HomeMy WebLinkAboutShort Environmental Assessment Form (SEAF) Part 1, June 25, 2018Short Environmental Assessment Form
Part 1 -Project Information
Instructions for Completing
Part 1 -Project Informatio n. The app licant or project s pon sor is re sponsible for the comp letion of Part 1. Responses
become part of the application for approval or funding, arc 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.
Complete all items in Part l. 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
Name of Action or Pro ect:
f AR j HI lb CA-~ t
Project Location (describe, and attach a location map):
l ~) 0 ---:Dan b 'Rd
Name of Applicant or Sponsor
Q., V M btA,cJJ
State:
)J
Zip Code:
fs]
1. Does the proposed action only involve the legislative adoption of a plan, local law, ordinance,
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.
2 . Does the proposed action require a permit, approval or funding from any other governmental Agency?
If Yes, list agency(s) IlJU!le and permit or approval:
NYS 6/hce d-Cfu/dren aJnd Fatni/i Serv/c€5 )' {C!iuti , cenf:.e C!are.
3.a. Total acreage of the site of the proposed action?
b. Total acreage to be physically disturbed?
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, adjoining and near the proposed action.
NO YES
~•
NO YES
•@
D Urban D Rural (non-agriculture) D Industrial p( Commercial QiJResidential (suburban) •Forest ~Agriculture •Aquatic •Other (specify): ________ _ •Parkland
Page I of 3
5. Is the proposed action , NO YES NIA
a. A p enn itted use under the zoning regulations? • l'v •
b. Consistent with th,e adopted comprehensive plan? • V
17 • 6 . Ts the proposed action cons istent with the predominant character of the existing built or natural NO YES/
landscape? • (/1
7 . Is the s ite of the proposed action located in, or does it adjoin, a s tate listed Critical Environmental Area? NO YES
Tf Yes, identify: 0 •
8. a. Will the proposed action resu lt in a substantial increase in traffic above present levels? NO YES
• fv
b. Are public transportation service(s) available at or near the site of the proposed action? • R 1 C.A1 ~'3
c. Are any pedestrian accommodations or bicycle routes available on or near site of the proposed action? lv1 • 9. Does the proposed action meet or exceed the state energy code requirements? NO YES
If the proposed action will exceed requirements, describe design features and technologies: 1'J JA • • I
JO. Will the proposed action connect to an existing public/private water supply? NO YE S
If No, describe method for providing potable water: • Gt
11. Will the proposed action connect to existing wastewater utilities? NO YES
I,
If No, describe method for providing wastewater treatment: • g
12. a. Does the site contain a structure that is listed on either the State or National Register of Historic NO YES
Places? ~ • b. Is the proposed action located in an archeological sensitive area? ~ • 13. a. Does any portion of the site of the proposed action, or lands adjoining the proposed action, contain NO YES
wetlands or other waterbodies regulated by a federal, state or local agency? ~ • 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:
14. Identify the typical habitat types that occur on, or are likely to be found on the project site. Check all that apply:
0 Shoreline O Forest D Agricultural/grasslands D Early mid-successional
0 Wetland •Urban •Suburban
15. Does the site of the proposed action contain any species of animal, or associated habitats, listed NO YES
by the State or Federal government as threatened or endangered? Southern Grizzled Skipper • ~
16. Is the project site located in the 100 year flood plain? NO, YES
1"'1 I
17. Will the proposed action create stonn water discharge, either from point or non-point sources? NO YES
If Yes,
0 NO G( • a. Will stonn water discharges flow to adjacent properties? •YES
b. Will storm water discharges be directed to established conveyance systems Doff and storm drains)?
ff Yes, briefly describe: NO []YES
Pagel of3
18. Does the proposed action include construction or other activities that result in the impoundment of
water or other liquids (e.g. retention pond, waste lagoon, dam)?
If Yes, explain purpose and size: ________________________ _
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: ____________________________ _
NO YES
•
YES
NO YES
0D
I AFFIRM THAT THE INFORMATION PROVIDED ABOVE IS TRUE AND ACCURATE TO THE BEST OF MY
KNOWLEDGE
Signature:
PRINT FORM l Page 3 of3