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Subdivision Application including deed Tax P rcd ILS Number. G JA14, I '12,01? Zoning District: .TOWN ..jp tuL Stage c � lica _e Sketch Plan SUige tj Preliminary Stagy w .. Final Stage Indicate th follomfina, Number of lots propped Residential or Commercial Total Lot image ud Proposed lot sr ,s I,A`7 Project location i let ro or Detailed Description of Project riunclu de current ptoposed,use)' n FIfut Irinrnuuw Address. lar 1. Home porus Cell{ Work,Phone Fax -Dalt N Ageht"s-Na e `,' "_ dress: .,,,. florae Phone Cell: i . r„ -Mall �' r" r° ICH, �n .�"-" ELI n,y ' ° , du P Town iDTOueeunsbury Flan arias•742yr .Queens ry,N,Y 1 8'04 518-761-8220 � Pre'iir nunnery 311ge Reyised April, 010 :P're-.err mmmWjQ1,1 Qog=nce Form 1. Tax Map M- -.O-q. Zoning IIassNficalion : ,gip- 1,.0 (1-? l :eas mi fora riem��; , .� � 4- Ordinante section" el 5. Pre- ubmissiomn Meeting Notes;Outstanding Items T res d inti sa 1_ Deed Yes O General [riformation Yes No Preliminary fiat. V yas No 4, La anut Mins "des. No f Construction DetailsYes No . Lnn "gee Plain Ye i T, Clearing Plan ''es No a. r rlliin9 C ,rc si an 7u trr]i1'' YNo 'n^rimw-n7ranerntai Report Ins 10. Statement f Intent yes 1140 11, trnrmnw;atter Flan f WP'PP Yes, No 12. Fees si o 1 n eu°s e's —N'O 14_ Subdivision Sign Posting yes � o 1 ,r Signature fade END J �v .............. ACL .A fp " C'q C ' Lk C' 3 Staff Reprss nt fu,v Applicant i Agent Date: Twin of n erustuury'Pla nni ng�e,- 742 Bay t sd °0 ueensbury,1 Y 12a04 • 618-761-8220 6, Statement Intent ubdi ii ion of a, 4.87 acre parcel into two residlendal lots of 3.0 and 1.87., Hif 1 A deed) has been provided to show, ownership H 2 No street Improvements will be needed for new parcel 3 Not applicable H 4 "it will be the new owner's responsibility to provide this information and a not+ will be added to the final pian. Waiver requiests Per, pre-suibrnisslon with staff=the fbillowing waivers are being requested or items have been deemed not applicable: Sketchy pian review Prelimirna plat: A 2, 5f Layout plans: I3 4 Constructiondetails: C 1, 3 ,Landscape plan: not applicable —responsibility of new owner, Clearing plan: not applicable —responsibility of new owner Grading/Erosion control plan: not applicable —responsibility of new owner toirrnwwater 'Management pllan. not applicable —responsibility of new owner P'rel iminary Stage Revised April 2'010 ITEMS TO BE IDENTIFIED BY STAFF DURING PRE-SUBMISSIDN MEETING. You should use, this page for SU'idance wKien drafting your application, however, It%1i I be completed bey .1, staff Fj,)eniben Submitt,A of a preliminary plat depicling existing and proposed conditions shall iMILide, the items as noted belovo. Faillure to,include all required inforniation may result ina determin0on of'incompleteness and a delay in the processingi of your application. §A183-13. Plat details and requirements. The applic-ant is required to subrnit one(:I I od&,W gad"1.. Cogles,of the preliminary plat apprication. SuchapplIcation shall include: the follovhqo documents andlor information: A. gRE'LIJAjjjAEY-PLAT. The pre[irninary plat shall be laid out by a licensed professional engineer andlor a licensed professional land surveyor, withh a properly executed New York Stale Education Department Exemption N. Such preliminary plat shafl be prepared at a scale of one [inch equals 50 feet zero inches, clearly 1) The location, of all existing and proposed property lines. buildings, watercourses and mother important topographic features,- 2) Existing and proposed contours showing elevations it ti.D-foot contour [intervals and extending at least 10C feet off site. 3) The location, names and Mciths of all existing and proposed streets,, easements, lots and building lines, wells and soptic tanks andl fields and similar facts regarding property immediately adjacent or opposite the proposed subdivielon 4) A location map shov%ring: (a)The zoning d[stdcl or districts in Mich the land to lee subdMcledis located', and (b) The: property included in die proposed subdhasion and all, corifiguous properties of ft proposed subdivislon and all properties Wthin 600 feet in each direction from the boundary Nna of the proposed subdivision along any contiguous street or highvvay. All proper ii ,$ "]l be identified by lot and parcel number and narnes of&-viners- 6) The location and size of any existing saw0r$ir Water Ma"'S' culverts and draiii pipes, electric, telephone and cable television ['J'nes anwrn d proposed se%vers. ater ains,, cWverts and drainpipes on the property or inim ediatelly adjacent to the property to be subdMded., 6) The proposed arrangement and approxiniate, area, width and length of street frontage and, setback requirements of each lot for time purpose of demonstrating to the Planning Board that,the proposed location of streets makes possible a layout of lots in actordance with the requirentents of the Town, of Queensbury Zoning Law for the district or districts in-which the subdivisibn,is located. 7) All Parcels.of land proposed to be dedicated to the putAic muse_ 8) The date, North arrow and scale® 9) The Me under which the proposed subdivision is to, be recordbed', Ath the names of the owner and, tie eng,ineer or land surveyor%?jho prepared the preliminary plot-, the license number and seal of the,engineer or land surveyor shall be affixed,to the drawing. fngineer or profe-ssiona,I Rcensqd B. LAYOUT PLA Layout plans shall be prepared by a pro,essional licensed e land surveyor, vAth a prolpedy executed New York (tate Education Department Exemption N. Such layout plans stiall,beincorporated on the prefirninary plat and shall! show the following., T) ThL- exact layout and dimensions, of proposed streets, including stationintli and fie,!Ti to the center-fine distpnces of existing,streets vAth monuments and other points, as required. Toym of Queensbury Planning Office!-742 Bay Road -Queensbury,NY 12804 -51 a-761-M0 2 Prefinfinary Stage Rev!Sed April 2010 3) Plans and detad't of any site: impirovemerits related to park or mcreation planning. Including layout. grading, planting and details of any improvoments. 4) Plans and details of any other publiG anTendies provided in the subdivision. 5), The date and acals. 6) The We numbe�r vehich the proposed subdiw[siain is to be recorded. with the names of the ovmer and landscape architect who pirepared the laodscape pl-aw, the licens�e!number and sea] of the landscape archiw�f shall be affixed to the dra%ving. E CL�ABI.UfLEJaa, A dearing plan shall be prepared at a scale of one inch equals 51G'feet zero inches. Such Plan shall show the following demills-. 'I) Exisdng ve-getation,piriorto any clearing, of the ske,for siw�inves�tigation purposas� 2) Areas of vegetation remloved From,tha site for investigation PINPOses. 3) The locakn of roadways, anderground or overhead ujilft[es not. [n roadways, [Imits of grading, proposed ptir location of any buildings, �se �C SyVeMSr Ypetis and dflvew,ays and any other improvernant% whith miglit require clearihg. 4) Areas where slopes are grea Wr than 2W as Per§AJ 83-26, 6) Limits of proposed clearing of�trees- 6) Measures to be taken to prate ct remaining trees,including details F- GRADjING AUID ERQMON Co a UIRQL P LAN,$.A arading plan.and arosion control plan shall be prepared at -s,cale of one Inch equals 50 feet zero,inches, Such plan shall show, th�e following, 1) A generalized grading and drainagis plan (does not require spot,9 radesor slope designation). 2) Any phasinfg,of tree!removil and;or con�Wucfion. G, LWgjRQNMFNTAL REE!QEtT� A long environmental assessment form, shall be prepared in accordance -,Oth the State EnviraiTm-antal Ova y Review Act describing the poteinflal environmentall impact of the proposed subdivision. H,. STATEMENT-OF INTEVI,. A statement of intent shall be submitted by the applicant. �Such statement shall include: 1) Pro,of of awnership of the laind to be siubdMded, in a form approved bythe T"I AttorneI, 2) The nature and extent of proposed street,impruvements- 3) The nature an:d exterit of any recreational featwes. park$. playgrounds, water supply, sewerage and drainagie ri�hts-of-viay and easements. retention basins and other land to be dedicated to public use and the conditions undier which dedication of these fleature's is to be!made!to the,Tovm- 4) A statement that the applicantwill instail all improvements in,accordance vAh ihe standar&prescribed by the departments olf the Town, hay[ng jurisdickn. and set 311 monuments as shown on the final plat.thereof in, such manner as the Board may diesignate, 1. A STORKWAT MANAGglAgUL PLA §IORMW.61,ER EO_L IQY, PREVEUTIQN PLAN A and a consistent vAth the r�quirements of'Chapter 147,Storm,water f4aljagement. Town of Queensbury Planning Me. 742 Bay Road,GUaen$b0rY,:My 12894-518-761,8220 Preliminary Stage Revised April 2010 Wil, FIFES. 1) -T'he application for prelimi, nary plat approval shall be accompanied by a fee fisted on the current schedule of fees for the"fco n of Queensbury;pasted in the Plainniitng Ofte. 2) In addition to the fee listed an the schedule of fees,the Plonnin9 Board may charge a fee to developers of projects requiring irin legal 'a ad technical revie v:, provided that the fee charged)reflects the actlual cost of time 'legal and technical assistance to the Planning Board. ` V the Ptanning Bard finds that any of the information requirements as set ficrih above .are inapprep(riate or not necessary, to, randnct an inifermed review„ it may waive zuch information requirements as it d'reerai;s appropriate—Any such waiver,shahf be made in writing, and shall. contain statenients of the reasons viby,the waived informati aln requirements are not necessary Blit Burn informed review,under the cimuurnstances- The Planning Boar) may grant such waivers on nts'a'wn initiative or at the written request (that sets forth the specific requirements that are requested to be: vaived and the reasons for the requesters waiver), of an applicant. A183-14. Submisslon and Review procedure-- Subdivision Sion Posting Requirements D. Notice. The subd'Mder shall display pr'orninentiy on the subject property,for 10 days preceding the dale of the public hearing, at leastone sign, two feet by thiree feet in size and carrying a legend prescribed' the Tern Planning Board, announcing the public heaMq. The sign shall!be in full public vie, fruri-i the street pavement and shall tae leguible from, the etreel, if the propefty°is mounded by more than one street, a sign s°hail be placed on each street that bounds the property. I i i Toym;of Queensbury Fsannlr4 Office, 74,' Say''Road Queensbury,NY 12204,518-161-8220 S Full En,virown.enial Asyessizient F orm Part I -Project and Seithig Instructions for Completing PRrt I Part I is to becomplel the applicant or project, ponsor. Responses become part of the application for approval or fundin& are subject to public,review,and may be subject to further verification- Complete Pan I based on:information currently available. If additionid,research or investigation would be needed to fully respond to any r1em,please answer as thoroughly as possible based on,current information;indicate:whether missing information does not ead$k, oris not reasonably available to the sponsoT,and,when possible,generally describe:work or studies which wouldbe necessary to update or,fully develop that infomation- Applicants/sponsors;must complete all items in Sections A&B,- In Stetions C,D&E,most items,contain an initial question,,that must be:answered either�Yes"or If the,answer to the initial question is"Yes",complete the subi-questions,that follow, If the answer to the initial question is"No",proceed to the next question, Section F allows the projectsponsor to identify and attach any additional infbirmation. Sectibn G requires the mane and signature of the project sponsor to verify that the information contained in Part I is accurate and complete. A.)Project and Sponsorl nformation. Norne.of Action or,PTojectt fna-m) Project Location(describe,and attach a general location map): 4 j i al ro- 2r, Brief Description of Proposed Action(include purpose,or need): d,/J erl-71, acre paraeli Name of Applicant/' ponsol Teleohonc: E-Mail: all AddrEzs, City/plo. State, Zip Code: Project Contact(if not some as sponsor;give name and fidl Telephone: E-Mail. Addms. City/Flo: State: Zip Code; Prop"Owner (if not same as sponslor)- Telephone: Address, City/po, State: Zip,Code: Page I 0fr 13 D.tprwvernrnnexit Approva.Is 13.iGovernmen(Approvals Fun ding,or Sponsorship. ("Funding"'inncinndes-grants,loans,,tax relief,and any nnthtr fCarrn-lw.s of larnarncial assistance.) overwnrnent Entity If Yes:Identify Agenvy and Approval(s) Application Date llteq ulred (Actual nnr pro j ected) a..City CouncilJown,13oard, a Yes 13 o, or' "i;llageBoardofTrustees fir,City,Town or Vil Iagde Mi Yes a No Planning Board or Commission � ��l l-ll ? c.City lawn or Yes a' WagerninT card efppe NoSU), Sid d.Other I dl agencies o Yes o No c,county agencies 0 Yes 10 No f.Rel agencies o Yes 0 No .'State agencies ra Yes lwlc I h.Federal a, erucies m"des m Ilio i. Coastal Resources. L Is the project site within a Coastal Area,or the waterfront area of a,Designated Inlan'Vd Waterway? Q Yes 9rNo If Yes, fl. Is thegarraject site located in a community with an approved local `aterfr rt Revitalization Program? L3 Yes o ilia Is tlne prl site wd1hin a Colastal Erosion Hazard,area? 13 Yes ONO C.I inning and Zoning C.1.Planning and zoning actions. Will administrative or legislative adaption,or amendment of a piarn,local law,crdliaance,:rule OT° regulation be:the 0 Yes,0 No only approval(s)which antust be granted to enable the Proposed action to prcacew?, If Yes,,complete sections C,F and,G. If No,proceed to question C2 and complete all remaining suctions and questions in part I . .adopted landuse plans.. a.Do any x nrunicipall -,adopted (city.,town,village or county oorngnrehensive land we plan(s)include th.a site ''des"is mere the proposed action would be located? If es does the:co nn relnensive,plarn include specific recernnmendations for the,sitewhere the proposed a ticin, C3 Yes 0 No would be located' ir.Is the site of the proposed action within any focal or regional special planning district(for exarraple. Greenway C`'des fl u Brownfield Opportunity,Area(BOA);designated'Stage lot Federal heritage area;watershed managenient plan; or over? Ifs es,iiden'nti P the plan(s): c. Is tine proposed action,located wholly or partially within aro area listed in an adopted'municipal operon space plan, 13 Yes o, or an ainunicipal fa,rmland protection plan? Ifs,identify the plan(s): i Plage 2 f 1 C.3. Wooing the site of the proposed actiaumu located in s municipality with an adopted 20ning lawor ordinance. W-1i rt No if'Ye:,what is the Wfling classification(s)irucluuding any applicable overlay district? b, is the:use permitted or alley ed by a'special or conditional use permit? 0 Yes 0 No c.is a zoning change requested as part of the proposed action? 0 Yes O No IIf'yes„ I What is the proposed new zoning for the site C-4.llr Asting eommmmsmunity services.. a.In what school district is the project site located? y b,What police or outer Fpublic protection f9rces seine the project site �,uu�'hlclm fire ��t ctiamuu sial ermmergcracy mumedical seru�ics ser+a�e tlme pr'��ect sitar? dm What pars serve the project;site? D.Project:Mtails DA.Prepescdd and lPetential DievelOPMERt a.What is the generaul muatrure of"the proposed actioou ie.g.,residential,industrial,commercial,recreational;ifrnitred,iuucltude all f 615, w-d- Ir.am.Trttal acreage oftlme site urf the:proposed action?' 4-b acres b.'Totaml acreage to be physically disturbed? e,cres c"Total e(project site and any contiguous properties)owned air controi�lled by the applicant or project Spansor9 ecres c,Is the proposed action an expansion of an existing project.or use? � � 1. If Yes,what,is time approximate percentage of the proposed a iouu and udenti flue rarbuts 'e. .,acres„rruiles,Itoumsin mmmtits, square feet;)? Un dl.Is the proposed action ax subdivision,or does it include a s:Adivision? des®No, lfes, it l rose or., polf sudivision?(e.g, residential,industr°ial,commercial„if mixed,specify types) IIi'. Is a cluslt r/conseri layout proposed? � Yes RL Number of lots proposed? � , iv.Minimum and maximum proposed lot sizes'? Minimum I$ " ilutt.utrm�+ e,Will proposed action be const ted in rauultiple pioamses? i. 'IT-No,anticipaterl period ofconstruction: _ rtuaurmtlus- ta. P Ti number of°pltases anticipated F ATiticipated commencement date of hawse l (including demolition) month year 0 Anticipatedcompletion date of final phase - month ___year 4P Generi describe connections or relationships among phases,includingany contingencies where progress of one pbase M.ay IL detemrrrtlrme'timing or duration fittutre phuasesa Page,3 of 1 ii,Describe how the proposed action would affect tinat waterbody Orvwetland.e-g.excavation,IiNI,placement of structures ar alteration of channels, banks and shorelines, Indicate extent of activities,alterations and additions in square feet or ncr-esr iii. ''moll proposed action cause or resunit in disturbance to bottom sediments? 0 Yes blas If Yes,describ - ivr Fill proposed action carcase or result in the destruct ion or rernoval of aquatic vegetation 13 '"fes"o If`u'es. ■ area of vegetation proposed to be removed expected acrca,ge Of aquatic vegetation remaining after project completion purpose of proposed removal(a,g.beach clearing, invasive species control,bunt access): proposed method of plant removal. ■ if chernicaUhevbicide tre.atment,will,be used,specie prandaact(s):,, v.Describe any proposed,reclamnalion/'amitig,ation following,disturbatnce, c.Will the proposed action.use,or create a new demand for water? E3 Yes wNo If Yes. i.Total anticipated water usag dernarad per,day- � gallons/day U Wiii the proposed action obtain water from an existing,Public water supply? r3 Yes jai No If Yes. Name of district or service area;. Danes the existing public:water supply have capacity to serve the proposal? 0 Yes'fit No is the project site in the existing district? 0 Yes 13 No. is expansion of the district me DI Yes 0 No Do existing limas serve the project site'?' o '"des El No, fii Will lime extension,vwwiith'in an existing district be necessary to,supply the prral 0 Yes P�No If Yes: Describe extensions or capacity expansions proposed to serve this pro ml. ■ Source(s)of supply for the district: iv, 'Is as new water supply district or service area proposed to be formed to serve the project situ 0"des o No lf,Yes. • Applicant/sponsor for new district.. • Date application submitted or aanticip,ated. • Proposed source(s)of supply for now distl v,l'fa public water supply will not be used,describe plans to provide water supply for the praj,ect. ui.lfwater supply will be Erorn wells paublic,or private),maximum pumping capacity. 9allomsirnlnunte,. d,Will the proposed actitum;�erne.rate Hquuidwaustes? ©ids b If Yes: i, 'Portal anticipated liquid waste,generation per day, _— gallo nsiday ft.,.Nature ofiliqurid wastes to be genw, (e.g.,sanitary wastewater,industrial;if comb xnation#describe all components mond approximate volumes or proportions s of eaichi UL Will the proposed action use any existing public wastewater, treatMent facilities? 0 Yes a No If Yes: Name of wastewater treatment plant to be used; Name of district- 6 Does the existing wastewater trealiment plant have capacity to serve the prajeaav? M Yes 0 No is the:project site in,the existing distil 13 Yes u No +� is,expansion,of the district needed? 0 Yes to No Page 5 of 1 P Do existing,sewer lines serve the Project site? Cl Yes El No a Will line extension within an existing district be necessary to serve the project? 12 Yes Eallo fyes. Describe extensions or capacity expansions proposed to serve this,project: iv, Wfil a now wastewater(sewage)treatment district be formed to serve the project site? 0 Yes O-No Wyes: Applicantfsponsor for new district. 6 Date application submitted or anticipated: 0 What,is the receiving water for the WaSteWaIelr discharge? v, If public facilities will,not be used,describe plans to provide wastewater treatment for the project including specifying,proposed receiving water(name and classification i f surface d isdtarge,Or describe subsurface dispose I plans): vi.Describe anMM y plans or designs to capture,recycle or reuse Hquid waste: e:.Will the proposed a0ion disturb more than one acre:and create stormwater runoff`,either ftm iiew point 11 Yes P-No souv=s,i(ie.ditches,pipes,s,wales,curbs,gutters or otherr concentrated flows of slormwater)or non-point source(i.e.sheet flow)during construction or post construction? Ifyes: 4 How much irupervious surfhee,will ibe project creale in relation to tolal size of project parcel? Square feet or acres(impervioussurfacc) Square feet or acres(parcel size) U. Describe types of neer point sources, id. Where w.il I the stonnwater runoff be directed(i.e.onsite stormwater management 1bci lity/structusm adjacent properties, gxvundwater,on-site surface water or off-,site surface watersr, * If to surfa=wMeTs,identify receiving watcr bodies or wetlands: . Will stormwater runoff flaw to a4acent properties? Yes to No iv.Does proposed plan minimize impeivious surfaces,use pervious materials or collect and re-use storm.water? 0 Yes El No f. Does the proposed action include,orwill it use on-sitti,one:err amort sources of air emissions,including fbel 0 Yes MIND combustion,waste incineration,or other processes or operations? If Y�es,identify: L Mobile sources during project operations(e,&,head vehicles equipment,fleet or dtfivery I it Stationary sources during construction jo-wer generation,structural beating,batch plant,crushers) fa Stationary sources,during operations(eg,pmcess emissions,large boilers,electric:generation) g.Will any alremission sources named in D.2_f(above),require aNY State Air Registration,Air Facility Permit, a Yes fdrNlo or Fedaral Clean Air Act Title IV or Title.'V Peurnit? Ifyies: i, Is the project,site located in an Air quality nori-ettainment area? (Area routinely or periodica]ly Nis,to,meet 0 Yes 0 No ambient air quality standards'for all or some parts,of the yeah) iff.In addition to emissions as calculated in the application,the project wfll generate. Tons ear(metric)ofCarbion Dioxide(CO's) Tbnslear(metria)of Nitroua Oxidle O) 0 Tons/year(metric)of Perfluorocarbons(PF'Cs) Tonslyear(metric)of'Sulf3r Hexafluoritle(SFO) Tons/y=(metric)of Carbon Dioxide equivallerd ofHydroflorocarbons(HUS) ___Yons/year(nietris),ofHazardostia Air Pollutants CHAPs) Page 6 of 13 h,Will the proposed action generate c+r emit methane(including,but not limited to,,sewage;treatrru nit plants, t] Yes to Nay landfills,composting facilities),? If Yes: i. Estimate methane generation in ta-nsl ear(araetr c): ff.Describe army methane capture,,control or al.r`rnnirnatican measures included in project design(e.g_combustion to generate heat or electricity.flaring); L'4w1,"'ill the proposed actibun result in the release of air pollutants from open-air operations or processes,such as 0,Yes iP�No quarry or landfill operations" If Yes:–Describe operations and nature of ernissicns(e.g.,diesel exhaust,rock pa'r,wc.uulat sd uust). j.Will the proposed action result in a substantial increase in traffic above present level's or generate Substantial 0 Yes c new demand for transportation facilities or sernrices f ffes, L'9 haeru is the peak traffic expected(Cheo c,all that apply): 1 Momirng d Evening OWeekend Q Randomly lusher,hours of to if.For commercial activities only,projected number of semi-trailer tnrucic trip 'day: fff.Parltinrg spaces: Exiaing � „ DPraaposed Net increase/decrease fn+',aces the proposed action includeany slurreduse parking? 0 Yes ru No ar, if the proposed action includes any m.ndlificatvom of"eutistirng,roads,creation of new roads or change in existing ace ss,describe: vi. Are public/private transpartatioun service(s)or facilities available within 14 uruilur of the proposed)site? Yes o No wff Will fhe propmwed actiaa a include ua.cce 5 to public transportations oraccommodations,for use of bybrid,,electric Er Yes of No or other altenruatuve:f'uteled vehicles' viff.Will the proposed action include plans for pedesl aan or bicycle accommodations for connections to existing 3 Yes tin,No pedestrian or bicytic routes? it.Will the proposed action(for commercial or industrial projects only)generate new or additional demand 13 Yes 0 No for energy's If Yes: f.Estimate annual electricity demand during operation of the prppoud tion: U Anticipated sourrcesisuupplliers cf leetricity for the pr jicot(e,g,cru-site combuistion,o n,site:rcrnewabla�via rid)'Icca.l utility,or, ocher): off, Will the proposed acdoan require a new,or an;urpgrade to,cru exiitrng—substation? 0 Yes m No 1.Hours of operation. Answer all items which apply. Z During 'onstructio n: fl. During,Operations: Monday m Friday-, Monday Friday- Saturday- riidary-Saturday: * Saturday-, unday: Sunday: 0 Hol'ida;ysi Holidays: Page 7'of 1 rru, Will the proposed action produce noise that will exceed exist'nirr.g ambient noise levels during.construction. 0 Yes P','No operation,or both? ffes. i. Provide details iruclu ing sources,time of day and duurautloun. H., Will proposed action remove existing rnoural barriers that could act as a noise barrieror screens. 0 Yes tu' ' Describe: ru.. Will the proposed action have outdoor lighting? If yes: L Describe source(s),location(s),height of fixture(s),directiordaim,and.proximity to nearest occupied st ctwes: ir. Will proposed action remove existing,natu ml barriers,that could act as a light barrier or Screen? 13 "Y'es 13 N Describe - o-Boons the proposed action have the potential to product odors formoretbani one hoar per days" 01 Yes PNo If Yes,,,describe possible sources,potential fictleerncy acnd duration-of odor emissions,and proximity to,nearest compied structures: p.Will the proposed action include any bulk,storage of petroleuurn(over p,l Opt gallons)or chemical products 0 Yes ONO hover 550 allorus) If Yes: L Product(s)to be stored U.Volume(s) per unit time (e.g„month,year) M. Generally dean&proposed stomSe facilities q.Will the proposed act on(commercial,industrial and recreational,projects Only)use pesticides(Le.,herbicides, 0 Yes 13 No insecticides)during construction or operation? If '"es,» L Describe proposed treatment(s). if,Will the proposed action use'fnte , ted pest lean ernent Practices? �3 Yes 13 No, r.WilI the proposed action(commercial or indestri al projects only)iruvolve or require the management or disposal 0 Yes []No of solid vras,te(excluding hazardous materials lfYes: 4 Describe any solid aste(s)'to be generated daring construction or operation of the facility: Construction: torus per (Ionit of time) Ope� kion: tons peer__,(unit of time) U.Describe any proposals for,ori-site minroiminflorn,recycling or reuse of'materials to avoid disposal solid waster 9 oostruction. M. Proposed disposal a rnetbods/facillties for solid waste generated on-site; Construction, OpeTation, Page, 8 of 1 s.Does the proposed action include cunstruction or modificadon Tufa solid waste managemem facility? 0 Yes If 'es:. i, Type of managernentor handling,of waste proposed For the site(e.g.,recycling or transfer station,composting, landfill,or anther disposal activificsy. H. Anticipated rate of disposaUprocessing: , —Tons/month,if transfer or other non-combustion/thermal treatment,'or jp, —Tonsw'`hour,if combustion or thermal treatment W. Iflandfil 1,anticipated site life. years t'Will Proposed action at ow She involve the cm-nmercial generation,treatment,Storage,,or disposal of hazardous 0 Yes P 'waste? If Yes: i.Name(s)of a]I hazardous wastes or constituents to be generated,handled or rnana:ged at facility: if, Generally describe pmceswes or activities involving hazardous;wastes or constituents: iff.Specify amount to be:hm4led or generated tons/month iv.Describe an,y proposals for on-she minimization,recycHug or reuse of hazardous constituents: v.Will any hazardous wastes be disposed at an existing off ffe Imardous waste facility? 0Yes ONO If Yet:WVidename and location offt:jIfty. IfNo:dcsrzibeproposed manag� ent of any hazardous wastes which will not be sent to a ha=dous,waste(acidity-; E.,Site and Setting cal'Proposed Action E.I.La ad uses on and surrounding toe,projeet:site a.Existing land uses, 4 aeck all uses that occur on,adjoining and near the project site. C Urban 13 Industrial 0 Commercial WRasidential(Suburban) 0 Rural{non-farm) Ell Forest p/Agriculture 13 Aquatic 11 Other(specify): fi. If taix of uses.,generally describe!: b.Land uses and coverrypes an the project site. Landuse or Current Acreage After Change Ac!rea&S_ Project Completion Roads,buildings,and other paved or impervious surfaces 6 Fores d 0 Meadows,grasslands;or brushlands(.non- agrzcultural,-in4,liulin g.:abandoned agricultLraj) 0 Ag*ultural, Oncludesactive orchards,AcK gmenhouse:etc.) Surface:water features (I ,eands,streams,rivers,,etc) * W 0146js(ftshwater or tidal) . ......... * Non-vegetated(bare rock,earth or fit H) * Other Descrtb= Page 9 of 13 T e projcct used lay raaerraber's oftlae eorarrrauanpit iar panblic rncreatlra ' sr �es;exp.11ain: _ d.Are there any facilities serving children,the elderly,people with disdlailities(e.g.,schools,hospitals,licensed 0 Yes bio day care centers,or Vvup!souses)within 15,00 fect of the project sites If Yes, p': Identify Facilities: e.Does the prat ect site contain ars existing dam? C3 Yes Q°No if Yes. i.Dimensions of the dam and i poundmeant- • Dain height-. � feet a Omen length- feet • Surface area: acres Volume impounded: gallons OR acre-feet R.Dam's ei hazard classificnation- tif.Provide date and summarize results of last inspection' f Has tilos project site ewer been used as,a municipal,commercial or industrial solid waste management 561ity, 0 Yes E],No ar does the pmjc:ct:site aadjiniaar property which is now.,or was at one thane„used as to solid waste rnarnsp;,enaaent facllipy' if Yes. L Ides the facility been f)orrnally closed? c 7 "des® No • If yes,cite soar,roes"-docurneaatration- ... . Ott.Describe the location of the project site relative to the laoaantl aries of the solid waste management i" I ty:. W, Describe any development constraints dare to the prior solid waste;activities. gN 1-lave hazwdous wastes been genes-ated,treated and/or disposed of at the site,or does the project site adjoin to Ye's tot 'o property which i,s now or was at one time used to commercially treat,,:store an.Wor dispose of h rdous,waste? IfY :, L Diescribe'awaste(s)handled and waste managerracrat activities;,inclu!ding approximate time when activides occaur dr h. Potential contamination history- Has there been a reported spill at the proposed project site,or have any 10 Yes o remedial actions been conducted at,or adjacent to the proposed site? if yes. L I .any portion of the sites fisted on the NY Spills Incidents database or Enviroanrneantal Site 0 Yes 112 l!~l'o .ernediation database? Check all that aappiy: in Yes—SpilIs Incidents database Provide,DEC ID naaaraher(s).. 0 Yes— nvironmental Site Remediation databasie Provide DEC ID naarnla r( ) 0 Neither dabbase it If site has been subject ofRCKA,corrective activities,describe control measures: M Is the project witItin 20,00 feet of any site in the NYSDEC Environmental Site Remediation database? D'Yes®No, If yes,provide DEC ID nuarrni ivy If yes,to i),(il)or(hij alcove,describe current status of sites) i Page 10 of 13 v. is the prpj t,site subject to an institutional control limmiting lnMerty uses? '"des P 1 If yes,ITEC'site ID number. Desceffie the type of irnstitational control(e.&,deed restriction or easement): Describe any use llnrnitatl!aas. Describe any en hieerimg,comtrcnls° Will the project affect the institutional or engineering,controls in placO 0 Yes 13 No i Eapl!airn F—, ¢ Natural Resources On or Fear Project Site aa.W at is,the average depth to baedrtaok on the project site? feet b.Are there bedrock outcropplap on the praject site" _ 0 Yes D No if Yes,'wa'hat proportion of the siite is comprised of bedrock outcroppings?s? c. redo imam soil type(s)present on project site. d.What is the cera depth to the grater table on the prtaj=t site:? Average: ,feet i o.Drainage status of project site soils.01 Well Drained: of Site Moderately Well}t mi ned; -of site * Poorly Drained of site . ap mximate proportion of proposed action 4tc with siopes: 0 t1-101°, . 0Aof site ❑I 10-15%; of site Ui l %or greater„ of site .Imre there any unique geologic features on the project site's 0 '"es 0 No If Yes,describe. b,Surface water features. i„Does my portion of the project site contain Wetlands Gr other ater6idies(imcludirng,sue=s,rivets, 1'"i''es"o pamds or lakes)? R. Do ani'wvdan4s or other atPrb+odies adjoin,the project site? 0 Yes EPNo If Yes to either i or tt,ocnlinue, if No,skip to E. .1. iii, Are any of the wvedarnds or watierbod"ues,within or aadjolnirtg;the project site regulated by any federal, Q Yes 13 No state or local age'rncy? iv,For each identified wwedand and w,raiterbuody on the project she,provide the following,inforrmation. Streams: Naine Classification Lakes or Ponds: Narmellassifieatiom 0 Wetlands: Na me Approximate S12e Welland No.(if regulated by DEC) Y. Are any of the above water bodies listed in the most recent compilation of NYS wwrater,quality-impaired MYes 0 No terbodi-es7' If yeas,ammo of impaired water body/bodies and basis for listing as impaired: L is the project site in a designated Floodwva; 13"des woNo J.1s the project site leen the 1.00,year Floodplain'? 0 Yes o No k,is the project site in,the 500 year p'loodplalri? C Yes El No 1.is the project site located over,or immediately adjoinin&a prirnsiry,principal or sole source aquiW' 01 Yes a No, If Yes- i.Narne of aquifer: It. Soutze of infiorm'natio, 't I of 1 . identify the predominant wildlife species that o upy or use the project site: r �n.Does the project site contain a designated significant natural community?uaaity? 0 Yes EI'No Ityes. a:Describe the habitat)ccnrrpruaaarrity(composition,function,and basis for designation). if, SorurCe(s)Ofde ript�iDn or eviduat`aon: W,Extent fccrparsu unity/habitat:. Currently: acres Following completion ofproject as;proposed _ acres rGain or loss(indicate+or ages o.Does project site contain any species of plant or animal that is listed by� e fid al �ve�Gua ent�r 1 � �'�Yes '�, endaingered ovrtbreatened,or does it contain any areas identified as babitat fear an endangered or threatened species"? If Ye& i, Species and listing(endangered or threatened): fi,Natrure of use ruse orf site by the species resident,Seasonal,trasi=,O p. Does the project site contain any species of plant or animal that is Bested by NYS as rare,or as a species of ! Yes ai d special concem? If ''es= pro Nature of se ofsite by the species,(e.g.,resident,seasonal,transient): q is the project site or adjoining areacurrent] used for hunting,trapping,fis,hirup„or shell fishing? a Yes P a lfycs,,Illr~e as brief description of how the proposed action may affect that use: E3. Designated Public Resources On or Fear Project Site RA's file project site,or any portion of it,located in a designated Rgi is ltaural distract certified pursuant to 13 Yes 0 No Agriculture andi Markets Law,Article 5-AA„Section 303 and 30+1' If Yes, provide county plays district namdnuambO: b.Are agricultural lands,consisting ofhgguly productive awls presents Yes aNO 4 l f es.acreage(s)err project site H. Source(s)of soil rating(s):I c, Dues the project site contain all ear part c ;or is at substantially contiguous to,a registered National Eli Yes u o Natural Landmark? if"des,: i. Nature of the naattrra ll landmark: E 13101ogieal Community n Gealogical Feature at. Provide brief description of landmark, includutt&,values behind designation and approximate size/extent: d,Is the project site located in yr dares it adjoin a state listed Critical Environmental Area? 13 Yes Mlqb lfYes. r;, CEA name: ff.Basis 1br designation: ft Designating agcy and date: Pale 1f 13 c,Does the Miect site contoin,or is it subvantially contiguous,lo,a building,,archaeological site,or district 0 Yes Q-No which Is lis ted on,Or has been norninate,4 by the NYS Board of Historic Preservation far inclusion on,We State or N-ational,R)egister of H isiodic Places? Iffes: L Nature of hist aric/archaeological resource: 0 ATchaealogical Site 0 Historic:Building or District fl-Name. M. Bdef descKpfion of attributes on which 45ting is based: f is the project she,or any pordon of it,l6cated in or adj-actnt to an area designated as sensitive for 0 Yes lavo archaeological sites on the.NY State Historic Preservation Office:(SHPO)archaeologjcal site inventory? g.'Have additional arch neologi cal or historic site(s)orresources been identified on the project sits? 0 Yes SANo IfYes. il Describe possible resource(s): U Basis,for idieniffication: h.Would the project site,be visible ftm any officially designated,and publicly accessible federal,state,or local 0 Yes PNo scenic or aesthetic resource?' If Yes, L Identify resource: U-Nature of,orbasis for,designalion(e.911,eslabfi;E;d—higlixway overlook,state or kcal park,state historic trail or scenic byway, etc.)'" RE Distance between project and resource. miles, L Is the project site located within a designated river corridor under the Wfldl Scenic and Recreational Rivers 0 Yes No Program 6 NYCRR 666? if Yes- L Identify the narneof the river and its designation. fl,Is the activity consistent ^ith development,restricdons,contained in 61,qYCRk Part.666? 0 Yes to No IF.Ad4itional Information Attach any additional information which may be needed to clarify your project. if you have Identified my adverse impacts which could be associated with your proposal,please describe Ouse impacts plus any measures which you propose'to avoid or-minimi a them, G. Verification I certify that,the in formation provided is true to the best of rn,y knowledge. Applicant/Sponsor Name (nd-'r'U J 6.ne Date 1— )6— 11 Signature"JLL Title DLI)ne'r 'ago 13 of'l 3 Full En viron mental Assewsment Foust Pari 2-Identification qfPblen,tial Project hnpacls Part 2 is to be eompleted by the lead agency. Part 2 is designO to help the lead agency inventory all potential resources that could be aftcled by a.proposed project or octiom. We recognize fliat floe lead ageney's revie,%ver(s)will not necessarily be environments] professionals,. So,the questions are designed to a reviewer through die assessment process by providing a series of q uesdons that can be answered using the inforination found in:Part 1. To further assist the lead agency in completing Part 2,the form lClentifics the most relevant q tiestions in Part I that wil I provide the information needed to answer the Pan 2 qyesti.on., When Pan�2 is completed,the lead agencywill have idenffied the relevant environmental areas that may be impacied by the proposed activity,, if the Wad agency is a state agency and the acdan is in any Coastal Area,comptete the Coastal Assessment Form before:proceeding with this assessment. ' ips for completing Farl 2: * Review all of the inforrnation provided in Part I * Review any application,ramps,supporting materials and the Full EAF Workbook. Answer each of the M questions in Pad 2. If you answer""Yes"to a numbered question,please complete all the questions that follow in that section. If you answer,"N'W:'to a numbered question,move on to the next numbered question. • Check appropriate oolumn to indicate the anticipated size of the impaet. • Proposed projects that would exceed a numeric threshold contained in a.question should result in the reviewing agency checking the box"Moderate to large impact may occur." • The reviewer is not expected to be an,expert inenvironmental analysis. If you are not sure or undecided about the size of ari impact,itmay help,to,review the:sub-questions for the:general question and consult the workbook. 0 When answering a question consider all components of the proposed activity,Chat is,the wwhole action". Consider the possibility for long-term and cumulative impacts as well as direct impacts. Answer the question in a reasonable manner considering the:scale and,context of the p "ect. I. Im pact on Land Proposed action may involve construction on,or physical alteration of, 0 NO, 0 YES the:land surface of the proposed site. (See Part 1.DA) If"Y' s", answer quegions a-j, If"No move on to Sec,t,ion 2. 17 Levan No.or l oderate 1 Part I small to large Question(s) impact impact may may occur "Cur ............ a.The proposed action may involve oonst=Non on;land,where depth to water table is E2d 0( less than 3 feet. —1 'bw The proposed action may involve constraction on slopes of 15%or greater. E2f C11 0 c.The pToposed action may involve construction on landwhere bledroc'k is exposed,or generally within 5 reet of existing ground surface. d.The proposed,action may involve the excavation and removal of more,than 1,000 tons l of natural material. e.The proposed action,rnr y involve tonst metion.that continues for more than one year Dl 0 or in,multiple plh se$. fThe proposed action may result in increased erosion,whether from physical Me,DZq disturbance or vegetation,removal(including fio:mi treattnent by herbicides). ga The proposed action,is,or may be,located Withift a,Coastal Eresion h=rd area. [El 01 b.Other impacts: Page I of 10 2. Impact on Geological Pen,tures The propos�edact i", m ay result.in the modification or destruction of,or inbibit access to,any uni que or unostta' land forms Gn, the site(e,g.,cliffs, dune5, 0 NO 0 YES minerals,jossils,caves). (See Part 1.E,2,g) "Yes", answer questions a-C. If"No move,on to Section 3. Retevant No,or Moderate )PH rt I $man to large Question(s) hnpact ignpact way maoccur occur a Identify the'specific land form(s),attached b."Th t proposed=ion may affect or is adjacent to a geological feature listed as a E3c 0 0 registered National Natural Landmark. Spec fire feature' c. other impacts: 0 13 3. Impacts on Surface Water The prop osed artion inay affect one or more wetlands or other surfAce water 0 NO 13 YES bodies(e.g.,streams,rivers;,ponds or lakes). (See Part I D.2,E. ,h) Yes ��i Relevin No,or MoOrate Part I small to In ree Question(s) impact IMPRet may may occur occur a:The proposed action may create a new water body. D2b,'lD M b,The proposed,action,mays resu I Itin an incrme ar decrease of over I 01/1a or more then a D2b 10 acre increase or'decrease in the surface area of any body of water. c.The,proposed action may involve dredging raore than 110Q cubic yards,of material D,2a 13 from a wetland or water body. d.The propmed action may involve construction,within or adjoining a fieshwater, or E211 0 0 Walwettarid e,'The proposed action may create turbidity in as wa�terbody,either frons upland Crosion, D2a,D2h 0 ru,,noff or by disturbing,bottom sediments. f 'The proposed action,mayinclude coiastruction of one or more intake(a),for withdrawal 2c of wMer from surface water, .'The proposed acdoa r may include construction of one or moreoutfall(s)for discharge D 0 of wastewater tosurface water(s K The proposed aeflon may cause soilerosion,or otherwise create a souroe of stormwater discharge that may lead to siltation,or other degradation of receiving water bodies. L'Ibe proposed,action mayaffect the water quality of any water bodies wilbin or p El downstream ofthe site of the proposed action j.The proposed action may involve the application of pesticides or herbicides in or D2%E2h 0 pod any water body. k.The proposed a,cdon may require the constraction oftew,or expansion ot existing, M a,D,2d wastewater treatment facilitics. Pap 2 of 10 1,Other impacts, f d. Impact on,groundwater The pro ostW au.etlon mmua 'result io new or additional use of ground,waler,or ©'NO 1131 "YES may have time potential two introduce contaminants,to ground wawa er or an,aquifer. (See Part 1.D 2.wa,DC 2.c':D.2 d,DmIp,D.1q, D.2-t) "Yes" answer questions a-At, If"No", move an to Section 5. Relevant No,or Modwmraute: Part Z small to,1mrge Question(s) impaet l rmpmact may may occur Occmr, a.The°proposed action may require new water supply wells,or create additional demand 2c 0 ma on supplies from existing tater sqft wwelk b.Water supply deumand from theproprumsed action may exceed safe and sustainableD2c D 0 withdrawal,capacity ratite of the tcc-W supply or aquifer. " Cine rauurce; e.The proposed ection may allow or result in residential uses in areas withcuut water and Ila,"1 2a 0 sewer serrvim. d,°,flue:proposed action may include or require wastewater discharged to groundwater, �,Dr2d,E21 � e.The proposed acJon may result in the construction of watersuupply wells in locations I2c,Elf, 0 13 where groundwater is,or is,suspected to he,contaminated- lh f.`"flue proposed action may require the bulk storage of petroleum or Chemical products 1)2p,E21 over gMund water or an aquifer. .The proposed action may involve the commercial application of pesticides within hitt h h, 2q, C] fect (potable dHnkin�water or irrigation suauurces, 21, h. ther aiumrpacrtssi;; u w Impact mm Flooding la The pro ed action may result in development on lands subject to Flooding. 0 NO lel YEs (See Pan 1.11 ,2) if A.Yes... answer are tIons am- ''No , move on to Scolon 6. ftelewwammt Suu,or 1Mdamuiemate. 'Partr f antatl to Marge Question ui Yurmpuu:t immmpct may e a �.Fmay, ecy r 01CCUr a.The proposed auction may result in development in a designated fluucudwa . E2:i lm;"The proposed action may result in development within a l DO yyear.11oodplaim E,2j � e.The prtuposed action may result in development within a 500 year,floodplain.. E2k 13 � d„ (loremamdlciom of emlstorn�drainage 332b, eparuou13 patterns. a.The proposed action may charigu„flood water flows that contribute to flomdiu I Kelm,moo, " E2k. f.Ifthere is,a dam located on time site ofthe proposed action,the dam has failed to umm;aet 1 one or more sa criteria on.its most recent inspeartion. -1- Page 3 cvf 1 S,Other impacts; 0 0 6. impacts on Air Time proposcd action may incMurde ra state regulated air emission source. 0 NO El YES (See Peat 1,D.21,D, hp 13. .j) "Yes", rarrswer uest'faaaas ra-f f " ", Y.iiove on to ectiom 7 7. ReL vaut o,orode to ,sort I small to large . cestsion(s) IYranpactimpact:ranay may occur occur a.If the proposed action requires federal or state air emission permits,the iction ruaaty also emit.one or more greenhouse gases at or;above the following lerrels. L More thorn'l 000 wnWyear of carbon dioxide(M. D2g 01 0 fl, More than 3.5 tonglyeaar ofnitrouus oxide( 10) i tau 0 M.More than, 1000 tonstye;ar ofcarbon equivalent of pertguuorracarl Dns(FFC's) D2Z 0 rr WMore than.04:5 monsfy ar of"sulfur heaaaflumoride(SF6) D4, ua v. More than 1000 lonsiYear of carbon dioxide equivalent of D2g hydroehloroflurrocarbons Vis)emissions v'l.43 touastyeuar or more of methane D h 0, b.The proposed action may generate 10 toWyear or more of any one designated D g hazardous air pollutant,or 25 tans+ ear or more of any combination of such,hazardous air pollutants- c.The proposed action may require a state air registration,or may produce an emissions Mf,,D2g U rate of total contaminants that may exceed 5 lbs_per hour,,or array.incluade a beat source capable of producing more than ttl million BTUs,per hour. d.The proposed action may reach 5tl' of any two or more of the thresholds,in"a' M)lg,D It 0' thurrar y"can,above e,The proposed action may resuuIt in the conbrrstion or thermal treatment of'rrmore than 1 D2& 0 m ton of'refuse per hour. f.tither impact&: m 7. Impact onPlants and,Animals The proposed action may result in ra loss of flora o fact na. (Slee Part, 1.1 ,:2.umr,-q) 0 NO ®YES If"Yes,�� answer questions ra J. F "No",,m on 10 Section 8. Re) ant No,or Moderate f"a:rt l sruua;ll to large Question(s) impact impact may Jx, MR occur occur, a.The proposed)action may cause reduction in popuiation or loss ofindividuals of MY' Mo 0 threatened or endangered species;,as lusted by New York State or the Federal govemment,that use,the site:,or urge found on,over,or near the site. b.The proposed actiari may result in a reduction or degradation.ofany habitat used by Ego 0 any rare,threatened or endAoSered species,as lasted by New York Sate or the federal; r;v= cnt. c.The proposed action may cause reduction in population,or loss ofindividuals.of any ' 2P species of speeisl concern or conservationneed,as'listed by New Yor%' tate Or the Federal errrment,that use the site,or are foundon,aver,,on near the site, d.The proposed action may,result:in a reduction or degradation,of any habitat uused by E2p any species,of special concern anag conservation.need,as Misted by New York State or the Fe&ral government, Page 4 of 1,0 e.The proposed aaado v may diminish the capacity of regisleredNationaINatural 1' c. D t Landmark to su ipw�rt the 6irrlan ical a rrarruutrtily it eras ralrlished tcw ruatect. f,'The proposed action may result in the removal rnf,or ground disturbance fn,any E2n u portion of a designated significant natural community, nity,. ource. g.The propos d action,may substantially interfere with Anesuingdbreeding,foraging,or � 0_ over-wintering,habltat f'ar the predominant specics that occupy or use the project,site. h.The propcsed action,requires,the conversiaan-afmore than 10 acres of forest, l b 0 grassland or any other re ;i-orWly or locally imptrrtaant habitat. Habitat type&information scarce; i.Proposed action(crmmmerciat,industrial or recreational projects,only)involves use of tl ua a herbicides.or pesticides. j•Other Impacts- 0 8. Impatt on Agricultural Resources The pToposed action may impact agricultural resources. (See Part L E.3.aand lona), ONO 13 YES "Yes", answer questions a h. If"No", move on to Section 9. elevow Na,ar Moderalt Part I small to Mame Question(s) impact impact Imay may cur occur a,The proposed action racy impact soil';classified within soil group I through 4 of the E2c,E3b 0 0 NYS Land Classification 5 atm.. b.The proposed action may sever,cross or otherwise Iirmuit access to agricultural land Ela„Elb 0 �inaludcs cropland,hayfields,pasture,vineyard,orchmd,etc)., c.The proposed action:may,result in the excavation or compaction of'the soil'Profile of B31b 13 0 active a "ccurltatral land. d, 17he proposed action may irmveusibly convert agricultural land to non-agricultural, ElbE3a o: t ruses,either more than 2-5 acres if located in an Agricurltural District,or more,tharu 10 acres if not.mit m am�g.ricultural District. e.The proposed action may disrupt or pecvent:instaullation of an agricultural land. Ela,Elb cu management system. C,The pressed ectioun may result,directly or indirectly,an increased demellopmLMt C2,c, 3 0 m tentiaul or pressure.an fkmland. Mc,D d S.The proposedproject is not consistent with'the adapted municipal Fatrrtmdand 01 0 Protection Marv. h Other impacts..I 9. Impact on AestbeticResources The land use of the proposed action are dbiviously diffirent ftom,or are in 0 NO lel YES shy contrast to,current lands use patterns fuetween the proposed,prqJect and scenic or aesthefic resourm (Part fx,E.I.a,E_Lb,E3:h,), 1' "Yes-, answer ,st ores a - . "No, 6 to Sestion 10 Relevant r Moderate te Part I small to latege Qu tion(s;) Impact Impact may r, �•_ rima sur r rrecnvr a,Proposed action may be visible from any allficially designated federal,state„or heal E3h 0 scenic or acs'thetic resource. b.The proposed action may result in the a bsiTuction„elu.rnination or significant h4 Ub C]� 0 scseenin nrnne or:rnare offiuelal9 des, vnated saenievieva^s. e.'The proposed action may be visible from publicly accessible vantage paints: ER i. Seasonally(e.g.,scmned by summer frullag,e,but visible during other seasons) D C1 H.Year round 01 10 d.Tlue situation or activity in which viewers are engaged while viewing the proposed Bah actian is. 132% I. Routine,travel by residents,includingtravel to acid p nr work 11 0 is.Recreational or uonrism based activities )plc ® ua e,The proposed action may cause a dimirvislvunent of the public enjoyment and EA o u appreciation of the designatedaesthetic resource. C There are similar projects visible w.ithiuu the follo ^indistance of the proposed Dl a,Ela, 13 project. D 1 i`;D g tl-1 mile %-3 mile 3-5 m ile 5+ mile g,.Other luuvpar is 0 10. Impact on Historic and Arebe legic'al Resources The pr posed action rru'ay,occur in or adjacent to a historic gar archaeological 13 NO 0 YES resource. (Part l. E,3-e,f.and g.) Y"Yes"', answer questions us-e. K.� �u"wu o to "eeli rr 11. R -vant No.or Moderate . u . part l small to large uestioan(s) Impact impact naay kPg ..r occur occur a.The proposed a,ct on may occur wholly or partially within,or Substantially contiguous Me Elr� to,any buildings,archaeologicalsite or distdot which is listed on or has been nominated by the NYS ldrrard of Historic preservation forr inclusion on the State or ' ational ReOver ofliistodc Places, Via..The proposed action may occur wbolly or partially within,or substantially contiguous E3f tea-,„an areadesignated as sensitive for archaeological,sites on the Ny we historic Preservation Office(SHPO)archaeologi ul,site inventory'. c.The proposed,action may occur wholly or partially wltblr4 or substantially contiguous E39, El to,an archaeological site not included on ffm l` .1 PO Inventory. Source- d.Other impacts: �i a.if any of the above(a-d)ars answered°s'le'etsW",continue rarith the following questions help,support oonclusions in part,1 I. The proposed action may result in the;destruction or alteration of all or part. Me,:133g, 0 of the site or,Property., ii. The proposed action mayresult in.the alteration of the Property's seting or p e,EM, lege 6,of 1 integrity. I is iii, `I"lue proposed action may resiult.iru the introduction aut'vuuFal elements which D&E-3h, are out of character with the site or groperty,or May au'41er its,setting. C2,C' �l. Impact on Open Space and Recreation The proposed action may result in a pass of recreational opportunities or a 13 NO 13 YES reduction of an open space resource as design.ated its any adopted municipal open space plan. (dee Fart 1. .2..c, E. . .), I "Yes' ans°urea°questions a-e. i "'ado"` o to&c1idn 12. - Relevant des or' Moderate, _. Part I sFriall to]arge r QUe5tiQD(5) iFnPRCt impact may may o ur� oor a.Tlueproposed action'quay result inan impaira�uuentof rmtura.I functions,or�.ecosysteuuu D2e,El b 0 0 scrvices�",providtd by an undeveloped area,,including but not Iirruited Lo stormwater E2b, storage,nutrient cycling,wildlife habitat. E2m,E2o, �2ru lun"Hue proposed action may result in the loss of a current of future:recreational resource. i C2 a,EI p, as m C c"_ " c.The proposed auctiouu may eliminate opera space or recreational re auurce in an area C22"C2c 113 with few such resources. Me,1E2q d.I he proposed action: quay resuult,:in loss of an area now used informally by the C2 ,El c 1 i 0 community as,an open space resource, I. 01her impacts; uu u 12. �act on Critical Environmental Ai real proposed act'utru may be:Iocated within or adjacent to a critical 13 NO, Ll YES envirouut entaal ares(CEA). (See Part I E.3.d) I "Yes", answee quesifons a_c. If'"" �a�' �to Section 11 Relevant No,,or Moderate i part I mall to large Question(s) Irrupact tra,ayr S Frim Decauar occur a.The proposed action,may result in a reduction in the quantity of the resu=:e or E3d t� � cb=cIerisliewhiphwas the basisfibr.designation of the CEA, � b,"The proposed action may result in a reduction in the quality oft e resourte or E3d El clumcter;stic which was the basis for designation of lbe:CEA, c.Other impacts;: i 13. Impoct on Transportation The pt posed action may result in as changeto existing transpDrtaflon stews. E NO E3 YEIS See Part l,.D.2,J If""Yes"° answer guesdons a If" o." ra to&,cdon 14. Relevant No,or ' 9iaulerate u part I small to llsurge uaestp(s) impact impact may ;a d . MAY caaeuaY occur ax PrP ected traffic increase may exceed caapaoio f existing road network. D2j � Page 7 of 10 b.`Gh-L-proposed action may result in the construction of°pave:d parking area for 500,or D2j, rnore Vehicles. c.The proposed action Zvi ll degrade existing transit access, Inj 0 t� d.The proposed action-sill degrade existing,pedestrian or bicycle accommodations. TD2j � proposed y present,pattern of movement of people or,goods. D2j � " �� osed act ion.may alter the rc� : g-Other impacts-, � 14. Impact on Energy The proposed action may cause an.increase in the use of any form o°f"energy. El 1"Mlf Yeg answer Reye 1, a ut'ioras,a�d � If to Sectio.n 15. ]relevant No,or Vadcs�a ! Part l small to large Caaesliad lun,paet imnpaet may mma oe-eur occur a.The Froeosed actionwill require a new,or an upgrade to an exis�tiq&substation. DA � bw"The proposed action will require the creation or extension of aro energy traas=issioru D,l f, a, oar supply systema to serve more than 50 single or two-family residences or to serve a D lqg k commercial or industrial use. c.The proposed action may utilize more than 2,5114 MW rs per year of elwtricity. D k d.The proposed actioni.mays involve heating an&or 000limg,of more than liltl,0l00 squire Dlg � m' feet.oftwildizu area rhes m feta l.. c.Other Impacts: 15. Impact an Noise,Odor,,aod Light The propmd action trua+'result in an inicrc�ascin noise,odors,or outdoor fighting. M NO 0 YES (See Part 1.D.,2-m.,n,., andr :) "Yes answer.questions a-,t IL.patio, o to SMign 16. Relevant No,or lklaualerata A w. part I small to large uauestlon impact Impart may May'Occur Occur a.The proposed auction may produce sound above noise Duels established by local D2M regulation. b,The proposed action may result in blasting within 1,500 feet of any residence, Cl2m, ld o El hospital,r cool,licensed clay care center,or nursing,home, c..The proposed action may result in routineodors for,more than one hour per day, M �t d.The Mposed action may result in light shining onto adjoining prepertoes. D m e.TN-proposed action may resWt in lighting creating sky-Slow brighter than existing Mt,lyla El area.conditions. Other impacts-, na 16. Impact on Human Health The' mru osed action may have an impad on human health from a o+sutre ONO 0 YES Page 8 of 10 to nlew or existing sources ofcontaminants. (See Part 1.D. ,.q.,E_1,d,f.g,and h.,) alewa.at -NOor Moderate Part l strusll to targe Question(s) impact impact rmaaa ma 'cauau'r auecur a.The prcpr sed action is located within 1500 fbet of:a school„hospital,licensed day Eld � care center, °r0T lacanc Eurg;im lacrme or retirement Community. la..The site of 11rc proposed action is currently undergoing remediation. E I;&I El h o tl c.There is a completed crraergenc,y spill reruaediation. °a;compsleted en ironmerutaal;sots �lg,�;11a � El rernediatiora era,war ail acemt to,tlnre site rrftlac rr r s d actiaan. d,The site of the action is suilajea to ars institutional cnuatrcl limiting the fuse:of time Elg„,,Ella 0 ea property e, easement,deed restricUon) e.ne proposed action,may affect institutional control measures that were punt in place E 1 g,E'l la 0 rrnm to ensure Haat the site remains protective of the environment and human health.. f The proposed action has,a gnate contrr l Measures in,;place to ensure that hture 2t 0 ra generation,tr-eatment and/or disposal of hazardous wastes will be protective of the environment and human laea'tpth, g.The proposed action involves construction or modification'ofa solid waste D2q,Elf 13 0 management facility.. la.The proposed action may result in,the a nearrtlming,of solid r hazardous waste. E)2q, If au L The proposed action may result in an increase in the rate of'dispasal„or processing,,of Mr, s; to solid)waste. J.The,proposed wflo.:n may result in excavatiran or other disturblance within,2000 feet of Elf,EIS t a,site used for the rlis oral of'solid cr:hazartlrarus waste.. lEa'l b � Ir.The proposed action May resurllt in,the migration ofexplosive gases from a landfill Elf,Ellg o site to adjacent off site stTructures. 1.Tle proposed action may resaalt in the release o ccntauminated leachate fmm the T2s,Elf, � tt Project site D2r M.Other impacts- 17. Consistency wit1i Community Plans The proposed action,is not consistent with adopted land)�e plans,. 0 NO L1 YES (;gee Part l.C.1,C.2.and C.3.) Relevant No,,or iIaderat Paart l small tau lar�;e „ w a Question(s) Impact may�ccur �eermr a. c proposed action's land use components may be different)roma,or in sharp C2,C5,.Dpa 01 as contrast to,current surruunding land use pattern(s). E1q,Elb b.The proposed action will.cause the,per'ma nent,population of the city,town oar vpllage C2 0 ira'ww Bich the raewjectis located to grow by more than 5%. c.Thepropos~d action is inconsistent with local land use plans or zoning,regulations, C7, ' ',C3 t d.The proposed action is inconsistent wftlr any County p'l'ans,or other regional land use CZ C2 ❑' c.ThemosedactionniRcause a Oaaro a in the dtnsi; ofdevelopment that is not ,D1c, 0 t3 Page'9 of 10 supported by existing infrostructw're mrr is distant from,existing infrastructure, iHD DI f the p rcp rused yaction is located in a n area characterized ii by low density development 40 r7 requirenew or ex andt:d tahiic inti° trust'ure; gTh The proposed acti.omtaru,i d 0 � t may induce at9vrd don� �eardevelopment oposed tu � , .�,;ridarrtial cro � t h.Other, Iiµ Cougistency with Comtrmunity+ hmaraeter- The proposed far t is inconsistent with the existing community chaGracter. 0 NO M '"'D`E'S I "" es'" camr c rr s a s r m "No",", � nue to Par l 'levant No,or I''w, odErate Part I sMAH to large uaestlen(i) IMPOCt Wpaet Infly a,The proposed action may replace or;eliminate existing facilities,structures,or areas Me,E3f,Egg 0 of historic CA 0 fir.The proposed action may create a demand for additional community s ices(0.9. j sobools plice and fIra: c. e p:rampamsed acti rm a y di place a Mordable or low-income housing is an area where C2,C3,Dl;f' o a tlhuuu is a shuurt a tafscciu h urusinge Dlg,Elora d.The roposed':action may interfere with this use or enjoyment of officially recognized C2,,E3 a 0 or designated public resources. e,The pro csed action is inconsistent with the predominant architectural scale and C2,lC3 0 to chwacter. f Plrgfuosed action is im eonsistenut with the character of the existing ruawrai lllan is " ,C3, a 0 Ela,Ella Mr.E2h, g.tither impacts. J, Page 10 Of 1 Upon review of the inf-aTmation recorded an this EAF,as.noted,plums this additional support information and consi deri ng bath the arauugnituudle and importance of each identified poterwtial impact,it is the conclusion of the as leap agency that: A. This project will result in no significant adverse impacts on the:envirarurnem,and,therefore,an environmental impact statement need not be prepared, , cctru-dingly,this uaegalive declaration is issued. 0 B. Althotugb this project could have a significant adverse impact on the environmemtt,that.impact will be avoided or ,seobstandally rni:tutated because of the following conditions which.will be required by the lead envy. There will,therefore,be no significantadverse impacts,from time project as conditioned,and;,therefem,this,conditioned negative: declaration is issued, A conditioned negative declaration may tusetl only for UNLISTED actions(see 6 NYC' 617md). `i his,Praject may result in one or more significant adverse impacts on the environment,and an ernviironurmental impact statement must be prepared)to furthassess,the impac �s)and possible mitigation and to ex,pla alternatives to,avoid or reduce those impacts. Acccirdingly,this positive declaration is issued. Name of Action: Nairne of Lead Agency, Name of Responsible Officer in Lead Ageney: Title of Responsible Officer: r: Signature of Responsible Officer in Lead Agency fate: Signature of Preparer(if different from Responsible Officer) Date: For nrtherInform ation:, 'Contact Person: Address: Telephone Number: E-mail For Type'1 Actions gad Conditioned pieptive Declarations,to copy ofthis Notice is&Mt to In ief Executive Of'f'icer of the political subdivision in which the action will be principally located fie., „,Town I unity I"'pillage of) ether iMelved agencies(if any) Applicant(if any) Envirtnrnrwerltal,Notice Buull>etin:l lttttr.(Lw2XV dee nv aoy'/'enblenklttr Ifus Ummmilll Made the dr day of lir.Kin teen Hundred,and El arty-Four. Betwwewen GENPAK COMRATTON.of till Warm strvx,Glens Falls,NcW york A. piny of the first plat„and THOMAS .SOT M SIU and MARY JANE SOTANM,itis wiI'le;of'5 Twkwood Lane,QueensbuFy.New York 12VA. a pamtles oftlmc second pan, WITNESSETH,, That the party of the First part.In consideration of one dollar(RCI,00) R lawnvf4rl mormy of the United States,paid by the parties of rine second part,does hereby gfrant,atud rcicauso unto time parties of the second part,their heirs and assigns forever, ALL,THAT CEPTAIN PIECE,PARCEL OR LUT OF'LAND sirw;nate In the Town of Queensbury,Warren County,New York and being a part of Lot,No.20 of the first dr%jsion or the Queensbury Patent bounded and described as U,Iowwas: BWINNING at ar point on the east side of IRockww+clf lboad rraeasixeid norlb"l' 16 east,{Iwlagrictic Mer Wan as of'April of tit)alopgg 0 the easterly bunds ol'sald Rockwell Road)a distance of 1„d'2'.58 leer from the southwest corner, of lands now or formerly of IR,nchm�d Rabcols descr"ubed,In a deed dated 1%fay,fa, l ul, .and marded in the Warren County ClcrWs 01rice May 7, 1964 l Book 441 of Deeds at Page 160. and runriingthrnrc south 85'21'east 836.7 fees to a point for a,corner,runnings thence souflw 71' W west 17 1, t feet to a paint for a-camer in the nortfIerkyr bmnrds of Hmlamd Drive—,running, �,! tlucnec sowutl 73'39merit;The northerly bounds of said I diland Drive 31,9.72 flet to a parent fora comer and coaninuin�;along the not rcheriy bounds of said Idllamd Drive maah 81'q 35"West v, 5IS,68 No to a point for a corner.running,thence on a curve to The north bawiing a radius of 24.50 feet a dlslatnce of 38,.9 feet To a punt an the easterly'bounds of said Rockwell,Road. n,Jnning Ill norib'7' To cyst,..-'5 fume to rlrepount or place Gfbeg�inning.ron!tainiung 4-93 ar:r of land more or less. TOGETHER R. inln a 50 foci wrwiude eawmocnt for,access to and from,the easterly 131.7 foot portion of the premises described bercnn along t'be prc5cat crossting road. aojoinl thea vew-described parcel Can,the cast,subject toall prior rights of others who may be � t called to u6iia the same in,co mmom with Town ofQuccnsbury, BEING the samncprennises conveyed by warranty,deed dated'March 9.1992 fromJames T. Stratford and "Virginia M. Slraifqrd to facnnpal: Corporation and recorded.1n the Warren q County Clelk's Office March M 1%2 in Book 848 of Deeds at Page 57, T`h'is conveyance does not constitutte.alll or sulwus"tanf6ally all of the corporate 8rantofs assets and this conveyance is ode in accordance with an by authorky of hs Board of Mrectou, "fids coanweyyance is rnadc sub�cct to the folic udng,covenants ariJ rtcgrac"tloarS w irticlr shall, be deer ned to run with the land-, 1. No rmainufacturing, im cErantllc or commercial business of any kind shill be conducted or pcirmiltodun fbe Fwcm, 6m whictl sball be usad for resid tial purpolses tinny.but this shall not pr Mbit refdrestafion,or,harvesting,oftrees,. 2e No dwelling exclusive of gamhaving,less than 17%,square Piet of lualaltsble l space as dcfmaed by the New Yorlt l3uild'ungg Construction Code shall be erected or mmaumtalmcd ora said prerniises,tete plains and specrlicaf hone of any said dwelling must be approved by the grantor I or assigns prior to eoamsrnaction.any said dwwrelliing,rruust be Construe ted cru Compliance with the New York I3uildlirgg Construraion Code and shall be a sirtple-famuily private dwuy-elling not mom than two and one"lnallf worries 1n18,h. 3.. Nogructaurm of a, tcrmporasy nail ,e. trailm basement, tent. barn or ca her outbuilding,shall be used at any fimme as ab t slderuee either ternporadlyy or ctrl y': ^' 4, No advertising sign or signs sbrdl be erecned or'maintained on said premises excepting only A'for sale or,"fear react"siign'wbich shall not exceed two,saluue fact In sarm m 5" No noxiow or rnlfensl'wae neWry shall be,card on or permitted noir shall=ydimg r t vow be done orl curtinednatn "n oftrasborrulbbl�Iub� Premises,.�lu cb baeor'become a nuisance In the neighborhood,iriduda that �t " p 5 dumping ;r b t 6, The lot Won crmrvey,'ecl shall inept bcfimherl subdivided COT pur0aepses rpfsdle cr otherwise except with the express wmiittcm c msent ofthe grantors, their heirs, execojors, adn timnistr,ators.or assigns, q 7. No building sivill bewcood or m lrilaanmpd on said lent within thipty-lime feet trfrtmy rutad adjoining said lot.and no buu'ilding,shall he creeeeted or rnaumtalmad wwiltlniat rilteen feet atfanym y° side or Few lune or said lest. p 8. No 51mcture 'intending;to tm the rear part of a building shall be ermed or maintained on samd prermisea,leaving the frons tort,unfinished or not .rata am ,,all exterarpr construction shall be yarn pleted within one year after oommcricing, F z I ry Tim: wwM true applmric uari s and all the estate of the party orthe�rst:palet leu and go tail .. t'rretrn'ia TO HAVE AND TO H=the bercin granted umle the parties orrhe second 'their heirs.and signs forever. i e i AND said party of'the.first parse covemant as l'clils ws FIRST.Than the pxnr es ofttne se and partx441 quietly enjoy the said gprerniiscs;; SECOND.Timi said party of the fwg pan uill forever warml the talLe 10 sa id premist's- MiIR A, Than, in compliance with, Sec, 0 of the Lien Law, the 'granter wilt receive the wnsiderafion frnm this conveyance and veiil hold the right No receive such conidcraflon as:a trust AM to be appEed est for the purpose of paying The cost of the urmprovepnest and,willapply the sarrpe feat to the peyfmnerlt ofthe cost ol't.'he;ivaaprcuvemenA before using any parr orthe,tarsal otthe ;ire Ibr any other purse„ IN WrMESS WHEREOF.the pamtyP oftho first part,has trey unnle:act its hand and.Saab the day and year first abovo,mon. i PRESENCE CE F . � z mer STATE OF NEk4''i ORO i On mhis "t'th day of July, Mnrtccn Hundred and Ninety-Four, belrpre me. the subscriber. tnersomally appeased � d to,Mptrsu'inally,l nowik who. ink,by me�duly swonli did depose and saythat hrJshc resides iattNt 1 i*[rra. New ytprlt that lu he,as an'Gbllin er f npak Corporation.the Coe r pmraaiomn described within hin and that W"she knauang flue seal of said CorPoratiov and adfmpeimg t'he scall to this instrmmmrrcP sirdar of the Roard orDblectors,of sand Corpmaian and by Nke order is lnun4 her rapacity as such,rrfti r, signed has/ber name hemp, I�tt, d & , NED Ftp SST t ,,o, NAKY L MtAM a « i U Ll 11 Sts JUL a 1 Ni 'Its air^wmnr 4 anile nil VA �mrxr�Ja�ar� .tNmnn '+SAN FER1 TAX r m�^,momw' ate,rs WARREN COUNV , r Preliminary Stage Revised April 2010 signatum! Page This page includes: 1.) Atithorization to Actas Agent Fornii, 21.) Engineering Fee Disclosure. 3,,) Authorization for,Site Visits,, 4.)1 Other Perrnft Responsibilities; 5,) Offidial Meeting, Disclosure and 6.) Agreement toprovide documentation required. IOWHEWs AGENT Fow, Complete the following if the�OWNER of the property is not diie same as the applicant owner.'� Designatee,�: As agent regarding: Variance Site Plan Subdivisiori For Tax Maip No.: Section 8 11 Lot Deed Reference, Book Page Date OWNERSIGNATURE. . DA7 E- APPLICANT'Si AGENT FORM,' Complete,the following if the APPLICANT is unable to attend themeefing or v4shes:to be represented by another pi Owner: Deskjnales, As-,11ent regarding: varWice Site Plan-Subdivision For Tax'Map,No.: SeC6,011 Block Lot Dead Referenioi�- Book Page Date OWNER SIGNATURE: DAT� I- g1ji EN61NEERING FEE jRj§gL2,'jj&j: Applications miarl Ili,&referred to fl)e Tov.,n consuliling engineer for reWevit of sepift design, storm dralMa. etz.as determined by,ihe Zoning oT Hatining Depaftriev.. Fees for engineering review services will hie chargied directly toi the applii;ant. Fees for anineering revibrNwill not exceed S 1:,,GCI,01 vii notification to the applicant. 3.1 60UO8Q-nON, FOR SITE VIS11a; By signiin, this page and submitilng, �he appWication, materials attathed hi the iftner, Applicant, and hiSffierAheir agen4s),hereby authorize the! Zoning Board or Flanning Board aP4 Tcwn Staff to enter Me subject Propert[es for the purpose of revtii the appHication submitted. Ij OTHER PERMIJ Rg§2qt65&6jTJE.S Other permits nW I)e riii for con5wrmn or afteration aftky subsequent to approval by the Zori Board or Pilanningi Board�. fj�is the applicanirs resportsbility,to obtaii�n any addillonal pwtn Its, 5 1, UEEliC A L MEETING, INUII,L§ Q,15� lr%v 110 c- It Is the practJ ce of 11he Cammunily Dieveloprnient Department to have a designated sterlographer tape record,the proceedlings of MsOngs resulting ftw appocaffon,. and rdnuW transcribed tom those tap"Bis Vie!official record of all proceWings, i &QREEMENT TO PRQVIQg,,gQ,&UNkN2jlQN RECLIRED- 1, ffia ondersIgned,have thoroughly read and understand the' Instructions fbf,submission and agree to the submission mquireni I acknoftMedge no,construction aclliiiiiltles shall hie tomirnancedl prior to Issvince oil 2 val�d pemIt. I cedify that the applicA, on, pWns and supporting niaterials: are a trUe. and complete sWement(descdothn of the,existing coiidbonz and,the worlit proposed, and that all work will be Performed in accwdancs,VAth the ��pproved plans and In Contomiance iM�10�af Zoning regulations. I acRinowledge that,pitor to accupyling the Mcf liffesproposod,I or my agents,rAl obtain a cert1ficate ol occupamy as neicessory. I also undet-sland that Me may,be�required to Providle an as-bi sui�m, y by a licensed 18fid suveyor of pill neWly constructed.faciltijes pdar,to Issuance of a certfflicMe of OCCUPiancy I have reald and agree to the above.. 7 ure Ca 'int Ra-Ae:jApplicant) D06 signiM ,Sign ure 01R, nt]�' Pr n Signattire [Agent] Pdnt N�ame [Agent] Date signed Town af Queensbury Flanning 011742 Bay Road-Quioembury, MY 12804-51,8-761-3220 '7