SITE PLAN REVIEW APP SIGNED Site Plan Review Application
Review Process:
Applicant and/or agent shall meet with Zoning Administrator to determine type of review needed
Pre-submission meeting with staff is required to determine general completeness of application materials (to
be held no later than 1 week prior to deadline submittal - Call (518) 761-8220 for an appointment).
Application submittal: one (1) original application package, one (1) deed and 14 copies of the application
package with the application fee*
Determination of application completeness and placement on an agenda
Planning Board meetings are generally the third & fourth Tuesday's of each month. You will be advised in
writing as to which meeting to attend.
Following the meeting you will be provided with a copy of the resolution stating the Board's decision on your
application. If your application was approved, the next likely step is a Building Permit. If your application
was denied your project cannot proceed as submitted.
*Fee: $100.00 (0 to 10,000 so; $250.00 (10,001 to 30,000 so; $500.00 (30,001 to 100,000 so; $1,000.00
(100,000+so
Zoi2ingl St ;ff,. ntact Information:
Craig Brown, Director of Planning, Zoning &Code Compliance cra.gb� c qq!u n b i not.
Laura Moore, Land Use Planner Irnoore@qu en,sb_ urv.net
Pam Whiting, Office Specialist (518-761-8220) partr�geary t
Site Plan Review Revised March 2014 1
Town of Queensbury Planning Office-742 Bay Road. Queensbury, NY 12804.518-761-8220
P
General Information
Tax Parcel ID: 279.4-50
Zoning District: NC(NEIGHBORHOOD COMMERCIAL)&MDR(MOD DENSITY RESIDENT)
Lot size: 24.04 ACRES
Current Use: VACANT-OPEN FIELD NORTHERLY 8-ACRES,WOODED&BORROW PIT SOUTHERLY
PORTION
Proposed Use: ,RATTLE&ROLL"CAR-HOP RESTAURANT&ICE CREAM AND
SHAKE__.. .r.dn�.�..�._. _.-......
FRUIT&VEGETABLE STAND BUILDING
ProjectLocation: 1447 RIDGE RD-SE CORNER OF INTERSECTION OF STATE RT.149&STATE RT.9L®- mmW
mm._ W
....W _._....._
Applicant Name DALE BALDWIN -__.. Address: P.O.BOX 621-BUTTERMILK FALLS
RD,FORT ANN,NY 12827
Home Phone
(518)792-1371 Celi:
(518)796-2284
Work Phone Fax
E-Mail:
Agent's Name: -ITmm ..... Address: 169 HAVILAND ROAD
HUTCHINS ENGINEERING
QUEENSBURY NY 12804
Work Phone (518) 745-0307 Faxm- m (518)745-0308
..._ .........
E-mail THUTCHINSOHUTCHINSENGINEERI 4G.COM
LWDOBIEt HU"rCHINSENGINEE IN ,. M
..
Owner's Name: SAME AS
APPLICANT _ Address..
_, Home Pho - �
ne Cell .._.w
Work Phone � Fax
E-mail
Site Plan Review Revised March 2014 2
Town of Queensbury Planning Office-742 Bay Road• Queensbury, NY 12804.518-761-8220
Site_Del+ rent_Data NC-ZONE
Area Type
.....�... _._.
Existing sq.ft. Proposed Total sq.ft.
Addition sa.ft.
A. Building footprint 6050 6050
B._.. Detached Garage
..... ----- .-,.
C. Accessory Structure(s)
D. P__ 42,270 - 42,270 _.
sued, gravel or otherr hard surfaced area
E. Porches/ Decks
._ -_-__.. �� ...e__._... ....... ._.. .._....... ....... _. _..
F. Other_ (i.e. boathouse, sundeck, etc.)
G.TotalNori.._-P .� ��.. .. ____.�. �-......... ._...- �....�.�.��_---- -------- - ����a._,...�..�....._._...._ m
Non.-'Permeable [Add A-F] ----- 48,320 48,320
H. Parcel Area [43,560 sq. if.
/acre] 1,047,305 ----- 1,047,305
ents of Impermeable Area(AFTER BOUNDARY LINE ADJUSTMENT)
I. Perce Im _. ..��.�.�._ � ..._.�.. � .mm_..a�..
g p A of Site [I=G/H]
---- 4.6% 4.6%
Setback Requirements NC-ZONE
Area R _
equired Existing Proposed
��... _.�.��. Fro _ �
RT 49] 75'(TRAVEL CORRIDOR) ..... 100'
Front[2]
RT 9L 75'(TRAVEL CORRIDOR) ----- 111.3'
Shoreline
Side Yard [1]
20' ----- _...._
Side Yard [2]
.........-......
� . ..._w�... ...._ ..��..._._
20' ...,...
Rear Yard [1] 15' -- -- ---.
Rear Yard
d [2]° 15, 26S.5'
WEST ._...
Travel Corridor 75'
Height [max] 30' 30'
Permeability
30% 100% _95.4°
No. of parking spaces 44
Add!V1-0n-ALR-rweqt Ilnfon tion
1. Will the proposal require a Septic Variance from the Town Board of Health? NO
2, If the parcel has previous approvals, list application number(s):
3. Does this project require coverage under the NYS DEC Stormwater Pollution Prevention Program?
YES
4. Estimated project duration: Start Date eWw_FALL 2016 End Date SUM.2017
5. Estimated total cost of project: —'-' $1 MILLION
6. Total area of land disturbance for project: _ ry 3.8-ACRES .
Floor Area Ratio Worksheet
FLOOR AREA RATIO (FAR) -- The relationship of building size to lot size, derived by dividing the total building
floor area by the lot size in square feet, yielding a percentage.
Zoning Symbol Floor Area.......
District S y _..___..._. Ratio [FAR]
ront Residential
W R 0.22
Commercial Moderate/Commercial Intensive CM ......�-
Cl 0.3
Main Str0.3eet MS
A. The comNned area,of all square footage, as measure from exterior walls of all structureson the property, including all
floors of the structures, garages, baser iients and attics with rnore than five (b) feet of ceiling height and covered
porches. Building square footage does not include: Open deck, docks and that portion of covered docks extending
over water and one storage steed of one hundred twenty (120) square feet or less. Any additional sheds will be
included. (See "FLOOR AREA RATIO").
B. Commercial or industrial: the total area in square feet as measured from the exterior of the outside walls of a building
or structure, and when applicable, the sum total of all floor areas of the principal and accessory buildings or structures
on the project site.
mmA Parcel Area .. .__.._ v _..�. ..._.._�� � M.....-...�. qµ
_ . [see above definition]
_.. �
B Extsttn Floor Area �
... , . __ ... ....- --C Proposed Additional Floor Area
. ...._
tel Floor Area - s . ft.
D Proms_ w
used To...�..��._��_..��..__. ._..._.�..�.......__��..,�._. .
towable Floor Area
. - ..-. (Area x [see above table]
.... .._w..� _ .._.��
T D is larger than E, a variance or revisions to your plan may be needed. Please consult
w/Staff.
Site Plan Review Revised March 2014 4
Town of Queensbury Planning Office. 742 Bay Road• Queensbury, NY 12804 • 518-761-8220
§ 179-9-080 Requirernepts tqi°Site Pi ra Apptov, 1. The Planning Board shall not approve a Site Plan unless it
first determines that such site plan meets the following Standards. Please prepare responses to each of the following
topics.
STANDARDS
A. The proposed project furthers or is consistent will the policies�of the Town's Comprehensive ensive Plan.
including the site Ian review standard....___......
B. The proposed protect complies with all other requirements of this Chapter, g p s as set forth in Paragraph F
of this section,the dimensional,bulk,and density regulations of the zoning district in which it is proposed to be located(Article 3 and Table 1),
the applicable requirements of all other Articles that apply.
C. The site plan encourages pedestrian acW4 internatly and,if practicable,to and
p sI paths kiew._k
nd from the site with erle�,riar�r �ttrs or sicie�waiies connected to
adjacent areas.
��mmTD. The site plan must confo ._.-_...._ � � .. ,-� �-�
nn to Chapter 136 Sewage and Sewage Disposal, Chapter 147 Stormwater Management Local Law, and other
applicable local laws.
E. the proposed useshall be in harmony with the general purpose or intent of this Chapter,specifically taking into account the location,characterµµ
and size of the proposed use and the description and purpose of the district In which such use is proposed,the nature and intensity of the
activities to be involved in or conducted in connection with the proposed use and the nature and rate of any increase in the burden on
supporting public services.and facilities which will follow the approval of the proposed use.
. The establishment,maintenance and operation of the proposuse will-not create public hazar .
Fad �
ds from traffic,traffic congestion or the parking
of vehicles and/or equipment or be otherwise detrimental to the health, safety or general welfare of persons residing or working in the
neighborhood or to the general welfare of the town.Traffic access and circulation, road intersections, road and driveway widths, and traffic
controls will be adequate.
G.....Off-street parkingm and loading facilities will be appropriately located and arranged and sufficient to meet traffic anticipated to be generated by
the new use. The establishment of vehicle links between parking areas of adjacent properties are provided where feasible. This furthers the
Town's goal of reducing curb cuts and reducing congestion. A twenty-foot wide connection is required. If adjacent properties are either
undeveloped or previously developed without having made provision for future linkage, then a future connection must be identified and
provided for in the site plan under review for such future linkage when the time arises. The Planning Board may require proof that the
applicant has made contact with adjacent property owners for purposes of coordinating linkages with adjacent properties.
H. The—project shall not have art undue adverse impact upon the natural,scenic,aesthetic, cmmo...l.ogical,wildlife,historic,
istoric,recreational or open space
resources of the town or the Adirondack Park or upon the adequate provision of supporting facilities and services made necessary by the
project, taking into account the commercial, industrial, residential, recreational or other benefits that might be derived from the project. In
making the determination hereunder, the Planning Board shall consider those factors pertinent to the project contained in the development
considerations set forth herein under§179-9-080 of this chapter,and in so doing,the Planning Board shall make a net overall evaluation of
the project in relation to the development objectives and general guidelines set forth in§179-9.080 of this Article.
p g p traffic access and circulation,waRma structures,
t fi
I. The provision for and arrangement of edr» titan fiat y structuresoorltrgi cat interjections with vehicular fiat"
and overall pedestrian convenience shall be safe and adequate for pedestrian movement Pedestrian connections between adjacent sites
shall be provided to encourage pedestrian use.
.�.,�.. J.�Stormwater_... ..__�.�...�... — _....�.�._..�.. �.�..._-..._-
drainage facilities will prevent an increase of post development drainage flows as compared to pre-development drainage flows.
Drainage of the site shall recharge ground water to the extent practical. Surface waters flowing off-site shall not degrade any streams or
adversely affect drainage on adjacent properties or public roads. Facilities shall be in conformance with the drainage standards of Chapter
147 of the Town Code and the Town of Queensbury Subdivision Regulations where applicable.
K. The water supply and sewage disposal facilities will be adequate and will meet all
. ppli applicable
e a ._
�. appliand current requirements set forth by Department
of Health regulations and Chapter 136 of the Town Code.
._. .-L�..� the: adequacy, type and arrangement of trees,shrubs and othersuitable plantings, landscaping and screening shall effectively provrti a
visual and/or noise buffer between the applicants and adjoining lands, including the maximum retention of existing vegetation and
maintenance,including replacement of dead or deceased plants.
M. Fire lanes,emergency zones,and fire hydrants will be adequate and meet the needs and requirements of emergency service providers.
N. The design of structures, roadways and landscaping In areas susceptible to ponding, flooding and/or erosion will minimize o"
r avoid such
impacts to the maximum extent practicable.
mmmuW0. The site plan conforms to the design standards,landscaping standards anderformanm.-......�.�.... �.
p ce standards of this chapter.
Site Plan Review Revised March 2014 5
Town of Queensbury Planning Office-742 Bay Road-Queensbury, NY 12804. 518-761-8220
Applicant/Owner: DALE BALDWIN - "SHAKE, RATTLE & ROLL"
Tax Parcel ID: 279.-1-50
179-9-080 Responses to standards questions A-O
& The proposed project is a restaurant & fruit & vegetable stand building within the
Neighborhood Commercial zone and is consistent with the policies of the Town's
Comprehensive Plan.
B. The proposed project meets the other requirements of the zoning chapter,
C. The proposed project has been designed to allow internal pedestrian activities as
necessary and applicable to these types of use.
D, The proposed project has been designed to be in compliance with Chapters 136 and 147
as applicable. Specifically, stormwater management in accordance with NYSDEC
standards is provided for the site.
E. The proposed project has been designed to be in harmony with the general purpose or
intent of this Chapter.
F. The proposed project has been designed to be in compliance with principles of good site
access, traffic flow, and safety and general welfare of the neighborhood.
G. The proposed project has been designed with the intent to provide safe, adequate, and
functional off-street parking and loading facilities.
H. The proposed project has been designed to not 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 activities as
necessary and applicable to this type of use.
J. The proposed project has been designed to be in compliance with Chapter 147 as
applicable.
K. The proposed project has been designed to be in compliance with NYS Department of
Health standards as well as the requirements of Chapter 136 of the Town Code.
L. The proposed project has been designed to provide an attractive 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 ponding with the exception of areas required for stormwater
controls.
O. The site has been designed with the intent of conforming to the design standards,
landscaping standards, and performance standards of this Chapter.
§ 179-9-050 Ap c tion fd Fite Plan Review
Absent any waiver or waivers, an application for Site Plan Review shall include the following:
REQUIREMENTS Sheet#
A vicinitymap drawn at the scale that shows the relationship of the proposal to existing community facilities which affect or serve it,
such as roads, shopping areas, schools, etc. The map shall also show all properties, identify owners, subdivisions, streets, and S2
easements within 500 feet of the property. Such a sketch may be superimposed on a United States Geological Survey map of the
area.
.ti P forty { __ ... .. ...._..._ ..._.._.__ __. g y.....
B t a scale of fo feet to the inch 1° =40 feet or such other scale as the Planning Board may dee
The site Ian shall be drawn a � r1
appropriate,on standard 24"x 36'sheets,with continuation on 8%z"x 11"sheets as necessary for written information. The information ALL
listed below shall be shown on the site plan and continuation sheets.
C Name of the project,boundaries,date,north arrow,and scale of the plan. ALL
D he record addresaolette of owner
of re on shall tor,and
required from he owner engineer,architect,or andsca
Name and of the landscape architect. if the applicant is not ALL
The location and use of all existing and proposed structures within the roe including all dimensions of height e
I; g p po property,rty,' g g t and floor area,all
exterior entrances,and all anticipated future additions and alterations. S1-S3
F The location of all present and proposed public and private ways, off-street parking y outdoor storage areas,
sidewalks,ramps,curbs,paths,landscaping,walls,and fences. Location, e,and screeningdetails for all waste disposal a aur
-
Sl-S3
shall also be shown.
_G aThe location,nd methods height,intensity,
onto adjoining soodiuem,incandescent,etc. of all external lighting The direction_ io _WWW-....... . _
g 'ty, typ { ) g g of illumination
to
g g p p rties must also be shown in compliance with§179-6-020. S5
location,height,size,materials,and design of
The Immm
Fi all proposed signs. S3
I The location of all present and proposed utility systems including:
1. Sewage or septic system;
2. Water supply system; S2-S3
3. Telephone,cable,and electrical systems; and
4. Stone drainage system including existing and proposed drain lines, culverts,catch basins,headwalls, endwalls,hydrants,
manholes,and drainage swales.
J Plans to prevent the pollution of surface or groundwater, erosion of soil both during and after construction, excessive runoff, and
flooding of other properties, as applicable. A Stormwater Pollution Prevention Plan (SWPPP) for all land development activities
(excluding agricultural activities) on the site that results in land disturbance of 1-acre or more. A SWPPP shall comply with the S3-S4
requirements of the DEC SPDES MS-4 General Permit and Chapter 147 of the Town of Queensbury Code. It shall be at the
discretion of the Planning Board as to whether a SWPPP or an erosion and control plan shall be required for a site plan review project
land disturbance of less than 1-acre.
K Existing and proposed topography at two-foot contour intervals, or such other contour interval as the Planning Board shall allow. All
elevations shall refer to the nearest United States Coastal and Geodetic Bench Mark. If any portion of the parcel is within the 100- S1&S2
year floodplain,the area will be shown,and base flood elevations given. Areas shall be indicated within the proposed site and within
50 feet of the proposed site where soil removal or filling is required,showing the approximate volume in cubic yards.
L A landscape plan showing all existing natural land features that may influence the design of the proposed use such as rock outcrops,'
stands of trees, single trees eight or more inches In diameter, forest cover, and water sources, and all proposed changes to these S6
features including sizes and types of plants. Water sources include ponds, lakes, wetlands and watercourses,aquifers,floodplains,
and drainage retention areas.
District
... ies with
in p50't0yfeet of the site's perimeter shall be drawn d on t well a m � .mm �
M Land Use District boundan and identified on the site plan, as well as any
OverlayDistricts that apply to the roe S1
Site Plan Review Revised March 2014 6
Town of Queensbury Planning Office-742 Bay Road- Queensbury, NY 12804•518-761-8220
REQUIREMENTS CONTINUED mm Sheet#
N Traffic flow patterns within the site, entrances and exits,and loading and unloading areas,as well as curb cuts on the site and within
100 feet of the site. The Planning Board may,at its discretion, require a detailed traffic study for large developments or for those in
heavy traffic areas,which shall include:
1. The projected number of motor vehicle trips to enter or leave the site, estimated for weekly and annual peak hour traffic
levels; S2-S3
2. The projected traffic flow pattern including vehicular movements at all major intersections likely to be affected by the
proposed use of the site;
3. The impact of this traffic on levels of service on abutting public streets and at affected intersections. Existing and proposed
weekly and annual peak hour traffic levels and road capacity levels shall also be given.
For new construction or alterations to any structure,a table containing the following information shall �..._ - .
O _......... _ .
be included.
1. Estimated area of structure to be used for particular purposes such as retail operation,office,storage,etc.;
2. Estimated maximum number of employees; S3
3. Maximum seating capacity,where applicable;and
4. Number of parking spaces existing and required for the intended use.
P 1. Floor Plans.
2. Elevations at a scale of one-quarter inch equals one foot(1/4"=1 foot)for all exterior facades of the proposed structure(s) and/or ARCH
alterations to or expansions of existing facades,showing design features and indicating the type and color of materials to be used.
Q oillogs,water supply well and percolation test results,and storm runoff calculations,as needed to determine and mitigate project__.. _ S2
impacts.
�
R Plans for disposal of construction and demolition waste,either on-site or at an approved disposal facility,
Plans for snow removal,including location(s)of on-site snow storage. S2-S3
An Environmental Assessment Form ("EAF'),as required by the SEQRA regulations,with Part 1 completed by the Applicant shall be
submitted as part of the application. If the proposed project requires a special use permit and an EAF has been submitted in APP
conjunction with a special use permit application,a duplicate EAF is not required for the site plan application..
U If an application is for parcel
p..�m_�._._ proposed,the applicant may submit a sing application
pp p I or parcels on which more than one use is ro os�mm-.,.,..-M single lication for
all such uses provided the proposed uses are accurately delineated on a site plan drawn pursuant to the requirements set forth
above. The Planning Board may grant the application with respect to some proposed uses and not others. For purposes of reviewing APP
an application (and for SEQRA compliance) all proposed uses on a single parcel or on contiguous parcels shall be considered
together.
A banes Comprehensive ve Plt on how the project proposed for review furthers or is consistent...r.w,��..._..�..����
V with the vision, oats and policies m the
wn's
P f P Pg P COVER
Site Plan Review Revised March 2014 7
Town of Queensbury Planning Office-742 Bay Road . Queensbury, NY 12804-518-761-8220
Pre-Submission Conference Form r179-4-040
7. Tax Map ID 279.-1-
IT 0
mm ... .
2. Zoning Classification N 'NEIGHBORHOOD COMMERICAL)&MDR
3. Table of Allowed Uses _ w _w _ is subject to Site Plan Review
4. Ordinance Section# I
0 14
5. Pre-Submission Meeting Notes; Outstanding Items To Be Addressed Include:
Deed Yes No
General Information complete Yes No
Site Development Data Complete Yes No
Setback Requirements Complete —Yes No
Additional Project Information Complete Yes _.._ No
*CoW agp__i _cr DEt 5 PI'P 'rp Yes No
FAR Worksheet complete Yes No
Standards addressed Yes No
Checklist items addressed Yes No
Environmental Form completed Yes No
Signature Page completed Yes No
kc
� c'c.,�(`�-.�t^ .�, 'i.�q�4. �� � �r.� � Viµ, c, c d`�'f
en," . . ('en C4
t
- ` ' ,
. �:
- .„. ." -" f I - r
*A fificant must rov!dE off c@ I h. of Irodtea t NOS: SWPPf Acce fence Form ITEC I tteris tagep raw rraber;
Notice of Termination NOT
Staff Representative: tlC
Applicant/Agent: _ m..
Date: t
Site Plan Review Revised March 2014 8
Town of Queensbury Planning Office-742 Bay Road •Queensbury, NY 12804 518-761-8220
Signature Page
This page includes the 1.) Authorization to Act as Agent Form: 2.) Engineering Fee Disclosure; 3.) Authorization for Site
Visits; 4.) Other Permit Responsibilities; 5.) Official Meeting Disclosure and 6.) Agreement to provide documentation
required.
OWNER's AGENT FORM:
Complete the following if the OWNER of the property is not the same as the applicant
Owner: DALE BALDWIN
Designates: HUTCHINS ENGINEERING
As agent regarding: Variance ✓ Site Plan Subdivision
For Tax Map No.: 279• Section 1 Block so Lot
Deed Reference: 057 Bo 56 Page 3/10/98 Date
OWNER SIGNATURE: DATE: 7/11/2016
APPLICANT's AGENT FORM:
Complete the following if the APPLICANT is unable to attend the meeting or wishes to be represented by another party
Owner: _ DALE BALDWIN
Designates: HUTCHINS ENGINEERING
As agent regarding: Variance ✓ Site Plan Subdivision
For Tax Map No.: 279• ection 1 Block 50 Lot
Deed Reference: 10" Boob 56 Page 3/10/98 Date
APPLICANT SIGNATURE: _ DATE 7/11/2016
2.) gNGIkEr=RJNG FEF IgjtgL-OSU'RE: Applications may be referred to the Town consulting engineer for review of septic design,
storm drainage, etc. as determined by the Zoning or Planning Department. Fees for engineering review services will be charged
directly to the applicant. Fees for engineering review will not exceed$1,000 without notification to the applicant.
3.) AQ1H0RIZATI01 _SITE By signing this page and submitting the application materials attached herein, the Owner,
Applicant, and his/her/their agent(s) hereby authorize the Zoning Board or Planning Board and Town Staff to enter the subject
properties for the purpose of reviewing the application submitted.
b, thOe HE P Board or Planning nSIMLITIElt- Other permits may be required for construction or alteration activity subsequent to approval
y g g is the applicant's responsibility to obtain any additional permits.
5.) fFF101�I MEI fIIVO MINUTES IISCLOtlrflf: It is the practice of the Community Development Department to have a designated
stenographer tape record the proceedings of meetings resulting from application, and minutes transcribed from those tapes constitutes
the official record of all proceedings.
6.) AGREEMENT "IIr p w/LSE DCg(L1 I, the undersigned, have thoroughly read and understand the
instructions for submission and agree to the submission requirements, I acknowledge no construction activities shall be commenced
prior to issuance of a valid permit. I certify that the application, plans and supporting materials are a true and complete
statement/description of the existing conditions and the work proposed, and that all work will be performed in accordance with the
approved plans and in conformance with local zoning regulations. I acknowledge that prior to occupying the facilities proposed, I or my
agents,will obtain a certificate of occupancy as necessary. I also understand that 1/we may be required to provide an as-built survey by
a licensed land surveyor of all newly constructed facilities prior to issuance of a certificate of occupancy
I hav r ad ar re to the above,
DALE BALDWIN 7/11/2016
Signa t Ili nt Print Name [Applicant] Date signed
LUCAS W.DOBIE,P.E. 7/11/2016
Signature[Agent] Print Name [Agent] Date signed
Site Plan Review Revised March 2014 9
Town of Queensbury Planning Office-742 Bay Road•Queensbury,NY 12804.518-761-8220
Short Environmental Assessment Form
Part I - Project Information
histructions for conmi tin
Part 1 - Project Information. The applicant or project sponsor is responsible for the completion of Part 1. Responses
become part of the application for approval or funding, are subject to public review, and may be subject to further verification.
Complete Part 1 based on information currently available. If additional research or investigation would be needed to fully
respond to any item, please answer as thoroughly as possible based on current information.
Complete all items in Part 1. You may also provide any additional information which you believe will be needed by or useful
to the lead agency; attach additional pages as necessary to supplement any item.
Part 1 - Project and Sponsor Information
.Name of.. W�....... ..._........... . _...._.. _ .
Action or Project:
SHAKE,RATTLE&ROLL RESTAURANT&ICE CREAM
Project Location describe, and attach .___....
..... ........
� ( a location map):
SOUTHWEST CORNER OF INTERSECTION OF STATE RT 9L&STATE RT 149
....... __ .._ w... .... ....... _...............
Brief Description of Proposed Action,.
CONSTRUCT NEW"SHAKE, RATTLE&ROLL"CAR-HOP RESTAURANT&ICE CREAM BUILDING AND NEW FRUIT&VEGETABLE
STAND BUILDING;ALSO ASSOCIATED SITE UTILITIES:PARKING, LIGHTING, LANDSCAPING,WATER,WASTEWATER,STORMWATER
Nameof Applicant........... _ .
or Sponsor: Telephone: (518)792-1371
DALE BALDWIN E-Mail;
__ _..._. _ ..... ...._.......
� Address:
P.O. BOX 621 -BUTTERMILK FALLS RD
City
/PO: .... .......__... . ...._ �...._._ _.........................
State: Zip Code:
FORT ANN NY 12827
.... ......__.. .......... ---
1. Does the proposed action only involve the legislative adoption of a plan, local law, ordinance, NO YES
administrative rule, or regulation?
If Yes,attach a narrative description of the intent of the proposed action and the environmental resources that LJ
may be affected in the municipality and proceed to Part 2. If no, continue to question 2.
...__....._
2 Does t........ _ ....._ _. .. ....... ..__
he proposed action require a permit,approval or funding from any other governmental Agency? NO YES
If Yes, list agency(s)name and permit or approval:
NYSDOH, NYSDEC, NYSDOT
..... _�... .__ _ .....�...... � _ .............
3.a. Total acreage of the site of the proposed action? 24.04 acres
b. Total acreage to be physically disturbed? 3.8 acres
................ ....,
c. Total acreage(project site and any contiguous properties)owned
or controlled by the applicant or project sponsor? 24.04 acres
4. Check all land uses that occur on, adjoining and near the proposed action.
❑Urban ❑Rural(non-agriculture) [Z]Industrial ®Commercial ®Residential(suburban)
m Forest ❑Agriculture ❑Aquatic ❑Other(specify):
❑Parkland
Page 1 of 3
5. s the proposed action, NO YES N/A
a. A permitted use under the zoning regulations?
b. Consistent with the adopted comprehensive plan? El
6. Is the or000sed action consistent with the predominant cha --- _•. ..
racter of the existing built lir natural NO YES
L.landscape?.._ IR 1
...."." __ -. __
7. Is theal Area?
site of the proposed action located in,or does it adjoin, a state listed Critical Environment J"]
��
NO YES
If Yes, identify: - - --'
... Lr J 1:1
8. a. Will the proposed action result in a substantial increase .,.,....mm_ b_."...... p � � �
in traffic above resent levels? NO YES
b. Are public transportation service(s)available at or near the site of the proposed action? IV I
._❑c.Are any pedestrian accommodations or bicycle routes available on or near site of the proposed action? �/
9. Does the pro proposed action meet or exceed the ....... ...... �w
p p state energy code requirements? NO YES
If the proposed action will exceed requirements, describe design features and technologies:
LED LIGH.TINC '
..... _ _ .., m
10, Will the proposed action connect to an existing public/private water supply? NO YES
If No,describe method for providing potable water:
NEW ON SITEWELL WITH WATER TREATMENT SYSTEM FOR PUBLIC WATER SUPPLY
11. Will thero osed action connect to existing ___............._.. __.._
p p ng wastewater utilities? NO YES
If No,describe method for providing wastewater treatment: c
NEW ON-SITE WASTEWATER SYSTEMS
........... _. ..._.... _ ...............
12. a. Does the site contain a structure that is listed on either the State or National Register of Historic NO YES
Places? IT�"'
b. Is the proposed action located in an archeological sensitive area?
13. a. Does any portion of the site of the proposed action,or landsµadjoining the proposed action,
rv_...... contain NO YES I
wetlands or other waterbodies regulated by a federal, state or local agency? mm
b. Would the proposed action physically alter, or encroach into, any existing wetland or waterbody? U
If Yes, identify the wetland or waterbody and extent of alterations in square feet or acres:
14. Identify
the
typical habitat es that occur .................... :........t
_ .. .fY tYP >�'P r
91
on; or are likely to be found on the protect site. Check all that apply-.
El Forest ❑Agricultural/grasslands ❑Early mid-successional
❑ Wetland ❑urban 91 Suburban
15. Does the site of the proposed action contain an species of animal,or associated.............ts ........
p p y p .... habitats, listed NO YES
by the State or Federal government as threatened or endangered? p�
16. Is the project site located in the 100 year flood plain? � ""..N0...... YES
17. Will the proposed action create storm water discharge, either from point or non-point sources"! NGYES
If Yes,
a. Will storm water discharges flow to adjacent properties? NO YES El V
b. Willl storin waiter discharges be directed to established conveyance systems(runoff and storm drains)?
I f Yes, briefly dvs(„ribe: W]NO DYES
Page 2 Of 3
18. Does the proposed action Include construction Wor other activities that resultm
in the impoundment of NO YE
water or other liquids(e.g. retention pond,waste lagoon, dam)?
If Yes,explain purpose and size
T(1RMIA/ATFRFTFNTI(1N R INFII TRATI(1N
19. Has the site of the proposed action or an adjoining property been the location of an active or closed NO YES
.....
solid waste management facility?
If Yes,describe
........ .. ........... ..... _ ... ...._ .._ �.
20. Has the site of the proposed action or an adjoining property been the subject of remediation(ongoing or NO YES
completed)for hazardous waste?
If Ye ,describe:
(FROMSEAF MAPPER. SEE FOLLOWING PAGE.)............... ... ... — , „ ......... .. ....._.. . ..__._
I AFFIRM THAT THE INFORMATION PROVIDED ABOVE IS TRUE AND ACCURATE TO THE BEST OF MY
KNOWLEDGE
� �licant�s onsor p
g LL�4@
N Date: JULY 13 2016
Signature: ���� IOAF 1;-11111111111111111-11111 _ .., ........... „ .. _ .,..,......
1l p � ...
PRINT FORM Page 3 of 3
EAF Mapper Summary Report Tuesday, July 12, 2016 1:30 PM
Disclaimer: The EAF Mapper is a screening tool intended to assist
project sponsors and reviewing agencies in preparing an environmental
assessment form(EAF).Not all questions asked in the EAF are
ansvicrod by!ho E PX C"»✓tappar Ad,66l anal on any EAF
questrvn Carl be obtained by constilting the EAF Workbooks Although
Me EAF Mapper provides Vie most up-to-date digital data available to
to obtainu +ay amu ccu iv Cui nd iiia 8i moi'i tl9 f uata suw ces lfi Utuer
V data not provided by the Mapper.Digital data is not a
substitute for agency determinations.
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Part 1 /Question 7 [Critical Environmental No
Area]
Part 1 /Question 12a [National Register of No
Historic Places]
Part 1 /Question 12b [Archeological Sites] Yes
Part 1 /Question 13a [Wetlands or Other Yes- Digital mapping information on local and federal wetlands and
Regulated Waterbodies] waterbodies is known to be incomplete. Refer to EAF Workbook.
Pan` 1 /Question 15 [Threatened or No
Endangered Animal]
Part 1 /Question 16 [100 Year Flood Plain] Digital mapping data are not available or are incomplete. Refer to EAF
Workbook.
Part 1 /Question 20 [Remediation Site] Yes
Short Environmental Assessment Form - EAF Mapper Summary Report