Site Plan Application OI „x.D
General Infonpation
"I""a Parcel ll]Number: 3,09.10-2-69 APR 16 2018
04 ��)F SUE EI,J,,_� N,�d�`Y
diraIGyitrct: Main �rmet 1Ll11^ 1dFO .
'mot size: 0.14 Acres
Derailed Description of Project [includes current&proposed ruse]:
E istim r h_ ra r rt r i r ri l a
Dation of project.
Applicant Name; Address: P.0.flex
rmrrr�ur�i�Cbalael of West�:r
5,132
Glens Falls Nle 12801
Home Phan 1.�.: X5181320_ 385
Work Phone Fax
E-Mail:: dcomrbsl@h rzo,gla .co
Agent's flame: address:
Home Phone Cell:
Work Pace Fax
E-mail
Owner's Namedre s
(same as aplirant) Ad
Horne Phone _ ill
Work Phone Fax
E-mail
2
Site Plea review application—Revised Wober 2016
Town sof Queensbury Planning Office-742 Bay Road,Queensbury,NY 1280
Site Development Data
Area/Type Existing,siq. Ft. Noposed Total. sq. ft.,
Addition sq. ft.
A. Building fbol�u nt
3,596 a, 3,5916
13. Detached Garage: 0 0 0
Cl. Accessory Structur ) 0 0 0
DPaved,gravel or other hard,surfaced arca 46,6 466
Porches/ Dcoks
263 0 263
F- Other 4010
0 40,0 Over Asphalt
G. Total Non-Permeable [Add A-F] 4,125 0 4,325
H. Parcel Area [43,560,sq. ft./acre] 6,303 0 6F303
L Pcromage,of Impermeable Area of Sito [I=G/Hj 68.6% a
Setback Rgquircinents
Area Req uir;"d— Existing prop 'd
Front(I
'A LO,
�Mnt �21
Shoreline
Side Yard[I]
..... -----
............
Side Yard I[ ]I
..... ..... ------
Rear,Yard [1 10"
Rear Yard [2]
Travel Corridor
...........
Height[max] Sol 30'+/- 30"-/+
Permeability 10% 31.4% 31.4%
No, of parking s,paces 2 2
3
Site plan Review application—Revised October 2016,
I"olmnofQatensbury Planning,Office-742 Say Road, Queensbury,NY 12804
Additional Profect Information
I Will the proposal require a Septic Variancee from the Town Board of Health.?' No
2. If the parcel has previous approvals, list application number(s): No
1, Does this project require coverage under the New York State Pollutant DischargeElimination, System
(SPDES) Permit Program No
4, Estimated project duratiom, Start late "R2018 End Date JUL 2018
5. Estimatedtotal cost of projecc $:2,000
6� Total area of land disturbance for project: 400,SF
Floor reit Ratio Worksheet
FL ARFA RATIO (FAR) -- The relationship of building size to lot size, derived by di by di the total
Lo
,b uilding por area by the lot size in, square :f&et, yielding a percentage,
g 0 r
Xuildin
�'—��yrnbol -1111...........
oninarty AR]
Zg Dist:ric
Waterfront R;es!�id�cn�d— WR 0,22
..............
Commercial .Moderate/ In sive CMJ C1 0.3
A. The combined area of all squa : footage, as :measure from c.xtc r walls of all structures on the property,
including all floors of the structu , garages, basernents and , ties with more than, five., ( feet of ceiling
height and covered,porches, Buildin quare fbotage does t inclu&:, Open deck" docks and that Portion of
covered docks, extending over water, an . ne storage sh '' of one hundred twenty (120), square feet or less.
Any additional sheds will be included, (Se6, " LOOR EA RATIO").
B. Commercial or industrial:: the total area in se uar I as measured from the exterior of the outside walls of a
building or structure,, and when applicable, th s total, of all floor areas of the principal and accessory
buildings orstructures on the project site.
Area .
U. Exis,ting Floor�Area 7 ft. [see,above definitio:rJ_
C. Proposed Add-ftio-nal F
D. Proplosed Total F or Area s q� ft:
or A
2
E. Total Allow It F71oor Area I'A�reax ke above,table
*1f D is 1a: ear than E a variance or,revisions to, lur plan may be:needed. Co7nsult w—ithStaff,
� a iz
*If D—is la 7er wthanj(E va, yo
r
4
Site Plan Review app licatian—Revised Ofetobler 2016
T Tow
own of QueensbiRry Planning Oiffice-742 Bay.Road,Queensbury, NY' 12804
§ 179-9�-080,Reguirements for Site Plan Alpgrovsl
The Planning Boerd shall not approve: a Site Plan unless it first dime Ines that such site plart Meets the
following Standards. Please prepare responses to each oftic following topics:
STANDARDS
The proposicd project Furlhers or is,consistent wi tit 010 policies of the Town's Comprchcrisive Plan.
797-TK1e7r;-Po;ed pr*47t cornplics with afl odier requirements oriiiis,cllapter,irlob im I a.i.ng Ou site plan review standards asset forth in.Panagraph
F of this section,the dimensional,bulk and density reguladons orthe zoning distrjet.in which it is pniposcd to be WcWcd(Article I and
1,al,A, pliacable requirements F all other ArLietes that apply.
C. The site plan oncoitrages pedestrian activity internally and,il7prazlicable.,Co and from the site with pedestrian paths,OT sidewalks conri;R—W
to adjacent arcas.
D.
The site plan must,conform to Chapter 136,Sewage and Srwagt Disposal,Chapter 14? Storrnwater Management Local Law,and other
applicalite,local laws,
E. -The—prupasod use shall be in harmony with the general Purpose,or intent of this Chapter,specifically taking,into account the location,
charaver and Size of the proposed use and the description and purpose of the distriet in which such use is proposed,the nature and intensity
of Elie activities;to be involved in or conducted in connection with,the proposed use and the naturo and rate of any increase,in,the burden on
supporting public services and facilities which will follow the approval of the:proposed use.
P
F. :estobli,5bmcnt,,main.,tenonoca.ndqperationorflic roposed use will nourreatepublic hazards,from traffic,traffic congestion or the
parking,or vehicles and/or cKp6pmev or be otherwise detri i1wrtial,to,the heafth,safety or general welfare,of persons rcsid ing or working in
the neighborhood or to the general welfare of the town. Traffic:access mid circulation,road ingerw(,tions,road and dri wuway widths and
Ira Me controls will be adequate!,
... ........
N F-s t r 0,-cI parking and 19oadin facilities will be appropriately located antl arranged and sufficiant to meet traffic anticipated to be generated
by the new osa, The establishment of vehicle links between parking areas ofadjaccat properties arc provided where feasible. This,furthers
the Town"s goal of reducing curb cuts and reducing anigestion.. A twenty root wide connection is required. Iradjacent properties are either
urudevdaped or previously developed without having made provision for ruluric linkage,then a future connection must be idLntificd and
provided for in the site plan under review for such future linkage when the time arises. The Planning Board may require:pnoof that t4-
appiicant bas made contact with adjacent property owners for pvtpowsofiwordinafing linkages with a4jaccm properties,
H.
Theproic�t Tshall not have an,undue adverse hripact upon lite:natural,sconic,aclsthcfic,ecological,wildlife,hislofic,recreational or open
space resourcos of the town or the Adirondack Park or upon the adequate provision of supporting facilities and services urate necessary try
the project,taking into aocount the commemiaI,indLiStFial,residential,recreational.or other boftefil,%that might be derived from the project,.
In making the determination hereunder,the Planning Roard shalt consider those factors pertinent to khe project contained in the
dovc1opment considerations set r0f1hr herein under§ 1791-9-080 ofth i's Chapicr,and in so,doing,,the planning Board shall niake a net ovcTall
ovalualion of the project in relation to the develrOpMellt objoefi Ve$and general guidelines set Wh in§ 179-9-090 of this Article_
The Provision for andarrangement of pedestrian traMe accem and circulation,walkway struuctures,controlof intersections,with vehicular
traffic and overall pedestrian convenience shall be safe:and adequatefor pedestrian movement, P'OdastriaTliconnections between adjacent
Sites shall be PrOVrl4LXJ to encourage pedestrian use.
J. watormwoter drainage Neil it[CS will Prevent an increase of post development drainage;flows as compared to pre-development drainage nows.
drainage of the site shal I recharge ground water to the extent practical- Surrace walers,flowing oft'--;site shal I not dogradc any streams,or
adversely affect drainage on adjacent properties or public roads. Facilities shall be in wriformanoo with the drainage stan4ards,of Chapter
147 of the Town Code and the Town of Quccnsbury Subdivision Repu Lat ions where applicable-
Thu water supply and sewage disposal farilities wilt be adequate and,wil,l mccl,all applicable:and current requirements set forth by
Department of HoaRh regulations and ;hapter 13�6 of the'Town Code-
The adoquacy,type and arrangement of treas,shrubs and other suitable plantings,landscaping and screening shall effective" y provide.a
v[sual and/Or noise buffcr between t applicants and adjoining lands.,indudiftg tho maximurn retention ofcxisting vcgctaAion and
main terianee, indiuding replacement of dead or deceased plants.
Mej— m
/"ire lanes,emergency zones and fire hydrants wi 11 be adequatc andmccl;the needs and rcqu i rcmcn:ts of emergency service providers.
T
I N. The desip ofstructurcs,roadways and landscaping in areas susceptible to pondiug,flooding and/or erosion will,MirfliMi ZC or avoid SJUCh
impacts;to the maximum extent practicable.
0, The site plan conforms to the design standards,landscaping slandards and,performance slandards ofthis chapter..
5
Site Plan Review application-Revised October 201,6
Town of'Qlueensbury Planning Office-742 Bay Road,Queensbury,NY 1284
179-9.0 0 beckl'ist-Application for Site Plan, Revie .
Application materials and site plan shall include utffici nt information for the Board to reviewer and provide a
decision. The applicant is to provide a site plan drawing and all arta hmcnts that address it ms,. -V, The
applicant may request a waiver frorn ,A-V and is to provide reasons far waives) requested. Please label
information n tau,be submitted.,
REQUIREMENTS 'Sheet#
A A vicinity map drawn at the scale that Shows the relationship of the proposal to existing irw'mmnuunily facilities wwhhch affect
or scrve it„suchen as roads,shhoppiq areas,s0oulis„cic. The reap shall also show all Properties,i;denaif'y owncrs,
&LLWivisiens,structs and easements,within 50Q reet of the property. Such a Aetch may pre superimposed on a united States
_Qeol2jiSal Survey map of"thue arca.
The site plan shall be drawn at a scale of Forty feet to the inch(I" =dfl feet)or such ether s.eale as the planning Board may
deem appropriate,on standard 24"x 36"sheets„,with tontinuuat i'on on$ p'2 wax I I"'sheets as necessary from wwrritam
information- The in NI-nation listed below shall be shown on the site plan and cominuatmon shmeets,.
C. Namc of the,project,boundaries,date,ni+rffi arrow,and scale of the plan..
D. Ramc and address of the owwrher-cof record,dew!cloper,anus seal of the engineer,arch itec,t or landscape archuit,cet. If throe
er a letter of autheri�atiaxn shall be,acquired frons thud ar_
�.mm�y... a ltcana�s twat she record va�wau„ .. l ., .,�.o.
Thee location and use oratl existing arumh proposed structures within the properly, iml uding ali diuncnsiions of height and
Root area.,all arterior entrances,and all ailliaipateld fuutuum additions,and alterations,
R The location sof all presuant and proposed public and private ways,eff-street parking areas,driveways,outdoor storage areas,
sidewalks,ramps,,curbs,paths,landscaping,walls and fences,. Location,type arld screening details for all waste disposal
wrttaincrs shall also be shown-
The location„height,intensity and bulb type(sodium,ineamrdesceru,etc)0f a]I cxtcm al lighting fpx:tunres_ The direetmemw or
illurrmination and methods to eliminate jilare onto!d ioin'in ro unties mrhoast also be shown in compliance with
The locatiipm,height, size,,mnaicria[,s and resign or all proposed signs,
The locati", orale present and proposed utility systerras Including.
1- Sewage or septic systean
2. Water supply system„
J, Telephone cable and clectrical systerns; and
4. 5trorrn drainage systems including existing and proposed drain fines,culverts,catch basins,headwalls,endwvalls,
hydrants,nhanholos and drainage s ales.
Phan,;to prevent the pollutiran.of surrace or grroundwwauter,crosion of snail,both during and after,construedon,etc waive runff
toff
and flooding OF othcT propert ics,as appl:icable_ A stormwwrater Pollution P'rcvontion Plan IS PPP)ror.all land developmroa'"-nt
actiwities(cxclWing agrieuultural activities)on the site that reswits in land disturbance of one acre or more, A'SWPPP shall
comply wvithr therequirements,of the DEry SPD,ES MS-4 GeneralMS-4G Pe nhit.and Chapter 17'-of the Town of Queensbury
Code, It shall beat the dlfscrodoo tart me Planning Board as to whether a SWPPP Or in cros,ion and control playa shall be
required for a site.plan review project land disturbance of less than one acre-
Existing and Propuscd topo raphe at two-foot contour intervals.or such other contour interval as the Manning Boam,i shall
allow. All elevatiton$shall rc:f'er to the nearest t.nited'Stamtes Coastal and Geridctic Bench Mark, If any pamrtfen or the parcel
is within the t00-year floodplain,the area ww^iII be shown and base flood elevalions given. Arras shall be indicated with in
the proposed site and within 50 feat of the proposed site where soil removal or filkng is rcquuim,r+d,showing the approxi:nwate
volume in cwu.faic yards,.
1 .. A landscape plan showing all existingnatural land Fealwres than mnay influence the:design of"die pa poswd use sued,as meta
w�=Tops,stands of trees„single Imes eight tar more iriches in diamoter„forest cover and'water sources and all jprapptxsed
changes to,these features,including sizes and types orplantse 't 4cr soiurccs include ponds,hakes,wetlands and
watercourses,aquirerrs,ffoo4plaiins and drainage retention areas.
M Land Use District boundaries within 500 feet of'thc site's perimeter shiaalI be drawn.and iaf,t.niifred on the, site prpan,as wwol:l
as any Overlay Districts that apply,to the property.
fa
Site Plan,Review application—Revised October 20,16
Town lofQueensbury Planning Office-742 Bay Road,Queensbury, ''Y 12.80
REQUIREMENTS (CONTINUED) Shot 9
T N.
:;�,Mc flow paUcrns within the site,entrances and Lxiexits,,
loading and unloading amus„amus„4%5 well,as curb,cuts on the site and
wifli in 100 feet aril,Si tcM The Planning Board may,at its discretion,require a doladed tnafrw study For large developments or
for those in heavy trafric arm,which shall include;
L The projected nurnlrer of raotor vehicle trips to cn1w or Icave The site,estimated,for weekly and
annual peak hour traffic IeMs;
2. The projected traffio flow pattern inciuding velficular moveArianis at all major intersootiorts Ii ol;y
to be aMuted by the proposed use of the site;
I The impact,of this trafflic on levels Of servioe on abutting pub He streets and at affected
intersections. Exisking and proposed weeklyand annual,peaR bour traffic levels and road,capacity
levels Shal I also be,given..
...........
For Tmw c+unstnirfilon or alterations to,any structure,a table ountaining the following information shall be included.,
I Ir Esli=,Ld area*1 sUvelum to be used,fur particular purposes such as retain operatiout,office,
Storage,etc.;,
I Estimated maximum number ofernployees;
3. Maximu tri seating capacity,where applicable;,and
4.. Number of parkinZ spaces exist ng and required FUT the intended,use.
... ..........
P.
1. Floor Plans.
2. Elevations at a scale of".e-quarlor inch cquals one,foot(114"'= I foot)for al i exterior facades a the
an(VoT alterations to or expansion 0 r existing facades,showing design features,and indicating the type and color o r materials
to bo usvL
Q. Soi I logs,water supply well and percolation test results,and storm.water ruitoffealculations as needed to determine and
mitigate project impacts.
Plans lot disposal ofconstTuction and demolh[on waste,either on-site or at facility®
Plans for snow removal,including loration(s)of on-side snow storage.
T. An Environmental Assessment Form("EAF"j,as mquit-W by the SEQRA rcgula6ons,with Part, I compteted by the Applicant
shall be Submitted as part of the application. Ifthe proposed pTojcc4 ruquircs a special use peTmil,and an EAI luras
submitted in conjunction with a special use permit application,a duplicate EAF is not rcquircd for the site plan application.
lj. ff—nuryplicautiun,is for a parcel or parols an which moro than one sense is proposed,,thrc applicant t may subn-d t a single
application for all such uses,,provided 1.11c prDposed uses ammo o"vraloly delineated on a site plan drawn pursuant to the
requirements set forth above. The Planning Board may grant the appnootion wO re", ctlo some proposed uses and not
olhers,. For purposes of review 4%an a plli"ti an(and for SEQRA comp I iance)all proposed.uses on a shig]a parcel or on
contiguous parcels shall be considered togathef,
Vl. A brief narrative statement on how,the project proposed ror rovicw furthers Or is,consistent with the vision,goals and pD11mia's
in the Town's Comprchcnsi:vc Plan.
..........
7
Site flan.Review applicadion,–Revised,October 20 16
Town of Queensbur°y Planning Office,742 Bay Road,Queensbury,NY 12 014
n
Pre-Subm, ission "r nfere ce For I' 'e tion 179-9-040
1'. Appikant Name. COM04LOlu QWXpel 0C
. "fax Mo lacration:
. Zoning Ctassification
4. Reason for Review: � L ,
. Zoning tiara - � � � - � ,
,., ire- ubmissiGn Meeting Notes.. Provided Oaattstan ing lessi paravi t,by
Deed tp
General Information a oralplet
Site Dev lopmont Data,Complete
Setback Requir'em-er-a.at a Complete
Additional al Projectt Information Complete
FAR addressed
Compliance with Zoning lira , :: .
Ghee Ali, t items,address
Environmental Form Boralet d 9� � Aw cc,A4,a Al C-t
Signature Pago completed,
p
cc M 0( 6: .
6.
p
n.
fn
p,
a,G
a � � I iw �� a. "w. a '
t
Wolf
tiew
Staff R resentati . q
Applicant/Agent" � Date- P"
Signature Page
This page inctudes the 1.) Authorization to of as Agent Farm: 2.) Engineering Fee Disclosure,; 3.) Authorization for Bite Visits; 4)
Other Permit Responsibilities;5.)Official Meeting Disclosure and 6,,)Agreement to pravide:documentation required.
.................
r
o�mplete the following ifthe OWNER ofthe property is;not the same as the applicant
Owner
Designates:
As,agent regarding: Variance Site Plan Subdivision
For Tax Map No., Section. ........ Block Lot
Deed Reference:: Book Page Date
OWNER SIGNATURE: DATE,
APPLICANT"S ACENT FoRm.
Complete the following If the APPLICANT is unable to attend the nieeting or wishes to be represented by another party:
Owner:
Designates;
.As agent regardiDg, .......—Variance Site Plan Stibdivision
For Tax Map No.,., Section Block Lot
Deed,Remferc�: Book Page Date
OWNER S.UGNATURE., �& :,7
DAM
Lj_—FI--GjN.EERjhp! FEE DISCLOSURE Applications may be referred to, the Tomm, consulting engineer for rcyiwAr of septic design, storm
draffiage,etc. as,4ptermiined by thc Zoning or Planning Department, Fees For engineering review services will be charged directly to the applicant.
Fees for engineering reviews wilt not"mcd S 1,01001 without notification to the applicant.
1)--6&THQRIZATfQK,,FOR SITE VJSETSn, Byr!&jj.,ning this page and Submitting the application matcrials a1ta,;hcd herein, the Owner,Applicant,
a:rvd his/hr.-r/their agcrn(s) hereby authorize the Zoning Board or Planning Board and Town Staff to enter the subject propertics For the purpose or
mviewing the application submitted.
I) -QT'HER PERMfrltES,PONSEB,l�L�I'TIES.,' Other permits may be rcquircd for construction,or alteration aCtiVityL subscquent to,approval by f4-
inning Board or Planning Board. ft is Hie appficant's,respionsibility to obtain any additional,permits.,
5.) OFFIC
]AL MEF
�TJNG MINUTES DISCLOSURE. it is the practice of die Community Development Deparunent to have a designated
stenographer tape record the proceedings ofmcefings resulting from application, and minutes transcribed from those tapes constitutes the official
record;ofall,proceedings,
6.) AGRFEMENT_jQ P
-R0VjDE DOC U MENTATION REQU FRED-. to the wldorsi6ned,have thoroughly rood and v ndorstand the instructions
forsubinkslion aroyl agree to the submission rNuirements, I acknowledge no construction activities Oat].be commenced prior to issuance ofa valid
pannit- I certify that.the application.,plans and,supporting materials are a true and complete statement/description offfic existingloonditions and the
Work proposed, and that all wof.k wiH ba:perform od in accordancz with the approved,plans,and in conformance with poop zoning regulations, I
acknow iedgc that prior to,occupying the Facilities pmopo%ed,I or my agcnts,will ablain as certificate ofoccupanqy as necessary. I also understand fliat
Uwe rnay bac rcquircd to provide an as-built survey by a I iunwd Land surveyor of all newly uonsirwlcd f0ailifies prior to is5uancc of a certificate of
"Qupancy
I have:read and agree to,the above,
,
Signatum [Applicant] PrintNan- [Applicant] Date sign ll.
Signavure [Agent] F rinl Name [Agent]I Daw. signed
91
Site Plan Review application Revised October 20,16
'Town of Queensbiury Planning Office-742 Bay Road,Queensbury,NY 12804
,Short Environmental Assessment Form
Part I - Project Information
Instructions,Lor ComBleting
Part I -Project Informatiov. 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 funher verification.,
Complete Part I based on information currently available, If additional research or investigationwould be needed to fully
respond to any item,pleaseanswer 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 leadagency;'attach additional pages as necessary to supplernent any item.
Part I ® Project and Sponsor Information
Corn mun4 Chapet Of Wes!t GF
_] atne of Action or Projea,
West Glens Falls Community Chapel Carport
Project location(describe-,and attach location map):
55 Main Street,Town of queensbury,Warren County
Brief Description of Proposed Action:
Conversion of an existing 51dewalk to a carport/awaing over the handicap access
Name of'Applicant or Sponson Telephone., (518)320_Z30%,
Commu nity Chapel Of West G F/Daphne Combs, b;Mail: dcombs0herzogjaw.rom,
aj r e_s'_S';.......................
65 Wisconsin Avenue
cilyfpo 'State: Zip Code,
Queensbury NY 128014
NY
1. Does the proposed action only involve the legislative adoption of a plan,local law,or'inance, NO, YES
administrative rule,or regulation?
If Yes,attach a narrative description of the intent of the proposed action and the environmental resources that 21 D
may be affected in the municipality and proceed to Part 1 If no,cominue to question 2..
2. Does the proposed action.require a peffnit,approval or funding from any other governmental Agency'? NO YES
If Yes, list agency(s)name and pennitor approvat
Town of Queensbury Planning Board&Zoning Board of Appeals El �._
3.a.,Total acreage of the site of the proposed actions acres
bi, Total acreage to be physically disturbed? m„ryacres
c. Total acreage,(projiect site and any contiguous properties)ow ited
or controlled by the applicant or project sponsor? acres
4, Check all land uses that,Occur on,adjoining andnear the proposed action.
0 Urban [3 Rural(non-agriculture) E]Industrial [Z]Commercial OResidential(suburban)
Forest ClAgriculture []Aquatic 0 Other i(speci fy),-
ElParkland.
Page 1 of 3
5. is the Proposed action, NO YES N/A
a. A permitted use under the zoning regulations?
F-1
b. Consistent with the adopted comprehensive plan?
6. Is the proposed action consistent with the predominant character of the existing built or natural NO
landscapel?
7� Is the site ofthe proposed action located in,or does it adjoin,a state listed Critical Environmental.Area? NO YES
If Yes,idcntify� F=
................ L�L]
Ile '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?
c. Are any pedestrian accommodations ur 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 the proposed action will exceed requirements,describe design features and technologies..
................ 21 17
........................
101. Will the proposed action connect to an existing public/private water supply? N6— YES
if No,describe method for providing potable water: 0
11, W'i It the proposed action connect to cxistin,g wastewater utilities;?' NO YES
If No,describe method for providing wastewater,treatment:
12. a, Does the site contain a structure that i s listed on either the State or National Register of flistori c: N6— YES
places? WTI FE71
b.Is the proposed action located in an archeologica I sensitive area?
13, a. Does any portion of the site of the proposed action,or lands adjoining the proposed act�ion,contain NO— YES
wetlands or offier waterbodies,regulated by a federal,state or local agency?
L4
b. Would the proposed action physically alter,or encroach into,any existing wetland or waterbody?
If Yes, identify E]
the wetland ar waterbody and extent of afterations in square 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.-
0 Shore4in.e ElForest [1I Agriculturallgrasslands Early mid-succcssional
Wetland 0 Urban 0 Suburban
15, Does the site of ffie proposed action contain any species of animal,or associated habitats,listed 0 YES_
by the,State,or,Federal government as,threatened or endangered? 71 ID
16, Is the project site located,in the 100,year flood plain? NO YES
IT Will the proposed action create storm water disebarge,either from point or non-point sources? NO YES
Iffes,
a. W it] storm water discharges flow to adjacent properties,? NO =YES
b. Wit I storm water discharges be directed to e�stablihed conveyance systems(nanoff and storm drains)?
If Yes,briefly describe. NO E:]YES
..............
Page 2 of 3
tu ipaooe
orother li
peep. s samwrtvdjua
WdUG�YG1 Il or other activities,
thal result in the impoundment f
� yids(e.g.retentionmond, to lagoon,ar " o YES
fY s,elan a
and size:
P1 , El
i' . the site of the propose action war an adjoining proppropehy been Cies location of aR alive or-;di- d
NO
solid was anagement facility?
If Yes,$escribe.
'Iryhas j sitl + in pr yp s ri action r adjoin'
ng pro been the subject of remediation(ongoing� T"�1'0D_ �
omelet )f ha mrd us waste's
„ n' .
If Yes, cc „�.
I :FIRM THAT THE, INFORMATIONR WDABOVE LS TRUE AND ACCURATE,TO T s; BEST OFKNOWLED
Applimn swrysr rta Date-
Signature:
aresi wt re
0RI -T FORM Page 3 of 3
Agency Use Only Diff applica blel
Project:
Date.
Short Environmental Assessment Form
Part 2 - Impact Assessiment
Part 2 is to be!completed by the Lead Agency.
Answer all of the fallowing questions in part 2 using the information contained in Part I and other materials subimitted by
the project sponsor or otherwise available to the revilewer. When answering the:questions the revicwcrshould be gu,ided,by
the concept"Have my responses been reasonable considering the scale and context of the proposed action?"
No,or Moaitrate
small to large
mm
impact impact
may may
occur Ottur
L 'Full the proposed aclian create YmatcHAI con fl ict wi than adopted land us,le plan or zomn
regulations?
2. Will the proposed action result in a change in the use or inwnsityefuse of land?'
I Will the proposed acticrn impair the character or quality of the existing community?
El
4, Will the proposed action have,an impact on the on 0 ron, mental,characteristics that caused the
establishment of a Critical,Environmental Area(CEA)?
5, Will the proposed action reault in an adverse change in Elie:existing level of trdfric or
a5cet existing infrastructure for rnass,transit,,biking gar walkway?
6. Wi I I the proposcd action,cause an increase in the use of energy and it fails to incorporate
reasonably available energy conservation or renewable encra opportunities?
7. Wi I I the proposed action impact,existin&
a. public i private water suppli es?
b. public/private:wastewater treatment utilities?
8. Will,the proposed action impair the 6aracter or quality of important historic, archaeological,
architectural or acstheticresources?
9. Will the proposed action result in an adverse chango to,natural resources Wetlands,
wate rbod ics,ground1water, ai r qual i ty, flora,and fauna)? El ID
10, Wil I the proposed action result in an increase in the potenfia I for erosion,flooding or drai niage:
problerns? L—J,
c proposed action create a hazard to en vi ronmen tal rOSOUrCOS Or h U man heal III?
. Will the
L--PRINl'T FORM Page I of.2
Age Use Only Iff-up licakle]
g,
Date:
S'hart Environmental Assessment Form
Part 3 Determination of Significance
For every question in Pan 2 that was answered"moderatc:to large impact may occue,or if there is,a n.wd to explain why a.
particular elernent of the proposed action may or will not resu It in R SigIlificant adverse environmental.impact.,plea.ST
completeNrt 3. part 3 should,in sufficient detail,identify the impact,including any measures or design derrimts that
have been includGd by the project sponsor to avoid or reduce impacts, Part 3 should also explain bow the lead agency
Mcnnined that the impact may or will not be significant, Each potential impact should be assesmA considering its setting,
probability of occurring,duration,irreversibility,geogmphic scope and magnitude. Also consider the potential f6rsbort-
tCrM, long-term and cumulativiu impacts,.
Check this box ifyou have deterritincd,based on the i nforrm6on and analysis ablio ve,and ant's upporting docamen tation,
that the proposed action rrmy result,in tame or more potentially large or significant adverse impacts and an
environtrx,rital.impact statement is required.
Check.this box if you have determined,based an the informatiovn and analysis above,and any supporting docurwnmfion,
that the proposed action will not result in any significant adverse environ men tal inipacts.
Narne of Lead.Agency Date
-1.1111111.1 ..........
Print or Type Nante of Responsible Officer in Lead Agency Title of Responsible Officer
..............
Sigrtaf um of Responsible Officer in Le ad Ag eney m S i griaturc of Prep (if di5brent frond Rcspomib le Officer)
[—,-.-.---PRINT FORM Page 2 of'2
Applicant/Owner: aJ" t Glens Falls Community Chape[
179-9.080 Responses to standards questions ,-
.. The proposed project to improve the site is consistent with the policies of the Town's
Comprehensive Plan.,
& The proposed project complies with all other requirements of this "chapter.
C. The proposed project has been designed to improve internal pedestrian activities, as
necessary and applicable to this,type of use.
D, The existing structure! conforms, with Chapter 1Siewwage and Sewage, Disposall, the
proposed project is diesigned to conform with Chapter 147, the Stoirmwater
Management Local Law and all other,applicable laws.
1=„ The proposed project has been designed to be in harmony with the general purpose
or intent of this Chapter.
F. The proposed proje t has been designed to be in compliance with principles of good
site access, traffic flow, and safety and general welfare of the neigh borholod:
G. The proposed project has (been designed with the intent to provide safe, adequate,
and functional riff-street parking and lauding facilities to the greatest extent feasible.
R The proposed project has been designed to net impact natural, scenic, aesthetic
ecological, wildlife, historic, recreational or open space resources,of the Town.
L The proposed project has been designed to improve internal pedestrian activitiies as
necessary and applicalblle to,this type of use.
I The proposed project has been designed to be in compliance with Chapter 14 as
applicable-
K There willl be no orange in water or wastewater,demand fuer the proposed project, the
existing residence was designed to be in compliance with NYS Department of health
standa cls as well as the requirements of Chapter 136 of the Towyn Code.
L. The proposed project has, been designed 'to provide an attractive, well-landscaped
facility while meeting all functional requirements.,
M. The project has been designed in effort to meet the needs of emergency service
providers adequately.,
N, The site grading and drainage provisions have been developed with the intent of
avoiding, flooding and pending With the exception of areas regu iiired for stcrrnwwater
conturolls.
0. The site has been designed with the intent of conforming to the design standards,
landscaping standards„ and performance standards of this Chapter.