Freshwater Wetlands Application ► p d:
TOWN OF QUEMBURY
�VMHWATER NWTLANDSPERAHT APPLICATION
APPLICATION .-
APPLICATION DATE:
This is an Application fuer a Pe ncuit to conduct/cause to conduct a regulated actives on or
adjacent to a freAwater wetland pursuant to FreshwaterProtection Law - Local
Law 1, 16.
TO: Town of the Town of Queensbury - Please inunediately forward its
application,, to the Planning Board of the Town of Queensbury by way of service upon the
Plazining Depgwfmcnt of the Town cfQueensbury.
TO: Applicant-Please:type or print the information required and complete all blanks,and.
answer all questions. if the information wrested is not, applicable,,please enter NIA. Ply
vide-0—iq9jjW4 plus 14 ccm ies of this ggplication with a 100 applLcation fee.
INFORMATION FOR APPLICATION
Name:
,fid e-11 ;a (?)W' 4F,
Phone: ". 5-6 0
Xraf ` ►>w:
1. Name of wetland or anybody of water/stream, involved:
2. Address.of parcel upon which wedand is located and address of parcels upon which
work isp
Updated, 03/0612,004,
. Tax Map No. of parcel upon wetland is located and Tax Map No. of parcel upon
which work is proposed-
. CurrC&Zoningof parcel upon wMch wetland is located and eurmt zorIing of parcel
upon which work is proposed T w Z A ,,-DR
5. To l area of property upon which work is proposed:
. "Total area of wetland: r
Existing � uses of if wetlaxids, any,a
9, Adjacent apses vAthin O fl. of wedwids,if
10. , tate,County,"Town lope within,500 ff.,ofwetland:
r
nation,About th 'eet.
I Purpose
elti, ter and extent Of propose d, lvltr on or adjacent to wetland,
q121— y
3. On a reap to he submitted with this appl eadon, slow the area of ft flesh titer
wetland or adjacent area directly affected with the leea ion ofth proposed activity
shown to scale thereon as well.
4. ''ill e pro,eet require any ether federal, t to a teed permits
y w P - ,
. Has work begun ran the project'?
. Approximate sUuting date ofprojiect? �
T Approximate Completion date of project?
Updated: 03/05/2004
About ffic-4acent m—oucrtv owners.
List the awes f the oars of record of lands Adjacent to the: freshwater wetland or
adjacent area upon which the project is to be undertaken.
. '��,D '.w
of claimants e water rights which you have noticed and which relate to any land
within or wiitl.0 n 100, 1 of the boundary of the property on whidh, the proposed regul
activity will be located:
The foregoing in orniaation will be reviewed,by the agency,and the Agency, maa if it desires,
request any further information necessary to make a decision..
I hereby affmn under, penalty of 'pe at' that the i�nfannation provided herein and all
attachments,submitted herewith are true!to the best oferny knowledge and belief,
.e-
Signature-
.0
I hereby auth ri a ..._.. ,,, to act agent represent me
in connection with tWis applieartion ort my b . f
NEW YORK STATE DEPARTMENTOF ENVIRONMENTAL CONSERVATION
Inlyision,of NatiurA Rescorces,Region 5
232 Goilf Coum Road.Muenisbui:g.NY 12885
R(S18)GZM203 t R,�518)623-3602
www,Aec.ny.gov
March 9,2017'
Mr.Robert Fulmer
54 Country Club Road
Queensbury,NY 12804
Re: Wetland Delineation,FrVVW GF-23
54 Coun"Ctub Road
Qlueensbury (T),Wa,rren (Co),
Dear Mr.Fultner,
On March 9',2017,NYSDEC staff inspected the,above-described property located on
Country Club Road, in the town of Queensbury, Warren County. The purpose of die, inspection
was to delineate the,boundary of state-regulated freshwater wettand GF-23. The actual wetland
boundary was determined to differ slightly,from what is mapped by the DEC. Th, e actual wetland,
boundary is marked in,black outline on ft, attached map,and corresponding 100-ft adjacent area
in gray shading,
A Freshwater Wetlands Permit from the DEC is required to conduct a regulated activity in the
wetiand or the 100-foot adjacent area surrounding the weaand. Some regulated activities in
placement of fill,excavation,,.and clear cutting of vegetation. Whether or not a freshwater
wetlands permit will.be required, you are responsible for determining if any other local, state or
federal permits,are required for development of ft property.
For information regarding permits,administered by the:Department of Environmental
Conservation,please contact the Division of Environmental,Permits at 5 18-623-1200. For
information regarding fresh water wetlands and permits administered by the United States Army
Corps of Engineers, contact their office in Waterviiet at 518-266-6350,.
Than you for your inquiry and,the opportunity to serve you. If you have any,questions regardin' g
the Freshwater Wetlands Law or Regulations,please contact met 518-623-125 0,'o't visit the
DEC website at the address above.
Sincerely,
na Leskovec
Fish &Wildlife Technician I
&MMnimenUl