Giovanone Site Plan Application � ' ►
TOWN OF QUEENSBURY
at Site Plan Review Application
Review Process:
1. Required Pre-submission meeting with staff to determine general completeness to be held no later than 1
week grior to deadline day. Call (518) 761-8265 or(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. Submittal to Warren County Planning, if applicable.
6. Planning Board meeting, generally the third & fourth Tuesday of each month. You will be advised in
writing as to which meeting to attend.
7. 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 approved, the next likely step is a Building Permit. Final
drawings must be provided for the next phase of review. If your application was denied, your project cannot
proceed as submitted.
DOCUMENTATION REQUIREMENTS hard copy & electronic):
Please submit 1 original& 14 copies of the completed application package to include:
• Completed Applicationpages 2-9, signed & dated
• Pre-Submission Meeting Dotes: signed by staff
• Copy of Deed
• Checklist& Plot Plan
• Environmental Assessment Form for any non-residential project
• Fee: $100 (0 — 10,000 sq. ft.); $250 (10,001 — 30,000 sq. ft.); $500 (30,001 -100,000 sq. ft.); $1,000
(100,000+ sq. ft.)
Staff& Contact Information:
Craig Brown, Zoning Administrator craipbik9geensbury.net
Laura Moore, Land Use Planner imoorckg ueensbu ry.net
Sunny Sweet, Office Specialist—Planning sunn s a ueensbu »net (518) 761-8220
Visit our website at www.gueensburv.net for further information and forms
1
Site Plan Review application—Revised October 2016
Town of Queensbury Planning Office-742 Bay Road,Queensbury,NY 12804
General Information
Tax Parcel ID Number: 309.17-1-23.23
Zoning District: CLI
Lot size: 1.84 acres
Detailed Description of Project [includes current&proposed use]:
Also to be used by Concord Pools for temporary,overflow storage of fiberglass swimming pools
Location of project:
West side of Big Boom Road,just south of Concord Pools.
Applicant Name: Giovanone Real Estate Partners Address: 70 Big Boom Road,Queensbury,NY
Home Phone Cell:
Work Phone.............
...........
_........
—'518-741-0860 Fax ..-._..........� ...................................................................................................._..-
w
E-Mail:
Agent's Name: _ Address„
Nace Engineering, PC 169 Haviland Road,Queensbury,NY
Home Phone Cell:
Work Phone 518-745-4400 Fax 518-792-8511
................. www_
E-mail
tom@l-survey.com
.....
Owner's Name Address
same as applicant
Home Phone Cell
Work Phone Fax
................................................................... .. ....
E-mail
2
Site Plan Review application—Revised October 2016
Town of Queensbury Planning Office-742 Bay Road,Queensbury,NY 12804
Site Development Data
Area/Type Existing sq. ft. Proposed Total sq. ft.
Additions . ft.
A. Building footprint 0 0 0
B. Detached Garage 0 0 0
C. Accessory Structure(s) 0 0 0
D. Paved, gravel or other hard surfaced area 21,497 0 21,497
E. Porches/Decks 0 0 0
F. Other 0 0 0
G. Total Non-Permeable [Add A-F] 21,497 21,497 21,497
.............-....... wawa.
H. Parcel Area [43,560 sq. ft./acre] 80,150 80,150 80,150
I. Percentage of Impermeable Area of Site _[I=G/H] 27% 27% 27%
Setback Requirements
Area Required Existing Proposed
................ ._m......................-........
__
Front[1]
Front[2]
Shoreline
Side Yard [1]
Side Yard [2]
Rear Yard [1]
Rear Yard [2]
Travel Corridor
Height[max]
Permeability
No. of parking spaces
3
Site Plan Review application—Revised October 2016
Town of Queensbury Planning Office-742 Bay Road,Queensbury,NY 12804
Additional Project Information
1. Will the proposal require a Septic Variance from the Town Board of Health. no
2. If the parcel has previous approvals, list application number(s):
3. Does this project require coverage under the New York State Pollutant Discharge Elimination System
(SPDES) Permit Program ? no _ . ... ..
4. Estimated project duration: Start Date 11/19/17 End Date 12/30/17
5. Estimated total cost of project: 0 mm_
6. Total area of land disturbance for project: 0.49 acres
Floor Area Ratio Worksheet
FLOOR AREA RATIO (FAR) -- The relationship of building size to lot size, derived by dividing the total
building floor area by the lot size in square feet, yielding a percentage.
Zoning District Symbol Floor Area Ratio [FAR]
Waterfront Residential WR 0.22
Commercial Moderate/ Intensive CM/CI 0.3
A. The combined area of all square footage, as measure from exterior walls of all structures on the property,
including all floors of the structures, garages, basements and attics with more than five (5) feet of ceiling
height and covered porches. Building square footage does not include: Open deck, docks and that portion of
covered docks extending over water and one storage shed of one hundred twenty (120) square feet or less.
Any additional sheds will be included. (See "FLOOR AREA RATIO").
B. Commercial or industrial: the total area in square feet as measured from the exterior of the outside walls of a
building or structure, and when applicable, the sum total of all floor areas of the principal and accessory
buildings or structures on the project site.
. _ ._ ...... ...................................._. _................
A. Parcel Area sq. ft.
B. Existin Floor Area s . ft. see above definition
C. Proposed Additional Floor Area sq. ft.
Area
D. wwProposed Total Floors
... ......... ... _ ._ .............
E. Total Allowable Floor Area (Area x [see above table
*If D is larger than E. a variance or revisions to your plan may be needed. Consult with Staff.
4
Site Plan Review application—Revised October 2016
Town of Queensbury Planning Office-742 Bay Road,Queensbury,NY 12804
§ 179-9-080 Re nil ement for Site flan Approval.
The Planning Board shall not approve a Site Plan unless it first determines that such site plan meets the
following Standards. Please prepare responses to each of the following topics:
SEE PROJECT NARATIVE
STANDARDS
A. The proposed project furthers or is consistent with the policies of the Town's Comprehensive Plan.
B. The proposed project complies with all other requirements of this Chapter,including the site plan review standards as set forth in Paragraph
F of this section,the dimensional,bulk and density regulations of the zoning district in which it is proposed to be located(Article 3 and
Table 1),the applicable requirements of all other Articles that apply.
C. The site plan encourages pedestrian activity internally and,if practicable,to and from the site with pedestrian paths or sidewalks connected
to adjacent areas.
D. The site plan must conform to Chapter 136 Sewage and Sewage Disposal,Chapter 147 Stormwater Management Local Law,and other
applicable local laws.
E. The proposed use shall be in harmony with the general purpose or intent of this Chapter,specifically taking into account the location,
character and size of the proposed use and the description and purpose of the district in which such use is proposed,the nature and intensity
of the activities to be involved in or conducted in connection with the proposed use and the nature and rate of any increase in the burden on
supporting public services and facilities which will follow the approval of the proposed use.
F. The establishment,maintenance and operation of the proposed use will not create public hazards from traffic,traffic congestion or the
parking of vehicles and/or equipment or be otherwise detrimental to the health,safety or general welfare of persons residing or working in
the neighborhood or to the general welfare of the town. Traffic access and circulation,road intersections,road and driveway widths and
traffic controls will be adequate.
__._ .........
G Off-street parking and 19oading facilities will be appropriately located and arranged and sufficient to meet traffic anticipated to be generated
by the new use. The establishment of vehicle links between parking areas of adjacent properties are provided where feasible. This furthers
the Town's goal of reducing curb cuts and reducing congestion. A twenty-foot wide connection is required. If adjacent properties are either
undeveloped or previously developed without having made provision for future linkage,then a future connection must be identified and
provided for in the site plan under review for such future linkage when the time arises. The Planning Board may require proof that the
applicant has made contact with adjacent property owners for purposes of coordinating linkages with adjacent properties.
H. The project shall not have an undue adverse impact upon the natural,scenic,aesthetic,ecological,wildlife,historic,recreational or open
space resources of the town or the Adirondack Park or upon the adequate provision of supporting facilities and services made necessary by
the project,taking into account the commercial,industrial,residential,recreational or other benefits that might be derived from the project.
In making the determination hereunder,the Planning Board shall consider those factors pertinent to the project contained in the
development considerations set forth herein under§ 179-9-080 of this Chapter,and in so doing,the Planning Board shall make a net overall
evaluation of the project in relation to the development objectives and general guidelines set forth in§ 179-9-080 of this Article.
j The provision for and arrangement of pedestrian traffic access and circulation,walkway structures,control of intersections with vehicular
traffic and overall pedestrian convenience shall be safe and adequate for pedestrian movement. Pedestrian connections between adjacent
sites shall be provided to encourage pedestrian use.
J Stormwater drainage facilities will prevent an increase of post development drainage flows as compared to pre-development drainage flows.
Drainage of the site shall recharge ground water to the extent practical. Surface waters flowing off-site shall not degrade any streams or
adversely affect drainage on adjacent properties or public roads. Facilities shall be in conformance with the drainage standards of Chapter
147 of the Town Code and the Town of Queensbury Subdivision Regulations where applicable.
K{ The water supply and sewage disposal facilities will be adequate and will meet all applicable and current requirements set forth by
Department of Health regulations and Chapter 136 of the Town Code.
_________ ______ w ........................
L The adequacy,type and arrangement of trees,shrubs and other suitable plantings,landscaping and screening shall effectively provide a
visual and/or noise buffer between the applicants and adjoining lands,including the maximum retention of existing vegetation and
maintenance,including replacement of dead or deceased plants.
M. Fire lanes,emergency zones and fire hydrants will be adequate and meet the needs and requirements of emergency service providers.
N The design of structures,roadways and landscaping in areas susceptible to ponding,flooding and/or erosion will minimize or avoid such
impacts to the maximum extent practicable.
0. The site plan conforms to the design standards,landscaping standards and performance standards of this chapter.
5
Site Plan Review application—Revised October 2016
Town of Queensbury Planning Office-742 Bay Road,Queensbury,NY 12804
§ 179-9-050 Checklist-Application for Site Plan Review.
Application materials and site plan shall include sufficient information for the Board to review and provide a
decision. The applicant is to provide a site plan drawing and all attachments that address items A-V. The
applicant may request a waiver from A-V and is to provide reasons for waiver(s) requested. Please label
information to be submitted.
REQUIREMENTS Sheet#
A. A vicinity map drawn at the scale that shows the relationship of the proposal to existing community facilities which affect S-1
or serve it,such as roads,shopping areas,schools,etc. The map shall also show all properties,identify owners,
subdivisions,streets and easements within 500 feet of the property. Such a sketch may be superimposed on a United States
Geolo ical Surve ma ofthe area.
B. The site plan shall be drawn at a scale of forty feet to the inch(1"=40 feet)or such other scale as the Planning Board may
deem appropriate,on standard 24"x 36"sheets,with continuation on 8 112"x 11"sheets as necessary for written S-1
information. The information listed below shall be shown on the site plan and continuation sheets.
C Name of the project,boundaries,date,north arrow,and scale of the plan. S-1
D. Name and address of the owner of record,developer,o
and seal of the engineer,architect or landscape architect If the
applicant is not the record owner,a letter of authorization shall be required from the owner. S-1
E The location and use of all existing and proposed structures within the property,including all dimensions of height and S-1
floor area,all exterior entrances,and all anticipated future additions and alterations.
F. The location of all present and proposed public and private ways,off-street parking areas,driveways,outdoor storage areas,
sidewalks,ramps,curbs,paths,landscaping,walls and fences. Location,type and screening details for all waste disposal S-1
containers shall also be shown.
G. The location,height,intensity and bulb type(sodium,incandescent,etc.)of all external lighting fixtures. The direction of NA
illumination and methods to eliminate glare onto ad'oinin ro erties must also be shown in com Bance with 179-6 020.
___
)-1. The location,height,size,materials and design of all proposed signs. NA
1, The location of all present and proposed utility systems including: S-1
1. Sewage or septic system;
2. Water supply system;
3. Telephone,cable and electrical systems;and
4. Storm drainage system including existing and proposed drain lines,culverts,catch basins,headwalls,endwalls,
hydrants,manholes and drainage swales.
J. Plans to prevent the pollution of surface or groundwater,erosion of soil both during and after construction,excessive runoff NA
and flooding of other properties,as applicable. A Stormwater Pollution Prevention Plan(SWPPP)for all land development
activities(excluding agricultural activities)on the site that results in land disturbance of one acre or more. A SWPPP shall
comply with the requirements of the DEC SPDES MS-4 General Permit and Chapter 147 of the Town of Queensbury
Code. It shall be at the discretion of the Planning Board as to whether a SWPPP or an erosion and control plan shall be
required for a site plan review project land disturbance of less than one acre.
K. Existing and proposed topography at two-foot contour intervals,or such other contour interval as the Planning Board shall
allow. All elevations shall refer to the nearest United States Coastal and Geodetic Bench Mark. If any portion of the parcel S-1
is within the 100-year floodplain,the area will be shown and base flood elevations given. Areas shall be indicated within
the proposed site and within 50 feet of the proposed site where soil removal or filling is required,showing the approximate
volume in cubic yards.
I A landscape plan showing all existing natural land features than may influence the design of the proposed use such as rock NA
outcrops,stands of trees,single trees eight or more inches in diameter,forest cover and water sources and all proposed
changes to these features,including sizes and types of plants. Water sources include ponds,lakes,wetlands and
watercourses,aquifers,11 odplains and drainage retention areas.
M. Land Use District boundaries within 500 feet of the site's perimeter shall be drawn and identified on the site plan,as well
as any Overlay Districts that apply to the property. S-1
6
Site Plan Review application—Revised October 2016
Town of Queensbury Planning Office-742 Bay Road,Queensbury,NY 12804
REQUIREMENTS (CONTINUED) Sheet#
N Traffic flow patterns within the site,entrances and exits,loading and unloading areas,as well as curb cuts on the site and
within 100 feet of the site. The Planning Board may,at its discretion,require a detailed traffic study for large developments or S-1
for those in heavy traffic areas,which shall include:
1. The projected number of motor vehicle trips to enter or leave the site,estimated for weekly and
annual peak hour traffic levels;
2. The projected traffic flow pattern including vehicular movements at all major intersections likely
to be affected by the proposed use of the site;
3. The impact of this traffic on levels of service on abutting public streets and at affected
intersections. Existing and proposed weekly and annual peak hour traffic levels and road capacity
levels shall also be given.
0, For new construction or alterations to any structure,a table containing the following information shall be included: NA
1. Estimated area of structure to be used for particular purposes such as retain operation,office,
Storage,etc.;
2. Estimated maximum number of employees;
3. Maximum seating capacity,where applicable;and
4. Number of parking spaces existing and required for the intended use.
....... ........._.._._.WWW W
P 1. Floor Plans. NA
2. Elevations at a scale of one-quarter inch equals one foot(1/4"=1 foot)for all exterior facades of the proposed structure(s)
and/or alterations to or expansions of existing facades,showing design features and indicating the type and color of materials
to be used.
Soil logs,water supply well and percolation test results,and stone water runoff calculations as needed to determine and
mitigate project impacts. NA
...............
R. Plans for disposal of construction and demolition waste,either on-site or at an approved disposal facility, NA
S. Plans for snow removal,including location(s)of on-site snow storage. S-1
wwwwwwW
T. An Environmental Assessment Form("EAF")as required by the SEQRA regulations,with Part 1 completed by the Applicant
shall be submitted as part of the application. If the proposed project requires a special use permit and an EAF has been attached
submitted in conjunction with a special use permit application,a duplicate EAF is not required for the site plan application.
U. If an application is for a parcel or parcels on which more than one use is proposed,the applicant may submit a single NA
application for all such uses,provided the proposed uses are accurately delineated on a site plan drawn pursuant to the
requirements set forth above. The Planning Board may grant the application with respect to some proposed uses and not
others. For purposes of reviewing an application(and for SEQRA compliance)all proposed uses on a single parcel or on
contiguous parcels shall be considered together.
_...........
`J A brief narrative statement on how the project proposed for review furthers or is consistent with the vision,goals and policies
in the Town's Comprehensive Plan. attached
7
Site Plan Review application—Revised October 2016
Town of Queensbury Planning Office-742 Bay Road,Queensbury,NY 12804
Signature Page
This page includes the 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: Giovanone Real Estate Partners,LP
Designates: Nace Ehgineering,PC
As agent regarding: Variance XX Site Plan Subdivision
For Tax Map No.: -3il9-- Section T—Block Lot
_
Deed Refe e: Book Page Date
OWNERSIGNATURE: DATE: T7
APPLICANT'S AGENT FORM:
Complete the following if theAPPLICANT is unable to attend the meeting or wishes to be represented by another party;
Owner; Giovanone Ileal Estate Partners,LP
Designates: Nace Engineering,PC
As agent regarding: Variance XX Site Plan Subdivision
For Tax Map No.: 3II9 Section T—Block 73--Z—Lot
Deed Refer nce: oink Page Date
.r OWNER SIGNATURE: „ON LA DATE: 91871.7
Applications maybe referred to the Town consulting engineer for review of septic design,storm
drainage,etc.as determined by the Zoning or Planning Department. Fees for engineering review services will be charged directly to the applicant.
Fees for engineering review will not exceed$1,000 without notiricalion to the applicant.
3.1 AllTI IQ'It ' "'JON FQIR S IT VISITS; By signing this page and submitting the application materials attached herein,the Owner,Applicant,
and his/her/their agent(s)hereby authorize the Zoning Board or Planning Board and Town Staff to enter the subject properties for the purpose of
reviewing the application submitted.
4. O"1'1110t 11101MI I" IIG SI' IIII l"1'li";y: Other permits may be required for construction or alteration activity subsequent to approval by the
Zoning Board or Planning Board. It is the applicant's responsibility to obtain any additional permits.
$11 Q FFI N:F;TIN ; MINw U 1 SCI. lliha R is the practice of the Community Development Department to have a designated
stenographer tape record the proceedings of meetings resulting from application,and minutes transcribed from those tapes constitutes the official
record of all proceedings.
6.' A RFF,MN";iNT TO I'lQ WID13 DOCUMENTATION 1It UI14M: I,the undersigned,have thoroughly read and understand the instructions
for submission and agree to the submission requirements,I acknowledge no construction activities shall be commenced prior to issuance of it valid
permit. I certify that the application,plans and supporting materials are a true and complete statementidescription of the existing conditions and the
work 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
I/we may be required to provide an as-built survey by a licensed land surveyor of all newly constructed facilities prior to issuance of a certificate of
occupancy
I have read and agree to the above.
WV04 �hael Giovanone 9/8/17
ign ltlr pp9ica11 Print Name[Applicant] Date signed
Thomas Nace _9/8/17
AgentJna Print Name[Agent]
ate signed
9
Site Plan Review application—Revised October 2016
Town of Queensbury Planning Office-742 Bay Road,Queensbury,NY 12804
i
I
G
Town of Queensbury Site Plan Pre-Submission Conference Form / Section 179-9-040
1. Applicant Name: Giovanone Real Estate Partners,LP
2. Tax Map ID 309.17-1-23.23 Location: Big Boom Road
3. Zoning Classification CLI
4. Reason for Review: U so— r")4- i'4('J' ex
5. Zoning Section (-LO
Lum,
6. Pre-Submission Meeting Notes: Provided Outstanding; Please provide by
Deed
General Information complete
Site Development Data Complete
Setback Requirements Complete
Additional Project Information Complete
FAR addressed
Requirements for Site Plan-Standards
Checklist items addressed
Environmental Form completed
Signature Page completed ........
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Staff Representative:
-------------------
Applicant
----------------Applicant/Agent: Date:
8
Site Plan Review application-Revised October 2016
Town of Queensbury Planning Office-742 Bay Road,Queensbury,NY 12804
PROJECT NARATIVE
GIOVANONE REAL ESTATE PARTNERS LP
TEMPORARY UPS TRUCK STAGING/POOL STORAGE AREA
Giovanone Real Estate Partners proposes to formalize the transitory use of a parcel of land on the
west side of Big Boom Road,just south of the Concord Pools facility. This parcel is part of a
three lot industrial/commercial subdivision made for Donald Kruger and later purchased by
Giovanone Real Estate Partners, LP.
The land was originally used for storage of box trailers and the stockpiling of soil. After the
purchase by Giovanone, the western two parcels were used for the construction of a boat and RV
storage facility and the box trailers and soil stockpiles removed from the easternmost parcel.
For the last 10 years this easternmost parcel has been used by UPS for the staging of trucks
during the busy holiday season (November 19 through December 30). Truck volume varies
between 10 and 18 trucks per day.
Last fall gravel was placed over the area used by the UPS trucks in order to define the travel
ways for the trucks and to minimize the tracking of dirt onto adjacent roadways.
This past summer, the parcel has been used intermittently by the adjacent Concord Pools for
temporary storage of fiberglass swimming pools.
Giovanone Real Estate Partners are now requesting approval to continue this temporary use of
Parcel 309.17-1-23.23 which allows the adjacent UPS distribution center to operate more
efficiently and keeps their trucks from having to park along the shoulders of Big Boom Road
during the busy holiday season.
WAIVER REQUEST
The applicant requests a waiver from having to provide a full stormwater analysis and design for
the placement of gravel on the area utilized by UPS trucks. As demonstrated by many soil test
pits and observation of construction excavations on this and adjacent sites, the native site soils
are deep, well drained sands. This, coupled with the fact that the site is very flat, means that all
rainfall is infiltrated into the ground and does not produce any runoff from the site.
The gravel used to delineate travel ways was large crushed stone, placed on top of the native
sands. This gravel maintains the porosity of the native soils and the fact that the traffic volume
on the gravel surface is small and only occurs for less than two months per year means that the
porosity of the surface should be maintained for several years. Therefore, we believe it is
reasonable to conclude that the stormwater characteristics of the site are not changed by the
proposed use of the site .
Short Environmental Assessment Form
Part 1 -Project Information
Instructions for Completing
Part 1 -Project Information. The applicant or project sponsor is responsible for the completion of Part 1. Responses
become part of the application for approval or funding,are subject to public review,and may be subject to further verification.
Complete Part 1 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.
Complete all items in Part 1. You may also provide any additional information which you believe will be needed by or useful
to the lead agency;attach additional pages as necessary to supplement any item.
Part 1 -Project and Sponsor Information
Name of Action or Project:
TEMPORARY UPS TRUCK STAGING AREA FOR BUSY HOLLIDAY SEASON
....... .....................
Project Location(describe,and attach a location map):
WEST SIDE OF BIG BOOM ROAD JUST SOUTH OF CONCORD POOLS
..www
Brief Description of Proposed Action:
GRAVEL PARKING AREA TO BE USED AS OVERFLOW STAGING FOR UPS TRUCKS DURING BUSY HOLIDAY SEASON OF
NOVEMBER 19 THROUGH DECEMBER 30.
Name of Applicant or Sponsor: Telephone: 518-741-0860
GIOVANONE REAL ESTATE PARTNERS,LP E-Mail:
Address:
70 BIG BOOM ROAD
City/PO: State: Zip Code:
QUEENSBURY NY 12804
1.Does the proposed action only involve the legislative adoption of a plan,local law,ordinance, NO YES
administrative rule,or regulation?
If Yes,attach a narrative description of the intent of the proposed action and the environmental resources that W1
may be affected in the municipality and proceed to Part 2. If no,continue to question 2.
2. Does the proposed action require a permit,approval or funding from any other governmental Agency? NO YES
If Yes,list agency(s)name and peit or approval: 101
y
g proposed .. .84 acres
3.a.Total acreage of the site of the ro osed actions 1
b.Total acreage to be physically disturbed? 0.49__acres
c.Total acreage(project site and any contiguous properties)owned
or controlled by the applicant or project sponsor? 1.84 acres
4. Check all land uses that occur on,adjoining and near the proposed action.
❑Urban [3 Rural(non-agriculture) m Industrial [Z]Commercial El Residential(suburban)
❑Forest ❑Agriculture ❑Aquatic ❑Other(specify):
❑Parkland
Page 1 of 3
5. Is the proposed action, NO YES N/A
a. A permitted use under the zoning regulations?
1:1 El
b.Consistent with the adopted comprehensive plan?
6. Is the proposed action consistent with the predominant character of the existing built or natural NO YES
landscape? 1:1 Z
7. Is the site of the proposed action located in,or does it adjoin,a state listed Critical Environmental Area? NO YES
If Yes,identify:
LZJ
8. a.Will the proposed action result in a substantial increase in traffic above present levels? NO YES
b.Are public transportation service(s)available at or near the site of the proposed action? J-
w —
c.Are any pedestrian accommodations or bicycle routes available on or near site of the proposed action?
9.Does the proposed action meet or exceed the state energy code requirements? NO YES
If .. ...Z
e proposed action will exceed requirements describe design features and technologies:
10. Will the proposed action connect to an existing public/private water supply?W--W- WWmm -WW--µWWW -NOWµµµµW -YESµµ
If No,describe method for providing potable water: ........_ _........
Z D
WATER USE FOR THIS PROJECT
NO.µ... ......... ....----- ____.__ _._._..._, . _. _._.rvm --~-m___m_. ------
11.Will the proposed action connect to existing wastewater utilities? NO YES
If No,describe method for providing wastewater treatment:µ ✓
NO WASTEWATER USE FOR THIS PROJECT
12. a.Does theµsite contain a structure that is listed on either the State or National Register of Historic NOmmmmmmmm.YES
Places? ,r
b.Is the proposed action located in an archeological sensitive area?
1 y p proposed J g proposed i _ _. YES
13.a.Does an portion of the site of the ro osed action or lands adjoining the ro osed action contain NO
wetlands or other waterbodies regulated by a federal,state or local agency? ✓ ._.
b.Would the proposed action physically alter,or encroach into,any existing wetland or waterbody?
fY Ysquare _ ....._. _._
If Yes,identify the wetland or waterbod and extent of alterations m feet or acres: „
14. Identify the typical habitat types that occur on,or are likely to be found on the project site. Check all that apply:
❑Shoreline ❑Forest ❑Agricultural/grasslands El Early mid-successional
❑ Wetland ❑Urban ❑Suburban
15.Does the site of the proposed action contain any species of animal,or associated habitats,listed NO YES
by the State or Federal government as threatened or endangered?
16.Is the project site located in the 100 year flood plain? NO YES
17.Will the proposed action create storm water discharge,either from point or non-point sources? NO YES
If Yes,
a.Will storm water discharges flow to adjacent properties? ❑NO DYES
b.Will storm water discharges be directed to established conveyance systems(runoff and storm drains)?
If Yes,briefly describe: ❑NO DYES
Page 2 of 3
18.Does the proposed action include construction or other activities that result in the impoundment of NO I YES
water or other liquids(e.g.retention pond,waste lagoon,dam)?
If Yes,explain purpose and size -- --.
19.Has the site of the proposed action or an adjoining property been the location of an active or closed NO YES
solid waste management facility?
If Yes,describe: - _...__..... — Z
20.Has the site of the proposed action or an adjoining property been the subject of remediation(ongoing or NO YES
completed)for hazardous waste?
IfYes,describe: ._.__..—__ m.................... ------- .-._n.._-__.m_____._._ .....m ne I� l
I AFFIRM THAT THE INFORMATION PROVIDED ABOVE IS TRUE AND ACCURATE TO THE BEST OF MY
KNOWLEDGE
Applicant/sponsor name: Thomas Nace Agent Date: 9/$/17
Signature
PRIFORM Page 3 of 3
Agency Use Only [If applicable]
Project:
Date:
Short Environmental Assessment Form
Part 2 -Impact Assessment
Part 2 is to be completed by the Lead Agency.
Answer all of the following questions in Part 2 using the information contained in Part 1 and other materials submitted by
the project sponsor or otherwise available to the reviewer. When answering the questions the reviewer should be guided by
the concept"Have my responses been reasonable considering the scale and context of the proposed action?"
No,or Moderate
small to large
impact impact
may may
occur occur
... ...............__.. ....W.. .................._ .. .... �... .
1. Will the proposed action create a material conflict with an adopted land use plan or zoning
regulations? —] R E]
2. Will the proposed action result in a change in the use or intensity of use of land.
3. Will the proposed ..................- - __ _._.._________________ _...r,......._..
p p impair the character or quality of the existing community?
n
4. Will the proposed action have an impact on the environmental characteristics that causedthe C
establishment of a Critical Environmental Area(CEA)? L�.l
5. Will the proposed action result in an adverse change in the existing level of traffic or
affect existing infrastructure for mass transit,biking or walkway?
6. Will the proposed action cause an increase in the use of energy and it fails to incorporate
reasonably available energy conservation or renewable energy opportunities?
7 Will thWu WW j�
e proposed action impact existing: ......._____. .._.. ................................................................................. ......._t_,_J....... �......�..........
a.public/private water supplies? 4 _J
b.public/private wastewater treatment utilities? El
... .. ........__ .. .............. ................
8. Will the proposed action impair the character or quality of important historic,archaeological, '
architectural or aesthetic resources?
El-
9. Will the proposed action result in an adverse change to natural resources(e.g.,wetlands,
waterbodies,groundwater,air quality,flora and fauna)? El El
10. Will the proposed action result in an increase in the potential for erosion,flooding or drainage E E]
problems?
11. Will the proposed action create a hazard to environmental . ... ........ ...............................................�............................... ....... ......... .........
ntal resources or human health. .. R
PRINT FORM Pagel of2
AgeUse Only[lf a ali�cable]
Project:
amMmiGiGium�
Date:
Short Environmental Assessment Form
Part 3 Determination of Significance
For every question in Part 2 that was answered"moderate to large impact may occur",or if there is a need to explain why a
particular element of the proposed action may or will not result in a significant adverse environmental impact,please
complete Part 3.Part 3 should,in sufficient detail,identify the impact,including any measures or design elements that
have been included by the project sponsor to avoid or reduce impacts. Part 3 should also explain how the lead agency
determined that the impact may or will not be significant.Each potential impact should be assessed considering its setting,
probability of occurring,duration,irreversibility,geographic scope and magnitude. Also consider the potential for short-
term,long-term and cumulative impacts.
this
.... ........ WWWWW ��.WW
hisoxify determined,
information
analysis above,and any supporting documentation,
ult
that theproposed action yr n one armorepotenllylar a significant
adverse impacts and an
environmental impact statement is required.
Check this box if you have determined,based on the information and analysis above,and any supporting documentation,
that the proposed action will not result in any significant adverse environmental impacts.
— ..__.. --- ----- --- ----------- ------_-----
Na... ....m.
me of Lead Agency Date
Print or Type Name of Responsibleonsible
Officer in Lead Agency '--- Title o .. .... .� ..
f Responsible Officer
---------------------------- .
Signature of Responsible Officer in Lead Agency Signature of Preparer(if different from Responsible Officer)
PRINT FORM
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