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Full Environmental Assessment Form Part 1 -Projec,f 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 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;indicate whether missing information does not exist, or is not reasonably 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: 1rp�'�ES. LGC —DU�SI,�Q 2oNl11lL� C Project Location(describe,and attach a general location map):EQ 2 ,3_0 AIA1AI E- 422�17) CoVEGNO&U /1/. /!9.35" Brief Description of Proposed Action(include purpose or need): ,t�E�r1 2�Jit?E CNAitJG� /Z off R- 4 o 7 o (8V /c%= Name of Applicant/Sponsor: Telephone-, 65•x} d 9 0? E-M it K C Z 69 Address: City/PO: State: ZiX/C de: soU L _ !! 771 Project Contact(if not same as sponsor;give name and title/role): Telephone: E-Mail: Address: City/PO: State: Zip Code: Property Owner (if not same as sponsor): Telephone: P1EpT1zcS LL C E-Mail: Address: p� p City/PO: ��G J State: Zip Co r J Page 1 of 13 r RESET FORM 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: Idenfify Agency and Approvals) Application Date Required (Actual or projected) a.City Council,Town Board, Yesi--No ",XA40/Ll 6*7� 1-0 CL®D or Village Board of Trustees b.City,Town or Village ❑YesgNo Planning Board or Commission C.City Council,Town or ❑Yes[KNo Village Zoning Board of Appeals _ d.Other local agencies ❑YesgNo e.County agencies ❑Yes No f.Regional agencies ❑YesWNo g.State agencies ❑YesXNo _ 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? ❑YesjoNo If Yes, ii. is the project site located in a community with an approved Local Waterfront Revitalization Program? (6YesF-lNo fii. Is the project site within a Coastal Erosion Hazard Area? ❑YesoNo C. Planning and Zoning C.I.Planning and zoning actions. Will administrative or legislative adoption,or amendment of a plan,local law,ordinance,rule or regulation be the Yes❑No 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 I 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 ❑YesXNo would bFBrownfield located? ite of the proposed action within any local or regional special planning district(for example: Greenway ❑YesXNo Opportunity Area(BOA); designated State or Fedetal heritage area;watershed management plan; r?) entify the plan(s): c. Is the proposed action located wholly or partially within an area listed in an adopted municipal open space plan, E3YesDjrNo or an adopted municipal farmland protection plan? If Yes, identify the plan(s): Page 2 of 13 RESET FORM C.3. Zoning a. Is the site of the proposed action located in a municipality with an adopted zoning law or ordinance. XYes(]No If Yes,what is the zoning classification(s) including any applicable overlay district? b. Is the use permitted or allowed by a special or conditional use permit? WYes(]No c.Is a zoning change requested as part of the proposed action? OYesE]No If Yes, i What is the proposed new zoning for the site? Gt�/Y�.24L B1�a5/ �B� CA. Existing community services. a. In what school district is the project site located? i!��,CTUC✓G me� /5,7 b. What police or other public protection forces serve the project site'? i UW/✓ a r mJ VOG,a Raaf DSP c. Which fire protection and emergency medical services serve the project site? d. What parks serve the project site? D.Project Details D.I.Proposed and Potential Development r� a.What is the general nature of the proposed action(e.g.,residential,industrial,commercial,recreational;if mixed,include all components)? b.a.Total acreage of the site of the proposed action? acres b.Total acreage to be physically disturbed? O acres c.Total acreage(project site and any contiguous properties)owned or controlled by the applicant or project sponsor? — 8 _ acres c.Is the proposed action an expansion of an existing project or use? ❑YeXN o i 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? CIYesWo If Yes, L Purpose or type of subdivision?(e.g.,residential,industrial,commercial; if mixed,specify types) ii. Is a cluster/conservation layout proposed? ❑Yes Wo- -iii.Number of lots proposed? _ iv. Minimum and maximum proposed lot sizes? Minimum Maximum_ e.Will proposed action be constructed in multiple phases? El YesDirNo L If No,anticipated period of construction: months it If Yes: • Total number of phases anticipated • Anticipated commencement date of phase 1 (including demolition) month year • Anticipated completion date of final phase month _wear • 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 RESET FORM Ff. Does the project include new res IfYes,show numbers of units proposed. ❑YesUrNo One Family Two Family Three Family Multiple Fancily.four ormorel Initial Phase At completion — of all phases g.Does the proposed action include new non-residential construction.(including expansions)? ❑Ye No If Yes, i.Total number of structures fl. Dimensions(in feet)of largest proposed structure: height; width; and _ length iii Approximate extent of building space to be heated of cooled: square feet Fh-Does, the proposed action include construction or other activities that will result in the impoundment of any ❑Yes No ds,such as creation of a water supply,reservoir,pond,lake,waste lagoon or other storage? pose of the impoundment: . a water impoundment,the principal source of the wate—r 0 Ground water[]Surface water streams ❑Other specify: Iii. If other than water, 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 o (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 Describe nature and characteristics of materials to be excavated er dredged,and plans to use,manage or dispose of them. iv. Will there be onsite dewatering or processing of excavated materials? If yes,describe. ❑Yes No v What is the total area to be dredged or excavated? _ vi. What is the maximum area to be worked at any one time? ,acres vii What would be the maximum depth of excavation or dredging? __acres viii. Will the excavation require blasting? — _feet ix Summarize site reclamation goals and plan: ❑Yes�No b. Would the proposed action cause or result in alteration of, increase or decrease in size of,or encroachment Te Q Fo 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): Page 4 of 13 RESET FORM it 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 proposed to be removed _ • 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 i eel amation/m itigation following disturbance: c. Will the proposed action use,or create a new demand for water? ❑Yes o If Yes. i. Total anticipated water usage/demand per day: gallons/day ii Will the proposed action obtain water from an existing public water supply? ❑YesP!gNo If Yes: • Name of district or service area: _ • 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? ❑YesXNo • Do existing lines serve the project site? $IYes❑No id Will line extension within an existing district be necessary to supply the project? ❑Yes Wo If Yes: • Describe extensions or capacity expansions proposed to serve this project: • Source(s)of supply for the 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? ❑YesC9No If Yes: i Total anticipated liquid waste generation per day: _ gallons/day ti Nature of liquid wastes to be generated(e.g.,sanitary wastewater, industrial; if combination,describe all components and approximate volumes or proportions of each): Iii. Will the proposed action use any existing public wastewater treatment facilities? EE3YesXNo If Yes: • Name of wastewater treatment plant to be used: • Name of district: • Does the existing wastewater treatment plant have capacity to serve the project? ❑YesXNo • Is the project site in the existing district? ❑Yeslo • Is expansion of the district needed? ❑YesWNo Page 5 of 13 RESET FORM • Do existing sewer lines serve the project site? ❑YesNo • Will line extension within an existing district be necessary to serve the project? ❑Yes No If Yes: • 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: • Date application submitted or anticipated: • What is the receiving water for the wastewater discharge? 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 ❑Yeswo 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 acres(impervious surface) Square feet or acres(parcel size) ii. Describe types of new point sources. 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)? • If to surface waters,identify receiving water bodies or wetlands: • 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? ❑YesRfNo f. Does the proposed action include,or will it use on-site,one or more sources of air emissions,including fuel ❑Yes;oNo combustion,waste incineration,or other processes or operations? If Yes, identify: 1.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) W. 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, ❑Yes No or Federal Clean Air Act Title IV or Title V Permit? If Yes: i Is the project site located in an Air quality non-attainment area? (Area routinely or periodically fails to meet ❑YesgNo ambient air quality 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(N20) • Tons/year(short tons)of Perfluorocarbons(PFCs) • _ Tons/year(short tons)of Sulfur Hexafluoride(3176) • _ Tons/year(short tons)of Carbon Dioxide equivalent of Hydroflourocarbons(HFCs) • Tons/year(short tons)of Hazardous Air Pollutants(HAPS) Page 6 of 13 F RESET FORM h.Will the proposed action generate or emit methane(including,but not limited to,sewage treatment plants, ❑Yes;KNo landfills,composting facilities)? If Yes. i Estimate methane generation in tons/year(metric): h. 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 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): ❑Morning ❑ Evening ❑Weekend ❑Randomly between hours of to ii. For commercial activities only,projected number of semi-trailer truck trips/day: iii Parking spaces: Existing_ Proposed Net increase/decrease iv Does the proposed action include any shared use parking? []Yes5rNo v If the proposed action includes any modification of existing roads,creation of new roads or change in existing access,describe: vi. Are public/private transportation service(s)or facilities available within %:mile of the proposed site? %Yes[]No via Will the proposed action include access to public transportation or accommodations for use of hybrid,electric ❑Yes1ft21No or other alternative fueled vehicles? viii. Will the proposed action include plans for pedestrian or bicycle accommodations for connections to existing ❑YestgNo pedestrian or bicycle routes? k.Will the proposed action(for commercial or industrial projects only)generate new or additional demand []YeslgNo for energy? If Yes: i. Estimate annual electricity demand during operation of the proposed action: ii. Anticipated sources/suppliers of electricity for the project(e.g.,ori-site combustion,on-site renewable,via grid/local utility,or other): 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: U. During Operations: • Monday-Friday: _ • Monday-Friday: • Saturday: • Saturday: • Sunday: Sunday: • Holidays: • Holidays: Page 7 of 13 RESET FORM M. Will the proposed action produce noise that will exceed existing ambient noise levels during construction, ❑Yes No operation,or both? If yes: L Provide details including sources,time of day and duration: H. Will proposed action remove existing natural barriers that could act as a noise barrier or screen? ❑Yes 91NO Describe: n.. Will the proposed action have outdoor lighting? ❑Yes5jTNo If yes: L Describe source(s),location(s),height of fixture(s),direction/aim,and proximity to nearest occupied structures: ii. Will proposed action remove existing natural barriers that could act as a light barrier or screen? ❑Yes WNo Describe: o. Does the proposed action have the potential to produce odors for more than one hour per day? ❑Yes Mo 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 No or chemical products(185 gallons in above ground storage or an amount in underground storage)? If Yes: L Product(s)to be stored U. Volume(s) per unit time (e.g.,month,'year) W. Generally describe proposed storage facilities: q.Will the proposed action(commercial,industrial and recreational projects only)use pesticides(i.e.,herbicides, ❑Yes XNo insecticides)during construction or operation? If Yes: L 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 ❑ 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: _ tons per (unit of time) • Operation : tons per (unit of time) fl. Describe any proposals for on-site minimization,recycling or reuse of materials to avoid disposal as solid waste: • Construction: • Operation: iii Proposed disposal methods/facilities for solid waste generated on••site: • Construction: • Operation: Page 8 of 13 CRESET FORM s. Does the proposed action include construction or modification of a solid waste management facility? ❑ Yes P9 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-combustioiVthennal treatment,or • Tons/hour,if combustion or thermal treatment iri. If landfill,anticipated site life:` years t. Will proposed action at the site involve the commercial generation,treatment,storage,or disposal of hazardous ❑YesoNo 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? Yes No 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.I.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 ❑ Industrial Commercial ❑ Residential(suburban) ❑ Rural(non-farm) ❑ Forest ❑ Agriculture ❑ Aquatic ❑ Other(specify):_ A If mix of uses,generally describe: 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 • Forested • Meadows,grasslands or brushlands(non- agricultural,including abandoned agricultural) 0 • Agricultural O (includes active orchards,field,greenhouse etc.) • Surface water features O (lakes,ponds,streams,rivers,etc.) • Wetlands(freshwater or tidal) • Non-vegetated(bare rock,earth or fill) • Other Describe: Page 9 of 13 RESET FORM c. Is the project site presently used by members of the community for public recreation? ❑Yes No L 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, L Identify Facilities: e.Does the project site contain an existing dam? ❑YesgNo If Yes: i. Dimensions of the dam and impoundment: O Dam height: feet O Dam length: feet O Surface area: acres U Volume impounded: _gallons OR acre-feet U. Dam's existing hazard classification: W. 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 management facility? If Yes: L Has the facility been formally closed? El Yes[] No • If yes,cite sources/documentation: U. 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 hazardous 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: L Is any portion of the site listed on the NYSDEC Spills Incidents database or Environmental Site ❑YesKNo 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: W. 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 r RESET FORM 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? ❑Ye No • Explain: E.2. Natural Resources On or Near Project Site a.What is the average depth to bedrock on the project site? feet b.Are there bedrock outcroppings on the project site? If Yes,what proportion of the site is comprised of bedrock outcroppings? % ❑Yes No c.Predominant soil type(s)present on project site: d. What is the average depth to the water table on the project site? Average: feet e.Drainage status of project site soils:❑ Well Drained: %of site Moderately Well Drained: Lffl_%of site ❑ Poorly Drained %of site f.Approximate proportion of proposed action site with slopes: 5d0-10%: _Jj60%of site ❑ 10-15%: %of site ❑ 15%or greater: %of site g.Are there any unique geologic features on the project site? ❑Yes If Yes,describe: o h.Surface water features. — i. Does any portion of the project site contain wetlands or other water bodies(including streams,rivers, ponds or lakes)? ❑Yes�No ii. Do any wetlands or other waterbodies adjoin the project site? If Yes to either i or ii,continue. If No,skip to E.2.i. ❑1`es�'No Hi. Are any of the wetlands or waterbodies within or adjoining the project site regulated by any federal, state or local agency? ❑Yesto 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: Name Approximate Size • 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 ED Yes Wo 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 — _ _ Yes�Io j.Is the project site in the 100 year Floodplain? _ ❑Yes o k. Is the project site in the 500 year Floodplain? ❑Yeslo I. Is the project site located over,or immediately adjoining,a primary,principal or sole source aquifer? ❑Yes( 10 If Yes: i Name of aquifer: Page 1 1 of 13 C RESET' FORM m. Identify the predominant wildlife species that occupy or use the roject site: A/C n.Does the project site contain a designated significant natural community? ElYes-iWo If Yes: i. Describe the habitat/community(composition,function,and basis for designation): fl. Source(s)of description or evaluation: W. Extent of cornmunity/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? p. Does the project site contain any species of plant or animal that is listed by NYS as rare,or as a species of 0YesDUNo special concern? q.Is the project site or adjoining area currently used for hunting,trapping,fishing or shell fishing? Elyesg<No 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 o i. 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 ❑YesXNo Natural Landmark? If Yes: i. 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? ❑YesDCNo If Yes: i. CEA name: ii Basis for designation: - iii. Designating agency and date: Page 12�Df 13 RESET FORM e. Does the project site contain,or is it substantially contiguous to,a building,archaeological site,or district O Ye 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: OArchaeological Site ❑Historic Building or District d 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 OYes%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? OYesbNo If Yes: i.Describe possible resource(s): ii. Basis for identification: h. Is the project site within five miles of any officially designated and publicly accessible federal,state,or local WesONo scenic or aesthetic resource? 1f Yes: ,J'OrIiS/DYIZGU dUNOS MlfX� CE,0.4X A44W IMII eek,fGl&iVAAV I#.-VDIVY& RAX le r Identify resource: &�,k,}`TM5 PA �� G��SX/ �illCfT�iq�'/�l<Si1/) ii Nature of,or basis for,designation(e.g.,established highway overlook,state or local park,state historic trail or scenic byway, etc.): V110 WN eA CQ At"_� iii Distance between project and resource: miles. L 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? -V A []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/Sponsor Name 4 A k7HA c fG_ Date 'PlIg 0/� Signature !��—ML _ Title PRINT FORM rage 13 of 13 [:RESET 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 sissist the lead agency in completing Part 2,the form identifies the most relevant questions in Pail I 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. • If you 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-tenn and cumulative impacts as well as direct impacts. • Answer the question in a reasonable manner considering the scale and context of the project. I. Impact on Land Proposed action may involve construction on, or physicall alteration of, %NO ❑YES the land surface of the proposed site. (See Part 1. D.1) I "Yes,", answer questions a j I No", move on to 7gec:tion _ xx :;! 2. F,i14 t�4'r { �`N ` . >•X-i Jan }�,1.�,n•,� _.,�,• 7' !k'"`..� >i.d G N••'� H`"[, o-YLi e• �n:f•rsr.•.{'. ..>��`f;i-1,gTyvt's.:ri`•'.•tr..�, ;rr� ..s�a�f2� LZ'"�s; 7 '�+, t�'�',:i ;JY r ,'Cx , r,K�., `� ", . Relevant P1 , Moderate S:r (' - f o or <�• .Y3`.: t Y,w S.: r)a.+ ;a tiny.•.� ?1;4. ; ;.''' i,, '., y �.,a•1 ,. c< 5�. E t= Part small to large yt;` v;rj.;`71 s 41 S'fie` CLI3tit ;3rd� P �°i Question(s) imp act impact may t` J' :,i h.0 3 t, .1a;;n ..75'�i,�•re:ti r« 3+zr,i S i i ^:Stiff... 'ks •� - f�+•-�.�: '�:� _ may occur occur a.The proposed action may involve construction on land where depth to water table is less than 3 feet. E2d ❑ ❑ 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 Eta ❑ ❑ generally within 5 feet of existing ground surface. _ d.The proposed action may involve the excavation and removal of more than 1,000 tons D2.a ❑ ❑ of natural material. e.The proposed action may involve construction that continues for more than one year D 1 e ❑ ❑ 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. B 1 i ❑ ❑ h.Other impacts: ❑ ❑ Page 1 of 10 C;ESET FORM 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) I "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 of her surface water ONO YES bodies(e.g.,streams,rivers, ponds or lakes). (See Part 1. D.2,E.21) 1 "Yes", answer questions a-1. If"No", move on to Section 4. = 'M' �:`s `gid' Relevant •; . No,or Moderate ;f' ,, :: 4•; �% :z .. '; s.>s�` Part I small to large 2�ztyY:: ,r_� "r�•h t•' 'A` :l.tlls',"y'}4 ;t '<< tl'tJ• ". y"r:r' r. i i Question(s) p impact impact may may occur occur a.The proposed action may create a new water body. 132b,Dlh p ❑ 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 ❑ Elof 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 proposed action may cause soil erosion,or otherwise create a source of D2e ❑ ❑ stormwater 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. Page 2 of 10 RESET FORM I.Other impacts: _ T ❑ ❑ 4. Impact on groundwater The proposed action may result in new or additional use of ground water, or gNO ❑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 S. = Relevant No,or Moderate t 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 1 a,D2c;sewer services. d.The proposed action may include or require wastewater discharged to groundwater. D2d,1321 ❑ e.The proposed action may result in the construction of water supply wells in locations D2c,EIf, ❑ where groundwater is,or is suspected to be,contaminated. Elg,l:lh f.The proposed action may require the bulk storage of petroleum or chemical products D2p,1321 ❑ 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: �q ❑ 5. Impact on Flooding — — The proposed action may result in development on lands subject to flooding. 9NO ❑YES (See Part 1. E.2) answer questions a- If"No" move on to Sec. ,cam _tion 6. !r,���,,,:; .,, r.F���, :�a;:•'' ;;, �: s', l-,:s..,,r: x.r4 Relevant 1`l0,or �• :�;�' '�, ti, _ �r• -7;��•,'' �:;;:,; ��; '•.:. ,�";::',� ;.,<'�.,,,::-;�,Y ,,��•��:�.� .'. 4:� Moderate �v`,'. ;';°. -i, t�' � V,•r4"s�,<,,I.�= r��•'",='E " �`.z�p-.,^�^� ,17y�crt�r ��S.sz .,�'�,` -u•. ,> ';�'1 '`�*, -;:�' .fs,, :jc ,-,.1� rw•,e i-^,,:,�.5%�:;.'`t;'s3-���%.'.,�':=}_� �/g'��C'rb,�;ylh�;4 i;�y..u� ,,+r�#.' Part 1[ Small to large F-"�. Kt _ 'i'..j. 1•',• ,�.. :' r ^�: n. _ }., `rev^.-`s;, �.�tTt,('ti 9,�'�i Q \uestion(s impact may act im act fi , J,,y�.i+�-� i��• � 'i•:,.g sS�, ,..,,-Y`.;,':,�T .;�'{y-��;r:.�,ntlt.^L :r�4�.�a's:�i,{}.;i.-�vuFc F.i1i'�1'�,� ) P P Y ».:�:Au;C.A�.�n{ta 4 `�_j.l�.•i'7+5''i2`S-.SIS<tr�-(� ��A h..S.r. \.YTyN.�. , ��•t 'cl"j,-F i` �}$E• .-}:b, L•r";S'xG.=-.•�.. YYr-._1.- ..�E t:d JY i?r 'T�'�••����aa Phi �.:t':• 1;:9.'f"w,:;r•+•• ma' occur occur a.The proposed action may result in development in a designated floodway. Eli ❑ ❑ 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 ❑ ❑ 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,Eli, ❑ ❑ E7_',E21< f. If there is a dam located on the site of the proposed action,is the dam in need of repair, E 1 e ❑ ❑ or upgrade? Page 3 of 10 F RESET FORM g.O 6. Impacts on Air _ The proposed action may include a state regulated air emission source. �NO DYES 7s Part 1. D.2.17., D,2,h, D.2.g) If"Yes", answer questions a-f. If"No", move on to Section 7. Relevant No,or Moderate ' r;= i;.tiJ,fcr,ya_lY � Parti small to large ,•,: rf_• Question(s) impact impact may -_ ma 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 3.5 tons/year of nitrous oxide(N20) D2g ❑ ❑ iii. More than 1000 tons/year of carbon equivalent of perfluorocat bons(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 ❑ ❑ hydrochloroflourocarbons(HFCs)emissions vi.43 tons/year or more of methane D2h ❑ El 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 rate of total contaminants that may exceed 5 lbs.per hour,or may include a heat D2f,D2g [] Ci source capable of producing more than 10 million BTU's per hour. d.The proposed action may reach 50%of any of the thresholds in"a"through"c", D2g ❑ above. e.The proposed action may result in the combustion or thermal treatment of more than I 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 1 "Yes", answer questions a-j, If`No", move on to Sec/ion �4r;.4.l^,�`-t,t�'•�t`,tkrP'2�:,L.'.12a!��,1t.'..r5s'J;.'•;e'tE,}f" `<'>,!kr:crr�)�;.;tyy..t�,��T.��;l�+n_-{:'�Ird;ol.,-`JZ1.Z'�i.'`t•i>-`,;:m`�7'.,7�=7y�,�5r�_:;k,tfY`;',��•i�.F�•�.�,yi�l,'::;=',,�i.i�#;v�`:r:'sV�._,,;�.` # Y �`rt,F,,#„,�•?'�f^qrs+ , ModRelevant or 'T erate A0 .r', ^it KIM, Part I small to large �'" ' ; ; •s ai, ..r: .; t {3>'� Question(s) impact impact may y'tM - ;r�r ,•;�� F� ;•< ma occur - occur a.The proposed action may cause reduction in population or loss of individuals of any E20 ❑ El 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 1hate 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. Page 4 ol210 RESET FORM e.The proposed action may diminish the capacity of a registered National Natural E3c ❑ ❑ Landmark to support the biological community it was establish(A to protect. f.The proposed action may result in the removal of,or ground disturbance in,any E2n ❑ ❑ portion of a designated significant natural community. Source: g.The proposed action may substantially interfere with nesting/breeding, foraging,or ❑ Elover-wintering habitat for the predominant species that occupy or use the project site. Elm h.The proposed action requires the conversion of more than 10 acres of forest, ❑ Elgrassland or any other regionally or locally important habitat. E16 Habitat type&information source: i.Proposed action(commercial,industrial or recreational projects, only)involves use of D2q ❑ ❑ herbicides or pesticides. j.Other impacts: El El 8. Impact on Agricultural Resources The proposed action may impact agricultural resources.-(See Part 1. E.3.a. and b.) MNO E]YES I "Yes", answer uestions a-h. I'`No", move on to Section 9. Relevant No,or Moderate ;i^ •,;ii;.:, r; r;;:' ,;. t, Part I small to large ', : cs •r;;�' r� ,•fir,_.:" :. =>s ;,•,, ,,s,'r _s Question(s) impact impact may <.<<' ;: ;i,• �,",- _ ,, may occur occur a.The proposed action may impact soil classified within soil group 1 through 4 of the E?.c,E3b ❑ ❑ NYS Land Classification System. b.The proposed action may sever,cross or otherwise limit access to agricultural land Ela,Elb ❑ ❑ (includes cropland,hayfields,pasture,vineyard,orchard,etc). c.The proposed action may result in the excavation or compaction of the soil profile of E3b ❑ ❑ active agricultural land. d.The proposed action may irreversibly convert agricultural land to non-agricultural E1b,E3a ❑ ❑ uses,either more than 2.5 acres if located in an Agricultural District,or more than 10 acres if not within an Agricultural District. e.The proposed action may disrupt or prevent installation of an agricultural land EI a,E1 b ❑ ❑ management system. f.The proposed action may result,directly or indirectly, in increased development C2c,C:3, ❑ ❑ potential or pressure on farmland. D2c,D2d g.The proposed project is not consistent with the adopted municipal Farmland C2c Cl ❑ th.Other tection Plan. impacts: ❑ ❑ Page 5 of 10 E-SET 9. Impact on Aesthetic Resources The land use of the proposed action are obviously different from, or are in XNO ❑YES sharp contrast to, current land use patterns between the proposed project and a scenic or aesthetic resource. (Part 1. E.t.a,E.Lb, E.3.h.) 1 "Yes", answeruestions a-g If`No", po to Section 10. - - Relevant No,or :impact erate Part I small arge "'. Question(s)�> Q (s) impact mayma occurur a. Proposed action may be visible from any officially designated federal,state,or local E3h El scenic or aesthetic resource. b.The proposed action may result in the obstruction,elimination or significant E3h,C2b ❑ [] screening of one or more officially designated scenic views. _ c.The proposed action may be visible from publicly accessible vantage points: E3h i. Seasonally(e.g.,screened by summer foliage,but visible during other seasons) ❑ [� ii. Year round ❑ C] d.The situation or activity in which viewers are engaged while viewing the proposed E3h action is: i. Routine travel by residents,including travel to and from work E2q' ii.Recreational or tourism based activities Ele ❑ ❑ ❑ ❑ e.The proposed action may cause a diminishment of the public enjoyment and E3h El appreciation of the designated aesthetic resource. f. There ate similar projects visible within the following distance of the proposed Dla,Ela, project: Dlf,Dlg ❑ El 0-1/2 mile %:-3 mile 3-5 mile 5+ mile g.Other impacts: ❑ ❑ 10. Impact on Historic and Archeological Resources The proposed action may occur in or adjacent to a historic or archaeological NO YES resource. (Part 1. E.3.e, f. and g.) If"Yes", answer questions a-e. If"No", go to Section 11. Relevant No or Mode '.. • ' ., ., ,,,. ,:. `-:'. .r" •` ,,•�:g• ; '�� '�_�:i,�,rt�:� Part I � rate small to large Q n(s) impact impact �,,: ,::. ^•y4:."-.r' � ir�$'r..;zy4`?,` �%aa'rr` , x+{'"�°' s i4 UCSt10may "•" ,::`.,•,_.:? ;.:'=c ';• ter;,(..r, ,;-.��t� .k-�. may occur occur a.The proposed action may occur wholly or partially within,or substantially contiguous De ❑ ❑ to,any buildings,archaeological site-or district 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. b.The proposed action may occur wholly or partially within,or substantially contiguous E3f El to,an area designated as sensitive for archaeological sites on the NY State Historic Preservation Office(SHPO)archaeological site inventory. c.The proposed action may occur wholly or partially within,or substantially contiguous E3g ❑ ❑ to,an archaeological site not included on the NY SHPO inventory. Source: Page 6 of 10 ER�T ��m d.Other impacts: _ ❑ Ele.1f any of the above(a-d)are answered"Yes",continue with the following questions to help support conclusions in Part 3: i. The proposed action may result in the destruction or alteration of all or part E3e E3 ❑ El the site or property. g' E3f ii. The proposed action may result in the alteration of the property's setting or E3e,EH, 11 Elintegrity. E3g, Ela, Elb iii. The proposed action may result in the introduction of visual elements which De,1:3f, ❑ Elare out of character with the site or property,or may alter its setting. E3g,E3h, C2,C3 11. Impact on Open Space and Recreation The proposed action may result in a loss of recreational opportunities or a NO ❑YES reduction of an open space resource as designated in any adopted municipal open space plan. (See Part 1, C.2.c, E.I.e., E.2.q.) I'"Yes", answer questions a-e I "No", o to Section 12. •fYa_ \ •�\z�5 _ yN u;.r `f '�S;}�(ti;:l,sars•'•`:ty.r r.'a Ytt Relevant '��',n=.�.,:;��i,�{•j t��'<' ��' ,..: .;,,;'-��. � . � , - - . '. '. :."� No,or Moderate ;: ._:,5.•,} ," �';rrr:•? ;i;':.. s>:fi.ti Part I �K �,t',. _ u)) r P-:` ,f,:'. \` s` '•�. - - ':';,._..�,,:, umaH to large wl"i� .rig •Z!d!'>r F� \(' !. r•.. Y�`••zf p :"A••r s ,y_'u is;; `I ,`,iff,� Yu.�.fyY Questions) impact impact may u<; may occur occur a.The proposed action may result in an impairment of natural functions,or"ecosystem D2e,Elb ❑ ❑ services",provided by an undeveloped area,including but not limited to stormwater E2h, storage,nutrient cycling,wildlife habitat. Elm,E2o, E2n,E2 b.The proposed action may result in the loss of a current or future recreational resource. C2a,EI c, ❑ ❑ C2c,E2 c.The proposed action may eliminate open space or recreational resource in an area C2a,C2c ❑ ❑ with few such resources. Bic,E2q d.The proposed action may result in loss of an area now used informally by the C2c,E l c ❑ community as an open space resource. ❑ Other impacts: _ — E e. ❑ 12. Impact on Critical Environmental Areas The proposed action may be located within or adjacent to a critical NO ❑*YE1 environmental area(CEA). (See Part 1. E.3.d) I "Yes", answer questions a-c. I `1Vo" oto Section 13. -77 Relevant No,or Part I smallQuestions) impactma occura.The proposed action may result in a reduction in the quantity of the resource or E3d characteristic which was the basis for designation of the CEA. ❑ b.The proposed action may result in a reduction in the quality of the resource or E3d characteristic which was the basis for designation of the CEA. ❑ ❑ c. Other impacts: Page / of 10 =R SET FORM 13. Impact on Transportation The proposed action may result in a change to existing transportation systems. MNO ❑YES (See Part 1. D.2,j) I "Yes", answer questions a•-g. If"No", go to Section 14. I r Relevant No,or Moderate ;;, >F . .,• Part I small to large Question(s) impact impact may ". may occur occur a.Projected traffic increase may exceed capacity of existing road network. D2j ❑ El b The proposed action may result in the construction of paved parking area for 500 or D2j El more vehicles. c The proposed action will degrade existing transit access. _ D2j ❑ ❑ d.The proposed action will degrade existing pedestrian or bicycle accommodations. D2j ❑ ❑ e.The proposed action may alter the present pattern of movement of'people or goods. D2j ❑ �� f. Other impacts: ❑ ❑ 14. Impact on Energy The proposed action may cause an increase in the use of any form of energy. NO DYES Part 1. D.2.k) I "Yes", answer questions a- e. If"No", go to Section 15. •,._f-, Relevant No,or Moderate I small to large e i?��'✓�;r, '�• i ; , ,. , , „`_,;-. _ �; , _. ':-.:�'��h'zk` '1.,,<;: ,cs:,r-. i.:. '��i:"•r •1:!st,;K 9, `frs ', s;-.i :i - 'r;i,, a'>kp.._,,'.•,:`j.j;�„-,I':A. .^,•a. •.; .,:, ,>;,.;:::�,..,:, .,. 7-., , :� Question(s) impact impact may �:1::1•r, �.;rt„� .��:`1.^i c^ ;{{�::1y `{•y•zt�.,:.y��.,.c_,• ".^• .,r,.,-i •i'.:• M K, .y 5.�. ;).`�3=...;i a?`K'•i`;'�w:` ret' rF i.,;•6r k��i'/.��&+fi �i t??S,,• r lt��:,,.ik�?�.�`•ta,.�fn�:r ma occur occur a.The proposed action will require a new,or an upgrade to an existing,substation. D2k ❑ ❑ b.The proposed action will require the;creation or extension of an energy transmission D1 f, ❑ ❑ or supply system to serve more than 50 single or two-family residences or to serve a D I q,D2k commercial or industrial use. c.The proposed action may utilize more than 2,500 MWhrs per year of electricity. D2k 1] ❑ d.The proposed action may involve heating and/or cooling of more than 100,000 square Dlg ❑ ❑ feet of building area when completed. e.Other Impacts: 15. Impact on Noise, Oldor,and Light The proposed action may result in an increase in noise, odors,or outdoor lighting. ' NO YES (See Part 1. D.2.m., n.,and o.) I "Yes”, answer questions a-f If"No" go to Section 16 • 7 -- -• `• '' '�� Relevant No,or Moderate Part I small to large Question(s) impact impact may may occur occur a.The proposed action may produce sound above noise levels established by local D2m El b.The proposed action may result in blasting within 1,500 feet of any residence, D2m,E I d [] hospital,school, licensed day care center,or nursing home. c.The proposed action may result in routine odors for more than one hour per day. D2o [] ❑ Page 8 of 10 RESET FORM d.The proposed action may result in light shini�ontoadjoining properties. D2n ❑ nEl e.The proposed action may result in lighting creating sky-glow brighter than existing D2n,Ela ❑ area conditions. f.Other impacts: ❑ ❑ 16. Impact on Human Health The proposed action may have an impact on human health from exposure NO ❑YES to new or existing sources of contaminants. (See Part 1.D.2.q., E.1. d. f.g. and h.) 1 "Yes", answer questions a-m. 1 "No",go to Section 17. Relevant No,or Moderate to large . > -,,4. ;•.;._'� Part l small e Question(s) impact impact may moly occur occur a.The proposed action is located within 1500 feet of a school,hospital, licensed day V Eld care center,group home,nursing home or retirement communes. ❑ ❑ b.The site of the proposed action is currently undergoing remediation. Elg,Elh _ ❑ ❑ c.There is a completed emergency spill remediation,or a completed environmental site Elg,Elh remediation on,or adjacent to,the site of the proposed action._ ❑ ❑ d.The site of the action is subject to an institutional control limiting the use of the Elg,Elh property(e.g.,easement or deed restriction). El El e.The proposed action may affect institutional control measures thait were put in place Elg,Elh to ensure that the site remains protective of the environment and human health. ❑ ❑ f.The proposed action has adequate control measures in place to ensure that future D2t generation,treatment and/or disposal of hazardous wastes wil I be protective of the El ❑ environment and human health. g.The proposed action involves construction or modification of a solid waste D2q,Elf management facility. ❑ ❑ h.The proposed action may result in the unearthing of solid or hazardous waste. D2q,E If 0 El i.The proposed action may result in an increase in the rate of disposal,or processing,of D2r,D2s solid waste. ❑ ❑ j.The proposed action may result in excavation or other disturbance within 2000 feet of Elf,Elg ❑ ❑ a site used for the disposal of solid or hazardous waste. Elh k.The proposed action may result in the migration of explosive gases from a landfill Elf,Ell; [] ❑ site to adjacent off site structures. 1.The proposed action may result in the release of contaminated leachate from the D2s,Elf, project site. ❑ ❑ D2r m.Other impacts: ❑ ❑ Page 9 of'10 =RESET FORM 17. Consistency with Community Plans The proposed action is not consistent with adopted land use plans. [%NO [JYES (See Part 1. C.l, C,2. and C.3.) If"Yes", answer questions a-h. If"No", go to Section 18. Relevant No,or Moderate Part I small to large Question(s) impact impact may V i4 may occur occur a.The proposed action's land use components may be different from,or in sharp C2,C3,Dla ❑ ❑ contrast to,current surrounding land use pattern(s). Ela,Elb b.The proposed action will cause the permanent population of the city,town or village C2 ❑ ❑ in which the project is located to grow by more than 5%. c.The proposed action is inconsistent with local land use plans or zoning regulations. C2,C2,C3 ❑ [] d.The proposed action is inconsistent with any County plans,or oth6r regional land use C2,C2 ❑ [] plans. e.The proposed action may cause a change in the density of development that is not C3,D lc, ❑ [] supported by existing infrastructure or is distant from existing infrastructure. Dld, Dlf, Dld, Elb f.The proposed action is located in an area characterized by low density development C4,D2c,D2d ❑ ❑ that will require new or expanded public infrastructure. D2j g.The proposed action may induce secondary development impacts(e.g.,residential or C2a ❑ ❑ commercial development not included in the proposed action) h.Other: — _ ❑ ❑ 1S. Consistency with Community Character The proposed project is inconsistent with the existing community character. NO EYES (See Part 1.C.2, C.3, D.2, E.3) I "Yes",ranswer questions "No",proceed to Part;3. ty i���X1h'�t:�,.L�C�,j�i�'�Y 1+7�'i't:.`. �` iy"`� `� t,f> hr� L }t )3'�,,•.,� t,:, ri.�c i.'� i�'",T.'.n�:"'-•,rr h �•. ' N' >it tri: 'z�,,�' C �` �1.`� ,�4;ti�?, ems`' '� � Relevant No or Moderate c�,� fi.�,yi, �i <ati,�?' ,{ r,Fi'• 7 � �, ��;�. �.}j?1't-'� hh ,,�,�fn' c�, }"". 1' C�i,.�i�' t��)'rcr v�'r`�� sy/ \� F< �. �40�` •? t �, iwj,`,y'�•,-..t �''t�'t'-,. ,Sc•�%'�;�>„..' .fi"�-`��.r��, :�?:'��:s�' � V_,y��''�' .�{ �'n;v,� ��,�•�,s.;� �i�`�kt �'k�� �` Part I small to large y v .,t'S s Y <•r;4` fC. jEi �z.�v:'.,dcprf 'i.�„' Ff cR.f R, ;f;'r r:f=.l+%,." rt�:4r,c r�'•t:X�. c t1l r} {r`scfr i;Y r 3lf�f, 4 r p} 7 ! ,• a t ”h" ;•.�i�< :� 3,,,•. „ : „ ,e giYs t 4����`i�, �,,,;.3, °]me't `,.r� y .: Question(s) impact impact may I•:.i.> j„ !d",Ut ". ?S '•:Z✓' „E''. L k' T i�'; �•' may occur occur a.The proposed action may replace or eliminate existing facilities,structures,or areas E3e,E3f,E3g ❑ [I of historic importance to the community. b.The proposed action may create a demand for additional community services(e.g. C4 ❑ CI schools,police and fire) c.The proposed action may displace affordable or low-income housing in an arca where C2,C3,Dlf ❑ ❑ there is a shortage of such housing_ Dlg,Ela d.The proposed action may interfere with the use or enjoyment of officially recognized C2,E3 ❑ ❑ or designated public resources. e.The proposed action is inconsistent with the predominant architectural scale and C2,C3 ❑ ❑ character. f. Proposed action is inconsistent with the character of the existing natural landscape. C2,C3 ❑ ❑ Ela,Elb E2g,E2h g.Other impacts: ❑ ❑ PRINT FULL FGRMI� Page 10 of 10 RESET FULL FORM Full Environmenl'al Assessment Form Part 3-Evaluation of the Magnitude and Importance of Project Impacts and Determination of Significance Part 3 provides the reasons in support of the determination of significance. The lead agency must complete Part 3 for every question in Part 2 where the impact has been identified as potentially moderate to large or where there is a need to explain why a particular element of the proposed action will not,or may,result in a significant adverse environmental impact. Based on the analysis in Part 3,the lead agency must decide whether to require an environmental impact statement to further assess the proposed action or whether available information is sufficient for the lead agency to conclude that the proposed action will not have a significant adverse environmental impact. By completing the certification on the next page,the lead agency can complete its determination of significance. Reasons Supporting This Determination: To complete this section: • Identify the impact based on the Part 2 responses and describe its magnitude. Magnitude considers factors such as severity, size or extent of an impact. • Assess the importance of the impact. Importance relates to the geographic scope,duration,probability of the impact occurring,number of people affected by the impact and any additional environmental consequences if the impact were to occur. • The assessment should take into consideration any design element or project changes. • Repeat this process for each Part 2 question where the iml')act has been identified as potentially moderate to large or where there is a need to explain why a particular element of the proposed action will not,or may,result in a significant adverse environmental impact. • Provide the reason(s)why the impact may,or will not,result in a significant adverse environmental impact • For Conditional Negative Declarations identify the specific condition(s)imposed that will modify the:proposed action so that no significant adverse environmental impacts will result. • Attach additional sheets,as needed. Determination of Significance-,Type 1 and Unlisted Actions SEQR Status: © Type I [,Unlisted Identify portions of EAF completed for this Project: OF' Part 1 []Part 2 Part 3 Fup n review of the information recorded on this EAF,as noted,plus this additional support information and considering both the magnitude and importance of each identified potential impact,it is the conclusion of the as lead agency that: El A. This project will result in no significant adverse impacts on the environment,and,therefore,an environmental impact statement need not be prepared. Accordingly,this negative declaration is issued. ❑ B. Although this project could have a significant adverse impact on the environment,that impact will be avoided or substantially mitigated because of the:following conditions which will be required by the lead agency: There will,therefore,be no significant adverse impacts from the prcject as conditioned,and,therefore,this conditioned negative declaration is issued. A conditioned negative declaration may be used only for UNLISTED actions(see 6 NYCRR 617.d). ❑ C. This Project may result in one or more significant adverse impacts on the environment,and an environmental impact statement must be prepared to further assess the impact(s)and possible mitigation and to explore alternatives to avoid or reduce those impacts. Accordingly,this positive declaration is issued. Name of Action: Name of Lead Agency: Name of Responsible Officer in Lead Agency: Title of Responsible Officer: Signature of Responsible Officer in Lead Agency: Date: Signature of Preparer(if different from Responsible Officer) Date: For Further Information: Contact Person: Address: Telephone Number: E-mail: For Type 1 Actions and Conditioned Negative Declarations,a copy of this Notice is sent to: Chief Executive Officer of the political subdivision in which the action will be principally located(e.g.,Town/City/ Other involved agencies(if any) Village of) Applicant(if any) Environmental Notice Bulletin: lett_ ti://w�Nw.dec.ny.eov/enb/enb html