Bhatti Application li ion
Review Proicess.
ppllat arab'
e' Or agent shall meet IlAith, arai.n
Adhunistrator to,cl te
rMine type caf ra l needed..
aaw- �a anis lon a�a ting With staff
be held as later than Week prior tdeadline submittal)�IMUW—red.to �� 1 �1 completeaY�saa � ll ation
12. l aa�atarials (to
foran aapp�aiaatara.,t.
Application Submittal: one (1), �ri
Package 'nal applicat�i n �, �
ax aag with application on fees (I) deed and 14 OOPies of the p li aatl
on
In Addition,-. n eii t , d co,
f the entire as ii']: i t� �►� a� �qs,
Determination,of application cca pl teness and Placement on an agen& -
Planning
Board rnetiaxs are generafly the.third itin as th ch meeting to idah Tuesday's f eaala a�a�rratla.
attend
You WiTl a adWsd in
FO1loi&i,ng the meeting
aaaa Will. YAmr a. pl,i4� ra, Provided
with t
x:
atan as! app r»sla
tioi stat)I the hoard's
decison orapplication, was cid Your projectroved �� ayct likely sip is �uldia Permit. iat Proceed as submitted. IfSar
.
X1 , (1+sq. ),; $5,0,0 (30,01 -1,0,0,01 l0 s . -X
M. .
Craig
Broom, Director of pl uln /Zoning
�� a
ZO'nindministrator
l,aaaura Moore, hand Use P'lanner
aaa�a�r�.^�°���� aaa"�^��:�;�aaaa• .,oast
Sunray Sit, Specialist planning
Site
Flom Erle VP111c,,f1on—RI ev sed March 2014
'Own t Queenstaaar pI iiin c -74 Ba;y 1 oad-Queens
518-76 1-822 " d4
IM u ;fQtl�Ir�
Tac Parcel I : a?
Zbnfng District:
Lot ize: �
Current FIs ;
71?,4(-
Proposed Use.
PrOled Location;
IYs;2;a
A pRea
Wires
R A&&I
Address:
Home Phone ) 9 Celt:
�,
I
o' I I v
Y J , b. ,
*I'Iit�
"h,W1
a
Agent", FrM
Ia F
Fax
r� �Jm rs
Hone Phone
7
ork,Pi�aawr�� ,
Fax
E-Mall
SAO PWn
T ofQueervabu'irypl'amuning y 742 Bay d-Queensbury, NY 1280 .618.764- 0
ATQa/Type
_ i- Ire _
� rryod Tlsq, .
A. HuRcUng10rNt
B.
I 9cEed Garage --Z�7=2
U. Accessory Structurem, ""r
N/10111-
. rave0j,gravai or other hard surface area
E, irha f Docks LAQU�L' 4L'670�6 6,3
F. herr o e sunk
[old -F)
ri. tarC91 Area q!. ft. acral
743
]� er eMa a Impermeable,Area of Site. [t M]
A"lllo
its
Required
Proposed
rrti
t(1l
Front[21
�$holtllne
81da,Yara El-I
Sidi
Malar Yard 11
HOW Yard[ " ��qe�lo
'ravel �rrir
Wel'a # [Max]
Vern eability
6
IID, OT parking spaces
Plan ReWeW Revised,M=hi 2014
Town Or Queensbury PlannIn O1il s tam Quelendwry,NY 12'804.618-7614220
Wibll the propo a,l require a ' eptio'' a,riamnce from the Ton Board of Health?
If the parcel has previous approvals, list application nurrn ber( ): � e N
Doesttuia project require coverage under,the New York Statin Pollutant If iaoharg,e Elimination System
((POE ) Permit Program?
,. Estimated project durationStain Date Erd ate
24
Estimated total coat of project.:
. TotaI area of bared disturbance for pro,i.ect._i� �F
Floor AreLRabo Worksheet
FLOOR AREA R TI (EAR) -._The relationship of bui4d'r,n i size to lot size,,derived by dividing the total building
floor area bye the bot f n in square feet, yielding a peraernta a.
Zon,in, D�istr>ict- ' yrr boll Fto r read Ratio,,[FAR]
Waterfront Residential
l
0.22
Commercial Moderate rate f ommercial lntensiive M/CII
Main ,street
0.
A. The combined arca of e�lV.�ua .foot �ern�ont eradl attics, with more, than-fi�e� fort "� � °i�' property, ��� alll
e, a measure frorn, exterior walls, of all structure on theInalud
cors o structures, ars ea b � ) o aellin height and covered
porches, Building square footage does not includla:Open, dectu, docks and-that portion of-covered docks extending,
over mater and one torage shed of one hundred-t-twenty (f 0) sq,uuare feet airless. 'lay, additional fi,eda 'winl bre
�in,cl.uuded. (Sea"FLOOD AREA� ATI0"). w
B, Commercial or lrudu trial: the total area in,square feet as measured from Yb,eto jibr of•t a outside,walla of a buildings
or structure, and when, applloable, the,surra total of all floor areas of the principal a,nd accessoFy builldingia;or strv,cIure
on the project site.
A. Parcel Area
B. xi tin Floor mares q, ft. (see definition above) "
C. Proposed Adldition,M Floor Area sq.ft.
C. proposed Additional Floor Area scl.mft.
D. proposed Total Floor Area
ft.
F. Total Allowable Floor area s
re,a x° (see above ta,ble)
V D is Larger than E„ a Varrianor re'visJons for your plain may be needed. Please consult
/ t; f1f.,
' iille Plan Revues Rievised March 2014 4
Town of Queensbury Planning Offlce-742 Say Road ,Queerisba ny, NY 12,804 ,b1'8-761-8220
rd se�df Sao e & tfe Play'. ss A'
The Planaft Sea each f the, f0gowing'
179-9-0801 11and�l a e Prepae responses Co
th
r t defo' t h
iis
STANDARD .............. p� �lr�pion.
A. prepdeed lra TeraeI
dfepaler Ial� �
art r ��Stande a fa
BI. The p e pr�irmll cdl VI inis � to be M led(A r�;lebe 3 eared Table VSA
uroo el'dll ee
�� ��a
Q. Trued plewn en, V9 pedeeaUleomn earl
eriilA �Iee
and fmM
elle'rd' po
e(Re�areasW 147 r manage" o other
9 « The d an UIAJBL ecanlr run l 'mapiar i5e Sawa lee i 6
aposcable,Iai le' lelal7oq INloa swcum lhoe iea A ahere
lor
sedtw nature
use ellbe Ntie ane rlp reb pit aeeeel the my V4011"Saoeurlu+'1 xrin euro use,is re a col'Apy se in burden aro
be Irwa ed use ed a or
line net
eec o In In c� a p� �>edee
Vlee PTO eo�lcr ern l fer�lVllee wM,Idl the el of Ma;p
e n e wrvul urat neele a Vla of pamo reed g er wr rl�ing I
eTh eabm rnuae epererlarn p Vh,n ,lery e
yah�w � VA�re�um �I�rypy q�ft ht��l O: c��yaftn food A N i d vdd1 a W WHO
p. � Me'+,+a APvww'�rlld'Y,��NPa"G1A«'AIWR9A '^'e 9.
r e � �1 or�Aa e7lne�rn+le+e d
nel a sir to this general ow�ellere ' Ian,
conlrams vdit be adequals. a by
d nand ehn3e ed end euu rwV deal
eru�lplpe,'kae�le bin
G.
the new a Tne ee e9 a �"b aTUI ,areas p p� 11A� Preperre M�'Vln er
rle kale« W
M at
he nee Gael tiara,Via.Mani Wde°eeprwcubMlo�o le I
ee ere e9drh
MOD
unnde�elepe OlI reducIng �aunab cA ai "� paten lar'Iurinare-;1rftGj e, n a r e mimaird an li just to lde act-that I
rm pdad in alts plea a review l'ec such lualunlle o see as erVeee, The I�rwraru�t�
d p heti
eine wrine�n, ' �rllMu eud�ereent a�per�,ee.
p r �� fours
has uraneuele �al Mln e�p rl; fetl�ldee I irme, necessary on it of open,speae
cl a ,by I
rot
aiii
ewe ruelurcVle ea aA ee lee ea
h e s a ewe I� preuak e ,
he awl� „
eel. In
l mA amitiaV,lndunslalelA reeldee l,M ellurrrrel llnne4V lac ntsI�ud f �dg lDpmarnl
F Gaauu of '�or ho eft pa*or'fin �r� ' �
.In
� �p � I I�d ems' dl
sale le eaol erarnle;� d
oca,and I .thq Plere- r e�V r�reVuea a eek overall e leyalVo p
�� dbVearoe re'U1Ce�'„ r
.. eftl
lluee
In relelVa lr7 dmto
r eu gamat gVWaMeeoe a h;
In �I
dae�e end dire e w qw�o r Irellle
° eluYala�r eeA a IVh nle�
e one
eelr rnlIll Isa sen elV
I« TIS pp�tibllea"n I'a�'and erreutu��ereerdC I� �ntik. P e�V�leuro n~ara ages
elne be p pled,le enaoeunrego pedeWlern Mo. p
. .
end rt�enaalV pt9eelrlruru, ,leunae�bye e�'e oea adequate r , ', nze eerrop�'le per prrn�arrl eeuga II
«
re I llllee peuuk Ir�woreeee p . earele+rn
�uat dralrue
�I. leorrnarre9V�a doeln eNueo� + the"4 qft�l pr norVee , elersr ra �+ -alts eleuill not de lade ems"el a oe c
l Vloe,el"oeM
udlnlla nude« PE '6VI las In eperaaehMu d deo Of ampler'
ednreree Dmtrmp�o��V&Rage a�ru a p 'ee Or P Ili erg e�pldl�e.
147 e1
the erwd llneTc n wal uaeeraabunry �e and ar 441 mneel,e Il ble nd'eu reel ob me ,e yet forth' IMo neral;
a vrreAer a —a"—fig epaeel a ''a is
teeq� +r epee the l' draf �G Vie« cme�rl Sha I Vdy Ipra�b
OU lisle demo nl�a le eIR Gew and
L. Tlne;ether s p�brnd erne gaeaer+k Irl l ee,eh a end; Ulnae seem mu n M r aeavllarw cal existing
ywal r m eas buarEfer�b �Ow l �of deeeeeed plhrrle e� Ie�deA Ira mdln� �M.
rnelnleaaeruaae, rerro'e�ruleoCI'i0rns my , a dere.
e �hlnm ¢�p
Fire lanes, ern+ nber,erA ,lire dreams WM adequat e
the needed
« � s�rilau
e�odlrng, llucidlu' eeul ar e�elan M or
design erne JO extent 1Dna�blro rad>eraepimp lrw e�'eee euaerae llV laa�p .
'1Vge dee .,,..
Impadai to The
Tlue elle 6'lern;m laalinew g`n els+ 'erdeA erendeaepin e�or�derde and pdrfanrnau�neu aleerderrie el Ihle ep r.
site plan Review fr evised'Mar ha 204
Torr,of Queeutrebulr'y ernrdrig l f icew'74 13 n:sd• u eenbury,W 12804.518-7611.82
Absent any Walver,or wa,lvers, an application for Site, Ptan Review shall Include de this 1011i
Ghost tI
MOP l, !
'wf rol r Map drawn at the Boater that s retotlonsht 91 t proposal t6 existingrotarrurruuarl 'lae�llmes�rtdch at or erwre t,
summa mods. � "as, sohooll o ThO Ma shall also dry all pmpaNse, ni ownal�subdi o , s e�� , and
easements n 400 lost s than prurperly. Buda a ska rdi may su odhiposed an 9,t,nited alletaa 0autddgkW Sur�a�r'mwu'ai of idle
Will
B, The
1a pt'an shall be drawn at a Kola of(i mat to the Inch, t"- dl)or such other scale as fln Itd_nntng � urd �
delam[
appilopdate.on standwd 94,"rr$alll,s'hola",width contlnaa'affol on lJkW.x 11"shfiets as napeseary for uwhten Inferrnaerrtram The h1o"altico
hated below shelf be aahaww a on,the site plan arid oaamftaffon sheets.
N'arrrwe of the Pmjsot,boundaries,date,wrtrrth;armww,and eoale of ft;flan.
N rdrma and a s owwraar a rdraeard Fwa a 9 r�rJ�rod a teas r a W,a mtdtaat,or landscape aw ct, It the app rat not
lc lmornancl �url It arae tm�'r s. -
uprop rtg,ftluding all dhnionsitons,
hottit and floor area,alt,F' The .
aaatedcr an�as4 end aml arrtl ,patad tura dddttlond and ualt�ratlend,
ticn Of BIC petit and proposed pUtltf�a pdd'rware s
Ir , o t( parRIngl areau�„ dr'm a as sA taalldr aw ,
oldta'w l , rri , be,�p a,lan apl �,'awa�lle,"team, R.pcetCdn,.We,and arra Iraq tRatal rad'waste 'r eon ea
shall adaa tea sham.
The k4stion,hgIght,lnj,amV*and blvb V13104"Idlurn, asnemt d .)et an demmal Itighlihig g rad. The dracjton.of jju'_
natte�n
and ftda d0 eltarutnate 141are onlra Al! epar'W' ��must also shown Cnnmplle fgw 17 •6M0« w�, I
7, _H_ The locefflanil,halght,alp,matedob',and dootgn of alll proposed ol'66e.°
lThai ll of,all Pret and pmpoaed WRY aY"steima lnWuWgg,'
a.. g;a ay��r d�dptmua �M . . .. -
g, Wow aypt ,
3s, Tei cablall and Allaolljoat .. ,.„
,awtarnet and, =
4. Steraarn drain ayelarru Inad'uding aaxkd[n and pmpcsgld drain press,ouNme, cratoh basln headwalls,anellwwatfa,'"rental
near rales, drWnuuge aurwalas
eppl'Icabma, A, SIono ater
w�i... lana to lar, ares g ,
P Prevent; the, I>ad� u of�garl�ea or�g �N� s �'milt�during and air e��enaMru+�tfen �� fig, and:
IhaedCn W I' er p' P , as �Qkl n Pran� on Plan PPP) all l udaysto and aua' r
(aaaotuading aprtcultarr it a wptled)on the alta that rel lg laM daturbance of Za ra or more. A SVOTP shall compity, urw4h lb
regptrereenta oI lha DEC SPDW M8.4 G„aneral alt-ani deplar 1,4 of the
dtsoradan gat the PSI rNing Board as her au or an ei lo andcontrol n shall
�l aura fade. It e vl t5� at Awa
WW W dfetuarbanee less n 1 warn. I �I,wa rau�utfraad Iter uia eller pier a reuwlaw p met
g d poop meadlip wjVM,!1Qi1- ur, rwal ,or auclu star w�rr the Plan n
a CSI shalt rarer a neat of d S adtel and, aaadatCe Bench r uu In resat l w. s��'
a - . e
t od, Ian than Mark nl ward dit a.
Proposed 1 dttruru rat the pmcpcssd elte and the loo,-
YOU
ori
f?' , ar+as,ill t,a aahraa�ra,and haae, eleuuallrmns lessen. wV,naas shall Iha tnutMYaart iw,lithln pa�raret la'w,rltFafn
60 hoot aat'tha rc aaed all Moira ao 'ranar�wal uw Illy td re I'red,s 'althfrr
Vit,laauudseape,plan shoydng all arctstlrag!natuwst lewd Irealaaree that rn Irtlmurena:e the pr lnws,'
tlirr ap to r�otunue fru inuhlo yards.
stands e+E t�aa,a da� r el pad.us'o such eu�s�rah true,
mn Ia trees e(ght or mole hwohae In ftneter,Irl r,and'water rces,uarwd all sad itanges to,
and draftiage Wea'utlorr area p p, � e,
IW Mar IIT�CIWIn spas and gas of lanis Water eours� pncl Ja end' Iwatlands wW watercourses,,al flood Pi
Land Use ldmi twaundtartaa �
rtn 50D,feet of phe p larleter shall be drawn and ldand on (he site faro,del as
Clyefty ttvet appt to the prapar
Me Plan
Town nl'Quoend�uluryr IPlabnnting Office-742�Bay,Road-Queenal ury, NY 121304-518-761-8220
w .
Sheet
R rUTAI!NEN, 8I^1P'I'p'NaI'USI)
ur�I Na�,dl�up���uu�q�edNrru�eral�lew�� enN �raurrb�arl ea7um�vaNlNtinrru
Tretoo Ilrm�rr pettari w RWn rr ki entr si rNNa,, re mtete ed tri rrpaudy Nor NuurNNa�developm�eruts at Nrar those,In
1001 olle. hey Plenning'E� sero afil ed rem
tweak Wft a123-WWh shall,ftkxW. � IIs;
1. I""Nwe'prgodwd num,bar at'ri v 019 tdpa to arutam or tease 01M.eetlarusi Jar w kly crud W,psar
lavenrur
e pMgealed t "ID wwr plasm Maluding areNwn'uruuneur morda $IC eI1 major Interi nksr 10 to affeurted by the
poposad use oflhO Oe„
"etre rrmWpuuaN oil '�traffica eer�Iae sass,�N�ui�t puubNNa e'tme earl at a1IeaN�d Nudtowe �rr� N�rNu��rwg andi Proposed ;
Wieft and rrrrau�°N um N+a�reNe crud ��� �n�NeuW+eNe IwenN� �pllarera.
0 guar now can alrau�t on ate murR lay di=tu�r ua totane oomaInnrlg!the NdNN'Igo n V�Ia poragn % Nkora N
1. Edd ,area o#
ry�Nab gid,(or perUO:Utbm puarp such ee ap�rglnuwrp,.uanlNl�e�eNare��,els,„
2. Ealkneted m axilrnuat number of '
4, Nur r r m e�iand m,qV :rr Intended
P 1, Floor PWAS. g rolurae( ') amrdi
p, ENevallaare Bit a erzele 04 one-quaert r ranch squab arwe Nmiat�'7i9�'�1'Naafi d, l e In g lh al pmap
alterations to pr,aearparrenaure boa4 ,slwaurdrwg destDn features emral n x nitie ape
'Nor��eterfla�be ue�dd
WoIN and eradega�n a r uut , r NN ae�ae
l �u ,uue � dmgbirwe�rwd�rrnq P �
R NPI disposol aI r rrw ouu rrmr,s, nd dernuollltan waste,abler ar Nre or at on,approved disposal Iso".
Sipita we ssr,snow removal,NraaNurdlrwg Nondae of dra=rRe 0"a1 edge, 011
be
o Er I�ap� N e e Ver u� id by the'EMRflwr'I ore„ PlIft 1 a wasp e d Ilb Nnl �kk hie
It dwrA pimwp ed pr4a squires a sogdIaal tree paruru�l an b",'busee IMSC; fru
e�ulb�'gldC as � � p �snA
Neuer ewppN
aaau aaatna dkw spr�Nr4� Nr bm roams«their,carte q42 Is Sed app%N nut Ally ra t�GIngpe%pl . brw for
errwwnt�eppl
g�.duagaeut� � a; gudnnd Name �p �etl
�9�
plovWad the VN mr o n;4
Won afire i area rw ,dre�w+rw pursuant� � a mall NB
If euw epp�uaetlu�a Ib Nd ' '�
elIuuaNn rases Nlue Praap site Pour
m are raur�auare '
"flue PN�rm roan Board may OPp t ter u�prepar<wad gree a rudN WiD rgeta shall be!conoldered
an ep InCon (prod,for '�c plle� N P 8 ed:Vs amu eu single Was)Or acri .1��
IaE�sN'Nwsr.
V A bol rtierre�tn�ea steterrwerut ams Nwuawv the pralor preprmo
ed for revN+ra fur 016 ar Neu a nen m vM the v is eru'd paNlr�oeu In 1Nwe
Towvrv`e Ccimprehansive'Plan.
Site Plan Review Revised Numb'2014
rw
r� wr eamu N uur^PN rwmwlOffice-742 Say Road,Qe,Mn� rys'NaN " 12504.518-761-S220
Pre-SubmtUW_C_0QLeMnc@, . . ' ,�`m z .
1. Tax flap I'D2ff,'� ,_.I
2. Zoning Classification Mr'"-�
dl. Table otAllowed Um CL
'A 0Cl\I CfA, Ilii Is s 'blerA t+e Site Plan Ravlow
;. re- ttbimlasion,Meeting aOutstanding items To Be Addressed Include:
Dead, vl c
Gemml Information ea plate _ZYc
Site:DevefopmerdData Complete Ye's o,
Setback Requirements *mpl ; as 'a
Iitional Pray Inform tip emplets Yes � o
promm ites —No
FAR Worksheet complete es 4,4'_f 'c
Standards addressed, V11yVes O
Checklist Items addressed ressed �es
Environmental Form Completed �"'ee � �No
Signature Page complet6d 'Yes, _i,::f'No
,*fit C, iC Ct.l
y
V . „
w ,- .
u
C.'a J A.
ApLeuLvil
w
0r( LA I
VC
t
(5 rljll i
n � "
MotLe lfiISM MMI
Staff R'apsreeeafiva.
Applicant./Agent:
Date* .
Site Pian Reviews Revised Maw 2014
a wa of Queemblury Plannhg Circe-742 Say Baud-Quemrn twurr ,NY 12B04�618-761-8220
61 7.20
AppendIrB
Part
eco I -�' Jt��7e OPPIk tlin� The eppHceat Or r�Jen��spo nso r�Is t un e fthe a��pla�ia��nu���"�����>U-
pn nIF the rbppli atlnrw r Approval or 1amnding,, tubj 10�rrblla re�l�c, �and lee,� � ��flrortluer Verification.Res,poe .
� pla r6 band lat�at�l aurr rail a ellekdc�, ld�addi`t nal ra +�aa h or,Investigation would'be needed' � ll
respond t any lternk please answer A$thorouShly as Possible based on carr-ft Infbrmation.
Complete ell Iterans lru Pert 1- YOU MAY,also provide any additional in(brroallaan�rrlrl �believe will :�eled Via 'or osellr'1
to the lead agency;ataa lu Additional pa ne neoWary to supplement hero
1F'rtrt x-"Wex And Sponsor Informs flon
['411mc Of Action or Project.
,=LnnAI(describe,and ae g'l�onerion p);
Y46�0�
brie+r' esuaelption orlmroposed' �orr., �I
� line _
pp rut�r'� ..
w 7"alAphrarr M
Ire,�p
E- all:
67,
barna
'ste: alp Cod
1.Dathe rn �osdl ah
p p �"gra only in �ai��kuru l �� lath euptloa����A�iewr�,local �otdiue
NO y"
ed�ri�uistr�ti�ru�rxrl���e re� lAti� n�' .
v. us
i �uxsa' e~Mach
a
tldinlr'i
aes�stahadte la�m
a norM��pall
iapaltriip're
tehraaalotAt rr�rvarafundi ate
an
u
rw�rces that
i ard ed' nut to question
2.
n: l l eS6 list agency($)name endprrltcrepa;lw Other 8DvernmantAlge .
No yES
ova."1 ctal w-rwiii of the
lte of the pip Action? �
b.Total aucreuugre to be physid'ally dlatuarl d? aor
c,`dotal Acre �(p er'elme any ar �g �as
or controlled by thin I nt air pro cot Sponsor?parties o�rn�d
4., Check all lead urses that"our on,,agoining Md,near the proposaction,u3 Urban [I
Rural rcrr- luuualtnre rndurustrlAl �"9OMM=10 0 Residential(suburban)
"
Forest icuslture 0 Aquatic a others ec.�l
�s�lc'land P ")W
PM90 I of
posed action,
ash permitted wn +e u"der the zoning repinniations _
b.COnsistent with Ilia adopted comp'mhensive pniiga?
da 1s the prOPOSCi l action consistent with,the p redorrilhent character of the extati pg built or,nunnrei ��
lsrndscsip�e?
w IS the sltHe of
e proposed actiin,or deer it a4'oprt,s sante listed Critical Environmental Area? VIES
lfY ,identi :
. ee llll
the:pursed action result in a;snnbsteu psl 5tereas0 In trafft above present lewrels? N'
b, republic transpomlon rrvlee(s)available at or near tiwe site of the proposed,a,etirbrn'
e.Are arrYei accommodations gar bicycle ratites available an or near site of'the p oopi action?
9.Dees the proposed action-Meet or a eed the state ever riderc horror ts? Y
]:f the pr'up'i Actl'on will exceed mquit' mate,describe design ftatur'cs.and teebrwttloles:
1 "illIf Yes,does-the existing tineNO, TYES
s steno have ee,ae Pc tel gide serrl�ce'i� I 0 1 YE
p posed lCtlan carwnect to an isti� veto I
If Noii ddsad a method for providing ptntebie water
r
If Y64,does the existiu system have p t+eovidltser Twr lM
l 1.''tl1N t Proposedaction connect ora wr�r3ica capang city
prcwldas setw�lee'l �P C3 YES
No,dew,lbe rrnetlnad for providing ww�ast water treatment,
12, sv 1 tlna all
w contain astructure tho is lista on either the Stale orN'i6nep iC;a;;, ister off-l°lsteric YE
l'larsea?
74-
ba lea the proposed action located In an,ar'olweel'apl l sensitive ami'
13.s,Mees unny p;ern of"the site of the proposed,eodon,,or lands acUoining the prop :d satl'a n,contain '01 YES
'Wetlands or other weaterbodl'es rnuletedby a Metal,state di local agency?
e "au'ldl thep m used action physical l alter,or encroach lVXt 6V existing wetland or wwreterbOf
if Y: I�lgt'nttlf�r a w tlend er wwws rbody,and extent ofalterations In squame feat or e'cres
K., lden141he it pikal habitat types t'bat 00=on,Of are;likely to be f'bnnnd on time project si'te., Chack all
that apply..;
E3 Shoreline Ml Forest 0 Agrioultnwraiiiiila 01 Early mW-successional
17 Witl d D Cuban, M Suburban
15.Dow thio site ofIke proposed action coi,y s 0f 11.0np'nta,l,or associated bsbitel „listed No Yl
by the Mate or Federal government as threatened or endangered?
M is the projc#site located in the 100year� � o YES� r
17p Will the'Propided i0flon Beate storm water discharge,either from point Jnrwwpoint sources? pl' YES
ityes"
L Wild sWir n wwraer dlsiAarges flow to adjacent properties' NO 13'YES
b,Will storm water disebarges be directed to established conveyance systems(rusnoffand sty drains)?
If'Yes,briefly describe, 0 NO 13 Y
Fagg 2 of 4
1 11,Omen the proposed action include constrwtetlout or other actiwitles boat result In the impoundment of 1 'ES
water or oth 11quids a;-&rate ion pond.,wast lann„dam)?
IfY�ea,explain purpose and size:
Ip.Has the site of the,proposed auction or an o4olhing property been the location of an Wive or closed ill 'D'E'S
solid waste:managem, ant fbcilit
If Yes,describe.
0.Has thea Ac:of the proposers action or am 0jotning property been the swtb%t or remdlatiom cm ln&our, NOYES
nplcta for hazardous gyrase:? 04
It,'yes.describe:
I lErpl11M, ,'T THEFORMATIO � Dl 's"+1'3p'
1� ��1i��r��l�f� � ���T"���T"jC11�
KNOWLEDG9
410 ppllcan pdnsor name � � �, bate.
,rt 2,-Imp t asses 1 Hast. Tia end Agency b responsibite for the completion of Part 2. Ammer SU of ft f6flowing
qu,esilcns in Part 2 using this informationcontained In Part I and other alerl"als submitted by the prcdwA Spamor or
atlnsra ltaa aw+allabie to tine rew+l'e er.
When oars erloa tha gpiemlons tbae rawlawrer should be guldted by the coraeept"Hgtva my
responses been reasoneibte consid4ring the scate and context of the p oposed actlon?"
%,or Moderate
small to large
Impact lmpae .
May may
Domer occur
1 M ad n N posed action create a material conflict with an adopted land use plan,w zoning,
resul. VAI tha proposed action result In a change In the tins*or Intenaaity of use of land?
'WYf ill the proposed salon Impair the chamoter or quality of the existing corn,munit d'
I
. Will Rhe proposed action,have an Impact on the eraviu ,rrrrnmul oharmcterlstics that caused the
,eslabRshmertt of n Critical,It„vivonmenial Area(CEA)?
Will the proposed action result in an adverse.change In the exisOng lawns Ortraffic or
affect exis'tlng Infiastructum for mm transit,biking or vralkwayy
. Will the proposed action cause an urease in the use of energy and It AM to inoorporate
re asongb ,zvatlabl e SEMLconservation or tenawable encr.a o ortaanitle '
7. Will'the proposed action,impact existing:
hb p,abl'lc J'pri'vats wwaW suapplics?
k pubilc/priwvate wastewater treatment utilities?
8. Will the proposed motion Impair the character or quality of important historic,archaeolb ica1,
architectural or aesthetic resources?
s Will the proposed action result In an edwerea chanp t;o natural resources(e.g.,'wetlands,
waterbodles,,groundwater,sdr ganalit„flora and tkun a)'?
Page 3 8f
a
or Moderate
small tb large
irmpaet impact
may' Miky
oftur occur
10. obi I �Sropo�d action result its am xmcrees In the pcuterutlal,for�arvsiam,floocdin;g or drainage
I I. Will the proposed Uti'on create a hazard to environmental resources or huaman health?
Part 3-Daterrrtimatsiatt of'sigmif Bance, The Lean Agency Is responsible for the complatlan of Part 3. For avexry;r
question in park,2 that was answered"Moderate to large impact tnay mer""",or if tires'is ameed to a pialn whir a particular
element of the proposed eetlon mai or will netraauult in a significant adverse environmental impact,pleam complete paA,3.
part,3 shmurld,Irt suf lotent datall,Ident*the,impact"Including any MOOSures or design elerrugnts that have been,Inclu de 'b
the project sponsor to avoid or reduce Impacts. part,3 sl ou Old also explain blow the lead agency'delermined that the Impact,
may or will not be signifloant.Each potential Impact should be assessed considering its settln&pmbabillty ofoccurring,
_ eatitil irreversibility,peo him scope end magnitude. Also consider the potential'fbc,short-terms lonittaumm muni
eclr.burs box:If,bra u hiV dat iniad _based on the,in ormatidn and analysis above.and any supporting dceu ur ntalW,
that the pro,pu ed, action =y result in one or More PotenUly large or significant advent Impacts and,an
environmental Impact statement Is required.,
Check this box if you have delterrmined,based on the information and analysis above-,and any supporting dccuutnen'tatION
that the proper action will not mutt In any sitmifacan't adverse environmental impacts,
armc of'iaead Agency ?ate
Print or Type,Nam of Res-Ponsible Offterin Lead Agency Tilde of Responsible Officer
IPa ure of responsible Officer ire head Ageno Signature of"l'reparer(ifdiflirrent from Res onsible ulcer
'Page 4 of
f r
Signature Page
This page includes the 1.)Authorization to,pct as Agent Form: 2) Engineering Fein DIsciEetlr , 3.) tthrrarizaftorr for Site
Left , 4..) other Permit Idea onnalbOtles .) oftlal Meetin,g Disclosure and 64 Agreement to pmvide, d t me menti n
required.
trnnlWNERIS Aet r'F'oFlpnit
Complete the f llowi n :11 the O'W'NER of the Property T rnot the some as they appitca t,
Owner
�^ grtes�;
As agernt regarding; Varl'arnce�She P'kan-Subdivision
F'cur'Tax Map No.: Section Block Lot,
Dead Reference-,,
'Book -Page Date
OWNER I liw AT F15-. DATE:
APPLIZAN els Aawtr Pow:
Complete the following If the APPLICANT Is unable to,attend the meetfnng or'wwishes to be represented'by another party
Owner.
Designates:
As agent reganrdkrg: Variance-Site PlainSubdivision
For Tax Map No. Section Block Lot
Deed Reference; Boo Page Date
wAlPP ICAN'T SIGNA"t"t.R ICN '
«) 9WAIREAHING E 0110 Appllic 'ons ma�y frit refer tothe Town consiwttIng engineer for review of,sleptio design,.
storm drainage, Mo. as determined doe Zoning or Planning Depefirnt. paee for, anginsiering r ete services will be charge
allreatty to the eppllcant. Fees for engineering re ewe will.not emceed 1,e00,without notlftatlon to the appilcant.
,.) AMIflONIZATto MIS SJTE Yjt By sIgn$ng thls page and subrnitting the application materials attached herein,theOmer,
Applicant, and htwhe0heir ergs) herabyp° authorize the Zoning Board or Planning Board, and 'Town $teff 10 enter the subgact
prcrpertle+s few the pare 0,r;vte+wwtrng the appflcatlorn submitted,
.) QTH;EA PERMIT, REM H' IIEtL M:- Other per ifs may be required for,consIrwictlon w,alteration&CUM euubs�equuant toopproval
by the,Zordng Board or Planning Board. It,Is the aplplloanft responsibility to owls any,eddith3nal permit
54 9FE191AL,MMUg MINMIESIt Is the practice of the Community DevelopmentDepartment W have it dosIgnalad
stenographer tape record the proceedings of meetings resulting from epplica on,and minutes transcribed from those tapes consthutes
the offictall record of all proceedings,
6.) N,912EMENT To MQIDE DG IUiNTEN jJ " c 1, the undersigned, have thomugbly read and Lmda and the
Instructions for submiaeion and agree to the submission requirom,o nts, I acknowledge no conMruatlon arrullv+lttes $hhall be commernaad
prier to Issnnance of s va'lild permit. I ceriily that, the application, plana and snuppodfgii mruaterlrals we a true and complete
statement/descrliption Of the existing aondftlons and the work proposed, and that ett work wilt be performed In =come; with the
"proved ptans and In cordorrnance with local zoning raguruletions. I acknowledge that p Ibr to o=pying the fi udlltise proposed,I cwr my
rets,will obtWn,a certificate of occupancy,as rnseesee ry, I also understand that la may be required to provide an as.bulft survey by
a licensed'lend survey9r,of all newly constructed Isol ittes priew to,Issuance of a certificate of accrnpanatr'
11 have ead e to tht ove.,
— ,
Pdnt 1ame pplt ty Date signed
Signature[Agent] Prtrnt Name [,gent] Date sigirted
Site Pleru Review ReAsed "2014
Town of tnneensburyr Plan'nrnin 011ce.742 Bad Road ,Queensbury„N'Y 12804-518-781-8220