Subdivision Prel. Stage Application I McPHILLIPS, FITZGERALULLUM L.L.P.
D ENNIS J.P11 ILLIPS ATTORNEYS AT LAW
WILLIAM E.FrrzcERA(,J) 288 GLEN STREET
JAMES E.CU LLUM CRI C C.SCI I WEN K ER
DANIELJ.1101GAN P.G� BOX�29,9 STEPHEN L.PERKINS
JOHN E.F1175GERALD JR.A GLENS,FALLS,NY 12801-0299 MARY K.COSE0
TIM(AVY S.SH 4G1'ER PH ONE; (518)792-1.174
NIELISSA DWVFR IMSCAUIA" FAX: (518)792-1675 or(518) 761-9810 ALO RLDAMULE
DENNIS J.O'CON'1'OR4 9"9 N F I'An,nue"swilic 209
ED�WARD P.FITZGERALD E-M.AIL. lawgmkilp.com NI I AM I SI+oRD_94 FL 3313�
W I-JASKINS PHONE:(305)751-8556
*A LSO ADM ITTED IN FLORIDA ESTABLISHED 1911 1013.MEF,:(877)895�4334
Ffle No.: 222811
January 16, 2018 AI
v Uf
FF
Town of Qusb
eenury PlanZon
ning Board & ing Board of Appeals FEB,
742 Bay Road
Queensbury, NY 12904
Tvi- J-)r 1,�T
1 Bopp (Richard & Sharon) —Variances and Subdivision of 45 Ogden. Road
Dear Board Members,
On behalf ol"Richard and Sharon Bapp, owners of the: premises, otherwise known as 45
Ogden Road, Town of Queensbury, Mate of Nev York, I submit the enclosed Application for 3
Area Variances and a, Preliminary Stage Subdivision Application. My clients, would like your
approval. of the Area Variances for purposes of subdividing their land at 45 Ogden Road. There
is no site planfor the possible new-parcel, so my clients therefore also seek waivers with respect
to ani.requirements associated with building plans f"or the possible new parcel.
Please consider the enclosed rnaterials, and I respectfully request that these items be
placed on the necessary agendas of the boards.,
Thank you, for your time and consideration..
Yoors very truly,
M&HILLIPS,XITZGERAL CULLUM L.L.P.
fstep LnIL. Perkins
sperkins@mfellp.com
SL11/JLM
F—.. _
TOW OF QUEENSBURY
'Preliminary Stage SubdivIsion Application
Review Process-.
ppli : �O `agent shall meet with Zoning dm, irni tr for to determine type of review needed.
Pre-submission, meeting with staff is required to determine geQneral completeness of application materials
to be held no later than 1 week prior to deadline submittal —Call 761-9220 for an appointment.
Application submittal: one 1 original application package, one 1 deed and 14 copies of the application
package with application be*
In,Addition: in l ire a li ati , is re nir d.r
Determ,ination of application completeness and placement on an agenda,
Planning Board meetings are g nn raHy the third& fourth Tuesday's of each month. Yo,u will be advised in
writing as to which meeting to attend
Following the meeting your will be provided with a copy of the resolution stating the Board's decision cern
your application,. If your application was approved, the next likely step is a Building Permit. If your
application was denied, your project cannot proceed as submitted.
' Fee: O
Staff'& Contact Information:
Craig Brown, Director of Planning/Zoning � ,i w �ueennsl zn� .an t
Zoning Administrator
Laura Moore, Land Use Planner �a� onr—e
Sunny Sweet,Office Specialist-Planning, ��arn�n�rs�x n�ee�� l��nry.nu t
Preliminary as a Subdivisio.n application
Town of Queensbury Planning Offit"442 Bay Road-Queensbary,NAY" 12804
518-761-8220
PreliminarStage Revised April 2010
Subdivis,ion Review Application
Prefliminary Stage
REviEw Pgocg§s:
1) Required Pre-submission meeting with staff to determine general eecompletenesstg held no Ipter
then, 1 wk r ior to deadline , -
P— jday. Call (518) 751-8220 for an appoint�ment
2), Subrn[ttal of complete application: 1 original and 14 copies of thie application packague by Month[y
deadline,
3), Determination of application completeness. All necessary Information must be provided and
appropriate fee(s), paid for,consideration for placernent 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,
6) Planning Board meet,ng, generally the,third Mourth Tuesday of each month. You wil'i be, advised In
wrifing as to,which meeting to attend,
6) Following the meeting you WO be provided with a copy of the, resolution stating the Board's decision
on your applicatilon. If your application was denied your project cannot proceed as submitted.
1), Please submit I original,& 14 copies,of the Completed application packagie to lnclude:;
Cour pigtod &pplj�cafi2n, signed & dated
Ere-Submisgion MeetinSI,
_N91tes: signed by staff
Cqpy of Deed, I
Survey
f9w, $50,00
ZONINr2 STAFF & CQ_NTACT INFORMATION:
a Craig Brown, Zoning Administrator craigb&,qu1eensbu[y.net
0 Laura Moore, Land Use Planner Lmocre
.@Qt)eens,bu[y.n
0 Pam Whfting,, Office Spec[alis-t 518-761-8220 parnma-Mueensburv,,net
Visit our wetmite at 28ffi"ueensbu .net for further,information and forms
TQwn of Queensbuiy Pilanning Office- 742 Bay Road, Qualensbury,NIY 12804 , 518-761�8220 0
Prelimlary Stage Revised April 2010
§..n.0 5 Infort; ation
Tax Parcel ID Number: . 30&.
Appliotion toe u m e
Sketch Plan tag
Preliminary Stere
Final Stage
Indicate the foal"lg5tag
Number of lots,proposed
Residential or Commercial � 4
Total'brat acreage
Proposed lot sizes 2,6-n '4/
Project loc tIon 45 c4
Detai led'Diesicription of Project[inclu -c r dnt&pm,posed rac]:
,Apat Nq' Address:
a
Home P'fier e Ce'pp;
WoT,k Phone Fax
-Mail.�.
ew ress
�W
Homo Mone � cell:
a
w ,
-
.1p, il ,"A
�#'s Nqn
v
a
Town of uree b'uryPlanning,Offi.ce.742,W,Road•Otleentbury,NY 128'04 5la-764-8220 I
P rellinijitiairy Stage Rey ised April 20110
ITEMS TO, BE IDENTIFIED BY STAFFDURING PRE-SUBMISSION MEETING. You should use this p,,-+ge for
guidance %Ken drafting your application„ however. it%ill be completed by a,staft member. SUbMittW Of 3 preliminary
plat depictIng existing and proposed conditions shall 'wicludie the items is inowd below, Failure to inClU d a all required
informaboili may result in a determination of inconi[Aeteness ind,a delay in the proloessirT of-four applic-uAtion-
§All 83-13. Plat detalls an4i mquireniients.
The applicant is,required to submit on2(1)oLi,gjgl and I'd co to of the pmliminwy plat application,Such application
shall,inchAde,the following documents and/or inform aWn.
A. PRELIMINARY PILAT. The preliminaty plat $hW1 be 12U OUI by' a liceDsed professiomal englineer and/or a
licensed professional land surveyor with a properly executed New York State Educafion Department
Exempfoh N. Such preliminary plat shall be prepared at a scale olf one inch equals 50 feetzlero iinches,,: cleady
shorwing-
1) The lormfion of atj existing and proposed property lines. buildings, Vlate'rrOcurs eS and other important
topogiraphic features.
2) Exisrting and pmposed' ,contours shoWing elevadons at tiro-foot contour Wervals and 6*-ending at least
100 feet off site.
3) The location, names and widtlis, of all existing and proposedstreets, easements::, lots and building lines,
well's and septic tanks andfields and sinaiiiar facts, regar&mg property Immediately adjacent or opposite the
Proposed:s�k(kAsi6n.
4') A location map showing:
(a)The zoning district or disWcts in which the land to be subdivided is looted; and
(b) The property included In the proposed subdbAsion and all con4guous; properfles of the proposed
subdiAsion and allf properties vvithin, 500 feet in each direction from Me bound-ary fine of the Proposed
subdivisiJon al" on tionfiguous, street or highway. All properties shall be identified by lot and, parcel
number, and,names of cWhers.
5) The location MO size of any existing severs. water nasions, culverts and drain pipM electric, telephone
and cable tel ovitior)0tvas and proposed sewers, vMer rnains, culverts and drain pipes on the property or
irnmedlale4,adjacent to the property to be subdiVided.
5r1 "Thr proposed arMiagement and approximate area, tiiidth and length of street firckrOge emend setback
requirements of each lot for tbe purpose of demionsrating to the Planning Board ftt the proposed locafion,
of streets makes;possible a layout of lob =
in ac vAt'h the requirements of the Tdvwn of Queensbury
Zoning l.aw for the district or districts in which the subdivision,is Wcated.
7) All parcels of land proposed to be dedicated to the public use-
8,) The dale, North anwi and scale:.
9) The 11fle, under which ire proper sed sub,divWon is to be recorded, with the names of the owner and the
engineer or land sou viafor whoepared the prefiminary plat; the lice number and seal of the enghaer
or land softyor shall be affixed tip The dm4nS
B. LAYOUT PLAN, , s shiall be pTepared bya professional licensed eingineer or profes,slonal licensed
�S,Layout plan
land-sumoyor with a properly' execute6 New York Mate Education Department Exempgory N. Much.tayout,
plans,shall be Incorporated on the preliminary plat and shall show the following.
1) The exact layout and dirriensions; of Proposed streets, including stMloning and fie-in to the center4ne
distgntes of existing streets with monwnents and other,points. as required.
T6vj,n ofQueemJ)ury Ptaftning Me. 742,Bay Road -Quesnisbury,NY 12894, 5113-751-112211, 2'
Preliminary Stage Revised April 2GIO
2) The locatim and widths, of all streets,pavements. curbs, sidewalks, easernents,parks and cAher open
spaces.
3) The proposed names of aMI streets, and the radi of all curves in the street fine.
4) The locatiort of all proposed utftes, including the proposed water,supply,sanitary sewers,srtorrawzteir
draina,ge systain and any other proposed underground utilities.
6) Proposed k4 lines.
6) The da*, North,arrow and scale.
7) The title und:er which the proposed subdivision is to be recorded,with the names of1he owner and
engineer or land surveyor who prepared the,la)*ut pkins;the license number and seal of the engineer or
land surveyor shafl be affixed to the draming.
G. �ONSIBUCJJQN DETAILS,Construction details AM be prepared by a licensed professicingi engineer or a
a
ricerised profosMional land surveyor with a properly executed Neve York State Education D p
Exempton N.Such details,shall include:
1) 'the proposed sanitary sewer system. including pipe sizes.bedding and pwfi&s.
:2) 'The proposed sWrm 4rainage systern, inc ding pipe sizes, beddlog, catch �basin and trkmhofe detals,
profiles and method of disposal of collected stormwater.
3) The pr" e4 water supplysystem.
4) Any other proposed underground ufi Ities-
6) Atypiczd cross section of the roadway, mcksding the right-of-v:ay width, pavement Mdth and depth of
pave r ment materials and subbase. the locatiOn of utilities, chracter and dirriensioft, of' cuft and
sidewa ks and side lope,,grading.
6) Rofiles, shoe&q the Cor I&al ground surface -and finished street surface at center lines of 611 streets,
percentage of grades of streets, st2tioning,and elevations,of M poi of curvature„ P61rftr dfNersecton,
paints of tangency and of rased sewers, drains, culverts, manholes and qllidr f"i,res., Irivert
. p
elemniflons and slopes of sewers and drains: and both surface and Wvert elevotions of Menholas shall bq��
indicated. Profiles, shaIl be drawn to the scale of four feet tD the inch vegical and 40 t ,,et t;). the, it
horizontal.The stationing shaM show accurate center." distances.. The elevations of the original ground
surface shall be to the nearest tenth of a t and'of fixed Wints to the noarost hundreft of'o foot.
7) ThIm location and e1joyallon of all,proposed,monument loc.,4cons.
The date and scale.
9) The tige unider, which ft proposed subdivis'r is to be recorded', wraith the nam,es -of 'the owner and
inner Who.prepared the construdon details; the license number and se,01 of Me dftgher shag be
'afted W the dravft.
D. .L PJ.&I A landscape plan shag, be prepared by a flcens,ed]WdsCape archtect f'W.subdivisions
greater than 10 lots.Smh landscape plan shad include:
1) The location and i;p9cWs of street trees, if retained Within ft right of-way or preop osedto be planted bythe
s0dlyider.
2) Oetajls of,methods of tree,protection and tree plantiN.
Tovm of'Weensbury-PlannIng Me- 742 Bay Road-OueensbuM NY 1204-M; 761-9220 3
Preliminary Stage Rey i sed April 20 1 a
3), Plans and details of any site improvemients related to park or recreallon anning,, Including layout.
grading, planting ind details of any improvements.
4) Plans and details of any other public amenities, provided in the subdivision-
6) T'he date and scale.
6) The title number -which the proposed subdivision is to 'be recorded, %Mth, ft names of the owner and
landscape architect who prepared the landscape plan; the license:numbar and seal of the landscape architect
s,11-6111 be affixed to the drawing.
A
E. CLUMIM, P A dea ringr pWin shall be Prepared,at a si�ale of one inch equals 50 feot zero inches,Such
plan shall show the Wowing details:
1) Existilng vegetation prier to,any clearing of the site for site inves4gation,purposes,
2) Areas of vegetation removed from the site for hvesfigation purposes.
3)
the location of roadways, underground or overhead Lffififies W in rioaclways,, limit-s of grading, proposed
location of any buildings. septic systems, walls and driveways and any other improvement's, 'which might,
reqLgre clearing.
4) Afeas where slopes are greater-than 2G%, as per§,A1 113-26.
6)
UM'Wof proposed doaring of trees.
6) Measures,to be taken to protect remaining lraes,,inclodhg details.
F. 114 CN E AN1
,Rg§lQN,C2UjR9QL,-P-L A grading plan iand erosion control plan shall be prepared at a
sicale of one Inch aqua ls 60 feet zero,inches- Such plan shall show the following:
1) A generalized grading,and drainage plan (does not require spot 91pdas oraliope designation).
2�) An,y phasing of tree ramp al anmilbr construction.
G. 9NV4FtnNMW1ALUCQ8;L, A long envimnmeinl:211 assessment-form !3hall,be prepared in 2ante wkh
f he §tataEnvironmental Qudrqy Review Act describing ft potential OWranmental impact. of the proposed
suWvlsn.
H. U&,=ENT QEl6. A statement of intent shall be submMad by ftopplUcont. Such slAtement shall
include:
1) Proof of ownership of ft land to be subdivided, in a form approved'.byltht 7iown Attorney.
2) The nature and extent of proposed street improvemen%.
3) The nature and extent of any recreational features, parks, playgm,401s., inater supply. sewerage and
drainage rithis-of-%vay and easements. reterWon basins and other tand to be dedicated' o public: use and the
wnditions under whith,dedication of these features is to be made to the Town.
4) A statenlent,that the,applicant will install all improvements it! the SUP,d6rds,pitescr.)b%d"by
the departments of the Taxn having,�iirisdicfion, and set all monuments As ebown on,ttle 11mal plot thereof in,
such-riuqnirreras,the Board may designate.
1, A STORMMLATER MANAGEMENT PLA and a STORMAUM EQLLUTION PREVENTIOR.,ELAN
M
consist entwlihthe rejuireMebts of Chapter 147,Stormwater Maneapment.
'Tovm of Cee bury Planning Office-742 Bay Road -Queensbdry, NY 1404-1518-7§1�02201 4
Preliminary Stage Revised April 2010
J, F'E.E
1f -The applicalon for preliminary plat apparoval,shall be accorrnpaaraiedd by a fee listed on the nUrrernt schedule.
of fees for the Tem of QueensbuTy pasted in the Planning Office.
2) In addition to the fee listen iwi the schedule of fees„the Planning,Board may charge a fee to developers of
projects requiring legal and technical review, provided that the fee Dar ed reflects the actual COZI of the legal
and tachiilcal assistance to the Planning Board.
Ko IMAULERS. If the Planning Board, finds that any of the lnforatatioo requirements. as set forth above are
i nappropTlate or not necessary to conduct ars informed review, it may walye such information re-quwrernnennts as
R deer ns apparoppriate., a such woiw�er shall be made in w,�rriOng,and shall contain statements of'the reasons
why the waived! information irequirements are .root necessary for era informed review cruder the circumstancos,
The Planning Board may grant such waioers on hs <wn inti five or at the w ritli n request (tha,k sets forth the
specific requirements that are: requested to be waived a;nd the reasons for the requested walver), of: ars
applicant..
A183-14. Submission, and Review pmo edurre— Subdivision Sign Posting Requirements
D. Notim. The:su4-riMder shall display promineatly on tp°tue sOlget property.,for'ill days preceding the date sof the
public hearing, at least�oune sign. two feet by three feet ins sand r riirrg.a legend presorlh d the Town
Planning Boiardm announcing the public hearing.The sign shall bein full public vievi fr= the street pawerrnent
and shall be legible from the street. l the property its bounded by more than one street„a sign shall be placed
on eao'h street that bounds the property.
Tom of Quee w burl Planning office-742 Bay, load .Queensbury,MY 128,0 51&761-gam, 5
P
m
Preliminary Stage Rei-is,e4 April 2,010
1. Tax Map ID. 3ff'6 o
. Zoning Classificalorc Dta(\C
3. Ion for IIin :
6. Pre- ubrnl's Ion Meeting Mote's,Outstanding Items To Be Addressed Inolrnd-e:
. General Informaftn No
Preliminary P fat —No
Layout Plans ar "
Construction Detal1r, iQ7 Yes No
16. Land ape Plan Yes T�z
7,. Clearing Plan _ .__Y °No
8. GradingErosion Control y". �"No
9. Environmental:Report No
111. Statem,ent of InWril Yes o
11, Stormwater Plan I SWPPP Yes �o
1 . Fees "deb I�Io
13. Waivers Yes No
14. Subdivk0on Sign Posting es No
15. Signature Page
Cj C. L
U ,r
VA
LO 2&A' I
.'
Up— i
..
.t)'LJ
,
St,ff H"it e P _
Applicant[Agent
Town of OusensbuTy Manning Illce-7 .Bays load ft ,NY 1'2a,04•518461-8220 6
Prefimin�a ry Stage Rev I sed April 2010
Signature Page
TW,page include&., 1.) Audiodzation to Act as .gent Form: 2.) Engineering;Fee Disclosure; 3.) Authorization for Site
Visits, 4.) Other Permit Responsibilities; 5,) Official Meeting Uisclosure and 6.) Agreement to provide documentation
rewired_
OWNEws Aaaw Foinm:
Complete the following if the OWNER of the,property is not the same as the applicant
Owner:
ALL,
Deslgnates: A,
ads agent regarding, Variance Site puw� nub division.
For Tax Map Nb.��. Sedon
Block '.I I Lot
b: Sauk Page fe ja:!!?V Data
OWNER A VATE,
SIGNATURE 11, _11— -,
7 gill
A,PPLtCAM,rS AQENT FORM:
Complete (he follovAng If Ihe APPUCANT is unable to attend the meleting or velshes to be repras-ented by another
Party: Owner: qr,� w4 Svos'D a
Designates;
As agent regarding: ariance Site Plan Subdivision
ForTaxUlapNo- Slection, —1 Block, L I
Deed Refe i; ook -3,*6pell, date
OWNER SIGNATU RE. j DATE"
ire referred rM4
23 ENGINEERING FEE DIjQ_LQ$URE, ApplIc3tMs may beref rred4l, Town=nsuftlng engimer far Wow Qf.seplic desjn,
� etc�as,deter hued bythe Zorgng;or Manning a &.1V GV&Oz� W111 be thasVed
storm drahagf IrtMem Fees for enginee"no,reA
directly to thaoppItant. Fe tsar iangineuring revje-.vvAj not sx�ce"S 14JODWIhaLft notificallcm to the applicant
3.1 AUTHOM-ZATION FOR S-IT'E WITS: Sy signing this, page and Wixdfting ft *pplicallon rnaldIals alta ed ftlorelN the
Owner. Applicant. Mid h1offierAtholt 0,90filfs) hereby atdtofte th�,, Zoning Board:or Planning Scard and Towni Staff ID enter the
subject pro"rtiOt for the,purpose of Fbewlesving the 2pplicatton scab mided.
4.1 .91U514-PERMIT 5FAPQ"§jj=.0 CHher permits may 11s9 req red for cansftucOon or alterattonadivi� SUbSEquent to
approval by,the Zoning Board or,Pla'nninp Floard. ltisthis applkaiiiUs:fesponsbiiltyto obWn any additional permIlLs.
5.) it Is the pmctki� d the Cornmurft DMIOPMent DePann*ntto bave Q
desionatert stent Orarher.r t1pe mord Ole praceadlRgs or ranee dings resuiung from, application, and run limnscilbO f1rom-those
Was constittfWS the official record af W1 proceedings.
613 AGRIEFEMENIJQ FROVIPE 00,CUMENL4Sjj0 HEQUIggg, 1,ale undersIgneid. have Moroughly read and tindermnd tw,
ln,struMnB W.spbWasion Ond igrep to the WMUsWin req lmmnants.I acknovdedge no construction acilvid'ds&M,211'00 tbMrAbhted
prig io .6$jjdiM 0 a Valid peft0t. 11 terdry Mat the applfcaWn, plans and supporting Material's are a true, zo, complete
statementidosaiptlon or The existing c*ndtlons,and Me wwk pTop�osed�and that all worR,W be perfaffinadin the
approve'd plans Md In comrmarice With�Iocal-zoning regubdions. I acknovAedge ti rat prior to loappying, the facillfes-pr&p6h#d[,I or
myagents.wIll obtaln aoerliificata ofoccupanq as necessary. I also understand ttmtVwe may be"W'M para de an,as-bu:llt
survey bja Icansed land surveyor of'oli" ar
ity,construded(killities prior to issuance Cfr a ice Oficate of occupancy
an � e
s f6n r,� [Appliciant baFe sig�,_ed
i Print Na�ne fAppllcantl
alt Prim t Mime (Agent) Date Vigne
Town of Opeembury Planning OWe,74:2 fay"Road .Queensbury, NY 42004-5't8-764-022 U 7
SP1 7,20
Appendix A
State En vironmental Quality RMinv
FuREnvironmental Assessment Form
Purpose. The Full Environmental Assessment Form '),provides an orderly and
comprehensive means for evaluating the potential environmental significance ofa proposed
action,. The question of whether an action m, ay be significant is not always easy to answer.
Frequently,there are aspects of a prolcet that are subjective or unmeasurable. It is also
understood that those who determine:significance may have little or no fbrmal lknowled e offfi,4��
gni 9
environment or may not,be technically expert in environmental analysis. in addition,many NVho
have know]edge in one particular area may not be aware,of the broader concerns affecting the
question of significance. The lzad.agency must use the Full EAP"fdr Type I actions and may use
it for Unlisted actions.
The Full EAF consists of'three parts and when oompkted it will serve as the determination of
significance:
Part I -Is completed by the:project sponsor. Pan I prevides basic information including a
description of tine proposed action,proposed site location,and its environmental resources. The
information provided in Part I is,later used by the reviewing agency to complete,Pads 2 and I
The questions in Pan I are grouped in sections A-G-.
SectionA gathers information that identifies the project sponsor,the proposed action,and the
proposed action's location.
Section B requests information about government,approvals or funding.
Section Crequests informadoh About planning,zoning and community services
Section D requests information about the proposed action.
Section E requests information about rosmirces on or,adjacent to the proposed,site.
Section F provides the project,sponsortine opportunity for supplying additional iriftyrmation
including project elements that may`avoid or reduce impacts.
Seotion is where tW,certifying signature of the P is,provided.
Part 2 -Is completed by the lead agency. Part'2 is designed to help the lead agency inventory all,
potential resources that could be affectcd by a proposed action and to determine the potential size
of the impact by providing a saies of qw.stions that can be, answered using the information
found in Part 1. To further assi,,st the,lead agency in completing Part 2,, the Borrn idenfifies the,
most relevant questions in Port.) fiat '`ill provide the information needed to,answer the:Pan 2
q rr.estion. Part .2 is designed to help"anrViewer identify any oleme�nt of a proposed project,Haat
may have a potential lysignificant advers4-,.impact on the environment.,
Part 3 -Is completed,by the,lead ggenty. Part, questions where the impact leas been identified
as potentially nioderite to-large orwberb there is a need to explain why a particular elernent,of
the proposed action will not,of my,--result,in a signIficant adverse environmental impact sl"nould
be explored in a series of written, well masoned statements in Part 3. The discussion of impacts
in Part 3 will serve as the°supportin docu mentation for the determination.of'significancc.
61 7.20
Appendix A
State Environmental Quality RMew
Full Env ironmewal Assessment Form
Purpose: The Foll Environmental Assessment Form(EAF),provides,an orderly and
comprehensive means for evaluating the potential environmental significance;of a proposed
action. The question of whether an action may be significant is not always easy to answer.
Frequently,,there are aspects of a project that are subjective or urimeasurable. It is also
understood that those who determine significance,may have little or no formal kTwwledge of the
environment or may not be technically expert in environmental analysis. In addition,many who
have knowledge in one particular area may not be aware of the broader ooncerns affecting the
question of significance. The lead agency must,us,e the Full EAF for Type I actions and may use
it for Unlisted actions.
The Full EAF` consists of three parts and when completed it will serve as the determination of
significance:
Part 1 - is completed by the project sponsor, Part I provides basic information including a
description of the proposed action,proposed site location and its environmental resources. The
information provided in Part I is later used by the reviewing agency to complete Parts 2 and 3.
The questions in PW I am grouped in sertJoTis A-G:
Section A gathers information thatidentifies,the project sponsor,the proposed action, and the
proposed action's,location.
• Section B requests information about govermnent approvals or funding.
Section C requests infon-nationabout planning,zoning and conimunity services.
Section D requests infotion 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 elements that may avoid or reduce:impacts,.
Section G is where the certifying signature of the preparer is provided.
P�art 2 -is,completed by the lead agency. Fart 2 is designed to help the lead ageney inventory al I
potential resources that could be affected by a proposed action and to determine the potential size
of the impact by providing a series of questions,that can be answered using the information
found iri Part L To further assist the lead agency in complefing Part 2,, the form,,ideatifies,the
most relevant questions in Part I that will providle the information needed to,answer the Part 2
question. Part 2 is,designed to help a reviewer identify any element of a proposed.project that
,may have a potentially significant adverse impact on the:environment.
P'8rrt 3 -Is completed by the lead agency, Part 2 questions,where the impact has been identified
as potentially moderate to large or where,there is a need to explain why a particular element of
the,proposed action will not, or may, mutt in a significant adverse environmental impact should
be explored in a series of wrirtten,,we'l I reasoned statements-in,Part 3. The'discun,ssioof impacts
in Part 3 will serve as the supporting,doeumentation for the determination of sipificance.
FiAl EAviianizzental Asseunrent,poi-m
Part I -Pr ye and Setting
Inst'ru�ctions for Completing Part 1,
Flitrt I is to,be completed by the applicant or project sponsor. Responses become part,of the application for approval or Jundinelt
are Subject to public review,and may be subject to furl her verificaflon.
Complete Part I based on information currently available. If additional research or investig8tionwould be needed to,fully respond to
any itern,please answer as thorpughly 8 Possible based on cuntnt inCon-nation;indicate whether missing infonfladon claves not CAST,
or is not rea,sDnably available:to the sponsor;and,wben,possible,generally describe work or Vedles Which would be:neccssary to
update or My develop that id—orinstion.
Applicants1sponsors must cbmplefl�all items in Sections A&B, In Sections C,D&E,most items contain an initial question that
must be answered eMM"Yes"ct"No".. If the answer to the initial qtmstion is"Yee",complete the sub-questions thfft fiellow. If the
answer to,the:initial.question is"Ne',,PrQceed to the next qpestion. Section F allows the project:Sponsor to Welktll and attach ogy
additional information Section,G requires the name and signature of the,project sponsor to verify that the information ntained in
Pan I is accurate and roreplete.
A.Project and Sponsor Informiation.
Name of Action,or Project:
Project Location(desmibe,and attach a., rre I location map)-
I I
ns, App
l3riefDescription of Proposed Action(iAludt purpose or n& )a:
Ae– CX
0,
Name of ApplicarWSponsor- Telephone.* LA I
Address:
CityRa. State:S) ZT Code*
Project Con I tact,(Wriot!'Mets ipdn,864 give nafne and title(role). Telephone:
Address:
cit [ :
Zip code�
L
Property Owner (ifnuk,mht as:�Oqn1qqt)!,J Wephone:
1.
Address:
C,ity/FO: State* I zip Co4m
Pale 1 of 13
)3.Gdvernmerrt Approvals
0.Government Approvals Funding,or Sponsorsbip. C"Funud"ane includes grants,lauans,tax reliief,and any other fraa-nas of financial
assistance.)
nwrerrraraa nt Entity If'`t°Pes:Ident;ify Agency and Apprwrya s) Application Date
Required (Actual or projected)
a,City Council,Town,l3oard, oYescijNo,
or ill )3raard rafTrustees
lr.City,Tovm or Village `" �Ye° s No,
Planning]Board or Cornmissita r r
.City ouancil,Town or Q "es a No
Village:Zoningg Beard of Appeals
d.Other local spnwnies al'"des No
f
e.County agencies M Yes INNO
f Regional agencies 0i'Yes ) o
g.stat agencies !yes�, No
ha Federal Agoncies 0 YtsN,No _
L Coastal Rescorces,
L is the project site WAin a Coastal Area,or the waterfront area of a Designated Inland Watermy? P Ye,%XNo
If Yes,
if, is the projiect site located in a community with an approvedI ocal'"Y aterfront Revitall2ation Praugraml' E3 Yes a No
fiV. is the prospect site vAthin a Coastal Erosion Hazard Area,? 0 Yes 0 No
a .P'l.maanipgaindZoning
,..f,.Planning and Zoning aetlaans.
Will adnatittiWative air legisIdlive aadoptiaaar,or amendaaue,nt of a plan,local low,„orclinwice,nate or regulation be, Q1 Y 11,No
only approval(s)which must be granted to enable the proposed auction to proceed?
6 IfVes,bompku,smd nus C,F and G.
9 If No,proceed to question C,2 and complete all rernaiding,sections,and questions in Part l
.2.Adapted farad rise planes.
aa.to any aoctoicipoll -adopted (0ty,town,village or, arca )comprehensive head use plan(s)lndude ft site
w
ere the wabpaye0i action wwaaalal he luted
If Yt$;°does h.e comprehensive-plan iardade specific recommendations for the site where the proposed acdon MY-es 0,No
would be lcuaata~d?
b.Is the site of the par pars d by a u within any local Baa"regional special pl-aanning district(far example. may_ ,= a�
Bkowwanfield;Opper 'hJt ,Atwiep 0A,);designated State or Federal laea tAge area.;watershed management plana;
rar art'hea?)
IfY" s, Identify the plan(s):
C. is pro ala ci locant 6"aall or partially within an area listed in an adopted municipalY�ANO
air an,adopted rd udii ip,al fkrttwlah l pote tion plasm"
It Yes,iderdlfrtheplan(*
,e 2 of 1
C.3. Zoning
a,. is the siteofthe proposed action located in a mwaacipal ity with an adopted aonig9 law or ordinance. —t
Yes 0 No,
.
If Yes,What is the zoning classification(s)irncludiq any applicable overlay district?
b. Is the use peraoitte,4 or allowed by a special or conditional nese permit? es Ell No,
c.is a Ring change requested as part of the proposed action? 'YCs'R,,No
If Yes,
i°What is the proposed new zoning for the sit?
'A Exisfihg comm unity services.
a.In what school district is the proieut site located?
.. . ........
b.What police Or other public protection farces sense the:project situ
c.Which lire pmte on and emergency medital services sere the project site? �
- =
d. hatparks serve the project site?
D.:Frtaject-Detalls
W. and PotentialDevelopment
a.' hat is fhl�Eeruerayl:mature of nCltie paoposcdl action l e. .,,residential,industrial,commercial,recreational;if mixed,incIdde all
mponents ?
e
b,a.'°i'oUl aicreage,of the,site of the proposed action? � "�� ' aorts
b.Total acr`0290 to,be physically diatunr'bed? tic s
or eonMille� thea applicant,or project on p perties� nruued
c.Total acrea� e(project site and� contiguous ro
c.is the Deed action expansion of orad esistira ect or use? yes
p ° g prof
4.ifYrs,what is the approxiitnate peen to gg of the proposed Wanrnsion and identify the units(a.&,acres,miles,housing.units.
square feet)? " Units,,
A U the prppusO action a subdivision,or does it inch a subdivision? es 0 No
if Yes,
I Purpose or wple of nnbd Visi ?(e,&,residential,Industrial,commercial;if mixed,specify types)
Z An, u-
ril a dustlara�crw�aationn lam t ose�d"i"" o
a�
Iv.Minim mnai andmaximum.proposed lock,sig-? Minimum �� MWnrarnaaa & --
e.Will proposed action be constructed in multiple phases? "cs AND,
I i;Mbi,4inti ipgted period of t nsr~acti n _ tndan«@ns
Total Aumbtr of phases anticipated
P AntipipaW comale crmeit doe of phase l tincludi;ng dentplition) _ _ lrntio�th:
■ Atnticipaytcd completion date offin l phase � trna�ti)n ��ear
e, 6Pqe=J)y d.es 'live-onnecliDris orrelationships among ph=s,iholtnd°ang any coa.iOn#en<npW where PrOSTess bfoiipphase may
dtteon6cllmirig or duration of future pleases:
Pagp 3 of 13
f.Does the project include new residtotial u5 ? 0 'Yes 0 No
if Yes„show nuurabers of units proposed'.
Ea—SPY., 1"'x,,2paw. Mir-g Family MyRinkqr nuugre
initial Phase
At completion
of all phases
,g.Does the proposed action include new non-residential tonstu sctiou(including,euup sions)? 0' Yes No
IfY�es,
L ToW number of structures
t1,Dimensions,(in feet)of largest prWosed structure. height;�width; and length
M. Approximate extent of building space to be lueated or cooled: square feet
lr_Does the prqvsed action include construction or other activities that will result in the impoundment Gf'Muy 0 Yes YNo
liquids,such, as creation of a water supply,reservoir,pond,hire,waste lagoon, other storage?
If Yes,
is Purpose of'the impoundment-
ii If a water impoundment.,the grin ipal source of the water, 0 Ground water E Surface water streams pct Offier s,pectea.
fff_ If other than wmwrater�identify the type of iruw ndedicustained liquridhs and their souurte,
Iv. Approximate sl re,of%be proposed impoundment. Voluumet Million gallons;sauface area' acres
v.Dimensions,of the pToposed;dam or impounding structure: height; length
vi.Conswixtion,method/materials for the proposed dam or irnpcauundin,g struttuare it fill, lr, ood,concrete):
D.2. Project Operations
n.Does the proposed aeliom include any excavation,mining,or dredgirug,during construction,opemdons,or both? a YesJO 3^,l�o
(lot including general site preparation,grading or installation of utilities or foundations ww here;all excavated
materials Will remain onsite)
U "es:
i.Aat is the purpose of tine e:rcawmtitun or dredging? ,
if,How much ri'rrterial (including,rock,earth,sediments,etc.)is proposed ito be removed frorm'the site?
* Volume(specify turves or cubic yard*
Over what duration of time?
M.Describe mature arum characteristics of materials to be excavated or dredged,and planus to,use,Tnanage ordispose of them.
iv, Will there be onsite dewatering,or puaocessing,ote eavated materials?" C3'Yes o No,
if"yes„°desbe.
v,Wbi is the total area to,be dredged our a v^ aced? at e
vi What is the maximum area to be wwo.rked at any one time? arras
vii.What would be the maximum depth oi'excavation or dredging?' fbet
Wit ''4huill the excavation require blasting" 1:1 Yes®Alo
Summmize site reclamation goals and plan:
b.Would the proposed action cause our result in alteration oi",increase or decrease in size,of,ormeroachment 0 Yesl'c
into any oxistlrng wetland,wwat>erhrndy,aluu limey beach or add ac;ent sma?
Iffes:
t Ideptify the wetland or wwraterbcdy which would be affeeW ft namt,water index numWr,wwweiland-map number or getgraphie
description):
Page 4 of 1.
U.1)escribe hcvw the proposed!,action would affect that waterbody or wetland,e.g.exzavalion,fill,placement of struct ares,or
alteration cl cbannel',%banks and shorefines. Indicate extent of activiiies,aheraflons and additims in square feet or t-iereq,
Ui. Will proposed action cause or result in disturbance to bottom sediments? m Yesai No
If Yes,describe:
N, Will,proposed action cause or result in the destruction,or removal,of aquatic vegetation? Yes O'No
area of vegetation proposed to be removed
• expected acreage of aqyatir-vege%tjon remaining after project completion
• purpose of proposed removal(e.g.beach clearing,ill species control,boat aems):
• proposed method otplant removal:
• irchemicalftierbicide treatment will be used,specify pruduct(s),
v,Describe any proposed reelarnation/mitigation following disluibiance:
c.Will the proposed,action use,or create anew demand for wateuMYes o
If Yes-
4 Total anticipated water usagelileril per day;
H. Will the proposed action obtain water ftm an existing public water Supply? 0 Yes 11 No
If Yes:
* Name of district or slice area:
* Dots the existing public water supply 11ave capacity to serve the prop l' M Yes Ell No
Is the project site in the wasting district? 01 Yes Ell No
Is expansion of the di&dct needed? C31 Yes M No
Do existing lines serve the project Mitt? M,Yes M No
In Will line extension,within an existing district be necessary to supply the project? E:i Yes 0 No
Iryes.
Describe extelrisions or capacity expansions proposed to serve this pivel
0 Sourcel of supply for the district:
iv.Is a,new water supply district or service area proposed in be fwd to sere the project,site? C)Yes;ONO
If,Yes:
a, Applicant/spol for new district-
0 Date application submitted or anticipated:
a Proposed source(s)of supply flarnew district,:
v,If a public water supply will not be used,describe plans-to provide VAIefsil for the Pil
If water supply will be from welts(public:or private),maxi muni,pull capacity:_gallonslil
d.Wil:I the proposed,arAl.on generate I iquidwil 0 Yes XNo
If Yes:
i, Total anticipated liquid waste genel per day. gallons/day
11,Nawre of liquidwal to be Senerated sanitary waskwiter,ififtdadal;if combinatio%.describe-all omponexits land
approximate volumes or proportions ol
HL Will the proposed notion use any existing pubtic Wastewater tteaftent fladil ifles? 0 Yes a No
If Yes:
Name ofwastewager treatment plaralto'be used;
Name of district-
Does 1hewdsting wastewater treatment pliant.bave ca; a*to serve the project? 0 Yes a No
* Is the project site in the existing distript? 0 Yes M No
* is expansion of the district needed? C�Yes El NO
Pap:5,Of 13
Do existing,sewer lines serve the prcujeci, site? 0 '"t"es 0 No
Wili line exte`rusicun with in am existing district be nice=,arw tui serve the priaJee? 0 'Yes a No,
if ''es.
$ Describe extensions or capacity expansions proposed to serve this project'-
iv-
roject iv-Will a new wastewater(sewage)treatment d wstrict be formed to serve:the pri site? 0 'Yes o
lf'les;
0, Applicant/sponisor fuer new district
o- Date application sutbrri;itted or anticipated-
What is the receiving eater for the wastewater disclill
v,. if public fheifitles will not be used,describe plans to providc wastiewater,trwment.fuer the project,inclu4iiog specifying proposed
receiving grater(nameand classification if i discharge,or describe subsurface disposal plaria).
Vii.Dwicribe any plans,or designs to,capture,recycle lot ruse liquid waste:
e,Will tine pr posed wtion disturb more than one acre and create storrrnw titer runoff,either fararra now point 0 '1 WN0
sources(Le..ditch ,pipes,swailes,enrrbs,gutters or other conn flaws aws of stormwurater)or non-prni rt
source(i.e.sheet flow)during eco nstranetieru or post construction?
If Yes:
i.How much impervious surface will the project,create'in relation to total else ofproject parcel"i~
Square feet or acme impi surface)
Square feet or acres1psrcel M20)
ra,'Describe types ofnew point souarom
tiff. Where will fhe vormwater runoff be directed(jx.on-site sttortrnw titer management facilitylstruocuures.adjacent properties,
grcundwater,on-site suurfacewvater or Off-site swurface,wl
. If to surface waters,identi fyreeelving wa+°al rbodies or wetlands:
ilil stom ater runoff flow to adjaceutt-piru~mpertinw,s'l 0,Yes 0 No
iv.Does proposed plan minimize impervious rfaaues, a peryiruus materials or collect and re-use sterrrai 0 Yes rn No
f. Does the proposed action include-or will it use:on-silt„,one er moire sources of air cmissio ns,including Fuel 0'"de) ro
mbuastion,waste incineration,er other pram,or operations?
"es,identify..
r.Mobile sources during pm uwct pec iri us e euttuipuuuu cut,pct uwr uiellwre wreluicles)
R Stationary sources during construction(pg,power generaticn,,�u uctnural heatiru ,batch plant;,crushers)
era,Stationary sources,during rnperaticarns(e.l peocdss,emissions,large bOers,electric:generation)
g.' ill any air ernission so es,named m D. - 6Fb ri taire a WY Y Air Ttegnstrratitorn,,;fir Facility pexnrtlt;, 0 Yes to
or Fiederal Clean,fir Act'Title IV or'T'itle,V Permit?
I:f yiesw
r. I's the project site located in an Air gani®lity°rrnut ttairnmentit area? routinely sur periodically fells to meet 13 Yes 0 No
a blicat air quality,starrodsurds for all or,some pmu.of"theyear),
FL luu;eddltiian tcu en isslu�wtus as calcuulatad n lite apptlupatiton,thitn project will gems:
} Tanslyear(metrltu)tof Cwbon,Dioxi e e)
7u sias ear(metric)-of hues Oxide(120)
” onts ear(metric)uof lloe uol(TT' ,)
Tun nslyear(met l ofSulfur Elexaflueldde(9F6)
Tbnns�rear(tuu>etri c)nofCorbotu DiolAdc equiVsletut of yduo ncsarba ns )
"f'"sonnsfyear(rimttiw).cif HAzardousAir Pollutants(HA-Ps)
Page 6 of 1
h.' ill the proposed action generate or email methane(including,,brant not limited to,sewage treatment plants,
landfills,cornpostin ,f iiitfles)'
Iffes.
i,Estimate rmelbanegeneration in,toms✓'wyeer(mnetric). -
ii 'describe any mnetharne ca nt,mre,control or elimination rrneasuures included in project design(e.g,.,cornlruustion to generate beat or
electricity,Marin
i.Will the proposed action result In the release of air pollutants from a+perm-air,operations or processes,such as 113 ''yes 0 leo
query or landfill operations?
If Yes.,Describe operations a n-d,matt=of emissions(e.g,diesel exhaust,rock pa icnnlate0dnnst).
J.Will fire proposed action result in a snubstorttia l increase in traffic above present levels or generate substantial 0. ` No
n dem and for transport0io n faeilifies or services?
)Ii" esw
t:When is the peak tic exp=ted( mak all th k apply). ON,ornigg, 13 Evening OWeekend
13 Randomly between lnornrs of to
U.For commercial act[vilies,only,,Project ed number of serrni filer ttunnclu trips/day.,
M.Parking spaces. ExjsqngProposed _ Net increaseidecrease
iv.Does the posed action imelnnde any shared,nese parking?' 0,Yes 0 No,
v. Iftlne proposed action includes,any,modification,of existing.roads,creation opmew roads or cb=ge in existing,access,describe:
nil, Are public/privote trartsportat'loil s ice(s)or f ilities available within ° anile oftlue proposed site? (I es a Nen
vlf Will the piroplosed acti rn umelude access to public transportation or accommodations for use;of hybrid,elecAric 0 'Yes t]No
or otheralternative:ative fueled vehicles?
vid.Will the proposed,action includeplans for pedestrlam or bicycle accommodations modations for connections to existing 0 Yes tq No
pedestrian or bicyc-le routes
7t.Will the proposed ee m r rnnrlizMal or industrial projects only)generate new or additional,domand o
for energy?
Ifyes.
L Estimate annual elecuicity demand during operation ot'tbe proposed ado n.
V,Anticipated sonnnrces/smpppliees of electricity for the project e.g.,on-site combustion,on-site renewable,via grid/local utility,or
other)..
M. Will the proposed"on r q u„lm to hew,or an upkMAe to,an existing;substation a a Yes El No
1,Hours ofoperation. Answer all itemns'hieb appy.
1 During Constructiarit tl. During Operations:
P Monday- iu yw m Monday Friday:
Saturday. m Saturday:
Sunday- utmda,yr.
holidays. Hol idays..
Page 7 of 13
rru, Will the pro,o, ed a lum produce ruuaise that will exceed existing arnbient noise levels during construction, ❑ Yeso
operation,or,both?
If yes-
i. Provide details including sourccs,time of day and duration:
��. Will ..�.
proposed action remove existing,natural barriers that could act as a noise atrier or screen? 0 es" o
Descritue
rr.. Neill the proposed action have outdoor lighting? ® "Yes fru
If s: g p
i.Describe,scuaree s le�caticn s ,height o iixtuuru dia kioru aarra,arud roxuauulty to:raeaurest nccumpaed atruetarres:
lt, hiliprewposed action remove;existing,natural harriers that uald acct as a light mer or screen? �es 'l�9ea
DescTihcw
.Maes flue proposed action have the potential to produce odors for morethm one hour per day? � des l�lra
If Yes,describe possible sources,potential frequency and duration of odor emissions,and proxirruit,Y to urearest
o ecce vied Structures:
p.Wild the�rropeased adt°Qn include any bulk storage of petroleum(over 1,100 gallons)or chemical products ® Ya ", No,. .
(over 550 an:lions)?
If Yes:
L dun s)tea -stoned
I!_Vojuamarejs)— per'uitit time—
m,
itm e— �e,��month,year)m, Generally descrikiptOp6sewl stOrA&e facilitic
q� will time prop ramet riaal,industrial and recreational prmaIeCts only)use pesticides i.e.,herNaieidesa_ 0 acs ¢a
Dead action
-itu=tleides)during eorusttuuction oroperatiotu?
lf "'es;•
L Descri�ie proposed.lreament(s).
H Wip t sed actioriuseIttemated Nst SRL- Pmcdccs? -
r.Will the propose , tiit�mm(tottrrnercial or Industrial projects only)involve or require the management or dlsq til 0 �s o
of'soliel vwaste(, uludtau las us materials)?
If Yes:
L Describe any mild st d)to lie;generated daring corustructirur�or eapeuation ofthe fa ilityw.
opstructld n'; tenons per _ (Orbit of time),
+� Opetatiou: tomos per (unit of time)
ll bescrilae Ohy proposWs1'or on-site mini muszat n,recycling or recuse of materials to aumid disposals as solid taste:
'Opfttiorra
r"a p ssd disposal: tethods w lit s%'or solus waste generated oit-sults.
onstru' Cu n:
Opermiearur
Page 9 of 1
s:.Does the propused action include construclion or madification of a solid waste management facility? E3 Yes%No
if YM
i. Type of managerrient or handling of waste proposed for the site(e.g.,recycling or transfer station,composting,landfill,or
other disposal activities)-
aa. Anticipated rate of disposallprocming;
Tons1month,if transfer or other non-combustionAhermal treatment,or
Tons/hour,if combustion or thermal treatment
fit Iflandfill',anficipa 1"site life: years
t.Will proposed ac on at the site invaIve the commercial genention,treatment,stomgc,or dis,posal of hazardous
waste?
if Yes;
P_Narne(s)of all ha=douswastes or constituents to be generated,handled or managed at facility:
E Gcnii7ally aese'r3be processes or activities involving b&zardous wastes or constituents:,
U1. pedify oxhoiant to be handled or generated torlsftonth
Iv.Da§rnbe an,y proposals for onsite minintization,recycfing or reuse of hazardous constituents:
v.Will any hi—�ous vasaes be disposed at an exi*ng offshe hm waste Mlity?
If Yes:#lb-Olde name and location of facility.-
Jf No,describe proposed man ermmeut of any bazardous wastes which will not be sent to:a hazardous waste tai lfty:
E.Site and SiMing of Proposed Action
E.I. and uses on and surrounding the project site
a.jiXisting land uses.,
L Cheek all uses Mat o�ccur on,adjoining and near the p,ro4ect site,
a UTb2o o industrial a Commercial Residential Ouburban) 11 Rural(norm-furru)
r,' Fomst � Agriculture 0 Aquatic 0 Wier(specify):
H. If Mik of pslts,generally describe;
b.IAO uses gna covertypies on the project site.
Land use err Current Acreap After Ch-ange
Coverlype CoMpletion (AC'M+/-)
RoaAs,buildings,'and other paved or impervious
sauce
Fisted
Madavo,grasslands or bruAilands(non-
g000ltucal,includ ig,abandonfed agricultural)
Agricultural
harem u*s!ac6ve orchards,field,,greenhouse etc.)
S p 6*0,*te r fe aluke s
(Jgkp,ponds,stremanus,.Ayars,etc-)
WOW$ §hwater iorifidal)
0 Nonmetated0are,Tock,earffi or fill)
Describe:
Page 9 of 13
-c.Is theproject,4itepresently used by members ol`the community forpublic recreatiorn? 0 Yes
If Yes.explain: _
d.Are,there any facilities serving,ehildrtn,the elder,lyr,people with disabilities(e.g.,schools,hospitals,licensed ID Yes YNG
day care centers,or group,homes)within 1500 feet of the pruiect site?
If Yes,
i. Identify Facilities.
e.Does the Deet site contain an existing,dam? 0Yes NO
Ifyes:
i,Dimensions of the darn and impoundmernt.
0 Dam height: feet
■ Dam,length: � feet
Surface area.- acres
Volume irnpounded:, gallons OR acn feet
f1.Dams existing,hazard classification.
zfi.Provide date and summarize results of last inspection.
f.Has the project site ever been used as a municipal,commercial or industrial solid waste management faweilityr,, Mi "lYes No
or does the project site adjoin propeM which is now,or was,at one time,used as a solid waste management facility?
If Yes:.
L,Has the facility been formally chased? OWSM .
0 If yes,cite sources/docurne ntation,
H 'Describe,the location of the project,site relative to the hrnrrrrdiaries of the solid waste-management facility:
v"lr Describe any development co sty rats due to the prir r solid waste activities:
.
Have hazardous wastes been generated,treated atnd1or disposed of at the site„orAoes the project site adi 0 i C31 Yel No
propekty Which is uowr or was at one time used to commercially treat,store aniVor dispose dbazardots waste?
If Yes;
L l lescribo wvaste(s)hand led and waste,management activities,including approxknate tfnne wwuhen activides ocourred.
h. Potential corntamination historyx. Iles there been a;reported spill at the proposed pre jest sl!ry,'or have any 0 Y No
remedllol,actionnus been conducted at or adjacent to the proposed site?
ifYes-.0
L is any portion of the site listed on the l^YSDEC Spills Incidents,database or] nvirommental Site 0 Yes No
Ifenanediakiorn dataWs heck all that apply;
01 Y —Spills Incidents database Provide DEC ID number(s):
rr Yes—Environmental,
Site Remdiadon,database provide ITEC M number(;).
0 Neither database
ff.If'silt. been-sub ct ofRCR4,corrective acdvides&des rite crrn rol measures:
M,It the project:within 00%ett of any site in the NYSDIEC rmVironmental Site Remediation. database? Q yesPo
If yes,,pr ide IDS IIS an be s
N.If yes to(1%Cd)or(iii)above,describe currentstatus,of'site(s)
"age 10 of 1
V,is the project site s;rtbitct to an institutional control limiting property rises? 113 'Yes No
9 If yes,DEC site ID number
0 Describe the type of institutional control deed restriction or easement).
0 Describe any,use limitations:
P Describe any engineering�control5:......,„_.
� °ate, ,.,
Wil l the:project affect the institutional or en incefirig controls in place �"? es� 'o
Explain:
rL . Natural pk:murees On or Near Project Site
a.What is the average depth to bedrock on the project site? feet
b.Are there:bedrockoutcroppings on the project site? 0 Yes No
'i
if-Yes,what;propodion of[he site is comprised of bedrock outcmppin ?
e»Predonrinant soil types)present on project si u
d. Vaat is the-avera:ge depth to the grater table on the project site? Mttage, feet,
e.Drainage tatau's of project site soils: Will Drained:
aF Moderately'Well Drained: of site
poorly Drained, %of site
f .Appr arimate proportion of proposed;wtion sires with slopes: 0.10%.: of site
10-15%:: ,of site
0 'lor greater. �%of site
&Are there any unique geologic featmes on the proiect site? 0 Yes!XNo
if Yes.,de rite:
h.' rrrface water features.
L Does arty portion of the pmj-eat site cotrtaiirr wetJands or other arraterbodies(including stroams,rivers, 0 Yes 'No
ponds or lakes)?
ea_DD weftnds oa other aterbodies adjoin the project sitc? E3 Yes o'
11' "es to,either 1'or It,continue. If No,strip to E-21
IM Are any of the wetlands or xwaterbodies within or adjoining the project site regulated by.any Rderal., 10' °es 'No
state or Venal agency?
iv.For each idenflified wetland and woubody on the:project spp e,pt, rpde the following in:f`orrnatiorL
t„rearns: Name Classification
Lakes or Ponds. Name Classification
a Wetlands: Name, Appmoximate,S�i
WedaW No.(if rego ated by DtCj
v. Are any of1he above water bodies,listed in the most,recent compilation of skater quality4mpaired 01 Yes o
wr^arte bodics?
1f yes.,name of impaired water body/bodies and basis for fisting impaired:
No
p.1s the prarje site:in a designated Floodwaray? eyes
is the project site In the 100,year Floodplain? 0
lr.is the project site in the 5001 year Floodplain? m Yes Flo
1.IIs the ptojW site located oyez,or inmediatel,y adjoinin ,a ppr`1ihOr ,principal or sole source aquifear? � es No
117 Yes:
i.Namo ofaquifcr. .
.i1 Source of information:
Page 11 of 1
va, ldentif�the predbmi�nant wildlife species that omi=ocuor use the project site:
D.Does the project site contain a designated significant natural.community? 0 YC5 No
l f yes;:
a, Daseribe the habitat/community(e reposition,fue tion,and basis fordesiorratiurr)
a� �au, e(s��f description ur ew�alra�ti�rw
M.Extent of cornrnu ni ° a itat.
„6Currently: acres
r Following eorrrplietibn of project as proposed, acres
a drain or loss(indicate+err-): _acres
o,I)oes project site contain any species of Pl-ant or anirnel that is listed by thefederaiguvcrnment or NYS as 0 Yes%No
endangered,or threatened,or does it contain any areas idenifflmd as habitat for an endangered or threatened species?
If Yes-.
i, Species and listing(endangered,cc threatened): _
R.Nature of use of site by the species resident,sea val,„transient).
p. Does the pv ,jieet site contain any species orplant or heal,dot-is listed by NYS as ire,or as a species of Q Yes o
special concern?
If Yes:
L Species and listing
Ia.Nature of use,of site by the species(eg,,resident,seasonal,transient);
q.Is the projeetsite or adjoining area currently used for hunting,trapping,fishing or Aelll fislwirrg? 0 Yc9X No
If yes,give a brief deserrption of how the proposed action may affect tl�tat W'e.:
� m
E.3. Designated Public Resources On or Near Project fte
.a.Is the project site,or any portion of it located,in a.designated agdcultural district cerdlied pursumit tea 0 Yep VNo
Agriculture and Markets Low,,article25-AA,'Section 305 and 304?
if Yes, prarridermunty plus district nanaev°hunibet4
b.Are agr'icuxltural lands consisting ofhighly productive sails present? 0 Yes ,N,
i,if'Yes: (s)on prorject sit i
a ou e(�)of sail rating(s).
c» Does the project site contain all or I ; r is it substantially corit(guops t a regist- I^l'ational � Yes 'l lea
Natural Landmark?
If Yes:
L Nshut of the natural landmark: U Blologibal,community 13 GeeloBieal1~eature
Ia'.:provide brief description of landmark,including Values behind designation tri approximate sized" . t'.
d.Is the project site located in;or does it Odjoin a;state listed riklErivimmemul urea? 0 Yes VNo
Ifyes.,
t:CEA nanat:
Basis:for&signgdon.
HL Designating agency and elate:
Page 12 of 13
e.Does the project site contain„or is it substantially eondguoais,to,a buoilding,archaeological site,or district C3 Yes
which is 1110 14 on,or has been norniiaated by the NYS Board,of&l istoric Preservation for irliclusion ori,tlw
State or National register of Histone Places?
If Yes,
1, Nature of histor c areba l ical resource: rebawlo ical Site 0 Historic Buildina or Disuict
ai,Nai¢ie:
r'aie Brief description of attributes on which living 1;SL biased:
f.is the project site or any port.iiari of it,luted in,or adjacent to an area desi;zrarated as sensitive for o Yes No
archaeological sins the NY Mate Historic Preservation, Off-me( 'O)archaeological site inventory?
g.slave additional archaeological or historic sites)or resources been idcuitified i ii the project site' � "� l�'0
If Y=
L Describe possible resouurce(s]l:
i'i.: asis for ideo,tifi-catim::
K Would the project site be visible from any officially desi natcd and publicly accessible federal,state or Vocal _ yes NO
scenic or aestheticresource?
IfYes-
i. Identify resource.
If,Nature of,or basis for,designation taibnlished highway Overlook,state or local park,state historic trail or scenic:byway,
HE Distance between proyjectand re.souirce:. _ .., mil-es.
I. is the pri4ect site located within a desiguuated river corridor under the;Wild,Scenic and Recreational:Divers E3 "des
Program6 XYCRR 666?
If Yes:
L Identify the name of the river sand its designation:
ii,bs ties activity insistent�writh de^waWl�obw�e�t restriiicuns er�atsuir�ed iri .D:fart �"� ���"es�lo
F.Additional Information
Much any additional informatlDnwhieh inay'be needed to clarify yourproject..
If you have identified any adverse impacts which could be associfiteA wM your proposal,please describe those iraipaeft pines any
measures which,you limon to avoid or rrudirnize Them-
Gw. Verification
I certify that the iiufhr7iiation;oA ed is tnac'to the best ofrity knowledge.
Signature
Poge y.3 of 1
Agency Use Only Jlfappfltablej�
Project;
Daw.
Short En,vironmental AssessmentForin
Part 2 -Impact Assessment
Part 2 is to be completed by the Lead,Agency.
Answer,all of the following questions i;l Rart,2using the information contained in Part I and other material$submitted by
the project sponsor or otherwise available to the reviewer., When answering the questions the reviewer sihould be guilded by
the concept"Have rny responses been T"sonable considering the scale and context of the proposed action:'
-Ko,—®r Maderate
small to large
impact irnp(act
may ma y
OcCur occur
I. Will the proposed action create a material conflict vdth am adopted land use plan or zomng
regulations? rEl
2, Will the proposed action result in a change in the use or, intensity of use of land? El
3,
''ill the proposed action impair the ch aracter or quality of the exist ing co mrn Un ity?
LEJ
4. Wi I I the proposed act ion have an i n�ipact an the envi ron mentall characteristics that caused the
establishment ofa Critical Environmental,Area,(CEA)l?
S. Wi I I the proposed action result in an adverse change in the existing level of traffic or
affect,existing infi-astrumve fdr mass transit,bilking or walkway? 11,
6. 'Fill the proposed action cause an intrease in the:use of energy and It fails to incorporate
reasonably available energy conservation,or,renewable energy opportunities? E3 0
7, Will the proposed action,impact existing,
a, public/PTNate Water SUPPI iCS? D El
Ib. public I private wastewatertreatment Of itigs? Ell ; D
S. WiR the proposed action impair the tharacter or quality ofimportant historic, archaeological, —1 D
architecturallor Aesthetic resources? E
9. Wi I I the proposed action result hi an adverse change:to natural resources(e.8-, wetlan4s,
waterbodies,groundvwAuT, air quality,flora and fauna)? F-1
10. illI the Proposed action result i n an i nerease in the potentia]for erosion,flooding or drainage
problems? LJI
11. Will the proposed action create a hazard to environmental resources orhuman health.?
PRINT FORM Page I of Z
Age:n r UseOnl r Mapr— 1--LI-11
Project.
Date,
Short Environmental Assessment Parm
Part 3 Determination qfSignificance
Fbr every,questioll in,part 2 that was answered "moderate to Large impav may ocour",or if there is a need to explain.why a
per [oular clement of the proposed action may or will [lot result in a significant adverse environmental impact,please
complete Part 3, Part 3 should,in sufficient detail:,,identify,the impact, int:1u4ng anymea5ures or design alernents that
have been included bly the project sponsor to avoid or reduce im Pacts. Fart 3 should a I'so explain how the load agency
determ lued that the irnpact may or�wi I I nor be significant.Each potential impact shoul d be assessed considering its setting,
probability of occun-ing,duration, irreversibility,geograpl.i,ic scope and inagnitude. Also consider,the potentiall for shart-
term,long-term and cumulative implacts,
=
that ctFke thp
i
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doromn tohree ipnoftoernmtiaatlilynlarge
oars slygsn fiacbaonvtea,davnedrsaenyhnspuWppos radnng a1
dno
cu mentat[on,
envronmental impact staternent is required.
Check this box ifyou have detemind,based oil the informaion and alalys[s above.and any supporfin�g documentation,that the proposed
action will not result in any sigilficant adverse envirorimmitaI impacts,
Name of Lead Agency Date .....
Print or Type Name of Respionsi ble�0,fficer in Leadl Agency Ti tier of Responsible Officer
Litalure olReson,-,ille Officer in Lead Ageney Signature of Preparer(if'different frorn Responsibille ffice-:r
EPRI T' FORM Page.2 oft