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Site Plan Application and narrative 169 Haviland Road Queensbury, NY 12804 Phone: (518) 745-0307 Hutchins Engineering Fax: (518) 745-0308 September 11, 2019 Town of Queensbury Planning Board 742 Bay Road Queensbury NY 12804 Re: 1454 State Route 9 LLC 1454 State Route 9, Tax Map ID: 288.12-1-21 Dear Planning Board Members: This office represents 1454 State Route 9 LLC and David Kenny with regards to the preparation of the site plan outlining some proposed improvements to the above-referenced facility. As you may recall, this board approved the original request on 5/15/18 (Site Plan 35-2018). This current request proposes a reduction in the size of the building. We respectfully request to be placed on the agenda for the October meeting. Please contact me if you have any questions or if you require additional information. Best Regards, G. Thomas Hutchins, P.E. Cc: Mr. Dave Kenny G. Thomas Hutchins, P.E. thutchins@hutchinsengineering.com TOWN OF QUEENSBURY Site Plan Review Application Review Process: to be held no later than1 1.Required Pre-submission meeting with staff to determine general completeness week prior todeadline day. Call (518) 761-8265or (518) 761-8220for an appointment. 2.Submittal of complete application: 1 original and 14 copies of the application package by monthlydeadline. 3.Determination of application completeness. All necessary information must be provided and appropriate fee(s) paid for consideration for placement on an agenda for that month. Incomplete applications will not be considered for placement on any agenda until all missing 4. informationhas been submitted. 5.Submittal to Warren County Planning, if applicable. 6.Planning Board meeting, generally the third & fourth Tuesday of each month. You will be advised in writing as towhich meeting to attend. 7.Following the meeting you will be provided with a copy of the resolution stating the Board’s decision on yourapplication. If your application was approved, the next likely step is a Building Permit. Final drawings must beprovided for the next phase of review. If your application was denied, your projectcannot proceed as submitted. DOCUMENTATION REQUIREMENTS (hard copy & electronic): 1 original & 14 copies Please submit of the completed application package to include: Completed Application pages 2-9,signed & dated Pre-Submission Meeting Notes: signed by staff Copy of Deed Checklist & Plot Plan Environmental Assessment Form for any non-residential project Fee: $100 (0 –10,000 sq. ft.); $250 (10,001 –30,000 sq. ft.); $500 (30,001 -100,000 sq. ft.);$1,000 (100,000+ sq. ft.) Staff & Contact Information: craigb@queensbury.net Craig Brown,Zoning Administrator lmoore@queensbury.net Laura Moore, Land Use Planner sunnys@queensbury.net(518) 761-8220 Sunny Sweet, Office Specialist –Planning www.queensbury.netfor further information and forms Visit our website at ï Site Plan Review application –Revised October 2016 Town of QueensburyPlanning Office-742 Bay Road, Queensbury, NY 12804 General Information ¬¦¦<¬::¬ Tax Parcel ID Number: ____________________ Site Development Data Area / TypeExisting sq. ft. Proposed Total sq. ft. Addition sq. ft. A. Building footprint ÷ÄÓÉÈÓÎÕúÇÓÐØÓÎÕ «¨?§ªóïðôðêéîêôêìé B. Detached Garage ìÊÍÌÍÉ×Øê×ÈÛÓÐúÇÓÐØÓÎÕ ðëôðïëëôðïë C. Accessory Structure(s) D. Paved, gravel or other hard surfaced area êðôççïëôèðèêêôéçç ûÉÌÔÛÐÈ E.Porches / Decks F. Other ùÍÎÙÊ×È×åÛÐÑÉ ééëîôìîïíôïçê G. Total Non-Permeable [Add A-F] çèôìèðíôïééïðïôêëé H. Parcel Area [43,560 sq. ft. / acre] ïìêôêíçðïìêôêíç I. Percentage of Impermeable Area of Site [I=G/H] êéòïêûîòïéûêçòíîû Setback Requirements AreaRequiredExistingProposed Front [1] éëùª§<ªë¾«·´¼·²¹÷¦§<¨ë¾«·´¼·²¹÷ Front [2] óóó Shoreline óóó Side Yard [1] ¬®ë³·²¬<¬ë¾«·´¼·²¹÷¬®<¦ë¾«·´¼·²¹÷ Ò±®¬¸ Side Yard [2] îðù§<¬ë¾«·´¼·²¹÷¨ª<ë¾«·´¼·²¹÷ Í±«¬¸ Rear Yard [1] îëù©©<ªë¾«·´¼·²¹÷ª¥¨<®ë¾«·´¼·²¹÷ Rear Yard [2] óóó Travel Corridor óóó Height [max] ìðù¬ªë¾«·´¼·²¹÷ Permeability íðûíîòèìûíðòêèû No. of parking spaces ïëçïíì í Site Plan Review application –Revised October 2016 Town of QueensburyPlanning Office-742 Bay Road, Queensbury, NY 12804 Additional Project Information Ò± 1.Will the proposal require a Septic Variance from the Town Board of Health? _______________ Òñß 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 Ò± (SPDES) Permit Program ? _______________ ¬®¥îðîï 4.Estimated project duration: Start Date __________ End Date __________ <©°¸¿»÷ 5.Estimated total cost of project: _______________ 6.Total area of land disturbancefor project: _______________ ª?¬¦®<º¬ò 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 DistrictSymbolFloor Area Ratio [FAR] Waterfront ResidentialWR0.22 Commercial Moderate/ IntensiveCM/ CI0.3 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. ïìêôêíç A.Parcel Area___________________________ sq. ft. êíôëðê B.Existing Floor Area ___________________________ sq. ft. [see above definition] :¥?§© C.Proposed Additional Floor Area___________________________ sq. ft. ëìôííï D.Proposed Total Floor Area ___________________________ sq. ft. ìíôççï E.Total Allowable Floor Area ___________________________ (Area x _____) [see above table] òíð *If D is larger than E. a variance or revisions to your plan may be needed. Consult with Staff. ì Site Plan Review application –Revised October 2016 Town of QueensburyPlanning Office-742 Bay Road, Queensbury, NY 12804 § 179-9-080 Requirements for Site Plan Approval. 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 with the policies of the Town’s Comprehensive Plan. B.The proposed project complies with all other requirements of this Chapter, including the site plan review standards 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 ofall other Articles that apply. C.The site plan encourages pedestrian activity internally and, if practicable, to and from the site with pedestrian paths or sidewalks connected to adjacent areas. D.The site plan must conform to Chapter 136 Sewage and Sewage Disposal, Chapter 147 Stormwater Management Local Law, and other applicable local laws. E.The proposed use shall be in harmony with the general purpose or intent of this Chapter, specifically taking into account thelocation, character 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. F.The establishment, maintenance and operation of the proposed use will not create public hazards 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 parking and l9oading 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 an undue adverse impact upon the natural, scenic, aesthetic, ecological, wildlife, historic, 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. I.The provision for and arrangement of pedestrian traffic access and circulation, walkway structures, control of intersections with vehicular traffic 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.Stormwaterdrainage 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 applicable and 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 provide a visual and/or noise buffer between the applicants and adjoining lands, including the maximum retention of existing vegetationand 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 or avoid such impacts to the maximum extent practicable. O.The site plan conforms to the design standards, landscaping standards and performance standards of this chapter. ë Site Plan Review application –Revised October 2016 Town of QueensburyPlanning Office-742 Bay Road, Queensbury, NY 12804 = éÈÛÈ×êÍÇÈ×ððù =ªªª ¥ éÈÛÈ×êÍÇÈ×èÛÄïÛÌóø ïéçóçó®¦® óÑ < < < < ? ? § 179-9-050Checklist-Application for Site Plan Review . Application materials and site plan shall include sufficient information for the Board to review and provide a decision. The applicant is to provide a site plan drawing and all attachments that address items A-V. The applicant may request a waiver from A-V and is to provide reasons for waiver(s) requested. Please label information to be submitted. REQUIREMENTS Sheet # A.A vicinity map 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, Íï subdivisions, streets and easements within 500 feet of the property. Such a sketch may be superimposed on a United States Geological Survey map of the area. B.The site plan shall be drawn at a scale of forty feet to the inch (1” = 40 feet) or such other scale as the Planning Board may ÍïóÍì deem appropriate, on standard 24” x 36” sheets, with continuation on 8 l/2 “x 11” sheets as necessary for written information. The information 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. ÍïóÍì D.Name and address of the owner of record, developer, and seal of the engineer, architect or landscape architect. If the ÍïóÍì applicant is not the record owner, a letter of authorization shall be required from the owner. E.The location and use of all existing and proposed structures within the property, including all dimensions of height and ÍïóÍî floor area, all exterior entrances, and all anticipated future additions and alterations. F.The location of all present and proposed public and private ways, off-street parking areas, driveways, outdoor storage areas, sidewalks, ramps, curbs, paths, landscaping, walls and fences. Location, type and screening details for all waste disposal ÍïóÍî containers shall also be shown. G.The location, height, intensity and bulb type (sodium, incandescent, etc.) of all external lighting fixtures. The direction of Òñß illumination and methods to eliminate glare onto adjoining properties must also be shown in compliance with § 179-6-020. H.The location, height, size, materials and design of all proposed signs. Òñß I.The location of all present andproposed utility systems including: 1. Sewage or septic system; 2. Water supply system; ÍïóÍí 3. Telephone, cable and electrical systems; and 4. Storm 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 one acre or more. A SWPPP shall Íí comply with the 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 one 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-year floodplain, the area will be shown and base flood elevations given. Areas shall be indicated within ÍïóÍì 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 than 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 Íì changes to these features, including sizes and types of plants. Water sources include ponds, lakes, wetlands and watercourses, aquifers, floodplains and drainage retention areas. M.Land Use District boundaries within 500 feet of the site’s perimeter shall be drawn and identified on the site plan, as well Òñß as any Overlay Districts that apply to the property. ê Site Plan Review application –Revised October 2016 Town of QueensburyPlanning Office-742 Bay Road, Queensbury, NY 12804 REQUIREMENTS (CONTINUED)Sheet # N.Traffic flow patterns within the site, entrances and exits, 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 motorvehicle trips to enter or leave the site, estimated for weekly and annual peak hour traffic levels; Íî 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. O.For new construction or alterations to any structure, a table containing the following information shall be included: 1. Estimated area of structure to be used for particular purposes such as retain operation, office, Storage, etc.; Íî 2. Estimated maximum number of employees; 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) ßï and/or alterations to or expansions of existing facades, showing design features and indicating the type and color of materials to be used. Q.Soil logs, water supply well and percolation test results,and storm water runoff calculations as needed to determine and Òñß mitigate project impacts. R.Plans for disposal of construction and demolition waste, either on-site or at an approved disposal facility. Òñß S.Plans for snow removal, including location(s) of on-site snow storage. Û¨·¬·²¹ T.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 anEAF has been ßÐÐ submitted in conjunction with a special use permit application, a duplicate EAF is not required for the site plan application. U.If an application is for a parcel or parcels on which more than one use is proposed, the applicant may submit a single application 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 Íî others.For purposes of reviewing an application (and for SEQRA compliance) all proposed uses on a single parcel or on contiguous parcels shall be considered together. V.A brief narrative statement on how the project proposed for review furthers or is consistent with the vision, goals and policies éÈÛÈ×êÍÇÈ×ððù éÈÛÈ×êÍÇÈ× éÈÛÈ×êÍÇÈ×ððù øÛÆÓØñ×ÎÎÃ õèÔÍÏÛÉôÇÈÙÔÓÎÉ [[729,165,1819,240][16][B,I,][Times New Roman]]Short Environmental Assessment Form [[934,244,1134,309][14][B,I,][Times New Roman]]Part 1 [[1098,244,1148,309][14][B,I,][Times New Roman]]- [[1131,244,1632,309][14][B,I,][Times New Roman]]Project Information Instructions for Completing Responses become part of the Part 1 – Project Information. The applicant or project sponsor is responsiblefor the completion of Part 1. 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 Action or Project: ûØÓÊÍÎØÛÙÑíÇÈÐ×ÈïÛÐÐÚÇÓÐØÓÎÕÊ×ØÇÙÈÓÍÎ Project Location (describe, and attach a location map): éÈÛÈ×êÍÇÈ×èÍÅÎÍÖëÇ××ÎÉÚÇÊÃåÛÊÊ×ÎùÍÇÎÈÃ Brief Description of Proposed Action: ê×ÆÓÉ×ØÛÌÌÊÍÆ×ØÉÓÈ×ÌÐÛÎ ÈÍÊ×ÏÍÆ×ÖÊÍÎÈÌÍÊÈÓÍÎÍÖÚÇÓÐØÓÎÕÓÎÙÐÇØÓÎÕÊ×ÉÈÛÇÊÛÎÈÛÎØÉ×ÙÈÓÍÎÍÖÈÅÍÉÈÍÊÃÔÍÈ×ÐÙÍÎÉÈÊÇÙÈÛ ÉËÖÈÊ×ÈÛÓÐÉÌÛÙ×ÅÓÈÔÛÉÉÍÙÓÛÈ×ØÉÈÍÊÏÅÛÈ×ÊÏÛÎÛÕ×Ï×ÎÈÙÍÎÈÊÍÐØ×ÆÓÙ×ÉÛÎØÌÛÊÑÓÎÕÛÊ×Û Name of Applicant or Sponsor: Telephone: E-Mail: éÈÛÈ×êÍÇÈ×ððù ØÒÒÑ×ÎÎÃüÕÏÛÓÐÙÍÏ Address: éÈÛÈ×êÍÇÈ× City/PO:State:Zip Code: ðÛÑ×õ×ÍÊÕ×îã 1.Does the proposed action only involve the legislative adoption of a plan, local law, ordinance, NOYES 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 government Agency? NOYES If Yes, list agency(s) name and permit or approval: èÍÅÎÍÖëÇ××ÎÉÚÇÊÃ 3.a. Total acreage of the site of the proposed action? __________ acres b.Total acreage to be physically disturbed? __________ acres c.Total acreage (project siteand any contiguous properties) owned or controlled by the applicant or project sponsor? __________ acres Check all land uses that occur on,adjoining near the proposed actio Rural(non-agriculture)ndustrialCommercialResidential(suburban) ForestAgriculture Parkland Page 1 of 3 5.Is the proposed action,NOYESN/A a.A permitted use under the zoning regulations? b.Consistent with the adopted comprehensive plan? NOYES 6.Is the proposed action consistent with the predominant character of the existing built or natural landscape? 7.Is the site of the proposed action located in, or does it adjoin, a state listed Critical Environmental Area? NOYES If Yes, identify: ________________________________________________________________________________ NOYES a.Will the proposed action result in a substantial increasein traffic above present levels? Are public transportationservices available at or near the site of the proposed action? Are any pedestrian accommodations or bicycle routesavailable on or nearsite of the proposed action? 9.Does the proposed action meet or exceed the state energy code requirements? NOYES If the proposed action will exceed requirements, describe design features and technologies: _____________________________________________________________________________________________ _____________________________________________________________________________________________ 10.Will the proposed action connect toan existingpublic/privatewater supply? NOYES If No, describe method for providing potable: _________________________________________ _____________________________________________________________________________________________ 11.Will the proposed action connect to existing wastewater utilities? NOYES If No, describe method for providing wastewater treatment: ______________________________________ _____________________________________________________________________________________________ NOYES . Does any portion of thesite of the proposed action, orlands adjoining the proposed action, contain NOYES wetlands or otherwaterbodies regulated byafederal, state or local agency? Would the proposed actionphysically alter, or encroach into, any existing wetland orwaterbody? If Yes, identify the wetland or waterbody and extent of alterations in square feet or acres: _____________________ _____________________________________________________________________________________________ _____________________________________________________________________________________________ Page 2 of 3 íÅÎ×Ê ÛßÚ Ó¿°°»® Í«³³¿®§ Î»°±®¬Wednesday, September 11, 2019 4:04 PM øÓÉÙÐÛÓÏ×Ê 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 answered by the EAF Mapper. Additional information on any EAF question can be obtained by consulting the EAF Workbooks. Although the EAF Mapper provides the most up-to-date digital data available to DEC, you may also need to contact local or other data sources in order to obtain data not provided by the Mapper. Digital data is not a substitute for agency determinations. Part 1 / Question 7 [Critical Environmental No Area] Part 1 / Question 12a [National or State No Register of Historic Places or State Eligible Sites] 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. Part 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]No Short Environmental Assessment Form - EAF Mapper Summary Report [[2414,3217,2464,3255][8][B,I,][Times New Roman]]1 Part 2 Answer all ofthefollowingquestionsin Part 2 using theinformation contained in Part 1 and other materialssubmitted by theprojectsponsoror otherwise availableto the reviewer. When answeringthequestionsthereviewershould be guided by theconc No, or Moderate small to large impact impact may may occuroccur 1.Will the proposed action create a material conflict with an adopted land use plan or zoning 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 establishmentof a Critical Environmental Area (CEA)? 5.Will the proposed action result in an adverse change in the existing level of traffic or 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 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? 8.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 proposed action result in an increase in the potential for erosion, flooding or drainage problems? 11.Will the proposedaction create a hazard to environmental resources or human health? 12 Page of ìêóîèöíêï Foreveryquestion in Part 2 that was particularelementoftheproposed action may orwillnotresultin a significantadverseenvironmentalimpact, please completePart3. Part 3 should, in sufficient detail,identifytheimpact, including anymeasuresor design elements that havebeen included by theprojectsponsorto avoid or reduceimpacts. Part 3 should also explain howthelead agency determined that theimpactmayorwillnotbesignificant. Each potential impactshould be assessed considering itssetting, probabilityofoccurring, duration, irreversibility, geographic scopeandmagnitude. Also consider thepotentialforshort- 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. Check this box if you have determined, based on the information and analysis above, and any supporting documentation, that the proposed action will notresult in any significant adverse environmental impacts. ________________________________________________________________________________________________ Name of Lead AgencyDate ________________________________________________________________________________________________ Print or Type Name of Responsible Officer in Lead AgencyTitle of Responsible Officer ________________________________________________________________________________________________ Signature of Responsible Officer in Lead AgencySignature of Preparer (if different from Responsible Officer) ìêóîèöíêï 22 Page of