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Appendix C' State Environmental Quality Review
SHORT ENVIRONMENTAL ASSESSMENT FORM
For UNLISTED ACTIONS Only
lf the action is in the Goastal Area. and vou are a state aoencv. complete the
CoastaiAssessment Form beiore p-roceedinq with this aS3essrirent
OVER
1
PAf(T I - PROJEGT INFORMATION (To be or
.I . APPLICANT/SPONSOR
VILLAGE OF CAYUGA HEIGHTS BOARD OF TRUSTEES
2. FROJECT NAME
ZON]NG AMENDMENT FOR FITNESS CENTERS
3. PROJECT LOCATION:
Municipality VILLAGE OF CAYUGA HEiGHTS countv TOMPKINS
4. PRECISE LOCATION (Street address and road intersections, prominent landmarks, etc., or provide map)
COMMERCIAL ZONING DISTRICT
PROPOSED ACTION IS:! ru"*I Expansion I fUoaificationla lteration
6. DESCRIBE PROJECT BRIEFLY:
INCLUDE A ''FITNESS CENTER'' AS A PERMITTED USE IN THE COMMERCIAL ZONING DISTRICT
7. AMOUNT OF LAND AFFECTED:
Initially o acres UltimateY 0 acres
8. WLLPROPOSEDACTIONCOMPLYW|THEXISTINGZONINGOROTHEREXISTINGLANDUSERESTRICTIONS?
fl v"" n *o tf No, describe briefty
9. WHAT IS PRESENT LAND USE IN VICINITYOF PROJECT?
fl Residential f] Inoustriat [Z commerciar I Agriculture I ParuForesvopenSpace I ot"t
Describe:
THE HXISTING COMMI]RCIAL ZONING DISTRICT iS CI]RRENTLY "BUILT-OUT'' WTTH COMMERCIAL USE
BUSINESSES.
,IO. DOES ACTION INVOLVE A PERMIT APPROVAL, OR FUNDING, NOWOR ULTIMATELY FROM ANY OTHER GOVERNMENTAL AGENCY
(FEDERAL, STATE OR LOCAL)?I v""El *o lf Yes, list agency(s) name and permiUapprovals:
11. DOES ANY ASPECT OF THE ACTION HAVE A CURRENTLY VALID PERMIT OR APPROVAL?
I V"" E] *o lf Yes, list agency(s) name and permit/approvals:
12" AS A RESULT OF PROPOSED ACTION WILL EXISTING PERMIT/APPROVAL REQUIRE MODIFICATION?[v"" M *o
I CERTIFY THAT THE INFORMATION PROVIDED ABOVE IS TRUE TO THE BEST OF MY KNOWLEDGE
Applicant/sponsor name: Date:
Signature:
Reset
ENT {To be Lead
A. DOES ACTION EXCEED ANY TYPE I THRESHOLD IN 6 NYCRR, PART 617.4?f,v"' n *o
lf yes, coordinate the review process and use the FULL EAF.
D.WILL ACTION RECEIVE CC}ORDINATED REVIEWAS PROVIDED FOR
declaration may be superseded by another involved agency.flves n ruo'
UNLISTED ACTIONS lN 6 NYCRR, PART 617.6? tf No, a negative
c' couLD AcTloN RESULT lN ANY ADVERSE EFFECTS AssOcIATED WITH THE FOLLoWING: (Answers may be handlwitten, if tegible)Cl Existing air quality,.surface or groundu/ater quality or quantity, noise levels, existing traffic pattern, solid waste produc.tion or disposal,potential for erosion, dninage orffooding problems? Explain briefly:
C2' Aesthetic, agricultural, archaeological, historic, or other natural or cultural resources: or community or neighborhood character? Explain briefly:
C3' Vegetationorfauna'fish,shellfishorwildlifespecies,significanthabitats,orthreatenedorendangeredspecies?Explainbriefly:
C4' A community's existing plans or goals as of{icially adopted, or a change in use or intensity of use of land or olher natural resources? Explain brieflv:
c5 Growih, subsequent development, or related activities likely to be induced by the proposed action? Explain briefly:
C6' Long term' short term, cumulative, or other effects not identified in C1-C5? Explain briefly:
G7' Other impacts (including changes in use of either quantity or type of energy)? Explain briefly:
D. WLL THE PROJECT HAVE AN IMPACT ON THE ENVIRONMENTAL CHARACTERISTICS THAT CAUSED THE ESTABLISHMENT OF A CRITICALENVIRONMENTAL AREA (CEA)?
I ves I *o tf yes, exptain briefty:
E" IS THERE, OR IS THERE LIKELY TO BE, CONTROVERSY RELATED TO POTENTIAL ADVERSE ENVIRONMENTAL IMPACTS?l-l Ves E *o tf yes, exptain briefty:
PART II - IMPACT ASSESSM
PART lll - DETERMINATION OF StcNtFtCANCE (To be completed byAgency)
g:11y:Ttflt:^l^"I^11"F1"-1_::L::l,i9".lti1".d above, determinJ whether it.is substantiat, targe, important or otherwise sisnificant. Eacheffect should be assessed in connection-with its (a) setting (i.e. urban orrural); (b) probabilityof o"cdr"ing; (c) duration; (O) in"eveiS-Unity; (eige9-graphic scope;.and (f) .rnagnitude. lf .necessary, add itiachments or refeience supporting materials. Ensure ttrat eiilanations containsufficient detail to show that all relevant adverse impacts have been identified and adequately a-ddressed. lf question D of iart ll was checkedyes, the determination of significance must evaluate the potential impact of the proposed action on the environmental characteristics of the CEA.
..
LJ glt:-cktllsboxifyouhaveidentifiedoneormorepotentiallylargeorsignificantadverseimpac{swhichMAyoccur. ThenproceeddirectlytotheFU
- EAF and/or prepare a positive declaration.
fl 9f't*f.tni".boxifyouha-vedetermined,basedontheinformationandanalysisaboveandanysupportingdocumentation,thattheproposedactionNoT result in any significant adverse environmental impacts AND provide, on attachmenti u" n"*"J"ry, the reasons supporting this determir
Print or Type ttame orFe@
Date
Signature of Preparer (lf different from responsiElE offGer)
Reset