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EXHIBIT E
- 11 "Nev
Full Environmental Assessment Form
Part 1 -Project and Setting
Instructions for Completing Part 1
Part 1 is to be completed by the applicant or project sponsor. Responses become part of the application for approval or funding,
are subject to public review,and may be subject to further verification.
Complete Part I 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; indicate whether missing information does not exist,
or is not reasonaply available to the sponsor;and,when possible,generally describe work or studies which would be necessary to
update or fully develop that information.
Applicants/sponsors must complete all items in Sections A&B. In Sections C,D&E,most items contain an initial question that
must be answered either"Yes"or"No". If the answer to the initial question is"Yes",complete the sub-questions that follow. If the
answer to the initial question is"No",proceed to the next question. Section F allows the project sponsor to identify and attach any
additional information. Section G requires the name and signature of the project sponsor to verify that the information contained in
Part 1 is accurate and complete.
A.Project and Sponsor Information.
Name of Action or Project:
Cerrone Builders Inc.29-Lot Conservation Subdivision
Project Location(describe,and attach a general location map):
North side of Sweet Road,Town of Queensbury,NY 12804
Brief Description of Proposed Action(include purpose or need):
The Application proposes to construct a 29-lot conservation subdivision in the MDR zone.The project will consist of 29 three bedroom single family
dwellings and associated development utilities.A HOA will be formed to manage common lands and the proposed passive recreation space along with
dedicated drainage areas and walking trails.Site improvements include;proposed town road,municipal water system,municipal sewer system,
landscaping,lighting,underground electric and gas utilities,and preservation of 55%+1-open space as part of the conservation design concept.
1
Name of Applicant'Sponsor: Telephone:518-798-4026
Cerrone Builders Inc. E-Mail:
ejcerrone@gmail.com
Address:51 Oak Valley Way
CityiPO:Queensbury State:NY Zip Code:12804
Project Contact(if not same as sponsor;give name and title role): Telephone:518-361-0942
Al Cerrone E-Mail:
Address:
City/PO: State: Zip Code:
Property Owner (if not same as sponsor): Telephone:
E-Mail:
Address:
City/PO: State: Zip Code:
1
Page 1 of 13
B. Government Approvals
B.Government Approvals Funding,or Sponsorship. ("Funding" includes grants,loans,tax relief,and any other forms of financial
assistance.)
Government Entity If Yes: Identify Agency and Approval(s) Application Date
Required (Actual or projected)
a.City Council,Town Board, ®Yes❑•o Route 9 Sanitary Sewer District Extension March 2013
or Village Board of Trustees
b.City.Town or Village ®Yes❑No Subdivision October 2013
Planning Board or Commission
c.City Council,gown or ❑Yes®No
Village Zoning Board of Appeals
d.Other local agencies ®Yes❑No TOQ Water Dept,TOO Sewer Agency, Feb 2014
TOO Hwy Dept
e.County agencies ❑Yes®■o
f.Regional agencies ❑Yes®No
g.State agencies ®Yes❑No DEC Stormwater Permit,DEC Sewer Main Ext Feb 2014
DOH Water Main Ext.DOH Realty Subdivision
h.Federal agencies ❑Yes®No
i. Coastal Resources.
i. Is the project site within a Coastal Area,or the waterfront area of a Designated Inland Waterway? ❑Yes®No
If Yes,
ii. Is the project site located in a community with an approved Local Waterfront Revitalization Program? ❑Yes❑No
iii. Is the project site within a Coastal Erosion Hazard Area? ❑Yes❑No
C.Planning and Zoning
C.1.Planning and zoning actions.
Will administrative or legislative adoption,or amendment of a plan,local law,ordinance,rule or regulation be the ❑Yeslo
only approval(s)which must be granted to enable the proposed action to proceed?
• If Yes,complete sections C,F and G.
• If No,proceed to question C.2 and complete all remaining sections and questions in Part 1
C.2.Adopted land use plans.
a.Do any municipally-adopted (city,town,village or county)comprehensive land use plan(s)include the site ®Yes❑No
where the proposed action would be located?
If Yes,does the comprehensive plan include specific recommendations for the site where the proposed action ®Yes❑No
would be located?
b.Is the site of the proposed action within any local or regional special planning district(for example: Greenway ❑Yes®No
Brownfield Opportunity Area(BOA);designated State or Federal heritage area;watershed management plan;
or other?)
If Yes,identify the plan(s):
c. Is the proposed action located wholly or partially within an area listed in an adopted municipal open space plan, ❑Yes®No
or an adopted municipal farmland protection plan?
If Yes,identify the plan(s):
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C.3. Zoning
a. Is the site of the proposed action located in a municipality with an adopted zoning law or ordinance. ®Yes❑No
If Yes,what is the zoning classification(s) including any applicable overlay district?
MDR-Moderate Density Residential
b. Is the use permitted or allowed by a special or conditional use permit? ❑Yes®No
c.Is a zoning change requested as part of the proposed action? ❑Yes®No
If Yes,
i. What is the proposed new zoning for the site?
C.4.Existing community services.
a.In what school district is the project site located?Queensbury Union Free School District
b.What police or other public protection forces serve the project site?
NY$Troopers/Warr1en County Sheriff
c.Which fire protection and emergency medical services serve the project site?
Qby Central Fire District,West GF EMS District
d. What parks serve the project site?
None
D.Project Details
D.1.Proposed and Potential Development
a.What is the general nature of the proposed action(e.g.,residential,industrial,commercial,recreational; if mixed,include all
components)? Residential Subdivision
b.a.Total acreage of the site of the proposed action? 29.49 acres
b. Total acreage to be physically disturbed? 15.82 acres
c.Total acreage(project site and any contiguous properties)owned
or controlled by the applicant or project sponsor? 29.49 acres
c.Is the proposed action an expansion of an existing project or use? ❑Yes®No
1. If Yes,what is the approximate percentage of the proposed expansion and identify the units(e.g.,acres,miles,housing units,
square feet)? % Units:
d.Is the proposed action a subdivision,or does it include a subdivision? ®Yes No
If Yes,
i.Purpose or type of subdivision?(e.g.,residential,industrial,commercial;if mixed, specify types)
Residential Single Family Dwellings
ii. Is a cluster/conservation layout proposed? Yes❑No
iii. Number of lots proposed? 29
iv.Minimum and maximum proposed lot sizes? Minimum 0.347 Maximum 0.347
e.Will proposed action be constructed in multiple phases? ❑Yes®No
i. If No,anticipated period of construction: 24 months
ii. If Yes:
• Total number of phases anticipated
• Anticipated commencement date of phase I (including demolition) month year
• Anticipated completion date of final phase month year
• Generally describe connections or relationships among phases, including any contingencies where progress of one phase may
determine timing or duration of future phases:
Page 3 of 13
1
f.Does the project include new residential uses? ElYes❑No
If Yes,show numbers of units proposed.
One Family Two Family Three Family Multiple Family(four or more)
Initial Phase 29
At completion
of all phases 29
g.Does the proposed action include new non-residential construction(including expansions)? ❑Yes®No
If Yes,
i.Total number of structures
ii. Dimensions(in feet)of largest proposed structure: height; width; and length
iii. Approximate extent of building space to be heated or cooled: square feet
h.Does the proposed action include construction or other activities that will result in the impoundment of any ❑Yes®No
liquids,such as creation of a water supply,reservoir,pond,lake,waste lagoon or other storage?
If Yes,
i. Purpose of the impoundment:
ii. If a water impoundment,the principal source of the water: ❑ Ground water❑Surface water streams DOther specify:
iii. If other than rater,identify the type of impounded/contained liquids and their source.
iv. Approximate size of the proposed impoundment. Volume: million gallons;surface area: acres
v.Dimensions of the proposed dam or impounding structure: height; length
vi. Construction method/materials for the proposed dam or impounding structure(e.g.,earth fill,rock,wood,concrete):
D.2. Project Operations
a.Does the proposed action include any excavation,mining,or dredging,during construction,operations,or both? ❑Yes®No
(Not including.general site preparation,grading or installation of utilities or foundations where all excavated
materials will remain onsite)
If Yes:
i.What is the purpose of the excavation or dredging?
ii. How much material(including rock,earth,sediments,etc.)is proposed to be removed from the site?
• Volume(specify tons or cubic yards):
• Over what duration of time?
iii. Describe nature and characteristics of materials to be excavated or dredged,and plans to use,manage or dispose of them.
iv. Will there be onsite dewatering or processing of excavated materials? ❑Yes❑No
If yes,describe.
v. What is the total area to be dredged or excavated? acres
vi. What is the maximum area to be worked at any one time? acres
vii. What wood Be the maximum depth of excavation or dredging? feet
viii. Will the excavation require blasting? ❑Yes❑No
ix. Summarize site reclamation goals and plan:
b. Would the proposed action cause or result in alteration of, increase or decrease in size of,or encroachment ❑Yes®No
into any existing wetland,waterbody,shoreline,beach or adjacent area?
If Yes:
i. Identify the wetland or waterbody which would be affected(by name,water index number,wetland map number or geographic
description):
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I
ii. Describe how the proposed action would affect that waterbody or wetland,e.g.excavation,fill,placement of structures,or
alteration of channels,banks and shorelines. Indicate extent of activities,alterations and additions in square feet or acres:
iii. Will proposed action cause or result in disturbance to bottom sediments? ❑Yes❑No
If Yes,describe:
iv. Will proposed action cause or result in the destruction or removal of aquatic vegetation? ❑Yes❑No
If Yes:
• acres of aquatic vegetation proposed to be removed:
• expected acreage of aquatic vegetation remaining after project completion:
• purpose of proposed removal(e.g.beach clearing, invasive species control,boat access):
• proposed method of plant removal:
• if chemical/herbicide treatment will be used,specify product(s):
v. Describe any proposed reclamation/mitigation following disturbance:
c.Will the proposed action use,or create a new demand for water? ®YesDio
If Yes:
i. Total anticipated water usage/demand per day: 9570 gallons-day
ii. Will the prolosed action obtain water from an existing public water supply? ®Yes❑:�Io
If Yes:
• Name of district or service area: Queensbury Water District
• Does the existing public water supply have capacity to serve the proposal? ®Yes❑No
• Is the project site in the existing district? ®Yes❑No
• Is expansion of the district needed? ❑Yes®No
• Do existing lines serve the project site? ❑Yes®No
iii. Will line extension within an existing district be necessary to supply the project? ®Yes DIo
If Yes:
• Describe extensions or capacity expansions proposed to serve this project:
Project will include extension of watermain to service fire safety and domestic needs within development from existing main in Sweet Rd
• Source(s)of supply for the district: Queensbury Water District
iv. Is a new water supply district or service area proposed to be formed to serve the project site? ❑ Yes®No
If,Yes:
• Applicant/sponsor for new district:
• Date application submitted or anticipated:
• Proposed source(s)of supply for new district:
v. If a public water supply will not be used,describe plans to provide water supply for the project:
vi. If water supply will be from wells(public or private),maximum pumping capacity: gallons/minute.
d.Will the proposed action generate liquid wastes? ®Yes❑No
If Yes:
i. Total anticipated liquid waste generation per day: 9570 gallons/day
ii. Nature ofliquid wastes to be generated(e.g.,sanitary wastewater, industrial;if combination,describe all components and
approximate volumes or proportions of each):
Domestic sanitary wastewater from 29 single family dwellings
iii. Will the proposed action use any existing public wastewater treatment facilities? 0 Yes❑No
If Yes:
• Name of wastewater treatment plant to be used: Glens Falls Wastewater Treatment Plant
• Name of district: Route 9 Sanitary Sewer District
• Does the existing wastewater treatment plant have capacity to serve the project? ®Yes❑No
• Is the project site in the existing district? ❑Yes®No
• Is expansion of the district needed? ®Yes❑No
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• Do existing sewer lines serve the project site? ❑YesIINo
• Will line extension within an existing district be necessary to serve the project? ❑Yes ONO
If Yes:1
• Describe extensions or capacity expansions proposed to serve this project:
iv. Will a new wastewater(sewage)treatment district be formed to serve the project site? ®Yes❑No
If Yes:
• Applicant/sponsor for new district:Cerrone Builders Inc.
• Date application submitted or anticipated:March 2013
• What is the receiving water for the wastewater discharge?Hudson River
v. If public facilities will not be used,describe plans to provide wastewater treatment for the project,including specifying proposed
receiving water(name and classification if surface discharge,or describe subsurface disposal plans):
vi.Describe any plans or designs to capture,recycle or reuse liquid waste:
e.Will the proposed action disturb more than one acre and create stormwater runoff,either from new point 1Yes❑No
sources(i.e.ditches,pipes,swales,curbs,gutters or other concentrated flows of stormwater)or non-point
source(i.e. sheet flow)during construction or post construction?
If Yes:
i. How much impervious surface will the project create in relation to total size of project parcel?
Square feet or 3.75 acres(impervious surface)
Square feet or 29.49 acres(parcel size)
ii. Describe lyptis of new point sources.SW collection and conveyance systems to include catch basins,culverts,basins
iii. Where will the stormwater runoff be directed(i.e.on site stormwater management facility/structures,adjacent properties,
groundwater,on-site surface water or off-site surface waters)?
Onsite SW management system will treat and direct runoff to two basins and owlet devices on the property,one which connects to the existing municipal
SW system in Sweet Rd and the other which discharges to the wetland area
• If to surface waters,identify receiving water bodies or wetlands:
Wetland field verified and shown in SE corner of property flagged by Roberts Environmental Consulting
• Will stormwater runoff flow to adjacent properties? ®Yes❑No
iv, Does proposed plan minimize impervious surfaces,use pervious materials or collect and re-use stormwater? mYes❑No
f. Does the proposed action include,or will it use on-site,one or more sources of air emissions, including fuel ❑Yes®No
combustion,waste incineration,or other processes or operations?
If Yes,identify:
i.Mobile sources during project operations(e.g.,heavy equipment,fleet or delivery vehicles)
ii. Stationary sources during construction(e.g.,power generation,structural heating,batch plant,crushers)
iii. Stationary sources during operations(e.g_,process emissions, large boilers,electric generation)
g.Will any air emission sources named in D.2.f(above),require a NY State Air Registration,Air Facility Permit, Dies No
or Federal Clean Air Act Title IV or Title V Permit?
If Yes:
i. Is the project s to located in an Air quality non-attainment area? (Area routinely or periodically fails to meet ❑Yes❑No
ambient aii-qu4ality standards for all or some parts of the year)
ii. In addition to emissions as calculated in the application,the project will generate:
• Tons/year(short tons)of Carbon Dioxide(CO2)
• Tons/year(short tons)of Nitrous Oxide(N2O)
• Tons/year(short tons)of Perfluorocarbons(PFCs)
• Tons/year(short tons)of Sulfur Hexafluoride(SF6)
• Tons/year(short tons)of Carbon Dioxide equivalent of Hydroflourocarbons(HFCs)
• Tons/year(short tons)of Hazardous Air Pollutants(HAPs)
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h.Will the proposed action generate or emit methane(including,but not limited to,sewage treatment plants, ❑Yes®No
landfills,composting facilities)?
If Yes: _ 1
i. Estimate methane generation in tons/year(metric):
ii.Describe any methane capture,control or elimination measures included in project design(e.g.,combustion to generate heat or
electricity,flaring):
i.Will the proposed action result in the release of air pollutants from open-air operations or processes,such as ❑Yes®No
quarry or landfill operations?
If Yes:Describe operations and nature of emissions(e.g.,diesel exhaust,rock particulates/dust):
j.Will the proposed action result in a substantial increase in traffic above present levels or generate substantial ®Yes❑No
new demand for transportation facilities or services?
If Yes:
i. When is the peak traffic expected(Check all that apply): m Morning VI Evening ❑Weekend ITE 29 trips/hr max
❑Randomly between hours of to
ii. For commercial activities only,projected number of semi trailer truck trips/day:
iii. Parking spaces: Existing Proposed 58 Net increase/decrease 58
iv.Does the proposed action include any shared use parking? ❑Yes®No
v. If the proposed action includes any modification of existing roads,creation of new roads or change in existing access,describe:
New Town Road proposed for the development
vi. Are public/private transportation service(s)or facilities available within 1/2 mile of the proposed site? ®Yes❑No
vii Will the propbsed action include access to public transportation or accommodations for use of hybrid,electric ❑Yes®No
or other alternative fueled vehicles?
viii.Will the proposed action include plans for pedestrian or bicycle accommodations for connections to existing ®Yes❑No
pedestrian or bicycle routes?
k.Will the proposed action(for commercial or industrial projects only)generate new or additional demand ®Yes❑No
for energy?
If Yes:
i. Estimate annual electricity demand during operation of the proposed action:
17,720 kWh
ii. Anticipated sources/suppliers of electricity for the project(e.g.,on site combustion,on-site renewable,via grid/local utility,or
other):
National Grid Power Company
iii. Will the proposed action require a new,or an upgrade to,an existing substation? ❑Yes®No
1.Hours of operation. Answer all items which apply.
i. During Construction: ii. During Operations:
• Monday-Friday: 7am-6pm • Monday-Friday: n/a
• Saturday: 7am-6pm • Saturday: n/a
• Sunday: • Sunday: n/a
• Holidays: • Holidays: n/a
I
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m.Will the proposed action produce noise that will exceed existing ambient noise levels during construction, Yes❑No
operation,or both?
If yes:
i. Provide details including sources,time of day and duration:
Daytime construction activity will create noise above ambient levels
1
ii. Will proposed action remove existing natural barriers that could act as a noise barrier or screen? Pi Yes❑No
Describe: Project proposes to remove onsite vegetation
n.. Will the proposed action have outdoor lighting? Yes❑No
If yes:
i. Describe source(s),location(s),height of fixture(s),direction/aim,and proximity to nearest occupied structures:
Project includes proposed street lighting with downcast cutoff fixtures pole mounted at 2oft+/-AGL
ii. Will proposed action remove existing natural barriers that could act as a light barrier or screen? mYes❑No
Describe:Project proposes to remove onsite vegetation
o.Does the proposed action have the potential to produce odors for more than one hour per day? ❑Yes INo
If Yes,describe possible sources,potential frequency and duration of odor emissions,and proximity to nearest
occupied structures:
p.Will the proposed action include any bulk storage of petroleum(combined capacity of over 1,100 gallons) ❑Yes ONo
or chemical products 185 gallons in above ground storage or any amount in underground storage?
If Yes:
i.Product(s)to be stored
ii. Volume(s) per unit time (e.g.,month,year)
iii. Generally describe proposed storage facilities:
1
q.Will the proposed action(commercial,industrial and recreational projects only)use pesticides(i.e.,herbicides, ❑Yes ViNo
insecticides)during construction or operation?
If Yes:
i. Describe proposed treatment(s):
ii. Will the proposed action use Integrated Pest Management Practices? ❑ Yes ❑No
r.Will the proposed action(commercial or industrial projects only)involve or require the management or disposal gl Yes ❑No
of solid waste(excluding hazardous materials)?
If Yes:
i. Describe any solid waste(s)to be generated during construction or operation of the facility:
• Construction: 10 tons per month (unit of time)
• Operation : 4 tons per month (unit of time)
ii. Describe any proposals for on-site minimization,recycling or reuse of materials to avoid disposal as solid waste:
• Construction:Construction materials will be recycled when possible
• Operation: Local trash services will include recycling pickup
iii. Proposed disposal methods/facilities for solid waste generated on-site:
• Construction:Residential Street/Curb Side Trash Service
• Operation: Residential Street/Curb Side Trash Service
Page 8 of 13
s.Does the proposed action include construction or modification of a solid waste management facility? ❑Yes 0 No
If Yes:
i. Type of management or handling of waste proposed for the site(e.g.,recycling or transfer station,composting,landfill,or
other disposal activities):
ii. Anticipated rate of disposal/processing:
• Tons/month,if transfer or other non-combustion/thermal treatment,or
• Tonsthour,if combustion or thermal treatment
iii. If landfill,anticipated site life: years
t.Will proposed fiction at the site involve the commercial generation.treatment,storage,or disposal of hazardous ❑Yes®No
waste?
If Yes:
i. Name(s)of all hazardous wastes or constituents to be generated,handled or managed at facility:
ii. Generally describe processes or activities involving hazardous wastes or constituents:
iii. Specify amount to be handled or generated tons/month
iv. Describe any proposals for on-site minimization,recycling or reuse of hazardous constituents:
v. Will any hazardous wastes be disposed at an existing offsite hazardous waste facility? ❑YesONo
If Yes: provide name and location of facility:
If No: describe proposed management of any hazardous wastes which will not be sent to a hazardous waste facility:
E.Site and Setting of Proposed Action
E.1.Land uses on and surrounding the project site
a.Existing land uses.
i.Check all uses that occur on,adjoining and near the project site.
❑ Urban 0 Industrial 0 Commercial 0 Residential(suburban) ❑ Rural(non-farm)
0 Forest ❑ Agriculture 0 Aquatic ❑ Other(specify):
ii. If mix of uses,generally describe:
Sweet Road is transition road between residential neighborhoods and intense commercial uses on Route 9
b.Land uses and covertypes on the project site.
Land use or Current Acreage After Change
Covertype Acreage Project Completion (Acres—.'-)
• Roads,buildings, and other paved or impervious
surfaces 3.75
• Forested 19.91 13.67
• Meadows,grasslands or brushlands(non-
agricultural, including abandoned agricultural)
• Agricultural
(includes active orchards,field,greenhouse etc.)
• Surface water features
(lakes,ponds, streams,rivers,etc.)
• Wetlands(freshwater or tidal) 0.02 0.02
• Non-vegetated(bare rock,earth or fill)
• Other
Describe:Mi 1 ng Pit/Open Space/Lawn 9.56(borrow pit) 1 p (open
space/lawn)
n
Page 9 of 13
c. Is the project site presently used by members of the community for public recreation? ❑Yes❑No
i. If Yes:explain:
d.Are there any facilities serving children,the elderly,people with disabilities(e.g.,schools,hospitals,licensed ❑Yes®No
day care centers,or group homes)within 1500 feet of the project site?
If Yes,
i. Identify Facilities:
e.Does the project site contain an existing dam? ❑Yes®No
If Yes:
i. Dimensions t•f the dam and impoundment:
• Dam height: feet
• Dam length: feet
• Surface area: acres
• Volume impounded: gallons OR acre-feet
ii. Dam's existing hazard classification:
iii.Provide date and summarize results of last inspection:
f.Has the project site ever been used as a municipal,commercial or industrial solid waste management facility, ❑Yes®No
or does the project site adjoin property which is now,or was at one time,used as a solid waste man agement facility?
If Yes:
i.Has the facility been formally closed? ❑Yes❑ No
• If yes,cite sources/documentation:
ii. Describe the location of the project site relative to the boundaries of the solid waste management facility:
iii. Describe any development constraints due to the prior solid waste activities:
g.Have hazardous wastes been generated,treated and/or disposed of at the site,or does the project site adjoin ❑Yes®No
property which is now or was at one time used to commercially treat, store and/or dispose of ha7nrdous waste?
If Yes:
i. Describe waste(s)handled and waste management activities,including approximate time when activities occurred:
h. Potential contamination history. Has there been a reported spill at the proposed project site,or have any Yes No
remedial actions been conducted at or adjacent to the proposed site?
If Yes:
i. Is any portion of the site listed on the NYSDEC Spills Incidents database or Environmental Site ❑Yes❑No
Remediation database? Check all that apply:
❑ Yes—Spills Incidents database Provide DEC ID number(s):
❑ Yes—Environmental Site Remediation database Provide DEC ID number(s):
❑ Neither database
ii. If site has been subject of RCRA corrective activities,describe control measures:
iii. Is the project within 2000 feet of any site in the NYSDEC Environmental Site Remediation database? ❑Yes❑No
If yes,provide DEC ID number(s):
iv. If yes to(i),(ii)or(iii)above,describe current status of site(s):
Page 10 of 13
v. Is the project site subject to an institutional control limiting property uses? ❑Yes®No
• If yes,DEC site ID number:
• Describe the type of institutional control(e.g.,deed restriction or easement):
• Describe any use limitations:
• Describe any engineering controls:
• Will the project affect the institutional or engineering controls in place? ❑Yes❑No
• Explain:
E.2. Natural Resources On or Near Project Site
a.What is the average depth to bedrock on the project site? >20 feet
b.Are there bedrock outcroppings on the project site? El
b.
If Yes,what.prolortion of the site is comprised of bedrock outcroppings? %
c.Predominant soil type(s)present on project site: Well drained LFS-oaB 93 %
Cobbly Sand-PoE,HnB 7 %
%
d.What is the average depth to the water table on the project site? Average: >13 feet
e.Drainage status of project site soils:El Well Drained: 100%of site
❑ Moderately Well Drained: %of site
❑ Poorly Drained %of site
f. Approximate proportion of proposed action site with slopes: ® 0-10%: 70 %of site
® 10-15%: 15 %of site
® 15%or greater: 15 %of site
g.Are there any unique geologic features on the project site? ®Yes❑No
If Yes,describe:Existing mine/borrow pit exists on the property which has been abandoned
h.Surface water features.
1. Does any portion of the project site contain wetlands or other waterbodies(including streams,rivers, ®Yes❑No
ponds or lakes)?
ii. Do any wetlands or other waterbodies adjoin the project site? ®Yes❑No
If Yes to either i or ii,continue. If No,skip to E.2.i.
iii. Are any of the wetlands or waterbodies within or adjoining the project site regulated by any federal, ®Yes❑N°
state or locallagency?
iv.For each identified regulated wetland and waterbody on the project site,provide the following information:
• Streams: Name Classification
• Lakes or Ponds: Name Classification
• Wetlands: Nameun-named wetland Approximate Size 0.02 ac
• Wetland No.(if regulated by DEC)
v. Are any of the above water bodies listed in the most recent compilation of NYS water quality-impaired ❑Yes EINo
waterbodies?
If yes,name of impaired water body/bodies and basis for listing as impaired:
i.Is the project site in a designated Floodway? ❑Yes®No
j.Is the project site in the 100 year Floodplain? ❑Yes®No
k.Is the project site in the 500 year Floodplain? ❑YesEINo
1.Is the project site located over,or immediately adjoining,a primary',principal or sole source aquifer? ['Yes No
If Yes:
i.Name of aquifer:
Page 11 of 13
1
m. Identify the predominant wildlife species that occupy or use the project site:
n.Does the project site contain a designated significant natural community? ❑Yes No
If Yes:
i. Describe the habitat/community(composition,function,and basis for designation):
ii. Source(s)of description or evaluation:
iii. Extent of community/habitat:
• Currently: acres
• Following completion of project as proposed: acres
• Gain or loss(indicate+or-): acres
o.Does project site contain any species of plant or animal that is listed by the federal government or NYS as ❑Yes®No
endangered or threatened,or does it contain any areas identified as habitat for an endangered or threatened species?
1
p. Does the project site contain any species of plant or animal that is listed by NYS as rare,or as a species of ❑Yes®No
special concern?
q.Is the project site or adjoining area currently used for hunting,trapping,fishing or shell fishing? ElYesIONo
If yes,give a brief description of how the proposed action may affect that use:
E.3. Designated Public Resources On or Near Project Site
a.Is the project site,or any portion of it,located in a designated agricultural district certified pursuant to ❑Yes®No
Agriculture and Markets Law,Article 25-AA, Section 303 and 304?
If Yes, provide county plus district name/number:
b.Are agricultural lands consisting of highly productive soils present? ❑Yes®No
L If Yes:acreage(s)on project site?
ii. Source(s)of soil rating(s):
c. Does the project site contain all or part of,or is it substantially contiguous to,a registered National ❑Yes®No
Natural Landitnark?
If Yes:
1. Nature of the natural landmark: ❑Biological Community ❑ Geological Feature
ii.Provide brief description of landmark,including values behind designation and approximate size/extent:
d.Is the project site located in or does it adjoin a state listed Critical Environmental Area? ❑Yes®No
If Yes:
i. CEA name:
ii.Basis for designation:
iii. Designating agency and date:
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1
e.Does the project site contain,or is it substantially contiguous to,a building,archaeological site,or district ❑Yes No
which is listed on,or has been nominated by the NYS Board of Historic Preservation for inclusion on,the
State or National Register of Historic Places?
If Yes:
i. Nature of historic/archaeological resource: ['Archaeological Site 0Historic Building or District
ii. Name:
iii. Brief description of attributes on which listing is based:
f.Is the project site,or any portion of it,located in or adjacent to an area designated as sensitive for ❑Yes®No
archaeological sites on the NY State Historic Preservation Office(SHPO)archaeological site inventory?
g.Have additional archaeological or historic site(s)or resources been identified on the project site? ❑Yes®No
If Yes:
i.Describe possible resource(s):
ii. Basis for identification:
h.Is the project site within fives miles of any officially designated and publicly accessible federal,state,or local ❑Yes21No
scenic or aesthetic resource?
If Yes:
i. Identify resource:
ii.Nature of,oil basis for,designation(e.g.,established highway overlook, state or local park,state historic trail or scenic byway,
etc.):
iii. Distance between project and resource: miles.
i. Is the project site located within a designated river corridor under the Wild,Scenic and Recreational Rivers ❑Yes®No
Program 6 NYCRR 666?
If Yes:
i. Identify the name of the river and its designation:
ii. Is the activity consistent with development restrictions contained in 6NYCRR Part 666? ❑Yes❑No
F.Additional Information
Attach any additional information which may be needed to clarify your project.
If you have identified any adverse impacts which could be associated with your proposal,please describe those impacts plus any
measures which you propose to avoid or minimize them.
G. Verification
I certify that the information provided is true to the best of my knowledge.
Applicant/Spon Name Daniel W. Ryan P.E. Date 10/15/13
Signature / Title Agent
PRINT FORM Page 13 of 13
Full Environmental Assessment Form
Part 2-Identification of Potential Project Impacts
Part 2 is to be completed by the lead agency. Part 2 is designed to help the lead agency inventory all potential resources that could
be affected by a proposed project or action. We recognize that the lead agency's reviewer(s)will not necessarily be environmental
professionals. So,the questions are designed to walk a reviewer through the assessment process by providing a series of questions that
can be answered using the information found in Part 1. To further assist the lead agency in completing Part 2,the form identifies the
most relevant questions in Part 1 that will provide the information needed to answer the Part 2 question. When Part 2 is completed,the
lead agency will have identified the relevant environmental areas that may be impacted by the proposed activity.
If the lead agency is a state agency and the action is in any Coastal Area,complete the Coastal Assessment Form before proceeding
with this assessment.
Tips for completing Part 2:
• Review all of the information provided in Part 1.
• Review any application,maps,supporting materials and the Full EAF Workbook.
• Answer each of the 18 questions in Part 2.
• If you answer"Yes"to a numbered question,please complete all the questions that follow in that section.
• If you answer"No"to a numbered question,move on to the next numbered question.
• Check appropriate column to indicate the anticipated size of the impact.
• Proposed projects that would exceed a numeric threshold contained in a question should result in the reviewing agency
checking the box"Moderate to large impact may occur."
• The reviewer is not expected to be an expert in environmental analysis.
• Ifyolt are not sure or undecided about the size of an impact,it may help to review the sub-questions for the general
question and consult the workbook.
• When answering a question consider all components of the proposed activity,that is,the"whole action".
• Consider the possibility for long-term and cumulative impacts as well as direct impacts.
• Answer the question in a reasonable manner considering the scale and context of the project.
1. Impact on Land
Proposed action may involve construction on, or physical alteration of, ❑ NO ❑ YES
the land surface of the proposed site. (See Part 1.D.1)
If"Yes", answer questions a-j. If"No", move on to Section 2.
Relevant No,or Moderate
Part I small to large
Question(s) impact impact may
may occur occur
a.The proposed action may involve construction on land where depth to water table is E2d ❑ ❑
less than 3 feet.
b.The proposed action may involve construction on slopes of 15%or greater. Elf ❑ ❑
c.The proposed action may involve construction on land where bedrock is exposed,or E2a ❑ ❑
generally within 5 feet of existing ground surface.
d.The proposed action may involve the excavation and removal of more than 1,000 tons D2a ❑ ❑
of natural material.
e.The proposed action may involve construction that continues for more than one year Dle ❑ ❑
or in multiple phases.
f.The proposed action may result in increased erosion,whether from physical D2e,D2q ❑ ❑
disturbance or vegetation removal(including from treatment by herbicides).
g.The proposed action is,or may be, located within a Coastal Erosion hazard area. B1 i ❑ ❑
h.Other impacts: ❑ ❑
Page 1 of 10
2. Impact on Geological Features
The proposed action may result in the modification or destruction of,or inhibit
access to,any unique or unusual land forms on the site(e.g., cliffs, dunes, ❑ NO ❑ YES
minerals,fossils, caves). (See Part 1.E.2.g)
If"Yes", answer questions a-c. If"No", move on to Section 3.
Relevant No,or Moderate
Part I small to large
Question(s) impact impact may
may occur occur
a.Identify the specific land form(s)attached: E2g ❑ ❑
b.The proposed action may affect or is adjacent to a geological feature listed as a E3c ❑ ❑
registered National Natural Landmark.
Specific feature:
c. Other impacts: ❑ ❑
3. Impacts on Surface Water
The proposed action may affect one or more wetlands or other surface water ❑NO ❑ YES
bodies(e.g., streams,rivers,ponds or lakes). (See Part 1. D.2,E.2.h)
If"Yes', answer questions a-1. If"No", move on to Section 4.
Relevant No,or Moderate
Part I small to large
Question(s) impact impact may
may occur occur
a.The proposed action may create a new water body. D2b,Dlh ❑ ❑
b.The proposed action may result in an increase or decrease of over 10%or more than a D2b ❑ ❑
10 acre increase or decrease in the surface area of any body of water.
c.The proposed action may involve dredging more than 100 cubic yards of material D2a ❑ ❑
from a wetland or water body.
d.The proposed action may involve construction within or adjoining a freshwater or E2h ❑ ❑
tidal wetland,or in the bed or banks of any other water body.
e.The proposed action may create turbidity in a waterbody,either from upland erosion, D2a,D2h ❑ ❑
runoff or by disturbing bottom sediments.
f.The proposed action may include construction of one or more intake(s)for withdrawal D2c ❑ ❑
of water from surface water.
g.The proposed action may include construction of one or more outfall(s)for discharge D2d ❑ ❑
of wastewater to surface water(s).
h.The proposedlaction may cause soil erosion,or otherwise create a source of D2e ❑ ❑
stormwat l discharge that may lead to siltation or other degradation of receiving
water bodies.
i.The proposed action may affect the water quality of any water bodies within or E2h ❑ ❑
downstream of the site of the proposed action.
j.The proposed action may involve the application of pesticides or herbicides in or D2q,E2h ❑ ❑
around any water body.
k.The proposed action may require the construction of new,or expansion of existing, Dla,D2d ❑ ❑
wastewater treatment facilities.
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1.Other impacts: ❑ ❑
4. Impact-on groundwater
The proposed action may result in new or additional use of ground water, or ❑ NO ❑ YES
may have the potential to introduce contaminants to ground water or an aquifer.
(See Part 1. D.2.a.D.2.c,D.2.d,D.2.p,D.2.q,D.2.t)
If"Yes", answer questions a-h. If"No", move on to Section 5.
Relevant No,or Moderate
Part I small to large
Question(s) impact impact may
may occur occur
a.The proposed action may require new water supply wells,or create additional demand D2c ❑ ❑
on supplies from existing water supply wells.
b.Water supply demand from the proposed action may exceed safe and sustainable D2c ❑ ❑
withdrawal capacity rate of the local supply or aquifer.
Cite Source:
c.The proposed action may allow or result in residential uses in areas without water and D l a,D2c ❑ ❑
sewer services.
d.The proposed action may include or require wastewater discharged to groundwater. D2d,E2l ❑ ❑
e.The proposed action may result in the construction of water supply wells in locations D2c,Elf, ❑ ❑
where groundwater is,or is suspected to be,contaminated. Elg,Elh
f.The proposed action may require the bulk storage of petroleum or chemical products D2p,E21 ❑ ❑
over ground water or an aquifer.
g.The proposed action may involve the commercial application of pesticides within 100 E2h,D2q, ❑ ❑
feet of potable drinking water or irrigation sources. E21,D2c
h. Other impacts: ❑ ❑
5. Impact on Flooding
The proposed action may result in development on lands subject to flooding. ❑ NO ❑ YES
(See Part 1. E.2)
If"Yes", answer questions a-g. If"No", move on to Section 6.
Relevant No,or Moderate
Part I small to large
Question(s) impact impact may
may occur occur
a.The proposed action may result in development in a designated floodway. E2i ❑ ❑
b.The proposed action may result in development within a 100 year floodplain. E2j ❑ ❑
c.The proposed action may result in development within a 500 year floodplain. E2k ❑ ❑
1
d.The proposed action may result in,or require,modification of existing drainage D2b,D2e ❑ ❑
patterns.
e.The proposed action may change flood water flows that contribute to flooding. D2b,E2i, ❑ ❑
E2j,E2k
f.If there is a dam located on the site of the proposed action,the dam has failed to meet E I e ❑ ❑
one or more safety criteria on its most recent inspection.
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g.Other impacts:
❑ ❑
6. Impacts on Air
The proposed action may include a state regulated air emission source. ❑NO ❑ YES
(See Part 11.D.2.f., D,2,h,D.2.g)
If"Yes , answer questions a-f. If"No", move on to Section 7.
Relevant No,or Moderate
Part I small to large
Question(s) impact impact may
may occur occur
a.If the proposed action requires federal or state air emission permits,the action may
also emit one or more greenhouse gases at or above the following levels:
i. More than 1000 tons/year of carbon dioxide(CO2) D2g ❑ ❑
ii. More than 15 tons/year of nitrous oxide(N20) D2g ❑ ❑
iii.More than 1000 tons/year of carbon equivalent of perfluorocarbons(PFCs) D2g ❑ ❑
iv.More than .045 tons/year of sulfur hexafluoride(SF6) D2g ❑ ❑
v. More than 1000 tons/year of carbon dioxide equivalent of D2g ❑ ❑
hydrochloroflurocarbons(HCFCs)emissions
vi.43 tons/year or more of methane D2h ❑ ❑
b.The proposed action may generate 10 tons/year or more of any one designated D2g ❑ ❑
hazardous air pollutant,or 25 tons/year or more of any combination of such hazardous
air pollutants.
c.The proposed action may require a state air registration,or may produce an emissions D2f,D2g ❑ ❑
rate of total contaminants that may exceed 5 lbs. per hour,or may include a heat
source capable of producing more than 10 million BTU's per hour.
d.The proposed action may reach 50%of any two or more of the thresholds in"a" DIg,D2k ❑ ❑
through"c",fbove.
e.The proposed action may result in the combustion or thermal treatment of more than 1 D2s ❑ ❑
ton of refuse per hour.
f.Other impacts: ❑ ❑
7. Impact on Plants and Animals
The proposed action may result in a loss of flora or fauna. (See Part 1. E.2. m.-q.) ❑ NO ❑ YES
If"Yes", answer questions a-j. If"No", move on to Section 8.
Relevant I No,or Moderate
Part I small to large
Question(s) impact impact may
may occur occur
a.The proposed action may cause reduction in population or loss of individuals of any E2o ❑ ❑
threatened or endangered species,as listed by New York State or the Federal
government,that use the site,or are found on,over,or near the site.
b.The proposed action may result in a reduction or degradation of any habitat used by E2o ❑ ❑
any rare,threatened or endangered species,as listed by New York State or the federal
government.
c.The proposed action may cause reduction in population,or loss of individuals,of any E2p ❑ ❑
species of special concern or conservation need,as listed by New York State or the
Federal government,that use the site,or are found on,over,or near the site.
d.The proposed action may result in a reduction or degradation of any habitat used by E2p ❑ ❑
any species of special concern and conservation need,as listed by New York State or
the Federal government.
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