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Application Revised May 2009 Site Plan Review Application REVIEW PROCESS: 1. Required Pre-submission meeting with staff to determine general completeness to be held no later than 1 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 by 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. 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 to which meeting to attend. 7. Following the meeting you will be provided with a copy of the resolution stating the Board's decision on your application. If your application was approved, the next likely step is a Building Permit. Final drawings must be provided for the next phase of review. If your application was denied your project cannot proceed as submitted. DOCUMENTATION REQUIREMENTS: Please submit 1 original & 14 copies of the completed application package to include: • Completed Application: pages 1-11 completed, signed & dated Pre-Submission Meeting Notes: signed by staff • for Site Plan Approval New: Checklist& Plot Plan Fee 0 - 10,000 sf = $100 10,001- 30,000 sf = $250 30,001- 100,000 sf= $500 100,000 + sf = $1000 ZONING STAFF & CONTACT INFORMATION: Craig Brown, Zoning Administrator craigb(o)gueensbury.net Keith Oborne, Land Use Planner keitho()gueensbury.net Pam Whiting, Office Specialist 518-761-8220 pamw(d)gueensbury.net Visit our website at www.gueensbury.net for further information and forms Town of Queensbury Planning Office 742 Bay Road Queensbury, NY 12804 518-761-8220 1 Revised May 2009 General Information Tax Parcel ID Number: 226.12-1-43 Zoning District: WR Detailed Description of Project [include current& proposed use]: The Applicant is proposing an addition to the already existing restaurant together with other necessary repairs. Location of project: 92 Mason Road Applicant Name: San Souci of Cleverdale, Inc. Address: 6 Holden Avenue Queensbury NY 12804 Home Phone Cell: Work Phone Fax E-Mail: Agent's Name: Bartlett Pontiff Stewart & Address: One Washington St PO Box Rhodes PC 2168 Glens Falls NY 12801 Home Phone Cell: Work Phone 792-2117 Fax 792-3309 E-mail sdb@bpsrlaw.com iclt7a.bpsrlaw.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, NY 12804 518-761-8220 2 Revised May 2009 Site Development Data Area /Type Existing sq. ft. Proposed Total sq. ft. Additions . ft. A. Building footprint 2119 217 2336 B. Detached Garage 0 0 0 C. Accessory Structure(s) 0 0 0 D. Paved, gravel or other hard surfaced area 5511 0 5511 E. Porches / Decks 277 -40 237 F. Other 0 0 0 G. Total Non-Permeable [Add A-F] 7907 8084 H. Parcel Area [43,560 sq. ft. / acre] 11760.49 11760.49 I. Percentage of Impermeable Area of Site []=G/H] 67.2% 68.7% Setback Requirements Area Required Existing Proposed Front [1] 30 30.5 30.5 Front [2] 30 32 24 Shoreline n/a Side Yard [1] 20 20.4 20.4 Side Yard [2] 20 9.2 9.2 Rear Yard [1] Rear Yard [2] Travel Corridor Height [max] 30 28 22ft (addition) Permeability 75 32.8 30.4 No. of parking spaces 32 16 16 Town of Queensbury Planning Office 742 Bay Road Queensbury, NY 12804 518-761-8220 3 Revised May 2009 Additional Project Information 1. Will the proposal require a Septic Variance from the Town Board of Health? yes 2. If the parcel has previous approvals, list application number(s): unknown 3. Does this project require coverage under the NYS DEC Stormwater Pollution Prevention Program? no 4. Estimated project duration: Start Date Fall 2009 End Date Spring 2010 5. Estimated total cost of project: _50,000_ 6. Total area of land disturbance for project: _1500 sq feet Floor Area Ratio Worksheet FLOOR AREA RATIO (FAR) -- The relationship of building size to lot size, derived by dividing the total building floor area by the lot size in square feet, yielding a percentage. Zoning District Symbol Floor Area Ratio [FAR] Waterfront Residential WR 0.22 Commercial Moderate CM 0.3 Commercial Intensive Cl 0.3 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. Parcel Area 11760.49 sq. ft. Existing Floor Area 4,112 sq. ft. see above definition Proposed Additional Floor 360 sq. ft. Area Proposed Total Floor Area 4,472 sq. ft. Total Allowable Floor Area _2587 (Area x .22 [see above table Town of Queensbury Planning Office 742 Bay Road Queensbury, NY 12804 518-761-8220 4 Revised May 2009 § 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-SEE ATTACHED SHEET A. The proposed project furthers or is consistent with the policies of the Town's Comprehensive Plan. The applicant is proposing to revitalize a site both aestically and environmentally with the incorporation of holding tanks. We feel that this modification is consistent with the Town's Comprehensive Plan since it helps to maintain a mixed use by providing a neighborhood commercial center in an area that is residential. This zone was just recently amended to allow for Food Establishments as a Special Use. This property pre-dates zoning and it exists as a neighborhood gathering place. This project helps create mixed use neighborhood commercial center which allowed for a neighborhood to grow around an area of commercial activity. This facility allows the neighborhood to go out to eat for a bite or have a drink at an establishment that they can walk to. 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 of all other Articles that apply. The best that It can with the pre-existing site under the current zoning. The Applicant is seeking waivers from the Landscaping, Lighting and Grading requirements and multiple variances from the Zoning Board of Appeals 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. Due to the fact that this serves as a gathering place to the nearby residents and predates zoning, it encourages pedestrian activity. D. The site plan must conform to Chapter 136 Sewage and Sewage Disposal, Chapter 147 Stormwater Management Local Law, and other applicable local laws. The Incorporation of holding tanks is pending before the Town Board. Stormwater Management is noted on the map of Nace Engineering. E. the proposed use shall be in harmony with the general purpose or intent of this Chapter, specifically taking into account the location, 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. Due to the fact that the Town Board rezoned this parcel so that modifications of this site can be considered,we believe it should be considered to be in harmony with the general purpose of this Chapter. This use predates zoning and was created specifically to serve and assist the community. The character and size is consistent with adjacent uses and its appearance is hopefully going to modified with the approval of this application. 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. The customers are familiar with the parking limitations and have learned to car pool and be creative with the existing layout. The Applicant does not feel this will create a hazard as proposed since it has been operating in this fashion for many years. G. Off-street parking and loading facilities will be appropriately located and arranged and sufficient to meet traffic anticipated to be generated by the new use. The establishment of vehicle links between parking areas of adjacent properties are provided where feasible. This furthers the Town's goal of reducing curb cuts and reducing congestion.A twenty-foot wide connection is required. If adjacent properties are either undeveloped or previously developed without having made provision for future linkage, then a future connection must be identified and provided for in the site plan under review for such future linkage when the time arises. The Planning Board may require proof that the applicant has made contact with adjacent property owners for purposes of coordinating linkages with adjacent properties. The Applicant does not anticipate more traffic to be generated by the proposed modification and feels that the parking and proposed layout is sufficient to meet its needs. 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- Town of Queensbury Planning Office 742 Bay Road , Queensbury, NY 12804 518-761-8220 5 Revised May 2009 O80 of this Article. This restaurant predates zoning and has become a part of this community. With the incorporation of the holding tanks it will only have a positive impact on the area. 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. The Applicant does not anticipate more traffic to be generated by the proposed modification and feels that the parking and proposed layout is sufficient to meet its needs. J. Stormwater drainage facilities will prevent an increase of post development drainage flows as compared to pre-development drainage flows. Drainage of the site shall recharge ground water to the extent practical. Surface waters flowing off-site shall not degrade any streams or adversely affect drainage on adjacent properties or public roads. Facilities shall be in conformance with the drainage standards of Chapter 147 of the Town Code and the Town of Queensbury Subdivision Regulations where applicable. Such preventions methods are identified in the map prepared by Nace Engineering. 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. The holding tanks will be reviewed by the Town Board hopefully this month. All other facilities will be sufficient to meet the Applicants needs. L. The adequacy, type and arrangement of trees, shrubs and other suitable 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 vegetation and maintenance, including replacement of dead or deceased plants. This is an existing use and as a result will be seeking a landscaping waiver M. Fire lanes, emergency zones and fire hydrants will be adequate and meet the needs and requirements of emergency service providers. The Applicant is willing to work with the Fire Marshall with whatever he suggests. 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. Applicant does not feel this will be an issue. O. The site plan conforms to the design standards,landscaping standards and performance standards of this chapter. Yes other than the Landscaping,Lighting,and Grading Waivers being requested. Town of Queensbury Planning Office- 742 Bay Road - Queensbury, NY 12804 518-761-8220 6 Revised May 2009 § 179-9-050 Analication for Site Plan Review Application for site plan approval shall be made to the Planning Board using forms supplied by the Board. Application materials and the site plan shall include sufficient information for the Board to make its findings under§ 179-9-070 and 179-9-080 below. In determining the content of the site plan and supporting documentation, the Planning Board may waive certain requirements if the Planning Board deems such requirements or information unnecessary for the type of project proposed. 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 of an applicant. Such request shall set forth the specific requirements that are requested to be waived and the reasons for the requested waiver. Absent any waiver or waivers, an application for Site Plan Review shall include the following: Shown on REQUIREMENTS Sheet# A A vicinity map drawn at the scale that shows the relationship of the proposal to existing community facilities which affect Nace 1 of 1 or serve it, such as roads, shopping areas, schools, etc. The map shall also show all properties, identify owners, 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 Nace 1 of 1 may deem appropriate, on standard 24"x 36"sheets,with continuation on 8%s"x 11" sheets as necessary for written information. The information listed below shall be shown on the site plan and continuation sheets. Q Name of the project,boundaries,date, north arrow, and scale of the plan. Nace 1 of 1 D Name and address of the owner of record,developer,and seal of the engineer, architect,or landscape architect. If the Nace 1 of 1 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 Williams floor area, all exterior entrances,and all anticipated future additions and alterations. Plans Pg 1,3,4,5 F The location of all present and proposed public and private ways, off-street parking areas, driveways, outdoor storage Nace 1 of 1 areas, sidewalks, ramps, curbs, paths, landscaping, walls, and fences. Location, type, and screening details for all waste disposal containers shall also be shown. G The location, height, intensity, and bulb type(sodium, incandescent,etc.) of all external lighting fixtures. The direction WAIVER of 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. No change proposed I The location of all present and proposed utility systems including: Nace 1 of 1 1. Sewage or septic system; 2. Water supply system; 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 Nace 1 of 1 runoff, and flooding of other properties, as applicable. A Stormwater Pollution Prevention Plan (SWPPP) for all land development activities(excluding agricultural activities)on the site that results in land disturbance of 1-acre or more. A SWPPP shall comply with the requirements of the DEC SPDES MS-4 General Permit and Chapter 147 of the Town of Queensbury Code. It shall be at the discretion of the Planning Board as to whether a SWPPP or an erosion and control plan shall be required for a site plan review project land disturbance of less than 1-acre. K Existing and proposed topography at two-foot contour intervals, or such other contour interval as the Planning Board WAIVER 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 the proposed site and within 50 feet of the proposed site where soil removal or filling is required, showing the approximate volume in cubic yards. L A landscape plan showing all existing natural land features that may influence the design of the proposed use such as WAIVER rock outcrops, stands of trees, single trees eight or more inches in diameter, forest cover, and water sources, and all proposed changes to these features including sizes and types of plants. Water sources include ponds, lakes,wetlands Town of Queensbury Planning Office 742 Bay Road Queensbury, NY 12804 518-761-8220 7 Revised May 2009 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 Nace 1 of 1 as any Overlay Districts that apply to the property. N Traffic flow patterns within the site, entrances and exits, and loading and unloading areas, as well as curb cuts on the WAIVER site and within 100 feet of the site. The Planning Board may, at its discretion, require a detailed traffic study for large developments or for those in heavy traffic areas,which shall include: 1.The projected number of motor vehicle trips to enter or leave the site, estimated for weekly and annual peak hour traffic levels; 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. 0 For new construction or alterations to any structure,a table containing the following information shall be included: Nace 1 of 1 1. Estimated area of structure to be used for particular purposes such as retail operation,office,storage,etc.; 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 Elevations at a scale of one-quarter inch equals one foot (1/4" = 1 foot) for all exterior facades of the proposed WILLIAMS structure(s)and/or alterations to or expansions of existing facades,showing design features and indicating the type and PG 1 color of materials to be used. Q Soil logs, water supply well and percolation test results, and storm runoff calculations, as needed to determine and Nace 1 of 1 mitigate project impacts, R Plans for disposal of construction and demolition waste,either on-site or at an approved disposal facility. Nace 1 of 1 S Plans for snow removal,including location(s)of on-site snow storage. Nace 1 of 1 T An Environmental Assessment Form ("EAF"), as required by the SEQRA regulations, with Part 1 completed by the UNLISTED Applicant shall be submitted as part of the application. If the proposed project requires a special use permit and an EAF has been submitted in 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 N/A 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 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 COVER LTR policies in the Town's Comprehensive Plan. Town of Queensbury Planning Office 742 Bay Road Queensbury, NY 12804 518-761-8220 $ Revised May 2009 Pre-Submission Conference Form 1`179-4-04//01 1. Tax Map ID �� yn•/�"� " `�� 2. Zoning Classification W 2. 3. Reason for Review: c wJ9N�C'/u C9f A /W STD' y /N f1 �i9. 4. Zoning Section#: /79 tom'- J17�1q,01U'` 0/0 5. Pre-Submission Meeting Notes; Outstanding Items�o Be Addressed Include: Deed ✓Yes —No General Information complete Yes —No Site Development Data Complete 7 Yes _ No Setback Requirements Complete Yes _ No Additional Project Information Complete 7-Yes —No FAR Worksheet complete 7 Yes _No Standards addressed Yes —No Checklist items addressed Yes _ No Environmental Form completed Yes _ No Signature Page completed Yes _ No pMN /Vc Staff Representative: Applicant/Agent: I Date: s 20 O V Town of Queensbury Planning Office- 742 Bay Road Queensbury, NY 12804 518-761-8220 8 Revised Oct.2008 REASON FOR REVIEW: APA/CEA/DEC/ACOE/NYS DOH 5/74f ldGAN /6-4--C,�leL(J A PRE-SUBMISSION MEETING NOTES: OUTSTANDING ITEMS TO BE ADDRESSED INCLUDE: Sf/c�ccJ P.9��/�t1G G9� G.S - S rl�.Eal cyf-�Tf=�E' o WA I c/�.S /F ANV' G,QADiiyl� LAN�4'-/; Staff Member: Applicant/Agent: c� Date: Town of Queensbury Planning Office- 742 Bay Road -Queensbury, NY 12804- 518-761-8220 6 --.-, SEQR to� ID.N�ER 617 . 21 J Appendix F — -- • State Environmental Quality Review SHORT ENVIRONMENTAL ASSESSMENT FORM For UNLISTED ACTIONS Only ART I - PROJECT INFORMATION (To be completed by Applicant or Project sponsor) APPLICANT ISPONSOR 2 . PROJECT NAME: AN SOUCI OF CLEVERDALE , INC. AREA VARIANCE AND SPECIAL USE PERMIT PROJECT LOCATION: WARREN OWN OF QUEENSBURY COUNTY PRECISE LOCATION (STREET ADDRESS AND ROAD INTERSECTIONS. PROMINENT LANDMARKS, ETC.. OR PROVIDE MAP) 2 MASON ROAD IS PROPOSED ACTION : NEW EXPANSION X MODIFICATION/ALTERATION DESCRIBE PROJECT BRIEFLY : APPLICANT IS PROPOSING AN ADDITION TO AN ALREADY EXISTING RESTAURANT DGETHER WITH OTHER NECESSARY REPAIRS . . AMOUNT OF LAND AFFECTED : NITIALLY . 27 ACRES ULTIMATELY . 27 ACRES . WILL PROPOSED ACTION COMPLY WITH EXISTING ZONING OR OTHER EXISTING LAND USE RESTRICTIONS? YES X No IF NO, DESCRIBE BRIEFLY ECAUSE OF THE NEWLY MODIFIED ZONING IN THE TOWN, THE USE IS PERMITTED WITH A SPECIAL USE PERMIT DWEVER, SETBACK, PARKING, FLOOR AREA RATION , PERMEABILITY AND A CONTINUATION VARIANCE ARE REQUIRED . WHAT IS PRESENT LAND USE IN VICINITY OF PROJECT? RESIDENTIAL INDUSTRIAL COMMERCIAL AGRICULTURE _ PARK FOREST OPEN SPACE ESCRIBE : ROPERTY IS IN CLEVERDALE BUT NOT ON THE LAKE IT IS BORDER BY TWO STREETS , MASON AND CLEVERDALE DAD. O . DOES ACTION INVOLVE A PERMIT APPROVAL , OR FUNDING , NOW OR ULTIMATELY FROM ANY OTHER DVERNMENTAL AGENCY (FEDERAL, STATE OR LOCAL) ? YES X NO IF YES , LIST AGENCY (S) AND PERMIT/APPROVALS 1 . DOES ANY ASPECT OF THE ACTION HAVE A CURRENTLY VALID A PERMIT OR APPROVAL ? YES X NO IF YES, LIST AGENCY (S) AND PERMIT/APPROVALS 2 . AS A RESULT OF PROPOSED ACTION, WILL EXISTING PERMIT/APPROVAL REQUIRE MODIFICATIONS? _ YES x No I CERTIFY THAT THE INFORMATION PROVIDED ABOVE IS TRUE TO THE BEST OF MY KNOWLEDGE .PPLICANT SPONSOR NAM////$$$$"" SAN SOUL/I�p'(�,CLEVERpALE , INC . DATE: JUNE 15, 2009 IGNATURE 7,�� 1 `' 1% • HAN C.yLAPPER, AS ATTORNEY/ It e action is in a oas a rea, and you are a state agency, complete the Coastal Assessment Form before proceeding with this assessment 1 in II - fVIRONMENTAL ASSESSMENT (To be completed by Agency) .. DOES ACTION EXCEED ANY TYPE I THRESHOLD IN 6 NYCRR, PART 617 .12? IF YES, COORDINATE THE REVIEW ROCESS AND USE THE FULL EAF. YES NO WILL ACTION RECEIVE COORDINATED REVIEW AS PROVIDED FOR UNLISTED ACTIONS IN 6NYCRR, PART 617 . 6? IF NO, NEGATIVE DECLARATION MAY BE SUPERSEDED BY ANOTHER INVOLVED AGENCY. _ YES No .. COULD ACTION RESULT IN ANY ADVERSE EFFECTS ASSOCIATED WITH THE FOLLOWING: (ANSWERS MAY BE HANDWRITTEN, IF EGIBLE) 'l . EXISTING AIR QUALITY, SURFACE OR GROUNDWATER QUALITY OR QUANTITY, NOISE LEVELS, EXISTING TRAFFIC ATTERNS, SOLID WASTE PRODUCTION OR DISPOSAL, POTENTIAL FOR EROSION, DRAINAGE OR FLOODING PROBLEMS? EXPLAIN RIEFLY: '2 . AESTHETIC, AGRICULTURAL, ARCHAEOLOGICAL, HISTORIC, OR OTHER NATURAL OR CULTURAL RESOURCES; OR COMMUNITY R NEIGHBORHOOD CHARACTER? EXPLAIN BRIEFLY: '3 . VEGETATION OR FAUNA, FISH, SHELLFISH OR WILDLIFE SPECIES, SIGNIFICANT HABITATS, OR THREATENED OR NDANGERED SPECIES? EXPLAIN BRIEFLY: A . A COMMUNITY'S EXISTING PLANS OR GOALS AS OFFICIALLY ADOPTED, OR A CHANGE IN USE OR INTENSITY OF USE OF AND OR OTHER NATURAL RESOURCES? EXPLAIN BRIEFLY. 'S. GROWTH, SUBSEQUENT DEVELOPMENT, OR RELATED ACTIVITIES LIKELY TO BE INDUCED BY THE PROPOSED ACTION? 'iXPLAIN BRIEFLY. 76 . LONG TERM, SHORT TERM, CUMULATIVE, OR OTHER EFFECTS NOT IDENTIFIED IN Cl-CS? EXPLAIN BRIEFLY. ,7 . OTHER IMPACTS (INCLUDING CHANGES IN USE OF EITHER QUANTITY OR TYPE OF ENERGY) ? EXPLAIN BRIEFLY. ). IS THERE, OR IS THERE LIKELY TO BE, CONTROVERSY RELATED TO POTENTIAL ADVERSE ENVIRONMENTAL IMPACTS? YES NO IF YES, EXPLAIN BRIEFLY. ?ART III - DETERMINATION OF SIGNIFICANCE (To BE COMPLETED BY AGENCY) INSTRUCTIONS: FOR EACH ADVERSE EFFECT IDENTIFIED ABOVE, DETERMINE WHETHER IT IS SUBSTANTIAL, LARGE, MPORTANT OR OTHERWISE SIGNIFICANT. EACH EFFECT SHOULD BE ASSESSED IN CONNECTION WITH ITS (A) SETTING (I.E. , URBAN IR RURAL) ; (B) PROBABILITY OF OCCURRING; (C) DURATION; (D) IRREVERSIBILITY; (E) GEOGRAPHIC SCOPE; AND (F) IAGNITUDE. IF NECESSARY, ADD ATTACHMENTS OR REFERENCE SUPPORTING MATERIALS. ENSURE THAT EXPLANATIONS CONTAIN !UFFICIENT DETAIL TO SHOW THAT ALL RELEVANT ADVERSE IMPACTS HAVE BEEN IDENTIFIED AND ADEQUATELY ADDRESSED. _ CHECK THIS BOX IF YOU HAVE IDENTIFIED ONE OR MORE POTENTIALLY LARGE OR SIGNIFICANT ADVERSE IMPACTS WHICH MAY OCCUR. THEN PROCEED DIRECTLY TO THE FULL EAF AND/OR PREPARE A POSITIVE DECLARATION. _ 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 AND PROVIDE ON ATTACHMENTS AS NECESSARY, THE REASONS SUPPORTING THIS DETERMINATION: TOWN OF OUEENSBURY ZONING BOARD OF APPEALS NAME OF LEAD AGENCY PRINT OR TYPE NAME OF RESPONSIBLE OFFICER IN LEAD AGENCY TITLE OF RESPONSIBLE OFFICER SIGNATURE OF RESPONSIBLE OFFICER IN LEAD AGENCY SIGNATORE OF PREPARER (IF DIFFERENT FROM RESPONSIBLE OFFICER) 2 1p ILL c 0 , 7- El l D ao oc e � � G t.,. . oil, ZI 1i '.3/2hbG 10:Jo ❑lo-r�a �� ,., Adiacent Lsers West 1. John and Lena Tabner -Residence-WR I A 89 N[ason Road (226.12-1-23) 2. Jonathan Berger-Residence-WR1A 93 Nlason Road(226.12-1-26) South I. John and Virginia Blinstrub-Residence-WR1 A 331 Clevezdale Road(226.12-1-42) E ast j. Hela:nl4orn-Residence-WR1A 336 Cleverdale Road(226.12-1-73) 2. James Bober-Residence-WRIA 334 Clcvcrdale Road (226.12-1-14) 3. Eric and Linda La 1 leur-Residence-WR1A 332 Cleverdale Road (226.12-1-75) North 1. Larry Clute-Residence-WRIA 337 Cleverdale Road (226.12-1-44) Revised Oct.2008 Signature Page This page includes the 1.)Authorization to Act as Agent Form: 2.) Engineering Fee Disclosure; 3.)Authorization for Site Visits; 4.) Other Permit Responsibilities; 5.) Official Meeting Disclosure and 6.) Agreement to provide documentation required. OWNER'S AGENT FORM: Complete the following if the OWNER of the property is not the same as the applicant Owner: San Souci of Cleverdale. Inc. Designates: Bartlatt. Pontiff Stewart & Rhodes, P.C. As agent regar ) g: X Variance 4 Site Plan_Subdivision For Tax M No.: 2 .1 ti 1 Block 43 Lot Dee efere Page Date i ' OWNER SIGNAT RE: DATE: APPLICANT'S ZGENTRM: Complete heg if the APPLICANT is unable to attend the meeting or wishes to be represented by another party: Owner: Designates: As agent regarding: Variance_Site Plan_Subdivision For Tax Map No.: Section Block Lot Deed Reference: —Book Page Date OWNER SIGNATURE: DATE: 2.) ENGINEERING FEE DISCLOSURE: Applications may be referred to the Town consulting engineer for review of septic design,storm drainage,etc.as determined by the Zoning or Planning Department. Fees for engineering review services will be charged directly to the applicant. Fees for engineering review will not exceed$1,000 without notification to the applicant. 3.) AUTHORIZATION FOR SITE VISITS: By signing this page and submitting the application materials attached herein,the Owner, Applicant, and his/her/their agent(s) hereby authorize the Zoning Board or Planning Board and Town Staff to enter the subject properties for the purpose of reviewing the application submitted. 4.) OTHER PERMIT RESPONSIBILITIES: Other permits may be required for construction or alteration activity subsequent to approval by the Zoning Board or Planning Board. It is the applicant's responsibility to obtain any additional permits. 5.) OFFICIAL MEETING MINUTES DISCLOSURE: It is the practice of the Community Development Department to have a designated stenographer tape record the proceedings of meetings resulting from application, and minutes transcribed from those tapes constitutes the official record of all proceedings. 6) AGREEMENT TO PROVIDE DOCUMENTATION REQUIRED: I, the undersigned, have thoroughly read and understand the instructions for submission and agree to the submission requirements, I acknowledge no construction activities shall be commenced prior to issuance of a valid petmit. I certify that the application, plans and supporting materials are a true and complete statement/description of the existing conditions and the work proposed, and that all work will be performed in accordance with the approved plans and in conformance with local zoning regulations. I acknowledge that prior to occupying the facilities proposed, I or my agents, will obtain a certi lea"occupancy as necessary. I also understand that I/we may be required to provide an as-built survey by a licens land surveyor of all newly constructed facilities prior to issuance of a certificate of occupancy I have read and agree to the above. SIGNATURE OF APPLICA DATE: SIGNATURE OF AGE DATE Town of Qu Planni Office-- Bay Road • Queensbu NY 12804- 518-761-8220 9 `: WARRANTY DEED WITH LIEN COVENANT 9d y THIS INDENTURE made the 31" day of March 2006,between CH STOI�H R L. COLLINS,44 Hunter Lane, Queensbury, New York 12804, and TIMO7 1f 4-&QG hLNSJ�9^ Hunter Lane, Queensbury, New York 12804,parties of the first part,and SANSOUl�ypFy CLEVERDALE, INC.,a New York corporation with offices at 13 Dawn Road,Queensbtyry, New York 12804, party of the second part, W ITNESSETH,that the parties of the first part, in consideration of ONE and NO1100 DOLLARS ($1.00)lawful money of the United States and other good and valuable consideration paid by the party of the second part,do hereby grant and release unto the party 46 N Wof the second part, its successors and assigns forever, z� ti ALL THAT CERTAIN PIECE OR PARCEL OF LAND situate, lying and r A m being in the Hamlet of Cleverdale,Town of Queensbury,County of Warren '3 3 and State of New York, more particularly bounded and described on Schedule"A" Fo annexed hereto. Together with all right,title and interest,if any,of the parties of the first part in and to any streets and roads abutting the above-described premises,to the centerline thereof. Together with the appurtenances and all the estate and rights of the parties of the first part in and to said premises. To have and to hold the premises herein granted unto the party of the second part,its successors and assigns forever. And said parties of the first part covenant as follows: First, that the party of the second part shall quietly enjoy the said premises; Second,that said parties of the first part will forever warrant the title to said premises. tion Thirteen of the Lien Law. Subject to the trust fund provisions of Sec ktp� f � . Y y 1C SCHE_ QULE"A" "ALL THAT PIECE OF PROPERTY situate in the Hamlet of Cloverdale,Town of Queensbury, County of Warren and State of New York, and more particularly bounded and described as follows: s of Cloverdale Road, which point marks the BEGINNING at a point in the westerly bound northeasterly corner of the premises herein conveyed and the southeasterly corner of premises now or formerly of Betty Lou and Frank G. Coburn,Jr. and running thence S 000 31'West along said westerly boundary a distance of 74.26 feet to an iron pipe set in the ground for a corner; st along the southerly boundary of premises herein conveyed and running thence N 860 14'W e the northerly boundary of premises now or formerly of Betty June Bobst a distance of 133.55 feet to an iron pipe set in the ground for a corner in the easterly boundary of Mason Road'; running thence N 11° 34' 30" East along said easterly boundary a distance of 113 feet more or:less to a point which marks the westerly terminus of an existing fence; running thence southeasterly along said fence line a distance of 46 feet more or less to an iron pipe set in the ground in the westerly rn; running S 6°33'West along said westerly bo boundary of lands of Cobu unds of Coburn a distance of 32 feet more or less to an iron pipe set in the ground for a corner running thence S ce of 69.18 feet to the 83° 36'30"East along the southerly boundary of lands of Coburn a distan place of beginning. ewith all of the grantor's right,title and interest, if any,in the following ALSO conveying her described parcel: BEGINNING at a point in the easterly boundary of Mason Road,which point marks the westerly terminus of the fence hereinbefore,referred oulr in the first described parcel and running thence N. e1Se4 n0the ground at the southwe" East ailong said easterlysterly corner o nerdof promises now oistance Of 11.25 r formerly ofet more or to an iron pip Jonathan and Shirley Berg and running thence Berge S. 83°19'30" East along the southerly boundary he premises ein conveyed ary of t 4of 5.53istance of dfeet to an iron pipe set in erly thecorner n the westerly boundsrof lands of Coburn;lest running thence S..06°33'W est along said westerly bounds a distance of 11.25 feet more or less to an terminus for a corner at the easterly iron ru nPng thence we serly aloround ng sa'd fence I ne 46 feet mo eor less t to the oplace no'f beginning.oned and Being the same premises described in a deed from Priscilla V. Sanderspree and W. il 26, 2000 and David Sanderspree to Christop Clerk's Office April26 Timothy2000 noBook 1163 of llins clatlad rDe ds att Page 52. recorded in the Warren County The above premises are more modernly described as follows: being in the CE OR PARCEof Wa en being more particuOF LAND,situate, ing dlarly bounded and o of ALL THAT CERTAIN PIE Queensbury,State of New York, County described as follows: BEGINNING at an iron rod found on the easterly bounds of Mason Street, said rod being the north west corner of lands now or formerly of Blin the easte ly s de4of saidthe southwest cc Mason Street N 11 r.of the herein described parcel; running thence along degrees 34 minutes 30 seconds E a distance of 124.21 feet to an iron rod found for a corner; an iron 9 rthence S od found for aocgrs orner;lu minutes nn ng then0ce S 06 degrees 33nminutes 00 seconds W istance of y feet to 8 distance of seconds a distance of 69.18 feet to an o iron c running thence od found n th 30 econds westerly bounds of Cleve dales )ng the westerly0Road- running 0 seconds W to distance of 74.26 feet to anhence alc �onrod found for acorner,saidrod being the rees 31 minutes co northwest corner of said lands now or formerly thence aloof ng the Nno(rtherly6bo>nds andtof Said landshe southwestof rner of the herein described parcel; running b, N 86 degrees he minutes 05 seconds W a distance of 133.55 feet to the iron rod Blinstr found u the easterly bounds of Mason Street and the point and place of beginning. Containing 0,27 acres of land more or less.