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HomeMy WebLinkAbout06.23.2025 ADDITION-PROJECT-SEQR-PART-1Page 1 of 3 Short Environmental Assessment Form Part 1 - Project Information Instructions for Completing Part 1 – Project Information. The applicant or project sponsor is responsible for the completion of Part 1. Responses become part of the application for approval or funding, are subject to public review, and may be subject to further verification. Complete Part 1 based on information currently available. If additional research or investigation would be needed to fully respond to any item, please answer as thoroughly as possible based on current information. Complete all items in Part 1. You may also provide any additional information which you believe will be needed by or useful to the lead agency; attach additional pages as necessary to supplement any item. Part 1 – Project and Sponsor Information Telephone: E-Mail: administrative rule, or regulation? If Yes, attach a narrative description of the intent of the proposed action and the environmental resources that may be affected in the municipality and proceed to Part 2. If no, continue to question 2. NO YES If Yes, list agency(s) name and permit or approval: b.Total acreage to be physically disturbed? __________ acres c. Total acreage (project site and any contiguous properties) owned or controlled by the applicant or project sponsor? __________ acres 4.Check all land uses that occur on, are adjoining or near the proposed action: Rural (non-agriculture) Industrial Commercial Residential (suburban) Aquatic Other(Specify):Agriculture □ Urban □ Forest SEAF 2019 Parkland Page 2 of 3 a.A permitted use under the zoning regulations? b.Consistent with the adopted comprehensive plan? 6.Is the proposed action consistent with the predominant character of the existing built or natural landscape?NO YES If Yes, identify: ________________________________________________________________________________ NO YES 8.a. Will the proposed action result in a substantial increase in traffic above present levels? b.Are public transportation services available at or near the site of the proposed action? c.Are any pedestrian accommodations or bicycle routes available on or near the site of the proposed action? NO YES If the proposed action will exceed requirements, describe design features and technologies: _____________________________________________________________________________________________ _____________________________________________________________________________________________ NO YES 10.Will the proposed action connect to an existing public/private water supply? If No, describe method for pr oviding potable water: _________________________________________ _____________________________________________________________________________________________ NO YES 11.Will the proposed action connect to existing wastewater utilities? If No, describe method for providing wastewater treatment: ______________________________________ _____________________________________________________________________________________________ NO YES archaeological sites on the NY State Historic Preservation Office (SHPO) archaeological site inventory? NO YES 13. a. Does any portion of the site of the proposed action, or lands adjoining the proposed action, contain wetlands or other waterbodies regulated by a federal, state or local ag ency? b.Would the proposed action physically alter, or encroach into, any existing wetland or waterbody? If Yes, identify the wetland or waterbody and extent of alterations in square feet or acres: _____________________ _____________________________________________________________________________________________ _____________________________________________________________________________________________ 12.a. Does the project site contain, or is it substantially contiguous to, a building, archaeological site, or district which is listed on the National or State Register of Historic Places, or that has been determined by the Commissioner of the NYS Office of Parks, Recreation and Historic Preservation to be eligible for listing on the State Register of Historic Places? b.Is the project site, or any portion of it, located in or adjacent to an area designated as sensitive for Page 3 of 3 14.Identify the typical habitat types that occur on, or are likely to be found on the project site. Check all that apply: □Shoreline □ Forest Agricultural/grasslands Early mid-successional Wetland □ Urban Suburban 15.Does the site of the proposed action contain any species of animal, or associated habitats, listed by the State or Federal government as threatened or endangered? 16.Is the project site located in the 100-year flood plan?NO YES 17.Will the proposed action create storm water discharge, either from point or non-point sources? If Yes, a.Will storm water discharges flow to adjacent properties? b.Will storm water discharges be directed to established conveyance systems (runoff and storm drains)? If Yes, briefly describe: _____________________________________________________________________________________________ _____________________________________________________________________________________________ 18.Does the proposed action include construction or other activities that would result in the impoundment of water or other liquids (e.g., retention pond, waste lagoon, dam)? If Yes, explain the purpose and size of the impoundment:______________________________________________ ____________________________________________________________________________________________ _ NO YES 19.Has the site of the proposed action or an adjoining property been the location of an active or closed solid waste management facility? If Yes, describe: _______________________________________________________________________________ _____________________________________________________________________________________________ 20.Has the site of the proposed action or an adjoining property been the subject of remediation (ongoing or completed) for hazardous waste? If Yes, describe: _______________________________________________________________________________ _____________________________________________________________________________________________ I CERTIFY THAT THE INFORMATION PROVIDED ABOVE IS TRUE AND ACCURATE TO THE BEST OF MY KNOWLEDGE Date: _____________________ Applicant/sponsor/name: ____________________________________________________ __________________________ Signature: _____________________________________________________Title:__________________________________