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ApplicationGeneral Information Application No (Office Use Only) Pre -Application Mtg. Date (office Use only) Application Stye Submitted Submitted (Check one): (To be determined at Pre -Application Meeting) Sketch Plan Stage Preliminary Stage Final Stage Indicate the following Number of lots proposed Residential - R or Commercial - C Lot acreage Project Location RECEIVED 9 2 g ?0lil1-� TOWN OF QUEENSBURY PLANNING OFFICE �&I •-rss�i2 (�iaC: D • Ss Tax Mao No Zone Classification: Lot size: �� (include current and proposed use): 11 L,4 , -r-,.6 t Applicant: ��c1ne , nc lnary �iJ�pJf ' avv�c . Address: btie...; 6.4 iglu( ILOa¢ Home Phone: Work Phone / Fax: _ cI Applicant's Agent: —r, �I�Cz f a N to pew Address: Home Phone: u�- �QZKSj�v 1SY Work Phone / Fax: 7AS- 4 %60 7 9 z- z it -I Property Owner' Address: �� 5 l (� e c Ntn a--e u.4 t 7A4-4 Work Phone / Fax: (ct �, _ 36 Jr r Directions to Site: S I : j" TcdI O�Dxc-r-r� t�s lL�. /., Revision Date: 7/12/00 § A183-11 Final Stage Review — Plat Details and Requirements A. Final plat. The applicant shall submit fifteen (15) copies, one original and fourteen copies,of the final plat application. The final plat shall be laid out by a licensed professional engineer with a properly executed New York State Education Department Exemption ivl or a licensed land surveyor. Such final plat shall be prepared at a scale of one (1) inch equals fifty (50) feet zero (0) inches, clearly showing: Check each box to indicate information has been provided U The bearing and length of all straight lines and the radii, lengths and central antles of all r curves along all property and street lines. . c The area of each lot in square feet or in acres, if such lot is larger than one (1) acre. The connection by proper measurement between street center lines where such streets are not straight across an intersecting street, both within the subdivision and where opposite existing streets or subdivision. �A system of monuments to be located at all comers of intersections and angle points. 0 Proposed block and lot numbers as approved by the Town Assessor. the building setback line for each lot. ire and school district boundaries within the subdivision area. Existing zoning, with the location of any district boundaries within two hundred (200) feet of the property to be subdivided. The boundaries of the property, the lines of proposed lots, streets and parks, and the � ylines of all adjoining streets, their names and exact survey locations. YJ The names of all subdivisions immediately adjacent and opposite, or, if not subdivided, the names of the owners of record of adjacent and opposite property. U�A statement that the plan is in compliance with the Zoning Ordinance of the Town of Qu eensbury. A statement reading as follows: " Approved under authority of a resolution adopted by the Planning Board of the Town of Queensbury, New York. Chairman." L�rA title block, showing the name of the subdivision, the owner, the scale, the date and ^rth point. C.I A certificate of the licensed engineer and/or land surveyor making such plan to the effect that the plan is correct and made from an actual survey, the license number and seal of the engineer and land surveyor shall be affixed to the drawing. B. Endorsement of state and county agencies. ❑ Evidence shall be supplied that anv proposed water supply and sewage disposal facilities �o Wq,Z�associated with the subdivision plat requiring approval by the Department of ram' Environmental Conservation and/or New York State Department of Heath have received at least preliminary approval(s) of such facilities and that any special district extensions required have been authorized by the Queensbury Town Board. Any proposed water supply and sewage disposal facility shall meet the Town of Queensbury design and construction standards for such facility. The plat shall not be stamped approved until all state- and or county -required approvals for each lot of the subdivision have been receiving in writing by the Planning Board. C. Other plans and reports. Other plans and reports shall be submitted as follows: yJ A drainage report demonstrating proper sizing of drainage swales, culverts, pipes and ets . planting plan illustrating species and location of proposed tree planting. A tree clearing plan illustrating areas and methods of protection of existing trees to 4main. n erosion control plan illustrating methods and location of erosion control devices and edule of maintenance of such devices and other actions to reduce erosion. Construction plans showing grading and other site improvements and details of those site improvements. D. Homeowners' association or condominium agreements ❑ If the subdivision is to be managed by a homeowners' association or condominium, 0 copies of their regulations and agreements, indicating any restrictions required by the �y Planning Board, shall be submitted. If the subdivision is to be sold fee simple, copies of deeds indicating any restrictions required by the Planning Board shall be submitted. E. Streets, recreation land or open space. The plat shall be endorsed with the necessary agreements in connection with required easements or releases. Offers of dedication to the town shall be presented prior to plat approval. Formal offers of dedication to the town of all streets and parks, not marked on the plat with notation to the effect that such dedication will not be offered, shall be filed with the Planning Board prior to plat approval. If the owner of the land or his agent who files the plat does not add as part of the plat a notation to the effect that no offer of dedication of such streets, highways or parks, or any of them, is made to the public, the filing of the plat in the office of the County Clerk or register shall constitute a continuing offer of dedication of the streets, highways or parks, or any of them, to the public, and said offer of dedication may be accepted by the Town Board at any time prior to revocation of said offer by the owner of the land or his agent. dThe approval by the Planning Board of a subdivision plat shall not be deemed to constitute or imply the acceptance by the town of any street, park, playground or other open space shown on said plat. The Planning Board may require said plat to be endorsed with appropriate notes to this effect. If the Town Board determines that a suitable park or parks of adequate size cannot be properly located in any such plat or is otherwise not practical, the Board may require, as a condition to approval of any such plat, a payment to the town of a sum to be determined by the town. which sum shall constitute a trust fund to be used by the Town Board exclusively for neighborhood park, playground or recreation purposes, including the acquisition of property. The Planning Board may require the filing of a written agreement between the applicant and the Town Board covering future title, dedication and provision for the cost of grading, development, equipment and maintenance of any park or playground area. F. Fees. ZThe application for final plat approval shall be accompanied by a fee listed on the correct schedule for fees for the Town of Queensbury posted in the Planning Office. The fee is $50 plus $5 per lot. )n 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. Date: Z y-s O Signature: Nzr a (Person responsible for providing information) • 0 vt Signature Page This Page includes the Authorization to Act as Agent Form, Engineering Fee Disclosure, Other Permit Responsibilities and Agreement to provide documentation required. Complete the following ifthe OWNER ofthe property is not the same as the applicant Owner's Agent Form Owner: Designates: As agent regarding For Tax Map No.: Deed Reference: SIGNATURE: Variance _ Site Plan _ Section Block Book _ Page Subdivision _ Lot Date (Owner) (Date) Complete the following if the APPLICANT is unable to attend the meeting or wishes to be represented by another party: Applicant's Agent Form Owner: Designates: As agent regarding: For Tax Map No.: SIGNATURE: _ Variance _ Site Plan _ Subdivision Section Block _Lot (Owner) Z 2, r j (Date) Enaineerine 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. Please Note: Other permits may be required for construction or alteration activity subsequent to approval by the Zoning Board or Phuming Board. It is the applicant's responsibility to obtain any additional permits. w Official Meetine Minutes Disclosure: It is the practice of the Community Development Dept. to have a designated stenographer tape record the proceedings of meetings resulting from application, and that minutes transcribed from those tapes constitute the official record of all proceedings. If there is a discrepancy between such record and the handwritten minutes taken by the designated stenographer, the handwritten minutes shall be deemed the official record. I, the undersigned, have thoroughly read and understand the instructions for submission, agree to the submission requirements and completed the checklist SIGNATURE OF APPLICANT: SIGNATURE OF AGENT: P Date Z 2 • 0 �8 q 2ODO TOWN OF QUEENSBURY 742 Bay Road, Queensbury, NY. 12804-5902 Memorandum To: Walter Haynes From: Laura Moore, Assistant Planner Date: June 4, 2001 Re: Baybrook Subdivision The Planning Office has received your request for comment on the above referenced project. The applicant has received a final subdivision approval conditioned upon receiving the necessary permits from NYSDEC. The information submitted to your office is consistent with our file information. Please see attached resolution. L:\Laura\LauraCorrespondence\Letters of 2001\haynesdecjune2001.doc r TOWN OF QUEENSBURY COMMUNITY DEVELOPMENT DEPARTMENT ' New York State Department of Environmental Conservation Notification of Availability for Review RECEIVEI.-! TAN o�Qw<e.rsbur� To ALAN L. KOECHLEIN MAY i 0 700y� WILLIAM B. WHITE WILLIAM E. LUPO TOWN OF QUEENSBURY U S ARMY CORPS OF ENGINEERS PLANNING OFFICE From WALTER L. HAYNES Send Date May 24, 2001 NYSDEC REGION 5 WARRENSBURG SUB -OFFICE Reply By June 09, 2001 WARRENSBURG NY 12885 0220 (518) 623-1281 Application Id 5-5234-00287/00003 SPDES ID Mined Land ID Solid Waste ID Permits Applied 1 -Article 24 Freshwater Wetlands 1 - Article 15 Title 5 Stream Protection 1 - Section 401 - Clean Water Act Water Quality Certification Applicant/Owner SCHERMERHORN CONSTRUCTION CORP Faci4Name BAYBROOK SUBDIVISION County WARREN COUNTY Town QUEENSBURY Description Install 2 culverts, construct stormwater basins in FWW buffer Batch ID Owner ID 894423 1152159 NYTM-E: 609.2 NYTM--N: 4800.0 Sender Comments This is basically the same application that was submitted in 1993 by Passarelli. Bill White, Les Saltsman would like to discuss this with you prior to issuance. Reviewed By Reviewer Comments / Recommendations Comments continued on back (name) Comments attached (unit) (phone) (date) 14-16-2 (9195)-7c 0 617.20 SEAR Appenaix A State Environmental Quality Review FULL ENVIRONMENTAL ASSESSMENT FORM Purpose: The full EAF is designed to help applicants and agencies determine, in an orderly manner, whether a project or action may be significant. The question of whether an action may be significant is not always easy to answer. Frequent- ly, there are aspects of a project that are suojective or unmeasureable. It is also understood that those who determine significance may have little or no formal knowledge of the environment or may not be technically expert it environmental analysis. In addition, many who have knowledge in one particular area may not be aware of the broader concems affecting the question of significance. The full EAF is intended to provide a method whereby applicants and agencies can be assured that the determination process has been orderly, comprehensive in nature, yet flexible enough to allow introduction of information to fit a project or action. Full EAF Components: The full EAF is comprised of three parts: Part 1: Provides colective data and information about a given project and its site. By identifying basic project data, it assists a reviewer in the analysis that takes place in Parts 2 and 3. Part 2: Focuses on identifying the range of possible impacts that may occur from a project or action. It provides guidance as to whether an impact is likely to be considered small to moderate orwhether it is a potentially - large impact. The form also identifies whether an impact can be mitigated or reduced. Part 3: If any impact in Part 2 is identified as potentiailvlarge, then Part 3 is used to evaluate whether or not the impact is actually important. DETERMINATION OF SIGNIFICANCE —Type 1 and Unlisted Actions Identify the Portions of EAF completed for this project: ❑ Part 1 ❑ Part 2 ❑Part 3 Upon review of the information recorded on this EAF (Parts 1 and 2 and 3 if appropriate). and any other supporting information, and considering both the magnitude and importance of each impact, it is reasonably determined by the lead agency that: ❑ A. The project will not result in any large and important impact(s) and, therefore, is one which will not have a significant impact on the environment, therefore a negative declaration will be prepared. ❑ B. Although the project could have a significant effect on the environment, there will not be a significant effect for this Unlisted Action because the mitigation measures described in PART 3 have been required, therefore a CONDITIONED negative declaration will be prepared.* ❑ C. The project may result in one or more large and important impacts that may have a significant impact on the environment, therefore a positive declaration will be prepared. A Conditioned Negative Declaration is only valid for Unlisted Actions of Action Name of Lead Agency Print or Type Name of Responsible Officer in Lead Agency Signature of Responsible Officer in Lead Agency Title of Responsible Officer Signature of Preparer(If different from responsible officer) Date 0 PART 1—PROJECT INFORMATION Prepared by Project Sponsor ti OTIC.E. "his document is ccsicneo to as,ist in aieternrintng whether tire action proposeo may have a significant effect :,n the environment Please complete the entire form Parts A through E..Answers to trsese Duesaons will be considered .is part of the aopuc.ation tar approval and may nr sublets to t,,rlher vemrcation and puDlic re•; tew Provide any additional inrormation you bellew,- wilt he neesied to comorete Pats 2 ana 3 .: Is expected that comDletrnn of the fuii EAF will be ceoencent on intormauon currentiv Available and will not involve new stuates. research or mveyttgatlon, it oformat,on reausnng such additional wrNrk is unavaiianit•, wo �nci( ate and specify each instance NAME OF ACTON �+ a �G�e�/✓✓l _T1a.iL C"Vtov O V sSr O U LC A AN OF ACTION ;mcwum st r . uumc�oa+�rw u•f 4Wnb� 0,04 evlsta NAME OF APPVCa1NUSPON On —}— SC-hP_°1M H0✓v\ J6 BL51NE55 1ELEPHOH J I ev cf�� J� 'S(� ADOFE55 ` I 1'" l6�i VS N 4-K aTy Po N 1e f ✓+S 1t9 /v Is C I N zl Z O9E �? NAME OF OWNER lit 11"Womi _ CA I BUSINESS TELEPHONE (.1. 1� c�S$G VQ s ADDFFSs 4 C J I�t cl"IPO Lµ 5iarE U 'JP COOE 1'�f'� ev✓fe 1 OESCib Pr;Oli Or ACTIL``N 14�i)11hd(�sys3tsp �o` �aos2SSiO�c1 6 \�-2 GL..,I V✓1V1 i(�iG sore 1 Nr -rip sl`0 �t'c�1 U.se Please Complete Each Question —Indicate N.A. if not applicable A_ Site Description Physical setting of overall protect, both deveioped and undeveloped areas. t Present land use ❑Urban Olndustnal ❑Commercial ❑Reside tial(suburbanl ❑Rural(noo-iamni ❑Fore,t C]Agnf cuiture ZOther V12221 2 Total acreage or project areaacres APPROXIMATE ACREAGE PRESENTLY AFTER COMPLETION Meadow or Eirushland (Nori•agncultural) 56 A Z '%cres 33 • w acres Forested G - I acres S acres Agrlculturai (Includes orchards, cropland. pasture, eic) acres "— acres Wetland (freshwater of tidal as per Articles 24. 25 of ECU rt" r S acres acres Water 51.lriace Area 0. If acres Cr) .1 acres linvegetated (Rock, earth or rill) acres acres Roads buildings and other paved surfaces © acres acres Other (Indicate tvpet / awl © acres a —7 acres 3. What is predominant soil tvpxist on prolect site? a. Sail drainage ❑Well drained 2 % of size ❑Moderately well drained -90 N of site ❑Poorly drained of site b. It anv agricultural land n involved. how many acres of sod are ciassitied within son group 1 through 4 of the Ny5 Land Classiiicatton System+ _acres. fSee t NYCRR 37M 4. Ate there bedrock outcroppings on project site ❑Yes a. What 1s deDth to bedrock' 2 tit 8 -I in feetl 7 w • 5 Approximate percentage or oroposea Project site with slopes ❑040% /06 % 01015% wo 015% or greater % 6. Is project substantially contiguous to, or contain a building, site. or district. listed on the State or the National Registers of Historic Places? ❑Yes XNO 7. Is project substantially contiguous to a site listed on the Register of National Natural Landmarks? ❑Yes Mo 8. What is the depth of the water table? Z. } tin feet) 9. Is site located over a primary, principal, or sole source aquifer? ❑Yes 540 10. Do hunting, fishing or shell fishing opportunities presently exist in the project area? ❑yes �.?o 11. Does project site contain any species of plant or animal life that is identified as threatened or endangered? ❑Yes ;*lo According to Identify each species 12. Are there any unique or unusual land forms on the project site? (i.e., cliffs, dunes, other geological formations) ❑Yes A&o Describe 13, Is the project site resentiy used by the community or neighborhood as an open space or recreation area? ❑Yes Wo If yes, explain 14. Does the present site include scenic views known to be important to the community? ❑Yes Xo 15. Streams within or contiguous to project area: E% L C� s _� ✓oc 'V— a. Name of Stream and name of River to which it is tributary "- ( Z�Jci 16. Lakes, ponds, wetland areas within or contiguous to project area: a. Name _'Fo u.M '�r�,nd Itrtvv.hov�te b. Size (In acres) ©ok 17. Is the site served by existing public utilities?Oes ❑No a) If Yes, does sufficient capacity exist to allow connection?'es []Nob) If Yes, will improvements be necessary to allow connection? ❑Yes '11*40 18. Is the site located in an agricultural district certified pursuant to Agriculture and Markets Law, Article 25-AA, Section 303 and 304? ❑Yes 26No 19. Is the site located in or substantially contiguous to a Critical Environmental Area designated pursuant to Article 8 of the ECL, and 6 NYCRR 617? ❑Yeslo 20. Has the site ever been used for the disposal of solid or hazardous wastes? ❑Yes yll�No B. ProJect Description 1. Physical dimensions and scale of project (fill in dimensions as appropriate) C� a. Total contiguous acreage owned or controlled by project sponsor P. A � acres. b. Project acreage to be developed. 41 r acres initially; acres ultimately. c. Project acreage to remain undeveloped acres. d. Length of project. in miles: L._ (If appropriate) e. If the project is an expansion, indicate percent of expansion proposed 4 4 A %: f Number of off-street parking spaces existing &Q_; proposed g. Maximum vehicular trips generated per hour IS-7 (upon completion of project)? h. If residential: Number and type of housing units: One Family Two Family Multiple Family Condominium Initially q Ultimately UP1 k-rjCLLkn i. Dimensions (in feet) of largest proposed structure_ height width, length. j. Linear feet of frontage along a public thoroughfare project will occupy is? 1.360 h. 3 I-cnv nlucn natural materat i e rum k. e•artn rlr I will br rrmovtxI 1'om tnr7 sger :onvcubir, v.srds i. W•II Outurbed areas be reciaimeor r1m,I,az::;No ❑N;A a If vestot what intended purpose n the stle kx ing rcclaimrdt LI-1 U/ el S b Vvill topsoil he uockpiled fur rrt Iamalsunt rurv. ❑NO r vytll tipper subsoil oe stockoiled roe rcclamaE.oni oy'es ❑Nn 4 How mnnv acres or vegetation (trees. shrubs. grouna covers? wdi he rersnve J imm suer 1. S acres i L4�11 anv mature inrest Inver {lift vrars oldl o• ot.ner locally -important Vegrtat An tre n•mnvrn t)•: this project? ,. It single phase project. Antrupated pentxl of rnnstructton Na^onths. Including cemnuliuns If mulu-onasea. a Total numoer or phases anucgj ten Z ;numovrl. b. Anticipated date of commencement Phase I f_L , month ZCX)I Year. tsncluding demohtionl c Approximate completion date of final phase _LA II Irty" month Year. d Is phase I functionally depencent on subsequent phases? ❑Yes *C1 8 will blactmg occur (iunng construcaoni QYes ANo 4. 4 Nurn Der of Ichi generated during construction -y3Q after project is complete In Numoer or ;obs eliminated by th•s project C_, '1 Vtill project require relocation er anv projects or ranlill"r ❑Y'es o If yes, explain 12 Is sunace houid waste Oisoosal involved? Oyes Vo a If ves, rneicate tvur ur wn,ty (x'wage, industrial, etc.) and amount b Name of water body into whirh rfilurnt will he discharited 17 Is subsurface finuid waste disposal involved+ Oyes )9�40 -Ype 14, Will surface area of an existing wAtet nudv encreaxe rx decrease by proposal? ❑Yes A{40 t xplam 15 is project or any portion or protect located in a 100 year flood plasne ❑Yes AN th will the project Reoerate solid waste? Pfies ONO a If Vrs. what is the amount per month .6 tons b It ves. will an existing sultd wastr faciility be used? Yes ❑No c. If ves. g9 give name 1t1Veetir'% ILL(a• (::A• T-o .(ri'j; location �-'A-Jdi6n d. wilt any wastes not go into a ,rwagr dt,posai Svstem or into a sanitary landtili? ❑Yes 21i4o e. If Yes, explain 17 will the project involve the disposal of solid waste? ❑Yes '0" a. If ves- what is the anticipated rate of disposal? tonvmonth h If yes• what is the anticipated site life? years. I& Will protect use herbicides rw prssicidesr ❑Yes *0 19will project routinely produce odors (more than one hour per day)? ❑Ycs )1�0 20 Will protect produce operating noise exceeding the local ambient none levels? ❑Yes 9No 21 Will project resuft in an increase in energy use? It yes . indicate tvpe(s) CI xe c- '.'[.�% ONO 22, If warrr Supply I, from ,veil S, indicate pumpmjt capacity ..f1i to � gallons;minute 23. Total anticipated water uvage prr day c3 Qallons?day. 24 Does project involve focal. State or Federal funding? ❑Ycs A*o tt Yes, explain 4 9 25. APprovab Required: :ity, low Vdlagr guardies ❑\q ::itv, tiwn Vdlagr Planning Hoard IAes ❑No i tv Town Zoning Hoard ❑yes o City. County Health Department ❑ycs 9NO Otner Locai Agencies ❑Yes ANn Other Regional Agencies O;les ❑No Sate Avrmie, ❑Yes ONO t rderal Agencies ❑Yes ONO Type Submittal Date S 2u,-c 1 8 FAy, c� C^ Ie vS,-, — 1L�asnrer. Qn,0-V k, R, e,n.� /6 )1 CGA C. Zoning and Planning Information _` t Ours prnpom.-d atui n invnlve a planning or zoning decision? Yes ❑No It Yes, indicate decision required - ❑zon,ng amendment. ❑zoning vanancr ❑ ix-cul use permit Aubdo,vion ❑%nr plan ❑new revision of master plan ❑re,ourcr management plan ❑other What is the zoning ciassuicationslor the vtr4 M 1Z S i What is the maximum potential deveiooment of the site if developed as permitted by the present zoning? .. 'Alai ii the proposed zoning or the site? A/ 17 Whet is the maximum potential deveicoment or the site it developed as permuted by the proposed zoning? 0 6 Is the proposed action consistent with the teturnmended toes in adopted local land use plarst Aes ONO What are the predominant land u,dsl and zoning Llassrfications within a 1: mile radius of proposed action? 1"A -5 ;fib , .5?-I N is I. the proposed action compatible with adianinq�surrounding land uses within a 'A milrr *C% ONO u If the proposed action is the subdivision of land, how many -lots are proposed? �40 a What is the minimum lot skze propd1"1' red?I96% - tu 'svdl proposed action require any authonzationls) for the ioxmation or sewer err water dntriruf )KYes ONO 11 Viell the proposed action create a demand tot any community provided services (recreationeducation, ponce. tire protr17000 AYe% ONO s a It ye,i. rs rx.isbng capacity sufficient to handle protected demand? Oes ❑No 12 Will the prupgsrd action result to the generation of traffic significantly above present levels? ❑Yes ONo a. It yes. is the existing road network adequate to handle the additional traffic+ Oyes ONO D. Informational Details Attach any additional information a, may he needed to claniv vour protect If there are or may be any adverse impacts associated with your prupotal please dh,cuss such impacts and the measures which you propose to mitigate or ,avoid them E. Verification I (.ertifv that the information Drowded above is true to the best at my knowiedee Apphrenlispnn ,r me ;J C:1,ieJMev�11L)✓�i Virojy. i," _.L*ir- Date t Z l (� Signatu _ kCZ.:> Title I3--en' If the action is in the Coastal Area, and you are a state agettcv, complete the Coastal Assessment Form before proceeding with this anessmerd. 5 • Part 2—•OJECT IMPACTS AND THEIR MAINITUDE Responsibility of Lead Agency General Information (Read Carefully) • In completing the form the reviewer should be guided by the question: Have my responses and determinations been reasonable? The reviewer is not expected to be an expert environmental analyst. • The Examples provided are to assist the reviewer by showing types of impacts and wherever possible the threshold of magnitude that would trigger a response in column 2. The examples are generally applicable throughout the State and for most situations. But, for any specific project or site other examples and/or lower thresholds may be appropriate for a Potential Large Impact response, thus requiring evaluation in Part 3. • The impacts of each project, on each site, in each locality, will vary. Therefore, the examples are illustrative and have been offered as guidance. They do not constitute an exhaustive list of impacts and thresholds to answer each question. • The number of examples per question does not indicate the importance of each question. • In identifying impacts, consider long term, short term and cumiative effects. Instructions (Read carefully) a. Answer each of the 20 questions In PART 2 Answer Yes If there will be any Impact b. Maybe answers should be considered as Yes answers. c. If answering Yes to a question then check the appropriate box (column 1 or 2) to Indicate the potential size of the Impact. If Impact threshold equals or exceeds any example provided, check column 2. If Impact will occur but threshold is lower than example, check column 1. d. Identifying that an Impact will be potentially large (column 2) does not mean that It is also necessarily significant Any large impact must be evaluated In PART 3 to determine significance. Identifying an Impact In column 2 simply asks that It be looked at further. e. If reviewer has doubt about size of the Impact then consider the Impact as potentially large and proceed to PART 3. I. If a potentially large impact checked In column 2 can be mitigated by change(s) In the project to a small to moderate Impact, also check the Yes box In column 3. A No response Indicates that such a reduction is not possible. This must be explained In Part 3. IMPACT ON LAND 1. Will the proposed action result in a physical change to the project site? []NO `YES Pexamplss that would apply to column 2 • Any construction on slopes of 15% or greater, (15 foot rise per 100 foot of length), or where the general slopes in the project area exceed 10%. (• construction on land where the depth to the water table is less than 3 feet • Construction of paved parking area for 1,000 or more vehicles. • Construction on land where bedrock is exposed or generally within 3 feet of existing ground surface. • Construction that will continue for more than 1 year or involve more than one phase or stage. • Excavation for mining purposes that would remove more than 1,000 tons of natural material (i.e., rock or soil) per year. • Construction or expansion of a sanitary landfill. • Construction in a designated I'loodwa . • Other impacts t^ Gi 1W ✓\ l9 x^ 2. Will there be an effect to any unique or unusual land fs found on the site? (i.e., cliffs, dunes, geological formations, etc. O ❑YES • • Specific land forms: 1 Small to Moderate Impact 2 Potential Large Impact 3 Can Impact Be Mitigated By Project Change ❑ ❑ ❑Yes ❑No 4 ❑ ,gYes []No ❑ ❑ ❑Yes ❑No ❑ ❑ ❑Yes ❑No ❑ ❑ ❑Yes ❑No ❑ ❑ ❑Yes []No ❑ ❑ ❑Yes ❑No ❑ ❑ ❑Yes ❑No ❑ ❑ Oyes ❑No ❑ ❑ ❑Yes ❑No IMPACT ON WATER 3. Will proposed action affect any water body designated as protected? (Under Articles 15, 24, 25 of the Environmental Conservation Law, E L) ❑NO *ES amples that would apply to column 2 • D velopable area of site contains a protected water body. � • Dredging more than 100 cubic yards of material from channel of a protected stream. • Extension of utility distribution facilities through a protected water body. • Construction in a designated freshwater or tidal wetland. • Other impacts: 4. Will proposed action affect any non -protected existing or new body of water? �kNO OYES Examples that would apply to column 2 • A 10% increase or decrease in the surface area of any body of water or more than a 10 acre increase or decrease. • Construction of a body of water that exceeds 10 acres of surface area. • Other impacts 5. Will Proposed Action affect surface or groundwate[ quality or quantity? ��7Cf `NO OYES Examples that would apply to column 2 • Proposed Action will require a discharge permit. • Proposed Action requires use of a source of water that does not . have approval to serve proposed (project) action. • Proposed Action requires water supply from wells with greater than 45 gallons per minute pumping capacity. • Construction or operation causing any contamination of a water supply system. • Proposed Action will adversely affect groundwater. • Liquid effluent will be conveyed off the site to facilities which presently do not exist or have inadequate capacity. • Proposed Action would use water in excess of 20,000 gallons per day. • Proposed Action will likely cause siltation or other discharge into an existing body of water to the extent that there will be an obvious visual contrast to natural conditions. • Proposed Action will require the storage of petroleum or chemical products greater than 1,100 gallons. • Proposed Action will allow residential uses in areas without water and/or sewer services. • Proposed Action locates commercial and/or industrial uses which may require new or expansion of existing waste treatment and/or storage facilities. • Other impacts: 6. Will proposed action alter drainage flow or patterns, or Trace water runoff? ONO YES •Examples that would apply to column 2 • Proposed Action would change flood water flows. 1 Small to Moderate Impact 2 Potential Large Impact 3 Can Impact Be Mitigated By Project Change ❑ Yes ❑No ❑ ❑ ❑Yes ❑No ❑ ❑ ❑Yes ❑No ❑ ❑ Oyes ❑No ❑ ❑ ❑Yes ❑No ❑ ❑ ❑Yes ❑No ❑ ❑ ❑Yes ❑No ❑ ❑ ❑Yes ❑No ❑ ❑ ❑Yes ❑No ❑ ❑ ❑Yes ❑No ❑ ❑ Oyes ❑No ❑ ❑ Oyes ❑No ❑ ❑ ❑Yes ❑No ❑ ❑ ❑Yes ❑No ❑ ❑ ❑Yes ❑No ❑ ❑ ❑Yes ❑No ❑ ❑ ❑Yes ❑No ❑ ❑ ❑Yes ❑No ❑ ❑ ❑Yes ❑No ❑ ❑ ❑Yes ❑No ❑ 13 0Yes ❑No • • Proposed Action may cause substantial erosion. • Proposed Action is incompatible with existing drainage patterns. • Proposed Action will Ilow development in a designated flo°°�' • Other impacts: c-� /��aVrr^� O<<Cn(�IEgCiKI IMPACT ON AIR 7. Will proposed action affect air quality? �IaO ❑YES Examples that would apply to column 2 • Proposed Action will induce 1,000 or more vehicle trips in any given hour. • Proposed Action will result in the incineration of more than 1 ton of refuse per hour. • Emission rate of total contaminants will exceed 5 lbs. per hour or a heat source producing more than 10 million BTU's per hour. • Proposed action will allow an increase in the amountof land committed to industrial use. • Proposed action will allow an increase in the density of industrial development within existing industrial areas. • Other impacts: IMPACT ON PLANTS AND ANIMALS • 8. Will Proposed Action affect any threatened or endangered species? -FK0 ❑YES Examples that would apply to column 2 • Reduction of one or more species listed on the New York or Federal list, using the site, over or near site or found on the site. • Removal of any portion of a critical or significant wildlife habitat. • Application of pesticide or herbicide more than twice a year, other than for agricultural purposes. • Other impacts: 9. Will Proposed Action substantially affect non -threatened or non -endangered species? �NO []YES Examples that would apply to column 2 • Proposed Action would substantially interfere with any resident or migratory fish, shellfish or wildlife species. • Proposed Action requires the removal of more than 10 acres of mature forest (over 100 years of age) or other locally important vegetation. IMPACT ON AGRICULTURAL LAND RESOURCES 10. Will the Proposed Action affect agricultural land resources? JNO ❑YES Examples that would apply to column 2 • The proposed action would sever, cross or limit access to agricultural . land (includes cropland. hayfields, pasture, vineyard, orchard, etc.) 8 1 Small to Moderate Impact 2 Potential Large Impact 3 Can Impact Be Mitigated By Project Change ❑ ❑ []Yes ❑No ❑ ❑ ❑Yes ❑No ❑ ❑ ❑Yes ❑No 'K ❑ Yes ❑No ❑ ❑ ❑Yes ❑No ❑ ❑ ❑Yes ❑No ❑ ❑ ❑Yes ❑No ❑ ❑ ❑Yes ❑No ❑ ❑ ❑Yes ❑No ❑ ❑ ❑Yes ❑No ❑ ❑ ❑Yes ❑No ❑ ❑ ❑Yes ❑No ❑ ❑ ❑Yes ❑No ❑ ❑ ❑Yes ❑No ❑ ❑ ❑Yes ❑No ❑ ❑ ❑Yes ❑No ❑ ❑ ❑Yes ❑No • • Construction activity would excavate or compact the soil profile of agricultural land. • The proposed action would irreversibly convert more than 10 acres of agricultural land or, if located in an Agricultutal District, more than 2.5 acres of agricultural land. • The proposed action would disrupt or prevent installation of agricultural land management systems (e.g., subsurface drain lines, outlet ditches, strip cropping); or create a need for such measures (e.g. cause a farm field to drain poorly due to increased runoff) • Other impacts: IMPACT ON AESTHETIC RESOURCES 11. Will proposed action affect aesthetic resources? O OYES (if necessary, use the Visual EAF Addendum in ection 617.20, Appendix B.) Examples that would apply to column 2 • Proposed land uses, or project components obviously different from or in sharp contrast to current surrounding land use patterns, whether man-made or natural. • Proposed land uses, or project components visible to users of aesthetic resources which will eliminate or significantly reduce their enjoyment of the aesthetic qualities of that resource. • • Project components that will result in the elimination or significant screening of scenic views known to be important to the area. • Other impacts: IMPACT ON HISTORIC AND ARCHAEOLOGICAL RESOURCES 12. Will Proposed Action impact any site or structure of historic, pre- historic or paleontological importance? 'fIqO OYES Examples that would apply to column 2 / • Proposed Action occurring wholly or partially within or substantially contiguous to any facility or site listed on the State or National Register of historic places. • Any impact to an archaeological site or fossil bed located within the project site. • Proposed Action will occur in an area designated as sensitive for archaeological sites on the NYS Site Inventory. • Other impacts: IMPACT ON OPEN SPACE AND RECREATION 13. Will Proposed Action affect the quantity or quality of existing or future open spaces or recreational opportunities? Examples that would apply to column 2 ';dNO OYES • The permanent foreclosure of a future recreational opportunity. • A major reduction of an open space important to the community. • • Other impacts: 1 Small to Moderate Impact 2 Potential Large Impact 3 Can Impact Be Mitigated By Project Change ❑ ❑ ❑Yes ❑No ❑ ❑ ❑Yes ❑No ❑ ❑ ❑Yes ❑No ❑ ❑ ❑Yes ❑No ❑ ❑ ❑Yes ❑No ❑ ❑ ❑Yes ❑No ❑ ❑ ❑Yes ❑No ❑ ❑ ❑Yes ❑No ❑ ❑ ❑Yes ❑No ❑ ❑ ❑Yes ❑No ❑ ❑ ❑Yes ❑No ❑ ❑ ❑Yes ❑No ❑ ❑ ❑Yes ❑No ❑ ❑ ❑Yes ❑No ❑ ❑ ❑Yes ❑No C, • 0 • IMPACT ON CRITICAL ENVIRONMENTAL AREAS 14. Will Proposed Action impact the exceptional or unique character- istics of a critical environmental area (CEA) established pursuant to subdivision 6 NYCRR 617.14(g)? ?KO OYES List the environmental characteristics that caused the designation of the CEA. Examples that would apply to column 2 • Proposed Action to locate within the CEA? • Proposed Action will result in a reduction in the quantity of the resource? • Proposed Action will result in a reduction in the quality of the resource? • Proposed Action will impact the use, function or enjoyment of the resource? • Other impacts: IMPACT ON TRANSPORTATION 15. Will there be an effect to existing transportation systems? 'Mwo OYES Examples that would apply to column 2 r • Alteration of present patterns of movement of people and/or goods. • Proposed Action will result in major traffic problems. • Other impacts: IMPACT ON ENERGY 16, Will proposed action affect the community's sources of fuel or energy supply? __r.b10 OYES Examples that would apply to column 2 / • Proposed Action will cause a greater than 5% increase in the use of any form of energy in the municipality. • Proposed Action will require the creation or extension of an energy transmission or supply system to serve more than 50 single or two family residences or to serve a major commercial or industrial use. • Other impacts: 10 1 Small to Moderate Impact 2 Potential Large Impact 3 Can Impact Be Mitigated By Project Change ❑ ❑ ❑Yes ONO ❑ ❑ ❑Yes ONO ❑ ❑ ❑Yes ONO ❑ ❑ ❑Yes ❑No ❑ ❑ ❑Yes ❑No ❑ ❑ ❑Yes ONO ❑ ❑ ❑Yes ONO ❑ ❑ ❑Yes ONO ❑ ❑ ❑Yes ONO ❑ ❑ ❑Yes ONO ❑ ❑ ❑Yes ONO 0 NOISE AND ODOR IMPACTS 17. Will there be objectionable odors, noise, or vibration as a result of the Proposed Action?{ OYES Examples that would apply to column 2 r • Blasting within 1,500 feet of a hospital, school or other sensitive facility. • Odors will occur routinely (more than one hour per day). • Proposed Action will produce operating noise exceeding the local ambient noise levels for noise outside of structures. • Proposed Action will remove natural barriers that would act as a noise screen. • Other impacts: IMPACT ON PUBLIC HEALTH 18. Will Proposed Action affect public health and safety? t O OYES Examples that would apply to column 2 /- • Proposed Action may cause a risk of explosion or release of hazardous substances (i.e. oil, pesticides, chemicals, radiation, etc.) in the event of accident or upset conditions, or there may be a chronic low level discharge or emission. • Proposed Action may result in the burial of "hazardous wastes" in any form (i.e. toxic, poisonous, highly reactive, radioactive, irritating, infectious, etc.) • Storage facilities for one million or more gallons of liquified natural gas or other flammable liquids. • Proposed action may result in the excavation or other disturbance . within 2,000 feet of a site used for the disposal of solid or hazardous waste. • Other impacts: IMPACT ON GROWTH AND CHARACTER OF COMMUNITY OR NEIGHBORHOOD 19. Will proposed action affect the character of the existing commu ty? []NOIYES Examples that would apply to column 2 • The permanent population of the city, town or village in which the project is located is likely to grow by more than 5%. • The municipal budget for capital expenditures or operating services will increase by more than 5% per year as a result of this project. • Proposed action will conflict with officially adopted plans or goals. •®roposed action will cause a change in the density of land use. • Proposed Action will replace or eliminate existing facilities, structures or areas of historic importance to the community. • Development will create a demand for additional community services (e.g. schools, police and fire, etc.) • Proposed Action will set an important precedent for future projects. • Proposed Action will create or eliminate employment. • Other impacts: L 1 Small to Moderate Impact 2 Potential Large Impact 3 Can Impact Be Mitigated By Project Change ❑ ❑ ❑Yes []No ❑ ❑ Oyes []No ❑ ❑ ❑Yes ❑No ❑ ❑ Dyes ❑No ❑ ❑ ❑Yes ❑No ❑ ❑ ❑Yes ❑No ❑ ❑ ❑Yes ❑No ❑ ❑ ❑Yes ❑No ❑ ❑ ❑Yes ❑NO ❑ ❑ ❑Yes ❑No ❑ ❑ ❑Yes ❑No ❑ ❑ ❑Yes ❑No ❑ ❑ Oyes [No ❑ ❑Yes ❑No ❑ ❑ ❑Yes ❑No ❑ ❑ Dyes ❑No ❑ ❑ ❑Yes ❑No ❑ ❑ ❑Yes ❑No ❑ ❑ Oyes ❑No 20. Is there, or is there likely to be, public controversy related to potential adverse environmental impaLcts? = ❑YES If any action In Part 2 identified as a potential largo Impact or If you cannot determine the magnitude of hap praosaa to Part 8 11 Part 3—EVALOUATION OF THE IMPORTANCtOF IMPACTS Responsibility of Lead Agency • Part 3 must be prepared if one or more impact(s) is considered to be potentially large, even if the impact(s) may be mitigated. Instructions Discuss the following for each impact identified in Column 2 of Part 2: 1 Briefly describe the impact. 2. Describe (if applicable) how the impact could be mitigated or reduced to a small to moderate impact by project change(s). 3. Based on the information available, decide if it is reasonable to conclude that this impact is important. To answer the question of importance, consider. • The probability of the impact occurring • The duration of the impact • Its irreversibility, including permanently lost resources of value • Whether the impact can or will be controlled • The regional consequence of the impact • Its potential divergence from local needs and goals • Whether known objections to the project relate to this impact (Continue on attachments) 0 • 12