Barber Subdivision application ' k"; ttm
Final Stage Revis.adl Apnil 20110
General Information
Tax Parcel IIS Number: '®D
Zoning District., QL ' .- )o ASII 1JI1
Iii lli mei OF QUEENSBURY
Sketch Plea to I��I SIN G F I Iff
Preliminary Stag
Final Stage
Residential or Commercilat
Total 1L t acreage
Proposed lot size �+ °u
Prpjed location, &U4.
Deitaliled Description of Pr'oji [InIIucurrent¤tproposed use]',
,,Addtess- e7
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Town of Que!lensbuiry PlannIng Oiffice-742 Bray Road Qurdsbury, NY 1 - 518-7611-8220
Final Stage Revised April 2.010
ITEMS TO BE IDENTIFIED BY STAFF DURING PRE-SUBMISSION MEET[NG
You Fhouldl use this pagie for guidance when drafting your application; however,, it will be completed by a statf member,
Submittal of a preliminary plat depicting existing and proposed conditions shall inctude the items as, noted below.
Faliure to include all required information may result in a dietermination, of incompleteness and a dellay in the
processing of your application,
§A183-16. Plat detalts and requirements.
The applicant is, required to submit one (1) original and fourteen (14) copies, of t!he final plat application. Such
application shall include the fol[owingi documents and/or information,
A. FINAL PLAT. The final plat shall be laid out by,a licensed professional engineer with a properly exeouted New
York State, Education Department Exemmnptilon, N or a, ficensed land surveyor. Such,final plat shall be prepared at a
scale,of one inch equals 50,feet zero inohes, clearly showingi:
(1�)The bearing and length i of all straight lines and the radii, lengths and centrall angles,of ailll rurves albong all
property,and street lines,
(2)The area,of each lot In square feet or In acres, if suc�h, lot is larger than one acre.
(3)The,connection by proper measurement between street center lines where such streets are not straight across
an intersecting street, both within the subdivis])on and where opposite exist'ing streets or subdivisions,
A system of monumentsto be located at all comers,of intersections and angle points.
(g)'The building,setback lines for each lot,
(6) Fire and school district boundaries within the subdivision area.
(7) Existing zoning,w'ith,the location of any,clistrict boundaries,within 200 feet of the property to be subdivided,
(8) The boundaries of the property® the lines of proposed lots,, streets and parks, and the lines of all adidinling
streets® theirnarnes and exact survey locations.
(9)'The'narnes,of all subdivisions Immediately adjacent and opposite or, if notsubdivIded, the names of the owners
of record of adjacent and opposite property.
(10)A statement that the plan its In co mpliance,with the Town of Queensbury Zoning Law.
(11)A staternent:reading as follows; "Approved under authodty of a resolution adopted
by the PlaTining Board of the Town of Quieensbury,I New York,
Chairman."
(12)A title biock, showing the name of the subdiv'is'ion, the owaerr, the scale,the date and North point.
(1 3),A certificate of the licensed engineerrancUor land surveyor making such plan to, the effect that the plan is
Qorr eot and made from an, actual suirvey; the license,number and seal of the engineer a ndl land su rveyor,sha 11,1'be
affixed to the drawing.
B, ENDORSEMENT Of STATE AND COUNTYAGrENCIES, Evidence shall be supplied that, any proposed water
supply and sewage disposal facilities assoliclated with the,subdMsion plat requiring approval by the Department
of Environmental Conservation and/or New York State Department of Health have received at least preliminary
approval(s) of such facilities and that any special district extensions required have been authorized by the
Queensbury Town Board,. Any proposed water supply and sewage disposal facility shall meet the Town of
Queensbury design and'oonstruction, standards for suich fa6lity. Editors Note. See Ch. 136, Sewers and Sewage
Disposal,, arndl h. 1731, Water. The plat shall not be starnped approved until all state-or county-requiired approvals
for each lot of the suibid[Vision have been received in writing by the Planning Board.
Town of Qtieensbury Planning 0 Moe- 742 Bay Road - Queensbury, NY 12804 . 518-761-8220 2
Final Sitagie, Revised April 2010
C., OTHER PLANS AND RE PORTS. Other plans and reports shall be submitted as follow&
(11) A planting plan Illustrating species,and location of proposed tree planting.
(2) A tree clearing plan illustrating areas and methods of protection of existing trees to remain,.
(3,) An erosion control plan Illustrating methods, and location of erosion control devices and schedule of
maintenance of'such devices and other actions to reduce erasion,
(4)A st�ormwater management plan and a pollution prevention plan consistent with the requirements of Town, of
Queensbury Storm, water Management Local Law, and with'the tarms of preliminary plat approvall.
(5) Construction plans showing grading and other site improvevrnents and details of those site improvernients.
13. If the subdivision is to Include any PROTECTED OPEN SPACE, all appropriate easements, deed coveriants,
conditions and restrictions approved by the Planning Board and/or the Town Attorney related to such protected
lands,
E. HOMEOWNERS"ASSOCIATION, OR CONDOMINIUM AGREEMENTS. Ifthe subdivision is to be managed by a,
ftomeowners"association or condominium,:, copies,of their regulations and agreements, Indicating any restrictions
required by the Planning Boarci, ,shall be submitted. Ifthe subdivision, is to, ter sold 'fee simple, copies of deds
indicating any restrictions re'qu'ired by the Planning Board shall be submitted.
F. STREETS, RECREATION LAND OR OPEN SPACE.
(1) The, plat shall be endorsed with the necessary agreements in, connection with required easements or releases.
Ofters of'dedication to the Town shall be presenter/ prior to,plat approval,. Formal offers of ded icaUon to, the Town
of all streets and parks, not marked on the plat with notation to the effect that such dedication will not be offered,
shall be filed wrwrithr the Planning Board prior to plat approval. If the owner of the land or his agent who file$ the plat
does not add as part of the plata notation to, the effect that no offer of' dedication of Such, streets, highways or
parks,, or any of them,,, is, made to the public, the fillng of the plat in the office of the County Clark or register shall
constitute a continuing offer of dedication of the streets, highways,or parks. or any of them, to the public, a ndl said
offer of dedication may be accepted by the Town Board,at any time prior to revocation of said offer by the owner
of the larndl or his agent.,
(2) The approval by the Planning Board of a subdivision plat shall not be dleemed to coinstitutea or imply the
acceptance by, the Town of any street, park, playground or other open space shown on said plat. The Planning
Board may require said plat to be endorsed with appropriate motes to this effect. If the'Town Board determines that
a suiltable parkor parks of adequate size cannot be properly located in any such Oat or Is otherwise not practical,
the Board may require, as a condition, to approval of any such pllat, a Payment to the Town of a surn to be
determined by the Town, which such shall consfitute, a trust fund to be used by the Town Board exclusively for
neighborhood park, playground or recreation purposes, inrWdirig the acquisition of property. The Planning Board
may require the filing of a wriftan agreement between, the, applicant and the Town Board covering future title.
dedication and provision for the cost of grading, development, equipment and maintenance of any park or
playground area.,
G. FEES.
(1) The ap
, plication for final plat approval shall be accompanied by a fee as established by the Town Board by
resolution and as listed on,the correct schedule of fees for the Tom of Queensbury posted In the Planning OffiGe.
(2') In addition to the fee, listed on the schedule of fees, the Planning Board may charge a fee todevelopers of
projects requiring legal and technical review . provided that the fee charged reflects the actuall cost of the legal and
technical assistance to the Planning Board,
Town,of Queensbury Planning Office- 742 Say Road °Queensbury, NY 12,8 04 , 518-761-B220 3
Final Stage Devised , pn120101
Pre-Submission Conference Form
1. Tax Map ID
2. Zoning Classification
31Reason for Review:
. Ordinance Section
. ire- 'u,abmiissIn Meeting Notes;; Outstanding Nt rme Tui Be Addressed Ilunclude.
1Deed Yes No
2. General Informations Yes No
. Final Plat Deteiis & Requirements Yes No
44. Fru i fiat Yes No
. Endorsement of Stag & County Agencles ."des No
. Other Plans &Reports "es No
7. Protected Open space d u,uranen "des No,
.. Homeowners Assoc, air Condominium Agreements "des No,
9. Streets, Recreation U_eruder Open Space "des No
10. Fees Yes No
1I1.,`Signature Page Yes o
Staff Representative,
Applicant/Agent:
Date:
Town of Quieensbury Planning Office, 742 Bay Road Queensbuiry, NY 128014 .5.18-751-8220
NAR,RATIVE APPLICATION
LANDS OF INGLEEIBARBER AND SANICE
On April 6, 2016 dewy lunglee, the:then owner of 3 5 Inglee Mountain Road (Lot
was issued a Notice of Violation in regards to a complaint by the adjoi,ning owner,
regarding land clewing.
Subsequent t that No�tic;e, meetings have occurred betwe rn Tines Barber, the
current owner r f' Ing,l e Mountain Toad and the Town.regarding the alleged violations
of the Subdivision, and Site Plan Regulations,,
This application being submitted in consultation with the:Town fueen buur
Planning Department seeking to resolve all outstanding issues. It is noted that the
adj oining owner, Jas ra P, S an key, is in litigation with the owner of 3 5 Trn lee Mountain
Road, and this application is being made b banth parties in an attempt to also, settle that
litigation.
n..
The Town o 'ane znsbuary hasdetermined that work on the existing driveway n.
and 48 ln,glee Mountain Rad occurred on slopes over, 1 %, thins requiring Site Plain
Review. As,the existing driveway was, not shown on.the original Subdivision Plan,
prepared in 2001, that created the lasts, a subdivision modification is alsorequired tea 1
appy �ved by the Town of Queensbury Plannrnirn Board..
As,part ofthe agreement between I .,glee/ arber and Sankey, a land traunsfe�will
occur. That land traunsfer will result in the elimination of Tot 3, as shown on the 2001
Subdivision Plain. A porti ru of Lot ,3 will be combined with Lot 2, now known wn as 48
lutigle>e Mountain untairn 'Road, Lands, f Sankey. The remaining portion of Trot 2 will be
combined with Lands of lin ;lee ar er,, that is located in the Town of Lake L u erns,As a
result, a portion f Lot 3, 1.2.2 acres in size will be left: in the Town n"n of Queensbury,
without frontage on a Town.Road. While legal access, in the: farm of-led easements
already exist to provide the access needed for Lot 3, an areaariarnee will.be required,
The variance is ;a result of the combining of the two, (2;) — ' strips of land for Lot 2 arnd
into, a single Q' wide strip, that swill he owned by Lot 2.
ABD Evineaes, LLQ" G B and 48,l gle Mountain Roy ad
7333-r an,-61151201 b
It is noted that the owner of Lot 2, Jason Sarikey, recently constructed a new
driveway on that strip of land, which, is the subject of a, Site Plan Approval application
being separately,applied for by Sankey.
In summary the applicationbefore the Town of Queensbury,Planning Board are
as follows:
I. Site Plan review for a driveway over 15% slope.
2. Subdivision modification to, allow the tran sfer of lands, creating revised
lot lines; between Lot and Lot 3 Lands of Sankey and, Inglee/Barber,
In conjunction with the Subdivision application the Town of Queensbury Zoning
Board of Appeals will need, to consider an area variance for Lot 3, as the only access will
be thru an existing access casement,, and the lot will not have ftontage:on a public
highway.
Site: Plan Application for Driveway Slope over 15%,
Access to Lands of Barber in the Town of Lake Lu7em,e, as, well as, to Lot 3,
known as 35 In lee Mountain Road is provided over existingdrive ways and along an
existing access road, that was originally created when the,property was logged. The
logging occurred prior to the Subdivision of the lands in 200 1.
Included in the Site Plan package are aeial photographs frorn, 20,04, 2009, and
2 13. All show, the existing access, driveway. The 2004 photo clearly shows the land after
the logging operation,, with areas of open land, Subsequent aerials show infill of the
logged areas with tree regrown th,
Mr. Barber, this Spring, performed maintenance on that access, drive. The
maintenance work consisted of some minor grading of the access drive to even out the
ruts that occurred, over the: year and improvements, to the driveway ditches, on the sides of
the access drive. No new material was used in the regrading, The access drive:has slopes
ranging from under 15% across a portion of 4 8 In lee Mountain Road and, La n.ds, of
Miller to varying,slopes, of 9 to 24 to 33% across the eastern portion of 35 and 48 Inglee
Mountain Road,
A site visit,was made on April 21, 2016 by AB D Engineers, LLP to observe this
road rmaintenance. It was verified that there was some disturbance of'land adjacent to the
'SBD Engineers,UP 35 and 48 lhg�ee Mountain Road
4 733A-narr-611512016
access drive that was associated with drainage work., A distu,rbance of 0.45 acres has
occurred. As the disturbance is, less than I acre, a Permitfirom NYSDEC was not
required.
The access driveway provides arc,ess to a seasonal use trailer, and cabin in the
Town of Lake Lug e. The access drive will not serve a year round residence. The
access road, is drivable by a 4--wheel drive: SUV type vehicle. It is noted that 8 In, lee
Mountain Road, which is the:house at the bottom of the hill, that is level with Tuthill
Road, is owned by Jeffrey Inglee:, a relative of the co-owner of 35 lqglee Road. A 4-
wheel drive all-terrain vehicle:is always available at that property, to use to, access the
lands of Inglee/Barker in the Town of Lake Luzerne,
It is ABD Engiw-,ers, LLPs professional opinion that the current driveway, while
over 15% slope, in places, does provide adequate access, to the seasonal use trailer and
cabin.
Subdivision Lot Line Adlustment
In, order to resolve a dispute between, the owners of 35 and 48 Inglee:Mountain
Road., a Lot Line Adjustment is proposed.
The western portion'of of 3 (35 Inglee Mountain Road) will be combined with
Lot 2 (48 Ingle:e Mountain Road), The eastem part of Lot, 3 will be combined with other
lands of Ingleen Barber in the Town of Lake Luzerne,
The result Fill be tine elimination of the:buildable lot adj:ace.nt to the home on 48
Ing,lee Mountain Road and the combination of the two (2) 4 ' ships of land into, one strip,
80' in width, that will be part of 48 Inglee Mountain Read.
This modifies the original 3 Lot Subdivision, done in 2001 to eliminate a lot. This
resolves, the dispute between the owner of 35 and 48 In lee Mountain Road, allowing the
driveway for 48 Inglee Mountain Road to be all on its own property and eliminating the
potential for construction of a house next to the existing house on 48 in, lee Mountain,
Road.
As a result of this Subdivision a variance fbr lot frontage:of 35 Inglee Mountain
Road is needed.,
.ABD EnginvarsLLP .3 35 and 48,lng)ee Moduplain Road
4733A-Fiaro-612'512016
Area Variances for,35 fa lee Motintain Riad
As 35 Inglee Mountain Road will no longer have fru to a on Tuthill Road an
Area Variance ds,req uired for 0' frontage,
In usti 'u tion for the area the following is provided:
I. Whether and undesirable charge will be Produced in the cha a ter of
the neighborhood or a detriment to nearby property will be created
by the granting of this area variance?
There will be no change in the c arra ter of the neighborhood as the
,access easement to, 35 Inglaee Mountain Road already exists. The
elimination the aa;tuaaal, rontae has no effect as, thalfrontage was, not
uIllizedfor access, Access was always to rua the success easement on, 8 and
48,Me lee Ma7u nta'aiaa Road
. Whether the benefit sought by the applicant can be achieved by some
method, feasible for the applicant tai pursue, other than an area
variance?
In order to settle the dispute between een the property owners of 35 and 48
Inglee Mountain Road the transfer of land is required, The transfer
ereutes the area variance requirement and thus noother anther vans to
accomplish the trca s er, other than the area variance is, ssibl-e
1 Whether time requested area variance issubstantial?
The variance is, substantial in th at it elim,inated all access, however it is
not substantial in that the access easements are already in place, resulting
in no changefrom the existing condition.
4. Whether the proposed variance will have an adverse effect or impact
on the physical or environmental conditions In the neighborhood or
district's
There will,be no effect on the physical or e wiron enttal conditions as,
there is, o actual pla siaal disturbance proposed
BD Enginears,LLP 4 35 and 481aglee Mountain Rona'
733'A--narr- !512 )6,
5� Whether the alle!ged difficulty was self-created?
The variance is 3elf-created, how ver it Foes not preclude the granting, of
the variance. The resolution the dispute bet ven the property own�er,
along with the elimination of one buildung lot outweigh the se?(-created
test,
It is,r'espectfully submitted that the Site Plan approval for the dnvewaye over 15%,
the of Line Adjustment and the Varianoe that is associated with the Lot Line
Adjustment be granted.
ABD Engineers. UP 5 35 aM 48 h�glee Mountaipp Road
47.3.3knan-&I 512016
61720
Appendix B
Short EnvironinentalAssessmant Form
Lnstructions for Cporn j2letin
Z
Part 1-Project Information. The applicant car project sponsor is responsible for the completion of Part 1. Respanses
become part of the application for a,pproal or funding are subject to public review,and may be subject:to further verification.
. Complete Part I based on inforrontion currently availaNe. If additional research or investigation would be needed to My
respond to any itern,please answer as,thorough ly as possible based on,culTent infor=tIon,
Complete:all items in]Part 1. You may also Provide any additional information whioli you believe will be Meded by or useful
to the lead agency;attach additional.pages as necessary to supplement any it=
Pan 1-Project and Sponsor Information
Name ofAction,arPrRjoct;
-111M 5
�_ TZ2611f4P,, Z ra';
Project Location (describe, and attach a.location ma,p):
a4 4tb
Brief Description of Proposed Action.-
Q"4
vcth,414,4e, (Pn
V-Q- 44W4
IS
Name of Applica,nt or Sponson Telepbone.
-<
Addrew
city/PQ: 'stater TIP Codc
1.Does the proposed action only involve the leghflative adoption of a plan,local law,ordinmice, NO YES
administrative rule, or regulation?
ff Yes, attadi a narr�ative description of the iramt ofthe proposed action,and the anvironmenta] resources that
m 'be aff p
ay ucted. in the municipality andproceed to Part 2. If no,continue to question.Z.,
2,Does the proposed action require a permit,approval Qrfurndirn from any other governmental Agen ? YES
IfYes,list agency(s)name and permit or approval;:
Veth'AA-oe� X0,
'3.a,Total acreage off the site of the proposed action? cres
bi.Totid aercag,e to be physically disturbed? cre:s
c.Total acreage(project site and any contigpous properties) owned
or controlled by the applicant or proJ1W sponsor?
4-Check all land uses that occur on,adjoining and near the proposed actl0n.
e'Urban oRural(non-agrieultam) o Industrial o Commercial 406sidential (suburban)
oF'orest o,Agriculture aAquafic o Other Opecify).-
o Parkland
Pap I of 4
b< is the proposed action, NO YES Nib
a,A permitted use under the zoning regulations?
b,Consistent with the adopted cernprahensi^ plan?
6, Is the proposed action consistent with the predominant character of'the eanisting bnrilt or natural YES
landscape?
7, is the site of the proposed action located in,or does itadjoin.a state listed Critical Environmental Area? � YE
pi'k'es„ identify-
8
dentif -ll. a.Will the proposed action resuuIt in a Substantial increase in traffic above present levels? NO YES
L Are public transper°tati(m serwlce(S)avai lable at Or new time site of the prerpewsed action?
c.Are any,pedestrian accommodations or bicycle routes available on or near site of the proposed action?
,Does the proposed action meet or exceed the state energy code requirements? NO
if the proposed action+gill exceed requirements,,describe design features and to nculcgies:
10, WRI the proposed action connect to an existing publidprivate water supply? YES
TfYes,dopes the existing system have capacity to,provide semi. e? �� 0 NO 0 YES.
If No, describe meted for proviftg potable water,
M
11.Will the proposed action connect to existing wastewater utilities? NO YES
ifYes, does the existing systern have capacity to provide service? � 0 SPO YES ,
If No,describe method forp rovidiru,g wastewater treatment:
I
12. &'DI ues the site contain a Ftructnrer that is listen on either the State or National "Register of Historic NO YES
p"l,a"s?'
b.is the proposed action located in an archeological sensitive area?
13.a.Does any portion of the site of the proposed action,our lands adjoining the proposed action,contain NO YES
wetlands or other waterbodies regaled by afedend,state or local agency?
b.Would the preposed action physically alter,oreracroaeh into,,any existing uvetiand or wvaterbody?
If'Yes, identify the watland or waterbody and extent ofalteratirans in square feet or vers.
14, Identi.fy the itrat types that occur on,.or are likely to be found an the project site. heclr all drat apply;
typicallu
0 Shot line � wm t Zuburhan ictiu ral/g slands 0Early �d-su, enional
0 Petland Il Urban
I ,Does tine site oftha proposed action contain any species o animal, or associated habitats,,listed N01 YES
by the State or Federal goverrunent as threatened or endangered?
16,Is the project site located in the 100 year flood plains NQ/ YES
1,7.Will the proposed action create storm water discharge,either from point or non-point sources;" NO, g
If Yes,
a. Will,storm waterdischarges,flow toadjacentpr perties?' ONO 0 YES
b. Will storm wvatet discharges be directed to established conveyance systems{runoff and storm drairtQ?
II`'t'es,briefly describe: ONO 0 YES
Page 2 of 4
18.Does the propuused action include crast:ruction.or ether activities that result in the iurrpoundmiant of 1"*lt YES
water or other liquids (e,g,retention pored„waste lagoon,dam)? �.
If Yes explain purpose and size,
1 V?,leas the site o f the papposed action or an adjoining property been thelocation n of an active or closed NO YES
solid,waste management facility"?
If Yes,alesacr~ibe:
20"Has the site of the proposed action or an adjoining property been the'sunbpect ofremediatti on (on oi:m or NO YE
completed) for hs ardouus'waste's
If"des"describe:
I AFFIRM THAT THE DMORMAMN PROVIDar) ABOVE IS TRUE AND ACCURATE TO THE BESTOF iB;+l
KNOWLEDGE E
Applicant/sponsor�pplicant/sponsorname:! ''
SignaturcI
Part 2-Impact Assessment. The Lead,Agency is responsible for the completion of"Part 2. Answ r a9.1 of the foI:[owing
questions in hart,2 using the infbIrmation contained in Part I and other materials submitted by the project sponsor or
otherwise available tothe reviewer. When an5 weringthe questionsthe reviewer should begWdedbythe concept"Haveracy
responses been reasonable consideu uugthe scale and context ofthiepToposedactuon?"
'flan„or Moderate
small to,large
impact impact
„
may may
occur occur
L Will the proposed action create a material conflict with anadopted land usse plan or zoning
regulations?
2. W it] the proposed action result in a change in the use or intensity oI of land?
3. Will the proposed action impair the cha=ter or quality of the existing community?
. Will the proposed action have,an impact on the environruental characteristics that caused the
establishment of"a Critical Environmental Area(C 2.A)?
5. Will the proposed action result in an adverse change in the existing,level oftraffic,or
affect existing ini astnucture for mass transit,biking or walkway?
6 Will the proposal action cause an inrcrease in the use of energy and it fails to incorporate
reasonably available energy conservation or renewable energy opportunities?
7„ Will the proposed action impact existing,:
a,public Iprivate water supplies?
b public:Iprivate wastewater treatment utilities"?
, +a' iii the proposed action inrrpair the character or quality of"important histork,arrhaeological,
architectural or aesthetic resources?
, Will the proposed action reswlt in an adverse change to natunraV resources (II wetlands,
waterbodie,s, groundwater,air quality, floor and ff runa)?
'age of
No,or Moderate
arnall to large
inirnict irapact
may may
occur occur
10. Will.Ilieproposed action, :result in an, increase in thopotential ibrerosion, flooding or drainage
Problems?
11. Will t he proposed action create a hazard,to,environmental resources or human MOW
Part 3-Detamination of significance. The,Lead Agency is resp on,sible for the tomp letion of Part 3. For every
question in Part 2 that was answered Inoderato to large,impaCt=y occur",or if there is,a need to explain why a particular
,element ofthe proposed action may or will notresult in a significant adverse environmental impact,please comp�late Part 3,
Pa.03 should,in sufficient detail,identify ithe impact,including any measures or design elements thatbave been included by
'tile project s�pornsior to avoid orreducc impacts.Part 3 should also explain how the lead ogenay deunnined that the impact
may gr ill not be significant,Bach potential impact should bloassessed considering fts sedin p obability0foccurring,
duration,irreversibility,geographic scope and magnitude-Also considerthepoftntial forshort-term,long-terin mid
cumulative impacts.
0 Chock this box if you have determined,based on,the infDrmad"on and analysis abovc�,and any supporting documentation,
that the: prqposed action may, result in one or,more plotendally large or significant adverse impacts and an
environmentalimplact statement is required-
0 Check this box if you have d4ermined,based on,the information and analysis above,and any supporting d0ounientation,
that the proposed action will not result in any sipificant adverse environmental impacts,
Name of Lead Agency Date
Print or' eName of Ruponsible Officer in Lead Xg—e—incy Title of Responsible Officer,
Signature of Responsible Officer in Lead Agency Signature of Preparer (if different from Responsible Mcer)
Page 4 of 4
Signature Page
This page Inicludes the t)Authorization to Act as Agent Form.2.,) Engineering Fee Disclosure; 3 Authorization for Site
Visft, 4.) Other Permit Responsibilitiec 5.) Official Meefinig Disclosure and 6j, Agreement to provide documentation
required.
OWNEIR'S AGENT FORM.
Complete the following If the OWNER of the property Is,not the same as the applicant
Owner- C
Designates: ni
As agent regarding: Vani Site Plan Subdivision
ror,Tax. Map No.: Seiction Block Lot
Dead Reference:, Book Page Date
OWNER SIGNATURE, DATE:
APPLICANT'S AGENT FORM:
Complete the follawing if the APP' CANT is unable to attend the meeting or wishes to be represented by another party
Ownern
Designates: A0 V
As, agent regarding: adance Site, Pitin lo6ubdivilsilon
For Tax Map No., Section '3700 t Block I Lot qo
Dead Reference: Hook Page Date
---1
APPLICANT SIGNIATURE: 12 DATE:
2.) ENGINEERIING, FEE DISCLOSUR2. Applications may be referred to the Town consulting engineer for reMew of septic i
storm drainage, etc, as determined by the Zoning or Planning Department. Fees fair usngiu oring review service's mill be charged
dired,ytar than applicam, Fessf6r einglinisering ravlaw will not exceed S 1,01100iwlthout notification to the applicant.
3.) AUTHORIZATION FOR SITE VI ,IT S,, By signing this page: and submitting the application materials attached hereln.,the Owner,
Applicant, and, hiialherftheir ogei hereby authorize the, Zoning Board or Planning Board and Town Staff to, enter the subject
properties for the,purpose of:revijewing the application submitted.
4.) OTH ER PERMu IT I'VE SPON SiIBILITI ES: Other perms to may be required for construction or alteration activity subsequent to,approval
by the ZoNng Board or Planning Board. It isthe applicant's responsibility to obtain any additional permits.
,5.) OFFICIAL MEETING MINUTES DtSCLOSURE., It Is the practice of the Community Development Department to have adiesignated
stenographer tape record the proceedings of meetings resulting from application,and minutes transcTibed from those tapes constitutes
the official record otaill proceedings.
6.) AGREEMENT TO PROVIDE DOCUMENTATION REQUIRED,c 1,the undersigned, have thorougiNy read and understand the
instructlions for submission and agree to the submission requiremerbi, I acknowledge u construdlon, activiflos aliall be commence4l
prior to issuoni of, a valid permit, r car* that the application;, plans onid supporting materials are a true andl complete
statemenl1descrilotbon of the existing conditions and the work proposed, and that all ,work will be performed in accordance viii'llh the.
approved plans, and In conformance with local zoning regulations. 11 acknowledge that prior to occupying the facIlifies, proposed, I or, my,
ageft will obtain a.certificate of occupancy as,necessary. I also understand that lAve may be required to provide an as-buillt survey by
a licensed land surveyor of, all n&Myr constructed facilities prior to Issuance of a cartificate of occupancy,
I have read-anuli ag ee to above,
Eigiiatur'e'[Apipficantj Print N,aame [applicant] Date signed
ignature,[Agent] Prinli! Name [Agent] Date signed
Sfte Plan Review R" heed Apr'1120,16
Town of:Queensbury Planning Mica- 742 Say Road -Queensilourry., NY 12804 -616-764-8,2201
rug- a rrnius ion Conference Form [179-4-0401 � "� � ��"
1. Tai Map l'C.m
2. Zoning Classification
�
. Table of ilu a dl t.ls s1�,f�"OAA Ck��f2�g,4 Q�3!S� subjecttoSite Plain Review
4. Ordinanice Section # Q(2 c?
5. lire-'~ uab mis ibn Meeting Notes,, 0 utstandng t rrus'Tv, Be Addresserl Include.
Dead Yes G
Glenera,l information complete s
Site Development Data o mplete�
m� Id �&C V, t
Setback Requirements Complete s 7, sae e,P (0 r—
Additional Project hformation Complete leo
FAR Woriksheet complete IA&Yes
Standards addressed y s
Checklist harms addressed) Yes
Environmental Foram completed Yes
Signature Pagecompleted Yes
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c-yp '[ S�& ,.
iga vAth Notice of hen NOJ)• SWPPP Acs taro lpn �§u inn po.Emit
naarrnb n~ Notice of Termination (NI OT)
Staff Representative-
Applicant
epr s nt tive-ppliicant Vent.
Date. Cum
Siitig Pian Review Pevus dl Aprill 2016
Tovmof Quueenabury IPlannEngOfficu e,7�42 Say Road-Qu eensb uiry, NIY 12504 518-761-5,2 m� ....
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