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46248-POIRIER - ISLANDVIEW DRIVE RIVERSIDE DRIVE SUBDIVISION - PRELIM. APP. NACE ENGINEERING, P.C. 169 Haviland Road, Queensbury,NY 12804 Phone-518-745-4400 Fax -518-792-8511 February 15, 2017 Project#46248 Mr. Stephan Traver, Chairman Town of Queensbury Planning Board 745 Bay Road Queensbury,NY 12804 Re: Paul Poirier Subdivision Dear Mr. Traver and Planning Board Members: Enclosed is a Sketch & Preliminary Subdivision Application for a subdivision for Mr. Paul Poirier located on an 18.5 acre parcel of land between Island View Drive and Riverside Drive. This subdivision will be a 4 lot residential subdivision with two shared driveways. Lots #1, #2 and#3 will be served by a shared driveway connected to an existing easement at the end of Island View Drive. Lot #4 will be served by a shared driveway which will extend from the termination of Riverside Drive. Construction of the shared driveway for lot #4 will entail disturbance within 100 feet of a wetland and construction of 2 stream crossings. Therefore, we are submitting a Freshwater Wetland Permit Application with this package. We will also be submitting a stream crossing permit to NYS DEC and Army Corps. Under separate cover, an Area Variance will be submitted to the Zoning Board to request relief from the required road frontage. We would respectfully request a waiver from Sketch Plan Review and the required 50 scale plan requirement. We have submitted the plans at 60 scale so it will fit on a 24 x 36 sheet. We would also request a waiver from the Stormwater Management Section 147 for the subdivision process. The lots are 2 acres or greater and potential purchases may locate the driveways, houses and cleared areas in different location. We would request that if the subdivision is approved, a condition requiring that each individual lot require site plan review for stormwater management design. Please feel free to contact us if you have any questions in regards to this application. Sincerely, Thomas R. Center Jr., P.E. Cc w/encl: Paul Poirier 46248 - POIRIER - ISLAND VIEW DRIVE & RIVERSIDE DRIVE SUBDIVISION Preliminary Stage Revised April 2010 Subdivision Review Application Preliminary Stage REVIEW PROCESS: 1) Required Pre-submission meeting with staff to determine general completeness to be held no later than I week prior to deadline day. Call (518)761-8220 for an appointment 2) Submittal of complete application: 1 original and 14 copies of the application package t y monthly deadline. 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. 4) Incomplete applications will not be considered for placement on any agenda until all missing information has been submitted_ 5) Planning Board meeting, generally the third &fourth Tuesday of each month. You will be advised in writing as to which meeting to attend_ 6) 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 denied your project cannot proceed as submitted_ DOCUMENTATION REQUIREMENTS: 1) Please submit 1 orioinal & 14 copies of the completed application package to include: Completed Application: signed& dated lore-Submission Meeting Notes: signed by staff Copy of Deed_ 1 Survey Fee_ $50.00 ZONING STAFF & CONTACT INFORMATION: ■ Craig Brown, Zoning Administrator crag b w ueensbu ne# Keith Obome, Land Use Planner keith0 crgueensbury_net Pam Whiting, Office Specialist 518-761-8220 PaMWCQ(JUeensbury.net Visit our website at www.clueensbury.net for further information and forms Town of Queensbury Planning Office- 742 Bay Road •Queensbury,NY 12804 • 518-761-8220 0 Preliminary Stage Revised April 2010 General Information Tax Parcel ID Number: 309.14-1-46 Zoning District; WR Am lication Stacie check cine Sketch Plan Stage Preliminary Stage ✓ Final Stage Indicate the followin Number of lots proposed 4 Residential or Commercial RESIDENTIAL Total Lot acreage 18.5 ACRES Proposed lot sizes 2.1.2 .1.4.9,9.4 ACRES Project location END OF ISLAND VIEW & RIVERSIDE DRIVES Detailed Description of Project [include current&proposed use]: APPLICANT PROPOSES A 4 LOT RESIDENTIAL SUBDIVISION WITH A SHARED DRIVEWAY FROM ISLAND VIEW DRIVE SERVING 3 LOTS & A SHARED DRIVEWAY FROM RIVERSIDE DR SERVING 1 LOT Applicant Name: PAUL POIRIER Address.- 2635 RUE SANDMORE QUEBEC, CANADA JZT2B1 Home Phone 450-458-8035 Cell. Work Phone Fax E-Niall: PPOIRQCAE.COM Agent's Name: NACE ENGINEERING Address: 169 HAVILAND ROAD QUEENSBURY,NY Home Phone Cell 796-2515 Work Phone 745-4400 Fax 792-8511 E-mail TCENTER36QYAHOO.COM Owner's Name SAME AS APPLICANT Address Home Phone Cell Work Phone Fax E-mail Town of Queensbury planning Office- 742 Bay Road-Queensbury, ICY 12804 • 518-761-6220 1 Preliminary Stage Revised April 2010 ITEMS TO BE IDENTIFIED BY STAFF DURING PRE-SUBMISSION MEETING. You should use this page for guidance when drafting your application; however, it will be completed by a staff member. Submittal of a preliminary 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 required to submit one 7 original acre! 14 copies of the preliminary plat application. Such application shall include the following documents andlor information: A. PRELIMINARY PLAT_ The preliminary plat shall be laid out by a licensed professional engineer and/or a licensed professional land surveyor with 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: �(LS-A� 1) The location of all existing and proposed property lines, buildings, watercourses and other important c" /,\ topographic features. r 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 tanks and fields and similar facts regarding property immediately adjacent or opposite the LDA � proposed subdivision. �tic f � n""Erri 4) A location map showing: CC (a)The zoning district or districts in which the land to be subdivided is located: and (b) The property included in the proposed subdivision and all contiguous 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 or highway. All properties shall be identified by lot and parcel number and names of owners_ 5) The location and size of any existing sewers, water mains, culverts and drain pipes, electric, telephone and cable television lines and proposed sewers, water mains, culverts and drain pipes on the property or immediately adjacent to the property to be subdivided. t i LV 6) The proposed arrangement and approximate area, width and length of street frontage and setback a 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 for the district or districts in which the subdivision is located. 7) All parcels of land 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 eng,neer or fang surveyor who prepared the preliminary plat; the license number and seal of the engineer or land surveyor shall be affixed to the drawing. B. LAYOUT PLANS. Layout plans shall be prepared by a professional licensed engineer or professional licensed land surveyor with a properly executed New York State Education Department Exempton N. Stich layout V-- plans shall be incorporated on the preliminary plat and shall show the following: �[ 1) The exact layout and dimensions of proposed streets, including stationing and tie-in to the center-line G distances of existing streets with monuments and other points, as required. Town of Queensbury Planning Office- 742 Bay Road •Queensbury, NY 12804 - 518-761-8220 2 Preliminary Stage Revised April 2010 alog 2) The location and widths of all streets, pavements, curbs, sidewalks, easements, parks and other open [��C C'C spaces. �l 3) The proposed names of ail streets, and the radii of all curves 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. l 5) Proposed lot lines. \ 6) The date, North arrow and scale. 7) The title under which the proposed subdivision is to be recorded,with the names 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. C014STRUCTION DETAILS. Construction details shall be prepared by a licensed professional engineer or a licensed professional land surveyor with a property executed New York State Education Department Exemption N_ Such details shall include: �QtC, 1) The proposed sanitary sewer system, including pipe sizes, bedding and profiles. 2) The proposed storm drainage system, including pipe sizes, bedding, catch basin and manhole details, P- profiles and method of disposal of collected stormwater. 3) The proposed water supply system. W � 4) Any other proposed underground utilities. �G 6) A typical cross section of the roadway, including the right-of-way width, pavement width and depth of �[L pavement materials and subbase, the location of utilities, character and dimensions of curbs and sidewalks and side slope grading. 1. 6) Profiles, showing the original ground surface and finished street surface at center lines of all streets, ,lea percentage of grades of streets; stationing and elevations of all points of curvature, points of intersection, points of tangency and of proposed sewers, drains, culverts, manholes and other features. Invert elevations and slopes of ewers 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 L 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 locations. C 8) The date and scale. The ich the th he l 9) ref tiproposed vrtnames of tinrner and engineewhoPrePaed the ostructo subdivision etails: the license numberand seal of the engineer be affixed to the drawing. „ D. LANDSCAPE PLAN. A landscape plan shall be prepared by a licensed landscape architect for subdivisions (\q ' r,k greater than '10 lots. Such landscape plan shall include: -t? 1) The location and species of street trees, if retained within the right-of-way or proposed to be planted by the (1 subdivider. 2) Details of methods of tree protection and tree planting_ Town of Queensbury Planning Office- 742 Bay Load -Queensbury, NY 12804 • 518-761-8220 3 Preliminary Stage Revised April 2010 3) Plans and details of any site improvements related to park or recreation planning, including layout, grading, planting and details of any improvements. 4) Pians and details of any other public amenities provided in the subdivision_ N 5) The date and scale. 6) The tifle number which 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. CLEARING PLAN. A clearing plan shall be prepared at a 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 vegetation removed from the site for investigation purposes. LtiV` 3) The location of roadways, underground or overhead utilities not in roadways, limits of grading, proposed location of any buildings, septic systems, wells and driveways and any other improvements which might require clearing. 4) Areas where slopes are greater than 20%, as per§A183-26- 5) Limits of proposed clearing of trees. 6) Measures to be taken to protect remaining trees, including details. F. GRADING AND EROSION CONTROL PLANS. 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 following.- 1) A generalized grading and drainage plan (does not require spot grades or slope designation). 2) Any phasing of tree removal and./or construction- �iJ'� G. ENVIRONMENTAL REPOEU. A long environmental assessment form shall be prepared in accordance with P 001 the State Environmental (duality Review Act describing the potential environmental impact of the proposed subdivision. H. -TATEMENT OF INTENT. A statement of intent shall be submitted by the applicant. Such statement shall �} include_ uk 1) Proof of ownership of the land to be subdivided, in a form approved by the Town Attorney 2) The nature and extent of proposed street improvements. n� 3) The nature 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 conditions under which dedication of these features is to be made to the Town. 4) A statement that the applicant will install all improvements in accordance with the standards prescribed by the departments of the Town having jurisdiction, and set all monuments as shown on the final plat thereof in such manner as the Board may designate. I. A STORMWATER MANAGEMENT PLAN and a STORMWATER POLLUTION PREVENTION PLAN co�stent mh the requirements of Chapter 147, Stormwater Management. Town of Queensbury Planning Office- 742 Bay Road -Queensbury, NY 12804 - 518-761-8220 4 Preliminary Stage Revised April 2010 J. FEES. 1) The application for preliminary plat approval shall be accompanied by a fee listed on the current schedule of fees for the Town of Queensbury posted in the Planning Office. 2) In addition to the fee listed on the schedule of fees,the Planning Board may charge a fee to developers of projects requiring legal and technical review, provided that the fee charged reflects the actual cost of the legal and technical assistance to the Planning Board_ K_ AIW VERS. 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 information requirements as it deems appropriate. Any such waiver shall be made in writing, and shall contain statements of the reasons why the waived information requirements are not necessary for an informed review under the circumstances. The Planning Board may grant such waivers on its own initiative or at the written request (that sets forth the specific requirements that are requested to be waived and the reasons for the requested waiver) of an applicant. §A183-14. Submission and Review procedure— Subdivision Sign Posting Requirements D. Notice. The subdivider shall display prominently 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 Town Planning Board, announcing the public hearing_ The sign shall be in full public view from the street pavement and shall 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 Queensbury Planning Office- 742 Bay Road •Queensbury, NY 12804 - 518-761-8220 5 Preliminary Stage Revised April 2010 Prue- ub►►ri sion Go►tferen a Form 1. Tax Map 10: 309.14-1-46 2, Zoning Classification: WR 3. Reason for Review: PRELIMINARY SUBDIVISION 4. Ordinance Section: 5. Pre-Submission Meeting Notes; Outstanding Items ToBeAddressed In Jude: r4utceG(ctS tic).1. Deed Yes uwl 2. General Information Yes No 3 Preliminary Plat ��Yes Na 4. Layout Plans Yes No 5. Construction Details /Yes No 6. Landscape Plan les No 7. Clearing Plan es No 8. Grading & Erosion Control +/ Yes No 9. Environmental Report Yes No 10. Statement of Intent Yes V, No���n 11. Stormwater Plan I SWPPP Yes No 12. Fees Yes r o 13. Waivers Yes J No 14. Subdivision Sign Posting Yes o 15. Signature Page Yes VNa L C e S�` 1C_ $C_ . L_U1`,S( UA U 0,CC2 S rrc le-1 1 L.J D r ck nCA cJ CC�f r� r, _ r,-C_ Cc G (! �L �-A c n 'L C, Me✓c rJ I L9 ek C a.2 a LoA- � l ' � cac_ V c Q ly\ t 7 �5. mac,,, l� C r a s4v r Aq WC1L.' i G c U1, C c ria 1L_ci n c r- c, l 0, - , C C 4e C Staff Representative: r c- r f� Applicant J Agent: Date: Town of Queensbury Planning Office- 742 Bay Road -Queensbury, NY 12804 - 518-761-8220 6 ";Iagp nc,iserl Apwii 2C Signature Page �UT-111-01Z.-VICI) t<i .��01 :..:2Fc:-,.-,. 2.) Enc; (-JB­ir-_ D -11 --,id-iCir z.1 [inn f. V, and 6. Ll t. t 1,7- J c. i n e I ta t I s i-s. 4.1 J, le�t �j $?J (PAINER'S AGE11-T Fcjg;p,% cil) ltzte �-I)e (DWNER Lf tile p�_cJeFt"' is rot"h,7- f,,;e ;:k�' t`-:e PAUL POILRIER I Il it s NAGE' ENGR. , SIBS & B-P,S & R. �ot d!11 ard"11 f e 3,09 14 ect 1-:11 1 46 L l-A C Z9 tAL (_JWNER iIGNATLIRE: DATE APPLI"--AN T's &--l-ENTFORNI 'trordete the f!1'f1ovVw._ d-e APPLI%'_.A1--JT rT F PAUL POTRIER NACE F-NGR. VD3 & 3.P.S' R. A -xie lit 1,e�I: !_31'!an-e p ai- _LlTp vi 46 Lot -I 3 WNER SR- NATURE DATE 2-1 EN(31NEER1dG FEE 0M.LOSURE. Appkatfar,s rul fie [hl,,Tovell cr fi'll'(L'Y16W Of Sr_-j:l1iC1 dP_S!i� P c1cp, 1~ 'a for oilgin,- he C1jrC"XY 0 fit F0,Si;',Of J;41ii17cBrirrJ rr-'q.*L.V jy it 11")1 8 ii pne._jpr-j4-:djt 3.1 AUTHORIZATION F(a SITE VIS By sign-ag tn�3 p..igs 31.1hmirl-ici --H, appIC—Iti0f, ri-Otcffials ila:red herein. u f-ve'ulaf r . - - f r 4�prllleal)E. a 6 hiTher,heic dr.ient�s.: nE­pt�-�, L3tjtVjrA:_� t110 Zcp" 11,�� 603M 0 r R raring Board a"d !3TIff t,-, 811(el- ':I ;J -'.:Fr tile'�)uroo'-e of the app4catc4i f!.(J'pnj- led 4--t Z]HER PERMIT R&SPQNSIBLME " _--min. Lerl"Ift sY 'S r� Lre-dw m oferioctiiyz l toCC11 Suc;mi :!r aatvv re-'-poi,-Rific, oerrifts s "r, 'lily 5A C)FEIC Ij7, jMp4=j L)1,1 1 .1.1 of i:N" Col-witi-ity Slen Ixe al r 'd rallscrlll;tl rut" I lit ffi� rtf -'Il JL6-28EEMENT -70 PgGVIDE DC)CUMENTATION Sgj)ujREEr; �ed hZ1 Ll W01,191"IVY I'R,3d dld LV (J8.r3tL1­u V ln_ztr(.10011� fOr 3Lll"JT43S,G11 L1111(l'aQfe-P iune .fc�� 'if 31,1113 Ji'd and o3mlise -1. / , •J: _ve- tru uf the Of no-iti-- a t WIE twclf'k that-ail v;t"rk ov'q 1:1�1 n accordw-ce J th- Pril-Li.to occu+�o 11-1.3 tie Ocillues proposed. I 1 a CJ4�'j Its Y 51's- u!_P1_�e1J`Stc1l_1c r,.i--'ty�'�i 'Cj,_xji,_(' 'I'Cvife an as-b�; L.1 — . A tru f--00-:.S 'orl0f-`C of 1"''_-cuijancy PAU.T: POTRIER 9-i5 _1F Ntirr-e [Apf_-dican[] C),aire Logneal TOM �"EN` %AC'E..TENG 9-15-116 '7 Itu r _x.;r! -jI F-.--i P'j-0, 7 Updated: 03/05/2004 (2L TOWN OF QUEENSBURY FRESHWATER WETLANDS PERMIT APPLICATION APPLICATION NO.: APPLICATION DATE: 2/15/17 This is an Application for a Permit to conduct/cause to conduct a regulated activity on or adjacent to a freshwater wetland pursuant to Freshwater Wetlands Protection Law - Local Law 1, 1976. TO: Town Clerk of the Town of Queensbury - Please immediately forward this application to the Planning Board of the Town of Queensbury by way of service upon the Planning Department of the Town of Queensbury. TO: Applicant- Please type or print the information required and complete all blanks and answer all questions. If the information requested is not applicable,please enter N/A. Please provide the original plus 14 copies of this application with a$100 application fee. * * * * * * * * * * * * * * * * * * * * * * * * * * * * * * * * * * * * * * * * * * * * * * * INFORMATION FOR APPLICATION Applicant: Name: PAUL POIRIER Address: 2635 RUE SANDMORE, OUEBEX,CANADA JZT2131 Phone: 450-458-8035 ITU verty Infornnatiot): L Name of wetland or any body of water/stream involved: UNAMED STREAM TRIBUTARY TO THE HUDSON RIVER 2. Address of parcel upon which wetland is located and address of parcel(s)upon which work is proposed. END OF RIVERSIDE DRIVE Updated: 03/05/2004 3. Tax Map No. of parcel upon wetland is located and Tax Map No. of parcel upon which work is proposed: 309.14-1-46 4. Current zoning of parcel upon which wetland is located and current zoning of parcel upon which work is proposed: WR 5. Total area of property upon which work is proposed: 18.5 ACRES 6. Total area of wetland: NA 7. Dimensions of wetland: NA 8. Existing uses of wetlands, if any: NA 9. Adjacent uses within 400 ft. of wetlands,if any: RESIDENTIAL&FOREST 10. State,County,Town property within 500 ft. of wetland: TOWN-RIVERSIDE DRIVE ROW Information About the Project: 1. Detailed description of proposed activity: CONSTRUCT 2 STREAM CROSSINGS FOR ACCESS TO A 1 LOT IN A 4 LOT SUBDIVISION 2. Purpose, character and extent of proposed activity upon or adjacent to wetland: CONSTRUCT A PRIVATE DRIVE TO ACCESS 1 RESIDNETIAL LOT 3. On a map to be submitted with this application, show the area of the freshwater wetland or adjacent area directly affected with the location of the proposed activity shown to scale thereon as well. 4. Will the project require any other Federal, State or local permits? TOWN FRESHWATER WETLAND PERMIT,NYS DEC&ARMY CORPS. 5. Has work begun on the project? NO 6. Approximate starting date of project? FALL 2017 7. Approximate completion date of project? FALL 2019 Updated: 03/05/2004 About the adiacent property owners: List the names of the owners of record of lands adjacent to the freshwater wetland or adjacent area upon which the project is to be undertaken: ALLEN ROZZELLE-37 RIVERSIDE DRIVE,QUEENSBURY,TOWN OF QUEENSBURY NIAGARA MOHAWK POWER CORP, Dame of claimants of water rights which you have noticed and which relate to any land within or within 100 ft. of the boundary of the property on which the proposed regulated activity will be located: NON-H The foregoing information will be reviewed by the agency, and the agency, may if it desires, request any fiarther information necessary to make a decision. I hereby affirm under penalty of perjury that the information provided herein and all attachments submitted herewith are true to the best of my knowledge and belief. Signature: _- I hereby authorize NAGE ENGR,a.P.S.R.&VDs SURVEY to act as my agent and represent me in connection with this application on my behalf. r 1 Full Environmental Assessment Form Part I-Project and Setting Instructions for Completing Part 1 Part 1 is to be completed by the applicant or project sponsor. 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;indicate whether missing information does not exist, or is not reasonably available to the sponsor;and,when possible,generally describe work or studies which would be necessary to update or fully develop that infortnation. Applicants/sponsors must complete all items in Sections A&B. In Sections C,D&E,most items contain an initial question that must be answered either"Yes"or"No". If the answer to the initial question is"Yes",complete the sub-questions that follow. If the answer to the initial question is"No",proceed to the next question. Section F allows the project sponsor to identify and attach any additional information. Section G requires the name and signature of the project sponsor to verify that the information contained in Part 1 is accurate and complete. A.Project and Sponsor Information. Name of Action or Project: Poirier - Islandview Dr & Riverside Drive Subdivision Project Location(describe,and attach a general location map): Between north end of Island view Dirve and west end of Riversi Brief Description of Proposed Action(include purpose or need): Construction of a 4 lot subdivision. # lots to be accessed from Riverside Drive. Name of Applicant/Sponsor: Telephone: PAUL POIRIER E-Mail:PPOIR@HOTMAIL.CA Address:2635 SANDMERE, City/PO:SAINT LAZARE State:QUEBEC, CANADJ Zip Code: Project Contact(if not same as sponsor;give name and title/role): Telephone:5187962515 NACE ENINGINEER, TOM CENTER E-Mail:TCENTER36@YAHOO.COM Address: 169 HAVILAND ROAD City/PO: State: Zip Code: QUEENSBURY NY 12804 Property Owner (if not same as sponsor): Telephone: SAME AS APPLICANT E-Mail: Address: City/PO: State: Zip Code: Page 1 of 13 B.Government Approvals B.Government Approvals,Funding,or Sponsorship. ("Funding"includes grants,loans,tax relief,and any other forms of financial assistance.) Government Entity If Yes:Identify Agency and Approval(s) Application Date Required (Actual or projected) a. City Council,Town Board, ❑Yes❑No or Village Board of Trustees b.City,Town or Village OYes❑No TOWN OF QUEENSBURY PLANNING BRD 2-14-17 Planning Board or Commission c. City Council,Town or OYes❑No TOWN OF QUEENSBURY ZBA 2-14-17 Village Zoning Board of Appeals d.Other local agencies ❑Yes❑No e. County agencies ❑Yes❑No f.Regional agencies ❑Yes❑No g. State agencies OYes❑No NYS DEC TBD h.Federal agencies OYes❑No ARMY CORPS TBD i. Coastal Resources. i. Is the project site within a Coastal Area,or the waterfront area of a Designated Inland Waterway? ❑Yes ONo ii. Is the project site located in a community with an approved Local Waterfront Revitalization Program? ❑YesONo iii. Is the project site within a Coastal Erosion Hazard Area? ❑YesONo C.Planning and Zoning C.1.Planning and zoning actions. Will administrative or legislative adoption,or amendment of a plan,local law,ordinance,rule or regulation be the ❑YesONo only approval(s)which must be granted to enable the proposed action to proceed? • If Yes,complete sections C,F and G. • If No,proceed to question C.2 and complete all remaining sections and questions in Part 1 C.2.Adopted land use plans. a.Do any municipally-adopted (city,town,village or county)comprehensive land use plan(s)include the site OYes❑No 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? b.Is the site of the proposed action within any local or regional special planning district(for example: Greenway ❑YesONo Brownfield Opportunity Area(BOA);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 in an adopted municipal open space plan, ❑YesONo or an adopted municipal farmland protection plan? If Yes,identify the plan(s): Page 2 of 13 C.3. Zoning a. Is the site of the proposed action located in a municipality with an adopted zoning law or ordinance. OYes❑No If Yes,what is the zoning classification(s)including any applicable overlay district? b. Is the use permitted or allowed by a special or conditional use permit? OYes❑No c.Is a zoning change requested as part of the proposed action? ❑YesONo If Yes, i.What is the proposed new zoning for the site?WATERFRONT RESIDENTIAL CA.Existing community services. a.In what school district is the project site located?QUEENSBURY UNION FREE SCHOOL DISTRICT b.What police or other public protection forces serve the project site? WARREN COUNTY SHERRIF c.Which fire protection and emergency medical services serve the project site? WEST GLENS FALLS FIRE&EMS d.What parks serve the project site? TOWN OF QUEEBSURY D.Project Details D.1.Proposed and Potential Development a.What is the general nature of the proposed action(e.g.,residential,industrial,commercial,recreational;if mixed,include all components)?RESIDENTIAL b.a.Total acreage of the site of the proposed action? 19.5 acres b.Total acreage to be physically disturbed? 3.33 acres c.Total acreage(project site and any contiguous properties)owned or controlled by the applicant or project sponsor? 19.5 acres c.Is the proposed action an expansion of an existing project or use? ❑YesO No i. If Yes,what is the approximate percentage of the proposed expansion and identify the units(e.g.,acres,miles,housing units, square feet)? %_ Units: d.Is the proposed action a subdivision,or does it include a subdivision? OYes❑No If Yes, i. Purpose or type of subdivision?(e.g.,residential,industrial,commercial;if mixed,specify types) RESIDENTIAL ii. Is a cluster/conservation layout proposed? [--]Yes J3No iii. Number of lots proposed? _ 4 iv. Minimum and maximum proposed lot sizes? Minimum _2.1 Maximum 9.4 e.Will proposed action be constructed in multiple phases? ❑YesONo i. If No,anticipated period of construction: 24 months ii. If Yes: • Total number of phases anticipated • Anticipated commencement date of phase 1 (including demolition) month year ■ Anticipated completion date of final phase month wear • Generally describe connections or relationships among phases,including any contingencies where progress of one phase may determine timing or duration of future phases: Page 3 of 13 f.Does the project include new residential uses? ❑Yes❑No If Yes,show numbers of units proposed. One Family Two Family Three Family Multi Ie Familyf�or more Initial Phase 4 At completion of all phases 4 g.Does the proposed action include new non-residential construction(including expansions)? ❑YesONo If Yes, i.Total number of structures ii. Dimensions(in feet)of largest proposed structure: height; width; and length iii. Approximate extent of building space to be heated or cooled: square feet h.Does the proposed action include construction or other activities that will result in the impoundment of any ❑Yes❑No liquids, such as creation of a water supply,reservoir,pond,lake,waste lagoon or other storage? If Yes, i. Purpose of the impoundment: ii. If a water impoundment,the principal source of the water: El Ground water❑Surface water streams ❑Other specify: iii. If other than water,identify the type of impounded/contained liquids and their source. iv. Approximate size of the proposed impoundment. Volume: million gallons;surface area: acres v. Dimensions of the proposed dam or impounding structure: height; length vi. Construction method/materials for the proposed dam or impounding structure(e.g.,earth fill,rock,wood,concrete): D.2. Project Operations a.Does the proposed action include any excavation,mining,or dredging,during construction,operations,or both? Yes o (Not including general site preparation,grading or installation of utilities or foundations where all excavated materials will remain onsite) If Yes: i What is the purpose of the excavation or dredging? ii. How much material(including rock,earth,sediments,etc.)is proposed to be removed from the site? • Volume(specify tons or cubic yards): • Over what duration of time? iii. Describe nature and characteristics of materials to be excavated or dredged,and plans to use,manage or dispose of them. iv. Will there be onsite dewatering or processing of excavated materials? Yes No If yes,describe. v. What is the total area to be dredged or excavated? acres vi. What is the maximum area to be worked at any one time? acres vii. What would be the maximum depth of excavation or dredging? feet viii. Will the excavation require blasting? ❑Yes❑No ix. Summarize site reclamation goals and plan: b.Would the proposed action cause or result in alteration of,increase or decrease in size of,or encroachment E]Yes❑No into any existing wetland,waterbody,shoreline,beach or adjacent area? If Yes: i. Identify the wetland or waterbody which would be affected(by name,water index number,wetland map number or geographic description):CONSTRUCTION OF 2 STREAM CROSSINGS WITH CULVERTS Page 4 of 13 ii. Describe how 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: APPLICANT WILL WORK WITH THE ARMY CORPS ENGINEERS TO DESIGN STREAM CROSSINGS FOR CONSTRUCTION OF DRI T*4. iii. Will proposed action cause or result in disturbance to bottom sediments? ®Yes❑No If Yes,describe:PLACEMENT OF CULVERTS MAY DISTURB SEDIMENT BOTTOM iv. Will proposed action cause or result in the destruction or removal of aquatic vegetation? ❑Yes®No If Yes: • acres of aquatic vegetation proposed to be removed: • expected acreage of aquatic vegetation remaining after project completion: • purpose of proposed removal(e.g.beach clearing,invasive species control,boat access): • proposed method of plant removal: • if chemical/herbicide treatment will be used,specify product(s): v. Describe any proposed reclamation/mitigation following disturbance: c.Will the proposed action use,or create a new demand for water? ®Yes[]No If Yes: i. Total anticipated water usage/demand per day: 1.760 gallons/day ii. Will the proposed action obtain water from an existing public water supply? ❑Yes OIo If Yes: ■ Name of district or service area: ■ Does the existing public water supply have capacity to serve the proposal? ❑Yes[--]No ■ Is the project site in the existing district? ❑Yes❑No • Is expansion of the district needed? ❑Yes[]No Do existing lines serve the project site? ❑Yes[]No iii. Will line extension within an existing district be necessary to supply the project? ❑Yes E]No If Yes: • Describe extensions or capacity expansions proposed to serve this project: • Source(s)of supply for the district: iv. Is a new water supply district or service area proposed to be formed to serve the project site? ❑Yes❑No If,Yes: • Applicant/sponsor for new district: • Date application submitted or anticipated: ■ Proposed source(s)of supply for new district: v. If a public water supply will not be used,describe plans to provide water supply for the project: vi.If water supply will be from wells(public or private),maximum pumping capacity: 5-15 gallons/minute. d.Will the proposed action generate liquid wastes? ®Yes❑No If Yes: i. Total anticipated liquid waste generation per day: 1,760 gallons/day ii. Nature of liquid wastes to be generated(e.g.,sanitary wastewater,industrial;if combination,describe all components and approximate volumes or proportions of each): _ RESIDENTIAL WASTEWATER iii. Will the proposed action use any existing public wastewater treatment facilities? ❑Yes®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? ❑Yes❑No ■ Is the project site in the existing district? ❑Yes❑No ■ Is expansion of the district needed? ❑Yes❑No Page 5 of 13 • Do existing sewer lines serve the project site? ❑Yes❑No • Will line extension within an existing district be necessary to serve the project? ❑Yes❑No If Yes: • Describe extensions or capacity expansions proposed to serve this project: iv. Will a new wastewater(sewage)treatment district be formed to serve the project site? ❑Yes❑No 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 specifying proposed receiving water(name and classification if surface discharge,or describe subsurface disposal plans): INDIVIDUAL RESIDENTIAL WASTEWATER TREATMENT SYSTEMS A Describe any plans or designs to capture,recycle or reuse liquid waste: NONE e.Will the proposed action disturb more than one acre and create stormwater runoff,either from new point OYes❑No sources(i.e.ditches,pipes,swales,curbs,gutters or other concentrated flows of stormwater)or non-point source(i.e.sheet flow)during construction or post construction? If Yes: i. How much impervious surface will the project create in relation to total size of project parcel? Square feet or 0.67 acres(impervious surface) Square feet or 14.85 acres(parcel size) ii. Describe types of new point sources DRIVEWAYS AND ROOFS iii. Where will the stormwater runoff be directed(i.e.on-site stormwater management facility/structures,adjacent properties, groundwater,on-site surface water or off-site surface waters)? NSITE STORMWATER MANAGEMENT ■ If to surface waters,identify receiving water bodies or wetlands: • Will stormwater runoff flow to adjacent properties? ❑YesONo Does proposed plan minimize impervious surfaces,use pervious materials or collect and re-use stormwater? OYes❑No f. Does the proposed action include,or will it use on-site,one or more sources of air emissions,including fuel ❑Yes ONo combustion,waste incineration,or other processes or operations? If Yes,identify: i.Mobile sources during project operations(e.g.,heavy equipment,fleet or delivery vehicles) ii. Stationary sources during construction(e.g.,power generation,structural heating,batch plant,crushers) iii. Stationary sources during operations(e.g.,process emissions,large boilers,electric generation) g.Will any air emission sources named in D.2.f(above),require a NY State Air Registration,Air Facility Permit, ❑YesONo or Federal Clean Air Act Title IV or Title V Permit? If Yes: i. Is the project site located in an Air quality non-attainment area? (Area routinely or periodically fails to meet ❑Yes[]No ambient air quality standards for all or some parts of the year) ii. In addition to emissions as calculated in the application,the project will generate: • Tons/year(short tons)of Carbon Dioxide(CO2) • Tons/year(short tons)of Nitrous Oxide(N20) Tons/year(short tons)of Perfluorocarbon(PFCs) ■ Tons/year(short tons)of Sulfur Hexafluoride(SF6) ■ Tons/year(short tons)of Carbon Dioxide equivalent of Hydroflourocarbons(HFCs) ■ Tons/year(short tons)of Hazardous Air Pollutants(HAPs) Page 6 of 13 h.Will the proposed action generate or emit methane(including,but not limited to,sewage treatment plants, ❑YesONo landfills,composting facilities)? If Yes: i. Estimate methane generation in tons/year(metric): ii.Describe any methane capture,control or elimination measures included in project design(e.g.,combustion to generate heat or electricity,flaring): i.Will the proposed action result in the release of air pollutants from open-air operations or processes,such as ❑YesONo quarry or landfill operations? If Yes:Describe operations and nature of emissions(e.g.,diesel exhaust,rock particulates/dust): j. Will the proposed action result in a substantial increase in traffic above present levels or generate substantial ❑YesoNo new demand for transportation facilities or services? If Yes: i. When is the peak traffic expected(Check all that apply): ❑Morning ❑Evening []Weekend ❑Randomly between hours of to ii. For commercial activities only,projected number of semi-trailer truck trips/day: iii. Parking spaces: Existing Proposed Net increase/decrease iv. Does the proposed action include any shared use parking? ❑Yes❑No v. If the proposed action includes any modification of existing roads,creation of new roads or change in existing access,describe: vi. Are public/private transportation service(s)or facilities available within'/z mile of the proposed site? ❑Yes❑No vii Will the proposed action include access to public transportation or accommodations for use of hybrid,electric ❑Yes❑No or other alternative fueled vehicles? viii.Will the proposed action include plans for pedestrian or bicycle accommodations for connections to existing ❑Yes❑No pedestrian or bicycle routes? k.Will the proposed action(for commercial or industrial projects only)generate new or additional demand ❑Yes❑No for energy? If Yes: i. Estimate annual electricity demand during operation of the proposed action: ii. Anticipated sources/suppliers of electricity for the project(e.g.,on-site combustion,on-site renewable,via grid/local utility,or other): iii. Will the proposed action require a new,or an upgrade to,an existing substation? []Yes[-]Na 1.Hours of operation. Answer all items which apply. i. During Construction: ii. During Operations: Monday-Friday: 7AM TO 5 PM + Monday-Friday: NA ■ Saturday: 7AM TO 5 PM • Saturday: • Sunday: 7AM TO 5 PM • Sunday: • Holidays: 7AM TO 5 PM • Holidays: Page 7 of 13 m.Will the proposed action produce noise that will exceed existing ambient noise levels during construction, 0 Yes[]No operation,or both? If yes: i. Provide details including sources,time of day and duration: CONSTRUCTION EQUIPMENT OCCASIONAL&VARYING THROUGHOUT WORK DAY ii. Will proposed action remove existing natural barriers that could act as a noise barrier or screen? ❑Yes ONo Describe: n.. Will the proposed action have outdoor lighting? OYes❑No If yes: i. Describe source(s),location(s),height of fixture(s),direction/aim, and proximity to nearest occupied structures: SECURITY LIGHTING REQUIRED BY NYS BLDG CODE ii. Will proposed action remove existing natural barriers that could act as a light barrier or screen? ❑Yes ONo Describe: o. Does the proposed action have the potential to produce odors for more than one hour per day? ❑Yes ONo If Yes,describe possible sources,potential frequency and duration of odor emissions,and proximity to nearest occupied structures: p.Will the proposed action include any bulk storage of petroleum(combined capacity of over 1,100 gallons) ❑Yes ONo or chemical products 185 gallons in above ground storage or any amount in underground storage? If Yes: i. Product(s)to be stored ii. Volume(s) per unit time (e.g.,month,year) iii. Generally describe proposed storage facilities: q.Will the proposed action(commercial,industrial and recreational projects only)use pesticides(i.e.,herbicides, ❑Yes []No insecticides)during construction or operation? If Yes: L Describe proposed treatment(s): ii. Will the proposed action use Integrated Pest Management Practices? ❑ Yes ❑No r.Will the proposed action(commercial or industrial projects only)involve or require the management or disposal ❑ Yes []No of solid waste(excluding hazardous materials)? If Yes: L Describe any solid waste(s)to be generated during construction or operation of the facility: • Construction: tons per (unit of time) ■ Operation: tons per (unit of time) ii. Describe any proposals for on-site minimization,recycling or reuse of materials to avoid disposal as solid waste: ■ Construction: ■ Operation: iii. Proposed disposal methods/facilities for solid waste generated on-site: ■ Construction: f Operation: Page 8 of 13 s. Does the proposed action include construction or modification of a solid waste management facility? ❑Yes 0 No If Yes: i. Type of management or handling of waste proposed for the site(e.g.,recycling or transfer station,composting,landfill,or other disposal activities): ii. Anticipated rate of disposal/processing: ■ Tons/month,if transfer or other non-combustion/thermal treatment,or ■ Tons/hour,if combustion or thermal treatment iii. If landfill,anticipated site life: years t.Will proposed action at the site involve the commercial generation,treatment,storage,or disposal of hazardous ❑Yes 0No waste? If Yes: i. Name(s)of all hazardous wastes or constituents to be generated,handled or managed at facility: ii. Generally describe processes or activities involving hazardous wastes or constituents: iii. Specify amount to be handled or generated tons/month iv. Describe any proposals for on-site minimization,recycling or reuse of hazardous constituents: v. Will any hazardous wastes be disposed at an existing offsite hazardous waste facility? Yes No If Yes:provide name 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.Existing land uses. i. Check all uses that occur on,adjoining and near the project site. ❑ Urban ❑ Industrial ❑ Commercial 0 Residential(suburban) ❑ Rural(non-farm) 0 Forest ❑ Agriculture ❑ Aquatic ❑ Other(specify): ii. If mix of uses,generally describe: b.Land uses and covertypes on the project site. Land use or Current Acreage After Change Covertype Acreage Project Completion (_Acres+/-) ■ Roads,buildings,and other paved or impervious 0.67 +0.67 surfaces _ ■ Forested 14.65 11.52 (-3.33) • Meadows,grasslands or brushlands(non- 2.66 +2.66 agricultural,including_ abandoned agricultural) ■ Agricultural (includes active orchards,field,greenhouse etc.) ■ Surface water features (lakes,ponds,streams,rivers,etc.) ■ Wetlands(freshwater or tidal) • Non-vegetated(bare rock,earth or fill) • Other Describe: Page 9 of 13 c.Is the project site presently used by members of the community for public recreation? ❑Yes❑No i. If Yes: explain: d.Are there any facilities serving children,the elderly,people with disabilities(e.g.,schools,hospitals,licensed ❑Yes®No day care centers,or group homes)within 1500 feet of the project site? If Yes, i. Identify Facilities: e.Does the project site contain an existing dam? ❑Yes®No If Yes: i. Dimensions of the dam and impoundment: • Dam height: feet • Dam length: feet • Surface area: acres ■ Volume impounded: gallons OR acre-feet U. Dam's existing hazard classification: W. Provide date and summarize results of last inspection: f.Has the project site ever been used as a municipal,commercial or industrial solid waste management facility, ❑Yes®No or does the project site adjoin property which is now,or was at one time,used as a solid waste management facility? If Yes: i. Has the facility been formally closed? ❑Yes❑ No • If yes,cite sources/documentation: ii. Describe the location of the project site relative to the boundaries of the solid waste management facility: W. Describe any development constraints due to the prior solid waste activities: g.Have hazardous wastes been generated,treated and/or disposed of at the site,or does the project site adjoin ❑Yes®No property which is now or was at one time used to commercially treat,store and/or dispose of hazardous waste? If Yes: i. Describe waste(s)handled and waste management activities,including approximate time when activities occurred: h. Potential contamination history. Has there been a reported spill at the proposed project site,or have any ❑Yes® No remedial actions been conducted at or adjacent to the proposed site? If Yes: i. Is any portion of the site listed on the NYSDEC Spills Incidents database or Environmental Site ❑Yes❑No Remediation database? Check all that apply: ❑ Yes—Spills Incidents database Provide DEC ID number(s): ❑ Yes—Environmental Site Remediation database Provide DEC ID number(s): ❑ Neither database ii. If site has been subject of RCRA corrective activities,describe control measures: W. Is the project within 2000 feet of any site in the NYSDEC Environmental Site Remediation database? ❑Yes®No If yes,provide DEC ID number(s): iv. If yes to(i),(ii)or(iii)above,describe current status of site(s), Page 10 of 13 v. Is the project site subject to an institutional control limiting property uses? ❑Yes❑No If yes,DEC site ID number: ■ Describe the type of institutional control(e.g.,deed restriction or easement): Describe any use limitations: ■ Describe any engineering controls: • Will the project affect the institutional or engineering controls in place? ❑Yes❑No ■ Explain: E.2. Natural Resources On or Near Project Site a.What is the average depth to bedrock on the project site? GREATER THAN 6 feet b.Are there bedrock outcroppings on the project site? ❑Yes®No If Yes,what proportion of the site is comprised of bedrock outcroppings? % c.Predominant soil type(s)present on project site: LOAMY SAND 100% d. What is the average depth to the water table on the project site? Average: 3 TO 6 feet e.Drainage status of project site soils:El Well Drained: %of site ® Moderately Well Drained: 100%of site ❑ Poorly Drained %of site f.Approximate proportion of proposed action site with slopes: ® 0-10%: 80%of site ® 10-15%: 4 %of site 0 15%or greater: 16%of site g.Are there any unique geologic features on the project site? ❑Yes®No If Yes,describe: h. Surface water features. i. Does any portion of the project site contain wetlands or other waterbodies(including streams,rivers, ®Yes❑No ponds or lakes)? ii. Do any wetlands or other waterbodies adjoin the project site? ®Yes❑No If Yes to either i or ii,continue. If No,skip to E.2.i. iii. Are any of the wetlands or waterbodies within or adjoining the project site regulated by any federal, ®Yes❑No state or local agency? iv. For each identified regulated wetland and waterbody on the project site,provide the following information: o Streams: Name 941-390 Classification C(T) • Lakes or Ponds: Name Classification Wetlands: Name Federal Waters,Federal Waters Approximate Size Wetland No.(if regulated by DEC) v. Are any of the above water bodies listed in the most recent compilation of NYS water quality-impaired ❑Yes 0,10 waterbodies? If yes,name of impaired water body/bodies and basis for listing as impaired: i.Is the project site in a designated Floodway? ®Yes❑No j.Is the project site in the 100 year Floodplain? ®Yes❑No k.Is the project site in the 500 year Floodplain? ®Yes❑No 1.Is the project site located over,or immediately adjoining,a primary,principal or sole source aquifer? ®Yes❑No If Yes: i.Name of aquifer:Principal Aquifer Page 11 of 13 in. Identify the predominant wildlife species that occupy or use the project site: COMMON WOODLAND CREATURES n.Does the project site contain a designated significant natural community? ❑YesOio If Yes: i. Describe the habitat/community(composition,function,and basis for designation): ii. Source(s)of description or evaluation: W. Extent of community/habitat: • Currently: acres • Following completion of project as proposed: acres • Gain or loss(indicate+or-): _ acres o.Does project site contain any species of plant or animal that is listed by the federal government or NYS as ❑Yes®No endangered or threatened,or does it contain any areas identified as habitat for an endangered or threatened species? p. Does the project site contain any species of plant or animal that is listed by NYS as rare,or as a species of OYesONo special concern? q.Is the project site or adjoining area currently used for hunting,trapping,fishing or shell fishing? ❑Yes®No If yes,give a brief description of how the proposed action may affect that use: E.3. Designated Public Resources On or Near Project Site a.Is the project site,or any portion of it,located in a designated agricultural district certified pursuant to ❑YesJZNo Agriculture and Markets Law,Article 25-AA,Section 303 and 304? If Yes, provide county plus district name/number: b.Are agricultural lands consisting of highly productive soils present? ❑Yes®No i. If Yes: acreage(s)on project site? ii. Source(s)of soil rating(s): c. Does the project site contain all or part of,or is it substantially contiguous to,a registered National ❑Yes®No Natural Landmark? If Yes: i. Nature of the natural landmark: ❑Biological Community ❑ Geological Feature ii. Provide brief description of landmark,including values behind designation and approximate size/extent: d.Is the project site located in or does it adjoin a state listed Critical Environmental Area? ❑Yes®No If Yes: i. CEA name: ii. Basis for designation: iii. Designating agency and date: Page 12 of 13 e.Does the project site contain,or is it substantially contiguous to,a building,archaeological site,or district ❑Yes®No which is listed on,or has been nominated by the NYS Board of Historic Preservation for inclusion on,the State or National Register of Historic Places? If Yes: i.Nature of historic/archaeological resource: ❑Archaeological Site ❑Historic Building or District ii. Name: iii. Brief description of attributes on which listing is based: f.Is the project site,or any portion of it,located in or adjacent to an area designated as sensitive for ®Yes❑No archaeological sites on the NY State Historic Preservation Office(SHPO)archaeological site inventory? g.Have additional archaeological or historic site(s)or resources been identified on the project site? ❑Yes❑No If Yes: i.Describe possible resource(s): ii. Basis for identification: h.Is the project site within fives miles of any officially designated and publicly accessible federal,state,or local ❑Yes®No scenic or aesthetic resource? If Yes: L Identify resource: U.Nature of,or basis for,designation(e.g.,established highway overlook,state or local park,state historic trail or scenic byway, etc.): iii. Distance between project and resource: miles. L Is the project site located within a designated river corridor under the Wild, Scenic and Recreational Rivers ❑Yes®No Program 6 NYCRR 666? If Yes: L Identify the name of the river and its designation: U. Is the activity consistent with development restrictions contained in 6NYCRR Part 666? []Yes[]No F.Additional Information Attach any additional information which may be needed to clarify your project. If you have identified any adverse impacts which could be associated with your proposal,please describe those impacts plus any measures which you propose to avoid or minimize them. G. Verification I certify that the information provided is true to the best of my knowledge. Applicant/Sponsor Name NN�� ��►C[�i!..•t Date �Z/ Signature ) Title Ap ,� G PRINT FORM Page 13 of 13 EAF Mapper Summary Report Monday, February 13, 2017 4:40 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 Q' {} answered by the EAF Mapper.Additional information on any EAF . question can be obtained by consulting the EAF Workbooks. Although G(e n S the EAF Mapper provides the most up-to-date digital data available to Q- DEC,you may also need to contact local or other data sources in order [I S N to obtain data not provided by the Mapper.Digital data is not a p substitute for agency determinations. U Gel J F-011� C?t1;a.a Muntleal )ueen ury f Tor un tc) i � peTltllt B..ton SisrlVflantt -'c'fact rir� pur�a Es€i, HERE, C:eLc,=me, USO.S. , Irtefmap, INCRIEtal,E'�'"b!5 t•.P.Car, Earl ,fir ;spar, ,.IETI, EsrlChirs ;Hcrg Kcrgj,Esri Pittsburgh Faxes, Eari;Thailsr•6}, A4spmy1r4ji9, NO C, Columbus Irte*rrap, 7D C' teett-43r C—_rtri Lutcrs, 9 r the GIS INCRE10ENT F, N:RCar, Eari +JSs Gemmunity` n.arr yyaJ���s((,,1:4ETl. EsriChira ;Hcrg B.i.i [Coastal or Waterfront Area] No B.i.ii [Local Waterfront Revitalization Area] No C.2.b. [Special Planning District] Digital mapping data are not available or are incomplete. Refer to EAF Workbook. E.1.h [DEC Spills or Remediation Site- Digital mapping data are not available or are incomplete. Refer to EAF Potential Contamination History] Workbook. E.1.h.i [DEC Spills or Remediation Site- Digital mapping data are not available or are incomplete. Refer to EAF Listed] Workbook. E.1.h.i [DEC Spills or Remediation Site- Digital mapping data are not available or are incomplete. Refer to EAF Environmental Site Remediation Database] Workbook. E.1.h.iii [Within 2,000' of DEC Remediation No Site] E.2.g [Unique Geologic Features] No E.2.h.i [Surface Water Features] Yes E.2.h.ii [Surface Water Features] Yes E.2.h.iii [Surface Water Features] Yes- Digital mapping information on local and federal wetlands and waterbodies is known to be incomplete. Refer to EAF Workbook. E.2.h.iv[Surface Water Features -Stream 941-390 Name] E.2.h.iv[Surface Water Features-Stream C(T) Classification] E.2.h.iv [Surface Water Features -Wetlands Federal Waters Name] E.2.h.v [Impaired Water Bodies] No E.2.i. [Floodway] Digital mapping data are not available or are incomplete. Refer to EAF Workbook. E.2.]. [100 Year Floodplain] Digital mapping data are not available or are incomplete. Refer to EAF Workbook. Full Environmental Assessment Form - EAF Mapper Summary Report r �.c.n. L.wv I cal rlUUUVlauij viynai 11101JNnIU UOLO aIc iw►avauavIc Ui 010 uiwuIPIOLO. rwici w Gr%F- Workbook. E.2.1. [Aquifers] Yes E.2.1. [Aquifer Names] Principal Aquifer E.2.n. [Natural Communities] No E.2.o. [Endangered or Threatened Species] No E.2.p. [Rare Plants or Animals] No E.3.a. [Agricultural District] No E.3.c. [National Natural Landmark] No E.3.d [Critical Environmental Area] No E.3.e. [National Register of Historic Places] Digital mapping data are not available or are incomplete. Refer to EAF Workbook. E.3.f. [Archeological Sites] Yes E.3.i. [Designated River Corridor] No Full Environmental Assessment Form - EAF Mapper Summary Report 2