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Application Area Variance [ZBAapproved: September212016] General Information 289.10-1-53 Tax Parcel ID Number: WR Zoning District: Detailed Description of Project [include current&proposed use]: Single Family Residential Current Use: Single Family Residential Proposed Use; 366 Glen lake Road Location of Project: Applicant Name: Gary Hillert Mailing Address 689 SW Bittern St Home Phone City, State,Zip Palm City,FL 34990 Work Phone Cell Phone 561-202-4548 E-Mail: gkc34990@gmail.comv FAX No. i Agent's Name: VanDusen& Steves Mailing Address 169 Haviland Road Home Phone City, State,Zip Queensbury,NY 12804 Work Phone 518-792-8474 Cell Phone E-mail matt@vandusenandsteves.com FAX No. 518-792-8511 Owner's Name Same Mailing Address Home Phone City, State,Zip Work Phone Cell Phone E-mail FAX No. Page 1 Area Variance [ZBAapproved: September212016] Site Development Data Area/Type Existing sq.ft Proposed Total sq.ft. Additions .ft. A. Building footprint 4205 0 4205 B. Detached Garage 0 0 0 C. Accessory Structure(s) 102 0 102 D. Paved, gravel or other hard surfaced area 4417 0 4417 E. Porches/Decks 483 0 483 F. Other 0 0 0 G. Total Non-Permeable [Add A-F] 9207 9207 H. Parcel Area [43,560 sq. ft./acre] 37002 0 37002 I. Percentage of Impermeable Area of Site [I=G/H] 24 8% 24.8% Setback Requirements Area Required Existing Proposed i Front Yard [1] 30 49 49 Front Yard [2] N/A N/A N/A Shoreline 50 10.3 10.3 Side Yard[1] 25 1.3 1.3 Side Yard[2] N/A N/A NA/ Rear Yard [1] N/A N/A N/A Rear Yard [2] N/A N/A N/A Travel Corridor N/A NA/ N/A Height [maximum] 28 18 18 Permeability 75% 75.2% 75.2% Number of parking spaces 2 2 2 Page 2 Area Variance [zBA approved: September 21 2016] Additional Pry ect Information 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 New York State Pollutant Discharge Elimination System(SPDES)Permit Program? _Yes/X No 4. Estimated project duration: Start Date: N/A End Date: N/A 5. Estimated total cost of project; N/A 6. Total area of land disturbance for project: NA/ 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 District Symbol Floor Area Ratio [FAR] Waterfront Residential WR 0.22 Commercial Moderate/Commercial CM/Cl 0.3 Intensive A. The combined area of all square footage, as measure from exterior walls of all structures on the property, including all floors of the structures, garages, basements and attics with more than five (5) 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 shed 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. Parcel Area 37DO2 s . ft. Existing Floor Area - 5 . ft. see above definition Proposed Additional Floor Area s . ft. Proposed Total Floor Area 4205 s . ft. Total Allowable Floor Area 8140 Area x see above table Page 3 Area Variance [ZBA approved: September 21 2016] Compliance with Zoning Ordinance Requesting relief from SECTION: Need relief from the requirement(s)listed below which can not be met by the project as proposed. [Check all that apply] Metback ❑ Buffer Zone ❑Lot Width ©other The following questions reflect the criteria for granting this type of variance. Please complete them; use additional sheets if needed. l. Whether an undesirable change will be produced in the character of the neighborhood or a detriment to nearby property will be created by the granting of this area variance? 2. Whether the benefit sought by the applicant can be achieved by some method, feasible for the applicant to pursue, other than an area variance? Deck consizuMd for-%afe reasons. 3. Whether the requested area variance is substantial? ViniMal 4. Whether the proposed variance will have an adverse effect or impact on the physical or environmental conditions in the neighborhood or district? None- 5. Whether the alleged difficulty was self-created? Yew Page 4 Area Variance [ZBAapproved: September212016] Section 179-14-030—Application materials Application materials and site plan drawing is to include sufficient information for the Board to review and provide a decision. The applicant is to provide a site plan drawing(s)—a survey showing existing conditions,a proposed conditions map(see page 00 for specific criteria)and include any other attachments that address A-D as applicable to the proposed project. A. General Shown on Sheet# 1 Title,Name, Address of applicant&person responsible for preparation of drawing S-1 2 Deed APP 3 North arrow, Tax Map ID, date pmg ared and scale minimum: finch=40 feet S-1 4 Boundaries of the property plotted to scale, zoning boundary S-1 5 Principal structures,accessory structures with exterior dimensions S-1 6 Site improvements Incl. outdoor storage areas, driveways,parking areas, etc.: existing& S-1 proposed 7 Setbacks for all structures and improvements: existin &proposed S-1 8 Elevations and floor plans of all proposed and affected structures N/A B. water& Sewer _ Shown on Sheet# 1 Project sewage disposal facilities,design details, construction details, flow rates, and number of N/A bedrooms ro osed 2 Water supply [i.e. well] &septic on adjoining lots with separation distances to existing or S-1 proposed on-site water supply and septic 3 Separation distances for proposed sewage disposal system to well and water bodies N/A 4 Existing public or private water supply [well, lake, etc.]. Method of securing public or private S-1 water, location, design and construction of water supply including daily water usage 5 Percolation test location and results N/A C. Parkin /Permeable Areas Shown on Sheet# 1 Number of spaces required for project including calculations and justification: existing& N/A proposed 2 No. of existing parking spaces,number to be removed,number to maintain and type of surfacing N/A material e. .,gravel, paved] 3 Provision for pedestrian and handicap access and parkin a: existing&proposed N/A 4 Desip details of ingress,a ss,loading areas and cuttin : existin &proposed N/A 5 Location and character of green areas [existing and proposed],modification to green area,buffer N/A zone to remain undisturbed 6 Lighting,htin location and desiE of all existin and proposed outdoor lighting N/A D. Additional Site Development and Miscellaneous Shown on Sheet# 1 On-site&adjacent watercourses,streams, rivers, lake and wetlands S-1 2 Utiiit /eneEm distributions stem fps,electric, solar,telephone]; existing& ro osed N/A 3 Location, design and construction details of all existing and proposed site improvements N/A including: drains, culverts,retaining walls,fences, fire&emer enc zones and hydrants,etc. 4 Square footage of bldg. area proposed for office, manufacturing, retail sales or other commercial N/A activities: existin &2T2osed 5 Si a e: Location, size, type,design and setback: existim&Proposed N/A 6 Waiver Request: provide letter with application requesting any waivers: please reference N/A specific items 7 Commercial/Industrial Development requires submission of Landscaping, Stormwater N/A Management, Grading&Lighting Plans 8 Identification of Federal, State or County permits required for the project together with a record N/A of application for all necessary permits Page 5 Area Variance[ZBA appmvcd; Septambw21 20161 Pre-Submission Conference Form/Section 179-9-040 1. Applicant Name: Gary Hillert 2. Tax i?lap IID 289.10-1-53 Location: 366 Glen Lake Road f 3. Zoning Classification WR Cif �St( �} ��U 51(y 4. Reason for Revie-ty. rti f PLC. i T 5. Zoning Section 6. Pre-Submission Meeting Notes: Provided Outstanding; Please provide by Deed General Information complete ?C Site Development Data Complete Setback Requirements Complete Additional Project Information Complete X �r��►, ,��� rar,-,,f�15 1 .i s ttC!I$AfJ���' FAR addressed 2( Compliance with Zoning Ordinance X Checklist items addressed -4 Environmental Form completed Signature Page completed 4— �. .(00 � y4YIIA ' v e ( --t~ - G- G r G Dv r 6 s,.i"ca'r`e.� P(-(5 P c.'(- L o t ti C fA4' �l1 tt ^ 7 o/l G{' r7C� —�D �. f to e QA41N - �l y f{C t ' ) C '� �f .t Q vt l G� ✓�f , r,. I`P Ut lrL 4e1 G cferrrc.e. t 6COC-L ( 'i L r C L dej- 0' _��-tOre t t` �l t IAA vt _.It_) # V L IV ' - n r . i t e. ! rt QY�I JO t c fH_('-�.rC C�� G�/l t C 3C� eC� �l al rcC�I .�� � C '► _G( Staff Representative; Applicant/Agent: Date: Page 6 Area Variance [zsA approved: September 21 2016] 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: Designates: as Agent regarding the following: Variance Site Plan_ Subdivision For Tax Map No.: Deed Reference: Book Page Date OWNER SIGNATURE: DATE: 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: ' Designates: l 9�,57 i52,-�-Cas Agent regarding the following: Variang�,L� Site Plan Subdivision For Tax Map No' -/U Deed Reference: Book Page Date zc Z 9— lC OWNER SIGNATURE: DATE: /— 9 2.1 ENGINEERING FEE DISCLOSURE: Applications may be referred to the "Gown 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 S 1,000 without notification to the applicant. 3. AUTHORIZATION FOR SITE VISITS: By signing this page and submitting the application materials attached herein, the Owner,Applicant,and hWher/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. 4. OTHER PERMIT RESPONSIBILITIES: Other permits may be required for construction or alteration activity subsequent to approval by the Zoning Board or Planning Boatel. It is the applicant's responsibility to obtain any additional permits. 5. ❑FFICIAL MEETING MINUTES DISCLOSURE: 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. d. AGREEMENT TO PROVIDE DOCUMENTATION REQUIRED: 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 I/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 have re d and agree to xh ab e ' Si awre[App ' Print Name[Applicant] Date signed rg ure gent Print Name[Agent] Date signed Page 7 Short Environmental Assessment Form Part I - Project Information Instructions for Completing 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 Gary Hillert Name of Action or Project: 366 Glen Lake Road Project Location(describe,and attach a location map): 366 Glen Lake Road Brief Description of Proposed Action: Existing single family home. Name of Applicant or Sponsor: Telephone: 561-202-4548 Gary Hillert E-Mail; _ gkc34990@gmail.com Address: 689 SW Bittern Street City/PO: State: Zip Code. Palm City FL 34990 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 may be affected in the municipality and proceed to Part 2. If no,continue to question 2. 2. Does the 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: ❑ ❑ 3.a. Total acreage of the site of the proposed action? .85 acres b.Total acreage to be physically disturbed? 0 acres c.Total acreage(project site and any contiguous properties)owned or controlled by the applicant or project sponsor? .85 acres 4. Check all land uses that occur on,adjoining and near the proposed action. ❑Urban ❑Rural(non-agriculture) ❑Industrial ❑Commercial 0Residential(suburban) ❑Forest ❑Agriculture mAquatic ❑Other(specify): ❑Parkland Page 1 of 3 5. Is the proposed action, NO YES N/A a.A permitted use under the zoning regulations? ❑ Z ❑ b. Consistent with the adopted comprehensive plan? ❑ 21 ❑ 6. Is the proposed action consistent with the predominant character of the existing built or natural NO YES landscape? ❑ C1 7. Is the site of the proposed action located in,or does it adjoin,a state listed Critical Environmental Area? NO YES If Yes,identify: ❑ ❑ 8. 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 or bicycle routes available on or near site of the proposed action? R ❑ 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: EJ 10. Will the proposed action connect to an existing public/private water supply? NO YES If No,describe method for providing potable water: ❑ Well 11.Will the proposed action connect to existing wastewater utilities? NO YES If No,describe method for providing wastewater treatment: Z ❑ Se tic S stem 12. a. Does the site contain a structure that is listed on either the State or National Register of Historic NO YES Places? ❑ ❑ b.Is the proposed action located in an archeological sensitive area? ❑ El 13.a.Does any portion of the site of the proposed action,or lands adjoining the proposed action,contain NO YES wetlands or other waterbodies regulated by a federal,state or local agency? b.Would the proposed action physically alter,or encroach into,any existing wetland or waterbody? ❑ El Yes,identify the wetland or waterbody and extent of alterations 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: m Shoreline ❑Forest ❑Agricultural/grasslands ❑Early mid-successional ❑ Wetland ❑Urban ❑Suburban 15.Does the site of the proposed action contain any species of animal,or associated habitats,listed NO YES by the State or Federal government as threatened or endangered? ❑ ❑ 16.Is the project site located in the 100 year flood plain? NO YES 17.Will the proposed action create storm water discharge,either from point or non-point sources? NO YES If Yes, a.Will storm water discharges flow to adjacent properties? ❑NO ❑YES ❑✓ ❑ b.Will storm water discharges be directed to established conveyance systems(runoff and storm drains)? If Yes,briefly describe: ❑NO ❑YES Page 2 of 3 18.Does the proposed action include construction or other activities that result in the impoundment of NO YES water or other liquids(e.g.retention pond,waste lagoon,dam)? If Yes,explain purpose and size: ❑ 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 Yes,describe: e ❑ I AFFIRM THAT THE INFORMATION PR ID D ABOVE IS TRUE AND ACCURATE TO THE BEST OF MY KNOWLEDGE Applicant/sponsor name: Date: l — Signature: �•� //�.�� PRINT FORM Page 3 of 3 Agency Use Only [If applicable] Project: Date: Short Environmental Assessment Form Part 2 -Impact Assessment Part 2 is to be completed by the Lead Agency. Answer all of the following questions in Part 2 using the information contained in Part 1 and other materials submitted by the project sponsor or otherwise available to the reviewer. When answering the questions the reviewer should be guided by the concept"Have my responses been reasonable considering the scale and context of the proposed action?" No,or Moderate small to large impact impact may may occur occur I. Will the proposed action create a material conflict with an adopted land use plan or zoning El ❑ regulations? 2. Will the proposed action result in a change in the use or intensity of use of land? ❑ ❑ 3. Will the proposed action impair the character or quality of the existing community? ❑ ❑ 4. Will the proposed action have an impact on the environmental characteristics that caused the El ❑ establishment of a Critical Environmental Area(CEA)? 5. Will the proposed action result in an adverse change in the existing level of traffic or El ❑ affect existing infrastructure for mass transit,biking or walkway? 6. Will the proposed action cause an increase in the use of energy and it fails to incorporate El ❑ reasonably available energy conservation or renewable energy opportunities? 7. Will the proposed action impact existing: ❑ ❑ a.public/private water supplies? b.public/private wastewater treatment utilities? S. Will the proposed action impair the character or quality of important historic, archaeological, ❑ ❑ architectural or aesthetic resources? 9. Will the proposed action result in an adverse change to natural resources(e.g., wetlands, waterbodies,groundwater, air quality, flora and fauna)? ❑ ❑ 10. Will the proposcd action result in an increase in the potential for erosion, flooding or drainage El ❑ problems? 11. Will the proposed action create a hazard to environmental resources or human health? PRINT FORM Pagel of2 Agency Use Only[if applicable) Project: Date: Short Environmental Assessment Form Part 3 Determination of Significance For every question in Part 2 that was answered"moderate to large impact may occur",or if there is a need to explain why a particular element of the proposed action may or will not result in a significant adverse environmental impact,please complete Part 3. Part 3 should,in sufficient detail,identify the impact,including any measures or design elements that have been included by the project sponsor to avoid or reduce impacts. Part 3 should also explain how the lead agency determined that the impact may or will not be significant.Each potential impact should be assessed considering its setting, probability of occurring,duration, irreversibility,geographic scope and magnitude. Also consider the potential for short- term, long-term and cumulative impacts. ❑ Check this box if you have determined,based on the information and analysis above,and any supporting documentation, that the proposed action may result in one or more potentially large or significant adverse impacts and an environmental impact statement is required. ElCheck this box if you have determined,based on the information and analysis above,and any supporting documentation, that the proposed action will not result in any significant adverse environmental impacts. Name of Lead Agency Date Print or Type Name of Responsible Officer in Lead Agency Title of Responsible Officer Signature of Responsible Officer in Lead Agency Signature of Preparer(if different from Responsible Officer) PRINT FORM Page 2 of WARREN COUNTY—STATE OF NEW YORK PAMELA J.VOGEL,COUNTY CLERK 1340 STATE ROUTE 9, *� LAKE GEORGE, NEW YORK 12845 '�"+rznufi. COUNTY CLERK'S RECORDING PAGE 'THIS PAGE IS PART OF THE DOCUMENT—DO NOT DETACH*** Recording: Cover Page 5.00 Recording Fee 30.00 Cultural Ed 14.25 Records Management - Coun 1.00 Records Management - Stat 4.75 Additional Names 0. 50 BOOK/PAGE: 5321 / 115 TP584 5.00 INSTRUMENT #: 2016-1551 RP5217 Residential/Agricu 116.00 RP5217 - County 9.00 Receipt#: 2016393533 --- Clerk: TR Sub Total : 185. 50 Rec Date: 03/08/2016 12: 38: 52 PM Doc Grp: RP Transfer Tax Descrip: DEED Transfer Tax - State 2450.00 Num Pgs: 3 Rec'd Frm: LYNNE E ACKNER ESQ Sub Total : 2450.00 Partyl: STAALESEN JUDITH N Party2 : HILLERT GARY TRSTE Total : 2635. 50 Town: QUEENSBURY **** NOTICE: THIS IS NOT A BILL **** ***** Transfer Tax ***** Transfer Tax #: 1740 Transfer Tax Consideration: 612500.00 Transfer Tax - State 2450.00 Total : 2450.00 WARNING*** I hereby certify that the within and foregoing was recorded in the Warren County Clerk's Office, Record and Return To: State of New York. This sheet constitutes the Clerks endorsement required by Section 316 of the Real Property Law Of the State of New York. GARY HILLERT 1675 BOWOOD ROAD Pamela J. Vogel NORTH PALM BEACH FL 33408 Warren County Clerk ( � THIS INDENTURE,Made this 29th day of February,Two Thousand and Sixteen �. BETWEEN 5 �r JUDITH N.STAALESENI,residing at 151 South East Rio Angelica,Port St. Lucie, FL 34984, a ' l- party of the first part, (�S and GARY HILLERT, as Trustee of The Gary HWert Revocable Trust, dated October 14, 2014, with a mailing address of 1675 Bowood Road, North Palm Beach, FL 33408, party of the second per, WITNESSETH, that the party of the first part in consideration of One and 00/100 DOLLARS ($1.00) lawful money of the United States, and other good and valuable consideration paid by the party of the second part, does hereby grant and release unto the party of the second part,their heirs,successors and assigns forever ALL THAT CERTAIN PARCEL OF LAND situate in the Town of Queensbury,County of Warren,and State of New York,being more particularly bounded and described as follows: BEGINNING at a point which point is 27.86 feet from the center line of the highway known as Glen Lake Road; said point also being the northwesterly comer of lands now or formerly of Spadaro; running thence S. 49 deg. 59 min. 30 sec. W. a distance of 279.34 feet and along the said lands of Spadaro to the shore line of Glen Lake; running thence in a generally northwesterly direction, following the shore line of Glen Lake as the same turns and winds,a distance of 259 plus or minus feet to the center line of Bentley Brook; running thence along the said center line of Bentley Brook in a generally northerly direction to a point in the center line of the aforesaid Glen Lake Road; running thence S. 80 deg. 21 min. E a distance of 143.8 feet to a point; running thence S. 66 deg. 11 min. E. a distance of 202.86 feet along the center line of Glen Lake Road to the point or place of beginning. SUBJECT to any and all existing and enforceable covenants, conditions, easements and restrictions of record, if any,affecting said premises. BEING the same premises conveyed to John Staalesen and Judith N. Staalesen from Robert E. Wilson, as Trustee of the Robert E. Wilson Trust by deed dated June 12, 1998 and recorded in the Warren County Clerk's Office on June 26, 1998 in Liber 1070 of Deeds at Page 151, the said John Staalesen died a resident of Warren County on August 1, 2010 leaving the grantor herein as surviving tenant by the entirety. TOGETHER with the appurtenances and all of the estate and rights of the party of the first part in and to said premises, TO HAVE AND TO HOLD the premises herein granted unto the parties of the second part,their heirs, successors and assigns forever. AND said party of the first part covenant as follows: FIRST,That the parties of the second part shall quietly enjoy the said premises; SECOND, That said party of the first part will forever WARRANT and defend the title to said premises THIRD, That in compliance with Section 13 of the Lien Law, the grantor will receive the consideration for this conveyance and will hold the right to receive such consideration as a trust fund to be applied first for the purpose of paying the cost of the improvements and will apply the same first to the payment of the cost of the improvements before using any part of the total of the same for any other purpose. IN WITNESS WHEREOF the party of the first part have executed this deed on the day and date first above mentioned. dith N. StaaI sen STATE OF NEW YORK COUNTY OF a. : ss.: On the Lgt day of February,2016,before me,the undersigned,personally appeared Judith N. Staalesen personally known to me or proved to me on the basis of satisfactory evidence to be the individual whose name is subscribed to the within Instrument and acknowledged to me that they executed the same in her capacities, and that by her signature on the Instrument, the individual, or person upon behalf of which the individual acted,executed the Instrument. DONNA L. THOMAS NOTARY PUBLIC-STATE OF NEW YORK Notary Public No OITH6202031 Qualified in Sarotogo County ~I� My Commission Expires March Da, 20 RECORD&RETURN TO: 1-k o-cc