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Site Plan Application n TOWN F QUEENSBURY,Site 1 i �i dal t III I-B' rV4 Review Process: L Required lire-subnis i n meeting with staff to determine general cornpleteness to he held nrl lgter+16..� Il week Drier to dendline d�- ., Call (518) 761-8265 or 48) 761-8220 for an appointment Submi'tw of complete application: 1 original and 14 copies ofthe application packageby monthly deadline,. I bete ruination Ofapplication completeness.,ess., All necessary information must be provided and appropriate fee(s)paid for consideration for placement on,an agenda for that month, 4.. t o letu lied not e c s der d lnr la ue tOn aau a. u:n n� m p d> infor nation has been su�bmit�ted. 5. Submittal to Wmen County Planning, ifapplicable., . Planning 'Board meeting, generally the tired & fob Tuesof each month, You will e advised in writing to which meeting t attend. day .. Folluwi.ng the meeting You, will be provided with a copy Of the resolution stating the Board's, decision, n your application. if your application was approved, the next likely step i a Building Permit, Final drawings must be provided for the next phase ofreview. if your application was denied, your project cannot proceed as submitted., 'DOCUME. 'TI (hard c Please suubmA t ®`d�a"nRl 1 ��of'the mpleted application package to include: tn�leted uuluati�uuu ages ', signed, &did 'reuuaruAsseu ltd 1Tte , signed by stak Cepy op Deed heck st&flot Flan a vir limo 'alessu euut lf" r� for any non-res,idential project a Fee: 100 ll — 10,000 sq. fL0 (10, 01. — .30,'000 sq. ft.); 0 (3%001 -100,000 sq. fl. , $1,011x, (100,000+ sq.fi. Staff& Contact l fbr aljon: Crag Brom, ,ZoningAdministrator eraigt@ gqeen2b M. .net Laura Moore, Land Use Planer 1 cure newt l�ua a�et Sunny Sweet, Office Specialist Planning unn juuee s:bu .u;et (518) 1-8220 Visit our website atue sbu het,for ¢ r An',fionnnation and forrns Site Plan Review application—Revised octuober' 01,6� To.wn of uueensbuuu K=ing,Office-742 Bay Road, Queensbury,NY 12804 I TOWN OF E .RY, 7421 Bay Road, QideensWwy, NY, 12804-5902 December 13,,20 1 CKT'Entorprises,lila StarrMowery 11 Lafayette St Quvensbury,lam'" 12804 Re, Multi-family building 2 Glendale Drive Tax Map cul. 302.7-1-24 Dear . Mowery' 1 arra writing you with regards to my revues of the abovc-rckrmced project and to document the rrecent. conversations between yow,eget William Miner and Laura,Moore of my office. Upon,my review 1 find that your pWoW will require a,Use Variand Site Plan,Revprior to the issuance of n building 'permit. A Use -is h our play Wills for the corn of e multi-family dwelling in a Commeroial Intensive district which does not allow such um. Site Fla Review is needed for the.unlisted use,should the Use Variance understand that you or your agents am prepw6ng the necessary application. materials. As h,Ahis letter will score the ne saar; , 'al letter for the 131"Gicessing of your applications. Should you have any questions or oomments ruing your application,pile a do not hesitate'to contact this office., tlol Craig Brown Zoning;Administratorr, CBAh Co.:William Miner L. i amvm=7 UfttnTimial l cwt I _UJ7. w " .onze of Natural' Beauty ... A Good pare to Lives" General Infonnatio Number- Zoning District: Lot sizesDeW led,Description of Project onctudes current&Proms use): ,y Location of project: Ar Applicant Name: � Address., Home Phone Cell: Ab a Work Phone ax E- nilti agent's Ta mei : Home Phone Cell: 'Work,Phone Fax E-mail, OwueesName cze, 4......... ,address � Homme' Phone Cell Cq work Phone Fax 519—A — � 30 &magl 61 %IF S fir^ V !' 2 Site Plan Review application—Devised October 01 Town of Queensbury Planning ff e-74213ay Read,Queeb ,NY 12804 Site DeyelppMent Data. Area Type )Cuingsq. ft. Proposed Total say. it. Addition *ft. A. Building footprint B. Detached Garage C. Accessory tructur ) . Pave l or other hard d area E. Pomp Dmks F. CmW (01 Tq H. Parcel:area (43,„560 sq. ft, acres 1 t. Percentage of,'Im lc. of Site, (x Setback Requirements Area Required Existing Ptl~o d Fret;[1] . Front ] .. Side Yard [1] , Side Yard' ] Rear Yard [Iy a Rm Y [ ] "ravel Corridor Height rn�iij- PermeabiliV, No.of spate t 3 Site Plan Review application—Revis6d October 2016 Town.of Queensbury Plann g Office-742 Office-742Bay load„ rnsb ,'N" 12904 Additional Pro"tet Information 1. Will the proposal require a Septic Variance from the Town Board of Health?' 2. If the parcel has previous approvals, list application naumb r(s): A �. . Does,this project require coverage under the New ork State'Pollutant Discharge l:iminati.on Systern pD Permit pr 4. Estimated project duration., Start Date hEnd Date . Estimited total!cost of project: Total area of land disturbance for project. Floor Area RatioWorksheet FLO. RRATIO ) __ The relationship of building size to lot size,, derived by dividing the: total building floor area by the lot size in square feat, yielding,a percentage. C Symbol Zoning District � bel lour, r �, tawrw AR Waterfront Residential 0.,22 Conunercial Moderate/Intensive C1 Cl 0.3 A. The non' ' a ofall square footage,, as uaro from exterior walls of all structures, on the property, in lud" all floc file structures, garages, basements and attics with more than. five ) f` off"oe:iliri height d porches. Building square footage does not include: Olden deck, docksand that portion of covered docks +extendin , o er water and, one storage shed of one hundred twenty (1 0) square feet or less. Any additional sheds vj,U be included. (See "FLOOR AREA RATIO,'�. B. Conunercial or industnal.: the total area in square fast as measured from.the exterior of the:outside walls of a building or se on a�project.site. s� total n all floor f this principal and accessory buildings A. Parcel Area sad .13 . Existing plrrar". gra 01w ft. see above d fxnitiori C. Proposed Additional Floor Area sq. .r U., Proposed Total L«per Area � � � ` 7= E. Total Allowable Floor Area � �a � s� ali ve table *If l is larger than E. a variance or revisions to your plan may be needed., Consuilt with 4 ateP'1an Review 1ication—Revised October20th "Towyn of u;eensbury1 tannin wee-742 Bay Road,Queensbury,NY 12,80 § 179-9-080ReAuireinents forSite Plan .Appacral. The Plaming Board shall not approve a Site Plan tial ss it first de ne , at su h, it Ian meets the termi s, th c , sits p following Standards. Please prepare responses to each of the fbIlowing topics: ...... ........ os" �,Wis cc�nsiyte.'��fthfhe;�wli A.- The p�rop e� roject bitt Oics of�the T31��sCom�prehens�PmFl—m The proposed Project compiles with I other,requirements of this Chapter,including the she plan review stand s as set forth in F'of this sWiM ffie dimerisional.,bulk and density rcgu,lationS of the Zoning district in which it is:proposed to be located(.,article 3,WW Table 1),the applicable re;quirements of all other Articles that apply, 1. C:. The site plan encourages,—pedesWan—activity internally and,if practicable,to mid from the,site With pedestrian padis or sidew 'ks connected to adjacent arm, site plan must conform to'Th—apter 136'Seg agcand Sewwblvos hapter,147'Stormwater Management Local Law,and offirz applicable local laws. W — e: oposed use s�Mi be in harmony with the general puqx*e or intent of Tis'Chapter, VeciflfallY taking,into account the loctiara,� character and size of the proposed usc and the description and purpose of the�district in which such use is Proposed,the nature.and ratcnSiV of the activities to beinvolved in or conduc ed oormettio�n with the proposed use t in and the nature,and rale otany in=w in the burden on sarpportiAg public services and facilMes which will follow the approval of the proposed u$ ' e, F. The establisbmen�maintcoance�and operationar6epropmed usewillnotcreate -ds from traffic,traffic=fft%tion,or the public ha7A parking of vehicles and/or equipment OT be:otherwise detrimental to thchealth,safbty or general welfare of persons residing.or woricing in the neighborhood,or,to the gencral welfare oftht town- Traffic access and circ ulatiM,road intersection%road and dnivcway widft,and trafficcontrols will be.adoquaW, I - ,wd _y , G. Off-strect ftading facilit �nat and 7 ed d ill be appro el�"red 4 an W P as oc pro c anticipated to be generated, by flie new use. The csWishment��o, � e �b f ad con e, v iel 11 etwcen ar"are Where feasible, This furthers Jan W bg n s , n the Town's goal of reducing curb cu'll w d u co ge Uo � A twe foot If adjaztnt propertica art either out hav 8 m undeveloped or previously derveloped review f in ade��ision for t,Vi ct�ion must b,c identified and' provided for in the site plan under rev or such li�,when,flue Sl the�larl�;rrp may t ce rt�owners 0,purposes of co" applicant has made contact with adjacen prm*pe require proof that the, owners � r purposes of coordirnating linkages,with ad properties. 'The project s.hall not have n the natu ral,socnic,Mthetial,ecological„wildlife,historic,recreationW,or open space resources of the town or the Adirondack Park or uport the adequate provision of supportiAg facilities and services madlene"Ssary by the project,taking into amunt the commercial,industrial resida",recreational or other benefits that MiSM be derived fivm the Project In making the determination hereunder,the Platming Board shall consider t1hose fiactors pertinent to the proJect contained in the development considerations set forth herein under§ 1794-M of this Chapta,and inso doftng,the planning Boards1W. l make a net over4l T. evatuatiOn of the project in reWion to the development objectives andgerteral guiddlines set forth in,J-179-9-080 of this Articfe� We Of es " oess ei'ou 7 ��shaj Saf and MZte fo,a, �isi6n'or and rran ",,m n,walkway strucu=s,control of intenections,'With vebiculir traffic GVQI an Co venie an tnovement, Pedestrian connections between Aacent siteso 'ge pedctdan us ,. shall Incbe p VIEtt!'o, J7.-- Stormwater drainage facilities will prevent an increase of post development drainage flows,as compued to Pr &Veloipm drainage flows. Drainage ofthe site:shall recharge:ground water to the extent practical. Surface waters,flov&g off-site Shell not degrade any krearns or n,adjAcent properfie&or,public roads. Facilities j1W]be in conformance with the,d in :standards of Chapter '5c' rai= age 147 ofVTownCod the Town of Queensbury,Subdivision Regulations,where applicable. ar K. The water supply and sewage disposal facilities Wiflil.be adequurute and will Met all applicable and current requirements;set forth by Dpartment of Health regulations and Chapter 136 of the Town Code, f The adequacy,type and attan8cmen t of trees,shrubs and other suitable plantings, landscaping and screening:shatir effectively provide a visual and/or noise buffer between the applicautts,and adjoining land,�luluding the maximum retention Of existing vegetsdon and maintenance,including replacement of dead or deceased plants, %I Fire[ants,emergency zones and fire hydrants will be adequate and meet the needs and requiremants,of emergency service Providers. d fV The dpi structures,,roadways and landscaping in areas,suscePtibleto ponding,flooding arWor erosion will minimize or avoid such impacts to the mamnium Went practicable. "Me site plan cotnforrns to the designrforrnaBucestauneat#his :hapter. Site P'lan Review applicatian—Revised Ntober 2016 TOW11 Of Queensbgry Planning Office-742 Bay Road,Q4eensbury, NY 12804 179-9-050 Checklist-Application for She PlanReview. Application materials and site alar shall include sufficient information for the Bayard to review a provide a decision. Tire applicant is to provide site pian, drawing and all attachments that address iteral.A-V. The applicant may request giver from AN and is to provide rem ora°1`dr waiver(s) requested,, Pleaie label information'to be submitted, REQ NT feet .. i map at � � P Proposalunsnnuta f sv h—ich affict or scnc its clas roadsug aTeas,schools,etc, The map shall allo show all properties,id owners, subdivisions,sure asu of the meets within 00 feet off`tthe prr:uperty. Such a sketch.may be suuperrrrup aced,on a United States Gooloaj�ql ., The site plat,shall be;drawn at a scale off4ay f�d tcu doe inch(1°"'=4fl feet)or such other scale as the.plaanin Board may deem appropriate, standard 24"x 36"'sheets,with continuation on 8 l I L""sheds as necessary for written ; on information, The information limed below shall be shown can the Lfte plan and continuation she s. C;. Name of project,botruudades„date,northu arroww",and scale of the plan, P.D Name and address of are o'wwner of record,developer,and seal sof the engineer,architect or landscape architect; If the applimnt is not,the record owneT a letter°6af authorization shall be. arired from the owner.. The location and use of all existing and proposed structures within die property,including all dimensions ofheight and floor areaall mderfor entrances;and all anticipated firture addltlo t and alterations„ F. auale ^aill ,raanp ,l—present and ouurbs,punthas„landscaping,blab crud fences.,ways, feat pa,>rfclrrg areas,da-uwewwrays„outdoor storage�, proposed public; private side aru shat . s. Locatioru,*W and scremin. details for all waste:disposal e cre ren a^r oont I also be sho wn. rbe location,height,intensity and,bulb e{s di r"in u.desto c.)of l ext li atm �l The dhteeCaon.art lu illumination and methods eliminate are onto adjoining o erti also be,shear is p `soca�i § 1" M-020. � - , The location,height,size, -materials and design of all proposed sign& l The location of all present and proposed,utility systems including: I. ' ewage aux septic systzrn., . Water supply stem; . Telephone,cable and elettricdl systems;ari;,tl , 4. Storm"nap System including existing read proposed drain pisses,carlvem.ca'tdh basins„headwalls,end Balls„ hydrants,manbdes and drainage sw?ales- Pl�to aevm.t the pollution of or ,oundwwater erosion ofsail _ �. p' p � � it beth during and slier eoaasttrtuctlurn,excessive runoff and flooding of other properties,as applicable, A Storrmwattr Pollution Prevention Plan( P)for all land devel.axpunent activities(excluding a izurltuural actlwudes)on the site that results in lanae dlshurimce of one acre or amore, A SWPPP shall comply with the requirements of the DECFDE MS4 General permit and Chapter 1.47 ofthe Town of Queensbury Code. It slush be at ane discrebon ofthe Planning Board as to-whether a WPPP''oT an erosion.and control plan shall be required for a site plan Miew project land disturbance of less than one acre" , Existing and proposed topography aat two-fbot contour intervals,or such other contour miWrval as the—Phffming beard shall lowAll a ryto the nearest United Coastal andGeodetic wa If art �rnion ofte. parcel is within theI e hood narea will be and elevations g�e� as shall bindicatewithinA— hproposed sire and w it in 50,feet of thin proposed site where soil removal or filling,is required,showing the approximate volume in cubic yards. landsc#e plan"wring all e,fisting natural land tfcatuures OM raaY in uence thedesign oftbhe proposed use such as rock outcrops,stands off trees,single trees eight or more inches in diameter,forest cover and water sources and all proposed changes to these features,iunchrding si7es and types of plants. '"Fater sources include pond—s',falces,wetlands and watercourses,aquuifers,ffloodplains and drainage retention areas. Land Use District bownda ies wwit�lhuru 5010,feet ofthe site's, " .perimeter shall be drawn and identified on the site plM as well as any Overlay Districts dust appkly tri rhVe pr oprer . Site phuu Revie:w application–Devised Ott b� 2016 Town of Queerlsbwy Planning Office-742 Bait Road,Queensbiury,' WY 12804 R E Q UI R E'M—"E—NTS (CO TINUED) .Tr affic pe m ............ s within Me site,entrances and log and unloading areas,as wel I ascwt cuts"on the site and flow e within 100 feet of the:site. The:Planning Board may,at its discretion,require a detailed traffic study for large developments or for those in heavy traffic arew%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,: Z The projected traffic flow pattern including vehicular movements at all major intersections likely ? 3B to be affected by the:proposed use of the site; 3. The impact of thistraffic on levels of service on abuning public streets and at affected intersections. Existing and proposed weekly and annual peakhour ttaffito levels and road capacity levels shall also be given. For new construction,or alterations to any strwture,a table containing the Poll w.mg inft=ation shall included: 1. Estimated=a Ofstructure to be used for particular purposes such as retain,operation",offlce„ Storage,etc., 2. EO,rnatcd maximum ITumber of employees; 3. Maximum'wating OapaciV.where applicable,and 4. Number of parking spaces existin9 and required for thea intended use, P. L Floor Plans. 2. Elevations at a scale of one-qyartcr inch quals,one.f6ot(114P= 1 foot)for all cxteflor facades of die proposed structure(s) anWor alterations to or eNpansicins of existing facadshowing design features and indicating,the type and color of materials to be used., Q Soil logs,water sup . ply well and percolation test results,and storm water runoff calculations asneeded W determine and mitigate project impacts. RPlans for dispoml of con facility, & Plans forsnow removal,including location(s)of on-site snow storage. T. An Er viroaxnental Assessment Form("EAF')as required by the SERA reguiii6ns,with Part I completed by the Ap plicant shall be:submitted as,part of the application, If the proposed project requires a specW use permit wid an.EAF has buten I submitted in conjunction with a special use permit application,a duplicate EAFis not required for the site plan aplitation. U If are application is,for aparcel or parcels on which more than,one use is proposed,the applicant may submit asinglo application for all such U=,provided the proposed use are accurately delineated on,a site plan drawn pursuant to the requirements set forth.above. The PlanninBoard may girant the application with,respect to,some proposed uses and not 9 others, For purposes Of reviewing an application(and for SEA compliance)all proposed.tins on as single parcel or on contiguous Parcels shall be considered loge r. V. binetnarrativc:statement on how tha project proposed for r!"iew furthers or is conslliierll�Wlthh be�Vlsion,y�,oalsand.poflcies�51� in the Tomm's Comprehensive Plan. 7 SitePlan,Review application—Re'vised.Octobicr 2016, Tovm, Of Queensbury Planning dice-74 Say.Road".Quectisbtuy,NY 12804 Town of QueensburySite Plan .''ire- 'u'hmission Conference Firm ection179-9-040 � 1, Applicant Name; L r� . Zoninclassirication d. Reason for]L?k.eieuv, U42 . ld'(4cf 61 Pr -Su�nnxsslon Meeting Notes: Provided Outstanding;. Please puede by Deed General Information complete Site Development Data Complete ' cfba k Requirements Complete , dditi nal Project Information,Complete OF3 ' FAR ad,d� sled l quire tints forSite Pl - tandards Checklist iterns addr s� d. C,r t r Environmental Form,corapteted ipat'ure Page completed „ 4 i tu� °jr -ac 1 lit ��� ' f rT i .... %A-), q tq Std'Representatim Applicant/ rpt. Vii . L(VL I 8 Site Plm Review application—revised October: 01 Town of Queensbury Planning Office-742 Darr Road,QueensIbury,NY 128,04 gnat rr Page This page includes the 1.)Authorization to pct as Agent,Foruxr° .) lEru irueering Fee Disclosure. .) Authorization for SiteVisits; 4•) Other Ther twit Responsibilities; . Official Meeting Disclosure,and Vin.)Agreement to provide doementation required, OwN,ERI's AGENT FOttRhrt;: Complete the,following ifthe OWNER of the property is not the sauce as the applicant Oester: Sf Designates- W f LULMLLILILJ�� As agent regarding: Vmiance site Plan Subdivision For Tax Map 140.,: �s eetion l� lot . Deed.D of r ee tno Paje Date APPLICANT'S AGENT FORM: urru'.plete the following if the Alf'PLIC 1NT is unable to attend the meet�ing or rhes to,be represented by another p": Truer: mates: As agent teWdirt : Variance Site Plan _..... Subdivision For Tax Map No, section Block Lot Deed Deference:: Took page bate OWNER SIGNATURE. DATE'. 2-1,-_.ENIIfLigRING FEE .d I' CLO �1�1a: Applications may the referred to the Town eonsunitiaug 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 appl°bcaru,tn Fees forengincerinZ review will not exceed 1,000 without notification to the Wliomt. 33, ,tiU'THONRLEA L R SITE Y :By signing this page and submitting the application materials amdied heron,the Deter„Applicant, and hist'heftit agent(s)hereby authorize the Zoning I4eard, or Planning Board and Town Staffto enter the subject properties for the purpose of reviewing the application submitted. LAMER PERM11 ESPONSMqjjff,5, Other pernn-uits,may be required for construction or altcradoru activity subsequent ue nt to approval by the Zoning Board,or Planning Board,. It is the appli is respomibility to obtain any additional perrruits. 1 T : It is the practice of the Conimunity Development Depa'tra at to have a designated stenographer We record the proceedings of meetings;resulting from application, and minutes traruseribed from those tapes,constitutes,the official record of all proceedings. 6.) AGREEMM TO PRO IDL,-DOCUMENTATION REQUIRED. Ir the undersigned,have thoroughly mead and understand the instructions for submission and agree to the submission requirements,I acckr,owled no construction activities shall be commenced prior to issuance of a,valid peer it 1 cenify that the application,plans and supporung materials are a.true and complete staternent)description of the existing conditions and the work propos l„ and that all work will he perf'offne+dl in accordance with the:approved p:lanns and in conformance with local zoning,regulations. l acknowledge that prier to occupying,the Lacitities propostA,I or gray agents,wilt curtain a certificate of occupancy as necessary. I also understand that IMe tray be required to provide an as-built survey by a.licensed land surveyor of all newly cGnsbwted facilities prior to issuance!of al certificate of occupancy I have read and agree to the above. Signature [Applicant) Print Name (applicant] Date signed iaest. �� 9 Site Plan Review application Revised October 2016 Tovin o'`Queensbury Planning Office-742 Buy Road,Queensbury,NY 12804 Short Environmental Assessment Form Part I - Project Information Instructions forCo, ­­,"--imnletin g Part,I -Project Information. 'I'hie applicant or project sponsor is responsible for the cGmpletiwa of Part 1, RC$pDnses become:part of the application for approvall or fundi ng,are Subject to public review,and,may be subject to further verification, Complete Part I based on information currently available. ffadditional research or investigation would be needed to, fully respond to,any mean.,,please answer as thoroughly as possible based on current information. Complete all items in Part 1, You may also provide any additional information whic:h you believe wl 11 be needed by or,useful to the lead agency;attar-la additional pages as necessary to,supplement any fttM Part I - Project and Sponsor Information, ame of Action or Project: ep"I le— Project Location(describe,and attach, �_Map)': a llocafin;T VIA w Ica, r. Brief Description of Proposed Action: IM Nf-0 VV\AA, T-Y CL OL r-'f -c,- Name ofApp 1icant or Sponsor. Telephone,. VIL -3 f :j�LAA,A E-Mail, city/po: 1�p C State: od'e; 7D e proposed acdon only in tht le'gislative adoption of a plan, local law,ordinance, NO Y I,$ administrative rule,or regulation? If Yes,Bch a narrative 4escril ption of the invert of the proposed action and the environmenta I resources that YF may be affi�ed in the municipality and proceed to,Part 2, if no,IcArnfinue to question 2. _�uire a pe rmi 4 approval or funding from any other governmental Agency? NO YES �2. Does the:proposed action�e If Yes,list agency(s)name and permit or approval: <� Y�uf L'o n 1a.Total acreage,of the site or the Proposed action. b,Total acreage to be physically disturbed? c.Total atreage(project site and any corifiguaw iis proporties)oned ohr__ acres or controlled by the applicant Or project:SponSoo c res 4. Check all land apses,that occur on,adjoining and near the:proposed action. 0 Urban EIRural (non-agriculture) []Industrial iWom'Mercial *s,idential(suburban) ElForest, DAgri u[tur-e El Aquatic 00ther(spec:ify). ElParkland p Page 1 of 3 ,5. Ithe Proposed actio n NO YES N)A as�A permitted,use under the zoning,regulations? � b.Consistent.with the adopted comprehensive plan" 6. Is the larwds ap proposed action rrs,ust oit VtV�t1� baa rVt rrrVr�art,character r tics asluru built or natural I1"�� YES i 7, 1sJ the site of the proposed action located in,or does it adjo'r.uu4 a state.listed,Critical ravironrw,ental Area? l REif Yes,identify: D9 0 Will the ro osed action, suit in a se'.bstantral�.-,,- i�. a,. ' p p ineu" ,st:in traffic above present levels? 0 Y> b.Are public transportation service(s)&vaitable at or wear the site of the pr s V action? c. etre any pedestrian accommodations or bVoycle routes available on or near site of the proposed action? 9. Does the proposed,action meet or exceed the state energy oodt req rrirements? 0 y�, Ifthe proposed action wVIV exceed requirements,describe design featums and!technologies: 10. Will the proparsed action connect to an existing public/private water srmpp;ly ,SES l If No,describe method for providing potable water, l i.W'lH throerrr p po^swrtd aetiorw connect to e�aisti:ng,wastewater utilities? I COY If No,describe method for providing wastewater treatrnent: r e.site contain a structure that is l'i,sted on either time State or•National ;,e, ister of istoricYES 1 ti.l oes tVr - N -- Places? b. is the proposed action located In an archeological sensitive area? LJ PEE 1 ,a.Dots arty portion of the sits offtive proposedac-tion,or lands agjoining the proposed action,contain S wedan s or other�'w�r°ateomb+odies regulated by a federal,state or local agency? b.Would the proposed action physic.alily alter,or encroach into,any existingwetland or, aterbody? IfYes, identify the ^eland or ^aterbody and extent ofaIb rations in square feet or acres„ 14, Identify the typical Iaabitat types that occurr on,or erre likely to be found on the project site. Cheep all that apply,. El Shoreline ElForest 0Agri culturalJ rasslands g [:]Early rrni,d,,srur_,pessiorra9 Ll Wetland C1 Urban El Suburban 15,Doe&the site of the proposed action corftain any species,of anirnal,or associated habitats„lis YES by the Mate or Federal government as threatened or endangered??' 16.Is the project site located in the 100 year flood plain? NO YE 17. Wil1 the proposed actiion create sttarrn water discharge,either from point.or,non-point sou.urccs? Q SES If Yes, a.Will storm grater discharges flow to adjacent properties' Wil'NO OYES, gym.Will storm water discharges be directed to established conveyaowce system,s,� ff acrd storm drains)," 1f Yes,briefly describe: �'Tl' 't F Page 18,Does the proposed action includeconstruction Or other activities that result in the impoundment refi WEA; water arr other Iiqu i'd:s(e. . retea tion pond,este I'a ooh, rru)? Iff"Yes�explain purpp so and size. 1 .Has the site off`the proposed action or an adjoining propertybeen the laeationti of an active car closed �E , solid waste management faeuiity? If Yes,describe. 20, Has the sitf the proposed action or aro adjoinirng property been floe subject o remediation (ong�iirn or 1 n� _ YES arrmplet dl) for hazardous waste? If Yes,describe: 1;AFFIRMTHAT THE INFORMATION PROVIDED ABOVE IS TRUE AND ACCURATE TO,THE BEST OF MY KNOWLEDGE pp 1 �„ liearu�"s ornsor n„argue. t� Da�te. Signature: PRINT FORMPage 3 of Agency Use Only 11f Appdveal lel Project: Date. Short Environmental Assessment Form Part - Impacl Assessment Part 2 is to be completed, by the Lead Agenicy. Answer all of the following questions,in,Part 2 using,the,information containedinPan I and other materialubmilted,by the project sponsor or otherwise aval[able to the reviewer. When answering the questi ons the,reviewer should be guided by the concept"Have my responses been reasonable considering the scale and context of the proposed action?" -Ko,or Moderate small to largo~ i1nip2tt impact may may occur occur 1. WJ 11 the proposed act!on create a mate:ria,l con flict with an adopted land use plan or zoning regulations? F] 2. W!I I the proposed action mu It in a change in the use or intensity of use:ofland? Li 3, Will the proposed action impair the character or quality of the existing community? 4. Wi I I the proposed action have an imp�act on the environmental characteristic's that.caused the establishment of a CHtlical Etivi ronnntntal Area(CEA)? 5. Will the proposed action result in an adverse change in the existing level of traffic or affect existing inft9tructure for inass,transit,biking or walkway'? o 6, Wi I I the proposed aWon,cause art increase in the use of energy and it fal Is to,incorporate reasonably avai fable energy,conservation or ren ewable energy opportunid es? 7. Will the proposed action impea existing. f--- a. plubi ic/pri vate water suppll iles? b,public/private wastewater tA-atrnenL utilifiee?' 8r. Wi 11,the proposed action impair the character or q,ual i ty of i mpoirtant h iswrie, archatologi cal, architectural or aesthetic resources? 9 Will the proposed action resuthe amadverse change to natural r=urces wetlands, odie9,groundwater,airuality,flora and fauna)? Ill. Wi I I the proposed action result in.an 1 ncrease In the potential for erosion,flooding or drainage problenis? 11. Wi I I the propsed action create a hazard to enviTontnental resources or hu man health? PRINT FORM Page 1 of 2 Age Use""y Only[if plica le Project-., S'hort Environmental Assessment Form Part 3 Dieterminatjo�n qfSignificance For eavety,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 r-ornplete Part . Part 3 should,in sufficient detail,identify the impact, including any measurese'r design elements that have been included by the project sponsor to avoid or reduce impacts, Par!3 should also explain how the lead agertey determined that,the implar-T may or will riot be significant. Each potential impact should be assessed considering Its,setting, probability ofoccurriM duration, irreversibility,geographic scope and magnitude. Also consider the Potential for short, term, long-term and,cum u lati ve,impacts, Chec:k thri5 box if you have deterruiried, based on the;in ation and analysis above,and any supporting documentation, that the proposed action rnay result in one or more;potentially large or signi ficant adverse impacts and art ,environmental impact statement is required. Check this box if you have detern-ii n4 based on,the information and analysis above,and any supporting documentat ion, that the proposed action wi 11 not result iii,any s!gnifi cant adverse cnvironmental impacts. of�LeadAgency­__' Date PH nt OT Type Name of Rspons ibi e Officvr i it Lad,Agene Y Title of Responshale Olei ctr Signature of Respionsible Officer,in LeadAgency Signature of Prepater(if different from lespomsible officer) PRINT FORM ge 2 of 2