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Subdivision Preliminary Stage Application Preliminary Mage Rev iAed April 2-010 Subdivision Review Application Preliminary Stage AUG 2017 REVIEW PRocl=ss: '}OWN OF QUEEN IBURY PLAN NlN(70FF1C E 1) Required Pre-submission meeting with staff to deteFrnina general completeness to be bald no later than 1 week riorto deadline d@y, Cal 1 (518)761-6220 for ars appointment 2) Submittal of complete application: t original and 14 copies of the application parrkage by monthly deadilne. ) Determination of application completeness. All nemssar} information must be prOvIded and appropriate fee(s) paid for consideration for placement on an agenda for that rnorlth. 4) Incomplete applicatlons 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 me nth. You will be advised in writing as to which meeting to attend. 8) Following the meeting you will be provided with a copy of the resolutlon stating the BOEtrd's decision on your application. if your application was denied your project cannot proceed as aUbrmitted. DOCUMENTATION REQUIREMENTS: 1) Please submit 1 original & 14 conies of the cornplated application package to include: orn P Ieted A p p Iicafion: signed &dated Pre-Submission Neefing Noes: signed by staff oav of Deed: I u Mey Pee: $50.00 ZONING STAFF & CONTACT INFORMATION: Craig Brown, Zoning Adm Inistrator drallo bQgueensbu .net Laura Moore, Land Use Planner Irnoore ueensbu .net 618-761-822.0 , Visit our website at www.jueensbu .net for further information and forms To1va of Queensbury planning Office• 74213 uy Road - Queensbury,NY I H04{ 518-761-BM Q Prelirk Imify Stage Rov i sed April 2 010 Genera! Informatiol Tax Parcel ID Number- ,:�2., 4 00_, , �- 1- 7 Zoning Disirict: P_en 001f D9 ILI MO e_h ornrCs 011' I� AppligyNOStage [check onel: Sketch Plan Stage Preliminary Stage -- Final Stade Ind"rcate the folmWh a: Number of lass proposed # esiderdal or Commercial n+"af Total Lot acreage — ,� AE Proposed Ick sizes .5 A e Prciect location 3 ,4 03A,�rz e Laoile Detailed Desai p an Project [irnclude ajadnt&proposed use]: ll br Applicant me: _3 KP pvr� 1 Addrea+s' n Lo-vie- .Hor Phone cell, Work.Phone Fax r7 A E-Mail- rf t c ; z. VNT LAIt. . h. 90_1� . .T", x� .. 'ice t�q++V 1 Town ofQueensburyPfanr rig Me-743 W Road Quee n1sbury,NY 12804 518-761-8220 1 Preliminary Stage Revised April 2010 ITEMS TO BE IDE TIDIED BY STAFF DURING PRE.SUB MIISSION MEETING, You should use this page far cuidance when drafting }aur application; however. it VAI be cum pleted by a staff meniber. SLtbraittal of a pre Iin7latarp plat 4aInii%tg ex[sting and proposed conditfons shall include the iterns rrs Hated below, Failure to include ail required information ni av result in a determina#ian of irfcomlAeteness and a delay in the pfocessiK of mut`appheotion. r Al 83-13. Plat diatoiIs and requirements. The applioan#is required to sulamit orae(11 nriyi oaf jird 74 conFes of the prWirinary plat applic*tioit.Stieb appricat[on she.Jf include the following documents andior information. A. PRELIMINARY PLAT. The preliminary plat shall be laid out by a licensee professiomil engineer andlor a licensed professioW land surveyor with a properly executsd New York State Education Oepar€ment Exemption N. Such prelirninary prat shall be prepared at a scala of one inch equals 50 feet zero inches, cisa6y sh ovAng. akl/kc�p� 1) The lar-0nn of all existing and proposed property tines, buildings, watercourses and tether importarnt topographic features_ AJA— ) Existing and proposed contours showing elevat!Dns at t•ao-foot contour intervals and extending at Jeast 100 feet off site. A 3) The location, names and widths of all existing and proposed streets, easements, lots and }wilding litres, Vielis and septjc tanks and fiaIds and s[milar facts regarding property immediately adjaoent or opposite the proposed suNivivon. 4) R focation rnap shov&g- 1'1 ( - �a)The zon Ing district br districts in Aich the land to be subdHded is located;and 4L'p ` f, (h) The property included in the proposed subdMsion and ail' corWguous properties of the proposed ( v subdivision and .7tl properties within 5130 feet in aach directioGt front the boundary lute of the proposed subdivision along any contiguous street of highway. ill€ properbes shall be identiWd by lot and parcel number aDd is rimes of awners. 6) The location and size of any existin ssvdse . Water rrrairGs. c F electric. telephone and cable television. Hries and p rs,�reate�a ias.�uluerts-and- n# a_on_1h"re#eKy-or- irnmediatelyadjacentto the propertyto be subdivided_ f� 6) The Proposed amangernent and aippmximate area, width and length of street frontage and sethark requirerrEerds of-e h lcit foi`the purpose of demonstrating to fire PJanring Board that the proposed location of streets makes possibte a layou!of lots in a zordance veith the req&smants of the Town of Queensbury Zoning-Law forth distWOor districts iri which the subdivision is located. 7) -All parcels of 1prtd proposed to be dedicated to the public use_ f ' } 6) The date,Norlh army and scale. j t B) The We under which the Prop ed suI?division is to be recorded, with the names of-fife owner and the engineer or Band�ssirvejoor vaho prepared the preliminary plat; the license number and weal of the enginear or land surueyO shall tie affixed to the dray.ing. B. 1_AYQUI PLAN&L-iypgl plans shall be prepared by a professional licensed engfaeer or professional [k ansed land sufyeyor vXth a properly executed Ne�Ar York State Education Department Exemp'trorr N, $ueh. layout plans sh*0 lie incorporated on the preliminary plat and shall show the follovring. h 1� 1) 7t* exact layVA 2nd dimensions of proposed streets, including stationing and-tie-in to tate center-litre 1` disOnces of efisting streets with monuments and other paints, 2S required. Tatem of.Cue bury glairn[ng.Office- 742 Bay Road -0 ueerG wry,-NY 12804 -618761-6220 PreliminaryStage Rev iised April 2010 l 2) The location and widit of all streets, pavenierrts, curbs. side::alks,easenients, paft and c>ther open spaces- 3) The proposed narnes of a street, and the fade of all cuffes in the street line. 4) The location of alt proposed t0liti�, [ncludineg the proposed waWrsupply.sanitary seyvers, atorm;rMtsr drainage system and any other proposed undergrcvLrr1d uti6ties- 5) Proposed tot lin es. 6) The date, North arrwi and scale, 7) The title under which the proposed subdMislon is to be re riled,with the r*vas ofth.e(yvntr-wid engineer or land surveyor who prepared the layout plans-,the license number and seal of the engineer or land surveyor shall be affixed to the drawing. - CONSTRU ON DETAILS,Cons"ction datails shall be prepared by a licensed professiorIal engineer or-a Iteensed professional In nd surveyor with a properly executed New Yolk Mate Educd on Deparl;rnent Exemption N. Such details ahall include: Fal I cw�4) The proposed sanitary sewer system. includiag pipe sizes-bedding arrtl profiles. pA 2) The proposed storm drainage system, including pipe sizes. baddingr catch basin and -manhole details, profiles and method of disposal of collected storrriwr aer. 3) The proposed water supply system, 4) Any other proposed underground utilities- b) A typical cross simctisn of the roadway. including the right-of-say widthr pavement width and depth of pavernent materials and subbase. the location of ulinies, chomcter and dimensions of curbs and sidewalks and side slope grading, 6) Pfofiles, showing the o6girml ground surface and finished street surface at center lines of all streets, Orceritage of grades of streekar staliorrirrg and elevations of al points of cu wmura, points -of intersection, points of hmgehr-y and of proposed sewers, drains, culverts, manholes and otI)O .futures- Irwert elevptions and slopes of sewers and drains and both surface and avert elevations of manholes shetil be indicated. Profiles shall be drawn to the scale of four feet to the inch vertical and 40 Fait tz the inch honzontal. The stationing shall shoe. accurate center-line distances. The elevations 4f the original ground surface shall be to ib6 nearest tenth of a foot and of fixed points to the noarest bundrodth-of a foot. 7) Thi[a cation and elevation of all proposed monument locati Dns. 9) The date and-scals- 9) The We under w1 ich thL- proposed zvbdivWon is to be recorded, wth the names 'of 'the miner jand engineer who prepared the construction details-, the license numirer and seal of the engineer shall be 'aMi5ed 1<o th'e drawing. D. LANDSCAPE ej.,W A landscape parr shall be prepared by a licensed landscape architect fa sOdWtsions greater than 10 Eats.Such landscape plan shall include; 4) The location and species.of streat trees, if retained vilthin the ri�-of stay or proposed-to be planed by the sul dwoer. ) Db-tails of methods cf tree protection and tree planting. Town Cf Queensbuiy Plamling Office•742 Say Road •Queensbury, NY 128A4 - 5t -7,51-8220 3. lorelintirtaryS 9eRevisedApriJ2C10 a) Plans and details of any site irnpraVements rela#ed to park or recreefion planning, including layout- grad ing, planking and detAN of any improvements, 4) Plans and details of any other public Iment#ies prarAded in the sobdivision- 5) The date and scale. 6) The tine numl3er rich the proposed subdivision a to be recorded, % ith the rtel'rles of the owner and landscape architect who prepared the €andscepe }plan: the license number and seal of the lalldEo;cap a arch itc-cr shall be affixed to the drav:ing- E CLEARING PLAT A clearing pian shall bs prepared at a scale of one inch erpals 50 feet zerx3 inches. Such plan shall shm,the follorwirtg details. +� t) Existing vegetation prior to any clearing of the site for site investigatinn purposes_ 2) Areas of vegi tWtion femoved Sion)trte sib Far investigation pt+rposes, 3) The IocafiM of rvadv y's, underground or uverbead !Militias not in roadwzgs, limits of grad1119, proposed lotgtiort of any bcrfUrigs, septic systerns, viells and drivew2ys and any other [hiprovements which might require clearing. 4) AAaas where slopes are greater ilhwi 26%r as per§AI83- . 5) Limits of proposed clearing of trees- $) Measures to betaken to protect remaining trees,inrlu&ng details. F- GRAUIRG.AND EROSION CONTROLP_LAUS. A grad na plan and erosion onntral plan shall be prepared at a scale-at one inch equals 5O feet zero inches_Such plan s11a€I shvii the.follawing: 11 Ageneralized grading and drainage Alar«�doas not require spotgrpdes orslope des[gnahon). 2) Any phasing of tree removal nrtdrar construction. E € A tang en,&cnmantal assessment form stAll-be prepared in accordance -&hl-r the Stene Environmental Quality ReAev Act describing the potential environmental impact of the proposed 1�''1� subdivision. H. STA-75-MENT OF INITENT- A statement of intent shall be submiEted by-the appli=nt. Such aUtemeat shall Include: j i) Proof of ownership o;the land to be.stjbdivided. in a form approved bythe'rawn Attorney. (XIII4X` L�lf 2) ire nature and extent of proposed street fmpro eernents. 3) The nature ar«d extent of any recreational features, parks, playgrognc#s, =ter supply, seWera9e and dr,3inage rights-of--Quay and aazemerita, rate rition basins and other lan4-ta be dedicated to public use and the nonditions under v&ich dedication of these features is to be made to the Town. 4) A-staterimeW that the appReant midi install all improvements iiithe standards presctibod by tie&pattments of tyre T n hiving jurls di ction, and set all monuments as-shvwrn on the final plat tFwreof in such manRer-as-ft Board may designate. L A TOR WATER MANAGEMENT, PLA and a STO RIMVjNM POLLUTION -PREVENTION .PLAN r con Wnt 901h the req u i rern e nbs of Chapter 147, toren-v.�atgrManagpmvrA. Town of Queembury F Fanning Otflm, 742 Bay load -0uecnsbiky, NY 12M-15-&M-8220 4 Preiirninary 5tagc Re-,:iced April 2010 J- FEES. 1 j The opprrcalon for prelirrrinary plat appra4ai shall be a ccorn par)led by a fee liswd on the current schedule j of fses for the Twort of Queensbury post€d in thr5 Planning Office. " 2) In addition to the fee listed or)the schedule of fees,the Planning Board may charge a fee tc> developers of projects requirIng legal and technical revie-rr, provided that the fee charged reflects the actual cost of the legal and techniml assistance to the PIanning Bayard, K 1N�[tl. S.. If the Planning Board Ends thak an'y of the inform lion requirements as set forth above are inappropriate or not necess;a* to conduct an inforrYxed revievr, it may a4ve such information requirements as it deems appropriate. Any such waiver shall be madla irn wddhg, and shall oontafrl statements of the reasons why tho vialvecl infomtation requirements aro not necessaryr fet an irrfomied review under the circurnstancM. The PJ�annhg Board niay grant such v.aiveis ors its awn lnidj3tive or at the w6tten fewest (that sets forth the specific requirements that are requested to be .valved end the reasons for the requestrad waiver) of an appiicant- Al8a-14. Submission and Review procedure— Subdivlslon Sign Posting RequIre ments D_ Kosice. The sQLdMder sholI display prominently an the su bjeet property,for 10 days preceding tha date of the public #-tearing, at least one sign. giro feat by three feet in size and carrying a legend prescribed by the Tawn Planning 9oard, announcing the public hearing, Thr; sign uhall be in fulI public view from the street pavement and shall be legible frorn the street- If the property is bounded by more than one street, a sign zolhA be placed on each street that bounds the property, TcAm of Ctueensburj Planning Office- 742 Bay Raid -aueeasWry,NY 12804. 518-791-0220 � RPS Property Dcscription Report Page 2 of 3 ROSy f X F {e Lim ffI rJl *u�i Imap-e Date: 511212014 Sales Information: .99 tiiite.. lnfonnation: ❑ IS--ftel Nbbd itc Nbad 11�blid Road Ent Zoning ode Sewer ater Utilities Pesire Type RatingIT—, e erode 166-MH ]rater 1 D,E Priva#e Privat Electric pical E E,—ge improved Insper iv1D1 Grade Land Information: ie #� nand # IDepth Acres Ft l 014PrimwY 1200 04-Residual 107=0 1.77 Residential Building Information: E Commercial Building Information: L7 _`.- Improvements Information: a Site# truet bode Dire 1 irn FT # onstr taratle Overall Gond r 13uiLt 1� IRG4-Gar-1.0 det 14 20 l� verage =Normal 1986 1�MH9-Mh: ood add 20 14 ® 10 Average orrnal 1186 IHS-Mobile #xome 70 I4 0 10 Average ormal 1980 FGI-Shed-machine 1L (} l Average ormal l} 0 Special District Infomation: ISPecial District J1Lnjt5 axable GMOOI-Emergency medical 110 66800 FP0077ire pmter#ion 110 166900 1 11 71 http.llparce[search.clueensbury.net/RPS_IN .A P?printkey=308,6-1- 7 611512017 .x a F IL �ff MOM I tf, 00 0 r X rci Prefimiriary tage Pei-ised April 2010 Pre-Submission Conferenoe Forret L- Tax Map ifl_ 2. ZoningE zssificailon. fil1,�-- Lwo-,Q , S. Reason 1!or Reviev:- 4, Ordinance Section: " 5_ Pre-Submission Meeting Notes-,Outstanding Items To$e Addressed l nntf` €-r���� �a Ala 1- Deed �'�s o 2- Ganem'. Iftf ration Yes No 3 Preliminary Plat �as �filo - Layout PlansYes No E., Construction Oei rls Yes No 6. Landscape Plan �Yts Ye�s NO7. Clearing Plan No 8. Grndiing & Erosion Control vN Yes. No 9. Environmental Report Yes tido 10- Statement of Intent Yes INo 11, Stormwater Plan f SWPPP Yes No 12. Fees Tr67'des No 11 Waivers Yes No 14. Subdivision Sign Pasting Yes �1,4o 16. Signature Page Yes No ` . -Ll L" , Staff Representative, IJIM Applrcmnt�Agont: EWe- Totwn of Queensbury Planning CM m-742 E3a]r Road Queensbum NY 128 CA- 512-761-62 6 Pre lie 4l*krySllgeRev iized Apr il20'10 Signature Page This page indodes: 1.) Autltn(zation to Act as Ageni Forn): 2.1 Engineering Fee Uisebsuret 1) Who rization,for She Visits; 4.) Other Pefaiil Responsi!iillties; 5.1 OfficW ME?eting Discbsure and G.) ,agreement to provide documurjtajion r�gtrired. OWHEnls A -r I*mis Comptate the following if the OWNER of the property is not]he sarne as the opglivarlt Owner. D.esi2nates: As agent reg4r&q: --- Variance Site Plan Subdjyj&jv6 ForTax heap No-.-- #ion Bloch �Lot Doe$Refem-ne-e. �1301)k _�Page �Date OWNER SI G N AT U RE' DATE APPLICANT'S AST 1 riRi+1: Gomplete the following If the APPLICANT is unable to attend the meeting or wishes to he represerded by.-Inather party. Owner- As agent ragardiao: %1eriwlce bite Plan. SubdWsion For Tax Map Mo.: edoll Block Lot Djaed Referarim: 'Book Page _ _ _Date OWNER S1GNAT URE: DATE= 2.1 ENGIN IN FEE DISCLOSURE. Applications may Ua referrer W ft Tuwn cnnsultfnn er*lri�ar forfeftvi Ql,1jsptTc design{ sWM 4I;1nW.etc.as det%mlrlad by the Zorlln9 or Plannvin Daparlment Fees for erugTneadnp teVle'.V uoMct's vAn ]ref charged directly to this i�ppllrant Falrs-for eng%inMr}y reAew Y41 not exceed S 1,00 D Alhaui noffl tlon to the applicarrL 3. AufoN ron S)n VISITS: By signing tltls page and slrbaitting tho MAICa#lork rYQ'ti Wr . &fWOW herein, U Owner. APpJiWt, eltd hN(Au PA00r iigW[s) hereby atftborUz the Zon[ng Board or Planning Board and Talo -§Ofi ii "46_n_ .u,e s134190 PTOD008 Itkr 016 Plftpose of WeWina tho applieaVon subm d_ D ER-PERMIT RES ❑i SIB1LffIM Other permits Wray be ri<quTred for comtfucUan or a[terabW adkily aebsffquent to apprn*ralhV.the Zoafaq 6oard otpWnntq Board. It Is the applicant's respmsb[l[tyto obtaTn any 00=1 permU_ - It Is the practice of the Community Developmeni M04MIM(to ti e e daslgnater! stenograpn�!r-tbm mord the proceedings or mmnps resulting from aplicitfori, and dn&o tmrtsellp8q fW#a faslf tapes CMUU s the offra'al record of 01 proraeedinps. 6. AGREEMETOPROMSE D MIE:11TATION REQUIRED• 1. Jje eadofslgn ,have ttlomghtr rew.artd ufidIW8nd 1he 1r truclic hs;f r. =0840n 0ogrl"to vie s0r%w rl requfrarnenls,I acknovkedae na construotton aeE dt span �O tbMb%)(m prior to ,> a. r f a +slid paffn i. ( t er,lfy that the appkatlon, pians and supporting nratadals are a irye, -41 0 Cump1mia statemenWescripHoo of Vie existing cotldit c and tits work proposed, Uld UMt all WWR WE be pjrforri]id 0 tids*WiMee-wM the ap '8 t' T7s at�d in c{ a�ri no tli�A ! arSlhg regulanons_ 1.ac%n1:i sledge that oftr to amupyhiq 1IM,fornJ1W6xPrl5PiAdb,1.,0T any agents,W11 obwn e. rtk i Ala,0f,0ac11pancy as necessary. I also understand khat Alfie nW be re1qulrP&O nrx djS ,�n es- Dnt shrug}T 'a IfctInVK14nd sum.P_,Vrof,7�ilevilYConstructBTfaciffies prior to Isroance of a caMncafe ofoccupant 4 have read-and agie thel � igrWb[Apps Ent] Print Name plicant] Dategrt gw G 2irI#j : - Print Name [Agent] DaW signed TM P1CWftnSWrY Eia;mlr IRtlipe• 742 Say Rcvjd-Queensbury,NY 12$O4 -h4&7§1-9220 7 l Z20 Appendix Stale Envirownewal Quality Review Pull Environmental-Assessment Form Purpo . ` be 1~u11 Environmental ,Assessment Forrn (EAF)provides an QT&rly and comprehtmsive rneans for evaluating the potential environmental significance,of a proposed action. The question of whether m ac#Lon may be significant is not always easy to OLD svo�r. Rcequently, 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 car may not be technically expert in environme,utal analysis. In addition,many who have knowledge in one particular area may not be aware ofthe broaden concems affecting the question of significance. The lead agency must use thce lull F.AP for Type I actions and may use it for Unlisted actions. The 1~ull EAF consists of three parts and when completed it will serve as the determination of sjgrificance: 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 re,soumes. The information provided in Part I is later used by the reviewing agency to complete parts 2 and 3. The questions in part I aro grouped in sections -G: Section A gathers infor3mati on that identifies the pro*t 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 se,rvices. • Section D requests infonrxation about the proposed action. • Section E requests information about resources.on or adjacent to the proposed site. • Section F provides the project Sponsor the opportunity for supplying additional information including project olements that may avoid or reduce impacts. • Section is where the, certifying signature of the preparer is provided. Fart 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 E 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 f6rm identifies the most relevant questions in Part I that wil l provide the information needed to answer the Part question. Part 2 is designed to help a reviewer identify any element of a proposed project that may have a potentially significant adverse impact ata the environment. Part 3 -Is completed by the lead agency. Part 2 questions knerc the impact has been identified as potentially moderate to large oar where there is a need to explain why a particular ekment of the proposed action will nod or may, result in a significant adverse envirmmenYtal impact should be explored in a series ofvvritten,well reasomd.statemenvj n Pari 3. Tlae discussion of impacts in part 3 will serve as the supporting documentatiozn for the determination of significance. Full En virontnenial Assessr enf Form PW I-Project wid Sening Instructions for Cowpiecing Pari 1 Part 1 is to be caro pitted by the applicant er project sponsor. Responses become pari of the application for approval or fivang, ore subjoct to public revsaw,and may be subiect to father verificatioo- ComptetePart l bused m in{orapaGDn turtently available, 1F additional research or investigation would be needed to frilly rtspmd to any item,please answer as thor Shly a�possible based cm Current infon nation;indicate whtihermissing lnrormation aloes not exist, or is not reasonably available to the spomw,and,when possible,generally descae work or studies wbich would be necessary to update or fully develop that inf xmatlan. Applicantslsponsom must compkft,all items is Sections A&lB. In Suctions C,D&E.most mems contain an initial question that must be ar severed efther-Yee'm"Ne, ]fine anstuerto the initial question is"Yes',complete the sub-questioms that-fo low. If the answer to the initial quesdwn is"W',prgceed to the noxi question. Sactim I'allows the project sponsor to identify and atter,any additional information. S6ctiou G re[l im the name$rad signature ofibc pxjeot sponsor tovedfy*at the information coraafiLed in Pert IIs aeeurate and compCt:+te. A.Project and Sponsor 1>Kfor4l.WOM Name of Auction or Project Pxqject Lacatnon(desen'bo.and map); q Onimen Lane. Birief DCMAi6m ofProposcd kid(include purpose or needy- , or o C, 5 _.�. } 1 fir. . ae � � �� f lz v _4_e;, 4eA-, .4,0 41A%-ed V&A44-r— Marnepplkc mttsvonsar. !el p gone: �� , Addr= / Jq CitylF4: cis p PxcdwA Camtart(if not seine as a na the and tillahole). Telephone: . ,4 J l-Mail: Addr=s: CitylpD: State: P Cvder PMP ]'Ovrners as s Telephone: . � 1 �iwiail: Ad�Css; Y State: made; Nge 1 of 13 B.Government Approvals K Government Approvals Funding,or Sponsorship. ("Funding"includes grants, loans,tax relief,and any other forams of financial assistance.) Covernmerst lEntity If Yes.I&ntify Agency Intl Approvals) r pplicatim l;]att Required (Actual or propjected) a.City Council,Town Board, a Y-CS N'o or Village Board of Trustees r b_City,Town or Village Yes Ido �— Planning b oard or Com rnissi c,City Council,Town-or 'Yes .o Vi Iage Zoning Board of Ap a '�_ � A !� -(V4 �te+ d,Other local 2gi�ncaes ❑Yes No C.Cotetity agw364M Q Yes ND f.regional ag�naies �des Tlo g.State agencies Q Yes 'No h.FeOeral agencies o Yes a I. Coastal kvwurces. 1. Is the pzaj aro site-Wilhin a Coastal Area,or the waterfront area of a Designated Inland WaterMY9 o Yep (1do If yet, fl. Is the pr*ot site luj%tcA in a community with an approved Local Waterfront Revitalization Program? M Yes f 'No rt#. Is the project site within a Coastal Erasion}tanrd Area? CIVesJ o C.Planpfikc-ah4l Zoning CJ.klanrt�hg and zoning actim. )Vil I sdmig4d3tiue br legisrtitiye adoption,or amendment of a plan,local law,ordinance,rule or regral ation bt:the t❑Ye�CNa only spvmvaal(s)vikich must be granted to enable the proposed action to praoced9 If Yes,cornpleleIsections O,V and G. ■ If No,proce�to question C,2 and complete all remaining sections and gvcstions in Part I C2.Adopts land'use plats. - a.Do any kaxibioipa11 -t46pE d (qty,town,village or county)comprehensive Iand use plan(s)include the site 'fit t Idi3 when;flke-pmp d cold Would be located? Ifcbriypmheaive,plan inolade specific recommendations for She.site where the proposed action ❑yo would be lor=A? b.is the site of the proposed%tika Wifbtit Bny local or regional special planning district(for example; Greenway .❑Y' o Bxownfield OpPor;ar ity Axta(SDA);designated State or Federal heritage area;watershed management plan; D r ot�Zr?) If Yes, deakEytheplan(s): c Isto P01300 P009A 1pcatttdwho ly-or partially vafthin-an area listed in as adopted municipal open Spam-pW.k El Yes No .Oran adi0pTet1.tnftMpaffartnhZd ."Wion plan? IfYe'5,1donti y lbtplat,(er); Pale 2 of 11 C.3. Zoning a, Is the site of the proposed action located in s municipality with an adopted zoning Jaw or ordinance. Yes a NO li'Ycs,wlsat is t e zpoing c�assification(s)ir�luding a pJicahle overlay district? b, Is the use permitted or allowed by a special or conditional nae permit? Y No c,Is a zoning cheagm requested as part of the proposed acticKn? E:F YNo If Yes, I Wbal is the pwposod new zoning for the she CA Exkttng community services. a.IR wt atarbool district is the project site located? b� What polies or outer public protection farces serve the project site? c. VhicJi circ proieeioa and emergency medical sezvices serve the project site2 f ' &What parks-se�ve the project site? [V IVA 1a.>'r#fc4f 1RetatRs D.I.Proposed nnd.1Petem#ial DOWlopmeot 0,mat kthe peDml nutUre of The pr posed action(e.&, i enual industrii&4 o41s11rmercia4 recraliu ;if mixed, all coomcnts)2 We b_a.Total poreagi�,ofthe,site of the proposed action? 2 . acres b.Total a0ft&10 bh pbysieslly dkUnbed? ^ acus r-."3`otal a ge(psq e"site and any onulaguaus properties)awned or coelttYJled by the spplictt or pracct spans ttares c.Is the Proposod aatlon an expensian of an existing project ar use? o YOFVL L If` *S,w#tat is the approximate ger=lage of the proposed expansion and identify thu win(n g.aores,rnfles,4ouasing.nmits, sgadsire*07 9'b Ilnits- d.� �d acsion a.subdivision,or does it include a subd'ruis$on? Yss o No Ify s; 4 Pugpxe:orWe of�wbdkision?(egg. restd tial industrial,cum nnercW;if mixed.specify tis). ,a psi U.'s 8 clustWoo�seVat"IWUt proposed? El Yes o-No .Hr.,f#urllw.iol' IOU~3.W7 V h.MFffZ mrt find Jnot m w proposed lot d=7 Minimum a.INDI pmp'oscd action becpps moUd in multiple phaves2 Yes Alo t 10400 ftakoed perfodofamstmotiom: 1{ to Al TOW M0b0#fphwmO tietpat,ed - - r Airt"tkijaa d eornmenc-,me at date-of plisse I (imsluding dem lWc m) _�'raysa&, _Year AMk.ip# �aurnpletion dateoffinal ph #t� year b. q 'des be x;Oone a#ions or relatimsbips wmong physes,including=,V minting 1s WbM Wgre -Oo plaaselnay ftmnble- tttiug.or duration offuture phases Page 3 of 13 f.Does the project include n w residernial uses? Yes 0 leo If Yes,sliawnum roposed. Family w-o1"aniill ThrccEz ?vlultiRl Faroi1y iaaror1nore Initial Phase At completion �of all phases g.Does the proposed action include new non-residenda€constmetion(inuluding expansions)? Yes Tla Ifyes, F.Total nurnbcr of stracturC6 R Dimensions(in feet)of largest proposed structure: height;----Width; arld length M. Approximate extent of building spare to be heated or cooled: square feet h.Dass the proposed action include construction or other activities that will result in the impoundment of any E3 Yes`kilo liquids,such as aeatico of a water supply,reservoir,pond,lake,waste lagoon or othes-storage? ]f Yes, L Purpose ofthtirrpovadmiwe ji If a water i mpouriftent,the principal source of the water. L7 Ground waver A Surfaet water streams t3 Other specify: iii. if A or tb2z water,identi fy the type of impoundedfcorttained liquids and their 8ourbe. b.Approximate size ofthc proposed itnpoundrment. Volume: _ raillian gallons;surface arca:_ ._ aor" V.Dimensions of the proposed dun or impounding structure: height; length vi, Construction mothadfmatcrials for the proposed dam or iMpourtding strLit;ture(t.&,tomb ftII,rock,Nvood,concrotc)- D.2. Project Operrrtiums a-Does the proposed action include any excavation,mining,or dredging,during construction,operations,or both? [� acsNo (blot ineludifig genual sit{prtparation,grading or installation of utilities or foundations where all excavated materials will rerrrai n axisite} JTYes: i.What is the purpwo of tho cxcovation or drudging? „`-- H,How much materia!(including rack,earth,sediments,etc.)is proposed to be removed from the site? Volume(specify tons or curio yards): n Over what duration of time? M. Deser$r,nature and Churaottrislies of tnattrial s.to be excavated nr drt<dgad,and plans to.use,manage or dispose of they. Tv.V011 there be orishe dewatering or processing ofexcavaotcd materials? Yes Q If.yes,•dmt;ribe. _ -- V,What s the total area to be dredged or emavatcd7 ohes vi.What is the maximum area to be worked at any one time? WPM vfl.What would b-e the maximum depth ofexcavation or dredgfng? fi:et Y L Will the excavation require blasting? a Yes 11 No fx.'Summarize silo reclamation goals and plan: b.Mould the Proposed action cause or result in alteration of,incr.case or decrease in Mixt of,Mcncxoaalrment M YesNb I nto any cAsAng-wetland,waWbody,%hurelinc,beach or adjacenit-w4x?- Tf i.ldextls t iewellmd or waterbody whieb would ba.affected(liy namb,w=r izid'Px nnmbar,;vct1and,nttp number`orgaogmphio Page 4-of 13 ii-Describe hDw the proposed action would affecl that waterbidy or wetland,e4.excavation,fill,placement of strum Ures,or alteration of channels,bangs and slsorelines. indicate extent of activities,alterations and addirluns in square fees or acres. fii. Will proposed action tau=or result in disttprbawe to bottom sedimeno b Yrs No If Yrs,describe: ix Will proposBd action cause or resell in the destnml on or removal of aquatic vegetation? a yes No If Yes: • ares of vegetation proposed to he removed * expected acreage of aquatic vegetation remodning alley project complctioo 8 purpose of proposed removal(e,g,beach clea6g,invasive species control,boas access): IP proposed method of plant rc moPmaL: 0 if themicaYhotbicide tmatrnent WM be used,specify pmaduci(s):_ F-Describe any proposed reclemmtior nitip int tbilowing disturbma : c.dill the propasod action use,or crease a new demand for Vvirte r Yes o If yes: i. Total anticipated water usagcfdemand per day: gallonsAky ii Will rhe proposed action obtain vuaterfram an existing publia vAftP'j4pO f Yes a No If Yes: * Nene ofdistriof or service area: !e-1)5 b C �J * D=the existing pubitic water svpply have capaciy to serve the p6TwaR Yes L l • Is the project site in the existing district? , Yes❑No • Is expansion of the district needed? M YcskNo • Do existing lines nave tine project site? In Yes d No IN. WHI line extension within an existing district be neat ary to supply the p eps? 4 Yes Nb If-Yes: i Describe extensions or capacity expansions proposed to serve this project: ■ Source(s)of supply for the district: iw is a new water snpply district or&mice arra proposed to be formed to serve the project sJte? 0 Yes Ido If.Yrs: AppLic amu ponsor for new district: • Date application submitted or swti#afed: • Pmwsed sources)of supply for neer disibda: r.If public veOET supply will nut be used,describe plam,toln.vvWe%t ,supply for the project: A If water supply will be from wells(priblia or private),maxknino FwRpitMg.oapaci4'=_- gallansfminate. d.Will the proposed action berate liquid wwtes? m Yes?ITo If Yes; i. Total mWeFlMed liquid waste gencxation per day: - al�onslday if Natum of liquid wages to be generated(e g.,smhwy wastewdter,jnftbiaL if eontbin�tion,.descn'be all components and epproxmrate volumes orpropaations of each): fif. Will the proposed aedon use any exislu public vwticmdAr ftlitphput fadlitiW. a Yrs If Yrs V Aurone ofwastewaler treabnent plant fo be us l.:- ■ Dame afdiside " + Dees the=dSft waStewater treatment plant have Mpgoj#y 16 scrim the lxo'&O? d Yes ci No 91 Is the project site in the existing district? 4 Yes o No ■ Is expmsion ofxhe district needed? q eyes o No Pam S.of 15 I?o existing sewer lines serve the project site? b Yes, No ■ Will lint extension wilbin an existing district be necessary to serve the project? Q, Yes C]No If Yes: Y Dcsoribe extensions or capacity expansions proposed to serve this project: N. Will a new wastewater(sewage)treatment distriot be formed to serve the prcjecs site? Ek Ye No If Yes: A ppl ivant/Wnsor for new district, Dat If, Wil I the proposed action generate ar eMit methane(including,but not limited to,sewage treatmEnt ptants, a Yes No landfills,composdrig facilities)? 3f Yes. j, EStimate met$Brie gCntration in tOnSlyear(rnetrlC): _ ff,Desed"be Zany methane capture,control or elimination measures incl aded in project design{a_g_,combustion to generale,heat or electricity, Flaring}: i.Will the proposed act ion resu It in the release of air pol I utanis from open-air operations or processes,such as El Yes No quarry or landfill operaticns7 If Yes:Drscrih a operations and nalwc of emissions(e_&diesel exhev sea rock perticala,tes/dust}: j.Will the proposed action result in a substaridal iuCrcase in traffic above present levels or generate substantial a y'�') new demand for tronsporia3ion.facilities or services? If Yes. x_ When is the peak traffic expected (Check all chat apply): D Morning 0 Evening ❑Weekend 13 Randomiy between hum of to if. For coretrrercial acRALOes.pnly,pmjecled numb cr of semi-trailer truck trips/day: M,parking spaces: lbd ing Proposed. Net increaseldecrease N. Does iho proposed notion inti-ode any shared use park ive fl 'Yes❑No v, )f the propose)action includes any modifioation of existing roads,creation of new roads or change in existing access,desul`bo: vi. Are pubUol %ivate transporka0an,se vice(z)or facilities available within'A mile of the proposed sitz? o Ye No Vii Will the proposed action.iidpdo access to public transpwtation or accommodations for use of hybrid,electric 0 Yes Nb or other alternative fueled r 6if zles? viii.Will the proposed action incltldtplan&for pedestrian or bicycle accommodadons for oonntotions to existing a YCS*N, Pedestrian of bicycle routes? k,Will tbke proposed actino(for ponarttercisl or indlis al prujucts only)generate new or additional demand Q Yes NO for Cncrv? Ifyes. L Estimate a=ual el wtriolty demand during operation'of the proposed action:_ ii_Anticipated s=ceslsupplfors of eliztrrcity f6r the project{r g.,on-site combustion,on-site renewable,via gddliocal utility,or older}: iii MU the proposed acOOA re4ujiV kOew,oa'an upgrade to,ao,existfgg sulrstatiou7 Q Yes o 1.Hours of operation. Anwar 011 i[crni5 *hia apply. 1 During Construcrttoo: E During OperaMorks- Monday-F7ride r: Monday-Friday:_ • Saturday: * Saturday: Sunday: t Sunday:. • �#olfdays:— _ _._ __ + Holidays: Page 7 of 13 M,Will the propGsed aoi on produce PDise that will exceed existing ambient noise €evcls during c0n5tFLIC:60T� 0 Yes NO operation,or both? Ifyes- i- provide details including swords,tune of day and duration: fi. Wil l proposed action remove existing n Stu ral barriers tbat could act a5 a noise barrier or screen? d Yes NO Describe: n.. will the Proposed action have outdoor lighting? Q Yes T G If yes: peseribc 5410Y e(S o-toe-ation(s),1leiglst of fxtMe(s),direc6cgVasm,and proximity to nearest ocmpied structures: ri. 'Jill proposed action rernovli existing natural barriers that could act as a light barrier or screen? o Yes No Describe: o,Does theproposed wti6n have the poiential to produce odors For more than one hour ptr d ay? 'es AlO if Ws,describe possibk souwrs,potential frequcncy and duration nfodor amiuluns,and proximity to ncgW =upied slnictures: p.Will the proposed potion in6lade-any bulk Mragar ofpctrolevm(over 1,100 gallons)or chemical products b Yes No (over 554 8aallans)9 If Yes: i.Produat{s)to k c-stored u Vatumc(s)_ putzlit lime {e g,month,year) iii. Generally describe p"ase d stozage facilities ti.-Will the propo%�od actkm(eammercial,indumial and recreational projects only)use pesuWdes(i-e.,herbicides, o Yts leo -insecticides)during constnsotion orapemtion? IfYes; 1. Desuribeproposed:tre4kmr_�nt( : itWill the Prosfldzl4wL use lnte rated Pest Management Practices? r.Will ihi�props"ed actiu(totdrapreial or industrial prof ects only)i Ywlve or require the rnunw,e Cnt or digposm 10 Yes O of solid waste(excluding hazardous.materials) If Yes: i.J)wa bEe star solid 1RF t s.)to be generated during construction or Operation of the facility: - * wa chars: tong W (unit of time) qk i~l0Mdon: .. . toms per (unit oftime) n.Describe PIV psxslrosak fax on-Site Minimixalion,recycling or reuse ofmatmials to avoid disposal as valid Ott l�nstrilC#iid�55 . * '��PYat3Qllt . iiL propased dispq al: te#ho c l#ties i baso]id waste Pnemited on-Sita: o ,�nnstntctit�zt: . .r Opermfot�: Page 9 of 13 s-Docs the proposed souon fnoiude consim ction or modification of a solid waste management facility? 4 Yes No 1f YM, i- 'lope-of management or Dandling of waste proposed for the s im(e .,recycling or transfer station,cornpasslog,lana C1 fill,or othtf disposal acilvities}- fi Anticipated rate of di sposalfprocessfng: To s{month.if transfer or other non c4mbustiorJtErGrn,ai treatment,or o �Tonslhpur,if combustion or them]al trtatmtnt W. If 1=dfil I,ary icipated site life: years t.Will proposed action at lilt site involve the cotnmtrcdal generation,treatment,storage,or disposal of hazardous ❑ Yes ]do waste? If Yes-, r. lame(s)Df all hazardous wastes or constituents to,be generated,handled or managed at facility: r`r- Cc a orally c5eribc processes or activities involving hozardaaas wastes or consiiluenls: UT Speolfy4001int to be handled or generated to:a l oath fi Descdhe any proposals far on-site migfWzation,recycling or muse ofhuardatm coastitasenis: Y,Wil I.any haxardaus wastes be disposed at an existing offsite hazardous waste facil ity7 Yrs Ida if :-Mvide name and location of facility: If MY d s.mffie proposed management of any hazardous wastes which will slat be sent to ii h=rdous male�fac ity- E.-Sife-and Sitting of Proposed Action E.L Land uses nit and sarrrounding the project site o.Exisag land uses. L Cheep.all rises that occur an,adjoining andn the project site, ll Urban o Industrial o Commercial ;J ]residential(suburban) o Mural(nOP-N-M) Q Forest 0 Agricultu-m 0 Aquatic 0 Other{specify}: ii- If>plx of UBOs, general ly d&wdbe: b.'LMAJ u ps and aove.*Pes on the project site. Land use or Current AareW AACr C�Pgc Crovampe Acreage P. ' cY Ccu'rip'TaMn AGMs+{-) ■ W*s,W ldings,and W=paved or impervious r ve sted • MC i dovj`s,.grtssbnds orbrushlands(Tiou- t J do txl,inoludin abandoned rieultural fV ' Agrivii1taral ( ttclesGtiYo orchaos,geld,greenhouse etc.){� � �pl �v�lfci-�eatuT�s ands,9trenls, iVers,etc. + rid freSlfwater o tidatl] Ail i Non vegetated.{barn~wncle -m th or fill) ° * lC3t1�.er I��esdclribp: PaSe 9 of 13 c.is the project site p=Enily used by members of the community for public reerealLon? Yes 0 F. if Yes:explain- d.Are there any facilities serving children,the elderly,people wilt disabilities(e,&,schools,hospitals,licensed a Yes o day cart centers,or group homes)within I500 feet of the Projekt silt? Wyes, L Identify Facilities- e.Does the project site contain an existing dam? If Yes: i.?dimensions of the dam and impoundment' a Dam hdzht: _-- _ /Eel n Ilam length: feet a Surface arca: _ _ -— sats r Vo]umo impounded: gallons OR%rc-feet f-Dam's existing baxard classification M. Provide.dste and summahre results of last inspection: f Inas the pzgjcat site evtr been used as a municipal,commuroial or industrial solid Wg& C tn=gemcnt facility, a 'Yes No or does the praj act site adjoin property which is now,or was at ano time,used as a sglid waste management feed ity? ]MIS. IS. i.Has tho facility been formally closed? a y , Nh P. lfyes,cite souTwddoGHFPMtatiou: Ji. Mscn`he the location of tht project site relative to the bou adaries oMF-solid WMIe.-MEIn agement facility' xir,DEscn'bo any developmeat oonstraints due to the prior solid waste activities: g.Have hwardous wastes been geri=ted,treated and/or disposed of at the site,vr.Ja-Es the project site adjoins o Yes No property which is now or was at one time used to commercially treat,store and/or zone of hazardods wsstE? ]f Ycs: L DasCribt wasft(s)hand led and waste m anagervent activities,including apprmXimaM Iitrle wii8n acdYkies vottu=d: h. Pptepffiil contamination history. Has there been a reported spill at the proposed pfojiwSRe,W6vssniy iYes No retniWi+l actions been conducted at or adjacent to the proposed site? If`fes. i.Is any portion of the sits listed on the NY DEC g.+'1is Incidents database or Enviromental Sitc 4 YosXNo RcuatdMon datalmse? Check ell that apply: Q 'Yes—Spills Incidents database Provide DEC]D numbbr(s): d Yes—EbAromental Site remediation database Provide DEC ID number(s): D weiftr Database u_164o W�s-been subject ofRCRA corrective activities,desrribe control racasuxe5: M. as the project Within 2000 feet of any site in the NYSDEC EnVironrrienUl Site lleme4atinn datal ash? p Yes No lf'res,pbvide DEC E]numbers)- iv.If yes to(1),(ii)or{iii}.above,descrz`be current stalyds ofsite(s}: Page 14-of 13 v.Is the prDjEGt sits subject to an instilukrial control limiting property uses? L'I yes No a If yes,DEC site 1D number; - o Describe the type of institutional control(eZ-,deed restriction or easement): �^ a Describe any use limitations- Dtscribe any tn&ccring controls= Will the project affect the institutionzl or engi necring controls in place? Yes Explain. E.2. Natural Resources On or Near Projeet Site a-What is the average depth to bedrock on the project site? feet b.Are there bedrock outcroppings on the project site? o Yes o If Yes,what propoltion oflhc site is comprised of bedrock outcroppings? CIA c.Pred6minant soil type(s)present an project site: °J6 °o d-What is the average depth to the water table on the project site? Menge: feet e.Drainage status❑fprojea site sails:0 Well Drained: 96 oFBi# 17 Mc deramly Wel I Dfaiocd: �%of site El Poorly Drained "A of Site f.Approximate proportion of proposed action site with slopes= D 0-10% °gib ofsite .0 10-1.5%; %ofske 0 15° orgreater: ° of site g.Are there any uMque geologic features on the project site? 4 Yes No if Yes,dcscriba h.surfam water features. i.Does any portion of the project site contain wetlands or other wliterbANs(including sttp-IBms,rivers, 0'Ye$XN0 ponds or lopes ff Do any wetlands or otherwaterbodics-adjoin thr.project site? ❑Ycs�Io If et;to either I or it.continuo. If No,skip to E.21 I� U, Are any of the wetlands or waterbodies within or adjoining flit project.sita regulated by any federal, Q Yes�Y No Mate or local agency? N.For each identified wetland and waterbody on tht gmject silo,proyldj�1he fnSlovtfir3g.irt oxmatiotti. ■ Streams: OR= sssification Lakes or Ponds: Name Class rkation Wetlands: Name -- — _ Apprwdmate Size wetland No.(if regulated by DEC) v Are any ofthtw above water bodies Hgted in the most remnt comgila#ion of NYS water qualaty--impaired 0 Yes No waterbodies? If yes,name Df impaired water body/bodies and basis for VmLng-gs irnpoirad: - i.Is tho project site in a designated Floodwyl 0 Yes ' No j.Is the project site in tha 100 year 1Flnodplpi0 0 Yes leo k.Is the project site itt the 500 year Floodplain? a Ye Sx A!o 1.js the ptopjt C#site located over,err immediately adjoin erg,aprirnlary, iii ci �l or solo soetrc aquifer? E]Yes No If Yes. L Nam,of aquifer. ;f J. Source of information: 11 of 15 rn, Identify the pied Dminant wildlife species that occupy or lust the projecE site: n.Does the project site cantaiT)A designated significant ika#ural community? Yes NO If Yes: t.Describe the habitat/community(composition,function,and basis for designation)' H Soerce(S)of descrioon or mluatim. fli. )Extent of oommunitylhabitat: a currcridy: acres • f=ollowing completion of project as pmposed: acres a Cain or loss(indicate+or-): acTgs o.Does project:site contain any species of plant or animal that is.1 fisted by the federal government or NYS as t:;L Yes No endangered or threatened,or floes it cwiWn any areas identified as habitat for an endangered or threztencd sper firs? If Yes: i Species and listing(endangered or threatened): f,Nature of use of site by the species(e.g.,=esident,seasoval,transient): p- Does the pro&ct site contain any-species of�platit ar au imM that-is listed by NYS as r0.Ce,or�5 a species of �Yez �-No special concern? IfYes- i_Species and listing: R.Nature of use of site by the species(e.g.,resident,seastinal,uansibnt): q.Is the proimt site or adjoining arra Currently used for hurtling,trapping,.fishing or shell fishing? a Yrs Aln If yes,give a brief description of how*1 ,proposeal action may affcot thin use: E.3.-Pesignated Public Resources On or Dear Project Site a-Is the project site,or any portion of it,located in a de.signa"agricultural district caroted pursuant to 4 Yes No Agriculture and Markets Law,Article Z-AA,Section 303 and 3047 If Yes, provide rounity plus district nwtirinumber,� b.Are agrim1toFal lands consisting ofhiZtf�y prmdudive soils present? ❑ Yes ala i- If Yez-acreage(s)on project site? u. Source(s)of soil ratings): c. Does.the project site contain all or part of oris it substan#ialfy cCrEW&dirs:to,a registered Nationzl ❑Y -Ro Natural Landrna.W If des: i. Nawreofthe natural lwndmark- ©' 131olegical.Corgmunily ❑ GwIcgicflFeature R. Frovida brief description of landrwgk,in6106ng values be iho designation and apprwdmate si-cfoxtent: d.Is the project site located in or does 11 Adjoitl a statel1*&N1104 FinviMignehO Area? Yes No If Yes. f. CEA namo: fi.Basis for designation: rat. Designarmg agency e-nd date. Pogo 12 of.13 e_Does the project site canotik,or is it sabslsntial]y cortiguaus to,a building,archaeological site,or district �T t�Yrs No which is lfst�d Dn, or has been nominated by the NO'S Board ofHistoric Preservation for inclusion on,the State or National Register offfistoric Places? 1 f Yes: L Nature of bistoriclarchaeological resource: ❑ Arehaeological Site v Bistoric 13uilding or Distdct 1L Nftrnc� X. Brief description of attributes on whfrh listing is based ~"� f*Is the project site,or any portion of it,located irk or ad jaetat to an area designated as sensitive for b yes 'No archacalogica]sites an the NY State I'l swric.Preservation Office(SILO)srahmological site inventory? g.Have additional archaeological or hjslo ie site(s)or resaurres been identified on the project site? If Yes: L Deswribc pcwible resources): if. basis for iden.tifcation: h.Would the project site bt visible from any officially designated and publicly accessible federal,state,or locaI NO scenic or amthttio resouroa? If Yes. L Identify rwouree- u.Nature of:,or basis for,designation(o, .,established highway ovetlaok,state or]oral park,state historic trail or see-M iC byway, X. Distance between pfoject ak3d resource: miles. i. Is the project site located wi6ih a desipated river corridor under the Wild,Scenic and Rtcrcatianal Rivers � Yes Tlo Program 6 NYCRR 6567 ]fees: i. Identify the name of'the river and its des9gnafiorn f4 1s the activity consistent with development reSM5 tions cooky in QWCRR Part 66b? a Yes o F.Additional Information Attach any additional information which maybe needed to clarify your projecC. Ifyou have identified ply adverse impacts which could be associated with your proposal,please describe those impacts plus any MMS13 MS WhiCb YW propose tO ZYOId or MiniUlU#lien. G. Wrificalion I certify that the infarmatian provide d is true to the drat/ofmy knowledge- Applicant/SpohsorNami e J 401 le&r'2 r-- Date / Pam 13 of 13 Full En virois ottenfol Assessment Farm Part 2-Iderrtrfearffon of Poknr?ralProject Impacts Part 2 is to be campleked by the Itad agency. Fart 2 is designcd to help the lead agency inventory all potelatial[esoure thof could be affctricd by a proposed project or acif on. We rcoognize that the lead agency's reviewers}will not necessarily be environmental prDfcssionals- So,the questions are designed tc walk a reviewer thrcmgb the assessment prooess by providing a series of`4uestions that can be answered using the Utforrnatian found in Part 1. To further assist the lead agency in completing Port?,the form i�dentilaes the most r0mnt qurstio4s it3 ort 1 that will provide the information needed to answer the fart 2 question, Vhm Part?-is Cornpleied,thfi Iead agency will have identified the relevant enviFeDinmtal areas that may be impacted by the proposed activity. ifthe Iced agency i5l-a MD agency nod:[be&ction is in any Coastal Area,complete tlhe C08S01 Assessment Form before proceeding witti this assessments Tips for rompifOng r#2t + Revitw all alhe information prov defla Part 1. ■ review applicatiun,maps,stupportfrig in2acrials and the Full EAF Workbook" o Answer each pf-tm B questions in Part 2. ifyou arfsys!t " e "to a numbered question,pftasc vxnplete all the questions that follow in that�;eaticn. o 1 Fyou eins*r"No"lou numbered question,move on to the next numbered question. ChPk aPPKQ.mate e0hirrin to inti RW the anticipated size of the impam Proposed ptoj"h that would excerA a Imineric threshold contained in a question should result jn the rdwicwing agucy checking ft bQx`Mcdcrate to large impact may oovar." • The mYkWcr's,Ooi expected to bean expert in environmental analysis. lfyou are-rM 44re or-undecided aboui tho si2E of an iwpa it may help to review the sub--questions for the getfeml question VO-cbpplt;hc workbook, o When PTirOz4.11PjX ques#7on consider all compop)Ws of the proposed activity,that is,the"whole action". ■ Cbns Ker le posS1%URy for long-term and cumulative impacts as well as direct impacts. + Anry ,khP ff�2tiori in i�reasonable manner consfdering the soar and context of the Foact. 1. Impact on Land Prop Dsed atll=M-0y biwlve canstmction m4 or physical afteratim of, �D 1:1 YES the land surfeaftha proposed site. (Sec Fart 1.D.1) if"Yes", am eY esftons a-j- I "No;move on to Seoron 2. f )tettvattt Ido,or I�3ndeYte Part d s UZU io large _; .:: Qnest€�z�(a i�lpattt tmpael:tmay ooctr a.The"bsW actiM RMY hN6lvr ennst v thou on land vrht<ra depth to water table is ]f�d Q � )ass#ham 3leaet, b.The prop,nsod scLiMr May lilvolvc conatimcdon.on slopes of 15%or greater. Uf n ❑ c.'Tho proposed&P-d an-may.iiYolyo oanstruotic�n on land whore hcdrock is exposed,or MEL ❑ generally within$TP-rd existing ground surface. d. The gropas actiba tFwirwtive the mozy lion and removal ofmore than 1,000 tons Me. � d Ofnstural material. e.Tht propos d a tlpri iQW.lye aatt notion that eontinlpeS far more f]Y¢x+s ono +ear DIC Gl � bt in rrtrsidple:p��. f The proposed actfon'rtray result in increased erosion,whether from physical Me,Wq 13 0 disN rl anrit pr uel eftr removal !nelu tig,larvm treatment by herbicides). g.T1W 1t �s d. t Not kay be.1000 d:44thin a Coastal Erasion hazard area. Big 'v n h.Other-iml aets: .411 Q Page I of 10 2. hinpael ap t3eologicAl Fcatuxes 71c proposed action may result in the Modification or destruction of, or inhibit access to,any unique or unusual land farms on the site(e.g.,cliffs,dunes, �(NO YE minerais,fossils,caves). (See Pari 1,E. .g) I "Yes",answer questions a-c. it"NO", move on to Secrfon 3. Itelcw.M 1Nn,or Moderate cart l Mail to large Questi"(S) Impact Npnctr3ray moy qpcar occtMr a.ldcnti-Fy the specific land fonn(s)attaahtd: g a ❑ .`]fit:pfibposed action mssy affect or is adjacent to a geological feature Umd as a Me p a r ,dist d National Natural Landmark, $Retina fCatLIre- t .tthet�rnp€�cts: a a 3, imppets on Surface Wnter IU pF*posed Rctiorx may affect one or more wetlands or other surface water 4 YES babies(e.g,,arcains, -ponds or lakes), {See Par# 1.D.2,)r 23t} 'Yes y. Cil wa }R p#LS R "No IJ70V6 37J7 to a'3?Ct3Q . r Rclevnial °leo,or Moderate - lard small to Large Que�tiori(s i>aWct impact may -iL Tft proppsed.actM may create a new water body. l)2b,Dl h ❑ fl 'b.The pzoposW action MAY result int an fn=easse or deemme of aver 10°10 or more!h ego a D2b ❑ In W vjftjqe.pasp or dec=ease in the surojec area of any body of water. a."1`'1i6-PmPtrs6d nctioo mai+involve dredging more than 100 cubic yards of material D2a ❑ In frorrr a wetind,or waterbpc . d,'] xe proposed action,may involve:construction wl n or adjoining a freshwater or E2h a p ural#yglantl,or ip th a bid or banks of any otbar water body. e.1hc pranpased e,at'ton may creato turbidity in a waterboily,eh4r from Upland CFGSInn, Wa,D2h 13 ron pr di'swrMtr3g bo flan sedirit . E TU p)o nsoti actioi3 mei include canstructioti of one or more Fntaiee s)for withdrawal D2c n of fro-nu sur ce. a#er. g.1130 prrspiasad action mey fuolt30 construction of one ormarc outf`aQ(s)For dFschatge b2d n a P?v+asta tePto sUzf'ace wat s . fa,Tho proposed aactifln M-y cause sail erasion,or otherwise creato,a scarce of D2t e, ❑ gtbr-m vtat�f d Fsclrar9V that mstiy load to snort or other degradation of receiving ,vRW be s. L Tbt:prWom.,644oh Way af#' t the water quality of any water bodies within or 122h a fl sl# Yt k tit Ofthe Fiff-40ftho plopostd action. �. is pupa! �-RDU(m may imrolve the Appfimtlon afpesticides or herbioidrs ifl or Ins E2h d p nail an hater hDd . k.The PmP0,Bd Ktiora may require the cGnstruction of acw,or expansion of eitstins, DX ,E)2,1 a o '�a�lt��b�'traatzntrni,faclrities. Page 2 of 10 i.Ther impact s, ❑ ❑ 4, Impact on grnnodwafer The proposcd action)nay.resuIt in new or eddtfional use of ground water, !Dr *'No D Y1;S may'Save the PDt,eatial 10 introduce cottanainants to grotrnd water or an aquifer_ (Sue Part 1.D.2^D.2.c,D.2,d,D.2.p,D.2.% D.2.t) I "Yes", answer quevions a-h. #f"No",move on to&cjian S. �. relevant No,or Moderate fart X smaEl to Fargt Questions) inl�act impact may b"Cur 4�€tlr a. ympwed action tt'iay require now w&ter supply welIs,ar create additior491 demand D2c ❑ an tupplies from r--dsting water supply wells. b.Water supply demand from the propased action may exceed safe and sustainublr< V2C t7 d vdlhdrawal capacity rate ofthe loco] supply or aquifer. Ow$o rw C,The prOp-O"action may allow or twirl#in residential uses in areas without wmer atzd' bl a,Mr ❑ ❑ �er�rets�rviaes. J.Tho proposed action may include or require westevmer disthargcd zo groundwatex. Md,E21 0 The Propvsed ftclion miy result in the construction ofwoter supply wells in Iotmtims WC.Elf, Q � where groundwaW is,or is suspected to be,contaminated- Bl ,Blh .f-rAtvprt<+posed action may requim the bulk storagt of petmieum or chemical prod"(.s D2p,EA [3 � over gratmd water or an aquifer. &Thi PNposcd action may involve tilt wmmercfal Opp]ication of pesticides within IOD nh,D2q. ❑ ❑ fet i,Df potable drinking Water or urigAU051 sources. X11,D20 �- Qiher irnparts: ti ❑ f Tlstpuet on Flooding TIO Proposed action may reszrlt in development on lands subject to flooding, SIO ❑ YES (Sl�e Nrt 1.E.2} " , answer esoons a- , J ""A'o": move im to Section . ;u # _} - 0Q Moderate small to large . i• " Qtiiesdon(s) Impact impatt tusy gCfiar UCCLSI' .0,The. pbscd dation may ras h in development in a designated floodway. Eli ❑ ❑ T'l}eVgpased4otinnMayYtsultindeyelvpmcntuwAIP) FlIGOytarflaadpliln_ � j v ❑ PrPPQ -action tray result in development within a�OQ year iloosIplaln. 92k E3 ra 4.-nr pt'aposed action may resulL inr Cr requim modififation ofexlsting drain ago 1 2b,.D2e R fl '4r Tb-pkcpo$A ILUI. n may change flood water flouts that contribute to flooding, Mb#RV2 p CP 'f.Jftev�1c-ad$m iooaiod on tbasite'of1hP,proposed;WW,the 4M has failed to X4061 Elle 3 a oily�-:nOTt Safety eiiteria kn its most recent ins YCtion. Page,3,Df 10 g. Other impaots: o ❑ 6. Impacts on Air The proposed action may include a-skate regulated air emission sov . A I ❑ 'ES (Sea Part 1.D.7.f.,D,2,b,D.2.g) 'r 25 r,+ C7fTS]yeY tlES�lLU7S[!- "IhFD r',1fi VC Ofi#70 alon 7. Relevant 1�Io:oC lti'ladcrate -� Hrt� Shall tolurge - M1 Question(s) impnet irnyzct may MAY nreur occur a.if the proposed action requires federal or stMe air cFnissiart perrf iM the Action may cLwo emit one or more grcenhouse.gases 8i or above the following levels: i. ?+fore than'l000 tonslyear Df carbon dioxide(CO.,) D29 a ❑ ii. Adore than 3.5 tonslyearofnitrous oxide(N30) D29 0 El i H.More than 1000 tonslyear of carbon equivalent of pmntfbrogwbows OTC ) D2g e ❑ N.More than.045 tonsfycar of sulfur hexa#luaride(SK) Mg o Y. Mose than 1DOD Ionslyear ofoubon dioxide equivalkat of 1)29 hydroohloroflurocarbans(HCFCs)emissions ❑ vi.43 tonslyear or marc of methane l o b.The proposed action may generate 10 toms/year or more ofatry ole dtsignatetl Dig a a hazardous sir pollutant,or 25 tonslyear or marc ofany ooriibbatfon of SACC hazardous air llutents- o.Theproposed setiaa may rcquire a state air rcei51mtior4,or ruayy}trvduive-an emissions Def,Dg 0 ❑ Tato ofto%l onntamioants that may exrced 5 lbs"per hour,oz'may indtlae a tical source capable of producing more tbAH lit million BTU's per how. d,The proposed action may rcadr 50%of any two or more of the thtesf DI&in'V D l s,Wk ❑ Q O ough"C"r above. e.Tho proposed actiDn may result in the combustion or thcrwl treatmcnt of mora Ilan 1 b2s ❑ ❑ ton of refuse per hour, f.Lather impacts: ❑ 13 I. Impact OD Maigts and Animals The proposed action may result:in a loss of flora or.fauaEL, (gee PEwt 1.i.2_rib,.l#.) 0 13 YES I' "Yes" answer UAWtons a- ' 'l devunt Not,or Moderate small to large impact impact may M� 0.1,bepmposed Action may cause redaction in population or 1o5s.e.$4Widvals 4EV t] ❑ lbrt atened or endangered species,as listed by New Pori{SWA 07.talc WEigd goveMment,that-use the sit or pre found all,over,or near�Le Sits. b.The proposed action may result in a reduelion or degradation of any hbi M used by a oily rare,threatened or endangered species,as listed by lvwYOrk- tkbg milker fede;�l government. e.Tho proposer;action may cg=teductian'in populutiory cr Ion o!fiMdividuc7s,0i` '3320 b 17 spe�ier.of spi;dal r+oneem or conservation need,as listed by Ne_w'Yort or the Fed uM goverrimeht,that use the site,or ora Tound an,nyas,iat Rot,the*4 . d.Tht propos4d action may resth in s reduction or degradatiiJn-ef 90fW habitat used by VP ° 0 arty speer:of cpeGtal concern and uonzemtian need;as listed tbrNvw YorkStale,or tlE>adera�govarnrroek+#. " page 4 `lo - e,The Proposed action may diminish the capacity of a registered National Nalural I?3c ❑ ❑ Landmark i(;support the biological community it was established to protect. f.Tll�proposed action may result in the rrmoV91 Of,ar ground disturbance in, any )EU 0 portion of designated significant natural community. Source, 9.Th a Proposed Belion may substantially interfere with nestingfteedxng,foraging,or 0 over-wintering habilat for the predominant spedes than occupy cruse the pfOjeel site, h.The proposed;act ion requires lhe waver Dil of more than 10 acres of forest, El b o 0 grassland or any other regionally or loyally impGrtarit habitat. AiNtat type&information 5011rce; 1.proposed action(commetoial,industrial or reereaticmal projects,mdy);involves use of D2q to a hmbiaides or pesticides. j.Other impacts, d 0 S. Impact on Agricultural Resources Tbav proposed actim ni ay impact agricultural mwr s. (See Pari 1.E.3.&and b.) *N 0 0 YES r "Yes'; answer qwsffons u-h. If"No", move on 10 Sa,aliyn 9. Uevapt NGaUC 1430darr8te 'V- ,' Part1 small to large „Y Qua:St�on{5 hnpact im"ct may a ma occur occur a The proposed aMion may impact soil dusifisd within sail gmpp 114rough 4 of the E%P.3b 0 ix NYS Und Claissificatfon System. b.T'he proposed uction may suer,cross or vtherw3se-1imV t t=ss So$grjeultural land )E1 a,Ub ❑ 0 includes cropland,€tar}fields,P2$1k1M,vriacyard,orchard,e o,The propmed action may result in the excavation ar compP40on oflilm soil profi7o of E3b n 0 active a 'cultura [ land. d.Tho proposed action may irrevcrsi bly convert agiimikural lags lo'n rr rieulturaaI Elb,E3a o uses,either mora than 2.5 acres if located izr an Apricdltural Df hitt.or more than ]0 acres if not within an AgticuIt iraI Dimim e.-Die proposed action m ay disrupt or prevent installation of an agri r�u Iti;ml Ind M a,Flb 0 a management syetom. f.Thu propased action inaq result,directly&indirect]}",in lncng�Lsed devalopment c2c,0, 0 0 otential or press=on f stand. 332c,D2d 9.'5C proposed proket is not consistertt wi'di1he aadopW retia*A1)E UWand C2c 0 0 Pmleotian Plan, h.other impacts:- 9. mpacts:9. Ixnpa'ct on Arsthefic Resouroes The land qco of thepropmcd tion-gse jabvicusJy d1T&LM-ftin,or are.in O 0 YES sharp ro trast%eument I=6 use patt$ml s bet vrotft-prbposetl,pYtrject and asrio sir aes#lleiic resource. (fart�1 E.1.a,�.�,I}r J�.. h�} J' "J`es". answer quesdons-a- 1 "yp"; o fo S' iOn JA -� •��- -� '� '���?,{�.?�,,;� ,�' -,, ;` 1W ant No,or Moderate Parti smell f F , to large "a-i ' y o L` µ' = lustlon(s) Impact impact MAY v'. , ,' occur acCcur a.Proposed actlan may be visible from any of clad ly des ignated feral,nate,or loco l E3h' 0 ❑ scenic,or oeMheft resource- b-Thc proposed acEion my resull in t4e;obstrudion,elimination or sigrnificant T33h,CA 0 ❑ screening of one,of more ofTicfaliy deli noted scenic-views. c.The proposed aclion may ha visible from publicly accessible vantage points. I 1� i.Seasonal ly(e.&,screened by summer faliagc,but visible doriag ether seasons) ❑ d ii.YCW round o d.The situation or aclivity in which viewers are engaged while viewing the pruposed F.3h action is: i- Routint travel by=1dents,incl udingtravel to and from work 9F ❑ ii.Recreational or tourism based nalvilits FIE ❑ ° ❑ e.The proposed action may cause a d npirtirJ&W of 4'he public enjoymcm and Mh a ❑ appreciaticat ofthe designated aosthe$c rdsburce. f- 'There are sim filar projects visible wfflan-lhie following dfstatice-df the proposed M a,B 1 a, ❑ ❑ project: Ill f,D1 g (�-]f2 sail e. YZ-3 anfle 3-5 mile 5+ rnile g-Other impacls: ❑ XI], Impact on Hbtorfre sited A,rchol�gleaI T'tesourees Thr;proposed tictlora may occur•in or-adjacent to a historic or archaeological Q 17 YES resource. (Fart 1.BJ.e,f. and g.) "Yrs'; answer quesitons.a-e. If" o", o to Section 11. _ Relevnnt No,ur l4Aoder�t� fart 1 small 4. to large Question(5) impact iet tt'muy rna occur occur a.71eproposed action ma} oa xr aLyt} p aEly vithin,oa subsea tally coati uons Me a o to,any buildings,ambaeologico site or elig6at whieb fs listed om-or has been nominetad by the NYE Board of H`tstnr16Pii s§ rvaftn for inulu0ol3 on the Statc or National R •sw-ofMiswelo Illgcm b.Ile proposod auL n may occur wholly Drpi rt 41 ly wilful,or substantially contiguous T33f ❑ ❑ ta,an area designated as sensit%tier arehaOAijp ioul$Flea on clue NY'Stm Historic 'Preservation OW=(ST 2 archaeologi2ALeilk mvento.U. c.The proposed action may occur wholly or parMlly 1°titllin, subs"it ally contiguous ls3g tri a to,an archaeofogigai skP uA included orr th&W 5MO invcptary. Source: d.Of=impacts: a o e.Ifemy cdthe.abave ,-4)ere tr�'Tos xMhUrlue VA$.dm fimfk3w4ng questions to help.support ooncl=50T)5 in pairt 3: L Tbo propos d Ac on may fesulf�n JTio%Wtrud.flcrn.ari.fllc Con ofall or part E3e.Mg, 0 b of,die eoilprdptr[y, Mf H. Tho proposed uc&n mriYT ult in1l1L--a1 etutient of the PMpW5lotting or 1330,133#'; Mg,ma, Page 6 of 10 integrity. Elb Ek,W, a Cl 7U proposed action may result irr the intrv&xtion of visual elements which Mg,ER, We out of character With the site aT-Woperly.or"y alter its setting. C2,C3 11- lMPCt on OPM.Space and Remotion The Prrrppsed a9hun mey result in li loss of recreational oppornrn1ties or a YNO E2 YES reduction of an open space resmrce.as designated in any adopted municipal apes space plan. (See Part 1. .e}E.] is ,F-2.q,) "Yes" rs a "r q wflow a-e. If"No" go to SOO ion 12. r Z, Mcmnt No,nr IY3ad�er-rt� Part I srnnl3 !o]a rge s - Qrrestiou(s) impet iaip'$#"t tnsy a.The proposed action im` y result En an h airmout of natural fupclioas,or Ilewsystern D2c,E3 b o � servie ",providGxl- . an pndeveloped 93=,indtiding but not limited to stormwalcr R2h, storage,notdegt,gy.6]Fhk'wAdlife-ba.bilat Mni,Ego, Mn g� b-'Ae prapused aetim niay result In the lass of a current or filtm recreational resource. C2a,E 10, ❑ ❑ C2c,I C.The proposr;d action may elir"i)ato opera S"C&er reumlional resource in ar)erea C2.C2c p � with few such mom1~s. EI c,E2q d,The proposed AMNq MY taPll in Joss Ofan area nowusrd inkmolly by the C2c,IE3 c ❑ p community as ars opCn- ace resource- c. 0111"impacts- e to 12. )1n}xaqon rit9l~aI�nvJronmentalAreas The ip oi;W action may be located wAMrt or adjaoea to a Critical � i� YES aMrOgMAMI ayft(PEA). (dee Pett 1.EL3..d) I ""des", arrsw uerfa�rg a- ► X0 to&CIft 13. Relevant No,or ]1IOdeC&ts Part I $mall lz 129C 'Qnesiion(s) Impact tMPIt=On�y`.' ,�;`• � {-,� -t.; :*`F ;; ora c.ec r �ficl:r a.The propDsMEdon-lrlityresult it►a redu ."e clnantity�theresoprco of Md ❑ C1 chmcleriWi;vrhf was,ihe basis for 400e44fr of9w CEA. lo.'lhe propersCcLantipri hta]�res3r[t irr a redkom in t qualit3+oftlto rturce or EM b b charatrteYi'; O-*hitAb M&ftig basis for designatim of1te CEW C-011ier ibpaot Q ��. Yr�p��c�t o��r+►: p7b �tion 'he Prop d WPA YAAy re it izt-4 r,14W to existing transportation systems. NO n YM (S=PaTt 1.D—M). relevant o,or fete QCrC ,�tp�l 'tOa9C��` - 'f•`:f R _ 'a'li °x %: - •~ -} 5,tlnL($) twp4d fly 'jlk MUY A,Fxo'ww �� oft6ft a ek lr 3. Rsa 4 �f.exis#i road network. D' j � Cr Page 7 of 10 b.Thr,propas;Ed acti an may result in the COMIruction of paved panleing area for 600 or D2j ❑ a MOM ve)iac)es" C.TIC proposed act ion wil I degrade existing transit access. D2j ❑ 13 d.Th'e proposed cation wi CI degrade existing pedestdn or bicycle accommodation. A2j a ❑ f:T91e pmposcd action may alter the presmi pattem of movement of people or goods" A2j o ❑ g.Other impacts: o ❑ 14. ImrppLet on Encrgp The proposed action may cause an int±reme in tiro use of arty form of energy. �A�O YES (Ser-Dart 1.D 2 k) IL'Yes", QMvqr avwdons a-e. If`No" o ro Section 15. Relevant iso,or 11Yod�aetc ,., 1part2 Sn1911 folalge -;; QuOdCoM #rnpact Impact ratty inay oar i reur a.The tnpsttd nc*%Wil)rc nae a pew.or an upLmdu tD an e]dstin subst(ttion. I 1J2# ¢ Q b.Thi progr&W action wiz)rquire the creation or exlension of an energy trap srnis!*O Dl f, a ❑ flr.supply system to MY-,mare than 50 single or two-family iwidences or to serve a € I%D rbminteMal pr indarsteig um3. c.Ti !u proposed aQtjom may utilim mare than 2,500 M ho;per year ofelectricity. D2k o d.The proposed 2GotiOn nil}'involve heating andfor cooling of mwe than 100,400 sgttart DIR 4 ❑ feet oflbuRding arca when ct tmp)cted. e.OChen xinpaets: - Xaa. )mpact on XQIst, 0401) and flgbt "fire proposed actiob mq result in an Jncj�in noise, odors,or outdoor lightiag, )INo » YES (See Part 1.D-2.rn,n, and o) '"1'es" arlwer, esrfians a -f I "No , o fo Section 16. Rder+ant Na0 yr 1Vpo#t ate =all to b mt Qu stlo*) 5'npRctr�l]?9LL"t may Ducar Thi proposed tic FoJi r.- p-Rducm aopnd aban noise levels established by local D2m to ❑ regtr1ation" .Th-C proposetl.action may result in blasting within I,500 feet of any residence, ff,2rrt,E1 ti � a IDOV W,sWxt[vl,11+0epse4d2ty'care center,grnursing bume. c.ThD proposed action nW rt It in routine odors for more than one hour per dap. D2o- 0 d,' he pr Rased wtico nviy miAt in light shining oaW adjoining prop&tics. Db Q Thla tnsod.at3ti .n may Wsuti in lighting creating sCcy-glow brighter than existing MbEla 0 p ogndit�or�.s, f:�Ot�SY�irrtpgctg; d [] _];tr.'fit vw ot'i$U4q )aetiltlr Th ' ' os l aWM 1by 1b' have an#m ct on hVmm heath from osa= 13 :1 &S Page 8 of 10 to new or existing sources Of contaminants. (SCe Part I D.2.q.,E-1. d. f.g.arld h.) I "Yes`,'answe) Fuestimm o-err. "No", o to,Section I Z - _ , . relevant I4u,or 14']udcrraie Fart r stoat to 12pte uestiaan{s} impact impact mly Ino cccua` oeeuz a,The proposed Retion is located witli in 1540 fees of a school,hospital,]icer,sed day El d tj ❑ czre cs nter, 11 goat+ nursin home a tciiremeMf comrATAn i b-'the site of the proposed action is currently undergoing remediafiDn- Elg,Ella d 0 o.There is a oomp]eted em etgcncy spill ra mtdiatian,or a completed enviropmental site E 1 g,lalh ❑ ❑ remediation on,or adjacent to,the site of the pro aced;3ctfon. d.The sloe of the action is subject to an institutional control limiting the use ofthe Elg,l�lix a ❑ C q(e,g.easement,did restriction) e.Tfre.proposed t4ti may affect institutional control measures that were put in plank )']g,Elh EJ to n�ure that the site retrtsuns.protective of the envir'onm nt and human health. f.The'proposed 60tH t hes adequate control measures in place to e=m haat kft" 132t ❑ d generation,treab=nt and/or disposal ofhamrdous wastes miH be protantive pflhe ;wironrnerlf and human licaith, ?,'the proposed action invOlm construction or modification of a solid waste D2q,Elf Q ti rnkp8gcruent fitGili . b.Mf -proposed action may reau]t in tine unearthing of solid or hazardous+Mute- D2q,El f p ❑ i.Thr.proposed action raaLy result in an increase in the rate of disposal,or pfocessing,of M,Ws ❑ ❑ �olid'4Yast�. J."Ric.proposed action may ruWt in excavation or other disturbance within 20UO feet,pf Elf,Ell g o ❑ a site used for the dr oral of solid or hazardms waste. E 1 h 1e.The propQsed acfioan may result in dko migration ofexplosivc gases from a landliii 1;1f,Elg ❑ bite to adj&cent Off site simctures. 1.Th6praposed aotiou may result in the release ofcontaminatcd leachate from the 1:735,Elf, d p project$iic. Ills in.QlWr impacts: X7. co'nslstency iflt tommanitp Plains The progOSed actlon is not Ccmsisbmt with adopted land use}dans. �� ❑ YES Se Part 1.C.1,C.2.and C.3.) "Yg s 0 cans per tesliam a-fir. 'Wo",go to Section 18. =�'-�' � { '- -,._- ",�.- ' -' -µyr..°� -� •-- - : . -,. :�F- "..Lo 4�'. ei vast O,dl 14Xb1�eT�t$ i � '�' f' 1? P#r 5rna7C to large Impact may orcrx� oeepr -a.The"=d actratr.'s land use components may be.different from,of jr),shmp ' ,D14 o ❑ #test boy eu�rcnt 5Xur4u Wing land use pattem�s), PMOOW agipn MdD ektse the permanent population of the city,town ori EU]10 C2 d iri-g1 11 the .Fojoct is tacated to grow b more that,5"!,. o. Ilse raposed,a,cfion N inconsistont with local land use plans or Zozing regulations. C2,�C2, 3 Q ❑ d.Thep6posed.notfanisiucamistcntwithanyCountyplans,orotherreglcmal.],m' a'4! ~ L:2,C2 0 ❑ pIras, e, }�e re .vsetl a90on ma ,cause a change in the derrsf of dMIOPM=1 flrat fs',uvl l:i,Dle� ❑ Page 9 of 10 supported by existirig infrestmewrc or is distant from' cxisting inJmtructurc. Dld,IDIf, Dld Elb f The pFoposcd action is]ooated in an area characterized by low density developmem C.'4,Mr,D2d ❑ � that will require new or expanded public infrasCruoturc. D2j '1]r a proposed action may ind ucc sexond$ry devcJ opment irnpiacts(c-g.,residcmtial or C2A tx commercial development riot included in the proposed action) h.Othcr: Cl a 18. Consistency with'Community Charstcter The proposed pojtct is inconsistent with the exisf'sng community Oaracter. �O I YES (SCO Part 1.C 2p C.3,D.2,E.3) _ "Tei; answei- shirrs a-g. I "No",proceed Ip Part 3. Relmllt TqO,OX J1 ederate fart 1 smnll to i$rge ": ` QuestiOn(a) impact Empnctmay IM ILY odour occur a.The proposed Ued=may lvplace or cUrninale existing facilities,struahtre;s,Qr an= M e,1 H,Mg Cr 13 ofbistoric importance do the comrnunity. b.'1'Be proposed action may create a demand for additional community services(1.g. C4 M LI schools,police turd fire) c.The pfopoW action may disp]ar.c affordable or law-income housing in.uri nfea.v4jere JC2,0,IDlf v � Fiore is a shortage of such housing. DI g,Ela d.The proposed action m ay interfere with th c use or enjoyment of officially r"ogk1fi!& C2,$3 a o or designated pub]ie resources. e.The pxopased action is inconsistcnt with the predominant architedtural seffe arW C2,C3 a ❑ character. f.Progosod action is inconsistent with the character of the exfst{Fig natural lan&mpe. C2,0 Cl o El2�121b E2p.E2h g.OthrX impacts- ❑ ❑ Page.10 of 10 Part 3}Evafrrrrlron of the Magri ifuee an d Importance pf Project Impaeg and Determination of Significance Pari 3 provides The reasons in support of ih4-determinsation-of signMoan= The load agency roust complete Pari 3 for emery question in Part 2 whore the impact has been identified as potential ly moderate to large or where there is a need to explain why €r particular elerner)t of the proposed action W11 not,or may,malt in a significant adverse environmenial impact_ B sled orr 1he atnalysi s in Part 3,the lead agency mu8t deride Whether is reclu ire ars mwironmental impact data mew to fu riper assess the proposed action or Whother Maw Inble information is 6uffiCient for the load agency to conclude that the proposed action will not have a significant adverim entvironinenta!impact. By c9m-pie q 1ha certification on the next page,the lead Egmuy can complete its determination of signifrumm REM sonsr SlopporiingImis DEW-ruination: To ooropletc this section: a Iden#ify the impact based ori the Part 2 responses ani{ descFEbe its magnitude. Mugnitade consid era factors such as severity, size or extent of an impact. + Assess 1he irnp w nce orthc impact_ imporEapcA relaxes tp the gaogmphia soope,duration,probability of tete i arnpact occurring,number of people affected by the ImpAck=d ahy addt[ional environmental consequences if the imp act.vmre to occur. + The assessarcnt should ike into consideFatidn any assign demerit or project chan'igm Ttepeat this process'for each part 2 questlor,whtrc tht impact has been idcntifred as potentially moderate to large or where there is a need to explain why a parLicufar.eleuehl onhe.proposed aoLion will not,or may,result in a significant adverse environmental impact ■ Provide the reasons)why the impact may,or will jow,resu It in a significant adverse envircnmcntal impact + For Conditional Negetive Declarations identify -.,i,p dfh:condldozn(s)imposed that will modify the proposed action so that na significant adverse environmenttil imparts Will rtst]It + Axach additional sheets,as needed_ Deternnination.o3` )g I�"Aee;}Type X and Unlisted Av-do s EQk Status: D Typo 1 b`Unliml identify paartians of FBF carRxplctcd for this�rpje�l: © fax#1 C� �'a;#2 � dart 3 U pco review of the infonnation recorded on Ih is EAF,es noted,plus this additional support information and considering botb the [magnitude and importance D each identified potential impact,it is the cOrichjsion of the BS lead agency that. Cl A. This projecE will Mullin no significrml adverse impacts on the environment,and,therefore,an envitonmP,1 al impact statcrnCht nerd not be prepared. Acotdi))giy,Ibis pegalive declaration is issued. 0 B. Although this pmject coin d bove a significant adverse impact on tke env#xo»ment,that impact will be avoided or sabstanVally mitigated because of the fhtlowing canditioms which wii I be reclnircd by the]cad agency: There WHI,therefort,be no significarkvRdfVevse impe is from the project as conditioned,and,therefore,this Conditioned negative decl&ration is issued. A mnditiont:d negative dedaraticm may#e aced only for iT LISTED actions(sere 6 NYM 617.d)- 0 O. This Project may result in Op 9r More sign if caltt.gdveme impacts on the en*onrnent,and an cnvrronrnet W i mpRct statement must be Prepated to furthiw asstsssihe impaet(s)and passible mitigation and to oxplo;e aitemadves to avoid or reduce those impels. Accordingly,this positive dee;lwmIkm Is issued. *Fame ofAction: Name of Lead Agency. Name ofRtspoasible Officer In Lead Aggeng: Vitle of Responsible Officer: Signature of)responsible WE=in L"d Agency: Date: Signature of Preparer(if different fx%rn ljcsponsihlt Officer) Date: For VurtkgrInform ation; Contact Person: Address: Telephone Dumber: ):,mail: For Type 1. Actions and Condritibned Nft aive DWarati0g,a copy of this Nutice is sent to: Ch ief Esk utivc Officer of the poji64 subdivision in whigh the actidn will be primipaliy located(e.g..Town 1 City f Vi 11agc of) Other Invohiod agedmcie$W wiy) Applicant(if any) Lrnvirornnental Notice fume �ttt lw�v+ ,tlec n r rrtrlivnblcnb.lytml