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Subdivision Preliminary Stage Application Preliminary Stage Revised April 2010 Subdivision Review Application Preliminary Stage REVIEW PROCESS: 1) Required Pre-submission meeting with staff to determine general completeness to be held no later than 1-week prior to deadline dav. Call (518) 761-8220 for an appointment 2) Submittal of complete application: 1 original and 14 copies of the application package by monthly deadline. 3) Determination of application completeness. All necessary information must be provided and appropriate fee(s) paid for consideration for placement on an agenda for that month. 4) Incomplete applications will not be considered for placement on any agenda until all missing information has been submitted, 5) Planning Board meeting, generally the third & fourth Tuesday of each month. You will be advised in writing as to which meeting to attend, 6) Following the meeting you will be provided with a copy of the resolution stating the Board's decision on your application. If your application was denied your project cannot proceed as submitted. DOCUMENTATION REQUIREMENTS: 1) Please submit 1 original & 14 copies of the completed application package to include: Completed Application: signed & dated Pre-Submission Meetina Notes., signed by staff Copy of Deed: 1 Survey Fee: $50.00 ZONING STAFF & CONTACT INFORMATION: • Craig Brown, Zoning Administrator craigb(cDclueensbua,ne • Laura Moore, Land Use Planner lmoore@queensbury.n • Pam Whiting, Office Specialist 518-761-8220 pamw@queensbury.net Visit our website at www,gueensbury.net for further information and forms Town of Queensbury Planning Office- 742 Bay Road - Queensbury, NY 12804 - 518-761-8220 0 Preliminary Stage Revised April 2010 General Informafiican Tax Parcel ID Number: V- C Zoning District". A licationStagg Igbgck one]: Sketch Plan Stage Preliminary Stage Final Stage Indicate the follp_winm Number of lots proposed Residential or Commercial Total Lot acreage Proposed lot sizes Project location fa c 01N Detailed Description of Project [ir)ClUde,current&proposed use]: ApplicantName: Address, 9,C) Home Phone Work Phone Fax Agent's Name: Address: Home Phone Cell: Work Phone Fax E-mail Owner's Name Address Ic Home'Phone Cell Work Phone Fax E-mail o 11 nrt LON,i� r f,J)I Tqon of QueensWry Planning Office- 142 Say Road -Queens)ury, NY 12804- 518-751-8220 Preliminary Stage Revised April 2010 ITEMS TO BE IDENTIFIED BY STAFF DURING PRE-SUBMISSION MEETING. "frau should use this page for guidance when drafting your application: lio'v°ever. it will be completed by a staff member. 'Submittal of a preliminary plat depicting existing and proposed conditions shall include the items as noted belor. Failure to include all required information may result in a determination of incompleteness and a delay in the processing Of your application. A183-13. Plot details and requirements. The applicant is required to submit one(1)orlainat and 14 co ies of the preliminary plat application. Such application shall include the following documents and/or information:. A. PRELIMINARY PLAT„ The preliminary pint shall be laid out by a licensed professional engineer andior a licensed professional land surrey=or with a properly executed New York State Education Department. Exemption N, Such preliminary plat shall be prepared ata scale of one inch equals 50 feet zero inches„ clearly showing- 1) howirn1) The location of all existing and proposed property lines, buildings, ,*;atercourses and other important topographic features, l 2) Existing feet site. proposed contours showing elevations at 1%%,o-foot contour intervals and extending at least 100 3) The location, names and 4dths of all existing and proposed streets, easements, lots and building lines, wells and septic tanks and melds and similar facts regarding property immediately.adjacent or opposite the proposed subdivision. 4) A location map showing: (a)The zoning district or districts in which the land to be Subdivided is located: and (b) The property included in the proposed subdivision and all contiguous properties of the proposed subdivision and all properties within 500 feet in each direction from the boundary line of the proposed subdivision along any contiguous street or Kgh�,vay. All properties shall be identified by lot and parcel number and names of owners.. f S) The location and .size of any existing sewers, water maims, culverts and drain pipes, electric, telephone t and cable television, lines and proposed sewers. writer mains, culverts and drain pipes on the property or immediately adjacent to the property to be subdivided. w m ,, na) The proposed arrangement and approximate arca. width and length of street frontage and setback requirements of each lot for the purpose of demonstrating to the Planning Board that the proposed location ,ir r r tM of streets makes possible a layout of Tats in accordance .%-ith the requirements of the Town of Queensbury "v fZoning 'Lave for the district ordistricts in which the Subdivision is located. 7') All parcels of land proposed to be dedicated to the public use. ( ' 8) The date„ Forth arrow and scale. 9) The title under which the proposed subdivision is to be recorded, with the names of the owner and the " ) engineer or land surveyor who prepared the preliminary plat; the license number and seal of the engineer or land surveyor shall be affixed to the drawing, B. LAYOUT PLANS, Layout plans shall be prepared by a professional licensed engineer or professional licensed land surveyor with a properly executed New York State Education Department Exemption N. Such layout plans shall be incorporated on the preliminary plat and shall shove the following.. 1) The exact layout and dimensions of proposed streets„ including stationing and tie-in to the center-line distances,of existing streets with monuments and other points, as required. Town of Crueensbury Planning Office.742 Bay Road °OUeensbury, NY 12804. 515-751-3220 2 Preliminary Stage Revised April 2010 3) Plans and details of any site improvements related to park or recreation planning, including layout. grading, planting and details of any ini prove rn ents- 4) Plans and details of any other public amenities provided in the Subdivision, 6) The date and scale, 6) The title number which the proposed sub&vision is to be recorded, with the narnes of the owner and landscape architect who prepared the landscape plan-, the license number andseal of the landscape architect shall be affixed,to the drawing. E. fj ELAN. A clearing plan shall be prepared at a scale of one inch equals 50 feet zero inches. Such plan shall show the following details: 1) Existing vegetation prior to any clearing of the site for site investigation purposes, 2) Areas of vegetation removed from the site for investigation purposes. 3) The location of roadways, underground or overhead utilities not in roadways, limits of grading, proposed w. location of any buildings, septic systems, and driveways and any other improvements which might require clearing. A) Areas where slopes are greater than 20%° as per§A'l 83-26. 5) Limits of proposed clearing of trees, 6) Measures to be taken to protect remaining trees.including details. F GRADING A.ND EEO 51QN CONTROL LAaIVS,A grading plan and erosion control plan shall be prepared at scale of one inch equals 50 feet zero inches. Such plan shall show the following: 1) A generalized grading and drainage plan (does not require spot grades or slope designation), 2) Any phasing of tree removal and!or construction. G. FNVISQUIALINTAL RLEUSI'. A long environmental assessment form shall be prepared in accordance with the State Environmental Ouality Review Act describing the potential environmental impact of the proposed subdivision. H. STLTEMENT, OE INTENT. A statement of intent shall be submitted by the applicant. Such statement shall I I , inclu -. de cc 1) Proof of ownership of the land to be subdivided, in a form approved by the Town Attorney. 2) The nature and extent of proposed street improvements. 3), The nature and extent of any recreational features, parks, playgrounds, water supply, sewerage and drainage rights-of-way and easements, retention basins and other land to be dedicated to public use and the conditions under which dedication of these features is to be made to the Town. 4) A statement that the applicant will install all improvements in accordance with the standards prescribed by the departments of the Town having jurisdiction, and set all monuments as shown on the final plat thereof in such manner as the Board may designate. 1, A STQRMYYATE R MANAGEMENT PL—AN and a STORMWATER POLLUTIQN PREVENTION PLAN consistentwith the requirements of Chapter 147,Stornwooter NI inagement. Town of QueeW)ury Planning Offlce• 712 Bay Road -Gueensbury, NY 12804. 518-761-8220 4 Preliminary Stage Revised April 2010 J. FEES. 1) .The application four preliminary plat approval shall be accompanied by a fee listen on the current schedule of fees for the ToyP;n of Queensbury posted in the Manning Office. 21 In addition to the fee listed on the schedule of fees,the Planning Board may charge a fare to developers gar" projects requiring legal and technical reviwv, provided that the fee charged reelects the actual cast of the legal and technical assistance to the Planning Board. 1 . WAIVERS. if the Planning Board finds that any of the information requirements as set forth above are inappropriate or riot necessary to conduct an informed revie .,�, it may waive such information requirements as li l it deems appropriate. Any such ;waiver shall be made in writing, sand' shall contain statements of the reasons -ashy the waived information requirements are not necessary for an informed review under the circumstances. A " The Planning Board may grant such v;aivers on its awn initiative or at the written request (that sets forth the specific requirements that are requested to be tiarived and the reasons for the requested .4-aiver) of an applicant. A183-14. Submission and Review procedure— Subdivision Sign Posting Requirements D. Notice. The subdivider shall display prominently on the subject property, for `lg days preceding the date of the public hearing, at least one sign, t,.-,o feet by three feet in size and carrying a legend prescribed by the To,ern Planning Board, announcing the public hearing. The sign shall be in full public view from the street pavement and shall be legible from the street. if the property is bounded by more than one street, a sign shall he placed on each street that bounds the property. Tovm of Queensbury Plarining Office. 742 day Road °Queensbury,Nle 12804 ® 518-761-8220 Preliminary Stage Revised April 2010 lire-Stibinission Conf vrence Form I. Tax rylap ll)� 4 2. Zoning Classification: '0. cle "I 111'�C' Q I Reason for Reviev;, 4, Ordinance Section: 6. Pre-Submission Meeting Notes-, Outstanding Items To Be Addressed Include: 1. Deed Yes No 2. General Information Yes No 3 Preliminari Plat Yes No 4. Layout Plans Yes No 5Construction Details Yes No 6. Landscape Plan Yes No 7. Clearing Plan Yes No 8. Grading & Erosion Control 9Yes No 9. Environmental Report Yes 1140 Statement of Intent Yes No ill. Stormwiter Plan f SWPPP EL Yes No 12. Fees *1 es Yes No '13. Wai'vers es No ,1'�' y 14, Subdivision Sign Posting YNa 15. Signature Pace Yes 12 innt Irl 4_c ki C' L Staff Representative: Applicant i Agent: DaW To,wn of Queenskwry Planning Office- 742 Biy Road -ChleenSbUry, NY 12804 - 518-751-8220 61 7.20' Appendix A State Environmental Quality Review Full Environmental Assessment Form Purpose: The Full Environmental Assessment Form(EAF)provides an orderly and comprehensive means for evaluating the potential environmental significance of a proposed action. The question of whether an action may be significant is not always easy to answer. Frequently,there are aspects of a project that are subjective or unmeasurable. It is also understood that those who determine significance may have little or no formal knowledge of the environment or may not be technically expert in environmental analysis. In addition, many who have knowledge in one particular area may not be aware of the broader concerns affecting the question of significance. The lead agency must use the Full EAF for Type I actions and may use it for Unlisted actions. The Full EAF consists of three parts and when completed it will serve as the determination of significance: Part I -Is completed by the project sponsor. Part I provides basic information including a description of the proposed action, proposed site location and its environmental resources. The information provided in Part I is later used by the reviewing agency to complete Parts 2 and 3. The questions in Part I are grouped in sections A-G: • Section A gathers information that identifies the project sponsor,the proposed action,and the proposed action's location. • Section B requests information about government approvals or funding. • Section C requests information about planning,zoning and community services. Section D requests infori-nation about the proposed action. Section E requests information about resources on or adjacent,to the proposedsite. Section F provides the project sponsor the opportunity for supplying additional information including project elements that may avoid or reduce impacts. • Section G is where the certifying signature of the preparer is provided. Part 2 -Is completed by the lead agency. Part 2 is designed to help the lead agency inventory all potential resources that could be affected by a proposed action and to determine the potential size of the impact by providing aseries of questions that can be answered using the information found in Part 1, To further assist the lead agency in completing Part 2,the form identifies the most relevant questions in Part I that will,provide the information needed to answer the Part 2 question. Part 2 is designed to help a reviewer identify any element of a proposed project that may have a potentially significant adverse impact on the environment. Part 3-Is completed by the lead agency. Part 2 questions where the impact has been identified as potentially moderate to large or where there is a need to explain why a particular element of the proposed action will not, or may, result in a significant adverse environmental impact should be explored in a series of written,well reasoned statements-in Part 3, The discussion of impacts in Part 3 will serve as the supporting documentation for the determination of significance. Full Environmental Assessment Form Part I -Project and Setting Instructions for Completing Part I Part I is to be completed by the applicant or project sponsor. Responses become part of the application for approval or funding, 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 item,please answer as thoroughly as possible based on current information; indicate whether missing information does not exist, or is not reasonably available to the sponsor,and,when possible,generally describe work or studies which would be necessary to update or fully develop that information. Applicants/sponsors must complete all items in Sections A&B. In Sections C,D&E,most items contain an initial question that must be answered either"Yes"or"No". If the answer to the initial question is"Yes",complete the sub-questions that follow. If the answer to the initial question is"No",proceed to the next question, Section F allows the project sponsor to identify and attach any additional information. Section G requires the name and signature of the project sponsor to verify that the information contained in Part lis accurate and complete. A.Project and Sponsor Information. Name of Action or Project: LY') Project Location(describe,and attach a general location map): Brief DescripilonAf Proposed Action(include-purpose need): .................... Name of Applicant/Sponsor: Telephone:5M E-Mail: �,Xvc Address: ity/pO: State: Zi Code, Project Contact(if notsameas,sponsor;give name and title/role): Telephond. E-Mail. Address: State: City/PO: Zip Code, Property Owner (if not same as sponsor): Telephone: E-Mail: Address: City/M Zip Code: P,age I of 13 U.Government Approvals B.Government Approvals Funding,or Sponsorship. ("Funding"includes grants,loans,tax relief,and any other forms,of financial assistance.) Government Entity If Yes:Identify Agency and Approval(s) Application Date Required (Actual or projected) a.City Council,Town Board, C3 Yes 0 No or Village Board of Trustees b,City,Town or Village 0 Yes 0 No V", — Plannina,Board or Commission c.City Council,Town or 0 Yes 0 No Village Zoning Board of Appeals d.Other local agencies 0 Yes 0 No e.County agencies a Yes 0 No f Regional agencies 0 Yes 0 No g.State agencies 0 Yes 0 No h.Federal agencies C]Yes 0 No i. Coastal Resources. i. Is the project site within a Coastal Area,or the waterfront area of a Designated Inland Waterway? 0 Yes 0 No If Yes, ii, Is the project site located in a community with an approved Local Waterfront Revitalization Program? 1:1 Yes 0 No Hi. Is the project site within a Coastal Erosion Hazard Area? 0 Yes 0 No C.Planning and Zoning C.I.Planning and zoning actions. Will administrative or legislative adoption,or amendment of a plan,local law,ordinance,rule or regulation be the No only approval(s)which must be granted to enable the proposed action to proceed? " If Yes,complete sections C,F and G. 0 If No,proceed to question C.2 and complete all remaining sections and questions in Part I C.2.Adopted land use plans. a�Do any municipally-adopted (city,town,village or county)comprehensive land use plan(s)include the site No where the proposed action would be located? If Yes,does the comprehensive plan include specific recommendations for the site where the proposed action n Yes No would be located? b.Is the site of the proposed action within any local or regional special planning district(for example; Greenway 13 Yes l No Brownfield Opportunity Area(BOA);designated State or Federal heritage area;watershed management plan; or other?) If Yes,identify the plan(s): c. Is the proposed action located wholly or partially within an area listed in an adopted municipal open space plan, L3 Yes No or an adopted municipal farmland protection plan? If Yes,identify the plan(s): Page 2 of 13 C.3. 'Zoning Ot a. Is the site of the proposed action located in a municipality with an adopted zoning law or ordinance. Yeslio if Yes,what is the aconin: class irecation including any applicable overly district, b. Is the use permitted or allowed by a,special or conditional use permit? 0 Yes o C.Is a zoning change requested as part of the proposed action? a Yes o If Yes, i. What is the proposed new zoning for the site? CA..Existing community services. a.In what school district is the project site located? " I b.What police or other public protection farces serve the project site? c.Which fire protection and emergency medical services serve the project site? d.What parks serve the project site? D.Project Details D.I.Proposed and Potential Development a.What is the general nature of the proposed action(e.g.,residential,industrial,commercial,recreational if mixed,include all components)? b.a.Total acreage of the site of the proposed action? acres b.Total acreage to be physically disturbed? acres c.Total acreage(project site and any contiguous properties)owned or controlled by the applicant or project sponsor? _._ .. acres c.Is the proposed action an expansion of an existing project or use? a YesX No L If Yes,what is the approximate percentage of the proposed expansion and identify the units(e.g.,acres,miles„housing units, square feet)? % Units: d.Is the proposed action a subdivision,or does it include a subdivision? XYes 0 No If Yes, I. purpose or type of subdivision?(e.g.,residential,industrial,commercial;if mixed,specify types) ,; - rt. Is a ," cluster/conservation layout proposed? 0 Yes ht No iiia Number of lots proposed? iv. Minimum and maximums proposed lot sizes? Minimum _�. Maximum _ c.Will proposed action be constructed in multiple phases'? _ o Yes No i. If No,anticipated period of construction: _ _........... months ii. Il'Yes • Total number of phases anticipated • Anticipated commencement date of phase I (including demolition) month yea • Anticipated completion date of final phase month .____year • Generally describe connections or relationships among phases,including any contingencies where progress of one phase may determine timing or duration of future phases: Page 3 of 13 f.Does the project include new residential uses? Yes No If Yes,show numbers of units proposed. M One Family Two rantil I"Itrce Family Mraltiple Fttrnil Error tar rct�are Initial phase tg At completion _ of all phases g.Does the proposed action include new non-residential construction(including expansions)? 0 Yc No If Yes, i.Total number of structures fi. Dimensions(in Feet)of largest proposed structure: height„ width,. and length iii, Approximate extent ofbuilding,space to be heated or cooled: __. square feet h.Does the proposed action include construction or other activities that will result in the impoundment ofany 0 Yes No liquids,such as creation of a water supply,reservoir,pond,lake,waste lagoon or other storage? if Yes, i, Purpose ofthe impoundment: ii. ifs;water impoundment,the principal source of the water: a (around water ®Surface water streams ct Other specify: uir If other than water,identify the type of impounded/contained liquids and their source, iv. Approximate size ofthe proposed impoundment, Volume: _..million gallons„surface area _ acres v.Dimensions of the proposed darn or impounding structure: _ height; m._ ...__.length vi.. Construction method/materials for the proposed dam or impounding structure(e.g,,earth fill,rock,wood,concrete): D.Z. Project Operations a.Does the proposed action include any excavation,mining,or dredging,during;construction,operations,or both" twa Yes No (Not including general site preparation,grading or installation of utilities or foundations where all excavated materials will remain onsite) If Yes: i.'What is the purpose of the excavation or dredging? H, How much material(including rock,earth,sediments,etc.)is proposed to be removed from the site? Volume(specify tons or cubic yards): Over what duration of time? W. Describe mature and characteristics of materials to be excavated or dredged,and plans to use,manage or dispose of them. iv. Will there be onsite dewatering or processing of excavated materials? a Yes ra No Ifycs,describe. v. What is the total area to be dredged or excavated? acres vi. What is the maximum area to be worked at any one time? acres vii. What would be the maximum depth ofexcavation or dredging;? _ ..._........ feet viii. Will the excavation require blasting? _ ra Yes ca No ix. Summarize site reclamation goals and plan: b.Would the proposed action cause or result in alteration of,increase or decrease in size of,or encroachment 0 Yes No into any existing wetland,wvaatcrbcdy,shoreline,beach or adjacent area? IfYes: L Identify the wetland or waterbody which would be affected(by name,water index number,wetland map number or geographic description): Paige 4 of 13 H. Describe how the proposed action would affect that waterbody or wetland,e.g,excavation,fill,placement of structures,or alteration:of channels,'banks and shorelines. Indicate extent of activities,alterations and additions in square feet or acres: iii. Will proposed action cause or result in disturbance to bottom sediments? 0 Yes 0 No If Yes,describe: iv. Will proposed action cause or result in the:destruction or removal of aquatic vegetation,? El Yes[]No If Yes-. • area of vegetation proposed to be removed • expected acreage of aquatic vegetation remaining after project completion • purpose of proposed removal(e.g.beach clearing,invasive species control,boat access): 0 proposed method of plant removal: • if chemical/herbicide treatment will be used,specify product(s): v. Describe any proposed reclamation/mitigation following disturbance: c.Will the proposed action use,or create a new demand for water? If Yes: i. Total anticipated water usage/demand per day: gallons/day fi. Will the proposed action obtain water from an existing public:water supply? 0 Yes 11 No I f Yvb. • Name of district or service area: • Does the existing public water supply have capacity to serve the proposal? 0 Yes 11 No • Is the project site in the existing district'? 11 Yes El No • Is expansion of the district needed? El Yes 1-1 No • Do existing lines serve the project site? El Yes n No iii. Will line extension within an existing district be necessary to supply the project? 13 Yes 0 No If Yes. • Describe extensions or capacity expansions proposed to serve this project: .......... • Source(s)of supply for the district: iv. Is a new water supply district or service area proposed to be formed to serve the project site? 0 Yes 11 No If,Yes: • Applicant/sponsor for new district: • Date application submitted or anticipated: • Proposed source(s)of supply for new district: v. If a public water supply will not be used,describe plans to provide water supply for the project: vi,if water supply will be from wells(public or private),maximum pumping capacity: gallons/minute. d.Will the:proposed action generate liquid wastes? 13 Yesy NO If Yes: f Total anticipated liquid waste generation per day: ._,.............. ---, gallons/day H.Nature of liquid wastes to be generated(e.g.,sanitary wastewater,industrial;if combination,describe all components and approximate volumes or proportions of each): iii. Will the proposed action use any existing public wastewater treatment facilities? El Yes 0 No If Yes: • Name of wastewater treatment plant to be used: • Name of district: • Does the existing wastewater treatment plant have capacity to serve the project? 0 Yes 0 No • Is the project site in the existing district? 0 Yes 13 No • Is expansion of the district needed? n Yes©No Page 5 of 13 * Do existing sewer lines serve the project site? E3 Yes 13 No & Will line extension within an existing district be necessary to serve the project? 0 Yes 0 No If Yes: o Describe extensions or capacity expansions proposed to serve this project; iv. Will a new wastewater(sewage)treatment district be formed to serve the project site? 0 Yes 0 No If Yes: • Applicant/sponsor for new district: Date application submitted or anticipated: ------ • What is the receiving water for the wastewater discharge? specifying proposed v. If public facilities will not be used,describe plans to provide wastewater treatment for the project,including spec receiving water(name and classification if surface discharge,or describe subsurface disposal plans)- vi. Describe any plans or designs to capture,recycle or reuse liquid waste: e.Will the proposed action disturb more than one acre and create stormwater runoff,either from new point Yes K 0 sources(i.e.ditches,pipes,swales,curbs,gutters or other concentrated flows of stormwater)or non-point source(i.e.sheet flow)during construction or post construction? If Yes: i.1-low much impervious surface will the project create its relation to total size of project parcel'? Square feet or acres(impervious surface) Square feet or acres(parcel size) if.Describe types of new point sources. W. Where will the stormwater runoff be directed(Le.on-site storinwater management facility/structures,adjacent properties, groundwater,on-site surface water or off-site surface waters)? 0 If to surface waters,identify receiving water bodies or wetlands; ............... 0 Will stormwater runoff flow to adjacent properties? 0 Yes ri No iv,Does proposed plan minimize impervious surfaces,use pervious materials or collect and re-use stormwater? 0 Yes 13 No f, Does the proposed action include,or will it use on-site,one or more sources of air emissions,including fuel C3 Yes No combustion,waste incineration,or other processes or operations? If Yes,identify: i.Mobile sources during project operations(e,g.,heavy equipment,fleet or delivery vehicles) ii. Stationary sources during construction(e.g.,power generation,structural heating,batch plant,crushers) W. Stationary sources during operations,(e,g.,process emissions, large boilers,clectric,generation) g.Will any air emission sources named in D,2.f(above),require a NY State Air Registration,Air Facility Permit, r�Yes No or federal Clean Air Act Title IV or Title V Permit? If Yes: i. Is the project site located in an Air quality non-attainment area? (Area routinely or periodically fails to meet fJ Yes 13 No ambient air quality standards for all or some parts of the year) U. In addition to emissions as calculated in the application,the project will generate: _._—Tons/year(metric)of Carbon Dioxide(CO2) Tons/year(metric)of Nitrous Oxide(N20) Tonslyear(metric)of Perfluorocarbons(PFCs,) Tons/year(metric)of Sulfur Hexafluoride(SFS,) (14CFS) 0 --Tons/year(metric)of Carbon Dioxide equivalent of Hydroflorocarbons Tons/year(metric)of Hazardous Air Pollutants(HAPs) Page 6 of 13 h. Will the proposed action generate or emit methane(including,but not limited to,sewage treatment plants, o Yes No Inndfills,composting facilities)? If Yes: i.Estimate methane generation in tons/year(metric). U.Describe any methane capture,control or elimination measures included in project design(e.g.,combustion to generate heat or electricity„flaring): i.Will the proposed action result in the release of air pollutants from open-air operations or processes,such as ❑Yes a No quarry or landfill operations? If Yes:Describe operations and nature of emissions(e.g.,diesel exhaust,rock particulates/dust): j.Will the proposed action result in a substantial increase in traffic above present levels or generate substantial 131 Yes` No new demand for transportation facilities or services? If Yes: L When is the peak traffic expected(Check all that apply): 0 Morning ❑Evening ❑Weekend 0 Randomly between hours of to ii.For commercial activities only,projected number ofsemi-trailer truck tripsfday: W.Parking spaces: Existing Proposed _ _ Net increase/decrease iv.['Does the proposed action include any shared use parking? m Yes 0 No v. If the proposed action includes any modification of existing roads,creation of new roads or change in existing access,describe: Vi. Are public/private transportation service(s)or facilities available within I/,utile of the proposed site? 12 Yes El No vii Will the proposed action include access to,public transportation or accommodations for use of hybrid,electric a Yes 0 No or other alternative fueled vehicles? viii.Will the proposed action include plans for pedestrian or bicycle accommodations for connections to existing Q Yes ct No pedestrian or bicycle routes? k.Will the proposed action(far commercial or industrial projects only)generate new or additional demand 0 Ycs No for energy? If Yes: L Estimate annual electricity demand during operation of the proposed action ii. Anticipated sources/suppliers of electricity for the project(e.g.,on-site combustion,on-site renewable,via grid/local utility,or other). W. Will the proposed action require a new,or an upgrade to,an existing substation? 0"Yes Ll No 1,Hours of operation. Answer all items which apply. I During Construction: ii. During Operations:. • Monday-Friday: • Monday-Friday: • Saturday: _ • Saturday: Sunday' • Sunda _.__.. Y� j Holidays: 0 Holidays: _ 'age 7 of 13 m.Will the proposed action produce noise that will exceed existing ambient noise levels during construction, 0 Yes No operation,or both? If yes: i. Provide details including sources,tirne of day and duration. ii. Will proposed action remove existing natural barriers that could act as a noise barrier or screen? m Yes rt No Describe: n..Will the proposed action have outdoor lighting? 0"Yes No If yes: i. Describe source(s),location(s),height of fixture(s),direction/aim,and proximity to nearest occupied structures: ir". Will proposed action remove existing natural barriers that could act as a light barrier or screen? 0 Yes 0 No Describe: a.Does the proposed action have the potential to produce odors for more than one hour per day"? n Yes o If Yes,describe possible sources,potential frequency and duration of odor emissions,and proximity to nearest occupied structures: P.Will the proposed action include any bulk storage of petroleum(over 1,100 gallons)or chemical products 0 Y "leo (over 550 gallons)? � If Yes: i. Product(s)to be stored ii. Volume(s) per unit time (e.g.,month,year) iii: Generally describe proposed storage facilities q,Will the proposed action(commercial,industrial and recreational projects only)use pesticides(i.e.,herbicides, 0 Yew No insecticides)during construction or operation? If Yes: i.Describe proposed treatment(s): ii. Will the proposed action use Integrated Pest Mana xement Practices? 0 Yes a No r.Will the proposed action(commercial or industrial projects only)involve or require the management or disposal 0 Yes ANo of solid waste(excluding hazardous materials)? If Yes: i. Describe any solid waste(s)to be generated during construction or operation of the facility. « Construction°, __.._... _ ...mm...... tons per (unit of time) « (Operation : tans per (unit of time) ii. Describe any proposals for on-site minimization,recycling or reuse of materials to avoid disposal as solid waste. « Construction; __ __..._...._ « Operation, W. Proposed disposal methods/facilities for solid waste generated on-site: « Construction: « (Operation: __ _,.___._...,..... _..._.._, _......,.,_.,... Page 8 of 13 s.Does the proposed action include construction or modification of a solid waste,management facility? 0 Yes?,NO If Yes: i. Type of management or handling of waste proposed for the site(e.g,recycling or transfer station,composting,landfill,or other disposal activities): ii. Anticipated rate of disposal/processing- • Tons/month,if transfer or other non-combustion/thermal treatment,or • Tons/hour,if combustion or thermal treatment ffi.If landfill,anticipated site life: years t,Will proposed action at the site involve the commercial generation,treatment,storage,or disposal of hazardous Ye 0 waste? If Yes: 1,Narne(s)of all hazardous wastes or constituents to be generated,handled or managed at facility: ii. Generally describe processes or activities involving hazardous wastes or constituents: iii. Specify amount to be handled Or generated tons/month iv. Describe any proposals for on-site minimization,recycling or reuse of hazardous constituents: v. Will any hazardous wastes be disposed at an existing offsite hazardous waste facility'? 0 Yes 0 No If Yes.provide name and location of facility. If No:describe proposed management of any'haz�ard_Ouswastes which will not be sent to a hazardous waste facility: E.Site and Setting of Proposed Action E.I.Land uses on and surrounding the project site a.Existing land uses. i, Check all uses that occur on,adjoining and near the project site. * Urban 13 Industrial n Commercial A Residential(suburban)" 0 Rural(non-farm) * Forest 0 Agriculture 0 Aquatic El Other(specify): ------- ii. If mix of uses,generally describe: b.Land uses and covertypes on the project site. Land use or Current Acreage After Change C;overtype Acreage Project Completion (Acres A]-) • Roads,buildings,and other paved or impervious surfaces —------77 • Forested 2 • Meadows,grasslands or brushlands(non- agricultural,including abandoned agricultural) • Agricultural (includes active orchards,field,greenhouse etc.) • Surface water features (lakes,ponds,streams,rivers,etc.) • Wetlands(freshwater or tidal) • Non-vegetated(bare rock,earth or fill) • Other Describe: Page 9 of 13 c.Is the project site presently used by members of the community for public recreation? 0 Ye ' o i. If Yes.explain: d.Are there any facilities serving children,the elderly,people with disabilities(e.g.,schools„hospitals,licensed 0'Y o day care centers,or group homes)within 1500 feet of the project site? If Yes, i. Identify Facilities: e.Does the project site contain an existing dam9 0 Yesa If Yes: Ir i. Dimensions of the dam and impoundment: • Dam height. _ feet • Dam length: feet • Surface area: acres + Volume impounded: gallons OR acre-feet ii. Dam's existing,hazard classification: iii.Provide date and summarize results of last inspection: f Has the project site ever been used as a municipal,commercial or industrial solid waste management facility, m Yes 00 or does the project site adjoin property which is now,or was at one time,used as a solid waste management facility? If Yes:. i. Has the facility been formally closed? 0 Yes b No Ifyes,cite sources/documentation _ ..._... _........_.____..._. ...... ....m...._� .._....r.__....._ fi. Describe the location of the project site relative to the boundaries of the solid waste management facility: rri. Describe any development constraints due to the prior solid waste activities: g.Have hazardous wastes been generated,treated and/or disposed of at the site,or does the project site adjoin ❑Yes o property which is now or was at one time used to commercially treat,store and/or dispose of hazardous waste? IfYes: i. Describe waste(s)handled and waste management activities,including approximate time when activities occurred: h. potential contamination history. Has there been a reported spill at the proposed project site,or have any ra Yes' o remedial actions been conducted at or adjacent to the proposed site? If Yes: i. Is any portion of the site listed on the NYSDEC Spills Incidents database or Environmental Site ❑Yes❑No Remediation database? Check all that apply: ❑ Yes—Spills Incidents database Provide DECID number(s): ❑ Yes—Environmental Site Remediation database provide DEC"ID number(s): ❑ Neither database ii. If site has been subject ofRCRA corrective activities,describe control measures:__ _...._ iii. Is the project within 2000 feet of any site in the NYSDEC Environmental Site Remediation database's ❑Yes❑No If yes,provide DEC ID numbers) _._. iv. If yes to(i),(ii)or(iii)above,describe current status ofsite(s): Page 10 of 13 v.Is the project site subject to an institutional control limiting property uses? 0 Yes"1 0 • If yes,DEC site ID number: • Describe the type of institutional control(e.g.,deed restriction or easement): • Describe any use limitations: • Describe any engineering controls: • Will the project affect the institutional or engineering controls in place? 0 Yes 0 No • Explain: E.Z. Natural Resources On or Near Project Site 0 a.What is the average depth to bedrock on the project site? feet b.Are there bedrock outcroppings on the project site? 0 YeWNo If Yes,what proportion of the site is comprised of bedrock outcroppings? c.Predominant soil type(s)present on project site: d.What is the average depth to the water table on the project site? Average: feet e,Drainage status of project site soils ell Drained: %of Site Moderately'WeDrained: %Well idof site W �LIE !El Poorly Drained %of Site f. Approximate proportion of proposed action site with slopes: 0-10%: %of site 0 10-15% of site 0 15%or greater: of site 9.Are there any unique geologic features on the project site? 0 Ye""o If Yes,describe: h.Surface water features. i. Does any portion of the project site contain wetlands or other waterbodies(including streams,rivers, 0 Yes 9yvo ponds or lakes)? ii. Do any wetlands or other waterbodies adjoin the project site'? 1J Yes 0 If Yes to either i or U,continue. If No,skip to E.2.i. ')QD iii. Are any of the wetlands or waterbodies within or adjoining the project site regulated by any federal, 0 Yes 0 state or local agency? iv. For each identified wetland and waterbody on the project site,provide the following information. • Streams: Name Classification • Lakes or Ponds: Name Classification • Wetlands: Name Approximate Size Wetland No.(if regulated by DEC) v, Are any of the above water bodies listed in the most recent compilation of NYS water quality-impaired 0 Yes 0 No waterbodies? If yes,name of impaired water body bodies and basis for listing as impairc& i.Is the project site in a designated Floodway? 0 Yes ti('No 9 j.is the project site in the 100 year Floodplain? 13 Yes 9r4o k.Is the project site in the 500 year Floodplain? 0 Yes An C4 1.is the project site located over,or immediately adjoining,a primary,principal or sole source aquifer? 13 Yes""`o If Yes: i.Name of aquifer: .........__­_....... ii. Source of information: Page 11 of 13 , Identify the predominant wildlife species that occupy or use the project site: n.Does the project site contain a designated significant natural community? 0 Y`141 e No If Yes: i. Describe the habitat/community(composition,function,and basis for designation): ii. Source(s)of description or evaluation: W. Extent of community/habitat: • Currently: _n...... acres • Following completion of project as proposed: acres • Gain or loss(indicate+or-): _ acres o.Does project site contain any species of plant or animal that is listed by the federal government or NYS as 0 Yes endangered or threatened,or does it contain any areas identified as habitat for an endangered or threatened species? If"Yes: i. Species and listing(endaugemd or thrcatencd): ii, Nature of use of site by the species(e,g.,resident,seasonal,transient): p. Does the project site contain any species of plant or animal that is listed by NYS as rare,or as a species of special concern? If Yes: i.Species and listing: ii. Nature of use of site by the species(e.g.,resident,seasonal,transient): q.Is the project site or adjoining area currently used for hunting„trapping,fishing or shell fishing? El es o If yes,give a brief description of how the proposed action may affect that use: .3. Designated Public Resources 4n or Near Project:Site a.Is the project site,or any portion of it,located in a designated agricultural district certified pursuant to n Ycgi& Agriculture and Markets Law,Article 25-AA,Section 303 and 304? If Yes, provide county plus district narne/number: b,Are agricultural lands consisting,of highly productive soils present"? ❑ Yes'?'No i. If Yes:acreage(s)on project site? ., ii. Source(s)of soil rating(s): c. Does the project site contain all or part of,or is it substantially contiguous to,a registered National m Yes/No Natural Landmark? If Yes: i. Nature of the natural landmark: 13 Biological Community a Geological Feature ii. Provide brief description of landmark,including values behind designation and approximate size/extent: d.Is the project site located in or does it adjoin a state listed Critical Environmental Area? Q Ye, No If Yes: i. CEA name: ii. oasis for designation: iii. Designating agency and date: Page 12of 1 e.Does the project site contain,or is it substantially contiguous to,a building,archaeological site,or district 0 Yb�tNo which is listed on,or has been nominated by the NYS Board of Historic Preservation for inclusion on,the State or National Register of Historic Places? If Yes: i, Nature of historic/archaeological resource: 0 Archaeological Site L3 Historic Building or District U, Name: iii. Brief description of attributes on which listing is based: f.Issite,or any portion of it,located in or adjacent to an area designated as sensitive for 0 Ye;�4'110 archaeological sites on the NY State Historic Preservation Office(SHPO)archaeological site inventory? g.Have additional archaeological or historic site(s)or resources been identified on the project site? 0 Ye�"o If Yes: i.Describe possible resource(s): ii. Basis for identification: h.Would the project site be visible from any officially designated and publicly accessible federal,state,or local C Y 0 scenic or aesthetic resource? If Yes: L Identify resource., ii-Nature of,or basis for,designation(e.g,,established highway overlook,state or local park,state historic trail or scenic byway, etc.): iii. Distance between project and resource: milcs� i. is the project site located within a designated river corridor under the Wild,Scenic and Recreational Rivers 13 Yes"o Program 6 NYCRR 6667 If Yes: i. Identify the name of the river and its designation: ii. Is the activity consistent with development restrictions contained in 6NYCRR Part 6667 0 Yes to No F.Additional Information Attach any additional information which may be needed to clarify your project. If you have identified any adverse impacts which could be associated with your proposal,please describe those impacts plus any measures which you propose to avoid or minimize them. G. Verification I certify that the information p ide�l is t tot best ledge. 41, Applicant/Sponsor Name i , —k— Date Signature Title Page 13 of 13 F 411 En vironmental A ssessment F orm Part 2-Identification ofPotential Project Impacts Part 2 is to be completed by the lead agency. Part 2 is designed to help the lead agency inventory all potential resources that could be affected by a proposed project or action. We recognize that the lead agency's reviewer(s)will not necessarily be environmental professionals. So,the questions are designed to walk a reviewer through the assessment process by providing a series of questions that can be:answered using the information found in Part 1. To further assist the lead agency in completing Part 2,the form identifies the most relevant questions in Part I that will provide the information needed to answer the Part 2 question, When Part 2 is completed,the lead agency will have identified the relevant environmental areas that may be:impacted by the proposed activity. if the lead agency is a state agency and the action is in any Coastal Area,complete the Coastal Assessment Form before proceeding with this assessment. Tips for completing Part 2: • Review all of the information provided in Part 1. • Review any application,maps,supporting materials and the Full EAF Workbook. • Answer each of the 18 questions in Part 2. If you answer"Yes"to a numbered question,please complete all the questions that follow in that section. • If you answer"No"to a numbered question,move on to the next numbered question. • Check appropriate column to indicate the anticipated size of the impact. • 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 in environmental analysis. • If you are not sure or undecided about the size of an impact,it may help to review the sub-questions for the general question and consult the workbook. • When answering a question consider all components of the proposed activity,that is,the"whole action". • Consider the possibility for long-term and cumulative impacts as well as direct impacts. • Answer the [uestion in a reasonable manner considering the scale and context of the project. Impact 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.D.1) Yes", answer queslions a J. If"No", inove on to Section 2. Relevant Na,or Moderate Part I small to large Question($) impact impact may : may occur occur a.The proposed action may involve construction on land where depth to water table is E2d 11 11 less than 3 feet. b.The proposed action may involve construction on slopes of 15%or greater. Elf 0 0 c.The proposed action may involve construction on land where bedrock is exposed,or Etat D 0 geencrally within 5 feet of existing ground surface. d.The proposed action may involve the excavation and removal of more than 1,000 tons D2a ofnatural material, e.The proposed action may involve construction that continues for more than one year Dle El 01 or in multiple phases. f.The proposed action may result in increased erosion,whether from physical D2e,D2q to 0 disturbance or vegetation removal(including from treatment by herbicides).._____ g.The proposed action is,or may be,located within a Coastal Erosion hazard area. Bli 0 0 li.Other impacts,: 0 a Page 1 of 10 ............----------- -------- 2. Impact on Geological Features The proposed action may result in the modification or destruction of,or inhibit access to,any unique or unusual land forms on the site(e.g.,cliffs,dunes, ONO 0 YES minerals, fossils, eaves). (See Part 1.E.2.g) Yes", answer questions a-c. Y"No", move an to Section 3. Relevant No,or Moderate Part I small to large Question($) impact iMPACt may ay occur occur a.Identify the specific land form(s)attached: E2g b.The proposed action may affect or is adjacent to a geological feature listed as a Be C1 El registered National Natural Landmark. Specific feature° c. Other impacts: 3. Impacts on Surface Water The proposed action may affect one or more ore wetlands or other surface water 0 NO El YES bodies(e.g,, streams,rivers,ponds or lakes). (See Part 1.D,2,E.2.h) If"'Yes", answer questions a-1. If""No" move on to Section 4. Relevant No,or Moderate Part I Small to large Question(s) impact impact may may occur occur a.The proposed action may create a new water body. D2b,lel li b,The proposed action may result in an increase or decrease of over 10%or more than a D2b 0 0 — 10 acre increase or decrease in the surface area of anybody of water. c.The proposed action may involve dredging more than 100 cubic yards of material D2a 0 0 from a wetland or water body. d.The proposed action may involve construction within or adjoining a freshwater or E2h 0 11 tidal wetland,or in the bed or banks of any other water body. e.The proposed action may create turbidity in a waterbody,either from upland erosion, D2a,132h 0 13 runoffor by disturbing bottom sediments. f.The proposed action may include construction of one or more intake(s)for withdrawal D2c 0 13 of water from surface water. g.The proposed action may include construction of one or more outfall(s)for discharge D2d 13 0 7 of wastewater to surface water(s). h.The proposed action may cause soil erosion,or otherwise create a source of D2e 0 11 stormwater discharge that may lead to siltation or other degradation of receiving water bodies. i.The proposed action may affect the water quality of any water bodies within or E2h ❑ U downstream of the site of the proposed action. j.The proposed action may involve the application of pesticides or herbicides in or D2q,E2h to 0 — around any water body. k.The proposed action may require the construction ofnew,or expansion of existing, DI a,D2d 0 0 wastewater treatment facilities. Page 2 of 10 1.Other impacts: 4.. Impact on groundwaterm The proposed action may result in new or additional use of ground water, or ONO © YES may have the potential to introduce contaminants to ground water or an aquifer. ('gee Part I. D.2.a,D.2,c,D.2.d,D.2.p,D.2.q,D.2.t) If"Yes", answer questions a- ii. If"No", move:on to Section 5, Relevant No,or Moderate Part I small to large Question(s) impact impact may —_ply occur occur a.The proposed action may require new water supply wells,or create additional demand D2c ❑ on supplies from existing water supply wells. b,Water supply demand from the proposed action may exceed safe and sustainable D2c ❑ ❑ withdrawal capacity rate of the Racal supply or aquifer. Cite Source: c.The proposed action may allow or result in residential uses in areas without water and Dl a,D2c ❑ ❑ sewer services" d.The proposed action may include or require wastewater discharged to groundwater. D2d,E21 � ❑ e.The proposed action may result in the construction ofwatcr supply wells in locations D2c,Elf, ❑ to where groundwater is,or is suspected to be,contaminated. Elg,Elh f.The proposed action may require the bulk storage of petroleum or chemical products C12p,E21 over ground water or an aquifer. g.The proposed action may involve the commercial application of pesticides within 100 E2h,D2q, feet of potable drinking water or irrigation sources. E21,D2c It. father impacts: 5. Impact on Flooding The proposed action may result in development on lands subject to flooding,. d NO ❑ YES (See Part 1.E.2) I Yes", answer questions a-g. I °"No', move on to Section t5. Relevant No,or Moderate Part.I small to large Question(s) impact impact may may occur occur a.The proposed action may result in development in a designated floodway. Eli b.The proposed action may result in development within a 11141 year floodplain. E2j ❑ ❑ c.The proposed action may result in development within a 5011 year floodplain. Elk ❑ ❑ d.The proposed action may result in,or require,modification of existing drainage D2b,D2e ❑ ❑ patterns. e.The proposed action may change flood water flows that contribute to flooding. D2b,Eli, ra ❑ 12" E2k f If there is a dam located on the site of the proposed action,the dam has failed to meet El e one or more safety criteria on its most recent inspection. ____ —J Page 3 of 10 a.Proposed action may be visible from any officially designated federal,state,or local E3h 0 0 scenic or aesthetic resource. b.The proposed action may result in the obstruction,elimination or significant F`3h,C2b 0 0 screening of one or more officially designated scenic views. I— c.The proposed action may be visible from publicly accessible vantage points: E3h i.Seasonally(e.g.,screened by summer foliage,but visible during other seasons) C1 0 ii.Year round 0 0 d.The situation or activity in which viewers are engaged while viewing the proposed E3h action is: E2q, i. Routine travel by residents,including travel to and from work 0 0 ii.Recreational or tourism based activities Ele 0 0 c.The proposed action may cause a diminishment of the public enjoyment and E3h ❑ 13 appreciation of the designated aesthetic resource. f. 'rbere are similar projects visible within the following distance:of the proposed Dla,Ela, ❑ 0 project: DlfDlg 0-112 mile 2-3 mile 3-5 mile 5+ mile g.Other impacts, 0 0 10. Impact on Historic and Archeological Resources The proposed action may occur in or adjacent to a historic or archaeological 0 NO 0 YES resource, (Part 1. E.3.e,f.and g.) to oaa — if"yes", , caRelevant No,or Moderate Part I small to large Question(s) impact impact Inay may occur occur a.The proposed action may occur wholly or partially within,or substantially contiguous De 0 n to,any buildings,archaeological site or district which is listed or)or has been nominated by the NYS Board of Historic Preservation for inclusion on the State or National Register of Historic Places, b.The proposed action may occur wholly or partially within,or substantially contiguous F,3f to,an area designated as sensitive for archaeological sites on the NY State Historic Preservation Office(SHPO)archaeological site inventory. c.The proposed action may occur wholly or partially within,or substantially contiguous E3g D 0 to,an archaeological site not included on the NY SI-EPO inventory. Source: d,Other impacts. to 0 e,If any of the above(a-d)are answered"Yes",continue with the following questions to help support conclusions in Part 3: i. The proposed action may result in the destruction or alteration of all or part De,E3g, of the site or property. E317 ii. The proposed action may result in the alteration of the property's setting or 133e,E3f, 11 0 E3g,E I a, Page 6 of 10 ....................... integrity. Elb Me,E3f, 0 0 iii. The proposed action may result in the introduction of visual elements which E3g,E3h, are out of character with the site or property,or may after its setting, C2,C3 ............. 11. Impact on Open Space and Recreation The proposed action may result in a loss of recreational opportunities or a Cl NO El YES reduction of an open space resource as designated in any adopted municipal open space plan. (See Part 1.C.2.c,E.I x.,E.2.q.) If"Yes", answer questions a-e. y"No", go to Section 12, Relevant No,or Moderate Part I small to large Question(s) impact impact may may occur -occur a.The proposed action may result in an impairment of natural functions,or"ecosystem D2e,E,b 0 services",provided by an undeveloped area,including but not limited to stormwater E211, storage,nutrient cycling,wildlife habitat. Elm,Ego, b.The proposed action may result in the loss of a current or future recreational resource. C2a,E I c, 0 13 C2c.E2Q c.The proposed action may eliminate open space or recreational resource in an area C2a,C2c 0 0 with few such resources. E I c,E2q d.The proposed action may result in loss of art area now used informally by the C2c,Etc 0 0 community as an o ens ace resource. e. Other impacts: a C1 12. Impact on Critical Environmental Areas The proposed action may be located within or adjacent to,a critical 0 NO 0 YES environmental area(CEA). (See Part 1.E.3.d) — If"Yes", answer qu estions a-c. 0 an M, cc on 13. Relevant No,or Mo I derate Part I small to large Question(s) impact impact may may occur occur a.The proposed action may result in a reduction in the quantity of the resource or EM 0 11 characteristic which was the basis for designation of the CEA. b.The proposed action may result in a reduction in the quality of the resource or EM to 0 characteristic which was the basis for designation of the CEA, c.Other impacts: 0 0 13. Impact on Transportation The proposed action may result in a change to existing transportation systems. 0 NO 0 YES (See Part 1.D-2J) "Yes", answer questions a- . I "No ' 0 10 Section 14. Relevant No,or Moderate Part I small to large Question(s) impact , impact may may occur-L occur -a.Prqjected traffic increase ing exceed capacity of existing road network. D2j Page 7 of 10 b.The proposed action may result in the construction of paved parking area for 500 or D2j to 11 more vehicles. c.The proposed action will degrade existing transit access. D2j a Ct d.The proposed action will degrade existing pedestrian or bicycle accommodations. D 0 f.The proposed action may alter the present pattern of movement of people or goods. D2j to ar g.tither impacts: 14. Impact on Energy The proposed action may cause an increase in the use of any form of energy. 0 NO 11 YES (See fart 1. ►.2.k) 1 "Yes", answer questions a e. L"No, o 1a section 15. Relevant No,or Moderate ,Dart I small to large Question(s) impact impact may ma o+Ceur occur a.The proposed action will require a new,or an upgrade to an existing,substation... DA o c� b.The proposed action will rewire the creation or extension of an energy transmission DIf, a v or supply system to serve more than 50 single or two-family residences or to serve a D l q,D2k commercial or industrial use. c.The proposed action may utilize more than 2,500 iMWhrs per year of electricity. D2k a ❑ d.The proposed action may involve heating and/or cooling of more than 100,000 square D l g ❑ 0 feet of buildin&area when completed, e.tither Impacts: 15. Impact on Noise,Odor,and Dight The proposed action may result in an increase in noise, odors,or outdoor lighting. ❑NO 0 YES (See part 1.D.2.m.,n.,and o.) 1 "Yes", answer questions a-f 1 "No", go to section 16 Relevant No,or ]Moderate Part I small to large Question(s) impact impact may may occur occur a.The proposed action may produce sound above noise levels established by local D2m n n regulation. b.The proposed action may result in blasting within 1,500 feet of any residence, D2m,E l d o ❑ hospital,school,licensed day care center,or nursing home. c.The proposed action may result in routine odors for more than one hour per day. D2o 0 0 d.The proposed action may result in light shining onto adjoining properties. D2n m to e.The proposed action may result in lighting creating sky-glow brighter than existing U2n,Ela a 13 area conditions. f.Other impacts: 0 01 16. Impact on Human health The proposed action ma have an impact on human health from ex osure ® NO El YES Page 8 of 10 to new or existing sources of contaminants, (See Part LD.2.q.,E.1,d. f gw and b.) 1 "Yes", answer questions a-in, If"No",go to Section 17. Relevant No,or Moderate Part I small to large Question(s) impact impact may ma cccuroccur a.The proposed action is located within 1500 feet of a school,hospital,licensed day Eld ❑ 0 care center,&r2up home,nursing home or retirement comnmnity. b.The site of the proposed action is currently undergoing remediation. E I g,E I h c.]here is a completed emergency spill remediation,or a completed environmental site El g,Elh El 13 remediation on,or adjacent to,the site of the proposed action. d.The site of the action is subject to an institutional control limiting the use of the El g,Elh 0 0 property(e.g.easement,deed restriction) e.The proposed action may affect institutional control measures that were put in place Eig,Elh 13 0 to ensure that the site remains protective of the environment and human health. f.The proposed action has adequate control measures in place to ensure that future D2t 1:3 a generation,treatment and/or disposal of hazardous wastes will be protective of the environment and human health. g.The proposed action involves construction or modification of a solid waste D2q,Elf management facility. h.The proposed action may result in the unearthing of solid or hazardous waste. 132q,Elf i,The proposed action rnay result in an increase in the rate of disposal,or processing,of D2r,D2S n 0 solid waste, i.The proposed action may result in excavation or other disturbance within 2000 feet of EI f,E19 0 0 a site used for the disposal of solid or hazardous waste. Elh k.The proposed action may result in the migration of explosive gases from a landfill Elf,EIg 0 ❑ site to adjacent off site structures. - 1.The proposed action may result in the release of contaminated leachate from the Ds,Elf„ 0 0 project site. Wr m.Other impacts: 17, Consistency with Community Plans The proposed action is not consistent with adopted land use plans. 0 NO 0 YES (See Part 1.CJ,C.2, and C.3.) If Yes", answer questions a-k If"No", Lo to Section 18. Relevant No,or Moderate Part I small to large Question(s) impact impact may may occur occur a.The proposed action's land use components may be different from,or in sharp C2,C3,DIa 0 0 contrast to,current surrounding land use pattem(s). Ela,Elb b,The proposed action will cause the:permanent population of the city,town or village C2 0 0 in"which the p!ojcct is located to grow by more than 5%. c.The proposed action is inconsistent with local land use plans or zoning regulations. C2,C2,C3 0 0 &The proposed action is inconsistent with any County plans,or other regional land use C2,C2 0 11 plans. I L e-The,prop2sed action may cause a change in the densis yoftievelopment that is not C3,Dlc, L 0 0 Page 9 of 10 supported by existing infrastructure or is distant from existing infrastructure. Dl d,D1f, DI d,Elb f.The proposed action is located in an area characterized by low density development C4,D2c,D2d 0 0 that will require new or expanded public infrastructure. D2j g.The proposed action may induce secondary development impacts(e.g.,residential or C2a ❑ ❑ commercial development not included in the proposed action) h.Other: ❑ ❑ 18. Consistency with Community Character The proposed project is inconsistent with the existing community character, 0 NO © YES (See.part 1.C.2,C,3,D.2,E..3) I "Yes'", answer questions a w gIf"No ",proceed to Part 3. Relevant No,or Moderate Part I small to large Question(s) impact impact may -.In?y Recur occur a.The proposed action may replace or eliminate existing facilities,structures,or areas E3e,E3f,E3g ❑ 0 of historic importance to the community, b.The proposed action may create a demand for additional community services(e.g. C:4 ❑ schools,police and fire) c.The proposed action may displace affordable or low-income housing in an area where. C2,C3,D1f ❑ ❑ there is a shortage of such housing. Dig,Ela d.The proposed action may interfere with the use or enjoyment of officially recognized C2,E3 ❑ or designated public resources. e.The proposed action is inconsistent with the predominant architectural scale and C2,C3 ❑ character. f.proposed action is inconsistent with the character of the existing natural Landscape. C2,C3 ❑ ❑ Ela,Elb E2 x,E2h g.Other impacts: - ❑ ❑ Page 10 of 10 Full En vironmental Assessment Form Part 3-Evaluation of the Magnitude and Importance of Project Impacts and Determination of Significance Part 3 provides the reasons in support of the determination of significance. The lead agency must complete Part 3 for every question in Part 2 where the impact has been identified as potentially moderate to large or where there is a need to explain why a particular element of the proposed action will not,or may,result in a significant adverse environmental impact. Based on the analysis in Part 3,the lead agency must decide whether to require an environmental impact statement to further assess the proposed action or whether available information is sufficient for the lead agency to conclude that the proposed action will not have a significant adverse environmental impact, By completing the certification on the next page,the lead agency can complete its determination otsignificance, Reasons Supporting This Determination: To complete this section: • Identify the impact based on the Part 2 responses and describe its magnitude. Magnitude considers factors such as severity, size or extent of an impact, • Assess the importance of the impact. Importance relates to the geographic scope,duration,probability of the impact occurring,number of people affected by the impact and any additional environmental consequences if the impact were to occur. • The assessment should take:into consideration any design element or project changes. • Repeat this process for each Part 2 question where the impact has been identified as potentially moderate to large or where there is a need to explain why a particular element of the proposed action will not,or may,result in a significant adverse environmental impact, • Provide the reason(s)why the impact may,or will not,result in a significant adverse environmental impact • For Conditional Negative Declarations identify the specific condition(s)imposed that will modify the proposed action so that no significant adverse environmental impacts will result. • Attach additional sheets,as needed. Determination of Significance-Type I and Unlisted Actions SEAR Status: 13 Type I El Unlisted Identify portions of EAI~completed for this Project: 0 Part 1 0 Part 2 0 Part 3 Upon review of the information recorded on this BAF,as noted,plats this additional support information and considering both the magnitude and importance of each identified potential impact,it is the conclusion of the as lead agency that: El A. This project will result in no significant adverse impacts on the environment,and,therefore,an environmental impact statement need not be prepared. Accordingly,this negative declaration is issued. B. Although this project could have a significant adverse impact on the environment,that impact will be avoided or substantially mitigated because of the following conditions which will be required by the lead agency: There will,therefore,be no significant adverse impacts from the project as conditioned,and,therefore,this conditioned negative declaration is issued. A conditioned negative:declaration may be used only for UNLISTED actions(see 6 N'YCRR 617A). 0 C. This Project may result in one or more significant adverse impacts on the environment,and an environmental impact statement must be prepared to further assess the impact(s)and possible mitigation and to explore alternatives to avoid or reduce those impacts. Accordingly,this positive declaration is issued. Name of Action: Name of lead.Agency: Name of Responsible Officer in Lead Agency: Title of Responsible Officer; Signature of Responsible Officer in Lead Agency: Date: Signature of Areparer(if different from Responsible Officer) Date: For Further Information: Contact Person. Address: Telephone Number: E-mail: For Type I Actions and Conditioned Negative Declarations,a copy of this Notice is seat to: ChiefExecutive Officer of the political subdivision in which the action will be principally located(e.g.,Town I City i Village of) Other involved ageneses(if any) Applicant(if any) Environmental Notice Bulletin: http://%vww.dec.ny.gov/enb/enb.html Preliminary Stage Revised April 2010 Signature Page This page includes: 1.) Authorization to Act as Agent Form: 2.) Engineering Fee Disclosure', 3.) Authorization for Site Visits; 4.) Other Permit Responsibilities; 5,) Official Meeting Disclosure and 6.) Agreement to provide documentation required. OWNER's AGENT FORM: Complete the following if the OWNER of the property is not the same as the applicant Owner: Designates: As agent regarding: Variance Site Plan Subdivision For Tax Map No : Secton Block Lot Deed Reference: Book Page Date OWNER SIGNATURE: LATE: APPLICANT's AGENT FORM'. Complete the following if the APPLICANT is unable to attend the meeting orvAshes to be represented by another party'. Owner: Designates: As agent regarding: Variance Site Plan Subdivision For Tax Map No.: Section Block Lot Deed Reference: Book Page Date OWNER SIGNATURE: DATE: 2.1 ENQlhIEERlNQ EEE : Appkations may be referred to the Town consulting engineer for review of septic design, storm drainage, etc. as determined by-lie Zoning or Planning Departmem. Fees for engineering review services voill be charged directly to the applicant. Fees for engineering review will not exceed S 11,1300,Mthou:notification to the applicant. 11 AUTHORIZATION FOR SITE VISITS: By signing this page and submitting the application materials attached hereln, the Owner, Applicant, and hist'heritheiir agent(s) hereby 36ilhorize the Zoning Board or Planning Board and Town Staff to enter the Subject properties for the purpose of reviev,,ing the application submi-ifted. at OTHER PEBM11 MEMMILUIES, Other oermits may be required for construction or alteration activity subsequent to approval by the Zoning Board or Planning Board, It is the applicants responsibility,to obtain any additional permits. 2.1 ULLICIOL MILUINQ MINUIES W&LQUEL'. It is the practice of the Community Development Department to have a designated stenographer tape record the proceedings of meOngs resUlfln< I from application, and minutes transcribed from those tapes constitute,,;the official record of all proceedings. 63 agRELMENT 10 PROVIDE U0CUMENTATION REOWfilL 1, the undersigned, have thoroughly read and understand the instructions for submission and agree to the SIL15mission requirements,i acknoWedge no construction activities shall be commenced prior to Issuance of a valid permit. I certify that the application, plans and supporting materials are a true and complete statemenMescription of the existing conditions and the vmrX proposed, and that all work Will be performed in accordance with the approved plans and in conformance with local zoning regUlatiOnS.. i acknowledge that prior to Occupying the facilities proposed, I or my agents,will obtain a certificate of occupancy as necessary. I also understand that INve may be required to provide an as-built survey by a licensed land Surveyor of all newly Constructed facilities prior to issuance of certificate of occupancy I have read and agree to the above. Signature[Applicant] Print Name [Applicant] Date signed Signature[Agent] Print Name [Argent] Date signed Town of Queensbury Planning Offlce• 742 Bay Road Queensbury, NY 12004. 518-761-8220 7