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3 - JP Gross Sketch Plan Short EAF 2020-01-15 Short Environmental Assessment Form Part 1 - Project Information Instructions for CompletinIz Part 1 - Project Information . The applicant or project sponsor is responsible for the completion of Part 1 . Responses become part of the application for approval or funding , are subject to public review , and may be subject to further verification . Complete Part 1 based on information currently available . If additional research or investigation would be needed to fully respond to any item , please answer as thoroughly as possible based on current information . Complete all items in Part 1 . You may also provide any additional information which you believe will be needed by or useful to the lead agency ; attach additional pages as necessary to supplement any item . Part 1 - Project and Sponsor Information Name of Action or Project : 748 Luzerne Road Subdivision Project Location ( describe , and attach a location map ) : 400 feet west of the Luzerne Road and West Mountain Road intersection . Brief Description of Proposed Action : Subdivision lands of approximately 50 . 52 acres which will be developed into eleven ( 11 ) residential lots and one ( 1 ) open space lot . Nine (9 ) of the residential lots will be located around a cukde-sac to be constructed extending north off of Luzerne Road . The other two (2 ) residential lots will be in the northwest and southeast corners of the property , one entering from Tuthill Road and the other from Twin Mountain Drive . Name of Applicant or Sponsor : Telephone : ( 518 ) 792 - 0216 JP Gross Properties LLC E-Mail : jgross@grosselectricinc . com Address : 27 Silver Circle City/PO : State : Zip Code : Queensbury NY 12804 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 . ❑ ❑ County Planning Review , Town Building Permit , Town Water Department , NYSDOH Septic Approval , APA Review 3 . a . Total acreage of the site of the proposed action? 50 . 52 acres b . Total acreage to be physically disturbed ? 7 . 00 acres c . Total acreage (project site and any contiguous properties ) owned or controlled by the applicant or project sponsor? 50 . 52 acres 4 . Check all land uses that occur on , adjoining and near the proposed action . ❑ Urban m Rural (non- agriculture) ❑ Industrial ❑ Commercial 0Residential ( suburban ) mForest ❑ Agriculture El Aquatic ❑ Other ( specify) : ❑ Parkland Page 1 of 3 5 . Is the proposed action , NO YES N/A a . A permitted use under the zoning regulations ? ❑ W1 El b . Consistent with the adopted comprehensive plan? ❑ W ❑ 6 . Is the proposed action consistent with the predominant character of the existing built or natural NO YES landscape? ❑ 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? ❑ 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 : 10 . Will the proposed action connect to an existing public/private water supply ? NO YES If No , describe method for providing potable water : ❑ 11 . Will the proposed action connect to existing wastewater utilities ? NO YES If No , describe method for providing wastewater treatment : ❑ Individual on -site septic disposal systems . 12 . a . Does the site contain a structure that is listed on either the State or National Register of Historic NO YES Places ? Fv( ❑ b . Is the proposed action located in an archeological sensitive area? ❑ 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? ElIf 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 : ❑ Shoreline ❑ Forest m Agricultural/grasslands ❑ Early mid - successional ❑ Wetland ❑ Urban m 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 Existing Streams and flow channels will he utMzed for controlled discharges 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 : FV F1 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 . FV 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 : V F] I AFFIRM THAT THE INFORMATION PROVIDED ABOVE IS TRUE AND ACCURATE TO THE BEST OF MY KNOWLEDGE / Applicant/sponso aame & ( . 1f--� 4C�✓l � ^2 Date : Signature : PRINT FORM Page 3 of 3 Agency Use Only [If applicable] Project : Date . Short Environmental Assessment Form Pant 2 n 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 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? ❑ El 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 1:1 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 1:1 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? ❑ ❑ 8 . Will the proposed action impair the character or quality of important historic, archaeological , ❑ El architectural or aesthetic resources? 9 . Will the proposed action result in an adverse change to natural resources (e . g . , wetlands , El 1:1 waterbodies , groundwater, air quality, flora and fauna)? 10 . Will the proposed action result in an increase in the potential for erosion, flooding or drainage El 1:1 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 : F�- 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. Check 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