Freshwater Wetlands Application Updated: 03/05/2004
TOWN OF QUEENSBURY
FRESHWATER WETLANDS PERMIT APPLICATION
APPLICATION NO.:
APPLICATION DATE:
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: Sharon Serini
177 Chapel Hill Road Highland NY,12528
Address:
Phone: 845-234-1104
Property Information:
1. Name of wetland or any body of water/stream involved:
On-site wetland, +/- 200 ft to Lake George
2. Address of parcel upon which wetland is located and address of parcel(s)upon which
work is proposed.
Private Road #1
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:
4. Current zoning of parcel upon which wetland is located and current zoning of parcel
upon which work is proposed:
5. Total area of property upon which work is proposed:
6. Total area of wetland: 16,000 sf (on parcel)
7. Dimensions of wetland: 220'X 50'
8. Existing uses of wetlands, if any:
none
9. Adjacent uses within 400 ft. of wetlands, if any:
on site well, on site wastewater, single family dwellings,
10. State, County,Town property within 500 ft. of wetland:
n/a
Information About the Project:
1. Detailed description of proposed activity:
Stormwater management within 1 00' from wetlands
2. Purpose, character and extent of proposed activity upon or adjacent to wetland:
Shallow grass depression within 1 00' from existing wetlands
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?
Site Plan Review
5. Has work begun on the project? No
6. Approximate starting date of project? Summer 2022
7. Approximate completion date of project? Winter 2022
Updated: 03/05/2004
About the adjacent 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:
Elizabeth Abkin, Jean & Edward Conway Rev Trust, Elizabeth Kirchhof
Peter Iwanyckyj, Alfonso Rullo
Name 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:
Elizabeth Abkin, Elizabeth Kirchhof
The foregoing information will be reviewed by the agency,and the agency,may if it desires,
request any further information necessary to make a decision.
I hereby affirm under penalty of perjury that the information provided herein and all
attachments subriirtt hrewith are true to-Pe best of my knowledge and belief.
Signature: > j -
I hereby au horize Environmental Design Partnership,LLP to act as my agent and represent me .
in connection with this application on my behalf.