Application_Preliminary Preliminary Stage Revised April 2010
General Information
Tax Farce ID Number. 296.13-1-22
Zoning District: HC-INT (COMMERCIAL INTENSIVE)
Application Stacie (check one;:
Sketch Plan Stage
Preliminary Stage ✓
Final Stage
Indicate the followina:
Number of lots proposed 2
Residential or Commercial COMMERCIAL
Total Lot acreage 3 .58-AC
Proposed 'Ot sizes 2 .58-AC, 1.0-AC
Project location 989 STATE ROUTE 9
Detailed Description of Project [nc ude :u-ren- . proposed use]:
SUBDIVIDE A 3 .58-ACRE PARCEL INTO A 2 .58-AC AND 1.0-AC PARCEL
Applicant Name: Address: 989 STATE ROUTE 9
697 UPPER GLEN STREET LLC QUEENSBURY NY 12804
Home Phone (518) 792-8836 Cell: (518) 376-3291
Work Phone Fax
E-Mail:
Agents Name: Add-es : 169 HAVILAND ROAD
HUTCHINS ENGINEERING QUEENSBURY NY 12804
Home Phone Cell:
Work Phone Fax
(518) 745-0307 (518) 745-0308
E mai' THUTCHINS HUTCHINSENGINEERENG.COM
Owner's Name Address
(SAME AS APPLICANT)
korre Phone Cell
Work Phone Fax
E-mail
Town of Queensbury PFanrIrg Office- 742 Bay Road - Queensbury, NY 12804 - 518-761-8220 1
Preliminary Stage Revised April 2010
Pre-Submission Conference Form I
1. Tax Map ID: (94 6‘ 1
-a a-
2. Zoning Classification: COrnmert('G( arli!7j`
3. Reason for Review: p9-L.-0-k: .SL3e .t(\JL St aiN
4. Ordinance Section: CitackI (Z
5. Pre-Submission Meeting Notes; Outstanding Items To Be Addressed Include:
1. Deed Yes ✓No
2. General Information Yes ---7 No
3 Preliminary Plat Yes No
4. Layout Plans Yes V No
5. Construction Details Yes No
—
6. Landscape Plan . Yes No
7. Clearing Plan Yes No
8. Grading &Erosion Control �. Yes No
9. Environmental Report Yes -7`No
10. Statement of Intent Yes —No
11. Stormwater Plan/SWPPP Yes No
12. Fees Yes +7-No
13. Waivers Yes No
14. Subdivision Sign Posting Yes No
15. Signature Page Yes v No
—
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Staff Representative: C-G ) cZ ✓t C eiVt t
Applicant/Agent �? f ,
7
Date: I/o(t 3
Town of Queensbury Planning Office- 742 Bay Road •Queensbury, NY 12804 • 518-761-8220 6
jie -
Preliminary Stage Revised April 2010
Signature Page
This page includes: 1.) Authorization to Act as Agent Fom-. 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 A:TENT FORM:
Complete the following if the OWNER of the property is not the same as the applicant
Owner:
Designates:
As agent regarding: Variance Site Plan Subdivision
For Tax M No.: 296.13 Section 1 Block 22 Lot
Deed Refe 68 B 56 Page 2/12 10 Date
OWNER SIGNATURE: DATE: cl
APPLICANT'S AGENT FORM:
Complete the following if the APPLICANT is unable to attend the meeting or wishes to be rep-esented by another
party:
Owner: 697 UPPER GLEN STREET LLC
Designates: HUTCHINS ENGINEERING
As agent regarding: Variance Site Plan / Subdivision
For Tax Map No.: 296.13 Section 1 Block 22 Lot
Deed Reference: 3968 Book 56 Page 2/12/10 Date
OWNER SIGNATURE: DATE.
2.) ENGINEERING FEE DISCLOSURE: Applications may be referred to the Town consulting engineer for review of septic design,
stone 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 S 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 hisiher?their agent(s hereby authorize the Zoning Board or Planning Board and Town Staff to enter the
subject properties for the purpose of -eviewing the application submitted.
4.) OTHER PERMIT RESPONSIBILITIES: -Other permits may be required for construction or alteration activity subsequent to
aporoval by the Zoning Board or Flarn rg Board_ tt is the applicants responsibility to obtain any additional permits.
5.1 OFFICIAL MEETING MINUTES DISCLOSURE: It is the practice of the Community Development Department to have a
designated stenographer tape :-eecrd the proceedings of meetings resulting from application, and minutes transcribed from those
tapes constitutes the official record of as proceedings.
6.) AGREEMENT TO PROVIDE DOCUMENTATION REQUIRED: I, the undersigned. have thoroughly read and understand the
instructions`or submission and agree to the submission requirements, 1 acknowledge no construction activities shal be commenced
prior to issuance of a valid permit 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 n 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 certificate of occupancy as necessary. I aiso understand that Owe may tie required to provide an as-twat
survey by a licensed land surveyor of all newly constructed facilities over to issuance of a certificate of occupancy
I 46- ve read and - -nee rove.
Signat . [Ap• -nt] Print Name[Applicant] Date sigrie
G. THOMAS HUTCHINS, P.E.
S. -ature [1W- • ] Print Name [Agent] Date signed
Town of Cueensbury Planning Office- 742 Bay Road • Queensbury. NY 12804 • 518-761-8220 7
61 7.20
Appendix 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. Frequently there are aspects of
a project that are subjective or unmeasurable. 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 in environmental analysis. In addition many who have knowledge
in one particular area may not be aware of the broader concerns 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 objective 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 or whether 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 potentially-large, then Part 3 is used to evaluate whether cr not the impact is
actually important.
THIS AREA FOR LEAD AGENCY USE ONLY
DETERMINATION OF SIGNIFICANCE -- Type 1 and Unlisted Actions
Identify the Portions of EAF completed for this project: El Part 1 [Ti Part 2 [1 Part 3
Upon review of the information recorded on this EA.F (Parts 1 and 2 and 3 if appropriates and any other supporting information and
considering both the magnitude and importance of each impact it is reasonably determined by the lead agency that:
ITA. The project will not result in any large and important impactis) and therefore is one which will not have a
significant impact on the environment therefore a negative declaration will be prepared.
riB. 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 wil 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 wil be prepared.
'A Conditioned Negative Declaration is only valid for Unlisted Actions
Name of Action
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 Signature c_f.Preparer (If different from responsible officer;
webs ite Date
Page ' 0'2 1
PART 1--PROJECT INFORMATION
Prepared by Project Sponsor
NOTICE: This document is designed to assist in determining whether the action proposed may have a significant effect on the
environment Please complete the entire form. Parts A through E. Answers to these questions will be considered as part of the
application for approval and may be subject to further verification and public review. Provide any additional information you believe
will be needed to complete Parts 2 and 3.
It is expected that completion of the full EAF will be dependent on information currency available and will not involve new studies.
research or investigation_ If information requiring such additional work is unavailable.so ndicate and specify each instance.
Name of Action SUBDIVISION
Location of Action (include Street Address. Municipality and County;
989 STATE ROUTE 9, TOWN OF QUEENSBURY, NEW YORK, WARREN COUNTY
Name of ApplicantSponsor 697 UPPER GLEN STREET LLC
Address 989 STATE ROUTE 9
city!PO QUEENSBURY StateNv Zip Code 12804
Business Telephone (518) 792-8885
Name of Owner(if different;
Address
City;PO State Zip Code
Business Telephone
Description of Action:
SUBDIVIDE 3 .58-ACRE COMMERCIAL PARCEL INTO TWO LOTS, CONSISTING OF A 2.58-ACRE AND 1.0-ACRE
LOT. THE 2 .58-ACRE PARCEL WILL RETAIN THE EXISTING BUILDINGS, WHILE THE 1 .0-ACRE PARCEL
WILL BECOME A COMMERCIAL BUILDING LOT.
Page 2 of 21
i
Please Complete Each Question--Indicate N.A. if not applicable
A. SITE DESCRIPTION
Physical setting of overall project, both developed and undeveloped areas.
1. Present Land Use: n Urban Industrial vi I Commercial El Residential (suburban) n Rural (non-farm)
riForest n Agriculture [1 Other
2. Total acreage of project area: 3 -58 acres.
APPROXIMATE ACREAGE PRESENTLY AFTER COMPLETION
Meadow or Brushland (Non-agricultural) 1.25 acres O.95 acres
Forested o .8 0 acres 0 .5 3 acres
Agricultural (Includes orchards cropland. pasture etc.) acres acres
Wetland (Freshwater or tidal as per Articles 24.25 of ECL) acres acres
Water Surface Area acres acres
Un egetated (Rock earth or fill) acres acres
Roads buildings and other paved surfaces 1 .53 acres 2 .10 acres
Other (Indicate type) acres acres
What is predominant soil type(s) on project site? HINCKLEY COBB.. SANDY LOAM
a. Soil drainage: Q Well drained of site I Moderately well drained of site.
nPoorly drained of site
b. If any agricultural land is involved how many acres of soil are classified within soil group 1 through 4 of the NYS Land
Classification System? acres (see 1 NYCRR 370).
4. Are there bedrock outcroppings on project site? n Yes I' i No
a. What is depth to bedrock >4 ' (in feet)
_. Approximate percentage of proposed project site with slopes:
0-10'?,,, n 10- 15% 15% or greater
6. Is project substantiallt contiguous to or contain a building. site or district listed on the State or National Registers of
Historic Places? Yes ✓ No
7. Is project substantially contiguous to a site listed on the Register of National Natural Landmarks? El 17 No
8. What is the depth of the water table? >4 ' in feet)
9. Is site located over a primary. principal. or sole source aquifer? 7Yes 0 No
10. Do hunting fishing or shell fishing opportunities presently exist in the project area Yes pi No
Page 3 of 21
11. Does project site contain any species of plant cc animal life that is identified as threatened or endangered? rlYes 0 No
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?
El Yes fl No
Describe:
13. Is the project site presently used by the community or neighborhood as an open space or recreation area?
fl Yes I✓ No
if yes, explain:
14. Does the present site include scenic views known to be important to the community? Yes 17 No
1 S. Streams within or contiguous to project area:
NONE
a. Name of Stream and name of River to ii:vitlich it is tributary
16. Lakes, ponds. wetland areas within or contiguous to project area:
NONE
b. Size (in acres):
Page 4 of 21
17. Is the site served by existing public utilities? 0 Yes No
a. If YES, does sufficient capacity exist to allow connection? !✓ Yes i No
b. If YES will improvements be necessary to allow connection:? Q Yes nNo
18. Is the site located in an agricultural district certified pursuant to Agriculture and Markets Law Article 25-AA. Section 303 and
304? Eyes r.71 No
19. Is the site located in or substantialfrNo ontiguous to a Critical Environmental Area designated pursuant to Article 8 of the ECL,
and 6 NYCRR 617? EYes
20. Has the site ever been used for the disposal of solid or hazardous wastes? Yes r7 No
B. Project Description
1. Physical dimensions and scale of project (fill in dimensions as appropriate).
a. Total contiguous acreage owned or controlled by project sponsor: 3 .58 acres.
b. Project acreage to be developed• 0 acres initially: 3 .3 acres ultimately.
c. Project acreage to remain undeveloped: 0 .2 9 acres.
d. Length of project, in miles: 0 .0 7 (if appropriate)
e. If the project is an expansion indicate percent of expansion proposed. 100
f. Number of off-street parking spaces existing 77 : proposed 99
g. Maximum vehicular trips generated per hour: (upon completion of project)?
h. If residential: Number and type of housing units:
One Family Two Family Multiple Family Condominium
Initially
Ultimately
i. Dimensions in feet) of largest proposed structure: 35 ' height: 100 ' width: 100' _ length.
j. Linear feet of frontage along a public thoroughfare project will occupy is? 380 ft.
2. How much natural material (i.e. rock, earth etc.) will be removed from the site? 500 tons cubic yards.
3. Will disturbed areas be reclaimed !✓ Yes n No IT N.A
a. If yes for what intended purpose is the site being reclaimed?
LAWN AREAS, STORMWATER MANAGEMENT
b. Will topsoil be stockpiled for reclamation? al Yes in No
c. Will upper subsoil be stockpiled for reclamation? DI Yes IT No
4. How many acres of vegetation (trees. shrubs. ground covers) will be removed from site? 0.6 acres.
Pace 5 of 21
S. Will any mature forest (over 100 years old) or other locally-important vegetation be removed by this project?
nYes pi No
6. If single phase project: Anticipated period of construction: 12 months (including demolition)
7. If multi-phased:
a. Total number of phases anticipated 1 (number)
b. Anticipated date of commencement phase 1: 3 month 2014 year (including demolition)
c. Approximate completion date of final phase: 3 month 2014 year.
d. Is phase 1 functionally dependent on subsequent phases? Yes I ✓ No
8. Will blasting occur during construction? n Yes 171 No
9. Number of jobs generated: during construction 1 r : after project is complete 10
10. Number of jobs eliminated by this project - .
11. Will project require relocation of any projects or facilities? n Yes 7 No
If yes. explain:
12. Is surface liquid waste disposal involved? El Yes Fl No
a. If yes indicate type of waste (sewage industrial etcl and amount
b. Name of water body into which effluent will be discharged
13. Is subsurface liquid waste disposal involved? 1✓ Yes n No Type SEWAGE EFFLUENT
14. Will surface area of an existing water body increase or decrease by proposal? Yes 1 ✓ No
If yes. explain:
1S. Is project or any portion of project located in a 100 year flood plain? r Yes INo
16. Will the project generate solid waste? 121 Yes IT No
a. If yes what is the amount per month? 2+ tons r
b. If yes will an existing solid waste facility be used? 1 ✓ Yes [ I No
c. If yes give name WASHINGTON CTY TRASH PLANT : location HUDSON FALLS, NY
d. Will any wastes not go into a sewage disposal system or into a sanitary landfill? I( 1 Yes ✓ No
Page 6 of 21
e. If yes, explain:
1 7. Will the project involve the disposal of solid waste? 151 Yes nNo
a If yes what is the anticipated rate of disposal? 2+ tonsrmonth.
b. If yes what is the anticipated site life? 50 years.
18. Will project use herbicides or pesticides? nYes ✓ No
19. Will project routinely produce odors (more than one hour per day)? U Yes !' No
20. Will project produce operating noise exceeding the local ambient noise levels? ► ` I Yes n No
21 Will project result in an increase in energy use? 1✓ Yes n No
If yes indicate type(s)
1 "
FUELS, ELECTRICITY
22. If water supply is from wells indicate pumping capacity gallons minute.
23. Total anticipated water usage per day 5 0 0 gallons/day.
24. Does project involve Local. State or Federal funding' n Yes is No
If yes explain:
Page 7 of 21
25. Approvals Required:
Type Submittal Date
City, Town. Village Board ❑Yes 131 No
TOWN OF QUEENSBURY SUBDIV-
City. Town. Village Planning Board El Yes n No
PLANNING BOARD FALL 2013
City. Town Zoning Board n Yes Ti No
City County Health Department ®Yes 0 No
=,t-r� _„__ er 1,--_ r Yes I✓ No
Other Regional Agencies r Yes 1” No
State Agencies p I Yes 17 No
Federal Agencies ❑Yes Ti No
C. Zoning and Planning Information
1. Does proposed action involve a planning or zoning decision? 0 Yes 1] No
If Yes, indicate decision required:
❑ Zoning amendment J Zoning variance Q New;fevision of master plan Ti Subdivision
❑ Site plan D Special use permit ❑Resource management plan ❑Other
Page 8 of 21
2. What is the zoning classification(s) of the site?
COMMERCIAL INTENSIVE
3. What is the maximum potential development of the site if developed as permitted by the present zoning?
70% LOT COVERAGE
4. What is the proposed zoning of the site?
COMMERCIAL INTENSIVE
5. What is the maximum potential development of the site if developed as permitted by the proposed zoning?
70°% LOT COVERAGE
G. Is the proposed action consistent with the recommended uses in adopted local land use plans? D Yes n No
7. What are the predominant land use(s) and zoning classifications within a i4 mile radius of proposed action?
COMMERCIAL INTENSIVE, AMUSEMENT ATTRACTIONS
8. Is the proposed action compatible with adjoining/surrounding land uses with a V4 mile? Q Yes fl No
9. If the proposed action is the subdivision of land, how many lots are proposed? 2
a. What is the minimum lot size proposed? 1.0-AC
Page 9of21
10. Will proposed action require any authorization(s) for the formation of sewer or water districts' T- Yes fl No
11. Will the proposed action create a demand for any community provided services (recreation, education, police fire protection?
!J Yes fl No
a. If yes is existing capacity sufficient to handle projected demand? fl Yes [ No
12. WH the proposed action result in the generation of traffic significantly above present levels' 171 Yes 151 No
a. If yes is the existing road net.,•,.,rk. adequate to handle the additional traffic. Yes fl No
I
D. Informational Details
Attach any additional information as may be needed to clarify your project. If there are or may be any adverse impacts
associated with your proposal please discuss such impacts and the measures which you propose to mitigate or avoid them.
E. Verification
I certify that the information provided above is true to the best of my knowledge.
Applicant/Sponsor Name 697 UPPER GLEN STREET LLC Date 9/1:5/i 3
Signature 01\
f _--
Title t\\C=i`Vt,%(-- &--
If the action is in the Coastal Area, and you are a state agency, complete the Coastal Assessment Form before procee ling with this
assessment.
Page 10Jof2
PART 2 - PROJECT IMPACTS AND THEIR MAGNITUDE
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 cumulative 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.
If answering Yes to a question then check the appropnate boxi;column 1 or 2:Ito 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 se of the impact then consider the impact as potentially large and proceed to PART 3.
f. If a potentially large impact checked in column 2 can be mitigated by changers;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.
2 3
Small to Potential Can Impact Be
Moderate Large Mitigated by
Impact Impact Project Change
Impact on Land
1. 'Nil(the Proposed Action result in a physical change to the project
site?
NO l l YES n
Examples that would apply to column 2
Any construction on slopes of 15% or greater. ('5 foot r E Yes ENo
rise per 100 foot of length;. or where the general slopes
in the project area exceed 10 .0.
Construction on land where the depth to the water table n E f Yes nNo
is less than 3 feet.
Construction of paved parking area for 1.000 or more I I [7 [7 Yes nNo
vehicles.
Construction on land where bedrock is exposed or n Q 17 Yes [7No
generally within 3 feet of existing ground surface.
Construction that will continue for more than 1 year or [ [7 Yes nNo
involve more than one phase or stage.
Excavation for mining purposes that would remove 1 1 [J fl Yes nNo
more than 1.000 tons of natural material (i.e.. rock or
soil; per year.
Page 1 1 of 2
1 2 3
Small to Potential Can Impact Be
Moderate Large Mitigated by
Impact Impact Project Change
Construction or expansion of a santary landfill. ri ❑ rives nNo
Construction in a designated floodway ❑ Fl ❑Yes ❑No
Other impacts: r r Yes FINo
2. Will there be an effect to any unique or unusual land forms found on
the site? (i.e.. cliffs, dunes.geological formations.etc.;
fNO ` YES
Specific land forms: El El ❑Yes ❑No
Impact on Water
3_ Will Proposed Action affect any water body designated as protected?
(Linder Artides '5. 24. 25 of the Environmental Conservation Law.
ECL I
flNO E YES
Examples that would apply to column 2
Developable area of site contains a protected water body. r ❑ nYes ❑No
Dredging more than 100 cubic yards of material from channel of ❑li U nYes nNo
a protected stream.
Extension of utility distribution facilities through a protected water n n n Yes nNo
body.
Construction in a designated freshwater or tidal wetland. 1 ❑ []Yes 11 No
Other impacts: L L ❑Yes nNo
4. Will Proposed Action affect any non-protected existing or new body of
water?
I I NO 7 YES
l
Examples that would apply to column 2 _
A 10% increase or decrease in the surface area of any body of [ ❑ r Yes n No
water or more than a 10 acre increase or decrease.
Construction of a body of water that exceeds 10 acres of surface Ti n riYss n No
area.
Other impacts: Ti Ti 0 Yes ❑No
Page 12 o`21
1 2 3
Small to Potential Can Impact Be
Moderate Large Mitigated by
Impact Impact Project Change
5. Will Proposed Action affect surface or groundwater quality or
quantity?
NO t lYES
Examples that would apply to column 2
Proposed Action will require a discharge permit. ❑ 17 F-7
*l,;
No
Proposed Action requires use of a source of water that does not FT r--1 ?
es ;j N:.
have approval to serve proposed (project)action.
Proposed Action requires water supply from wells with greater l i 17 n l Yes l No
than 45 gallons per minute pumping capacity.
Construction or operation causing any contamination of a water IT Y es F-1 No
supply system.
Proposed Action will adversely affect groundwater. C ❑ nYes ! I No
Liquid effluent will be conveyed off the site to facilities which 7 ❑ nYes n No
presently do not exist or have inadequate capacity.
Proposed Action would use water in excess of 20.000 gallons R I IT IT Yes n No
per day.
Proposed Action will likely cause siltation or other discharge into l j ❑ nYes % I No
an existrig 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 ❑ I I [1Yes 7 No
chemical products greater than 1.100 gallons.
Proposed Action will allow residential uses in areas without r nYes J No
water and/or sewer services.
Proposed Action locates commercial and.or industrial uses r r J Yes n No
which may require new or expansion of existing waste treatment
and/or storage facilities_
Other impacts: I , ❑ r lYes No
Page 13 of
1 2 3
Small to Potential Can Impact Be
Moderate Large Mitigated by
Impact Impact Project Change
6. Will Proposed Action alter drainage flow or patterns. or surface water
runoff?
rlNO EYES
Examples that would apply to column 2 _
Proposed Action would change flood water flows ❑ I J r]Yes ! No
Proposed Action may cause substantial erosion. M [ lYes M No
Proposed Action is incompatible with existing drainage patterns. r Yes riNo
Proposed Action will albw development in a designated T r Yes r No
floodway.
Other impacts: ❑ 11Yes riNo
IMPACT ON AIR
7. Will Proposed Action affect air quality?
[iNO ri"ES
Examples that would apply to column 2
Proposed Action will induce 1.000 or more vehicle trips in any T n ryes [iNo
given hour. tt
Proposed Action will result in the incineration of more than 1 tan ❑ I Eves [iNo
of refuse per hour.
Emission rate of total contaminants will exceed 5 lbs. per hour ❑ 11 Yes No
or a heat source producing more than 10 million BTU's per
hour.
Proposed Action will allow an increase in the amount of land ❑ ❑ Eyes ❑No
committed to industrial use.
Proposed Action will allow an increase in the density of ❑ IT ❑Yes []No
industrial devebpment within exeting industrial areas.
Other impacts: ❑ ❑ Eyes ❑No
IMPACT ON PLANTS AND ANIMALS
8. Will Proposed Action affect any threatened or endangered species?
❑NO I YES
Examples that would apply to column 2
Reduction of one or more species listed on the New York or I [lYes riNo
Federal list. using the site. over or near
the site. or found on the site.
Page 14 of 21
1 2 3
Small to Potential Can Impact Be
Moderate Large Mitigated by
Impact Impact Project Change
Removal of any portion of a critical or significant widlife habitat. IIff U []Yes [iNo
L
Application of pesticide or herbicide more than twice a year. __.� ❑ FI Yes L INo
other than for agnccitural purposes.
Other impacts: 0 ❑ I iYes FIND
9. Will Proposed Action substantially affect non-threatened or non-
endange red species?
I NO YES
Examples that would apply to column 2
Proposed Action would substantially interfere with any resident FI yes No
or migratory fish. shellfish or wildlife species.
Proposed Action requires the removal of more than 10 acres of f T1 [T Yes FIND
mature forest(over 100 years of age;or other locally important
vegetation. ��-----��
IOther impacts:
I Yes FIND
IMPACT ON AGRICULTURAL LAND RESOURCES
10. Will Proposed Action affect agncultural land resources?
FINO OYES
Examples that would apply to column 2 I�
The Proposed Action would sever. cross or limit access to L I n FI Yes 1_J No
agncultural land (includes cropland. hayfields,pasture. vineyard.
orchard.etc.)
Construction activity would excavate or compact the soil profile of C Yes ❑No
agricultural land.
The Proposed Action would irreversibly convert more than 10 FI Li Yes !J No
acres of agricultural land or. if located in an Agricultural District.
more than 2.5 acres of agncultural land.
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Small to Potential Can Impact Be
Moderate Large Mitigated by
Impact Impact Project Change
The Proposed Action would disrupt or prevent installation of r7 Yes f' I No
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',. (—� Ti impacts: f J ❑ IT Yes !; j No
IMPACT ON AESTHETIC RESOURCES
'1. Will Proposed Action affect aesthetic resources?(If necessary. use
the Visual EAF Addendum in Section 611.20.Appendix B.)
NO YES
Examples that would apply to column 2
Proposed land uses. or project components obviously different ri f Yes No
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 ❑ ❑ eves Ti No
aesthetic resources which will eliminate or significantly reduce
their enjoyment of the aesthetic qualities of that resource.
Project components that wil result in the elimination or 'l ❑ ❑Yes - No
significant screening of scenic views known to be important to
the area.
Other impacts: ❑ I ; ❑Yes fl No
IMPACT ON HISTORIC AND ARCHAEOLOGICAL RESOURCES
'2. Will Proposed Action impact any site or structure of historic.
prehistoric or paleontological importance?
FT NO ❑YES
Examples that would apply to column 2 -�---��
Proposed Action occurring wholly or partially within or ❑ Yes ❑ No
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 ❑ ❑ ❑ Yes ❑No
the project site.
Proposed Action will occur in an area designated as sensitive ; I Ti ❑ Yes Ti No
for archaeological sites on the NYS Site Inventory.
Page 17 of 21
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Small to Potential Can Impact Be
Moderate Large Mitigated by
Impact Impact Project Change
Other impacts: l' J [I Yes I I No
IMPACT ON OPEN SPACE AND RECREATION
3. 4'vi1l proposed Action affect the quantity or quality of existing or future
open spaces or recreational opportunities?
t l NO (_ YES
Examples that would apply to column 2 _
The permanent foreclosure of a future recreational opportunity_ f r r-Yes I No
A major reduction of an open space important to the community. fYes I No
Other impacts: fl f 17 Yes riNo
IMPACT ON CRITICAL E NV RONM EN TAL AREAS
14. Will Proposed Action impact the exceptional or unique
characteristics of a critical environmental area (CEA established
pursuant to subdivision 6NYCRR 61 T.14f g;?
fl NO [i YES
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? [71 Yes I—INo
Proposed Action will result in a reduction in the quantity of the IT Yes I1No
resource?
Proposed Action will result in a reduction in the quality of the El Yes C No
resource?
Proposed Action will impact the use. function or enjoyment of the C Yes I No
resource? I Other impacts: i Yes I No
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Small to Potential Can Impact Be
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IMPACT ON TRANSPORTATION
15. Will there be an effect to existing transportation systems?
7 N EYES
Examples that would apply to column 2 r '
Alteration of present patterns of movement of people and/or f l EYes LI NO
goods.
Proposed Action will result in mapr traffic problems. [ I 1 nYes ❑No
Other impacts: ❑ — es ❑No
IMPACT ON ENERGY
-b. Will Proposed Action affect the community's sources of fuel or
energy supply?
n NO YES
Examples that would apply to column 2
Proposed Action will cause a greater than 5°./. increase in the LI I j Ye; I No
use of any form of energy in the municipality.
Proposed Action will require the creation or extension of an ❑ Ti ! I-'es n r`.c
energy transmission or supply system to serve more than 50
single or two fan dv residences or to serve a major commercial
or industrial use. (�I
Other impacts: ❑ I I 'es C No
NOISE AND ODOR IMPACT
7. Will there be objectionable odors. noise. or vibration as a result of
the Proposed Action?
nNO EYES
Examples that would apply to column 2
Blasting within 1.50D feet of a hospital. school or other sensitive [1 I I r I'%es 17,
facility.
Odors will occur routinely(more than one hour per day;. ❑ ❑ ❑ *es C No
Proposed Action will produce operating noise exceeding the ❑ 'es No
local ambient noise levels for noise outside of structures.
Proposed Action will remove natural barriers that would act as a I� �ves 1 No
noise screen.
Other impacts: ❑ [1 ❑''es C No
1 2 3
Small to Potential Can Impact Be
Moderate Large Mitigated by
Impact Impact Project Change
IMPACT ON PUBLIC HEALTH
B. Will Proposed Action affect pubic health and safety?
NO '_...YES
Proposed Action may cause a risk of explosion or release of ❑ [1 1Yes I No
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 ❑ ❑ nYes ❑No
in any form (i.e. toxic. poisonous. highly reactive.radioactive.
irritating. infectious.etc.:
Storage facilities for one million or more gallons of iquefied El ❑ Elves ❑No
natural gas or other flammable liquids.
Proposed Action may result in the excavation or other ❑ El Elves ❑No
disturbance within 2.000 feet of a site used for the disposal of
solid or hazardous waste.
Other impacts: 11 f ! I1
'�es I IN
IMPACT ON GROWTH AND CHARACTER
OF COMMUNITY OR NEIGHBORHOOD
19. Will Proposed Action affect the character of the existing community?
nNO 7YES
Examples that would apply to column 2
The permanent population of the city. town or village in which the I I ❑ Yes No
project is located is likehv to grow by more than 5'•0.
The municipal budget for capital expenditures or operating r ❑ Ryes ❑No
services will increase by more than 5% per year as a result of
this project.
Proposed Action will conflict with officialy adopted plans or ❑ [iYes ❑No
goals.
Proposed Action will cause a change in the density of land use. ❑ ❑ Eyes
Proposed Action will replace or eliminate existing facilities. ❑ ❑ Ekes [ t•,,
structures or areas of historic importance to the community.
Development will create a demand for additional community El ❑ lives No
services(e.g. schools. police and fire.etc.,
Page 19 of 21
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Small to Potential Can Impact Be
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Impact Impact Project Change
Proposed Action will set an important precedent for future I—� E [ Yes C No
projects.
Proposed Action will create or ekminate employment. ❑ nYes n No
Other impacts: nYes ❑No
20. Is there. or is there likely to be. public controversy related to potential
adverse environment impacts?
n No f YES
If Any Action in Part 2 Is Identified as a Potential Large Impact or If you Cannot Determine the Magnitude of
Impact Proceed to Part 3
Page 20 of 2 l
Part 3 - EVALUATION OF THE IMPORTANCE OF IMPACTS
Responsibility of Lead Agency
Part 3 must be prepared if one or more impacts; is considered to be potentially large. even if the ripact(s; may
be mitigated.
Instructions If you need more space. attach additional sheets)
Discuss the following for each impact identified in Column 2 of Part 2:
' Bnefly describe the impact.
2. Descnbe if applicable; how the impact could be mitigated or reduced to a small to moderate impact by
project changeiis;.
3 Based on the information available. decide if it is reasonable to cvnciude 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
! 'fihether known objections to the project relate to this impact.
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