doc20180605143539 Prefimirary '_'tage Revised, Apn1 D
Tax Paroc el: UD Number: 3165-1,13 Rf
Zoning District- Waterfront Residential — A FIR4,
JC�b2�,k Mvv'114 0 F Q Q E E-NS6 U RN'
P uUN?,,,I
Sketcb PlanStage
Preliminary Stage
Final Stage
fgljojog;�
Number of lots proposed 2
Residential or CornrnerciM Residential
Total Lot acreage 2.06 Acres
PiWosed lot sizes 0.58&1.48
Prcect focafion Sperry Road
Detailed Description of Project [include current& propo�sed use],
T,w,o-Lot Residential Subdivision
Applicant Name; Marcia Parker Address- 11 Sperry Road
I Queenskyury NY 12804
Home Phone (518)3077230 Cell-
Work Phone Fax
E-Mail- mparkermail0roadrunner.corn
Agent's Name: Van Duwn&Reves Land Surveyors Address: 169 Haviland Road
Queensbury NY 12804
Home Phone Cell:
Work Phone (518)745-0,307 Fax (518),745-0308
E-mail mattOvandusenandsteves.com
Owner's Name, ddress
(same as applicant) A
Home, Phone Cell
Work Phone, Fax
E-mail
Town of Queensbury Planning Office- 7412 Bay Road -Queensbury, NY 12804 - 518-761-8220 1
.............
Preliminary Stage Revised April,2'0`10
ITEMS TO BE IDENTIFIED BY STAFF DURING PRE-SUBMISSION MEETING- You should use this page for
guidance when drafting your application: however, itwill be completed by a staff mernber- Submittal of a prelinniinary
plat depicting existing and proposed conditions shall include the items as noted below- Failure to include all required
information may result in a determination of incompleteness and a delay in,the processing of your application
§A183-13. Plat details and requirements.
The applicant is re qu i re d to sju4ni it gUWjj2dg&?a1,and 14 cojo;es of the pre I im inary plat application- Such a pplication
shall iinclude the foliowing documents an 'or informatiow
A., PRELIMINARY PLAT The prelini4nary plat shall be laid out by a licensed professional engineer andlor a
licensed profbssional land sur'veyor ,vfth a properly executed New York State Education. Department
Exemption N- Such preliminary plat shall be prepared at a scale of one inch equals 50 feet zero inches, clearly
showing:
1) The location of all existing and proposed property lines, buildingsra watercourses and other important
topographic features,
2) Existing and proposed contours showing elevations at two-foot contour intervals, and extending at least
100 feet off site-
3) The location, names and widths of all existing and proposed streets,, easements, lots and building lines,
wells and septic tan k s and fields and similar facts, regarding property immediately adjacent or opposite the
proposed subdivision,
4), A location,map showing:
(a)The zoning district or districts in which the land to be subdivided is located; and
Ci WVCCk'A
(b), The property included in the proposed subdivision and all WntigUCUS properties of the proposed
subdivision and all properties within 500 feet in each direction from the boundary line of the proposed
subdivision along any contiguous street oar highway. All properties shall be identifed by lot and parcel
number and names of owners,
6) The location and size of any existing sewers, water mains, culverts and drain pipes, electric, telephone
A and cable television lines and proposed sewers, water mairts, culverts and drain pipes on the property or
immediately adjacent to the property to,be S Ubd ivid ed,
The proposed arrangement and approximate area, width and length of street frontage and setback
requirements of each lot for the purpose of demonstrating to the Planning Board,,that the proposed location,
of streets makes possible a layout of lots in:accordance with the, requirements of the Town of Queensbury
Zoning Law,forthe district or districts in,which the subdivision is located.
7) All parcels of laad proposed,to be dedicated,to the public use.
8) The date, North arrow and scale,,
9) The title under which, the proposed subdivision is to be recorded, with the names of the owner and the
C' engineer or land surveyor who prepared the preliminary plat; the license number and sea] of the engineer
or land stirveyor shall)be affixed,to the drawing.
B- LAYOUT PUN5, Layout plans shall be prepared by a professional) licensed engineer or professional licensed
land surveyor with a properly executed INe^a York State Education, Department Exemption, N, Such layout
plans shall be Incorporatedon the preliminary plat and shall show the following-,
1) The exact layout and dimer rasions of proposed': streets., including stationing and tie-in to the center-line
dislances of existing streets with monuinients;and other points,, as required.
Town al"Clueenswiry PlanningOffice- 742 Bay Road - Queensbury, NY 12804 , 518,7611-8220 2
....................................
Preliminary Stage Revised April 20,110,
2) The location and widths of all streets, pavernents, curbs, sidewalks, easenients, parRs and other open
spaces.
3) The proposed narnes of al$streets, and the radii of all curvies,in the street line,
4) The location of all proposed utilities, including the proposed water supply, sanitary sewers, stormwater
drainage system and any other proposed underground utilities.
5) Proposed lot fines.
6) T he date, N o rth a rrow and sc ate
7) The title under which,the proposed SUbdivivon is to be recorded, with the narries,of the owner and,
engineer or land surveyor,who prepared the layout plans; the license,number and seal of the engineer or
land surveyor shall be,affixed to the drawing-
C- TBELUIMALL, Construction details shall be prepared by,a licensed professional engineer or a
N& licensed professional land surveyor with a properly eXeclrted Nery York State Education Department
Exemption N. Such details shall include,
1) The proposed sanitary sewer syslem, including pipe sizes, bedding and profiles.
2) The proposed storm drainage SySten"r including pipe sizes, bedding, catch basin and rnariWe details,
profiles and rnethod of disposal of collected stormwater.
3) The proposedwater,supply syste rn.,
4) Any ollier proposed underground Utilities,
5) A typical cross section of the roadway, inclbding 'the right-of-way width, pavement width and depth of
pavement materials and subbase, the location of utilities, character and cliniensions of curbs and
side,walks,and side slope grading.,
6) Profiles. showing the original ground surface and finished street surface at center lines of all streets,
percentage of grades of streets, stationing and elevations of all points of curvature, points of intersection,
points of tarigency, and o'f proposed sewers, drains, culverts, manholes and other, features. Invert
elevations and slopes of sewers and drains and both surface and invert elevations of manholes shall be
indicated. Profiles shall be drawn: to the scale of four feet to the inch vertical and 40 feet to the inch
horizontal, The stationing shall show accurate center-line distances. The elevations of the original ground
surface shall be,to the nearest tenth of a foot and of fixed points to the nearest hundredth of a foot-
'7) The location and elevation of all proposed monument beatioin s.
8) The date and scale.
9) The tide under wr hich the proposed subdivision is to be recorded, with the names of the owner and
- kcense flumber and seal of the engineer shall be,
engineer who prepared the constructiun details; the
affixed to the drawing.
D. LANDSCAPE PLA, A, landscape plan shall be prepared by a licensed landscape architect for subdivisions
greater than 10,(lots, Such landscape plan shall include
1) The location and species of street trees, if retained within the righ(t-of-way or proposed to be planted by the
subdivider-
2) Details of methods of tree protecfion and tree planting-
Town of Queensbury PlannIng Office- 742 Bay Road -Queensbury, NY 128CI4 - 518-761-8220 3
...................................... ............................................................................................................................
Preliminary Stage Rev iced Aprd 2010
3) Plans and details of any site iniprovements, related to park or recreation planning, including layout
grading, planting and,details of any improvements.
4) Plans and details of any other public amenities provided in the subdivision-
:5) The date,and scale.
6) The title number ,%,hich the proposed, subdivision is, to be recorded, with the names of the owner and
landscape architect Who prepared the landscape plan, the license number and seal] of the landscape architect
!shall! be affixed to the drawing,
E- " EARING PLA— A clearing plan shall be prepared ata scale of one inch, equals 50, feet zero inches. Such
plan :shall show the following details.
1 Existing vegetation prior to any clearing of the site for site investigation purposes,
2) Areas of vegetafion removed from the site for investigation purposes,
3) The location of, roadways, underground or overhead utilities not h roadways, limb of gradiing, proposed,
location of any Wildings, :septic systems, vveils and driveways and any other improvements which might
require clearing.
4) Areas,where slopes are greater than 201%, as per§AI B3-26.
I.
5) Urnitsof proposed clearing,of trees,
6) Measures to be taken to,protect rennaining trees,, including detains.
F. GRADING AND EROSION
f,J �QUJBQL PLAU, A grading plan and erosion control plan shall be prepared at a
scale of one inch equals 50 feet zero,inches, Such plan shall show the folloWn%
11) A generalized grading and drainage plan (does not require spot grades or slope designation),
2j Any phasing of tree removal,andlor construction,
G. LNVIROWL TAL RIERORT, A long environmental assessment form shall be prepared in accordance vfith
the State Environmental Quality Review Act describing the potential environmental inipact of the, proposed
subdivision-
H. STATMLNT QE JUIEUI. A statement of intent shall be submitted by the applirant� Such statement shall
include:
1 Proof of ownership of the land to,be subdivided, in a forni approved by the Town Attorney.
2) The nature,and extent of proposed street Nniprovements,
3) The naWre and extent of any recreational features, parks, playgrounds, water supply,, sewerage and
drainage rights-of-way and easements, retention basins and' other land to be dedicated to public use and the
cuiditions, under which dedication ofthese features is to be made to the Town,
4) A statement that tine applicant will install all improverrients, in accordance with the standards prescribed by
the departments of'the Town havi�ng jurisdiction, and set all monuments as shmn on the final plat thereof in
such m an ner as the Board may de sig nate-
I A LMHyJAJ,LR M ANAG
PLAN, and aSTORMWATER POLLUJQN M,=1TION PLAN
consistent with,the requ,[renients of Chapter 147, Stormyoater Management.
Town of Queensbuiry Planning Office- 742 Bay Road - Queensbury, NY 12804 - 518-761-8220 4
Preliinn.inary Stage (Revised Apri li, gf
J
f) The application for preliminary plat approval shall be accompanied by a fee lasted on the current schedule
of fees for the Town of Queensbury posted in,the Planning Office_
In addition'to the fee listed on the schedule of fees„the Planning Board may charge a fee to developers of
projects requ ii,ring legal and technical review, provided that the fee charged reflects,the actual dcQ, t of the legal
and technical assistance to the Planning Board.
If' The Planning Board finds that any of the information requirements as set forth above, are
inappropriate or not necessary to conduct an informed review, it may waive such ilrnform,abon requirements a
it deernns appropriate. Any such waiver shall be made in writing, and shall contain statements of the reasons
by the waived information requirements are not necessary for an informed review under the ci;r uinistaun e ,
The Planning Board mays grant such waivers on its own iniitiative or at the written request 'that sets Bertha the
specific requirements, that ,are requested to be waived and the reasons for the requested waiver) of an
applicant.
§ A183-14. Su,ibmissi un, and Review procedure— Subdivision Sign Posting Requirements
D� Noliee. Thne subdirvideir shall display prominernfly on the subject property, for 10, days preceding the date of the
public hearing, at least one sign, two feet by three feet in size and carrying a legend prescribed by the 'Ta-wuwunn
Planning Board,, announcing the public hearing. The sign, shall, be in full public view fromi the street paveannent
,and shnaill be legible from the,street_ If the property is bounded by more than one street, a sign shall be placed
on each street that bounds the property-
Town of Queensbur/Planning Office. 742 Bay Road . unsi)ury, 12804 ° 518-761-8220
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Preliminary Stage Revised ApTi 12 010
Pre-Submission ConfereilgS,Eggjj
1. Tax Map ID-. 316Z-1-8 —
2. Zoning Classification. WR
3. Reason:for Review', 2-LGt Residential SubdivisiGn
4. Ordinance SecWn: 1, 2)
5. Pre-Sub mission Meeting Notes., OtAsta riding Items To B eAddiressed tirhrEW Mi.,[
I. Deed Yas No
2. General Information --ZYeS No
3 Preliminary Plat --P/ Yes No
4. Layout Plans —.L1 Yes No
5. Construdion Details Yes No
6. Landscape Plan Yes No
7. Clearing Plan Yes No
8. Gra6ng & Erosion Control �' 'Yes No
9. Environmental Report Yes No
101- Statenient ofinlent Yes No
111- Stormwater Plan/ SWPPP Yes No
12- Fees 0 Yes No
13- Waivers ") Yes No
14- Subdivision Sign Posting Yes -- No
15- Signature Page Yes r7'No
4
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Staff Representative:
Applicant I Agent
Date, '0�
Tovin of Queensbu,iry Planning Offlce- 742 Bay Road -Queensbuiry, NY i2a04 518-761- 1]' 6
61720
Appendix A
Seare Environmental Qiialfty Review
F�iffl'En vironmeneal Assespnent Foript
Purpose.- The Full Environmental .Assessment Form(EW),provides an orderly and
comprehensive means for evaluating the potential environmental signific;ance of a proposed,
action. The question of whether anactionr may be significant is not always easy to answer.
Frequtntly, there are aspects of a pr9ject that are subjective or tinmeasurable. it is also
understood that those who determine significance may have little or no formalknowledge of the
environment or may not be technically expert in environmental analysis. In addition, many who
have knowledge in one particular area may not he aware of the broader concerns affecting flip,
question of significance. The leadagency must use the Full l' for Type I actions and may use
it for Unlisted actions.
The,full EAF consists of three parts and when completed it,will sv--rve as the determination of
significance;
Part 1 -Iq 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 Part 1, are: grouped in sections A-G:
Section A gathers information that identifies,the project sponsor,the proposed action, and the
proposed action's location.
Section B reqtievs information about government approvals or funding.
Section C requests information about planning, zoning and community services.
Section D mquests information abaut the propo8edaction.
Section E requests, information about resourccs on or adjacent to,the proposed site.
Section F provides,the project sponsor the opportun4 for supplying additional information
including project elements thatmay avoid or reduce 'impacts,
Section G is where the certifying signature of the preparer is provided.
Part 2 -Is,completed by the lead agency. Part 2 is designed to help,tile lead agency inventory all
potential resources that could be affected by a proposed action and to determine the potential size
of the impact by providing a series of questions,that can.be answered using the information
found in Part I. 'To further assist the lead agency in,compleiing Part 2,the form identifies the
most:relevant questions in Part, 1 that will provide the inforrnation needed to answer the:Part 2
question, Part 2 is,designed to help a reviewer identify any element of a.propo,sed project that
may have a potentially significant adverse, impact on the. environment.
Part 3 -Is oomplete,d 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 by a particular element of
the proposed action will not, or may,,result in a signific-ant adverse environme*tal impact should
lie explored in a series of written,well reasoned statements-in Part:3. The discussion ofimpacts
in Part 3 will serve as the supporting docurnentation for the determination of'significanof.
FaIlEnviron,0111emal Assessment Form
Part I -Project and Setting
Instructions for,Completing Part 1,
Part I Is to be campleted.by the aptiticant or,project sponsor. Responses become part of the application for approvalor funding,
are subject to public,rev iew,and inay be subject to farther verification,
Complete Part I based on information curienfly available. If additional research or investigation would be needed to fully respond to
any item,please answer as thoroughly as,possible based.on current information;indicate whether missing inforrrmfion does not exist,
or is not reasoitab ly available to the sponsor;and,when possible,generally describe work or studies which would be necessary to
update orfiully: develop that infamation,
Applicants/sponsors rmnuust complete all items in Sections A&R. In Sections C, D& E,most iterns contain an initial question that
must be answered either'Yes,"'or"No,"'. If the answer to the initial question is"Yes",eomplete the sub-questions that follow, If tine
answer to the initi a]question is,"No", proceed to the next.question, Sertion F allows the project sponsor to identify and attach an.y
addifional information. Section G requims the name and signature of the project sponsor to,vel-iffy that the infdrmadon czntained in
Part I is accurate and complete,
Project and Sponsor Information.
Marne of Action or Project,,
Parker Residential Sub d lvision
Project Location(describe,and attach a general location map):
I I Sperry Road,'TGwn of Queensbury,Wra,rren County
Brief Description of Proposed Action(include purpose or need):
Proposed 2-Lot Residential Subdivision
..........
Narne of.ApplicantfSponsorm Telephone: (518)307-7231!
Marcia Parker E-Maj: rnparkermaitsir02:drunner,com
Address:
Citry/PO,.- 11SperryRoad
State: —
Queensbury NY I!Tt 1280,4_
Project Contact(if not same as,sponsor; give name and tiflelrole): Telephone:
Address:
cityw: State- Zip code:
Property Owner (ifutot same as sponsor): Telephone:
E-Mail.
Address�
Citylpo:: State, Zip Code:
P'age I of 13,
B. Government Approvals
B. Government Approvals Funding,or Spousorship. ffunding"includes grants,loans,to relief,and any other fornis offinancial
aWstance-),
Government Entity If Yes: Identify Agency and Approval(s) Application Date
Required (Actual or projcztcd)
a.City Council,Town Board, E1YcsEjNe
or Village Board of Tru.-Aces
b,City,Town or Village []Ycs[]No,
Planning Board,or Commission
c,City Council,Town or OYesE]Nc�el
o Area Varian ,
Vil!a& Zonin ,oard ofA.p
g B peals
d, Other local agencies es OYesONo
e.,County agencies [3YesElNo,
f Regional,agencies [3Ycs0No
g. State agencies esND
h. Federal agencies, 'es I^
i- Coastal Resources,
L Is the project site within a Coastal Area,or the waterfront area of a Designated Inland Waterway? "'es No
If Yes"
it. Is the project site located in a community with an approved Local,Waterfront Revitalization Prograrn? YesO No
W. Is the project site within a Coastal Erosion Hazard Area? 0 YesO No
Cl.Planning,and,Zoning
C.I.Planning,and Zoning actions,
Will administrative or legis'lative adoption,or amendment of a,plan, local law,ordinancie,rule or regulation be the [3YcsONo
only approval(s), which must be Ltranted to,enable the:proposed action to proceed?
40 If Yes,campletc:Sections C, F and 0a.
Il"i o,proceed to question C.2 and,corrip[etc a]I remaining sections and questions in Part I
C.2.Adopted land use plans.
a.. Do a,ny municipally-adopted (city,town,village or county)comprehonsive land use plan(s) include the site OY'esONo
where the proposed action would be located?
If Yes, does,the comprehensive plan include specific;recommendations for the site where the proposed action Oyes No
would be located?
lam Is the site of the proposed action within any local or regional special planning district(for example., Greenway OYesO'No
Brownfield Opportunity Area(ROA);designated State or Federal heritage area;watershed management plan;
or other'?)
If Yes, identify the plan(s,)-.
c. Is the proposed action located wholly or partially within an area listed inan adoptedmunicipal open space plan, [:]YeSONG
or an adopted municipal farmland protection plan?
If Yes,identify the plavi(s)-
...................................................................-.................................................................................................................
P'a,ge 2 off
C3. Zoning
a.. is the site of the proposed action located in a municipality with anadopted zoning:law or ordinance. 0 Yes[]No
If Yes,what is the zoning classification(s) including any applicable overlay district?
'W'aterfrGnt Residential
b. Is the use permitteder allowed by a special or conditional use permit? 10 Yes No
c. Is azoning change requested as part ofthe proposed action? El YeSONO
If Yes,
i. What is the proposed new zoning for the site?
CA. Existing commuTifty,services.
a.. In what schooldistrict is the project site,located"? Queensbury Union,Free,School,District —-—-----
b. What police or other public protection forces sme the project site?
Warren Ca uro Sberiff
c. Which fire protection and emergency inedical services servethe project site?
West Mena Falls EELS
d., What parks serve the project site,?
'own ufg-u!1�, bu �_Dlrllk,s
............. ......
D. Project Details
D.I. Proposed and Potential Development
a.. What is the general mature of the proposed action(e,g-,residential,industrial,,commercial,recreational if mixed,incl ude aill
components)?
Residential
b, a, Total acreage of the site of the proposed achion? 106 acres,
b. Total acreage to he physically disturbed? D-00, acres
c.Total acreage(project site and any contiguous properties)owned
or controlled by the appificant.or project 5ponsor? 2.016 acres
c. Is,the proposed action an expansion,ofan,existing project or used 0 Yes O No
i".. If Yes,what is the approximate percentage of the proposed expansion and identify the units(,e,g., acres, miles,housing units,
square feal)? % Units:. ..............
d,. is the proposed action a subdivision,or does it include a subdivision? 0 Yes[:]No
If Yrs,
1. Purpose or type orsubdivision?(e,g., residential,industrial,cormnercial, irmixed,specify types,)
Residential,
I 1,I. Is a clusterfcon;�rvadon fayZ'proposed? []Yes ONo
W., Number of lots proposed? 2
its. Minimum and maximum proposed lot sizes? Minimurn 0158 Maximum 2-48
e. Will proposed ar-tion he constructed in.multiple phases? OYesONo,
i, lMu,anticipated period ofconstniction: —0 mondis
ff. If Yes,:
*
"fora)number of phases;anticipated
0 Anticipated commencement date of phase I (including demolition) mm ont-h .................................................year
0 Anticipated completion date:o�f final phase month year
4P Generally describe con nections orrelationships among phases, including any COTIORgOnCieS,Where progress of one phase may
determine e fi ming or duration of future phases: .........---"..........
............................... ......................
.....................—.11,11....................
Page 3 of 13
fi; Desicnibe haw the proposed action would affect that waterbody or wetland,e,g, excavation, fill,placement of structures,,or
alteration of channels,banks and shorelines. Indicate extent of activities;,alterations and additions in square feet or acres:
filo Will proposed action cause or result in disturbance to bottom se4imenLq? El YesO No
If Yes,,,describe:
iv., Will proposed action cause or r�sult t ;iz�on or removal of aquatic vegetation? E]YCSO No
If Yes:
acres of aquatic vegetation proposed to be renioved::
expected acreage lo faquatic vegetation remaining after project completion:
purpose of proposed removal(e.g.beach clearing, invasive species control,boat accessF
proposed method,ofplant removaL
if chernical1herbicide treattirw—ri will be used,specify producl(s),,
v. Describe any proposed reclamation/mitigation following disturbance-
c. Will the proposedaction ruse;,oi a new demand for water? Elyes ONO
If Yes:
ii. Total anticipated water usRgeldernari per day. gallons/day
U Will the proposed action obtain water from an existingpublic water supply? [3yes 0q,o
If Yes:
" Name,of district or service area:
19 Does,the existing public water supply have capacity tai serve the proposay? C]Yes[]No
• Is the project site in the existing district? [I Y [J No
• Is expansion of the district needed? [3 Yes[J No
• Do,existing lines serve the project site:'? El Yes[]No
HL Will line extension within an existing,district be.necessary to supply the project'? El Yes ONe
If Yes°
0 Describle extensions or,capacity expansions proposed to serve this project'.
" Source(s)of supply fair the district;
iv,, Is a new water supply,district,or service area proposed to be,formed to serve the project site? E:) YesOli
Applicant/sponsor for new district:
ID Date application submitted or anticiplated: .......................................
0 11roposed source(s)of supply for new district-,
v If a publip water supply will not be used,describe plans to provide water supply for the project:
........................................................................................ -, "',..........................................................................................................................................................................................
14. If water supply,will be:from wells(public or private),maximurn pumping;capacity._gallons/minute.
di,Will,the proposed action generate liquid wi OYesONo
If Yes;
i. Total anticipated liquid waste generation per day-, 44,0, gaflonsIday
U. Nature of liquid wastes to be generated,(e.g.,sanitary wastewater, industrial; if combination, describe all,components and
approximate voluirri proportions,in f each); Sanitary
iii. Will the proposed a176 0"n use any existing public wastewater treatment facilitics? [--]YesW]No
If Yes:
• Name of wastewater treatment plant:to be used.
• Name of district:
• Does the existing wastewater treatment plant have capacity to serve the project? E]YesE]No
• Is the project site in the existing;district`? Yes[]No
Is expansion of the district needed? OYes[]No
Page 5 of t3
• Do ex isli ng sewer lines serve the project site? E]YesONo
• Will tine extension within an existing district be necessary to serve,the projece? 0 yes 0 No
If yes;
Describe extensions or capacity expansions proposed to sere this,project:-,
..........
iv. Will a new wastewater(sewage)treatment district be formed to serve the project site? ClYesONo
If Yes.
Applicant/sponsor for new district:
Date application submitted or anticipated: ............. ...........
What is,the receiving water for the wastewater discharge .........
v.. If public facilities will not be used,describe plans to provide wastewater treatment for the project, including specifw ffig proposed
receiving water(name and classification if surface discharge,or describe subsurface dispasal plans):
0, Describe away plans,or designs to,capwre, recycle or reuse liquid waste.
e, Will the proposed action disturb more than one acre and create stonnwater runoff,either from new puint EJVes0No
sources(i.e.ditches,pipes,swales,curbs,gutters or other concentrated flaws,ofstormwater)or non-point
source(i,e_sbeet flow)during,construction or,past const ruction?
If Yes:
L liow much impervious surface;willthe project create in relation to,total size of project parcel?
Square feet or acres(impervious surface)
Square feet or acres(parcel size)
U, Describe types of new point sources.
a.i, Where wi I I the stormwater runoff be directed(Le.on-site stormwater management faci litylstructures,adjacent prop orties,
groundwater,on-site surface water or off-site surface waters)?
..........-.............. ..................
• If to surface waters, identify receiving water bodies or wetlands-
....................
• Will stormwater runoff flow to adjacent proplerties.) ED YesO No
iv- Does,proposed.plan minimize impervious surfaces,,use pervious materials ar collect and re-use stormwater? JZI Yes[]No
f. Does,the proposed action include,or will it use on-site,one or more sources,of air emissions,including fuel ElYesONo
combustion,waste incineration,or other processes,or operations'?
if Yes,identify.,
k Mobile sources during project operations(e.g.,heavy equipment, fleet or delivery vehicles)
..................—
U..
............—U.. Stationary sources duTipg construction,(e,g_.,power generation, structural heating,batch plant,crushers)
w. gia-ii o n-a"r,y-s-o'u—rces,duringoperatians(e-g..,process emissions, large boilers,electric generation)
g. Will.any air em I is�sion sources named in 13.21(above),require a,N Y State,Air Registration,Air Facility Permit, LAYesONo
or Federal Clean Air Act Title IV or Title V Permit?
I f Yes,
i,, is the project,site located in an Air quality non-attainment area? (Area routinely or periodically fails to meet [:]Yes,ON,o
ambient air quality standards for all or some parts of the year)
U, In addition to ernissilons as calculated in,the application,the project will generate:
0 Tornslyear(short tons)of Carbon Dioxide(f: 2)
0 Tuns year(short tons),of Nitrou.5 Oxide(N20)
(short tons)of Perfluorocarbons(PFCs)
........................................ ,, Tons/year(short torns),of Sul fur flexafluoride(S F6)
Tonslyear(short tons)of Carbon Dioxide equivalent of H ydroflotrocarbons(HM)
.—,,--Tons/year(short tans)of Hazardous Air Rol I utants,(BAPS-)
Pagc 61 of 1,3,
s,. Does the proposed acti on i nclutle construction or mod ification of a solid waste management facility? Yes No
ffycs':
1. Type of management orhandling of waste proposed for the site(e.g,,recycling oraransfer station,composting,landfill,or
other disposal activities):
h- Anticipated raft-of disposaYproceising.
-_Tonsimonth,if transfier or other,non-cornbusli on/thermal treat ment,or
.. ........ Tons/hour,if combustion or thermal treatment
iii.. Ifland.fill.,anticipated sitelife, years
t Will proposed action at the site involve the commercial generation,treatment,storage,or disposal of hazardous
waste?
If yes:
i. Nwne(s)of al t hazardous,wastes,or constituents to be generated,handled or managed at facility:
ff, Generally describe processes or activities involving ha=dous wastes or constituents
............................... ..........
iff. Specify amount to be handled or generated tomOmonth
iv. Describe any proposals for on-site minimization,recycl ing or reuse of hazardous constituents, ..................
v. Will any hazardous wastes be disposed at an existing offshe hazardous,waste facility? V_CSOK`uw
if Yes; provide narne and location of facility;
If No.. describe proposed management of any hazardous,wastes which will not be,sent to a hazardous waste facility,
.........
E. Site and Setting of Proposed Action
E.1.Land uses on and surrounding the project site
a. Ex'StirIg land uses.
i,, Check all uses,that occur on,adjoining and near the project site,
0 Urban Ell Industrial Ell Commercial 0 Residential (suburban) El Rural(non-farm)
0 Forest 0 Agriculture JZl Aquatic Other(qpecif),
ii,. Iftnix of uses,generally describe.:
...............
b, Laud uses and covertypLs on the proj wt site,
Band use:or Current Acreage After Cbange
CQVVrtype Acreage Prio°�ect Completion (Acres,+/.)
0 Roads,buildings,and other paved or impervious, C1.20 0
Surfaces
Forested 0.,90 0.50 0
Meadows, grasslands or-brushlands,(non- 1, 1 0
cultural,including abandoned agricultural)
0 Agricultural 0 0
(includes artive orchards,field,greenhouse,etc,
9 Surface water features 0 0
(lakes,ponds,streams,rivers,etc.)
Wetlands,(freshwater or tidal) .05 .05 0
Non-vegetated(bare rock,earth or fill) OJO 030 030
Other
Describe:,
Page 9 of13
mm
c. Is the project site presently used by members of the community for public recreation?
i, If yesexplain: ......
d.Are:them any facilities serving children, the elderly,people with disabilities,(e.g;.„schools,,hospitals,licensed E]Te-soNo'
,day carecenters,or group homes) within 1500 feet of the project site?
If Yes,
L Identify Facilities.
e, Does theproject site contain an ex isting daie? 'des
If Yes.
L Dimensions of the d;om and impoundinent:
* Dam height: feet
a Dam length: feet
* Surface area. acres
* Volume:impounded:: gallons OR acre-Feet
fi. Dam's,existing hazardelassification: .........................................
iii. Frovide date and summarize results oflast inspection:
...........................
-——------------
f.Has the project site ever be&n.used as a municipal,commercial or industrial solid waste management facility, E)Yes No
or does the project site adjoin property which ismow,or was at one time,used as,a solid waste-managet nent facility?
If Yes.
1. Ha,,the facility been fonnally closed? El YesF_], No
M If yes,cite sources1docurnentation: ..................................................... ........
um. Describe the location of the project site relative to the boundaries,of the solid,wasle managernerit facility-.
. ................. ............
W. Describe azdi—ev"c io"p ment constraints due to the prior solidwaste activities:
...............
& Have hazardous wastes been generated,treated andlor disposed of at the site,or does the project situ„adjoin El es !No
property wh,ich,is now or was at one time used to,commercially treat,store and/or dispose of hazardous waste?
If Yes:
L Describe waste(s)bandied and waste management activities„including approx imate time when activities occurred.
........... ...............
h, Potential contamination history., Has there been a reported spill at the proposed project site,or have any [:]Y'esO No,
remedial actions been conducted at oradjacent to the proposed site?
If yes:
L Is any poition of the she listed on the N YS�DSEC Spills Incidents database or Environmental Site El Y esO No
Remediaflion database'? Check all that apply:
Yes,-Spills Incidents databasie Provide DEC ID number(s)-
Yes-Environmental Site Remediation,database Provide DECID number(s):
Neither database
fi. If site has bleensubject of KORA corrective activities,describe control'Measures'-___,"",...........................
—--——------------------------
.................
iii, IF the project WLithin 2000 feet of any site in the NYSDEC,Environmental Site Rernediation database? El Yu:Z No
If yes,provide DEC IDS number(s):� ............. —-----
iv- I f'yes to(j).(ii)or(iii)above,describe current status of sitc(*,
Page 1.0 of 13
-
e. Does the project site contain,or is it substantially contiguous to,a building, archaeolagicai site,or district YCS21Nu
which is listed on,OT hag been nondnated by the NYS Roard.of Historic Preservation for hiclusion oli, tile
State or National Register of 1-fistorit Ptaces?
If Yes-
L Nature of historiclar0aeological resource: ElArchaedlogical Site []Historic Building or District
1L Name:
U0. Brief description of attributes on which listing is base&
......................
F Is the project site,Or any portion of it,located in or adjacent to an area designated as sensitive for L]Yesl_—]No
archaeological setas on the NY State 14istoric Preservation Office(SHPO)archaeological site inventory?
9,1 Have additional archaeological or historic site(s)or resources been identified on the project site? YesoNo
If Yes:�
L Describe possible resource(s):
U., Basis for identification,
h, Is the project sitewithin fives miles ofany offic[ally designated,and publicly accessible federal,state,or local Yes' INo
scenic:or aesthetic resource:?
If Yes:
i, Identify resource: ........... ............
fl. Nature of,or ba5is,for,designation(e.g.,,estabtished highway overlook, state or local park, state historic trail or Scenic byway,
etc.)
i.4..i., Dista,ncebetween project and resriurce, Miles.
i. Is the project site located within a designated river corTildoir tinder the Wild,Scenic and Recreational Rivers. "es 'JNo
Program.6 NYCRR 666?
If yes'
4 Identify the name of the river and its designation.
fl, is the activity consistent with,development restrictions contained in 6,NYCRR Part 61166? Yes[] 'cm
F.Additional tFtformation.
Attach any additional information which may be needed to clarify your project,
I f you have identified any adverse impacts which could be associated with your proposal,,please describe those impacts plus any
measures ivhich you propose to avoid or minimize therm
G. Verification
I certify that the information provided is true to the best 101"my knowledge.
Applicant/Sponsor NameMACIA Date
'99
Signature Lo Title
.............. ................
TSF ORM Pagg 13 of 13,
Fall Enviriannzental Assessment Form
Part 2 - Idemijicadon oj'Potenfial Project Impacts
Part 2 Is to be completed by the tead agency. Part 2 is designed to help the lead agency inveatory all potential resources that Muld
be affected by a proposed project.or action. We recognize that the lead agency's reviewer(s)will not necessarily be environmental
professionals, ' o, the questions are designed to walk areviewer through the assessment process,by providing:ia series of'questions that
can be answered using the information fond in Part t- To,further assist the lead agency in completing Part 2,the form identi fi es the
most relevant questions in Part I that will provide the information needed to answer the Part 2 question. When Part 2 i completed,the
lead agency twill have identified the relevant environmenta I areas that may be impacted by the proposed activity.
If the,lead agency is a state agency and the action is;in any Coastal Area,complete the Coasta I Assessment,Form before proceeding
With this assessment.
Tips,for completing Part 2,
• Review all ef the information provided in Part 1.
• Review any application,maps, supporting materials and the Full EA F Workbook.
• Answer each of the 18 questions in Part 2.
• If you answer-"Yes"'to a numbered question,please complete all the questions that followin that section.
• If you answer"No"to a numbered question, move,on to the next numbered question.
• Check appropriate column to indicate:the anticipated size of the impact-
• Proposed projects,that would exceed a numeric:threshold contained in a question should result in the reviewin agency
checking the box"Moderate to large impact may occur."
• The reviewerisnot expected to,be an expert in environmental analysis-
• If you are not sure,or undecided about the size of an impact,it may help to review the sub-questions for the:general,
question and consult the Workbook.
• W hen amswetl ng a question consider all components,of the proposed activity,that is,the "whole action".
• Consider the possibility for long-terrn and cumulative irnpacts,as well as direct impacts.
• Answer the question in a reasonable manner considering the scale and context of the prpject.
1. Impact on Land
Proposed action may involve oonstruction on, or physical alteration of, E]NO LJ YES
the land,surface of the proposed site, (See Part 1, D,I)
Yes", answer questions cm-,L IL"No", move o'n to Section 2.
Relev;n—t No,or Moderate
Part I SM911 to,large
Qucsdon(ut) Impact Impact may
rna occur J Occur
......................
aF The prDpused action may involve construction on land where depth to water table is
less than 3 feet. E2d
b. The proposed action may i nVolvie construction onslopes of 15%or greater. L2f
c,The proposed action may involve construction on land where bedrock is exposed,or E
--general ly within 5 feet of ex isti ng ground surface.
d."The proposed action may involve the excavation and removal ofinose than 40001 tons l
of natural material,.
c.The propsied action may i nvolve construction that continues for more than one year Die
or in muulti ie lnases�.
f The proposed action may result in increased erosion,whether from physical Me, D,2q
disturbanceor vegetation removal,(including from treatrnentbX herbicides).
g.The proposed action is,or may be,located within a Coastal Erosion.hazard area. B1 i
h,Other impacts,
pagc 1, of 10
Pre I iminary Stage Rev ised April 2010
Signature Page
This page mcludes�: 1.), Authorization to Act as Agent Form.- �2..), Engineering Fee Disclosure; 3.), Aut,horization for Site
VisiW 4,,) Cqher Remit Responsibilities; 51.) Official Meeting Disclosuire and 6.) Agreement to provide docunien4ation
required,
OWNER's A6ENT,Fow-
Complete the following if the OWNER of the property is not the saine �sthe applkant
Designates:
As agent regarding: V Variance V Site Plan V Subdivision
For Tax Map No..:: Section, Block Lot,
Deed Reference: Book p1ge Date
-OWNER SIGNATURE: DATE
AP-PLICANT's,AGUITTOR�Ivt::
Complete the folloviing if the APPLICANT is unable to attend the rneeting or v4shes to be represented by another
party"
Owner: Marcia Parker
Designates: Van Dittsen&Steves Land SurvSyors
As,,agent regarding:: V Variance Site, Plan V Sobdivisilon
For Tax �Map No_,.� 316.5 Section, I Block s Lot
Deed Ref renice: 1374Aook 244 Page 3/16/04 Date P A
6t
-OWNER SIGNATURIE,� &,ArL� - DAT E� V A
2.1 EN!G1NEEaWr&FgL21$CL0SURE:: AppEications may lie referred to the Tolan consulting engineef for,review ofsepuc design,
storm� drainage, etc, as determined by t:he Zoning or Planning Department. Fees for engineering review servires Will be charged
directly to the applicant Fees for engineering review wi[[not exceed $, 1,0001 vafficut nofflication to the applicant
11 AUTHILAMI.M.E.0 SITE VISI�TS: By signing this page and subrnittinig the application materials anachect herein, the
0%&ner, Applicant, and histhe-trLheir agent(s) hereby authorize the Zonilng Board or Planning Board and Town Staffto enter the
su bject properties,for the pwpose of reVievAng the application submitted.
OTHER Pf,,,&Ul 8g2PQNS1BILFT]ES: Other permits may lie required for cons,TNucton or alleraVon WlVily subsequent to
approval bylbe Zoning Board or Pla,,Wng Board Ift is the a ppl ica,nt's,responsibility to Obtain Iny 3011044 oerm IM.
I OFFICI�ALMEfZIUGMINUllFlij2LvLQLQJUZL: It is the practice of �Ihe Commu0ty Development Departmenitto, have a
designated ster7ographer tape record the pfoiceedings of meetings fasulting, fron) appliration, an4 alinutes trans,cribed from those
tapes constitutes Me officiN retord of alt proceadings.
6.1 AGRELMOTa,PROVIDE DOCUMENTATION REQUIRED 1, 1J)e vnd4,rsjgnjed, have 11joroughty reid and understand the
inistructions for suhmjs�sjon[-,j�nd,agree to thesubmission requifernents, I ac*nowledge no ocinstruclion aiclivities sball be commenced
prior to tssuance of a vLIM' pernlift- 11 cerffy that the application. plaris and supporting niaterials are a true and complete
statenienVdiescriplion of the existing conicIfficinis and the woO proposed, and that all work will be performed in accordance voith the
appriavO plains and in Conformance with �ocal zoning regulations. I a0nowledge that prior to oocupying the fadfit[es proposed, I or
my agents, vAlt o,,b�tajn a cerdfrcate of Occupancy as necessary, I also undersland that Ime may ti required 110 provide an as-built
survey by a licensed�land surveyor of aill n&vft constructedfacillties prior to Issuance of a certificate of loctupancy
I have read and agree to the above-
-M 0, , ,- Marcia,Parker
8ibnatGre [Applicant] Print Name (Applicant] Date signed
KatthewSteve.&LLS 12_/J51
SjgFhature[,Agent] Print Nar-ne (Agent] D6te siginied
Town Of QUeensbuPj Planning Office�, 7,42 Bay Road - Que-ensbury, NY 12804 - 518-761�8220 7