Site Plan 32-2017 Modification Application ; a T SRS ,
Site ala, Review,ApplIt ion fAR 2, �.
C)r Qtk J j ,�`p
ReAew Proms: t!
1. Required'Pre-submission meeting with staff to determine general completeness 12 he held no later than
or I,to a line dgywCall 18)761-8220 for an appointment.
. Submittal of'complete application: l original and 14 copies of the application pace by monthly deadline.
. Determination ofapplication completeness. All necessary information must be provided and appropriate
fee(s) -paid for consideration.for placement on,an agenda for that month„
4. 1919MRIEV ARPAstions.will:not be conddgEtA&_i vlaeement tett guy a mra 1,missiggighrmtion
has been sa,briitted.
. SubmittW to Warren County Planning,ifipplicrnLble.
6. $lnnnni g,Board meeting,generally the third,&fourth Tuesday of each,tenth. You,will be advised in writing as to
which meeting to attend-
7. Following the meeting you mill be provided with a copy of the;resolution stating the:ld 's decision on your
application. if yowapolication was approved,the next likely steps is a Building Permit. Final drawings must be
provided for the r t phase ofreview. If your application was derA dp your project cannot proceed as submitted,
DOCUMENTATION,REQUIREMENTS (haLd co : electronic):
Please submit ld govies of'the completed application package to include-,
0 Comuleted AgnUeatlaatt pages 1-11. completed signed & dated
Pre-Submission NegURg N2t : si,gnned,by std''
0 QR191fted
lee. $100 (0— 1' ,,l000 sq .)m 25'0 10,01 l 1 0,00' . ft. , Q (30,001 ,-100,,O00sq. ft,,); $1,000
Stet Contact Informatiow,
Craig Brown,Zoning dmitnistatorcrtaia uocnnsbar .root
Laura Moore,, d Use Planner Iuaunanre a;geenslnnu .ne;t
Sunny 'Sweet, Office POO —Plana�niarn" surntnys�gu tnsbury.tn t (518) 761-8220
Visit our bsite:at wwwgueqns burv.net for furthu irnfortrtaat ott and fomis
Site Plan Review application—Revised October.2016
Town of uoo nsbury Planning Office-742 Day Road,Queenns ry,l '1 804-51,9-761-8220 9-'p61-82211
general I*rmQjj4
Tax Parcel ID.-,
Zoning District:
Lot size; � ,a
Current R.i's
Proposed Use,
Project Location:
Address,
Home Phone Celt
VVbrk Phone rn __755 � � Fax723
E-Mail:
I ee, 01
Agenfss:
1.6 AAIL
Home!Phone Celt: C,7121
Work Phone Fax
43v4v4s Name' Address
Home Phoma Cil
Work PhoneFax
E-mail
Site dun Review RevJsad ober,2016
"Tawn ofQueensbury Planning c °742 Bay Road-Queensbury. NY 12804°518-761-8220
2
SiteIppmpnt Data
Area I Type Existing sq, ft.,. Proposed Total sq. f't.
ddhlorn Vit:.
A. Buildirn,g otprirnt
Bp Detached Garage
C. Accessory Structure(s)
ULDD. Paved,gu aVel or other hard surfaced area
E. Porches /Decks
F. Other.
m
G. Total Non-Permeable (Add A-Fj
H. Parcel Area [43,5601 sq.ft. I acre)
r
L Percentage of ImpermeableArea of SiteV=G/H]
Area RequVed Existing Prop,olse!ld
Front( �
Pi nt 121
Shoreline
Side Yard I[1)
w
Side Yard [ ]
Ducar Yard [f 1
Reer Yard 121
Trail corridor
Hefg ht(max]
Permeabilfty
No. of p6rking spaces
P-
Sfie Flan Revlerw Revised 06tober 2016
Town of Queensbury Planning Offlce.742 My Road-Queensbury,NY 12004-616-781,82201
3
;d itjon l Project Information
. Will the proposal require a Septic Variance from the Town Board of Health?
. If the parcel has previous approvals, hist application nurn�berte): ,
1. Does this project require coverage sunder the New,YorkState Pollutant IDischarge Efirntnation, Syster
(SMES), Permit ProgramF
4. Estimated project,duration: Start Date End plate
61. Estitrnated'tote$cost of project: if Q
6. Total area,of Iland disturbance for project: C-
Floor Area, RatioWorksheet
sh eat
FLOOR AREA RATIO(FAR) --The relationship of building size to lot s1ze,derived by dividing the foul'building
flour a re,a by the lot size in square feet,yielding a pereerntage.,
Zoning D19ttlet Symbol Floor area Ratio,[FAR,]
,]
teriirornt Residentlial WR fl.`
orrnmuerdial Moderate f Comm, eroial Intensive 0,3
. The oomblinedl area of all square footage„ as measure froi n exterior wills of all structures on the preoperly.,including
all floors of the structures, garages„ basements ;and attics with more than five ( :) feet of colllhg height and
covered porches, Building square footage does rootoluade: ripen deck, docks and that portio„„ of fired docks
wittandling over water and one storagge shed of one hundred minty (120 square feet or lees. Any additional
sheds will tie included.(See"FLOOR AREA RATIO).
Commercial or industrial, the total area in square feet as measured from the exterior of the outside WaIlls of a
buildin i or structure, anid when applicable, the surn total of all floor areas of'the principal and accessory buildings or
structures on the project site:
A. Parcel Airee W I ft.
B. IExisting.Floor Area � _ _W '112 sub.ft. (see definition above)(
C. Proposed Additionail Floor Area /7> sq,ft. C
i
0, ProposedTotal Floor Area $4 ft.
It. Total!Allowable Floor Are (area x—) (see abo a table[
If'i is larger than E, a variance or revisions toyour our plain may be heeded. Please consult wilstaff.
Sfte Pram.RevIew Revised'Odober 201
Town cf Queensbury Plan nIng Offiea•742 euuy Roadl,QueeinsWryw NY 1 -518-761.88220
4
179-94,80guir
Re or Site,Nan Approval. The Planning Board shall not a rove a SitPlan unless it e einents f PP
first deterrafnes,that such site plan meets the following Standards. Please prepare responses,to each of the
.fol,lowing topics:
STANDARDS
A. Tbo proposed project fitrihers or is consistent Ynth the policies of the Town's Camprebansive Plan.
R, The proposed project complies with all other requiremnis of this Chapter,Including the site plan reviewslandards as set forth in Paragraph
F ofthis section,the dimensional,bulk and derWty regulations of the zoning district in which it is pTopGsed,,to be:located(Article 3 and
Table 1),the applicable requirements of all other Articles that apply,
The site plan encourages pedestrian activity internally and,If practicable,to and,frorn site I th pedestrian paths or sidewalks amected
to adjacent areas.- 4LCI
R' The site plan truat conform,to Chapter 136 Sewage MW Sewage Disposal,Chapter 147 StoamaterhWagement Local Law,and iidw
applicable local 1aW9L
E. The proposed use shall be in harmony with the:general,purpose or intent of this Chapter,specifically taking into account the locid6n,
character.and size ofthe prqposed use and the description and purpose of the district in which such use is proposed,the nature amd Intensity
of the activities to be involved in or conducted in.connection with the proposed use end the nature an%ILI of any,miclease in the burden on
,vim and facilities which will f6flow the approval of the propose
supporting public str d use.
F The tslablisliment,maintenance:and,operation of the proposed use will not,mate public hazards,frown ftaffic,traf1k,coAgestion or the
parking,of velticW-s"or equipment or he OlberrMse detrimental to the health:,saftty or general welfare of persons residing or working,in
the neighborhood ar to the general welfwe of the UYwn. TmMe access u4 cilmulatm,road intersectiam,read and drivemy widths and,
traffic controU will be:adequate.
G. Off-strect parking and l9oading,Mlitics will be appropriaWy located,and arranged and suflicient to meet traffic anticipated to be generated
by the,now use;. The establishment of vehicle links between parking areas of adjacent properties are provided whem feasible. This:Atrthers
the Town's goal of reducing curb cuts and reducing congestion. A twenly-fool wide connection is required. it adjacent properties we either
undeveloped or previously developedwithaut having made,provision for future linkage,then a future con=fion must beidentified and
provided for in the site plan under review for such filture 1hikage when the tim arises, The Planning Board may require proof that the
applicant has made,contact with adjaccunt property owners,for purposes of coordinating linkages with adjacent properties.
7be prpied shall not have an undue ad-verse impact upon the natural,scenic,aestlictic,ecological,wildlife,historic,recreational our open
space resources,of the town Or the Adirondack Park or upon the:ade4uate provision of supporting facilities and services made necessary by
the projwt,talcing into account the commemial,industrial,residential,rmeational or other benefits that might be derived frorn the project,
in making the determination hereunder,the planning Board shall consider those factors,pertinent tea the project Contained in,the
development considerations set forth herein under§ 179- -080 of this Chapter,and in so doing,,the Planning Board shall make a,net ovenill
evaluation of the project in rclation to the development objectives and general guidelines set furffi in J 179-9-080,of this Arficle.
Ile provision for and arrangement of pedestrian traffic access and circulation,walkway structures,control of intersections with vehicular
traffic and overall pedestrian convenience shall be safe and adequate:for pedestrian movernant. Pedestrian connections,between adjacent
sites shall be.provided to encouMa A pedestrian use.
J. Stormwater drainage,facilities will prevent an increase of post development drainage flows as compared to pre-development drainage flows.
Drainage of the site shall.recharge ground water to the waent practical, Surface waters flowing aff-site shall not degrade any strearns,or
adversely of drainage on adjacent properties;or public:roads, Faeftes shall be in conformance with the drainage standards of Chapter
147 of the Town Code and the Town,of Queensbury Subdivision Regulations where applicable.
K. The water supply and sevvage,disposal Mlijits,will be:adequate and will meet all applicable and current requhtments set forth by,
Department of Health iegulations and Chapter 136 of the:Town Code.
L„. The adequacy,type and arrangement of trees,shrubs and other,suitable plantings,Imidscaping and screening shall efiectively provide a
visual and/or noise buffer beomen the applicants and adjoining lands,including the raaxi'mum retention of existing vegetation and,
maintenance,including reptacenteat of4ead or&ceased plants.
M. Fire lanes,emergency zones and fire:hydrim,is will be adequate and met the needs and requiraments,of emergency servize providers.
N. The design of structures,roadways and landscaping in areas susceptible:to ponding,flooding;and/or erosion will minimize or,avoid s�uch
Impacts to the nmirnum extent practicable.
.0. The site plan conforms to the:design standards,landscaping standards and performance,standards of this c:haptex.
Site Pl=Review Revised Octoberr 20,16
Town OfQuccnsbury Planning Office:,742,Day Road,Queensbury,NY 12804-518,761-8220
179-0-M 9140 Heyl , App]ication 11°at 1"'ials,and the she plan shall in lud
sufficient information for the Boardto review and proe vide a, decision. T'he applicant is to pr visite a site
plan dirawirt and all attachments that address items AN. 'etre applicant can mquest.a waiver from AN and.
is to provide reasons for waiver(s) requested. Please label information to be submitted.
I FA. A vicinity map drawn at the scale that shows the relationship of the proposal to existing Corn tunny facilities which affect
or serve it,sa+as roods„shopping areas,"schools,eto. The map,shall also show all properties,,identify owners,
subdivisions,,streets and easemnenis wwithin S00 feet of the properly. Such a Oetch may be superimposed on a UnitedStates
Geological SuM map of the area.
B The site plan slmall be:drawn at a scale of forty feet to the inch ail 40 root)or such odw.scale as the PlamningBoard rimy
deem appropriate,on standard 24"x 3,6"sheets,with continuation on 8 VZ"x 11"'sheets as necessary for written
information. The information listed below shall be shorn on the site plan.and cmntinuat,ion sheets.
C. Name of the project„boundaries,chute„noorth arrow,and scale of the plan.
D, Na=and address of the r vener of record,developer,and seal of the engineer,architect or landscape.architect. If the
appilleent is not the record orwrier,a,lettazr of auathwirAtm'on shall,be required.from time owner.
E. The location and use ofali existing and proposed structures within the property,including anal dimensions of height and
floor area all exterior entr noes .and all anticipated ated futaure additions and alterations.
F The location of all present and proposed public and private ways,off-itreet parking areas,olr:uu CWq%.OlUtdOOT'AMW areas,
sidewalks,ramps,curbs,paths,landscaping,'walls and fps. Location,.type and screening details for all ate d4perW
containers shall also be shown.
G. The 4ocatioon,height;intensity and bulb type(sodium,incandescent,etc, of all external lighting fixtures. The direction of a
illumination and rmuuetlmoads to eliminate glarc onto ad,joinigg propprfies must also be shown in uaorn liance with 1794-OX oor,81 s5
The location,height"size,,materials and design of all proposed signs.
ro The locstiuon of all present'aid proposed utility systems includirW.
1. Sewage or septio°system;
2, Wow supply system;
3, Teleplhone,cable and electrical sysitm,s;;and
4. Storni drMnage systema including existing and proposed drain lines,cauhiert%catch basins,headwalls,endwmralls,
hydrants,manholes and drainage swwaVles.
Plans,to ptewreuut the pollution of surface or groundwater,,erosion of soil both during and afla construction,excessive rumofd'
anti flooding of'other properties,as applicable. .A Stormwater Pollution Prevention.Plan w PP)for all land development
activities(cxdluding agricuiltuural activities),on the site that results in land disturbance of one acre or more. A SWPPP`shall �
comply wwith'the requirements of the DECSPDES 1 S41 General'Permit and Chapter 147 of the'Town ofQuoensbury
Code. It shall be at the discretion of'the Planning Bogard as,to whether a Haub or=erosion and cmtrol plain shall be
required for a site plan review project land disturbance of less than one acre.
.. ExitfiAg.and proposed topography at tiro-W.contour intervals,or such other contour interval as the Platin np,hoard,slu l
allow, All.elevations shall refer to the nearest Uniterd States Coastal and Geodetic Bench Mark. lfany portion of the parcel
is wq�itbin.the 1010-yew floodplain,the area will be shown and base flood elevations given. Areas shall be indicated within
the proposed site and within 50 fret of the proposed site where sail removal or fillirgg is required,showing the approximate
v'otilumne in cuobie yards.
A.landscape plan shoring rail existing natural land features than may ihfluettoe the design of the proposed use such as,rock
outcrops,.stands omftnes,single trees eight or more inches in diameter,forest cowemr armd water sources and all proposed
changes to these features,incWding sizes and s orf plants. waster sourms inoultu+iVe pomds,'lalmes,wetlands and,
watercourses,squuifers,floodplains;and drainage retention areas.
Lend Use District boundaries within 500 feet of the site's perimeter shall be&arwn and identified on the aite plan,as well
as any overlay f istm ticts that supply to the prop Mr 1i
Site Plan Review'Rzvised October 2016
Town,of Queensbury Planning Offloe-742 Bay Road,Queensbiury,l"wY 12804-518,-761-92201
N
REQU=MENTS ' IN Sheet
N. "frafflc flow patterns within the site,entrances and exits,.loading and unloading areas,as well as curb cuts on the site and
within lElft feet o-f the site. The Planning Board may.st its discretion,require a detailed traffic study for lie developments or,
for those in heavy traffic areas,which shall include;
1, The pgjecned number ofmotor vehicle trips to enter or leave the site,estimated for Ymckly and
annual peak.houur traffic levels',;
2. The projected trafrk flow pattern including vehicular movements at all major,inursec6ow lMy
to be affec d by the proposed use ofthe site;
3, "l'w impact of this traffic on levels of service on abutting public streets and at affected,
intersections. Exiting and proposed weekly and annual peak hour traffic.levels and road capacity
levels shall also be givenn.
. For new construction or alterations to any stru duuae,a,table containing,,the folloavinng iaufuu�uatlon"I be included;
1. Estimated apnea of struuctuure to be used for particular purposes such as retain operation,office,
`to e,etc,;
2, Estimated maximum number of employ"aes
3. Maximum scating capacity,where applicable;and
4., Number bf'pa fang spaces existing-anvil required for the intended use.
P. I, Floor Plans,
. Elevations,at a sole of one-quarter inch equals one snot(IPI"-l foot)for all,exterior facades of"the proposed structure(s)
and/or alterations,to or expansions of existing facades,showing,desip fWwres wA indicating,the type and color ofmaterials
to be used.
Soil Ides,awas er snnpply well and peroolation test results,.and staxrm avater rumcaff'calculations lations ars needed to iletemme and
mitigate project impacts.
R Plans for disposal ofconstruction and demolition v aste,either on-site or at an approved dispoul facility.
S. Plans for mow removal,including location(s)oforu-site snow storage.
T. An Environmental Assessment Forma("EAF")as required by the SEQRA'regulations.with-Pan l completed by the Applicant
shall bo susbm ittead.as part of the application, lf°the propoW projeot r gnires a special use permit and an EAF has been.
submitted in a�aryjunmatlom with a special use permit application,a duplicate is not required fbx the site plan application
l
U. If an application is fur a parcel or parcels on which more than orae use its proposed,the applicant may submit a single
application for all such uses,pmvided the proposed rases are accurately deilinneate+d on a site plan drawn pursuant to the
requirements set fbrib above. 'lane Planning Board may,grant the application with respect to some proposed uses and not
others," For,purposes ofreviewing an application lanai for SEQ11A compliance)all proposed uses on a single parcel or onu
contiguous parcels shall be conunsidemd togedter.
V. A brief narrative statement om how the,project proposed for review furthers o'r,is consistemt with the vision,goals and policies
in the Touiwn's CompxehensivePlan,
t
Site P'larReview Revised October,210,16
Town of Queensbury Planning lff'ioa*742 Bay Rolad,Queensbury,TalY 128,014 18--761-322 1
7
Town of QueensburySite Plan pre- ubmi s ion Conferences Form I Section 17'9- -0,4
3. Zoningla sifiativa C'
4. Reason for Review- CXR
- -0 C)
5. Zoning Section N: r
b, Pre-Submission Meting Notest Provid d Outstanding; Please provide by
Ned
General lnrormation complete
Site D v lop tint Data Complete
tali Rcquir rru ruts Complete
Additional Projecl Informationomp- lete
FAR adldress ,l
Requirements for Site Plr - tandards
e,ck ist items addressed
Environmental Form romplet d
Signature Page completed
uJ' r' 'CW, tock.
- kY
� �4^�,
0')re" "I(Orcilcol
Fw
f ! PI
TV
:Staff Representative. La-u4r c
Applicant,f Agent: Date: '3 M �
8
Site:Plea Review app]icat a -.Revised October20'1
Town of Qsensbury Planning ffffuc -74 lay Road,Queensbury,NY 12804
Signature Page
This page inctud'es the fi)Authorization to Act as Agent Form., .)Engineering Ree Disclosure; .)AuthorIzation for sfte
Visits; 4,) Other Permit Responsibilities; 5.) Official f eeting Disclosure and 6.) Agreement to provide do urmentallon
required,
amiITS AGENT FORM,
Complete the fo1110iing fthe Nf Nr::R of the Property is not The same as the supplicant
jg
As agent regarding varliance Sile Plan, Subdivision
For Tax Map NO.' Section Block Lot
Dead Refareru s BOOK Page Bata
OWNER SlIGNATURE-, DATE., tj
APPLI aN7"$ AGENT POW.',
Complete the t'uiIllouwlrtg It thio JkPIPLICANSAIn to attend the meeting or wishes to,be represented by another party
Designates:
As went rep d'tngl. a an, Site Plan Subdivislon
For Tax flap No.11f,II-1 n Block Lot
Diced Reference., 8 "ck � Pae Data
AP LICANT SIGNATURE DATE: r
2ji ENGl,NE,,ERihE2,-EEE-D[,SCLC,SURE.Applicatlo s rmay be referred to the Town consuttling engineer for review of sepdic design„
storm drainage., etc, as determined by ffie Zo,- or Planning Department. Fees for engineering review services, ll' be charged)
directly to the applicant. Fees for engineeinan" 7f view,will not exceed S 11,000 wutlhout notification,to the apptidam_
3,)I AUTHORIZATION TION FOR, SITE VISITS, By signing this page,. and subralitting the application materials attached, herein, the Owner.
Applicant, and hlahaer/their agent(s) hereby authorize the ;Zominig Board or Planning Board and Town Staff to enter than subject
praapertles for the purpose of rawlewwlirmg the application submitted.
4) OTHE, Fi:MI j RESPON' t9dLi"t"t '. Otherpermits may be regluireci for constructian or alteratlbn actiwity subsequent uent to a;pprewaf
by the Zoning Board or Planning Saard. tt istihe epplicanrg� resp sibltity to obtain eny add�itmcnat perrni .
5) OFFICIAL MEETING MINUTES DISCLOSURE. It i die practice of the Community Development[),apartment to have a designated
stenographer tape record the proceedings of meetings resulting)frormi appliicatlon,and minutes transcribed from thuosetapas oonstbtu a
the o ficlall record of aid proceedings-
6) AGREEMENT TO PROVIDE DOCLIMlENTATION REQUIRED: 1,the undersigned., have thoroughly read and u,nderstand they
inatruncdions for submission and agree to the suybiramiswsuon reglunirei II acknowledge no construction ac&Mfles shall be commenced
prior to issuance of a valid permit. t certify that the application, p�dans and sup omit mati are a true amid complete
statemmuenUctescriplion of the existing conditions and the work proposed', and that all work will be performed In accordance with the
approvedplans and In conformance tb Mail zoning s gLutaticns. l acknoMedige that prior ccacupyin the fa�iluiti�ea proposed„ t cr myagen , i 111 obtain,a certificateof occupancy as necessary. t also rumderstamd that [/we maybe reguirs tc provide an as-bunt surer by
a licensed land surveyor of all rmi constructed faci tees prior to issuanco of a certificate of occupancy
I havp read andl agree to the above.
ii r; Print Name,[Applicant] Date si ned
,Signature [Agent] grins balm [Agent] Date siigneid
$rite Plan Rei Revised October 201
Town of u' ueensbiury Planning Office- 742 Bay Road -Queensbuury, NY 12604
9
Short Environmental Assessment Form
Part I -Prqjecl Inforniation
Instru tions for Com P1
Part I -Project Information., The applicant or project sponsor is responsible for the completion of Part 1. Responses
become part of the application for approval:or funding,are subjiect to public review,and may be,subject to further verification,
Complete Part I based on information currently available. Ifadditionatresearch or investigation would be;needed to Mlly
respond to any item,please:answer as,thoroughly as,possible based on current Information,
Complete all items in Part 1, You may also provide any additional information which you befieve will be aeaded by or useflul
to the lead agency;artach,additional pages,as necessary to supplement any item-
PartI -Project and Sponsor I niforran tion
Name of Action or Project:
Project Location(describle,and attach a location map):
BriefDescription of Proposed Actiow
Name of Applimnt or Sponsor: Telephone:
E-Mail:
Address:
city/pa': State: Zip Code:
L Does the proposed action only involve the legislative adoption tufa plan, local law,ordinance, NO S
administrative rule,air regollation?
If Yes,attach a narrative description of the intent of the proposed action and the environmente I resourms that
may be affected in the municipality and proceed to Part 2, If nA,continue to,question 2. 'M
2. Does the proposedaction requiTe a pe:rmi4 approval or fundling frorn any other govgumental,Agency? No YES
If Yes, list ageripy(s)name and permit or approval
c LOn C4 Q ' 4"I'DY3
3.a.Total acreage of the site,of the proposed actlon acres
b.Tolalacreage to be physically disturbed? --acre:s
c.Total acreage:(projoct.site and any contiguous properlies)owned
or controlled by the applicant or project sponsor? acms
4: �htok;U! iand uses that accur on,adjoining,and near the proposed actim
E]Urban El Rural(non-agricu Iture) [][ndustrial (--loommercial OlResidential(suburban)
M'Fortst LIAgriculture ClArquatic .990ther(specify
ElParkland
Page I of'3
is the prop�osed ani-m, NQ VIES IN I
_.
a.A permitted use rounder the zoning regulations?
b.Consistent with the adbpted comprehensive plan?
6, 1s throe proposed action consistent with the pr'edorarinaunt character of'the existing built or natural_ NC) dE
landscape? FF
T, Is the site of the proposed action located in,or does it adjoin, a state listed C'ritical Environmental Area? R-0 YE
If Yes,Identify:
13 d a.'pw ill the proposed action result in:a substantial inomase in traffd7c above present levels'? NO YES
K,ire public transportation services)available at or near the site ofthe proposed actian?
c. Are any pedestrian accommodations or bicycle routes,available on or near site of the proposed action?
9.'.Moes the proposed action meet or exceed the state energy code requirements? NO
Ifthe proposed action will exceed requirements,des ibe design fgatores and tecilmncic im
10. Will the proposed artisan eonnw to an es€istiiRg paub,IWpriwate Water supply'? NO YES
If No,d=ri,be method for providing potable wvater: Ih�"l
El
1'1.Will time proposed action connect to existing wastewater mitafities? -K-0 YE
if lam,describe rmmetl d ffor providing wastewater treatment
12, a,Does time site contain a structure that is Iisted on either time State or National Register of~l listoric NO YES
Places?'
ha.is the proposed action located in an archeological sensitive area?
I Li
13,& Maes any portion of time site of time proposed action.,or lands adjoining the proposed action,contain I fo YES
wetlands or other,ww°aterbo dies regulated by a federal,state or local agency?
b.Would the proposed action physically a]ter,or encroach into,any existing wwetland'or wwate ody? s�
if Yes,identify the wetland or water6o4y ands stent of alterations in square feet,or acre�s:
14. Identify the typical habitat types that occur on,or are likely to be found on the project site. Check all that apply:
El Sboreline EN Forest 0 A riruultruraUgirasslan Early mid-successional
Wettand El Urban El Suburban,
IS.Does the site of the proposed action contai ni any species of an innal,or associated habitats,fisted! NO 7YES
by the State or Federal government as threatened or endange d? �
16, is the project site located in the 10110,year flood,plain,? NO YES
17. Will the proposed action create storm water discharge,either from point or non-point sources? NQ YES'
If Yes,
u. ' i!ll storm water di tbarges flow to adjacent properties' El NO oyrs EJ
b.Will storm water discharges be directed to establli hed conveyance systeut s runoff and storm drains)?
if Yes,briefly describe: NO 01YES
Pap 2 of 3
1'8. D=dh proposed lotion include conVraae ion or Other scti;i les that result iru the impoundment of NO vEs
,etem or other Iolds �,, r�tearo� pori � ���lagoon,dem)?
If
If Y s,explain purpose and size:
7Has ofthe proposeduuetlon or an ad oinin property ben flee locati n ruff rr0ve or closed ISI YES
mrreunagement facility?
. �I
20. Has the site of'the pr posed action or an adjoining prop, y been the subject of r uaaediatie,mu (ongoing or V ,
completed)for hazardous,waMe?
I'f'Yes;,dfu lbe.
I AFFIRM THAT THE INFORMATION ION RO IDED ABOVEIS"TRUE AND ACCURATE TO THE BEST OF
KNOWLEDGE,
Appal sru "sponjs name: � .
Llato;
Signatur, A..
PRINT FORS I Page .3 of
rAgency Use Only[If Applicable]
Project-
Date:
Short EnvirionmentalAssessment Foam
Part ImpaclAssessiment
Part 2 is to he cam pleted by the Lead Agency,
Answer all of the fol lowing questions in Part using the infformuation contained in,part I and other rnatenals suubrm i tted by
the project sponsor or otherwise available to the reviewer, When answering the questions the reviewer should be guidedlay
the concept"Have my responses been reasonable considering the scale aMd context of the proposed action'''
N air Maderat
Small to Inrge
Impact Impact
may May
occur occur
L
Will the
proposed auction create a material conflict with an adopt [amus disc plan or zoning
regul
, Wlli the proposed act loin result inn a change in the use or intensity of use of land?
. Will the proposed auction impair the character or quality off the existing Community?
I
"l. Willthe proposed)action hai an imppaGt on the environmental characteristics that caused the
estabiiuh meat of Critical Environmental Area(CEA)? JAIEl
5. Will the proposed action result in an adverse change,in the existing level of traffic or
affect,existing i nfrastructure fbr mass transit,biking or walkway's
6. Wl III the proposed action cause an increase in the use of energy and it fails to incorporate
reasonably available energyconservation or reneuwabile energy opportunities?
?. Will the proposed Wfon 1 mpact existiu g, I
a public I private water su°ppll'u "
b. puubiic P private wastewater t:reatrment utilities? 91 El
_
S. MIt the proposed action impair the character or quality of ivauportant historic,archaeological, tq p
ar aitectu�ral oraesthetic, ouurces? N
m Will the proposed action result in an adverse change to natural ru uouurces e.g., wiaHands„
terbodies,groundwater,,air quality,fora and Nunay?
10. Will the proposed action result In aro increase in the potential for erosion,flooding or drainage
problems
Ll
I, WiII the proposed action create a Nzard to environmental resources or human hea.lthi?
PRINT FORM ' p 1 of 21
Age eHeIyUseOnj✓ (lfae licaahle],
Proj Wit.
' rate
Sh v rt Enviro mental Asse sment Form
Part 3 Determination of Signiflcance
For every question m mart 2 that was answered"moderate to large i.rnpact may ocouaP''",or if there is.a Reed to explain why a
particular element ofthe p posed action may or will not result in a significant adverse environmental impact„please.
complete Bert 3.Bart 3 should,in sufficient detail,identifY the'impact,irwclud:iirtg arny measures or design elements that.
have been included by the prgjen;"t sponsor to,avoid or reduce,irnmpdct& part 3 should also explains homy the lead'agency
determined Chat the i mpact may or wilI not be signi ficant.Each potential impact should bye assessed considering its setting,
probability ofa ccanrTing,duration,irreversibility,geographic scope and mnaagnituude. Also consider the potential fbr short.
term, bang-terra and cumulative impacts„
Check this box if you have determined, based on the inforrn tion and analysis above,and any supporting documentation",
t that the proposed action may alt in orae or more pottntially large or sigalflicant adverse umpras and an
environmental impact statement is required,
Check this box if you have determined,based on,the information and E nalysis abo and any suppcutiin,g documruenmtatuon„
that the proposed action will not result in any,significant adverse environntmmal impacts.
Marne of Lead Agency Date
Print or Type Name of Responsible Officer in Lead Agency Title of Respoinsible Officer
Signature of Responsible Officer in Lead .agency S ignmat.unre of Preparer(if different fi"o m responsible t3ffiicer)
L11 PINT FORM Page 2. oft
Requirements
Two site plan maps will be pro"iced to, show the location
Glenn Tree Art on the existing Great Escape parking lot.
There win be no need for either sewer or water supply. The
existing topography will not be changed or shared.
Standards for
Site Plan Approval
Glenn Tree Art
A. l will be moving my existingbusiness at 1084 St Rt 9 where I have
been located p r 4 years to Great Escapes axilla parking in lot next t
Martha'sIce Cream,. Turning the existing parking i lit into a sculpture
,harden with anew dynanii c tree sculptures,.
B. The prajct will cow lir with. .l site plan standards
C. The existing fbnceby the side wally parallel to RT9 will 'be removed t
allow for easy pedestrian access .to site.
D. There will be no disposal of sewerage,
E. This plan will not increase the need for additional public services..
F. My business is low traffic maybe a. dozencars a day I or 2 at time..
G. The curb, cut will make for easy entrance and exit of traffic and pari .; ,..
., Theulp will encircle and h o n top of e i tin; planter '-25'
with the old maple tree enhancing the nature setting. M l -1 ' rustic
shed will be located to the right and, behind the plante6r.
1. Easy pedestrian access.
I There will he no digging, d there will beno henimpact on . tonn water.
K. A
L. The landscape will be enhanced by the sculptures.
M .There will be no, impact on, ti,:re l ares as a. portion the fencing new
entrance will be plastic link.
N. 'There will he no changing of the landscape that will cause p n,ding or
create erosion..
. The site pian will conforms and exceed all design and landscape
standards.