Site Plan Application TOWN, OF QUEENSBURY
Site Plan. Review Application
1. Required Pre-sub issirrn meeting with staff to determine general completeness to, be held no later than 1
aleck r`i« to deadline,da „ Call (518) 761-8265 r (518) X61-82 0 for an appointment.
2, Submittal of complete application: 1 original and 14 copies of the application package by monthlydeadline.
. Determination of application completeness. All necessary information must lay provided and appropriate
fee(s)paid for consideration for placement on as agenda for that month.
4. I ncom lete applications will not be considered fuer placement on, aU agenda until allmann,
information Inas been snnb*itted.
. Submittal to, Warren ou nt l:'rng„ if applicable.
. Planning Board meeting, generally the third & fourth. Thesday of each mo ntlnk You will be advised in
writing as to which meeting to attend.
7. Following the meeting you will be provided with a coley of the resolution stating the Board's decision on
your.. application. If your application was apprru` d, the. next likely step is a Building Permit. Pinnal
drawings must be provided for the next please of review, if your application was denied, your.project cannot
proceed as submitted.
DOCUMENTATION' REQUIRE MENTshard copy & gel ectr ni r
Please submit 1 nnn 'nual& 14 coo iues of the completed application package to include.
�
n ages - ,, signed date�
Completed lis,lu'� d .
P"ar - nnbmissi an$Meetirn N'u signed 6y staff
CIll of Deed .
. en hist& Plot Plan
Environmental sscssmen7;t Forts four any non-residential project
�� 0 F' e-. $100 -- 10,E sqv ft--); , (l ,001 - 30,000 sq. ); 00 �0, 1 -1�w ,0� aq. il1,00
(100.$000+sq. .
Siff& Contact Information',
Craig Brown,' Zoning Administrator CrziTlrkgueensbu ryxet
Laura Moore, Land, Use Planner lm2,ore ue2pslnuu . t
Sunny'Sweet, Office Specialist-Plamung, sterna s, nn nns un .ny t l~ 76142211
Visit our website at w- uneennsbu for further information and forms
Site Plan Review appikation-Revised ct ber 2016
oyni erf Queensbury.Planning Office-742 gay Road,Queensbury,NY 1290
General Information'
................... ......
Tax.Parcel ID Number: 3
Zoning District:
Luiz :, AK
Detained Description.of Project [includes current&proposed use]I:
3
Location.ofproject-
3
.
Applicant Name. 04,4ia "Digce , . dress:
Hoye Phone Cell.:
l ev — °
Work Phage Fax
.Agent's Name. dd w.
use Phone ell:.
Work Phow Fax
Owner 's Name DtZO4Address
ir^�ir
Home Phone1 .
Work Phorue Fax
E,m.ail
Site Plain Review application—Revised October 2016
ToofQueensbury Planning Office-742.Bay Road,Queensbury,-NY 12804
Site DeVel meat Data
Area T 'e Existing,s+ ft. Proposed 'Total.sq. ft..
Addition sq. i°t.
A. Building,footprint A6 670:
B. Detached Gary
. Accessory Structure(s)
D. Paved, gravel or other lard surfaced area
1 . car /Decks
''. Other
. Total Npan-Per eable IA.dd A-F] _0 1/75A
0 ./acre 1,
13. Parcel arca � � � � � 1k �
Alf
1. Percentage.of Imp rme,able Area.of Site [1= ] I'A Oh. � � '016
Setback Requirements
Areal equit- d Existing Proposed
Front[11 .
Front[ ]
Shoreline
Side Yard [l� -
Side'Yard
Rear Yard[l]
Rear Yard [2]
Travel Corridor
Hila [rPa j 1
1rrncahilit
30 04
No,of'parking spaces .«
'Site playa Roview application—Reprised October X416
Too of aeernsbury Planning Office-742 Bad Road,Queensbury,N'Y 12804
Additional Prof cf Information
1. Will the proposal require a Septic Vari nc frothe Tow Board of health?
2. If the parcel bas previous,approvals, list application number(s); pe v v4,114
'. Boas this project:requa,.'ne coverage trader the New York State Pollutant Discharge Elimination System
FIT Permit Program
4. Estimated project duration., Sty bate • Enid Date .. +� -
. Estimated, total cost of project: nq
. Total area of land disturbance for project:
Floor Area Battu,-Workshee
FLOOR AREA RATIO ) -- Tlrwe relationship of building size to lot size, derived b dividing the total
building floor area by the lot size in square are feet, yielding a percentage.
Zoning;District Symbol Floor Area Matic [FSI;
Waterfront Residential � WR 0,22
Commercial Moderate/ Intensive I ' Cl 0.3
A. The combined area, of all square fboltage, as measure rom exterior walls of all structures, . the property,
including all fl,00ts of the structures, garages, basements and attics with more flran.fie feet of"ceiling
height and covered porches. Building,square footage docs not include: Open deck, docks and that portico of
covered docks.extending cover, water and one storage shed ofone hundred twenty (120 sgparc feet or less.
Any additional sheds will beincluded (Sec"FLOOR AREA RATIO").
B. Commercial or industrial: the total area in square feet as measured from the exterior cf'the outside walls of a
building or structure, and when applicable, the sum total ofall floor areas of the principal and accessory
buildings or structures on the prof t.site.
A. Parcel Area sq. ff.
B. Existing Floor Area ft. see above definition
'. fracuus�ed ,.dudit a nai Floor Are . ft.
i
D. s „ fl.
E. Total Allowable Floor Area, sec Bove table'
*If D, is larger,thn E, a variance or recisions to your plan may be needed. Consult with ' taff.,
4
Site Plan Review application-Bevis .Ocrtu a r 2016
Town ofQ' ue nsbuarPlanning Office,-742 Bay Road,Queensbury,NY t 8
§ 179-9-0,80Reg1 irements for Site Plan.,Approval
The Planning Board shall not apprSite Plan unless it first determines that such site plan meets the
follovd,ng Standards,. Please prepare responses,to each.of the following topics:
STANDARDS
A. The pwposed project furthers or is consistent with ft:policies of the Town's Coanpuw herasive Plan.
B. ,rhe proposed project complies with all other requirements of this Chapter,including the site plan review,standards as set forth in Paragraph
F ofthis stcdon,,the:dimensional,bulk and density regulations of the zoning,district in which it is proposed to be located(Article 3 and
"fable J),the applicable requirements of all other.Articles that apply. Yv;
C,
`Tice site plan euuooawrages pedestrian activity Intemally and,if practicablc,,W and from the site with pedestrian paths,or sidewalks connected
to adjacent areas. ko I A
D. The site plan must conform to Chapter 1.36 Sewage,and,'Sewage Disposal,Chapter. 147 Stormwater Management Local Law.,and other
applicable local law&
lam. The proposed use shall,be in harmony with the general purpose or intent'of this Chapter,specifically taking into account the location,
character and size of the proposed usc and the description and purpose of the district in which such use is proposed,the nature and intensity
of the activities to be involved in or conducted in connection with 6e proposed use and the nature and rate of any increase ire the burden on
supporting public services and facilitics,which will follow the approval,of the proposed use.
IC5
F.
"the establishment,maintenance and operation of the proposed use:will nott create public hazards,from traffic,traffic COD", ion.or the
parldrig ofvehicles andVor equipment or be otherwise detrimental to the health,safety or gateral welfare,of persons residing or working in
the neighborhood or to the general welfare of the town. Traffic access and circulation,roadl intersections,road and drivcway widths and
traffic controls will be adequate.
G. M-ar—ectparking and l9oading facilities will,be appropriately located and amnged and sufficient to meet traffic anticipated to,be generated
by the new use, The establiA-ment of vehicle links between parking areas of adjacent properties are provided where feasible. This,i%r1h=
the Town's goal of reduzing curb cuts and reducing congestion. A twenty-fo-ot wide connection is required. If ad*, tnt properties am either
undeveloped or previously developed without having made provision for future linkage,then a future connection must be identifled and
provided for in the site plan under review for such,future linkage when the time arises. The Planning Board may requ,ire proofthat,the
applicant has made contact with adjacent property owners for purposes oUcoordinating linkages withadjacent propertles. -n
H. The project shall not have an undue adverse impact upon the natural,scenic,aesduetie, ecological,wildlife,Mitorle,recreational or-open
,space resources of the;town or the Adirontlack Park or upon the ade:quate provision of suppnrting fAeflifics and.5ervices,made necessary by
the project,taking,into account the commercial,industrial,residential,re=ational or other benefits that might be derived from the project.,
in making,the determination hereunder,the Planning Board shrill consider those factors pertinent to,the project contained in the
develapment considerations set forth herein under§ 1794480 of this;Chapter,and in so,doing,the Planning Board shall mak�e a,net overall
evaluation of the project in relation W the development objectives and gencral guidelines set forth in§-1 -9-illx0 of this A11,101c.
1. The provision for and arrangement of pedestrian traffic access and circulation,walkway structures,control of intersections Nvith vehicular
traffic crud overall pedestrian convenience shall be safe and adequate for pedestrian movement- pedestrian com. cetions between adjacent
slues shall be provided to encourage pedestrian use� 11 1A
J. Stormwater drainage facilities will prevent anincrease of post development drainage flows as,compared to,pre-development drainage:flows.
Drainage of the site shall recharge ground water to the extent practical. Ssurface waters flowing off-site shall not degrade any kim. am or
advc�rscly affect drainage:on 4acent properties or public roads. Facilities shall be in conformance with the drainage standards of Chapter
147 of the Town Code and the Town of Queensbury Subdivision Regulations where:applicable.
The water—supply and sewage disposal.facilities will be adequate and will meet all applicable and current requirements set forth by
Department,of Healthregulations and Chaptcr'136 of the Town Code. -40e
0
The adequacy,type and arrangement of trees,-shrubs and other suitable,plantings,landscaping and screening shall effectively'provide a
visual ancVbr noise buffer between the applicants and adjoiniAg lands,including the maximum retention of existing vegetation and
maintenance, including replacement of dead or deceased plants.
Fire lanes,ernergenoy zones and fire hydrants will beadequate and meet the needs and requirements ofernergency Service providem, i
such''
design of structures,roadways,and landscaping in areas susceptible to pending,flooding i
and/or croson.will minimize or avoid such
impacts to the maximu m extent,practicable,
0. The site plan conforms to the design standards,landscaping standards and pufarmance standards of this chapter.
5
Site Plan Review-application—RevisedOctober 2016
Town of QueensburyPlannin1ffice-742 Bay Road,Qnieensbury,,NY 12804
179-9-050 Cheeldist-Application for Site:Plan Review.
Application materials and site plan shall include sufficient infonnation for the Boardto review and, provide a
decision. The applicant is to provide a,site plandraw in; mid all attaclunents that address items A-V. The
applicant may request a,waiver from AN and is,to provide reasons for waiver(s)requested. Please label
infonnation to be submitted.
REQUIREMENTS 7—S,heet 4
A. vicinity reap drawiwn at the scale that shows,the relationship of the proposal to existing communky facilities which affect
or serve it,such as reads,,shopping areas,schools,etc. The map,shall also show all,properties,identify owners,
subdivisions,streets and,easements within 500 feet of the property. Such a sketch may be superimposed on a United States swv Ve,
Geological SuTypy me of thus arcs.:
B. The site plan shall be drawn ata scale of forty feet to the inch,(1, 40 feet)or such other scale as the Planning Board mWY_
deem appropriale,on Mndaird 24"'x 3V sheets,withcontinuation on 8 112`x I V sheetss as.necessary for written SLewpm
e�,
infarmMion. The information listed belovshall be shown on the;site plan and continuation sheets.
C. Name of the project,boundaries,date,north wow,and scale of the plan, uv
Di, Nameand address of Ke ow ner of record,developer,and seal of the engineer,architcd or landscape ambiont, If the
applicant is,not the record owner,as letter of authorization shall be Mulred from the o�wn,er,
E. The location and LM Of all existing and proposed strueburcs within the propeutyP,,including all dimensions of height and
floor=a,,all exterior entrances,and all amici .aced fitture addidom and alterations.
The Imatilon of all present arid proposed public and-private ways.ostrcct parEng areas,driveways,outdoor,storage areas,
sddcwalks,ramps:,curbs,paths,landscaping,,walls and knces. Locallon,'type and screening details f6r all waste disposal
containers shall also be shown.
G. The liocatlon,,height intensity and bulb type(sodium,inc andescent'etc.),of all external lighting fixtures. The direction of cv;lhoy
illumination and methods to eliminate glare,anti adjoining pLopegies must"be shown in 2mplianee with_Ll 79-6-020. 1�QjVh'j 11"9 -ID VA,4L;t
The location height,size,materials and design of all proposed signs.
A,
'The location of all pre,,mnt and proposed utility systems including.,
1, Sewage or septic system,
�2. Wa�ter supply system,;
3, Wephone,cable and electrical systeins;and
4. Storm drainage system including existing and proposed drain fines',culverts,,,catch basins,headwalls,endwalls,
hydrants,manholes and drainage swales.
Plans,to,prevent the pollution,of surface or groundwater,erosion of scall both during,and after oonstruction,excessive runoff
and flooding of other properties,as applicable. A Slormwater Pollution.Prevention Plan(SWPPP)for all land development
activities(excluding agricultural acdvities)on the site that results in land disturbance of one acre,or more., A S�WPP'P Shall �VV
comply with the requirements of the DEC SPDES MS4 General Permit and Chapter 1,47 of the Town of Queensbury
Codr_, It shall be at the discretion of the Planning Board as to whether a S:WPPP or an erosion and control plan"I be
required for a site plan review project liuid disturbance of less than one acre.
K. Existing and proposed topography at two-foot contour intervals,or such othercontour interval as the Planning Board,shall
allow. All elevations shall refer 0 the nearest United States Coastal and Geodetic Bench Mark. Harty,portion of die pexcel
is within the I 00-year floodplain„the area will be shown and base:flood clevations given. Areas,shall be:indicated within <
the proposed,site and within 50 feet of the proposed site where soil removal or filling is required,showing the;approximate
volume in cubk yards,
L. A tan&rapc plan showing all existing natural,land features,than may influence the design,of the proposed use such as wk
outcrops,sumods of trees.si rigle trees eight or Mre inches in,diamir er.forest cover andwater sources and al I proposed
changes bothe features,,including sizes and types of plants. Water sources include ponds,lakes,,wet ds and
watcrMurses,aquifers,floodplains and drainage retention meas,
k
A Land Use District boundaries within 500&iej,of the sites perimeter shall be drawn and identified on the site:plan,aswell
as any Overlay Districts than apply to the proputy.
6
Site Plan Review applioation—Revised October 2016
Town of Queembury Planning Office-742 Bay Road,Qaembray,'KY 12804
REQUIREMENTS (CONTINUED), sheet#
Traffic flow patterns-within the site,entrances and exits, loading and unloading areas,as well as curb cuts on the site and
within 100 feet of the site. Thm
e Planning.Board ay,at its discreflom,require a detailed traffic study for large developmenta or
for those in heavy traffic areas,whichshall include- wig
L The projected number of motor vehicle trips to enter or leave the site,estimated for weekly and 6paces
annual peak hour traffic levels; rt5i de�
2. The projected traffic flow pattern including,vehicular movements at rill major intersections Bluely
vu'Se'
to,be;affected by the proposed use of the site;.
I The impwt of this traffic on levels of service on,abutting public streets and at affected Ch' ki
intersections. Existing and proposed weekly and annual peak,hour traffic levels and mad capacity,
levels shall also be given.
0. For new construction or alterations to any structure,a table containing the following inform,ation shall bme:indu
1. Estimated area of structure to be used for particular purposessuch as retain operation,office,
Storage,etc.; Nk,
2, Estimated maximurn number of employees;
3. Maximum seating capacirty,whereapplicabler,and
4, NurnbcT of parking spaces existing,and required for the intended,use,
P. L FloorPlan&
Z Elevations at.a.scale of ne-quarter inch equals me foot(1/4"-I foot)for all,exterior facades of the proposed st=ture(s)
and/or alterations to,or,expansions:of existing facades,shoWing design features and indicating the type andcolor Of matcrials 3
to'be used..
Q. Soil log$,water supply well and percolation test,results,and storm water junoff calaulations,as needed to determine and
Mitigate project impacts.
4z
R, Plans for disposal of construclionand demolition waste,either on-site or at an approved disposal facility.
S. plans,for-snow removal,including location(s)ofon-site snow storage.
T An Environmental-Assessment Form C'EAF'J as pequired by the SEQRA regulations,with Part I complete:d by the Applicant
shat I be submitted as pan of the appl icatiom If the proposed projectrequires a special use permit and an EAF has been
submitted in conjunction with a special use permit application,a duplicate EAF is not required for the:site plan application.
U. if aM— pplication is,for a parcel,or parcels on which more than one use is prqpo�jed,the applicant may submit a single
application for Wlsuch uscs,p�rovided the prqpos�d uses an accurately delineated on a site:plandrawn pursuant to the
requirements set forth,above. The Planning Board mAy gram the application with respect to some,pToposed uses and not MA
others. For Purposes of reviewing an application(and for SFA compliance)all proposed uses on a single pa=l or o,n
contiguous parcels tall be considered together.
ative statement an how the project proposed for rervicw ffirthers or is consistent with the vision,goals and policies
ruvlcw�b Went with MsUm
in the Town's Comprehensive Plan.
A brief narr
P�UAPLUA J
7'
Site Plan Review application—Rivised October 2016,
Town olf Queetisbury Planning Office-742 Bay Road,,Queembury,NY 12804
Pre-Subr.n 6siConference Form I Section 179-9-040
ll,. Applicant Name* Daatd, ` . p,
zoning Classification
VII O(Z
4. Reason for Review- A f v
5,. onlr� ;Section:#:
. Pre-Submissan Mee ing motes; Provided Outstanding; PIC2Se provide by
Deed
General Inforination complete
Site Development Data Complee,
Setback,Requirements rnplete
Additional Project Inn rmatiGn Complete
FAR addressrd
tandler&Addressed(ate),
hn lls-t ite s addressed
Environmental Foran completed 77- _
' aignaturPa as corn feted,
rry � t
CA 0
CA
n
VC
t
r-
� V��
. NL C heo 6t
IL '
't ff Representative
Applicant/Agent: Date: 3 10 14-
Sue Plan Revim Rvised October 201.6
Town of Queensbury Planning ffi -742 Bay RiDad,Queonsbury, Y 12804-.118-161.-8220 8
Signature Page
This pa,991ricludes the 1),AultiorIzati Act as Agent Form,.2,)Englineering FeedDisclosure, 1),Authorizationfor 8fte
Visits. 4.) t,her Permit Responsibilities; 5,) Offidal Meeting Disclosure and 6.) Agreement to pro le documentaflon,
reqtifTed.
OMER'SAGENT FORM:
Complete the fdlowing V the OWNER of the property is not thesarne as the applicant
Owner:
Designates:
As agent,regarding". Variants SR&P'lan ub livision
For Tax Map No.: Section Block Lot
Deed keference,e Book Page Date
OWNER SIGNATURE: DATE:
APIP,UCANrs AGENT FORM
Complei following I the APPLICANT is unable to attend the meeting or wishes,to be represented by another party
Owner:
Designates:
As, agent regarding, Variance Ske! Plan Subdivisioni
IFor Taw Map, No,: Section. Block Lot
Deed Referents' Book 'Page Date
APPLICANT SIGNATURE. DATE:
2.) ENGINEERM FEE 10119CLOSURE—Applicatlons rini be refened to 'the Town consufflng engineer for review of septic dasigq,
slorrin, drainage, etc, as, cletear ned by the Zoning or PlaninIng oepartmienit, Fees for,engineering re%iew Services will be charged
d1reCIlly to the applicant, Fees for engineering review will!not exceed$ 1,P100 Without notiflication to the applicant.
3.) AUTHORIZATION FOR SITE VISIM, By signing this page, and submitting the application materials attached fierelA." Owner,,,
Applicant,.and h1affierltheir agent(A) hereby ai (hie Zoning Board or Planning Board mid 'Towns Staff to enter the subject
propertles for the purpossof mviewing the,application iWbrnitled.
4,)OTHER E9,801 RESPONSIRLM( & Other parrinIts miay be re"Iced for,wriatruttlon or alteration advily suNequaril to approval
4the Zoning Board oT Plane lrig SoaM. Itisthe applIcant's respontilWilty to,obtain"additional per,mile,
6) OFFICIAL MEETING MINUTES DISCLOSURE,-. It Is the practice of the Community Development Department to have 9,designated
stenographer tape record the,pracaadlingis of meetings resulting frorn application,and minutes trens cribled from those tapes tonstnui
the oftial record of
8,), AGREEMENT TO PROVIDE DOCUMENTATION REQUIRED,. Ni,the underidginedi, hava,thorough read and understand this
instructions for submission and agree to the submisslon Wuiraments, I act inoWedge no 1=0 -Ules'shall be cornmenjoed
prixto Issuance of a valid permilt. I oe*#w the apolication, plans Bandl supporting materials are a true and complete
statementlidescription of, the exMq owd1flons and the we* proposed, end that ell work will be performed In accordance with the
approved plains and In conkwrnance with [oml mning regulations.It acknowleda that prkw to accup ngi the,facilities proposed,,I or my
agents,wa obtain a certificate of occupancy as nec�essqry. I also understand gat 11we ma,y be oto4rued ta,pmvildo an ars-bullt survey by
a licansed land surveyor of all newly constructed facilities prior to W I suance of a cartiftcate of occLipancy
I have read And agree ta ft above,
d'a
MCI 2. m6eetA 2m-
ignature[,Applicant] Pdnt Name[Applicant] Date signed
Signature[Agent) Print Name [Agent] Date signed
Site Plan Review ReAsed October 2046,
Town of Queensbury Planning Office,742 Bay Road �Queeini NY '12804-518-761-8220
9
ShortEnvironmental Assessment Form
Part I -Project Informadon
Instructionsfor,Completing
Part I-Project Information, The applicant or projkct sponsor is responsible for the completion of'Part L Responses
become part of the application for approval or fundiqg,are subject to public review,and may be subject to further verification.
Complete Part I based on information currently available. If additional research or investigation would be needed to fully
respond to any itern:,please answer as thoroughly as possible based on current information.,
Complete all items in Part 1,, You=y,also provide any additional information which you believe will be needed by or useful
to the lead agency;attach additional pages as necessary to.supplemept any item.
Part I-Project and Sponsor Informallon
Name of Action or Project:
af*1-*4V)eW+ LAA�J
11 P I'roject Location(describe,and Wti7cK Tiocation mjap):
5-ku(z Lq &ta 00ce ws'b'
11111111111111k,e V J� to
cription of Proposed Actiow
Qv
17
bat4 ; xl be- 1930'S
Name rat',Applicant or Sponsor: Telephoriv.
2
E-MM10
pew ,J D;5cl- dl—
Ad ss,:
Iq
Cityw.. S tate: Zip Code:
(kqtf 44f? 1�24 AVY
1,Does the proposed",on only inVolve the legislative adoption of a plan,local law,ordinance, NO YES
administrative nite,or regulation?
If Yes,attach.a naxTafiyo description of the intent of the proposed acitioo and the environmontal resources,that
may be affected in the municipality and proceed to Part 2. if no.,continue to question 2r.
2. Does the proposed action require a permit-,11 approval 4 funding from any Other gorvernmental Agency? NO YES
If'Yes,list agoncy(s)name:and permit:or approval: c�O I
Ka.Total acreage of tho site of the;propose:d'action? acres
b.Total acreage to be physically disturbed? acres
c.Total acreage(projict site,and any coritiguous properties)ownetl
or controlled by the applicant or pf6ect sponsor? -12�421 acres
4. Check all land uses that occur on,adjioining.�nd near the propmed action.
[]Urban 0I ural (non-agrictilture) (211ndustrial ElCommorcia'I Wesidentlal(suburban)
OForest []Agriculture []Aquatic C3,0ther(specify):
ElParkland
Page I of 3
YES
Is'the proposed action, 1_I
.A permitted unse under the zoning regulaitiorns? p�pLi
b°Consistent with the adopted comprehensive plan?
t~a° Is the proposed action consistent with the predominant character of the existing,built or natural NO E
landscape?
7. Is the site of the proposed aotiorn located in,or does it adjoin,a state 1ist d Critical Environmental Arel NO ICES
If e , identify-
8, a.Will the proposed action result ina substantial increase in traffic above present lel NO YE
b.erre public transportation service(s)available at or near the site of the proposed action?
c.Are an pedestrian acconrmruodautions orbicycle rountea,avauilaulol on or near site°ofthe proposed action°'
1.Dou s the proposed auction meet orexceed the state energy anode reultriremenfis? YES
proposed requirements,describe design features and tcu:hrndlogies:
Li
I�`the eased au�uour�aurull emceed � ..
Will Will the proposed auction connect to an existing puublidprivate garter supply? NO' YE
If No,describe mothad for providing potable water:
11.Will the proposed auction connect to existing wastewater utilities? lir"
If No,describe method for rovidirng wastewater treatment: 10
1 70 - , -
NO YES
12. a.Does the site�ountai n au structure that is listed on either the State or National It g4ter ofHistorio
places?s?
b.Is the,proposed auction luted in an archeological sensitive area?
rra ea
horn of the site of the sed.action,or lands adjoining the proposed action,contain No YES
1 .a. Cportion
wetlandsleer svaterbodi,uas regulated or of proposed
by a federal,starts ol agency?
b. Would the proposed)action Phys,Wly alter,or encroach into,any existing.wel or waterbod
If Yes,identify the wetland or waterbod,y and extent of alterations in square feet or aloresn
5. Identify the typical habitat types that occur on,or are likely to be found on the project site. Check all that apply.
Shoreline ❑Forest 0 Agriculturftrasslands ❑,Eafly mid-successional
❑ Wetland ❑Urban MSuburbiin
15.D�oes the site of the proposed action contain any species of al or associated habitats,listed N,O YES
by the State or Federal government as threatened or endaar gem 4?
16.Is tlae project site located in the 100 year flood plain? NO Y
ES
l7Will the proposed action create storm water discharge,either from point or morn-point sources?
NO —YES
if Yes,
a.Will storm water discharges flow do adja,ceutt properties' NO,
OM
b�WilI storm water disclwrges be directed to established conveyance systems runoff and stormdrains)?
If Yes,bri f y describe;. No, p"
Page 2 of
18.Does the proposed action include construction or other activities that result in the impoundment of Yi ,
water or other Iiquuids(e. .retention pored;,waste lagoon,chore)?
if Y�es,,explain purpose arad size:
19.Inas the site of the proposed action or, an adjoining propertybeen the location of an active or closedl"+i YE
solid waste ma6nti,apmernt facility?
lf'Yes,dewriWe
2 .Has the site o:f the proposed action or an adjoining proper been the suabject of remediation(oAgoing or NO YES
completed)f'o it hazardous waste?
If Yes,describw
I AFFIRM THAT THE INFORMATION PROVIDE ABOVE,IS TRUE AND ACCURATE TO THE BES'TT'OF MY
KNOWLE DC E
pplicsperusor rnarua.e: � date: ' d
Signature.
PRINT FORM ar 3 of
Agency Use ICtnly III applicahie]I
Project,
Date;
Short En iroa mental Assessment Form
Part 2 -InVact Assessmen
Part 2 is to be completed by the Lead.Agency.
Ansaaw,wer,all of the following questions in Part 2 using the information contained in Part l and other materials submitted by
the project soonrsor or otherwise available to the reviewer. When answering the,questions the reviewer should be guided by
the concept"'Have racy responses been reasonable comngidering,tine,scale and context of the proposed action?""
No or Moderate
small to targe
impact Impact
may May
occur occur
1, Will the proposed action create a materia➢conflict with an adopted land use plan or zoning
regulations? E
. 'mill the proposed action result in a change in the use or inntennisity of arse of land" l_V
. Will the proposed action irnupair the character or quality of the existing,oonun unit ' 'El El
4. Will the proposed action have an irapact on the-e:nvirorumnueuntaal charactedstics that coursed the �I �l
cstablishnnent of Critical pu.adron erntal (CEA)? L.J 1LJ
S. Will the propo d action yah in an adverse change in the existing,level of traffic our
affect existing infrastructure ffbr mass,transit,biking or walkway? E3
. WilI the proposed action cause an increase in the-use of energy and it fails to incorporate 1�
rnably available energy conservation or renewable or opportunities? l_�
7, Will the proposed actionimpact existing; El
a.public I private water supplies?
b.public/priwaute wastewatertreaatment Utilities:?
ll. Will the proposed action ir,npair the character or quality of important historic,archaeological*
architectural or aesewic,resources
9. Will,the propo rd action result in an adverse change to natural.resources e. ,wetlands,
waterbodies,groundwater,air quality,Mora and fauna)? El D
10. Will the
nsproposed action result in an, increase in tlnc potential for erosion,flooding or drainage
7 �
11. Fill the proposed action create a ha2ard to enviromuiuerntal resources or hmurunanhealth?
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uusfDnl [d ,7ulcadnl0]
Pr0joct:;
Date;
Short Environmen'talAssessinent Farm
Part 3 Determination offtnificance
For every question in part 2 that was answered°"moderate to large impact may occur",,jar if there is a need to explain washy a
particular element of the proposed action may 0r will not result in a significant adverse environmental impact,please
complete Part.3.Part.3 should,in suuffizuerut detail,identify the impact,including any measlurescr design elements that
have been included by the project sponsor to avoid or reduce impacts. Part 3 shouldalso explain how the lead agency
determined that the impact may or will not be significant.Each potential impact should be assessed considering its settinn&
probability of occurrire,,duration,irreversibility,geographic scope and magnitude. Also consider the potelntiA for short-
term,long-tarn Ruud cumulative impacts.
Check this box if your have udeteriniaed,based on the information and analysis above,„d nd any supportifig supportingdocumentation,
that the proposed action may result in one or.more potentially large or significant adverse impacts and an
environmental irua statement is required.
this box if you have determined,based on the information atid analysis above,and any,supporting documentation,
that 1110 proposed action will not result in auruy sigrniftatat ad um environmental impacts,
Name of Lead Agency Dat
Print or T pe Name o 'Respo nsible Officer in Lead Agency Title of Responsible Officer
Signature of kespo nsible Officer inn:Lead Agency Signature:of Prepares(if di real from Responsible Officer)
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