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Home My WebLink About509 Wyckoff Rd. SEQR Short EAF617.20 Appendix B Short Environmentol Assessment Form Instructions for Completins Paft I - Project Informafion. ,The applicant or project sponsor is responsible for the completion of part I. Responsesbecome part of the applicatior for approval or tunding are subject to pubiic review, and may be sub.yect to further verificationcomplete Part I based on information currently availible. If ;dditional research or investigation would be needed to firllyrespond to any item' please answer as fhoroughly as possible based on current information. complete all items in Part 1: -Ioo may also provide any additional information which you believe wrll be needed by or usefulto the lead agency; attach additional pages as necessary to supplement any item. Part 1 - Project and Sponsor Informatian Name of Action or Project:s"fl i"t ifc4a tr F Ex Wxte t d;l Prqect Location (describe, and attach tt 5c4 w yeVFF W+n (sue alP{trt' ry^trA Brief Description of Propdsed Co$+-Wt)aT ^ /&:O"X 4a"A"* vrlwp FFp<E Vwlgt*tt^.,ir+ bTTfebkab a)for-FpUy Tw w;N"(6Ti $6buiUpgJ €'ttlt f'li.t/.4al,t-ti it ^ ",- ,'^.- t*-. ll*,^"@tttr-01*t4 6+t>4 +f,AV E A l..ieWf\-)w/ t-i ffz$a{ /m€g'rhJ6? v@vrl, vte€4rLg - *h.+ +f,AvE A rueW K{l6{+g;nit#,crc.IzY/l'l€ETtrl& WVrl AND t-tVir")a, 6PAWVrl AND t-tviN67 SPPG Name of Applicant or Sfonsor: ^&$"L(14 v F4! 't'*o'ffi++sak l. Does the proposed action only involve th; administrative rule, or regulation? If Yes, attach a narative description of the intent of the proposed action and the environmental resources thatmay be affected in the municipality and proceed to part i. irno, continue to questron 2. 2. Does the proposed action require a permit, ;lffiru,'ry.Tlr{,"W&w.W4Nyry,^qx.spry*:uiq"t U"Ot xtG 7W-tvlrT YFcvt T4'€ q7 3.a. Total acreage of tfrb slte of iiri proposeO actiinZ b. Total ac;eage to be physically disturbed? c. Total acreage (project site and any configuous properties) orarned or controlled by the applicant or project sponsor? lForest flAgriculture flPart<tand lAquatic flother(specify): Check all land uses that occur on, udjoining flurban flRural (non-agriculrure) []Industrial Icommerciar D&esidential (suburban) Page 1 of4 Is the proposed action, a. A permitted use under the zoning regulations? b. Consistent with the adopted comprehensive plan? NO YES NiAuXur L X I 6. Is the proposed action consistent with the predomin ant chancter or*t" olJffitt ointiut landscape? NO YESuIX7 _Is the site of the proposed action locat If Yes, identify: Area?NO YES K u q' vt trL ure prupostlu asuon resull m a Substantlal lncrease tn traftic above present levels? b' Are public transportation servrce(s) available at or near the site of the proposed action? c' Are any pedestrian accommodafions or bicycle routes available on or near stte of the prooosed acfion? NO YESlfK 2, uovr rrre pr'poseo acilon me9t or exceed the state energy code requirements?If fhe proposed action will exceed requirements, describe-design featuies arro technolosies: NO I YES u X- 10. Will the proposed action connect to an If No, describe method for providing potable water: 1 I ' will the proposed action connect to existing wastewater utilitres? If No, describe method for providing wastewater treatment: NO YES u NO K YESrK z a uoes tne sile contaln a structure that ts listed on either the State or National Register of Histolc Places? b. Is the proposed action located in an archeorogical sensitive area? NO YESI Ll3.a'Doesanyportionofthe-siteoftheproposedaction,ordd'udjo*i"gtr'"pffi wetlands or other waterbodies regulated by a federal, state or local asencv? - b' Would the proposed action physically alter" or encroach into, any exisfing wetland or waterbody?If Yes, identify the wetland or waterbody and extent of alterations ltt rqu*" feet or acres: NO YES KK l fl"llt] 1l-t,cyplcauabltat types that occur on, or are likely to be found on the project site. Check all that apply:LJ shoreltne ll Forest - [ ngricultural/grasslands D eany mid-successionalfl Wetland flurban Eguburban uuEti ure srre or Tne proposed actlon contatn any species of animal, or associated habitats, listed by the State or Federal govemment as threatened or endansered? NO YES X lproJesr srre tocareo m tne IUU year flood plarn?I'lo^YES 17. Will the proposed action create storm water di; If Yes. a. Will storm water discharges flow to adjacent properties?X*o []ves b' will storm water discharges be directed to established conveyance qystems (runoff and6tgrm drains)?If Yes" briefly describe: trnO "6;; NO YDS u K Page2 of 4 l8.Doestheproposedactionincludeconstructionorotheractivitiestdm water or other liquids (e.g. retention pond, waste lagoon, dam)? If Yes, explain purpose and size: l9.Hasthesiteoftheproposedactionoranadjoiningp'op"'|y solid waste management facilitv? 20.Hasthesiteoftheproposedactionoranadjoiningpropertybeenthe'@ completed) for hazardous waste? If Yes, describe: l*xl*yJg*r rHE rNF,oRMArroN pRovrDED ABovE Lr* r'*s"[ Patt 2 'Impact Assessment The Lead Agency is responsible for the completion of Part 2, Answer all of ttre followingquestions in Part 2 using the information contained in Part 1 and other materials submrtted by the prqect sponsor orotherwise available to the reviewer' when answering the questions the reviewer should Ue guiAed uy the concept..Have myresponses been reasonable considering the scale and iontext ofthe proposed action?', Will the proposed action create a mate.ia regulations? | 2. will the proposed action result in a change in the use or intensity of use of land? t I i wlu the proposed action impair the character or quality of the existing commgnity? 4' wlll the proposed action have an impact on the environmental characteristics that caused theestablishment of a Critical Environmental Area (CEA)? 5. Will the proporrA u affect existing infrastructure for mass transit, biking or walkway? 6. Will the proposed "rruronubly urruilubb *n"rgy rort"*ution ot r"n.*"bl" "rr".# opportunities? 7. Will the proposed action impact existing: a. public /4xi-ra+e water supplies? | I b. public /p++ria*owastewater treatment utilities? I Will the proposed action impair the character or quality of important historic, archaeological, architectural or aesthetic resources? will the proposed action result in an adverse change to natural resources (e.g. waterbodies, groundwater, air quality, flora and fauna)? wetlands, No, or small impact may occur Moderate to large impact may occur K l X T X l X n X nxu X T K u X n X n Page 3 of 4 Moderate to large impact may occur Will the proposed action result in an increase in the potential for erosion, flooding or drainageproblems? l1' Will the proposed action create ahazard,to environmental resources or human health? Part 3 - Determination of significance. The L,ead Agency is responsihle for lhe completion of part 3. For everyquestion in Part 2 that was answered "moderate to targJ impact may occur", or if there is a need to explain why a particularelement of the proposed action may or will not resulti-n a significant adverse environmental impact, please compiete part 3.Parl 3 should' in sufficient detail' identifi' the impacl incluJng any measures or design elements that have been included bythe project sponsor to avoid or reduce impacts. Part 3 should also explain how the lead agency determined that the impactmay or will not be significant. Each potential impact should be assesied considering its setting, probability of occurring,durafion, ineversibility, geographic scope and rnagnitude. Also consider the potential for short-term, long-term andcumulative impacts. 1te W"rn eu*,rt'odi0$^cffi^/ d^.0 W *1 ul-f-il"e ureaQ,&k a-n4e-d *"^e *d.Ar! t ry VeAr o- q W u\ru*r< aryreAo4-{ fiQ,qr(6- | PRINT Check this box if you have determined, *19: tt:f1ed actrol. may result in one or more potentially large or significant ua,r"rr* i.purts and anenvironmental impact statement is required. Check this box if you have determinei, based on the information and analysis above, and any supporting documentation,that the proposed action will not result in arry significant adverse environmental impacts. Ctt*Rln*^l fiU" Name of Lead Agency Print or Type $ame of of ResponEble Officer in L-ead AgenCy Page 4 of 4