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Application Richard E. Jones Associates Architects - Environmental Planners 339 Aviation Road Queensbury,NY 12804 Phone: (518) 793-1015 Fax: (518) 793-2223 E mail:richardjones @rejaarchitects.com Transmittal To: Town of Queensbury Planning Office RFCAVED 742 Bay Road OCT 1 5 2013 Queensbury, NY 12804 Date: 10/15/13 Job #: 1316 Re: West Mountain Health Center& Pharmacy Site Plan Review- Additional Parking on adjacent lot Copies Date No. Description 15 - Original and 14 copies of Site Plan Review Application, Pre- Submission Conference Form 15 - - Project Narrative, Planning Standards, Waiver Request,Tset pit info 1 - - Property Deed 15 - - Drawing SP-1 1 10/15/13 15250 Check in the amount of$250 for application fee Sincerely, Richard E. Jones, AIA Cc: Owner REJA file P:\Ol-Prciects\2013\1316\Vansmi tal 131015 SPR subrrr�on.doc C7 14, JAL Site Plan Review Revised June 2009 General Information Tax Parcel ID Number: 't-'`t ° 13 -I- • . l= 2 :OCT 15 201i Zoning District: LI Detailed Description of Project [include current& proposed usel: LW ri. t.1- C,A) Location of project: Southwest corner of Carey Road (eastern most)and Corinth Road. Applicant Name: Hudson Headwaters Health Address: 9 Carey Road Network Queensbury, NY 12804 Home Phone - Cell: 518-232-9663 Work Phone 518-761-0300 Fax 518-745-1378 E-Mail: gpurdue @hhhn.org I Agent's Name: Richard E. Jones Associates Address: 339 Aviation Road Queensbury, NY 12804 Home Phone Cell: 518-791-1960 Work Phone 518-793-1015 x 311 Fax 518-793-2223 E-mail richardjones @rejaarchitects.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 Site Plan Review Revised June 2009 Site Development Data Area /Type 1 Existing sq. ft. I Proposed I Total sq. ft. Addition sq. ft. ' A. Building footprint 49 t9 B. Detached Garage v LP C. Accessory Structure(s) C- 0 D. Paved, gravel or other hard surfaced area U j] 1-12L 1 1 1 1 ZZ E. Porches / Decks C; 0 d F. Other e% D 0 G. Total Non-Permeable [Add A-F] ` 1/ 1Z-L 11117-2- H. Parcel Area [43,560 sq. ft. / acre] Grh h i .77 1.S 159-5 1,2 6 i Sq 5 1. Percentage of Impermeable Area of Site [1=G/H] 6 `' Setback Requirements Area Required Existing Proposed Front [1] I 50' HM H/4 Front [2] Shoreline NA )4/A. /A Side Yard [1] 30' % f4/A Side Yard [2] Rear Yard [1] 30' WA (`1/A Rear Yard [2] Travel Corridor r — — Height [max] 50' Al/A t-01(t� Permeability 30% )°°7° 9 Z i570 No. of parking spaces , � © 17 it Town of Queensbury Planning Office- 742 Bay Road• Queensbury, NY 12804• 518-761-8220 3 Site Plan Review Revised June 2009 Additional Project Information 1. Will the proposal require a Septic Variance from the Town Board of Health? No 2. If the parcel has previous approvals, list application number(s): Mei 3. Does this project require coverage under the NYS DEC Stormwater Pollution Prevention Program? No 4. Estimated project duration: Start Date i V30M End Date '001" 5. Estimated total cost of project: "1-0)49 - 6. Total area of land disturbance for project: 1`7 I C11't lr Floor Area Ratio Worksheet N/A 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 I Floor Area Ratio [FAR] Waterfront Residential WR 0.22 Commercial Moderate CM 0.3 Commercial Intensive CI 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 sq. ft. Existing Floor Area sq. ft. [see above definition] Proposed Additional Floor Area sq. ft. Proposed Total Floor Area sq. ft. Total Allowable Floor Area (Area x ) [see above table] Town of Queensbury Planning Office. 742 Bay Road • Queensbury, NY 12804 • 518-761-8220 4 Site Plan Review Revised June 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 A. The proposed project furthers or is consistent with the policies of the Town's Comprehensive Plan. 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. 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. D. The site plan must conform to Chapter 136 Sewage and Sewage Disposal, Chapter 147 Stormwater Management Local Law, and other applicable local laws. 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. 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. 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. 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- 080 of this Article. 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. 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. 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. 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. M. Fire lanes, emergency zones and fire hydrants will be adequate and meet the needs and requirements of emergency service providers. 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. O. The site plan conforms to the design standards. landscaping standards and performance standards of this chapter. Town of Queensbury Planning Office- 742 Bay Road • Queensbury, NY 12804• 518-761-8220 5 Site Plan Review Revised June 2009 § 179-9-050 Application 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 REQUIREMENTS on Sheet A A vicinity map drawn at the scale that shows the relationship of the proposal to existing community facilities which affect 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 'pr— 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 may deem appropriate, on standard 24"x 36"sheets, with continuation on SW x 11"sheets as necessary for written information. /-2(2„...1 I The information listed below shall be shown on the site plan and continuation sheets. C Name of the project, boundaries,date.north arrow,and scale of the plan. D Name and address of the owner of record.developer,and seal of the engineer, architect,or landscape architect. If the applicant is not the record owner, a letter of authorization shall be required from the owner 6i7 -1 E The location and use of all existing and proposed structures within the property, including all dimensions of height and floor area. all exterior entrances,and all anticipated future additions and alterations. 4! F The location of all present and proposed public and private ways. off-street parking areas, driveways, outdoor storage areas, sidewalks, ramps, curbs, paths. landscaping, walls, and fences. Location, type. and screening details for all waste disposal 12 i containers shall also be shown. G The location, height, intensity, and bulb type (sodium, incandescent. etc.) of all external lighting fixtures. The direction of C j_1 4 illumination and methods to eliminate glare onto adjoining properties must also be shown in compliance with§179-6-020. 6/4� � GALL H The location,height,size,materials,and design of all proposed signs. t 1 /A I The location of all present and proposed utility systems including: !�•/ 1. Sewage or septic system; ii-v1L 2. Water supply system; d� i 3. Telephone,cable,and electrical systems; and JA I 4. Storm drainage system including existing and proposed drain lines. culverts, catch basins, headwalls, ? endwalls, hydrants,manholes,and drainage swales. `�i -i j Plans to prevent the pollution of surface or groundwater, erosion of soil both during and after construction, excessive runoff. and flooding of other properties. as applicable. A Storrnwater 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 4 r--I 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 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 4- j2.l proposed site and within 50 feet of the proposed site where soil removal or filling is required,showing the approximate volume tt in cubic yards. L A landscape plan showing all existing natural land features that may influence the design of the proposed use such as 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 and watercourses, aquifers.floodplains,and drainage retention areas. ('IA(,t}i-0 Town of Queensbury Planning Office- 742 Bay Road - Queensbury, NY 12804• 518-761-8220 6 • Site Plan Review Revised June 2009 M Land Use District boundaries within 500 feet of the site's perimeter shall be drawn and identified on the site plan, as well as any Overlay Districts that apply to the property. ! CJ N Traffic flow patterns within the site, entrances and exits, and loading and unloading areas,as well as curb cuts on the 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 C"�i� traffic levels; P 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 f' proposed weekly and annual peak hour traffic levels and road capacity levels shall also be given. ,/ O For new construction or alterations to any structure, a table containing the following information shall be included: 1. Estimated area of structure to be used for particular purposes such as retail operation,office,storage,etc.: 2. Estimated maximum number of employees: r"1/4 3. Maximum seating capacity,where applicable;and 4. Number of parking spaces existing and required for the intended use P 1. Floor Plans. i 2. Elevations at a scale of one-quarter inch equals one foot(1/4"= 1 foot)for all exterior facades of the proposed structure(s) I I /A and/or alterations to or expansions of existing facades, showing design features and indicating the type and color of materials 1 i to be used. Q Soil logs, water supply well and percolation test results. and storm runoff calculations, as needed to determine and mitigate project impacts, kAJA ik)k 1 R Plans for disposal of construction and demolition waste,either on-site or at an approved disposal facility. j i /A I �r S Plans for snow removal. including location(s)of on-site snow storage. T An Environmental Assessment Form ("EAF"), as required by the SEQRA regulations, with Part 1 completed by the 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. A jAG/-I til U If an application is for a parcel or parcels on which more than one use is proposed, the applicant may submit a single 1 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 l i /A contiguous parcels shall be considered together. + ✓ A brief narrative statement on how the project proposed for review furthers or is consistent with the vision. goals and policies t in the Town's Comprehensive Plan. A +-fili)-1+11 Town of Queensbury Planning Office. 742 Bay Road • Queensbury, NY 12804 - 518-761-8220 7 Site Plan Review Revised June 2009 Pre-Submission Conference Form 1179-4-0401 1. Tax Map ID jalq I /;°` L- l , Z- 2. Zoning Classification C'(1l 3. Reason for Review: A120,7014 O f eA✓L1ll r4Gl T4 'JX'Ai-.1 rA kt- p(, 4. Zoning Section#: 17C1 -5`1° 5. Pre-Submission Meeting Notes; Outstanding Itemo Be Addressed Include: Deed Yes o General Information complete V Yes No Site Development Data Complete V/Yes No Setback Requirements Complete ✓ Yes Na Additional Project Information Complete ✓ Yes No—FAR Worksheet complete 17,Yes No Standards Yes No Checklist items addressed Yes Flo Environmental Form completed Yes ✓Flo Signature Page completed ;/Yes r o -i P 'i'ct.-4-P o % ` o(1 4rvc. s 4 ca z. ,v c...�. �_ `_ 4 I ��-\ctv-u. vr..,c 5 (9(1 c et 0,4162 ei(f psr I 1lat,1 1 IBC i4lC 1 � f, �E) P t,t Ad a Qf(�Cc4/0-A (11C&4 ii4S.. d,ad (�ra(.t�( S. U Pon)` o pCe e S l.F(( - ne.../ �O)M s L r a c- (WY5 c `k 1 r F-6 t(etc(S C S 0, 1 1..s << <C c o ,A pg,A(Ccn3 f cz%J�(Q�_ iA r - c& c c: .'\ 1,.-, ` f~p�`�C �1 L'1 t L.Q)CSi - /1[7 ct c p�G5 C DG c lLc' i`r CC Oc i(ci( Pk'1 a Staff Representative: 0Q( �1v�t"& Applicant/Agent: GT/�. `� Date: 1.O l l t \CS Town of Queensbury Planning Office- 742 Bay Road • Queensbury, NY 12804. 518-761-8220 8 Site Plan Review Revised June 2009 Signature Page This page includes the -I.) 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: Designates: As agent regarding: Variance Site Plan Subdivision or Tax Map No.: Section Block Lot Deed Reference: Book Page Date OWNER SIGNATURE: DATE: APPLICANT'S AGENT FORM: l Complete the followirg if the APPLICANT is unable to attend the meeting or wishes to be represented by another party: Owner: Hudson Headwaters Health Network Designates: Richard E. Jones, AIA As agent regarding: Variance X Sate Plan Subdivision For Tax Map No.: 309.13 Section 2 Block 31 Lot Deed Reference: 4092 Book 106 Page 9/23/10 Date OWNER SIGNATURE: DATE_ 10/0912013 2.) ENGINEERING FEE DISCLOSURE: Applications may be referred to the Town consulting engineer for review ci sept,c 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. L AUTHORIZATION FOR SITE VISITS: By signing this page and submitting the application materials attached heroin. 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 submtted. 4.). 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. 5j_ 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. 61 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 permit. I certify that the application. plans and supporting materials are a twee and complete statement description of the existing conditions and the work proposed, and that all work will be perlurmee in accordance with the approved plans and in conformance with local zoning regulations. I acknowledge that prior to occufyrog the facilities proposed. I or my agents, will obtain a certificate of occupancy as necessary. I also understand that i:we rr;av to required to provide an as-built survey by a licensed land surveyor of all newly constructed facilities prior to issnanee 01 a certificate of occupancy ! have read and agree to •- above. f/ George Purdue 10/09/2013 ._ignat re Appli - t Print Name [Applicant} Date signed �� �,/ - ,y- Richard E. Jones, NA 10/09/2013 _- Signature [Agent, Print Name [Agent] Date signed Town of Queensbury Planning Office- 742 Bay Road Queensbury, NY 12804 518-761-8220 i t 617.20 Appendix B Short Environmental Assessment Form Instructions for Completing Part 1 -Project Information. The applicant or project sponsor is responsible for the completion of Part 1. Responses become part of the application for approval or funding,are subject to public review,and may be subject to further verification. Complete Part 1 based on information currently available. If additional research or investigation would be needed to fully respond to any item,please answer as thoroughly as possible based on current information. Complete all items in Part 1. You may also provide any additional information which you believe will be needed by or useful to the lead agency;attach additional pages as necessary to supplement any item. Part 1 -Project and Sponsor Information NOtI/Aa►-i a-- _ dtACdid /4,11 1?/' - FAkI41 1-14 Lel Name of Action or Project: 'i 0440-16 Li(f Project Location(descri ,and attach a location map): ieil 6411' -( f22 , q Or' ti eik)zii 1-H-( Brief Description of Proposed Action: AWIT/Ofri at -;'it- pApti411-1A 6rAf_fA Name,off Applicant or Sponsor: Telephone:'/i b,-79,� , )01j je 5ii G�R�� J®tom' 7 , A i- E-Mail: Cvrro(or erotrai41.66-b• Cotm Address: J 4171 .4010')19 p6 City/PO: State: Zip Code: 1.Does the proposed action only involve the legislative adoption of a plan,local law,ordinance, NO YES administrative rule,or regulation? If Yes,attach a narrative description of the intent of the proposed action and the environmental resources that �J may be affected in the municipality and proceed to Part 2. If no,continue to question 2. /1 2. Does the proposed action require a permit,approval or funding from any other governmental Agency? NO YES If Yes,list agency(s)name and permit or approval: 3.a.Total acreage of the site of the proposed action? 's7.5 1 acres b.Total acreage to be physically disturbed? • 2.'5 acres c.Total acreage(project site and any contiguous properties)owned or controlled by the applicant or project sponsor? 'O•33 acres 4. Check all land uses that occur on,adjoining and near the proposed action. ❑Urban ❑Rural(non-agriculture) Industrial .'Commercial XResidential(suburban) ❑Forest ❑Agriculture ❑ Aquatic ❑Other(specify): ❑Parkland Page 1 of 4 4 4, 5. Is the proposed action, NO YES N/A a.A permitted use under the zoning regulations? X b.Consistent with the adopted comprehensive plan? X' 6. Is the proposed action consistent with the predominant character of the existing built or natural NO YES landscape? x 7. Is the site of the proposed action located in,or does it adjoin,a state listed Critical Environmental Area? NO YES If Yes,identify: X 8. a.Will the proposed action result in a substantial increase in traffic above present levels? NO YES X b.Are public transportation service(s)available at or near the site of the proposed action? �/ c.Are any pedestrian accommodations or bicycle routes available on or near site of the proposed action? /` 9.Does the proposed action meet or exceed the state energy code requirements? NO YES If the proposed action will exceed requirements,describe design features and technologies: X 10. Will the proposed action connect to an existing public/private water supply? NO YES If Yes,does the existing system have capacity to provide service? ❑NO❑YES If No,describe method for providing potable water: ?[ 11.Will the proposed action connect to existing wastewater utilities? NO YES_ If Yes,does the existing system have capacity to provide service? El NO❑YES If No,describe method for providing wastewater treatment: 12. a.Does the site contain a structure that is listed on either the State or National Register of Historic NO YES Places? x b.Is the proposed action located in an archeological sensitive area? X 13.a.Does any portion of the site of the proposed action,or lands adjoining the proposed action,contain NO YES wetlands or other waterbodies regulated by a federal,state or local agency? r b.Would the proposed action physically alter,or encroach into,any existing wetland or waterbody? If Yes,identify the wetland or waterbody and extent of alterations in square feet or acres: X 14. Identify the typical habitat types that occur on,or are likely to be found on the project site. Check all that apply: ❑ Shoreline ❑Forest ❑Agricultural/grasslands Early mid-successional ❑ Wetland ❑Urban El Suburban 15.Does the site of the proposed action contain any species of animal,or associated habitats,listed NO YES by the State or Federal government as threatened or endangered? j 16.Is the project site located in the 100 year flood plain? NO YES X 17.Will the proposed action create storm water discharge,either from point or non-point sources? NO YES If Yes, a.Will storm water discharges flow to adjacent properties? ANO❑YES X b.Will storm water discharges be directed to established conveyance systems(runoff and storm drains)? If Yes,briefly describe: NO❑YES Page 2 of 4 . 18.Does the proposed action include construction or other activities that result in the impoundment of NO YES water or other liquids(e.g.retention pond,waste lagoon,dam)? If Yes,explain purpose and size: 19.Has the site of the proposed action or an adjoining property been the location of an active or closed NO YES solid waste management facility? If Yes,describe: 20.Has the site of the proposed action or an adjoining property been the subject of remediation(ongoing or NO YES completed)for hazardous waste? If Yes,describe: I AFFIRM THAT THE INFORMATION PROVIDED ABOVE IS TRUE AND ACCURATE TO THE BEST OF MY KNOWLEDGE ��)) T Applicant/sponsor,n / IC4)�b i-' �Enif i at�/i Jute: 1 0/15/1-4 Signature: L�GC� r�i I Part 2-Impact Assessment. The Lead Agency is responsible for the completion of Part 2. Answer all of the following questions in Part 2 using the information contained in Part 1 and other materials submitted by the project sponsor or otherwise available to the reviewer. When answering the questions the reviewer should be guided by the concept"Have my responses been reasonable considering the scale and context of the proposed action?" No,or Moderate small to large impact impact may may occur occur 1. Will the proposed action create a material conflict with an adopted land use plan or zoning regulations? 2. Will the proposed action result in a change in the use or intensity of use of land? 3. Will the proposed action impair the character or quality of the existing community? 4. Will the proposed action have an impact on the environmental characteristics that caused the establishment of a Critical Environmental Area(CEA)? 5. Will the proposed action result in an adverse change in the existing level of traffic or affect existing infrastructure for mass transit,biking or walkway? 6. Will the proposed action cause an increase in the use of energy and it fails to incorporate reasonably available energy conservation or renewable energy opportunities? 7. Will the proposed action impact existing: a.public/private water supplies? b.public/private wastewater treatment utilities? 8. Will the proposed action impair the character or quality of important historic,archaeological, architectural or aesthetic resources? 9. Will the proposed action result in an adverse change to natural resources(e.g.,wetlands, waterbodies,groundwater,air quality,flora and fauna)? Page 3 of 4 4. No,or Moderate small to large impact impact may may occur occur 10. Will the proposed action result in an increase in the potential for erosion,flooding or drainage problems? 11. Will the proposed action create a hazard to environmental resources or human health? Part 3-Determination of significance. The Lead Agency is responsible for the completion of Part 3. For every question in Part 2 that was answered"moderate to large impact may occur",or if there is a need to explain why a particular element of the proposed action may or will not result in a significant adverse environmental impact,please complete Part 3. Part 3 should,in sufficient detail,identify the impact,including any measures or design elements that have been included by the project sponsor to avoid or reduce impacts. Part 3 should also explain how the lead agency determined that the impact may or will not be significant.Each potential impact should be assessed considering its setting,probability of occurring, duration,irreversibility,geographic scope and magnitude. Also consider the potential for short-term,long-term and cumulative impacts. ❑ Check this box if you have determined,based on the information and analysis above,and any supporting documentation, that the proposed action may result in one or more potentially large or significant adverse impacts and an environmental impact statement is required. ❑ Check this box if you have determined,based on the information and analysis above,and any supporting documentation, that the proposed action will not result in any significant adverse environmental impacts. Name of Lead Agency Date Print or Type Name of Responsible Officer in Lead Agency Title of Responsible Officer Signature of Responsible Officer in Lead Agency Signature of Preparer(if different from Responsible Officer) Page 4 of 4 IF/ . Richard E. Jones Associates Architects- Environmental Planners OCT 15 2013 339 Aviation Road Queensbury,NY 12804 Phone: (518)793-1015 Fax: (518) 793-7723 - E-mail:info @rejaarchitects.com October 9, 2013 Project Narrative and Town of Queensbury Planning Standards Re: Hudson Headwaters Health Network Carey Road Tax Map Parcel 309.13-2-31.2 Project Narrative: The proposed project involves the addition of 34 parking spaces to the site adjacent to the existing Health Center and Pharmacy building which is located in a CLI Zone. The parcel is owned by Hudson Headwaters Health Network and the proposed parking wolot would be adjacent to the esisting parking and drive areas for the Health Center. A new sidewalk would be provided to connect the parking lot to the existing Health Center site for pedestrian access and safety. The proposed paved area will accommodate site circulation and parking for the intended parking expansion and include light poles, similar to the existing located on the Health Center site for general lighting of the parking lot and driveway connection The additional parking has been provided to accommodate the two proposed uses with an increase above the required amounts specifically for the Health Center usage. The current facility is adding additional medical staff which will increase requirements for both staff and patient parking on the site. The existing trees on the site would be utilized to screen the proposed lot from adjoin properties. The existing deep test pit information and percolation test results from the Health Center site indicate that the adjacent site will adequately address the on-site storm water infiltration requirements for the paved area as proposed. The new parking area will have an infiltration around the perimeter of the paved area for collection and infiltration of storm water. The remaining portion of the parcel will remain undeveloped at this time. Either during the review time before the scheduled planning board meeting or during construction test pits would be completed to confirm the actual soil type and percolation rates The use of the site is compatible with the existing zoning and provides an area to expand parking for the current Health Center facility to enable it to meet its current and projected parking needs. P:\01-Projects\2013\1316\Letter-TOQ Standards for SPR-76-03-13.doc Planning Standards: Standard A: The proposed project does further and is consistent with the policies of the Town's Comprehensive Plan. Standard B: The project is on a conforming parcel and complies with all requirements of the site plan review standards. Standard C: The site plan encourages safe pedestrian activity internally but does not encourage pedestrian access to and from the site as it is not practicable based upon the location of the site and the surrounding uses. Standard D: The site plan does conform to Chapter 136 and Chapter 147 of the Town Code as well as other applicable local laws. Standard E: The intended use is in harmony with the general intent of this Chapter. The use or intensity is minor in nature and affords a transition zone between the potential industrial uses and the existing residential uses in that general area. Standard F: The proposed use will not create hazards of any kind to the public, or residents of the existing neighborhood. The existing public roadways and on site parking are adequate to handle the proposed use. Standard G: Off-street parking will be adequate for the intended use with the proposed addition of 34 spaces. A driveway link has already been provided between parcels thus connecting the sites. Standard H: The proposed use has no adverse impact upon any Town resources. Standard I: The site plan encourages safe pedestrian activity internally but does not encourage pedestrian access to and from the site as it is not practicable based upon the location of the site and the surrounding uses. Standard J: Proposed storm water drainage Facilities as provided do conform to the requirements of Chapter 147 of the Town Code and no changes to the existing systems on the Health Center site are proposed. Standard K: No water supply and sewage disposal facilities are required. Standard I.: Existing trees on the site are adequate to provide the required visual barriers as required by the Town requirements between uses. Standard M: Existing fire lanes, emergency zones and fire hydrants for the Health Center site are adequate and meet he needs and requirements of emergency service providers. Standard N: The design of the proposed parking area and connecting driveway do conform to the requirements of Chapter 147 of the Town Code. Standard 0: The proposed site as designed complies with all design standards and requirements of this Chapter. Richard E. Jones Associates Architects- Environmental Planners 339 Aviation Road Queensbury,NY 12804 Phone: (518) 793-1015 Fax: (518) 793-2993 E-mail:info @rejaarchitects.com October 9, 2013 Waiver Requests from Site Plan Review Requirements Re: Hudson Headwaters Health Network Carey Road Tax Map Parcel 309.13-2-31.2 Waiver Request Narrative: Item L-Landscaping: A waiver from this requirement is requested as the existing trees that will remain on the site are adequate to provide the required screening from the adjacent parcels and uses. Item Q-Soil Logs, etc.: A waiver from this requirement is requested as the data that had been completed and presented for the original site plan review for the Health Center indicate soils that will be consistent with this site. Either during the review time before the scheduled planning board meeting or during construction test pits would be completed to confirm the actual soil type and percolation rates P:\01-Projects\2013\1316\Letter-Waivers for SPR-07-11-13.doc Stantec Consulting Services Inc. 3 Columbia Circle Suite 6 Albany NY 12203-5158 Tel (518)452-4358 Fax (518)452-9234 Stantec July 12, 2011 Town of Queensbury 742 Bay Road Queensbury, New York 12804 Attn: Mr. Craig Brown,Zoning Administrator Reference: Hudson Headwaters Health Network— Health Center and Pharmacy Town of Queensbury: Site Plan ref# 45-2010 Report of Percolation Tests for Storm Water System Dear Mr. Brown: As per the notice sent to you by Mr. Jones, Stantec conducted additional percolation tests on the site today July, 12, 2011. These tests were conducted in conformance with the NYSDEC requirements in Appendix "D" of the design manual for infiltration practices. The tests were observed by a representative of Chazen — Kelsey Gnoinski. The results of the tests are listed below. Tests pit in the vicinity of Dry Well#3 (easterly side of site) : Description of test pit: test pit dug approximately 11 feet below grade. This provided a test location 4 feet below the bottom elevation of the dry well. Sandy gravel material throughout depth of excavation. See soils report for details of soils and depth of borings—no bed rock encountered. A length of 6-inch diameter plastic pipe approximately 60 —inch long was installed in the bottom of the test pits to allow percolation testing. See attached photos. Observations Test cycle#1: At 9:00:00 AM plastic pipe filled with water to a depth of 33 inches. At 9:02 :00 AM water level had dropped to 12 " : Result 21 inches in 2 minutes Observations Test cycle#2: At 9:04 AM plastic pipe filled with water to a depth of 33 inches. At 9:06 AM water level had dropped to 10 " : Result 23 inches in 2 minutes Observations Test cycle#3: At 9:07:30 AM plastic pipe filled with water to a depth of 34 inches. At 9:09:30 AM water level had dropped to 7" : Result 27 inches in 2 minutes Observations Test cycle#4: At 9:11:30 AM plastic pipe filled with water to a depth of 33 inches. At 9:13:30 AM water level had dropped to 11 " : Result 22 inches in 2 minutes Average Value for the four tests= 11.6 inches per minute (or 698 inches per hour) $ i$eC July 12, 2011 Page 2 of 4 Reference: Report on results of percolation tests Tests pit in the vicinity of Dry Well#5 (westerly side of site) : Description of test pit: test pit dug approximately 10 1/2 feet below grade. Sandy gravel material throughout depth of excavation. This provided a test location 4 feet below the bottom elevation of the dry well. See soils report for details of soils and depth of borings — no bed rock encountered. A length of 6-inch diameter plastic pipe approximately 60 —inch long was installed in the bottom of the test pits to allow percolation testing.See attached photos. Time of test: begin test at 9:18:30 AM Observations Test cycle# 1: At 9:18:30 AM plastic pipe filled with water to a depth 24 inches from top of the pipe. At 9:19:30AM water level had dropped to 43 "from top of pipe : Result 19 inches in 1 minute Observations Test cycle#2: At 9:20:30 AM plastic pipe filled with water to a depth 24 inches from top of the pipe. At 9:21:30 AM water level had dropped to 44"from top of pipe : Result 20 inches in 1 minute Observations Test cycle#3: At 9:22:40 AM plastic pipe filled with water to a depth 24 inches from the top of the pipe. At 9:23:40 AM water level had dropped to 46inches from top of pipe. : Result 22 inches in 1 minute Observations Test cycle#4: At 9:24:40 AM plastic pipe filled with water to a depth 24 inches from top of the pipe. At 9:25:40 AM water level had dropped to 44 inches from top of pipe: Result 20 inches in 2 minutes Average Value for the four tests = 20.25 inches per minute (or 1,215 inches per hour) If you have any comments or questions, please contact me at(518)452-4358. Sincerely, STANTEC CONSULTING SERVICES INC. \J Bruce H. Secor Senior Civil Engineer Tel: (518) 452-4358 Fax: (518)452-9234 bru ce.secor @stantec.com cc. R. Jones S. Doty/Chazen Companies File Attachments: photos 84/11/2011 14:34 518-792-0065 BARTLETT PONTIFF PAGE 02/04 rrK��i�i �r vvvc• r+.i�.u!is ri i .m UUfl06S7 PAMELA J. Vd6 ±P E; 4-092 PAGE: i 05 11111111 COUNTY CLERK 11111111 Lake George, NY 12845 Volm-4092 Pg-105 GO 2010...,7 Instrument Number: 2010- 00006530 As Recorded On: September 24, 2010 Deed Commercial or Vacant Parties: CAREY REAL ESTATE DEVELOPMENT CORP To HUDSON HEADWATERS NEALTH NETWORK Billable Pages: 2 Recorded By: COMMUNITY TITLE AGENCY INC Num Of Pages: 3 Comment: "Examined and Charged as Follows: *` Deed Commercial or Vacant 50.00 Cover 5.00 RP-5217 Commercia' 250,00 TP-554 5.00 Recording Charge: 310.00 Consideration Amount Amount RSfNCSit Transfer Tax 2,100.00 525,000.00 TT 308 Basic 0.00 QUEENSBURY Lu at 0.00 Special Additional 0.00 Addi{ivy 0.00 Transfer 2,100.00 Tax Charge: Z100.00 RECEIVED RECORDED OCT . 15 2013 Counts Clerks Office Sep 2402010 02:37P PcoRlui J. Vine' TG Warren Counts Clerk -,L,E THIS PAGE IS PART OF THE INSTRUMENT** I hereby certify that the within and foregoing was recorded in the Clerk's Office For: WARREN COUNTY, NY File Information: Record and Return To: Document Number: 2010.-00006530 BARTLETT PONTIFF STEWART & RHODES PC Receipt Number: 180298 PO BOX 2168 Recorded Date/Time: September 24, 2010 02:37:31P ONE WASHINGTON ST Book-VolIPg: Bk-RP VI-4092 Pg-105 GLENS FALLS NY 1280 Cashier 1 Station: C Latham I Cash Station 3 04/11/2011 14:34 518-792-0065 BARTLETT PONTIFF PAGE 03/04 DOCUt-t T� 000067,30 VOLUME= 4092 PACE: 106 Warranty Deed with Lien Covenant Record and Return to 6Jonathan C. Lapper. Esq. ') / Bartlett, Pontiff. Stewart& Rhodes, P.C. PO Box 2188 One Washington Street \c'e) Glens Falls, New York 12801-2168 This Indenture Made the 23rd day of September, Two Thousand Ten v)) Between CAREY REAL ESTATE DEVELOPMENT CORPORATION, a New York corporation with an address at 3342 Lake Point Boulevard. Sarasota, Florida 34231, party t of the first part, and HUDSON HEADWATERS HEALTH NETWORK. a New York not-for-profit \ corporation with an address at PO Box 3253, Glens Falls, New York 12801, party of the second part, r. f Witnesseth that the party of the first part, in consideration of One Dollar ($ 1.00) acv° lawful money of the United States, paid by the party of the second part, does hereby grant r wq and release unto the party of the second part, its successors and assigns forever. ALL THAT CERTAIN LOT, PIECE OR PARCEL OF LAND, situate in the Town of u d r Queensbury, County of Warren and State of New York, shown on a map entitled Northern Distributing Subdivision, Town of Queensbury, Phase 2, made by Rist-Frost Associates, E o(9 P.C., dated February, 1989, filed in the Office of the County Clerk of the County of Warren U on October 3, 1989 in the Oversize Map Cabinet as Map E-3, as Lots Numbers 17 and 19_ Being a portion of the premises conveyed to the party of the first part by deed from William F. Carey and Carole J. Carey, as Trustees of an intervivos trust created by John J. Carey by Agreement dated October 14, 1967, known as The Carey Real Estate Trust, dated January 30, 1990 and recorded in the Warren County Clerk's Office on February 7. 1990 in Liber 783 at page 158. Subject to all covenants, easements and restrictions of record_ This conveyance is made by the unanimous consent of all of the shareholders of the party of the first part, and does not constitute a transfer of all or substantially all of the assets of the party of the first part pursuant to Section 909 of the Business Corporation Law of the State of New York. Together with the appurtenances and all the estate and rights of the party of the first part in and to said premises, ' ' 04/11/2011 14:34 518-792-0065 BARTLETT PONTIFF PAGE 04/04 DOCUMENT 00006530 VOLUME 4092 PAGE : 107 warranty bead'XF.h Lien Covenant To have and to hold the premises herein granted unto the party of the second part, its successors and assigns forever. And said party of the first part covenants as follows: First, That the party of the second part shall quietly enjoy the said premises; Second, That said party of the first part will forever Warrant the title to said premises; and Third, That, in compliance with Sec. 13 of the Lien Law, the party of the first part will receive the consideration for the conveyance and will hold the right to receive such consideration as a trust fund to be applied first for the purpose of paying the cost of the improvement and will apply the same first to the payment of the cost of the improvement before using any part of the total of the same for any other purpose. in Witness Whereof, the party of the first part has hereunto set its hand and seal the day and year first above written. CAREY REAL ESTATE DEVELOPMENT CORPORATION In Presence of By: x _ _l o—___ Barbara A. Britton, Vice President STATE OF NEW YORK ) ) ss.: COUNTY OF WARREN ) On the 23' day of September in the year 2010, before me, the undersigned, personally appeared BARBARA A. BRITTON, personally known to me or proved to me on the basis of satisfactory evidence to be the individual whose name is subscribed to the within instrument and acknowledged to me that she executed the same in her capacity, and that by her signature on the instrument. the individual or the person upon behalf of which the individual acted, executed the instrument. KaL eallii(d6—C- R:VCCL`.CAREY.REV._a+'7IX I\knndco= Notary Public KANA ,SW,off*"Mobil "York No.4977749 4uaN ted In Albany County Commtnabn E,iplrles Feh,t?, �b 1I 2