance of less than 1-acre.
K Existing and proposed topography at two-foot contour intervals,or such other contour interval as the Planning Board shall allow. All
elevations shall refer to the nearest United States Coastal and Geodetic Bench Mark. If any portion of the parcel Is within the 100-
year floodplain,the area will be shown,and base flood elevations given. Areas shall be Indicated within the proposed site and within
50 feet of the proposed site where soil removal or filling is required,showing the approximate volume In cubic yards.
L A landscape plan showing all existing natural land features that may influence the design of the proposed use such as rock outcrops,
stands of trees,single trees eight or more Inches in diameter,forest cover,and water sources,and all proposed changes to these
features Including sizes and types of plants. Water sources include ponds,lakes,wetlands and watercourses,aquifers,floodplalns,
and drainage retention areas.
M Land Use District boundaries within 600 feet of the site's perimeter shall be drawn and identified on the site plan, as well as any
Overlay Districts that apply to the property.
Town of Queensbury Planning Office.742 Bay Road•Queensbury,NY 12804•518-761-8220 6
Site Plan Review Revised June 2009
N Traffic flow patterns within the site,entrances and exits,and loading and unloading areas,as well as curb cuts on the site and within
100 feet of the site. The Planning Board may,at its discretion,require a detailed traffic study for large developments or for those in
heavy traffic areas,which shall include:
1. The projected number of motor vehicle trips to enter or leave the site, estimated for weekly and annual peak hour traffic
levels;
2. The projected traffic flow pattern including vehicular movements at all major intersections likely to be affected by the
proposed use of the site;
3. The Impact of this traffic on levels of service on abutting public streets and at affected intersections. Existing and proposed
weekly and annual peak hour traffic levels and road capacity levels shall also be given.
0 For new construction or alterations to any structure,a table containing the following information shall be included:
1. Estimated area of structure to be used for particular purposes such as retail operation,office,storage,etc.;
2. Estimated maximum number of employees;
3. Maximum seating capacity,where applicable;and
4. Number of parking spaces existing and required for the intended use.
P 1. Floor Plans.
2. Elevations at a scale of one-quarter inch equals one foot(1/4"=1 foot)for all exterior facades of the proposed structure(s)and/or
alterations to or expansions of existing facades,showing design features and indicating the type and color of materials to be used.
Q Soil logs,water supply well and percolation test results, and storm runoff calculations,as needed to determine and mitigate project
impacts.
R Plans for disposal of construction and demolition waste,either on-site or at an approved disposal facility.
S Plans for snow removal,including location(s)of on-site snow storage.
T An Environmental Assessment Form("EAF"),as required by the SEQRA regulations,with Part 1 completed by the Applicant shall be
submitted as part of the application. If the proposed project requires a special use permit and an EAF has been submitted In
conjunction with a special use permit application,a duplicate EAF is not required for the site plan application..
U If an application is for a parcel or parcels on which more than one use is proposed,the applicant may submit a single application for
all such uses provided the proposed uses are accurately delineated on a site plan drawn pursuant to the requirements set forth
above. The Planning Board may grant the application with respect to some proposed uses and not others. For purposes of
reviewing an application (and for SEQRA compliance) all proposed uses on a single parcel or on contiguous parcels shall be
considered together.
✓ A brief narrative statement on how the project proposed for review furthers or is consistent with the vision,goals and policies in the
Town's Comprehensive Plan.
Town of Queensbury Planning Office.742 Bay Road•Queensbury, NY 12804 518-761-8220 7
Site Plan Review Revised June 2009
Pre-Submission Conference Form 1179-4-0401
1. Tax Map ID
2. Zoning Classification
3. Code Reference for Review:
4. Ordinance Reference#:
5. Pre-Submission Meeting Notes; Outstanding Items To Be Addressed Include:
Deed Yes No
General Information complete Yes No
Site Development Data Complete Yes No
Setback Requirements Complete Yes No
Additional Project Information Complete Yes No
*Coverage under DEC SWPPP Program Yes No
—
FAR Worksheet complete Yes No
—
Standards addressed Yes No
—
Checklist items addressed Yes No
Environmental Form completed Yes No
Signature Page completed Yes No
•A••licant must • 'vide office with Notice of Intent NOI • SWPPP Acce•tance o DEC letter issuin• •ermit number
Notice of Termination(NOT)
Staff Representative:
Applicant/Agent:
Date:
Town of Queensbury Planning Office.742 Bay Road•Queensbury,NY 12804. 518-761-8220 8
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. ito•Plan Ntview fievisert.June:2009
Signature Page
This page. ncludes thol..)Apaription'ttOci.ea A'Oeitt. Engineering Fee.0iritiOstire; AuthOrization fix-Site
Visits, 44) Othet Pentdt.Reetionsibilities, •&fitted Meeting t)liclosa e and 6.) AureOnient to provide dOCUnientben
required.
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Appendix B
Short Environmental Assessment Form
Instructions for Completing
Part 1 -Project Information. The applicant or project sponsor is responsible for the completion of Part 1. 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.
Complete all items in Part 1. You may also provide any additional information which you believe will be needed by or useful
to the lead agency;attach additional pages as necessary to supplement any item.
Part 1 -Project and Sponsor Information
Name of Actio or P1ro ecctp: n
tsrgit fl,f- l/r iCO
Project Location(describe,and attach a location map):
LOt- O I and 12t 44-2 Of Ord- G..�ca ih e Pa,k
Brief Description of Proposed Action:
Name of Applicant or Sponsor:
j' Telephone:LO I--- pi 4- 14 (f
5 W �� E-Mail: cr ) t� o bp e., 'iC t
Address: w„ t Q
I, c�cunQ ►� 1
City/PO: o J State: ,^ ,, Zip Code:
1 1210
I.Does the proposed action only involve the legislative adoption of a plan,local law,ordinance, NO YES
administrative rule,or regulation?
If Yes,attach a narrative description of the intent of the proposed action and the environmental resources that
may be affected in the municipality and proceed to Part 2. If no,continue to question 2.
2. Does the proposed action require a permit,approval or funding from any other governmental Agency? NO YES
If Yes,list agency(s)name and permit or approval:
AI
3.a.Total acreage of the site of the proposed action? acres
b.Total acreage to be physically disturbed? --- acres
c.Total acreage(project site and any contiguous properties)owned
or controlled by the applicant or project sponsor? acres
4. Check all land uses that occur on,adjoining and near the proposed action.
o Urban ❑Rural(non-agriculture) ❑Industrial X Commercial "Residential(suburban)
le Forest ❑Agriculture ❑Aquatic ❑ Other(specify):
❑Parkland
Page 1 of 4
5. Is the proposed action, NO YES N/A
a.A permitted use under the zoning regulations?
b.Consistent with the adopted comprehensive plan? X
6. Is the proposed action consistent with the predominant character of the existing built or natural NO YES
landscape?
X
7. Is the site of the proposed action located in,or does it adjoin,a state listed Critical Environmental Area? NO YES
If Yes, identify: x
8. a. Will the proposed action result in a substantial increase in traffic above present levels? NO YES
b.Are public transportation service(s)available at or near the site of the proposed action?
c. Are any pedestrian accommodations or bicycle routes available on or near site of the proposed action?
9.Does the proposed action meet or exceed the state energy code requirements? NO YES
If the proposed action will exceed requirements,describe design features and technologies:
10. Will the proposed action connect to an existing public/private water supply? NO YES
If Yes,does the existing system have capacity to provide service? ❑NO❑YES
If No,describe method for providing potable water:
11. Will the proposed action connect to existing wastewater utilities? NO YES
If Yes,does the existing system have capacity to provide service? ❑NO❑YES
If No,describe method for providing wastewater treatment:
12. a.Does the site contain a structure that is listed on either the State or National Register of Historic NO YES
Places?
b.Is the proposed action located in an archeological sensitive area? X
13. a.Does any portion of the site of the proposed action,or lands adjoining the proposed action,contain NO YES
wetlands or other waterbodies regulated by a federal,state or local agency?
b. Would the proposed action physically alter,or encroach into,any existing wetland or waterbody? X
If Yes, identify the wetland or waterbody and extent of alterations in square feet or acres: /y
14. Identify the typical habitat types that occur on,or are likely to be found on the project site. Check all that apply:
❑ Shoreline ❑ Forest ❑Agricultural/grasslands ❑Early mid-successional
❑ Wetland ❑Urban ❑Suburban
15.Does the site of the proposed action contain any species of animal,or associated habitats,listed NO YES
by the State or Federal government as threatened or endangered? >,
16. Is the project site located in the 100 year flood plain? NO YES
17.Will the proposed action create storm water discharge,either from point or non-point sources? NO YES
If Yes,
a. Will storm water discharges flow to adjacent properties? ❑NO❑YES X
b.Will storm water discharges be directed to established conveyance systems(runoff and storm drains)?
If Yes,briefly describe: ❑NO❑YES ?C'
Page 2 of 4
18.Does the proposed action include construction or other activities that result in the impoundment of NO YES
water or other liquids(e.g.retention pond,waste lagoon,dam)?
If Yes,explain purpose and size:
19.Has the site of the proposed action or an adjoining property been the location of an active or closed NO YES
solid waste management facility?
If Yes,describe: k"
20.Has the site of the proposed action or an adjoining property been the subject of remediation(ongoing or NO YES
completed)for hazardous waste?
If Yes,describe:
I AFFIRM THAT THE INFORMATION PROVIDED ABOVE IS TRUE AND ACCURATE TO THE BEST OF MY
KNOWLEDGE t 41114•Applicant/spon r name: -- Date: '�
Signature: ` /�,� N A
Part 2-Impact Assessment. The Lead Agency is responsible for the completion of Part 2. Answer all of the following
questions in Part 2 using the information contained in Part 1 and other materials submitted by the project sponsor or
otherwise available to the reviewer. When answering the questions the reviewer should be guided by the concept"Have my
responses been reasonable considering the scale and context of the proposed action?"
No,or Moderate
small to large
impact impact
may may
occur occur
1. Will the proposed action create a material conflict with an adopted land use plan or zoning
regulations?
2. Will the proposed action result in a change in the use or intensity of use of land? X
3. Will the proposed action impair the character or quality of the existing community? Ni
4. Will the proposed action have an impact on the environmental characteristics that caused the K
establishment of a Critical Environmental Area(CEA)?
5. Will the proposed action result in an adverse change in the existing level of traffic or
affect existing infrastructure for mass transit,biking or walkway?
6. Will the proposed action cause an increase in the use of energy and it fails to incorporate
reasonably available energy conservation or renewable energy opportunities? X.
7. Will the proposed action impact existing:
a.public/private water supplies? .
b.public/private wastewater treatment utilities? x,
8. Will the proposed action impair the character or quality of important historic,archaeological,
architectural or aesthetic resources? S.
9. Will the proposed action result in an adverse change to natural resources(e.g.,wetlands, h 1
waterbodies,groundwater,air quality,flora and fauna)? Vim'
Page 3 of 4
No,or Moderate
small to large
impact impact
may may
occur occur
10. Will the proposed action result in an increase in the potential for erosion,flooding or drainage
problems? 9C
11. Will the proposed action create a hazard to environmental resources or human health?
Part 3-Determination of significance. The Lead Agency is responsible for the completion of Part 3. For every
question in Part 2 that was answered"moderate to large impact may occur",or if there is a need to explain why a particular
element of the proposed action may or will not result in a significant adverse environmental impact,please complete Part 3.
Part 3 should,in sufficient detail,identify the impact,including any measures or design elements that have been included by
the project sponsor to avoid or reduce impacts. Part 3 should also explain how the lead agency determined that the impact
may or will not be significant.Each potential impact should be assessed considering its setting,probability of occurring,
duration,irreversibility,geographic scope and magnitude. Also consider the potential for short-term,long-term and
cumulative impacts.
❑ Check this box if you have determined,based on the information and analysis above,and any supporting documentation,
that the proposed action may result in one or more potentially large or significant adverse impacts and an
environmental impact statement is required.
❑ Check this box if you have determined,based on the information and analysis above,and any supporting documentation,
that the proposed action will not result in an significant adverse environmental impacts.
-r110 a. t Thar an
(4,--1'1
Name o L ad A ency Drat
Print o Ty.e Name of Res on.ibl- Offic, in Lead Agency Ties onsible O�cef
1,A`IJ A. P 414,1.4/4, g Y P
Signature of Responsible Officer in Lead Agency Signature of Preparer(if different from Responsible Officer)
a
Page 4 of 4
,)i.4.4,..4--- et) 1PI&c1'.>5.-4
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,., Company West ern Surety
,,,,
rlCONTINUATION CERTIFICATE
1
8 Western Surety Company hereby continues in force Bond No. 62353590 .briefly
described as HOLD HARMLESS FOR TRANSIENT ME,BJIANT MARKET LICENSE TOWNSHIP or
QUEEN BURX..______ ---
•
for MIRE STATE TOWING AND RECOVERY ASSOCIATION
as Principal,
A.
in the sum of$ TF.N THOUSAND AND NO/100 Dollars, for the term beginning
Apr,1 07 , 2016 , and ending April 07 , ..2-0.1.7_.--, subject to all
the covenants and conditions of the original bond referred to above.
This continuation is issued upon the express condition that the liability of Western Surety Company ,
under said Bond and this and all continuations thereof shah not be cumulative and shall in no event exceed
c.
the total sum above written.
•
Dated this 29 day of Febztzy , 2016 •
is;s���tylyt+++.�? WESTERN iJRETY COMPANY
�ti i4IF,fi fr• y.
' , ' �,N
Y
y ..:4:1:t.,. 'zt- By Paul T.B t,Vice President '
J Cyd I
a
� 441.eere.l46.
I
4
THIS"Continuation Certificate"MUST BE PILED WITH THE ABOVE BOND.
y Form 90-A-&2012
F=J�x.r_.r�•_a..!�cx_-....r._r. .. . -, -- - ,." :.., ---- ., .- x-a-i: rs.=s.cr.-rx.c.�r�1�
Western Surety
Company
POWER OF ATTORNEY
KNOW ALL MEN BY THESE PRESENTS:
That WESTERN SURETY COMPANY,a corporation organized and existing under the laws of the State of South Dakota,
and authorized and licensed to do business in the States of Alabama, Alaska, Arizona, Arkansas, California, Colorado,
Connecticut, Delaware, District of Columbia, Florida, Georgia, Hawaii, Idaho, Whole, Indiana, Iowa, Kansas, Kentuoky,
Louisiana, Maine, Maryland, Massachusetts, Michigan, Minnesota, Mississippi, Missouri, Montana, Nebraska, Nevada, New
Hampshire, New Jersey, New Mexico, New York, North Carolina, North Dakota, Ohio, Oklahoma, Oregon, Pennsylvania,
Rhode Island, South Carolina, South Dakota, Tennessee, Texas, Utah, Vermont, Virginia, Washington, West Virginia,
Wisconsin,Wyoming,and the United States of America,does hereby make,oonetitute and appoint
_ Paul T. Brufiat of Sioux Falls
State of South Dakota ,its regularly elected Vice President
as Attorney-in-Fact,with full power and authority hereby conferred upon him to sign, execute, acknowledge and deliver for
and on Its behalf as Surety and as its act and deed,the following bond;
One Is r . : ;di , i ' r ;+ ► ; . t ,T MARKET LZcENSE TOWNSHIP OF
QUEENSBURY
bond with bond number 2
for
as Principal In the penalty amount not to exceed:$10 000.00
Western Surety Company further certifies that the following is a true and exact copy of Section 7 of the by-laws of Western Surety
Company duly adopted and now in force,to-wit:
Section 7. All bonds,policies,undertakings,Powers of Attorney,or other obligations of the corporation shall be executed in the corporate
name of the Company by the President,Secretary,any Assistant Secretary,Treasurer,or any Vice President,or by such other officers as the
Board of Directors may authorize. The President, any Vioe President, Secretary, any Assistant Secretary,or the Treasurer may appoint
Attorneys-in-Fact or agents who shall have authority to issue bonds,policies,or undertakings in the name of the Company.The corporate
seal is not necessary for the validity of any bonds,policies, undertakings, Powers of Attorney or other obligations of the corporation. The
signature of any such officer and the corporate seal may be printed by facsim0e.
In Witness Whereof, the said WESTERN SURETY COMPANY,has caused these presents to be executed by its
Vice President with the corporate seal affixed this day of February , 2016,
ATTEST WE N SSU U RR COMPANY
By•
L.Nelson,Assistant Secretary Pau ,Bruflat,Vice President
01gst:E3atr,io
�
"a,.0,9 Oft d ,°
rY
w
STATE OF SOUTH DAKOTA ssyyM•
w •� 4
COUNTY OF MINNEHAHA w„ $?;'••.: �►
On this 29 day of February ' , 2016 ,before me,a Notary Public,personally appeared
Paul T.Bruflat and L. Nelson
who,being by me duly sworn,acknowledged that they signed the above Power of Attorney as Vice President
and Assistant Seoretary, respectively, of the said WESTERN SURETY COMPANY, and acknowledged said instrument to
be the voluntary act and deed of said Corporation.
+w444 ��ew44e,w�.,444e.aay444+
s J. MOHR
,SOUTH DAKOTA NOTARY PUBLIC
Notary Public
;444�.w.o�a4444g�•,yy44444ggie+ My Commission Expires June 23,2021
To validate bond authenticity, go to w►wvw.cnasurety,coxp > Owner/Obligee Services > Validate Bond
Coverage.
Form F1976-1.2016 (0
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