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Application cont'd._5 SITE NAME: Pilot Knob SITE NUMBER: NYGLE573 ATTY/DATE: NP DRAFT 6/6/12 APA SITE Exhibit "A" (Sketch of Premises within Property) 13304149.9 1 NOTES: 1. THE PLAN WAS DEVELOPED FROM AERIAL PHOTOGRAPHY, TAX MAPS &A SITE VISIT PERFORMED BY TCC ON 6/21/10. EXISTING CONDITIONS ARE APPROXIMATE AND NOT THE RESULT OF A FORMAL INSTRUMENT SURVEY. LESSEE PROPOSED 12 FT. 2. NORTH ORIENTATION IS APPROXIMATE AND WAS WIDE ACCESS EASEMENT ESTABUSHED FROM PHOTOCRAMMElRY TAXEN FROM THE 1 NEW YOUR STATE ORTHOIMAGERY WEB SITE. "c■Z 11 1 1 3. PROPOSE 00)/100 LEASE AREA.W/ ACCESS MD LMUTY LOCKHART ROAD I� (PUBLIC RIGHT OF WAY) I11 1 1....._ ..... ..., i I 1 I r. l 1 — 1 1 • LESSEE PROPOSED 30 FT. I 1 — ` WIOS ACCESS AND UT1UTY EASFYEHT 1 \ \— LESSEE PROPOSED\ \ \ \ 100/100 LEASE AREA 1 I `TAX PARCEL/ — 265.00-1-52 _\____ 44- 6 I 1 1 670.88 ACRES 88 1 7 LANDLORD APPROVA 1 1 TAX PARCEL/ 1 DATE: 9 zs2oo-1-B _ �i — i 85,59 ACRES 5 THIS DRAWING IS FOR OPTION. LEASE. UCENSE AND PERMITTING PURPOSES ONLY AND 5 NOT TO BE USED FOR CONSTRUCTION. R . CEIICO PARTNERSHIP CHAZEN ENGINEERING, LAND SURVEYING , PILOT KNOB-NYGLE67] it \........r...........'''' �// LANDSCAPE ARCHITECTURE CO., P.C. WM 1..1]00• ve" r ''''�S g'"--a�z LEASE EXHIBIT n.. w..._c....Am. w .a_ Mr....7•yam n,i.n,r 3091 s.OB In roe MO 180 WASHINGTON TONN VAILEY ROAD 'µ'"°,in '"'"'Th"1°f'°' '."" q"'TM'1"� M F BEDMINSTER, NJ 07921 J TOWN Or QUEENSBURY,WARREN COUNTY,NEW YORK LE-1 . I NOTES: - / 1ELSTRARY 12 WIDE 1. THE PLAN TAX MAPS WAA S ED FROM RFORMED BY TCC ON - _J I ACCESS RIOHTtOF WAY CONSTRUCTION EASEMENT 6/21/10. EXISTING CONDIRONS ARE APPROXIMATE AND \ oE AREA NOT THE RESULT OF A FORMAL INS1RUMENT SURVEY. // - - 2. NORTH ORIENTATION IS APPROXIMATE AND WAS / T ESTABLISHED FROM PHOTOCRAMMEIRY TAKEN FROM THE I ~ _ -,a NEW YOUR STATE ORTHOIMAGERY WEB SSE I.r ..- ' - - 1111-01.MI ) 3. PROPOSED 100'>r10D LANO SPACE W/ACCESS AND / LITY RIGOF WAYI g I I 4. SHADED AREA REPRESENTS EASEMENT OBTAINED FROM A 1 0001ART ROAD/ (PUUOUC RIGHT OF WAY) // 8 IN: DIFFERENT SOURCE. 1 8 Ax mai. 111 / TAX P�/ 1 252.00-1-15.5 / _ 1 e r 25200_, 5.2 I1 TAX 1/ / �-t # # I ` g Vi °C Y��/ l PERMANENT,r WIDE �� i ACCESS EASEMENT 1 § i POLE(SCORNING IIR I APPROXNMTE LOCATION POLE CCESS AN OF U 30' OF EXISTING 1-ACRE L 1 I + WIDE ACCESS AND UTIIJTY f/�EASEMENT : QS EASEIIEN1) 0/ ��PROPOSTED ,2 FT. & `Cb WIDE ACCESS RIGHT OF WAY L TAX PARCEL/ LICSSfE PROPOSED 30Ff. _I 25200•-tRES p WIDE ACCESS AND UTRlfY _ i 1 35.97 ACRES ti i- RIGHT OF WAY_ L - - 7 �� \ RA EASEMENT 200FT. e \ TAX PARCEL/ 111 ~� JI I� 1�RESiRICfINC TREE CUTTING e 25239-1-1 7 1 1 r Z 1 1 1 1 1\ \ / LAND CE 4 a - 1 LANDLORD APPROV air I -- -------- ' ' \1 L TAX PARCEL/ \ V I TAX PARCEL/ 1 65.59 ACRES TAX PARCEL/ \ DATE: 9 74.16 ACRES 1 7 1 265.00-1-52 1 ' / 670.86 ACRES�` 8, THIS DRAWING IS FOR OPTION, LEASE, LICENSE AND PERMRTINC PURPOSES ONLY ANO IS NOT TO BE USED FOR CONSTRUCTION. S . 1 CELLCO PARTNERSHIP CHAZEH ENGINEERING, LAND SURVEYING ....\ PILOT KNOB•NVGLEST3 � Onion onaed b , X dlbh U.K LANDSCAPE ARCHITECTURE CO., P.C. °a1 '°°" om•■__��+ice LEASE EXHIBIT °"'" VBrI�Ij wireless ° " ]0915.06 180 WASHINGTON n��VALLEY ROAD ^"" ' 1 �"0 �"1'�"O Ma ^��' "",.iio0 LE-2 • LA BEOMINSTER, NJ 07921 TOYR1 OF OUEENSBURY,WARREN COUNTY.NEW YORK o . CE#458 617.20 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 or 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: 113 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 Callao Partnership d•'bia Vcrizon Wireless-Pilot Knob Wireless Telecommunications Facility 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 of Preparer (If different from responsible officer) August 6,2013 Revised 4'812013 Date Page 1 of 21 A 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 currently available and will not involve new studies, research or investigation. If information requiring such additional work is unavailable,so indicate and specify each instance. Name of Action Cellco Partnership dib/a Verizon Wireless-Pilot Knob Wireless Telecommunications Facility Location of Action(include Street Address, Municipality and County) 441 Lockhart Mountain Road,Town of Queensbury,Warren County(T.A.#265.-1-52 Parent Parcel) Name of Applicant/Sponsor Celico Partnership d/b/a Verizon Wireless Address 175 Calkins Road City/PO Rochester State NY Zip Code 14623 Business Telephone 585-321-5435 Kathy Pomponio Name of Owner(if different) Lost Chalets,LLC Address 441 Lockhart Mountain Road City/PO Lake George • State NY Zip Code 128=1? Business Telephone 518-668-3000(James Feeney) Description of Action: Cellco Partnership dib/a Verizon Wireless is proposing a 86'monopine(91'overall height w/RF Simulated Pine Branches),an 11'-7"x30'-1"equipment building on a 11'-7"x30'-1"concrete pad within a 42'x50'fenced(6'tall with barb wire top)compound,along with other associated improvements.Access to the site via existing driveways from 12'Lockhart Mountain Road and a proposed 12' wide gravel driveway. Page 2 of 21 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: EJ Urban 1_....i Industrial ['Commercial I Residential (suburban) I 1 Rural (non-farm) Forest El Agriculture Fl Other Top of the World Golf Course Lease Parcel 0.23 + Permanent Access Easement 1.60 2. Total acreage of project area: 1.81 "/- acres. APPROXIMATE ACREAGE PRESENTLY AFTER COMPLETION Meadow or Brushland (Non-agricultural) 0.40,acres 0.28 acres Forested 0.39 acres 0.11 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 Unvegetated (Rock, earth or fill) driveway 1.04 acres 1.431 acres Roads, buildings and other paved surfaces acres 0.009 acres Other (Indicate type) acres acres 3. What is predominant soil type(s) on project site? NC Bice Very boukicry tine sandy loam Per NRCS Web Soil Survey a. Soil drainage: I7]Well drained 100%of site L.I Moderately well drained % of site. ❑Poorly 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? n`a acres (see 1 NYCRR 370). 4. Are there bedrock outcroppings on project site? 1 i I Yes ri No a. What is depth to bedrock >6.6' (in feet) Depth to restrictive feature per NRCS Soil Survey 5. Approximate percentage of proposed project site with slopes: • 1710-10% 90% pi 10- 15% 10 % [1 15% or greater % 6. Is project substantial) contiguous to, or contain a building, site, or district, listed on the State or National Registers of Historic Places? t Yes l ' I No 7. Is project substantially contiguous to a site listed on the Register of National Natural Landmarks? ❑Yes [lNo 8. What is the depth of the water table? >6.6' (in feet) per NRCS Web Soil Survey 9. Is site located over a primary, principal, or sole source aquifer? I IYes 0 No 10. Do hunting, fishing or shell fishing opportunities presently exist in the project area? ri Yes 171 i No Page 3 of 21 11. Does project site contain any species of plant or animal life that is identified as threatened or endangered? ❑Yes []No According to: No per NYSDEC Natural Heritage Program letter dated 12120/2012. Identify each species: 12. Are there any unique or unusual land forms on the project site? (i.e., cliffs, dunes, other geological formations? r—Ycts No Describe: 1 3. Is the project site presently used by the community or neighborhood as an open space or recreation area? U Yes I 1No If yes, explain: Existing golf course 14. Does the present site include scenic views known to be important to the community? Yes I ■ INo 15. Streams within or contiguous to project area: Norio a. Name of Stream and name of River to which it is tributary 16. Lakes, ponds, wetland areas within or contiguous to project area: Per the National Wetlands Inventory Maps,there are no federal wetlands in the project area. Per APA mapping,there arc APA wetlands approximately 893'+/-southwest of the project area associated with the existing pond. b. Size(in acres): 10+1- Page 4 of 21 17. Is the site served by existing public utilities? n Yes 1] No a. If YES, does sufficient capacity exist to allow connection? 101 Yes n No b. If YES, will improvements be necessary to allow connection? F.], Yes ONo 18. Is the site located in an agricultural district certified pursuant to Agriculture and Markets Law, Article 25-AA, Section 303 and 304? fYes D No 19. Is the site located in or substantiall contiguous to a Critical Environmental Area designated pursuant to Article 8 of the ECL, and 6NYCRR617? nYes a No 20. Has the site ever been used for the disposal of solid or hazardous wastes? ii Yes nNo 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: 1.83 acres. (Lease parcel&access) b. Project acreage to be developed: 1.44 acres initially: 1-44 acres ultimately. c. Project acreage to remain undeveloped: 0.39 acres. d. Length of project, in miles: N/A (if appropriate) e. If the project is an expansion, indicate percent of expansion proposed. N/A % f. Number of off-street parking spaces existing N/A ; proposed 2 g. Maximum vehicular trips generated per hour: 2-3 month (upon completion of project)? h, If residential: Number and type of housing units: One Family Two Family Multiple Family Condominium Initially N/A Ultimately i. Dimensions (in feet) of largest proposed structure: $b' height; I l'-7" width: 30'-I" length. {91'overall) shelter j. Linear feet of frontage along a public thoroughfare project will occupy is? 30' ft. access/Willies easement 2. How much natural material (i.e. rock. earth, etc.) will be removed from the site? 0 tons/cubic yards. 3. Will disturbed areas be reclaimed nYes nNo n NIA a. If yes, for what intended purpose is the site being reclaimed? grading and seeding b. Will topsoil be stockpiled for reclamation? ©Yes ri No c. Will upper subsoil be stockpiled for reclamation? Yes El No 4. How many acres of vegetation (trees, shrubs, ground covers) will be removed from site? 0.28 acres. Page 5 of 21 l 5. Will any mature forest (over 100 years old) or other locally-important vegetation be removed by this project? n Yes I o J No 6. If single phase project: Anticipated period of construction: 3 months. (including demolition) 7. If multi-phased: NiA a. Total number of phases anticipated (number) b. Anticipated date of commencement phase 1: month year, (including demolition) c. Approximate completion date of final phase: month year. d. Is phase 1 functionally dependent on subsequent phases? n Yes n No 8. Will blasting occur during construction? 0 Yes ❑No 9. Number of jobs generated: during construction 10 ; after project is complete 0 10. Number of jobs eliminated by this project 0 11. Will project require relocation of any projects or facilities? El Yes 0 No If yes, explain: 12. Is surface liquid waste disposal involved? n Yes 1;1 No a. If yes. indicate type of waste (sewage, industrial, etc) and amount b. Name of water body into which effluent will be discharged 13. Is subsurface liquid waste disposal involved? n Yes rill No Type 14. Will surface area of an existing water body increase or decrease by proposal? Elves 0 No If yes, explain: 15. Is project or any portion of project located in a 100 year flood plain? n E Yes No 16. Will the project generate solid waste? ❑Yes f ' 1 No a. If yes, what is the amount per month? tons b. If yes, will an existing solid waste facility be used? 11 Yes 11 No c. If yes, give name ; location d. Will any wastes not go into a sewage disposal system or into a sanitary landfill? ❑Yes No Page 6 of 21 e. If yes, explain: 17. Will the project involve the disposal of solid waste? Yes • No a. If yes, what is the anticipated rate of disposal? tons/month. b. If yes, what is the anticipated site life? years. 18. Will project use herbicides or pesticides? nYes —111 No 19. Will project routinely produce odors (more than one hour per day)? ,Yes • l No 20. Will project produce operating noise exceeding the local ambient noise levels? ,Yes • No 21. Will project result in an increase in energy use? • Yes n No If yes, indicate type(s) Electric 400 amps,240/120V, 1P 22. If water supply is from wells, indicate pumping capacity N/A gallons/minute. 23. Total anticipated water usage per day N/A gallons/day. 24. Does project involve Local, State or Federal funding? Yes © No If yes, explain: Page 7 of 2'l 25. Approvals Required: Type Submittal Date City, Town, Village Board D Yes ill No ('�� ['� Site Plan Approval City, Town, Village Planning Board I ' 1 Yes f l N• o Use Variance City, Town Zoning Board 0 Yes n N• o City, County Health Department ❑Yes El No Freshwater wetlands Permit Other Local Agencies 1-211 Yes a No Stormwater Permit (as part of site plan review) Other Regional Agencies Yes I It No Adirondack Park Agency State Agencies 0 Yes 11 N• o Federal Agencies n Yes I ' t No C. Zoning and Planning Information 1. Does proposed action involve a planning or zoning decision? RI Yes J I No If Yes, indicate decision required: riZoning amendment Fl Zoning variance E New/revision of master plan n Subdivision Site plan ❑Special use permit Resource management plan j • Other Page 8 of 21 2. What is the zoning classification(s) of the site? Top of the NVorld PLD(Planned Unit Development) 3. What is the maximum potential development of the site if developed as permitted by the present zoning? N.A 4. What is the proposed zoning of the site? Same as existing 5. What is the maximum potential development of the site if developed as permitted by the proposed zoning? N/A 6. Is the proposed action consistent with the recommended uses in adopted local land use plans? D Yes ❑No 7. What are the predominant land use(s)and zoning classifications within a Y4 mile radius of proposed action? Land Uses: Forest,Golf Course,Residential Zoning Districts: Top of the World PUD,Land Conservation 10 Acre,Rural Residential 5 Acre, 8. Is the proposed action compatible with adjoining/surrounding land uses with a V4 mile? El Yes No 9. If the proposed action is the subdivision of land, how many lots are proposed? N/A a. What is the minimum lot size proposed? Page 9 of 21 • 10. Will proposed action require any authorization(s) for the formation of sewer or water districts? n Yes ! vi No 11. Will the proposed action create a demand for any community provided services (recreation, education, police, fire protection? Yes i ' 1 No a. If yes, is existing capacity sufficient to handle projected demand? n Yes n No 12. Will the proposed action result in the generation of traffic significantly above present levels? ED Yes Q No a. If yes, is the existing road network adequate to handle the additional traffic. Dyes ❑No 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 Cellco Partnership d/b/a Verizon Wireless Date 8/6/2013 Rev. 8/8/2013 Signature t e 1 f Title David A. Weisenreder,P.E.-Costich Engineering-Project Engineer,Agent for Applicant If the action is in the Coastal Area, and you are a state agency, complete the Coastal Assessment Form before proceeding with this assessment. Page 10 of 21 In the Matter of Verizon Wireless' Application to the Town of Queensbury for Approval to Construct and Operate an 86' AFFIDAVIT OF Wireless Telecommunications Tower (with an Additional 5' MAILING of Simulated Pine Branches) and Ancillary Facilities Near 441 Lockhart Mountain Road in the Town of Queensbury,New York STATE OF NEW YORK) COUNTY OF MONROE) ss.: Kristie Savastano, being duly sworn, deposes and says that: 1. I am over the age of eighteen years and am employed by Nixon Peabody LLP, the attorneys for the Applicant in the above-referenced matter. 2. On August 9, 2013,before 6:00 o'clock P.M. in the City of Rochester, Monroe County,New York, I personally mailed the attached notices to (1)municipalities neighboring the Town of Queensbury, (2) Saratoga County, (3) Washington County, and(4)the Director of Warren County Emergency Services, all in connection with the above-captioned project, via First Class Mail, by depositing the same properly enclosed in a postpaid wrapper, at the United States Postal Service station located at Clinton Square, in the City of Rochester, Monroe County,New York. -t_ c::-.230-4-7 6 Kristie Savastano Snprn to befo me th. q'/— day of 2013. fia,4 00tir Notary Public MARK A.DEWATERS Notary Public State of**YC'kc No.01buoesa:.: Co 3-,o 14555482.1