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HomeMy WebLinkAboutI - 01 Aquifer Protection Permit - Hospitality Restaurant GroupMichael McCracken 860 NY-13, Cortlandville, NY 13045 95.20-02-04.000 X B-3 $1,250.00 290 Elwood Davis Road, Liverpool, NY 13088 315-451-9603 290 Elwood Davis Road Liverpool, NY 13088 315-451-9603Hospitality Restaurant Group Demolition of the existing structure, and construction of a new drive-thru style restaurant. 10/16/2023 Mike McCracken PROJECT LOCATION MAP PREPARED BY: C-1 SHEET INDEX: SITE LOCATION MAP PROJECT LOCATION 110 FAYETTE STREET MANLIUS, NEW YORK 13104 email: MNAP@NAPCON.COM PH: (315) 682-5580 FAX: (315) 682-5544 N A P I E R A L A C O N S U L T I N G PROFESSIONAL ENGINEER, P.C. SITE DESIGN ENGINEERING TACO BELL CORTLANDVILLE 860 NY-13 TOWN OF CORTLANDVILLE CORTLAND COUNTY STATE OF NEW YORK TITLE SHEET C-1 DEMOLITION PLAN C-2 LAYOUT AND LANDSCAPING PLAN C-3 GRADING PLAN C-4 UTILITY PLAN C-5 LIGHTING PLAN C-6 SITE DETAILS C-7 SITE DETAILS C-8 AERIAL MAP PROJECT LOCATION NAME APPROVED BY OWNER DATE PROJECT LOCATION NAPIERALA CONSULTING COPYRIGHT C 2023 NO.REVISION/ISSUE DATE SHEETPROJECT NO.DATE 23-2180 16 OCT 2023 SHEET TITLE: TITLE SHEET IT IS A VIOLATION OF LAW FOR ANY PERSON, UNLESS ACTING UNDER THE DIRECTION OF A LICENSED ARCHITECT, PROFESSIONAL ENGINEER, LANDSCAPE ARCHITECT, OR LAND SURVEYOR TO ALTER ANY ITEM ON THIS DOCUMENT IN ANY WAY. ANY LICENSEE WHO ALTERS THIS DOCUMENT IS REQUIRED BY LAW TO AFFIX HIS OR HER SEAL AND THE NOTATION "ALTERED BY" FOLLOWED BY HIS OR HER SIGNATURE AND SPECIFIC DESCRIPTION OF THE ALTERATIONS. TACO BELL CORTLANDVILLE TOWN OF CORTLANDVILLE CORTLAND COUNTY, NY MATTHEW R. NAPIERALA, P.E. NYS REGISTRATION # 068733 PLAN SEAL BY: PREPARED FOR: 290 ELWOOD DAVIS ROAD LIVERPOOL, NEW YORK 13088 HOSPITALITY RESTAURANT GROUP NY - 1 3 LIME HOLLOW RD. WE S T R D . LAMONT CIR. S. LAMONT NY-13 AP P L E B E E ' S S I G N MIL E M A R K E R OHW OHW OHW OHW OHW OHW OHW OHW TRAFFI C S I G N A L S VA U L T RI M = 1 2 0 8 . 1 8 15 " P V C IN V = 1 1 9 6 . 5 MB GM T R (3 ) E R 6" 6" 6" 4" 6'Ø 6'Ø LP BO L 4'Ø 6'Ø (2 ) E R OH W OH W OHW OHW OHW OHW OHW OH W OH W OH W OH W OH W OH W OH W OH W 24 " "N O S T O P P I N G " DM H SM H SS SS SS SS SS SS SS SS SS SS SS SS SS SS SS OH W OH W OH W WV W W W W 12 " 8" 12 " 8" 12 " W W W W W W W W 5'Ø 3'Ø 8'Ø 4'Ø 4'Ø WV SV EM T R WV 8'Ø HH NE W Y O R K S T A T E R O U T E 1 3 (V A R I A B L E W I D T H R I G H T O F W A Y ) HY D WV O H W O H W O H W TP E D NG 1 0 0 NM 1 0 1 HH WV TP E D SM H TS B TS B TS P RI M = 1 2 0 4 . 6 5 IN V = 1 1 9 3 . 7 6" 6" 6" TS B TS P G G G G G G G G G 6" C I M A I N 6" H D P E IN V = 1 2 0 1 . 3 RI M = 1 2 0 5 . 5 3 3'X 3 ' D R Y W E L L MU L T I P L E H O L E S 6" H D P E IN V = 1 2 0 5 . 2 DM H RI M = 1 2 0 8 . 6 5 3'X 3 ' D R Y W E L L MU L T I P L E H O L E S SU M P = 1 2 0 1 . 8 SU M P = 1 1 9 8 . 7 TL M OH W OH W OH W OH W OH W OH W OH W OH W HI G H W A Y B O U N D A R Y W PR O J E C T N O . DA T E SC A L E SH E E T MA T T H E W R . N A P I E R A L A , P . E . NY S R E G I S T R A T I O N # 0 6 8 7 3 3 PL A N S E A L B Y : PR E P A R E D B Y : NA P I E R A L A C O N S U L T I N G CO P Y R I G H T C 2 0 2 3 NO . RE V I S I O N / I S S U E SH E E T T I T L E : DA T E PR E P A R E D F O R : PR O J E C T T I T L E : 11 0 F AY E T T E STR E E T MAN L I U S , NEW YOR K 13 1 0 4 em a i l : MN A P @ N A P C O N . C O M PH : (3 1 5 ) 6 8 2 - 5 5 8 0 FA X : (3 1 5 ) 6 8 2 - 5 5 4 4 N A P I E R A L A C O N S U L T I N G PR O F E S S I O N A L E N G I N E E R , P . C . SI T E D E S I G N E N G I N E E R I N G IT I S A V I O L A T I O N O F L A W F O R A N Y PE R S O N , U N L E S S A C T I N G U N D E R T H E DI R E C T I O N O F A L I C E N S E D A R C H I T E C T , PR O F E S S I O N A L E N G I N E E R , LA N D S C A P E A R C H I T E C T , O R L A N D SU R V E Y O R T O A L T E R A N Y I T E M O N TH I S D O C U M E N T I N A N Y W A Y . AN Y L I C E N S E E W H O A L T E R S T H I S DO C U M E N T I S R E Q U I R E D B Y L A W T O AF F I X H I S O R H E R S E A L A N D T H E NO T A T I O N " A L T E R E D B Y " F O L L O W E D BY H I S O R H E R S I G N A T U R E A N D SP E C I F I C D E S C R I P T I O N O F T H E AL T E R A T I O N S . TA C O B E L L CO R T L A N D V I L L E TO W N O F C O R T L A N D V I L L E CO R T L A N D C O U N T Y , N Y HO S P I T A L I T Y R E S T A U R A N T G R O U P 29 0 E L W O O D D A V I S R O A D LI V E R P O O L , N Y 1 3 0 8 8 DE M O L I T I O N P L A N 23 - 2 1 8 0 16 O C T 2 0 2 3 1" = 2 0 ' C- 2 PRELIMINARY FOR PLANNING PURPOSES ONLY, NOT FOR CONSTRUCTION. SO L I D W H I T E L I N E SO L I D W H I T E L I N E SO L I D W H I T E L I N E SO L I D W H I T E L I N E SO L I D W H I T E L I N E SO L I D W H I T E L I N E CR O S S W A L K PE D E S T R I A N CR O S S I N G P O L E NE W Y O R K S T A T E R O U T E 1 3 SO L I D W H I T E L I N E SO L I D W H I T E L I N E ON E WA Y ON E WA Y PR O J E C T N O . DA T E SC A L E SH E E T MA T T H E W R . N A P I E R A L A , P . E . NY S R E G I S T R A T I O N # 0 6 8 7 3 3 PL A N S E A L B Y : PR E P A R E D B Y : NA P I E R A L A C O N S U L T I N G CO P Y R I G H T C 2 0 2 3 NO . RE V I S I O N / I S S U E SH E E T T I T L E : DA T E PR E P A R E D F O R : PR O J E C T T I T L E : 11 0 F AY E T T E STR E E T MAN L I U S , NEW YOR K 13 1 0 4 em a i l : MN A P @ N A P C O N . C O M PH : (3 1 5 ) 6 8 2 - 5 5 8 0 FA X : (3 1 5 ) 6 8 2 - 5 5 4 4 N A P I E R A L A C O N S U L T I N G PR O F E S S I O N A L E N G I N E E R , P . C . SI T E D E S I G N E N G I N E E R I N G IT I S A V I O L A T I O N O F L A W F O R A N Y PE R S O N , U N L E S S A C T I N G U N D E R T H E DI R E C T I O N O F A L I C E N S E D A R C H I T E C T , PR O F E S S I O N A L E N G I N E E R , LA N D S C A P E A R C H I T E C T , O R L A N D SU R V E Y O R T O A L T E R A N Y I T E M O N TH I S D O C U M E N T I N A N Y W A Y . AN Y L I C E N S E E W H O A L T E R S T H I S DO C U M E N T I S R E Q U I R E D B Y L A W T O AF F I X H I S O R H E R S E A L A N D T H E NO T A T I O N " A L T E R E D B Y " F O L L O W E D BY H I S O R H E R S I G N A T U R E A N D SP E C I F I C D E S C R I P T I O N O F T H E AL T E R A T I O N S . TA C O B E L L CO R T L A N D V I L L E TO W N O F C O R T L A N D V I L L E CO R T L A N D C O U N T Y , N Y HO S P I T A L I T Y R E S T A U R A N T G R O U P 29 0 E L W O O D D A V I S R O A D LI V E R P O O L , N Y 1 3 0 8 8 LA Y O U T A N D LA N D S C A P I N G P L A N 23 - 2 1 8 0 16 O C T 2 0 2 3 1" = 2 0 ' C- 3 PRELIMINARY FOR PLANNING PURPOSES ONLY, NOT FOR CONSTRUCTION. SHRUBS HERBACEOUS PLANTS DECIDUOUS TREE SHRUB PLANTING DETAIL TREE PLANTING DETAIL RI M = 1 2 0 8 . 1 8 IN V = 1 1 9 6 . 5 NE W Y O R K S T A T E R O U T E 1 3 RI M = 1 2 0 4 . 6 5 IN V = 1 1 9 3 . 7 6" C I M A I N 12 0 5 120 6 12 0 7 120 7 1 2 0 7 12 0 6 12 0 8 120 8 12 0 8 12 0 8 12 0 5 120 5 1205 1206 1206 12 0 6 12 0 6 1 2 0 6 1 2 0 6 1 2 0 6 120 8 1 2 0 7 12 0 7 12 0 8 12 0 8 120 7 1206 12 0 5 1 2 0 5 12 0 3 12 0 3 1 2 0 2 1 2 0 2 1 2 0 2 1 2 0 3 1 2 0 3 12 0 4 1 2 0 4 1 2 0 4 1205 120 5 12 0 5 1 2 0 5 12 0 5 12 0 4 FFE=1208.5 PR O J E C T N O . DA T E SC A L E SH E E T MA T T H E W R . N A P I E R A L A , P . E . NY S R E G I S T R A T I O N # 0 6 8 7 3 3 PL A N S E A L B Y : PR E P A R E D B Y : NA P I E R A L A C O N S U L T I N G CO P Y R I G H T C 2 0 2 3 NO . RE V I S I O N / I S S U E SH E E T T I T L E : DA T E PR E P A R E D F O R : PR O J E C T T I T L E : 11 0 F AY E T T E STR E E T MAN L I U S , NEW YOR K 13 1 0 4 em a i l : MN A P @ N A P C O N . C O M PH : (3 1 5 ) 6 8 2 - 5 5 8 0 FA X : (3 1 5 ) 6 8 2 - 5 5 4 4 N A P I E R A L A C O N S U L T I N G PR O F E S S I O N A L E N G I N E E R , P . C . SI T E D E S I G N E N G I N E E R I N G IT I S A V I O L A T I O N O F L A W F O R A N Y PE R S O N , U N L E S S A C T I N G U N D E R T H E DI R E C T I O N O F A L I C E N S E D A R C H I T E C T , PR O F E S S I O N A L E N G I N E E R , LA N D S C A P E A R C H I T E C T , O R L A N D SU R V E Y O R T O A L T E R A N Y I T E M O N TH I S D O C U M E N T I N A N Y W A Y . AN Y L I C E N S E E W H O A L T E R S T H I S DO C U M E N T I S R E Q U I R E D B Y L A W T O AF F I X H I S O R H E R S E A L A N D T H E NO T A T I O N " A L T E R E D B Y " F O L L O W E D BY H I S O R H E R S I G N A T U R E A N D SP E C I F I C D E S C R I P T I O N O F T H E AL T E R A T I O N S . TA C O B E L L CO R T L A N D V I L L E TO W N O F C O R T L A N D V I L L E CO R T L A N D C O U N T Y , N Y HO S P I T A L I T Y R E S T A U R A N T G R O U P 29 0 E L W O O D D A V I S R O A D LI V E R P O O L , N Y 1 3 0 8 8 GR A D I N G P L A N 23 - 2 1 8 0 16 O C T 2 0 2 3 1" = 2 0 ' C- 4 PRELIMINARY FOR PLANNING PURPOSES ONLY, NOT FOR CONSTRUCTION. AP P L E B E E ' S S I G N MIL E M A R K E R OHW OHW OHW OHW OHW OHW OHW OHW TRAFFI C S I G N A L S VA U L T RI M = 1 2 0 8 . 1 8 15 " P V C IN V = 1 1 9 6 . 5 ST O P ST O P ST O P GM T R OH W OH W OHW OHW OHW OHW OHW OH W OH W OH W OH W OH W OH W OH W OH W "N O S T O P P I N G " DM H SS SS SS SS SS SS SS SS SS SS SS SS SS SS SS OH W OH W OH W WV W W W W W W W W W W W W WV WV NE W Y O R K S T A T E R O U T E 1 3 (V A R I A B L E W I D T H R I G H T O F W A Y ) HY D WV O H W O H W O H W TP E D WV TP E D RI M = 1 2 0 4 . 6 5 IN V = 1 1 9 3 . 7 G G G G G G G G G 6" C I M A I N 6" H D P E IN V = 1 2 0 1 . 3 RI M = 1 2 0 5 . 5 3 3'X 3 ' D R Y W E L L MU L T I P L E H O L E S 6" H D P E IN V = 1 2 0 5 . 2 DM H RI M = 1 2 0 8 . 6 5 3'X 3 ' D R Y W E L L MU L T I P L E H O L E S SU M P = 1 2 0 1 . 8 SU M P = 1 1 9 8 . 7 TL M OH W OH W OH W OH W OH W OH W OH W OH W ST ST HI G H W A Y B O U N D A R Y UE UE UE W PR O J E C T N O . DA T E SC A L E SH E E T MA T T H E W R . N A P I E R A L A , P . E . NY S R E G I S T R A T I O N # 0 6 8 7 3 3 PL A N S E A L B Y : PR E P A R E D B Y : NA P I E R A L A C O N S U L T I N G CO P Y R I G H T C 2 0 2 3 NO . RE V I S I O N / I S S U E SH E E T T I T L E : DA T E PR E P A R E D F O R : PR O J E C T T I T L E : 11 0 F AY E T T E STR E E T MAN L I U S , NEW YOR K 13 1 0 4 em a i l : MN A P @ N A P C O N . C O M PH : (3 1 5 ) 6 8 2 - 5 5 8 0 FA X : (3 1 5 ) 6 8 2 - 5 5 4 4 N A P I E R A L A C O N S U L T I N G PR O F E S S I O N A L E N G I N E E R , P . C . SI T E D E S I G N E N G I N E E R I N G IT I S A V I O L A T I O N O F L A W F O R A N Y PE R S O N , U N L E S S A C T I N G U N D E R T H E DI R E C T I O N O F A L I C E N S E D A R C H I T E C T , PR O F E S S I O N A L E N G I N E E R , LA N D S C A P E A R C H I T E C T , O R L A N D SU R V E Y O R T O A L T E R A N Y I T E M O N TH I S D O C U M E N T I N A N Y W A Y . AN Y L I C E N S E E W H O A L T E R S T H I S DO C U M E N T I S R E Q U I R E D B Y L A W T O AF F I X H I S O R H E R S E A L A N D T H E NO T A T I O N " A L T E R E D B Y " F O L L O W E D BY H I S O R H E R S I G N A T U R E A N D SP E C I F I C D E S C R I P T I O N O F T H E AL T E R A T I O N S . TA C O B E L L CO R T L A N D V I L L E TO W N O F C O R T L A N D V I L L E CO R T L A N D C O U N T Y , N Y HO S P I T A L I T Y R E S T A U R A N T G R O U P 29 0 E L W O O D D A V I S R O A D LI V E R P O O L , N Y 1 3 0 8 8 UT L I T Y P L A N 23 - 2 1 8 0 16 O C T 2 0 2 3 1" = 2 0 ' C- 5 PRELIMINARY FOR PLANNING PURPOSES ONLY, NOT FOR CONSTRUCTION. W SS G OHW UE NE W Y O R K S T A T E R O U T E 1 3 6" C I M A I N PR O J E C T N O . DA T E SC A L E SH E E T MA T T H E W R . N A P I E R A L A , P . E . NY S R E G I S T R A T I O N # 0 6 8 7 3 3 PL A N S E A L B Y : PR E P A R E D B Y : NA P I E R A L A C O N S U L T I N G CO P Y R I G H T C 2 0 2 3 NO . RE V I S I O N / I S S U E SH E E T T I T L E : DA T E PR E P A R E D F O R : PR O J E C T T I T L E : 11 0 F AY E T T E STR E E T MAN L I U S , NEW YOR K 13 1 0 4 em a i l : MN A P @ N A P C O N . C O M PH : (3 1 5 ) 6 8 2 - 5 5 8 0 FA X : (3 1 5 ) 6 8 2 - 5 5 4 4 N A P I E R A L A C O N S U L T I N G PR O F E S S I O N A L E N G I N E E R , P . C . SI T E D E S I G N E N G I N E E R I N G IT I S A V I O L A T I O N O F L A W F O R A N Y PE R S O N , U N L E S S A C T I N G U N D E R T H E DI R E C T I O N O F A L I C E N S E D A R C H I T E C T , PR O F E S S I O N A L E N G I N E E R , LA N D S C A P E A R C H I T E C T , O R L A N D SU R V E Y O R T O A L T E R A N Y I T E M O N TH I S D O C U M E N T I N A N Y W A Y . AN Y L I C E N S E E W H O A L T E R S T H I S DO C U M E N T I S R E Q U I R E D B Y L A W T O AF F I X H I S O R H E R S E A L A N D T H E NO T A T I O N " A L T E R E D B Y " F O L L O W E D BY H I S O R H E R S I G N A T U R E A N D SP E C I F I C D E S C R I P T I O N O F T H E AL T E R A T I O N S . TA C O B E L L CO R T L A N D V I L L E TO W N O F C O R T L A N D V I L L E CO R T L A N D C O U N T Y , N Y HO S P I T A L I T Y R E S T A U R A N T G R O U P 29 0 E L W O O D D A V I S R O A D LI V E R P O O L , N Y 1 3 0 8 8 LI G H T I N G P L A N 23 - 2 1 8 0 16 O C T 2 0 2 3 1" = 2 0 ' C- 6 PRELIMINARY FOR PLANNING PURPOSES ONLY, NOT FOR CONSTRUCTION. LIGHT POLE ELEVATION LIGHT POLE BASE PR O J E C T N O . DA T E SC A L E SH E E T MA T T H E W R . N A P I E R A L A , P . E . NY S R E G I S T R A T I O N # 0 6 8 7 3 3 PL A N S E A L B Y : PR E P A R E D B Y : NA P I E R A L A C O N S U L T I N G CO P Y R I G H T C 2 0 2 3 NO . RE V I S I O N / I S S U E SH E E T T I T L E : DA T E PR E P A R E D F O R : PR O J E C T T I T L E : 11 0 F AY E T T E STR E E T MAN L I U S , NEW YOR K 13 1 0 4 em a i l : MN A P @ N A P C O N . C O M PH : (3 1 5 ) 6 8 2 - 5 5 8 0 FA X : (3 1 5 ) 6 8 2 - 5 5 4 4 N A P I E R A L A C O N S U L T I N G PR O F E S S I O N A L E N G I N E E R , P . C . SI T E D E S I G N E N G I N E E R I N G IT I S A V I O L A T I O N O F L A W F O R A N Y PE R S O N , U N L E S S A C T I N G U N D E R T H E DI R E C T I O N O F A L I C E N S E D A R C H I T E C T , PR O F E S S I O N A L E N G I N E E R , LA N D S C A P E A R C H I T E C T , O R L A N D SU R V E Y O R T O A L T E R A N Y I T E M O N TH I S D O C U M E N T I N A N Y W A Y . AN Y L I C E N S E E W H O A L T E R S T H I S DO C U M E N T I S R E Q U I R E D B Y L A W T O AF F I X H I S O R H E R S E A L A N D T H E NO T A T I O N " A L T E R E D B Y " F O L L O W E D BY H I S O R H E R S I G N A T U R E A N D SP E C I F I C D E S C R I P T I O N O F T H E AL T E R A T I O N S . TA C O B E L L CO R T L A N D V I L L E TO W N O F C O R T L A N D V I L L E CO R T L A N D C O U N T Y , N Y HO S P I T A L I T Y R E S T A U R A N T G R O U P 29 0 E L W O O D D A V I S R O A D LI V E R P O O L , N Y 1 3 0 8 8 SI T E D E T A I L S 23 - 2 1 8 0 16 O C T 2 0 2 3 NT S C- 7 INTEGRAL CURB AND SIDEWALKSTANDARD PAVEMENT SECTION SIDEWALK ACCESSIBLE PARKING PAVEMENT MARKING DETAIL GRANITE CURB ACCESSIBLE PARKING SIGNS ACCESSIBLE PARKING SIGNS BREAK-AWAY SIGN POSTCONCRETE PIPE BOLLARD DUMPSTER PAD AND ENCLOSURE PRELIMINARY FOR PLANNING PURPOSES ONLY, NOT FOR CONSTRUCTION. PR O J E C T N O . DA T E SC A L E SH E E T MA T T H E W R . N A P I E R A L A , P . E . NY S R E G I S T R A T I O N # 0 6 8 7 3 3 PL A N S E A L B Y : PR E P A R E D B Y : NA P I E R A L A C O N S U L T I N G CO P Y R I G H T C 2 0 2 3 NO . RE V I S I O N / I S S U E SH E E T T I T L E : DA T E PR E P A R E D F O R : PR O J E C T T I T L E : 11 0 F AY E T T E STR E E T MAN L I U S , NEW YOR K 13 1 0 4 em a i l : MN A P @ N A P C O N . C O M PH : (3 1 5 ) 6 8 2 - 5 5 8 0 FA X : (3 1 5 ) 6 8 2 - 5 5 4 4 N A P I E R A L A C O N S U L T I N G PR O F E S S I O N A L E N G I N E E R , P . C . SI T E D E S I G N E N G I N E E R I N G IT I S A V I O L A T I O N O F L A W F O R A N Y PE R S O N , U N L E S S A C T I N G U N D E R T H E DI R E C T I O N O F A L I C E N S E D A R C H I T E C T , PR O F E S S I O N A L E N G I N E E R , LA N D S C A P E A R C H I T E C T , O R L A N D SU R V E Y O R T O A L T E R A N Y I T E M O N TH I S D O C U M E N T I N A N Y W A Y . AN Y L I C E N S E E W H O A L T E R S T H I S DO C U M E N T I S R E Q U I R E D B Y L A W T O AF F I X H I S O R H E R S E A L A N D T H E NO T A T I O N " A L T E R E D B Y " F O L L O W E D BY H I S O R H E R S I G N A T U R E A N D SP E C I F I C D E S C R I P T I O N O F T H E AL T E R A T I O N S . TA C O B E L L CO R T L A N D V I L L E TO W N O F C O R T L A N D V I L L E CO R T L A N D C O U N T Y , N Y HO S P I T A L I T Y R E S T A U R A N T G R O U P 29 0 E L W O O D D A V I S D R I V E LI V E R P O O L , N Y 1 3 0 8 8 SI T E D E T A I L S 23 - 2 1 8 0 16 O C T 2 0 2 3 NT S C- 8 TYPICAL SEWER AND DRAIN TRENCH CAST IRON VENT AND TRAP TYPICAL SEWER CLEANOUT WATER SERVICE CONNECTION 1000 GALLON GREASE TRAP ROOF LEADER CONNECTION NEW SEWER SERVICE CONNECTION PRELIMINARY FOR PLANNING PURPOSES ONLY, NOT FOR CONSTRUCTION. PR O J E C T N O . DA T E SC A L E SH E E T MA T T H E W R . N A P I E R A L A , P . E . NY S R E G I S T R A T I O N # 0 6 8 7 3 3 PL A N S E A L B Y : PR E P A R E D B Y : NA P I E R A L A C O N S U L T I N G CO P Y R I G H T C 2 0 2 3 NO . RE V I S I O N / I S S U E SH E E T T I T L E : DA T E PR E P A R E D F O R : PR O J E C T T I T L E : 11 0 F AY E T T E STR E E T MAN L I U S , NEW YOR K 13 1 0 4 em a i l : MN A P @ N A P C O N . C O M PH : (3 1 5 ) 6 8 2 - 5 5 8 0 FA X : (3 1 5 ) 6 8 2 - 5 5 4 4 N A P I E R A L A C O N S U L T I N G PR O F E S S I O N A L E N G I N E E R , P . C . SI T E D E S I G N E N G I N E E R I N G IT I S A V I O L A T I O N O F L A W F O R A N Y PE R S O N , U N L E S S A C T I N G U N D E R T H E DI R E C T I O N O F A L I C E N S E D A R C H I T E C T , PR O F E S S I O N A L E N G I N E E R , LA N D S C A P E A R C H I T E C T , O R L A N D SU R V E Y O R T O A L T E R A N Y I T E M O N TH I S D O C U M E N T I N A N Y W A Y . 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HIEMSTRA, P.E. 60 Central Ave • Cortland, New York 13045-2838 Director of Planning Telephone: (607) 753-5043 Email: thiemstra@cortland-co.org General Municipal Law (GML) 239 Report November 9, 2023 GML # 95.20-02-04.000 & 95.20-02-03.000 Town of Cortlandville 860 NYS Route 13 Site Plan Review, Special Use Permit, Aquifer Protection District Special Permit, Hospitality Restaurant Group TO: Cortland County Planning Board FROM: Cortland County Planning Department This application for a site plan review, special use permit, and aquifer protection district special permit is being referred to the Cortland County Planning Board pursuant to General Municipal Law §239-M because the property is located within 500 ft. NYS Route 13. GENERAL INFORMATION Date Received: October 18, 2023 Applicant: Hospitality Restaurant Group submitted by Michael McCracken Status of Applicant: owner Requested Action: site plan review, special use permit, aquifer protection district special permit Purpose: demolition of existing structure and construction of a new drive-thru style restaurant Location: 860 NYS Route 13, across from Lime Hollow Road, in front of (northeast of) Lowe's Size: 0.823 ± acres & 0.238 f acres Existing Zoning: B-3 (Planned Commercial Business) Existing Land Use: business (bank) 1 Surrounding Zoning: I-2 (General Industrial) Surrounding Land Uses: N — Lowe's S — Appleby's restaurant E — Cortlandville Crossing mall W — McDonald's restaurant, Advance Auto Parts ANALYSIS The existing building on tax map parcel # 95.20-02-04.000 was built in 1972, and, according to one record, was owned by Marine Mid., likely Marine Midland Bank. The parcel number at that time was # 95-20-01-03-B. It was sold to Ronald Reed and remodeled to a dentist's office in 1986-1987. For a requested sign permit, this parcel was referred to as # 95.20-01-03.200 in February of 1994. This parcel was sold to Cortland Savings Bank in April of 1994 and still referred to as # 95.20-01-03.200. Ownership was shown as being by First Niagara Bank in 1996, when the parcel is shown as being renumbered to # 95.20-02-04.000. It has been listed by this parcel number thereafter. There were five sign permit variance requests granted from May 1997 to September 2002, the last being a name change from Cortland Savings to First Niagara Bank. In July of 2016, a sign permit was approved to change the name on the sign to Key Bank. The building was last renovated under the name of Key Bank in 2018. The second parcel involved in this project is an adjoining parcel with tax map parcel # 95.20-02- 03.000. This parcel is currently used as a parking lot. Applicant requests to redevelop this site (both parcels) to construct a 2,600 sq. ft. drive-thru restaurant -style building and parking lot. This use necessitates obtaining a site plan review, special use permit, and aquifer protection district special permit. Town of Cortlandville Code (hereinafter "Code") Article VIIIA Planned Commercial Business B-3 District § 178-36.8 Permitted Structures and Uses Subiect to Site Plan Approval indicates that (A) Permitted uses subject to site plan approval shall be as follows: (1) All those permitted structures and uses, and those permitted uses subject to site plan approval, allowed under B-1 and B-2 Districts, except for multiple family residences and their permitted accessory uses. Code Article VIII Hi6wav Commercial Business B-2 District § 178-36.1 Permitted Uses Subiect to Site Plan Aooroval indicates (A) Permitted structures and uses subject to site plan approval shall be as follows: (5) Indoor and drive -through restaurants and taverns. This application is for the construction of a drive -through restaurant. Therefore, applicant has applied for site plan approval. Code 178 Attachment 5 Town of Cortlandville Business Districts Bulk Regulations indicates that (2) Permitted Uses Subiect to Site Plan Approval (b) businesses in these districts must meet bulk size requirements related to setbacks and coverage As required by Planning Board. Therefore, it is recommended that the Town of Cortlandville determine whether the proposed site plan meets acceptable bulk requirements of Code 178 Attachment related to setbacks and lot coverage. The proposed project shows the removal of an existing overhead power line to be coordinated with National Grid. The project also indicates placement of a new underground electric connection. An existing gas line is to be retired and a new gas line placed several feet from the northern side of the new building. Therefore, it is recommended that the Town require the applicant to coordinate all energy service and infrastructure changes with National Grid. 0) Site plan indicates proposed removal of an existing sanitary structure, and creation of a 4" sanitary sewer chimney lateral connection sited west of the building. This proposed project also indicates a new 2" copper water distribution line at the northwestern edge of the property. Applicant has indicated that proposed addition would be connected to the existing public water supply and existing wastewater utilities. The connection to the Cortlandville public water supply and sewer system requires review by the County Health Department and approval of Cortlandville and shall include an engineering report for the installation of the required back flow prevention device for the public water supply. A grease trap would also be installed as part of the public sewer connection. This grease trap would require approval of the County Health Department. Any proposed floor drains would be required to be connected to the municipal sewer system. Applicant's proposed site plan indicates 29 planned parking spaces, two of which are accessible. This meets the required minimum number of accessible parking spaces permitted by ADA design standards, according to the 2010 ADA Standards for Accessible Desian. There are no set requirements for parking in the Town's zoning law, rather, according to Code 178 Attachment 5, parking is as required by the Planning Board. Therefore, it is recommended that Town determine whether this proposed number of parking spaces and accessible spaces are sufficient for the proposed use. Applicant's proposed site plan includes a drive -through food pickup area. Applicant has indicated that the drive -through has the capacity to accommodate 18 vehicles in a queue without impeding movement on the parcel. There is also a lane to circumvent the drive -through itself. There is a landscaping barrier between the parking area and the drive -through, which appears sufficient to prevent cars from blocking parking access. Code §178-71 Information Required for Site Plan Application indicates that applicant is to provide location, design and construction materials of all parking and truck loading areas. Applicant has indicated that trucks deliveries will be offloaded behind the building twice a week, mainly on weekends, outside of open hours. Applicant's proposed site plan shows a pylon sign located 15 ft. from the street line in conformity with Code § 178-111; however, applicant has not submitted a signage package for the proposed new restaurant. Any signage would be required to conform to the "Zoning Local Law of the Town of Cortlandville" Article XVIII Signs unless the appropriate variance(s) are applied for and obtained. Therefore, it is recommended that the Town require the applicant to provide additional information to the Town for the proposed signage and demonstrate compliance with Article XVIII Signs. Code § 178-71 Information Required for Site Plan Application indicates that applicant must provide (S) a General landscaping plan and planting schedule. Applicant's site plan indicates landscaping plan that will retain existing trees to the northeast. Additional trees are to be planted along the eastern perimeter of the property. Applicant has also provided a species list and locations of additional landscaping that will increase greenspace on the parcel. Applicant indicates proposed site would have a dumpster located on a concrete pad enclosed with a chain link fence on the east side of the property, shielded on three sides by landscaping features. According to Code § 178-71, all site plans applications must include (H) Provisions for pedestrian access. The provided site plan includes a free-standing sidewalk around the front and one side of the proposed building. The Town does not have a sidewalk along NYS Route 13 at this location at this point; 3 however, there is a sidewalk to the north between two parcels. Therefore, it is recommended that the Town consider requiring the applicant to provide a sidewalk for pedestrian access that connects to the nearby sidewalk. Applicant has not included emergency services infrastructure plans as part of the site plan. Provisions for location of fire and other emergency zones are required by Code § 178-71 Information Required for Site Plan Application (M). Additionally, Cortlandville Fire District has issued a Commercial Renovation and Development Information Guide that specifies site plan needs, including hydrants, fire apparatus access, sprinkler requirements, fire alarm system requirements, Knox Lockbox program requirements, and Business Emergency Contact Form. It is recommended that the Town require the applicant to provide confirmation from the Cortlandville Fire Department indicating that emergency site plan needs have been satisfied. Applicant has provided a lighting plan with fixture specifications. Applicant has indicated that the proposed LED lighting in the parking area will be sufficient to promote safety but not impinge upon neighboring parcels. As part of the Coordinated Review Committee (CRC), The Cortland County Health Department advised that all food service applicants to obtain a Food Service Establishment permit. In order to receive this permit, applicant must follow Food Service Establishment Pre -operational Review Procedure for Plan Submission and Approval instructions. This process includes completing and submitting a form, entitled Details of Proposed Food Service Facilities, available from the Cortland County Health Department, along with the appropriate fee; and I. Submitting: 1. A scaled diagram of the kitchen/facility floor layout and the equipment arrangement 2. The construction materials and finishes in all areas 3. The size and type of all equipment, lighting, ventilation, toilet facilities, locker rooms, refuse storage area and all other facilities applicable to the food operation including plumbing, water supply and sewage disposal 4. A sample menu II. Gaining: Plan Approval III. Completing Inspections and Permit Issuance. Therefore, it is recommended that the Town require the applicant to complete requirements and obtain approval for a Food Service Establishment permit from the Cortland County Health Department. Code §178-36.10 Hours of Operation indicates that No business establishments in any B-3 District shall be open to the public except between the hours of 6:00 a.m. and 12: 00 midnight. Therefore, applicant shall only be open to the public 6:00 a.m. to 12:00 midnight. It is recommended that the Town require that the applicant make a separate application to the Town if it wishes to extend open hours. Applicant has not included evidence of any plan to install stormwater management structures on site; and the grading plan provided suggests that all stormwater runoff on the property will travel in the form of sheet flow toward the current Price Chopper parking lot. Stormwater should be dealt with on the property that is generating the stormwater. The Soil and Water Conservation District recommends that applicant use infiltration swales or retention basins in the grassed areas of the landscaping in order to deal with stormwater quantity and quality. Therefore, it is recommended that the town require the applicant to update the site plan to include stormwater management features. L, According to the New York State Department of Environmental Conservation (NYSDEC), Construction General Permit (GP-0-20-001), if more than one acre of soil is to be exposed, then applicant would be required to develop a Stormwater Pollution Prevention Plan (SWPPP) and gain coverage under the permit. These combined parcels cover just over one acre. If soil over >1 acre of the combined parcels is to be exposed, applicant must develop a Stormwater Pollution Prevention Plan (SWPPP) and obtain coverage under the permit. Applicant has indicated that grassed areas toward the rear of the property will be sufficient for use as snow storage areas. This proposed project involves two parcels, the second (and smaller) of which is currently used only for parking and contains no structures. Since this smaller parcel would, in fact, be absorbed into the main parcel, it is recommended that the Town require the applicant to submit a subdivision request and obtain approval to combine these two parcels. Code § 178-46 Special Permits indicates that Any use of property within the Aquifer Protection District shall be permitted only upon obtaining a special permit from the Town Board of Cortlandville when the use: (B) Is a development, other than residential, of real property exceeding $150, 000 in development cost. This parcel exists within the Aquifer Protection District, and this proposed project meets these qualifications, therefore, applicant has applied for a special permit. As this parcel is located within the Aquifer Protection District, applicant must adhere to all applicable regulations of Code §178-45 Restrictions and Requirements, including (A) Prohibited Uses (1) The discharge, land application or disposal of any hazardous material, toxic substance and (B) (2) Bulk storage of toxic substances or hazardous materials is subject to compliance with Article XVIII of the Sanitary Code of the Cortland County Health District. Applicant has indicated that there will be no toxic or hazardous substances used on site and that all cleaning products will be environmentally safe. Code §178-49 indicates that (B) In the event that a special permit is granted or granted with stated condition, it shall be a requirement that the applicant use the best available means to prevent the contamination of the groundwater and the aquifers of the Town of Cortlandville. This shall be a continuing requirement. It is therefore recommended that the Town require the applicant ensure that they shall continually use the best available means to prevent the contamination of the groundwater and the aquifers of the Town of Cortlandville. Finally, this proposal is considered a Type 2 Action under SEQR: (9) construction or expansion of a primary or accessory/appurtenant, non-residential structure or facility involving less than 4,000 square feet or gross floor area and not involving a change in zoning or a use variance and consistent with local land use controls, and therefore does not require completion of an Environmental Assessment Form. RECOMMENDATION The staff recommends approval of this application for site plan review, special use permit, and aquifer protection district special permit to redevelop this parcel to contain a drive-thru style restaurant with a parking area in a B-3 (Planned Commercial Business) district only under the following conditions: 1. that the Town of Cortlandville determine whether the proposed site plan meets acceptable bulk requirements of Code 178 Attachment 5 Town of Cortlandville Business Districts Bulk Regulations related to setbacks and lot coverage 2. that the Town require the applicant to coordinate all energy service and infrastructure changes with National Grid 3. that the connection to the Cortlandville public water supply and sewer system be reviewed by the County Health Department and approval obtained from Cortlandville; approval shall include an engineering report for the installation of the required back flow prevention device for the public water supply 4. that a grease trap approved by the County Health Department is installed as part of the public sewer connection 5. that any proposed floor drains are connected to the municipal sewer system 6. that Town determine whether this proposed number of parking spaces and accessible spaces are sufficient for the proposed use as required by the Planning Board as per Code 178 Attachment 5 7. that the Town require the applicant to provide additional information to the Town for the proposed signage and demonstrate compliance with Article XVIII Signs 8. that the Town consider requiring the applicant to provide a sidewalk for pedestrian access that connects to the nearby sidewalk 9. that the Town require the applicant to provide confirmation from the Cortlandville Fire Department indicating that emergency site plan needs have been satisfied 10. that the Town require the applicant to complete requirements and obtain approval for a Food Service Establishment permit from the Cortland County Health Department 11. that the Town require that the applicant make a separate application to the Town if it wishes to extend open hours 12. that the town require the applicant to update the site plan to include said stormwater management features 13. that if soil over >1 acre of the combined parcels is to be exposed, applicant develop a Stormwater Pollution Prevention Plan (SWPPP) and obtain coverage under the permit 0 14. that the Town require the applicant to submit a subdivision request and obtain approval to combine these two parcels 15. that the Town require the applicant ensure that they shall continually use the best available means to prevent the contamination of the groundwater and the aquifers of the Town of Cortlandville 16. compliance with SEQR requirements. Pre by: Gina0assidy, Land Use Planner 7 Reviewed b �? Trisha R. Hiems a, P.E., Director of Planning 110 FAYETTE STREET, MANLIUS, NY 13104 PH: 315- 682-5580 FAX: 315-682-5544 EMAIL: MNAP@NAPCON.COM DATE: 10/16/2023 PROJECT: Cortlandville Taco Bell TO: Town of Cortlandville Planning Board Town of Cortlandville The Raymond G. Thorpe Munic. Building 3577 Terrace Road, PHONE: 607-756-7052 Cortland, NY 13045 FAX: ATTENTION: Mr. Bruce Webber SENDING BY: MAIL MESSENGER OVERNIGHT FAX TRANSMITTING THE FOLLOWING: Description Date Number County Comment Response Letter 11/21/2023 8 REMARKS: Please review the enclosed materials on behalf of Mr. Mike McCracken of Hospitality Restaurant Group for the upcoming November Town Planning Board Meeting. If you have any questions or comments, please contact us at (315) 682-5580. Thank-you. COPIES: Respectfully Submitted, NAPIERALA CONSULTING Matthew Napierala, P.E. Owner/Managing Engineer 110 F AYETTE S TREET M ANLIUS , N EW Y ORK 13104 PH 315 -682 -5580 • F A X 315-682 -5544 • EMAIL : M N A P @ N A P C O N . C O M November 21, 2023 Mr. Christopher Newell Town of Cortlandville Planning Board The Raymond G. Thorpe Municipal Building 3577 Terrace Road Cortland, NY 13045 Re: Cortlandville Taco Bell Dear Mr. Newell, Our office has received comments from the Cortland County Planning Board via email dated 11/09/2023 and offer the below responses: 1.) Comment 4, “That a grease trap approved by the county Health Department is installed as part of the public sewer connection.” • A 1,000-gallon, dual chamber grease trap will be provided (indicated just north of the sanitary sewer line shown on Sheet C-5). 2.) Comment 8, “That the town require the applicant to provide a sidewalk for pedestrian access that connects to the nearby sidewalk.” • We concur. Pedestrian access from the existing private sidewalk to the site will be provided. 3.) Comment 9, “That the Town require the applicant to provide confirmation from the Cortlandville Fire Department indicating the emergency site plan needs have been satisfied.” • We will seek confirmation with the Cortlandville Fire Department that the requirements for fire safety zones, fire access lanes, and other site requirements have been met. 4.) Comment 12, “That the town require the applicant to update the site plan to include said stormwater management features.” • Storm runoff will be collected and discharged in a similar fashion as occurs in the existing condition. The redevelopment of the former bank site will have slightly less impervious area and as such there will be no increase in runoff than occurs in the existing condition. The overall site disturbance is well under one acre and as such no NYSDEC SPDES permit is required for the development. 5.) Comment 14, “That the Town require the applicant to submit a subdivision request and obtain approval to combine these two parcels.” • A land survey plat map has been prepared to combine the two existing parcels into one. The ‘Lot Line Adjustment will be submitted to the code office for ‘administrative review’ and then properly filed at the county real property office. 6.) Comment 15, “That the Town require the applicant ensure that they shall continually use the best available means to prevent contamination of the groundwater and the aquifers of the Town of Cortlandville.” • Means will be taken to prevent the contamination of the groundwater and the aquifers of the Town of Cortlandville as per the Aquifer Protection District Special Permit. In addition to the response to the County’s comments, the Planning Board requested a breakdown of the pre and post development lot coverage. There is a proposed decrease in impervious area by approximately 8.4%. The proposed development would cover 69.0% of the combined lots whereas the existing impervious area is approximately 77.4% as measured on the survey by C.T. Male Associates of Latham, NY. NAPIERALA CONSULTING Professional Engineer, P.C. Matthew Napierala, P.E. Managing Engineer / President 1 RESOLUTION NO. 23-34 ON THE MOTION OF: Paul Slowey Ann Swisher GML # 95.20-02-04.000 & 95.20-02-03.000 Town of Cortlandville Site Plan Review Aquifer Protection District Special Permit Special Permit 860 NYS Route 13 Hospitality Restaurant Group WHEREAS, on October 18, 2023 the Code Enforcement Officer, Town of Cortlandville, pursuant to General Municipal Law 239 M, submitted an application for site plan review, aquifer protection district special permit, and special permit because because the property is located within 500 ft. NYS Route 13. WHEREAS, the Cortland County Planning Department has reviewed this request and submitted a written report dated November 9, 2023, which is on file, AND WHEREAS, the Cortland County Planning Board, on November 15, 2023, held a regular meeting with a quorum and did consider this request, AND WHEREAS, the Cortland County Planning Board did thoroughly consider the material submitted by the petitioner, Department comments, and all other relevant reports on file, NOW THEREFORE BE IT RESOLVED, that only under the following conditions does the Board recommend approval of demolition of existing structure and construction of a new drive-thru style restaurant: 1. that the Town of Cortlandville determine whether the proposed site plan meets acceptable bulk requirements of Code 178 Attachment 5 Town of Cortlandville Business Districts Bulk Regulations related to setbacks and lot coverage 2. that the Town require the applicant to coordinate all energy service and infrastructure changes with National Grid 3. that the connection to the Cortlandville public water supply and sewer system be reviewed by the County Health Department and approval obtained from Cortlandville; approval shall include an engineering report for the installation of the required back flow prevention device for the public water supply 4. that a grease trap approved by the County Health Department is installed as part of the public sewer connection 2 5. that any proposed floor drains are connected to the municipal sewer system 6. that Town determine whether this proposed number of parking spaces and accessible spaces are sufficient for the proposed use as required by the Planning Board as per Code 178 Attachment 5 7. that the Town require the applicant to provide additional information to the Town for the proposed signage and demonstrate compliance with Town of Cortlandville Zoning Code Article XVIII Signs 8. that the Town consider requiring the applicant to provide a sidewalk for pedestrian access that connects to the nearby sidewalk 9. that the Town require the applicant to provide confirmation from the Cortlandville Fire Department indicating that emergency site plan needs have been satisfied 10. that the Town require the applicant to complete requirements and obtain approval for a Food Service Establishment permit from the Cortland County Health Department 11. that the Town require that the applicant make a separate application to the Town if it wishes to extend open hours 12. that the Town require the applicant to update the site plan to include stormwater management features 13. that if soil over 1 acre of the combined parcels is to be exposed, applicant develop a Stormwater Pollution Prevention Plan (SWPPP) and obtain coverage under the permit 14. that the Town require the applicant to submit a subdivision request and obtain approval to combine these two parcels 15. that the Town require the applicant ensure that they shall continually use the best available means to prevent the contamination of the groundwater and the aquifers of the Town of Cortlandville 16. that, if the Town of Cortlandville Code §178-2.4 (A) (8) Wellhead Protection Area District 1A regulation is applicable, applicant reduce the parcel’s impervious surface by 5% over existing lot coverage or apply for and obtain a variance 17. compliance with SEQR requirements. 3 BE IT FURTHER RESOLVED, that the Board reminds the Town of Cortlandville that the requirements of General Municipal Law Section 239 M that a supermajority vote is to be attained by the Town of Cortlandville in order to approve this application unless every contingency documented in this resolution is followed, AND BE IT FURTHER RESOLVED, that the Board reminds the Town of Cortlandville the requirements of General Municipal Law Section 239 M that the Town of Cortlandville is to file a report of final action with the Planning Department within thirty days after final action, AND BE IT FURTHER RESOLVED, that the Planning Department is hereby authorized to convey this action to the Code Enforcement Officer, Town of Cortlandville. Laurie Comfort, Secretary Cortland County Planning Board November 16, 2023 Ayes: 10 Nays: 0 Absent: 1 Page 1 of 2 Agency Use Only [If applicable] Project: Date: Short Environmental Assessment Form Part 2 - Impact Assessment Part 2 is to be completed by the Lead Agency. Answer all of the following questions in Part 2 using the information contained in Part 1 and other materials submitted by the project sponsor or otherwise available to the reviewer. When answering the questions the reviewer should be guided by the concept “Have my responses been reasonable considering the scale and context of the proposed action?” No, or small impact may occur Moderate to large impact may occur 1. Will the proposed action create a material conflict with an adopted land use plan or zoning regulations? 2.Will the proposed action result in a change in the use or intensity of use of land? 3.Will the proposed action impair the character or quality of the existing community? 4.Will the proposed action have an impact on the environmental characteristics that caused the establishment of a Critical Environmental Area (CEA)? 5.Will the proposed action result in an adverse change in the existing level of traffic or affect existing infrastructure for mass transit, biking or walkway? 6.Will the proposed action cause an increase in the use of energy and it fails to incorporate reasonably available energy conservation or renewable energy opportunities? 7.Will the proposed action impact existing: a. public / private water supplies? b. public / private wastewater treatment utilities? 8.Will the proposed action impair the character or quality of important historic, archaeological, architectural or aesthetic resources? 9.Will the proposed action result in an adverse change to natural resources (e.g., wetlands, waterbodies, groundwater, air quality, flora and fauna)? 10.Will the proposed action result in an increase in the potential for erosion, flooding or drainage problems? 11.Will the proposed action create a hazard to environmental resources or human health? SEAF 2019 Page 2 of 2 For every question in Part 2 that was answered “moderate to large impact may occur”, or if there is a need to explain why a particular element of the proposed action may or will not result in a significant adverse environmental impact, please complete Part 3. Part 3 should, in sufficient detail, identify the impact, including any measures or design elements that have been included by the project sponsor to avoid or reduce impacts. Part 3 should also explain how the lead agency determined that the impact may or will not be significant. Each potential impact should be assessed considering its setting, probability of occurring, duration, irreversibility, geographic scope and magnitude. Also consider the potential for short- term, long-term and cumulative impacts. Check this box if you have determined, based on the information and analysis above, and any supporting documentation, that the proposed action may result in one or more potentially large or significant adverse impacts and an environmental impact statement is required. Check this box if you have determined, based on the information and analysis above, and any supporting documentation, that the proposed action will not result in any significant adverse environmental impacts. _________________________________________________ _______________________________________________ Name of Lead Agency Date _________________________________________________ _______________________________________________ Print or Type Name of Responsible Officer in Lead Agency Title of Responsible Officer _________________________________________________ _______________________________________________ Signature of Responsible Officer in Lead Agency Signature of Preparer (if different from Responsible Officer) Short Environmental Assessment Form Part 3 Determination of Significance Agency Use Only [If applicable] Project: Date: