HomeMy WebLinkAbout20210696 85 Nelson Use Variance Application CARUSONE & CARUSONE
Attorneys at L�w
491 Broadway-P.O. Box 478
Saratoga Springs, New York 12866
Tel. {Sl8) 5$4-3z40
Fax (518) 584-745]
July 9, 2021
Zonii�� Board
City of Sarato�a Springs
474 Broadway
Saratoga Sprin�;s, NY 128fi6
Re: Theodc�re J. Waite, III
85 Nels�n Avenue
Saratoga Sprin�s, NY
Dear Sir, Madam:
Enclased herew�th p�ease find ati original and c�up�icate of applicatian for appeal t�
the zoning board, environmental assessment fonn and checks to t�le Cammissioner of
Finailce totalin� $1,150.00 regarding the above referenced.
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�`�` ���a CITY OF SARATOGA SPRINGS
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A : -i Gi�(-r,� F-{a(.L - 474 f3ro-a-o�tnra-y (APplication#)
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AP�'LICATION FC7R:
APPEAL TO THE ZONING B�ARD FOR AN
INTERPRETATION, USE VARIANCE,AREA VARIANCE ANb�QR VARIANCE EXTENSiON
APPLlCANT(5�'" OWNER(�(Ifnotapplicant} ATTORNEYIAGENT
Theodore J.Waite, I!I
Na�,� John J. Garusone,,J
85 Nelson A�enue 491 Broadway
Address
Saratoga Springs, NY 12$66 Saratoga Springs, NY �2866
518-441-6939
Phone ___ / � 51$-584-3240
theowaite@aol.eom ' jcarusone@carusonelaw,com
Email
�An applEcant must 6e tha properry owner, 1essee, or one witf�an option to lease or purchase the property in question.
Applicant's interest in the premises: � Owner ❑ Lessee ❑ Under option to lease or purchase
PRdPERTY INFQRMATION
85 Nelson Avenue 17g 21 2 1g
I. Property Address/Location: Tax Parcel No.: - _
(for example: 165.52—4—��')
0511312fl 13 U R2
2. Date acquired by turrent owner: 3. Zoning District when purchased:
3 Family f2esidential UR2
4. Present use of property, 5. Current Zoning District:
6. Has a previous ZBA appiicationlappeal been filed for this property?
❑Yes(when? For what? )
❑ No
7. Is property located within (check all that apply)?: ❑ Historic pistrict 0 Architectural Review District
❑ 50Q'oi a State Park, city boundary, or county/state highway?
8. Brief description of proposed action:
Varian�e to permit premises to be used as a 3 family rssidence.
9. Is there a written violation ior this parcel that is not the sublect af this applicacion? �Yes ❑ No
I 0. Has the work, use or occupancy to which this appea! relates alreac�y begun? �Yes �No
I I. Identify the type o4 appeal you are requesting (check all[hat apply�
❑ IkVTERPRETATIpN (P. 2� ❑ VARIANCE E>4TE1'dSION (p, Z� � U5E VARIANCE(PP. �-6} �AR�,a Va,�ti,aNc� (pp. 6-7)
Revised 0112019
ZONING BpARI7 Qf APPEALSAPPLICqTlON FORM ���f Z
FEEs; Make checks payabie to the"Commissioner of Finance". Fees are cumulative and required for each request below.
❑ Interpretation $ 500
❑ Use variance $�,ppp
�Area varianee
-Residential uselproperty: $ �,pp
-Non-residen[ial uselproperty: $ 6Qp
❑ Exte�sions: $ 15Q
INTERPF�ETATION—PLEASE ANSWE{t THE FOLLOWING(add additional informatipn as necessary):
I. Identify the section(s)of the Zoning Urdinance for which you are seeking an interpretarion:
Section{s)
2. How do you request that this section be interpreted?
3. If interpreration is denied,do you wish to request alternative zoning relief? �Yes ❑No
4. If the answer t4 #3 is "yes," what alternative relief do you request?❑ Use Variance ❑Area Variance
EJCTENS�ON OF A VARMANCE—PLEASE ANSwER TFlE FOLL4wING(add additional information as necessary}:
I. Date original variance was granted: 2. Type od variance granted? ❑ �lJse ❑Area
3. Date original variance expired:
5. Explain why the extension�s necessary.Why wasn'[the original timeframe sufficient?
1Nhen requesting an extension of time for an existing variance, the applicant must prove that the circumstances upon which the original
variance was granted have not changed, SpecificaEly demonstra[e that there have been no significant changes on the site, in [he
neighborhood,or within the circurt�stances upon which ct�e original variat�ce was granted:
Revised 0112019
ZOAIlNG BDARD OFAPFEALSAPPLICqTION FOkM
PACE 3
USE VARIANCE—�LEASE AtdSWER THE F�LLQWfNG(add additiana� information as necessary):
A use variance is requested to permit the following;
For the�oning Boare! to grant a request fpr a use variance, an applitant must prove that the zoning regulations create an unnecessary
har__ dship in relation to that property. In seeking a use variance,New Yark State faw requires an applicant ta prove all four of[he following
"tests".
!. That the applitant cannot realize a reasona6ie financial return on initial investment for any currentiv permitted use on tfte property.
"Dollars¢s"proof must be submitted as evidence.The property in question cannot yield a reasonable return for the fo!lawing
reasons:
Applicant purchased#he premises belreving it to be a three family residence. Attached are the foilowing: Praperty record
bill far 2D20, all of which shaw the remises to be a three fami! on the Ci fax rall both before and after a IFcant
purchased the prerr�ises. Applicant relies on the incpme from#he subjecE premises far hrs retirement income.
A. Submit the foflowing financial evidence relating to Chis praperty(attach additior�a!evidence as needed):
5/1312013 801,500.00
I) Date of p�rrchase: Purchase amount: $
2) Indicate dates and costs o{any improvements made to praperty after purchase:
Date Improvement Cost
2�19 ilVew raof $27,OQ0
���3 Interior painting
$1 b,000
20�3 Upgraded appliances ����a�
3,OOQ.QO 11,989.46
3)Annual maintenance expenses: $ 4)Annual taxes:$
75,0OO.OQ
5)Annual income generated from property:$
413,OOD.00 .62 666.129.6
6}City assessed value: $ Equalization rate: Estimated Market Value; $�
nla
�Appraised Yalue: $ A�praiser:
Date:
Appraisal Assumptions:
Revised 03/2019
ZONlNG B�ARD OFAPPEALSAPPLlCATlC�N FORM PAGE 4
B. Has property been listed for sale with QYes If"yes",for how long?
tF�e Multiple Listing Service(MLS)? [�No
I)Original listing date(s}: Original lfsting price: $
ff listing price was reds�ced, describe when and to what extent:
2) Has the praperty 6een advertised in the newspapers or other publications? [�Yes Q)No
If yes,descri6e frequency and name of publica[iar�s:
3) Has the propercy had a"For Sale" sign posted an it? ❑Yes 0 No
If yes, list dates w�hen sign was posted:
4) How many times has the�roperty been shown and with what resul[s?
NIA
2. That the fnancial hardshi reiatin to this rQ ert is uni ue and does no[ apply to a substantial portion of the neighborhood.
DifficuC[ies shared with nrsmerous other properties in tf�e same neighborhood or district would not satisiy this requirement. �his
previausiy�dentified financial hardship is unique foT the foflowing reasons:
7o the knowledge of the applicant,th�subject property is the only one in the neighborhood which has been assessed as a three
family residence without either a zaning variance o�r the property being grandfathered.
Revised Dl/2Q1�
ZRN1lVG BOARD OFAPPEAI,.S APPLlC4 rlON FORM PAGE S
3. That the variance, if granted, will not alter the essentiaf character of the nei�hborhaod. Changes that wil! alter the characeer of a
neighborhood or district would be ac odds with the purpose of the Zoning Ordinance. T�e reques[sd variance will not aiter the
character of the neighbarhood for the following reasons:
Between Wri ht Street and CresCent on the,westerly side of�lelson are the fol,l.owinq properties and uses: .
1.Comer of Nelson and Wright-Cammercial parking lot
2. 93 Nelson Avenue-5ingle Family
3. 89 Nelson Avenue-Singie Family with detached carriage house
4. 87 Nelson Avenue-Single Family with d�etached garage/apartment
5. 85 Nelson Avenue (subject property)-3 Family
6. Nelsan Avenue-Twa Famil
7.$1 t�elson Avenue-Single Family with large commercial parking lot
8. 75 Nelson Avenue-Race View(believed to be mulki-units)
5ee attached continuation.
4. That the alleged ha.rdship has not been self-created.An applicant{whether the property owner orone acting on behalf of tha property
owner)cannot claim "unnecessary hardship" if that hardship was crea[etl by the a�plicant, or if the applicant acc�uirec!the property
knowing(orwas in a pasition to know)the�onditions for which the applicant is seeking relief.T'he hardship has not 6een self-created
for the following r2asons:
As previously noted, the subject property has been listed on the tax rolls af the City of 5aratoga Sprin�s as three family since priar
to the acquisition af the subject property by the applicar�t. The applicant had a right to rely on the desigr�ati�n of the property by
the City of Saratoga Springs and the hardship is therefore not self-created.
Revised O112029
t'ONING BOARD pFAPPE4L5APPClGqT/0N FORM PAGE S
DISCLC�SIJRE
Does any City oificer,employee,or family member tF�ereof have a financial interest(as defined by General Municipal Law Section$fl9)in
this application� Q��I\1a �Yes If"yes",a statement disclosing Che name, residence and nature and extent ot this interest must be filed
with[his application.
APPLICAf�fT CER7IFICATION
I�we, the property owner(s), or purchaser(s)/fessee(s) under cantract, of the land in question, hereby request an appearance before
the Zoning Board of Appeals.
By the signature{s)attached hereto, I�we certify that the information provided within this application and a�companying
documentatian is,to the best of myJour knowlecfge, true and accurate. I/we further understand that intentionally providing false or
misleading information is grounds for immediate denial of this applitation.
Furthermore, Ilwe hereby authorize the mem6e of the Zon ng Board of Appeals and designated City staff to enter the property
associated ti�is pplication for purposes of onducting a necessary site ir�spections relating to this appeal.
�
Date:
(ap i nt s ture)
Date:
(applicant sigr�ature)
If applicant is not the�urrently the owner of[he property, the current owner must also sign.
Owner Signature: Date:
�wner Signature: Date:
Revised 01/2(319
CoEltinuation of Para��h 3
Qn the west sicie of Nelso� Avem�e, south ot Crescent Street there is the
Horseshoe Bar and Restaurant, Brentwood Motel, and Mexican Connection, alf of whrch
op�rate year rou�lcf. On the east sic�e of Nelson Avenue, across frorn the subject premises
is the Saratoga Race Track, '
The use of tlie applic�nt's prQperty as � thi•ee fa��lily res�dence will in no way alter
tl�e character of the neighborhood.
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OWlVERSHIF Il4FORMA'�'�ON PAf�CEL IVp: 179,21-2-i9
liERMAN, DAYYp� 8 N�aii: 85 NELSON AV�
$5 [VEL.Sd1V/�1VE 5ARi4TOCA SPRTNGS NY 12865-5211
Il4SID�}VY i2866-52Ii pt-ipNE 1+1UMBER•
COUIVTY: SARATdGA CENSUS TRAC'�: 0521.00
PRdPERTY CLASS: 2��������-V YEAR-FtOUNQ
�tESIDENC�
SALE INFOItWIAT;ON Sate Dafe Price $ 0 Deecl Date
Arms Length N �.ibre Yp60 P�ge i94 #Totai Parcels
S�iler Buyer Persqr�al Property
PFIIOR ARMS �
SALES PRICE DATP SELLER BUYER
EENGTH
1Vo sale histc�ry in database for this p�rcel.
STRtiCTURAt TNF8F2MpTIpIH !OT INFOl�I�AT30N TAX INFORMATIQN
5qaare Feet 3,575 Lot Seze Dim.: 5f.00x333.50 Tax ID# 179.21-2-19
Sqft. 1st Floor 1,$65 '�and S(ZFT i7,009 Assesseil Value$ 4i3,000
Sqf#. 2nd Floor 1,7I0 Lot Sixe Acres 0.35 Land Assesment$ 130,Odo
Fin. �asement Sc�€t.a �oning UR2 School Tax$ �,,��1
Year Buift 189fl Nbad Cod� iS120 County/sown Tax$ 1,z10
B�d9 �{Y�� OLQ �'�E 41 f 500- SARATOGA Ci g �
# Units � 5chool District SPRINGS tY/Villa e Tax 2,474
7otaf Tax$ g gp�
#S#aries 2.00 Desirability TYPICA� Fulr Tax Value$ 503,658
# Baths 4 FULL Water Fr�nt N
# Bedrooms f Sewer COMMERCIAL/PUBLIC E�ualization Rate O.BZ
Pripr Tax iD#f �20.-20-7
# Fireplaces 0 1Nater COMMERCIAL/PUB�IC ���� �nd Value$ 158,536
# Kitchens 3 Utilities GAS/ElECTRIC
GAR-f,5 A�, r'dbk�d. Rating AVERAGE ���e cafculated tax amounts are not
SUI�T: 20Qf, Nbad.Type €�RgAf�f
732 S FT, exact. Np special district tax amounts
Garage Type C��T�_ #fte5. Sit�s 1 or exemptions have been included, AIE
NORMAL, #�'a��• S�tes D num�ers are estRrnated based on
GRADE: C 5wis Code 411501 t6wn values. Taxes shoufd be verified
Garage Bays ; direc�ly from khe 3ocal tax collector.
Caoling petail €Vdf�E
Hcat T FiEAT. (H(7T AIR) Updated:QZ/05/2p1� 10:02 am
ype
FUEL: (GP5)
Exterior ALUM/ViNYt
Condition NORMAL
Basement Type RARTIAL
EXEi�APTIOlVS:
BASIC STAR 1999-Z000
TiNPROVEMEIVTS-
(1) PORCH-QPEN, BUILT 2003, 0 SQFT, CONpITiON f�QRMAL
(1) P�RCH-CpVERD, BUiLT 189Q, 132.00 SQFT, COfVpI�ION �Vf]RMA�
{1) GAR-1.5 ATf, BftILT 2001, 732.0�SQFt`, CONDII'!O(�! I�EQRMAL
(�} PORCH-lJP OPN, SUILT Z003, 40.00 SQFT, CQlVDITIOfV IVORMAL
(1) PORCH-UP OPN, BUILT 2003, 0 SQFT, CONQITIfliN NORMAL
(1) PORCN-SCREEN, BUILT 2L103, 40.p0 SQFT, CbiVDITION fVORMAL
Note: Display indicates first residential site and up to four improvem�nts.
real-infc�.00m makes no warranty ur guuante�concerning the accuracy or reliability of the eorrteni contained in ih;s site_InformaEion is
ob[aine�!fr�rn many sources.rea]-info.coiu shaE��ot be liable€e�r errnrs mnlained hereeu or fur any damages in cunoeetiau with the use uf
d�e informalion rnorai��ed hereiu.
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�ratoga Springs C�ty School District ��n No. aos���
a�� . �ox� s�noQi -raX ��llnl�ll���������flllll�lllfllll�I��I��I����� �11I
ail Fiscal Year Ending 06/30/24 ' Warrant Date Q91q4119 I�9 c�Q5�3� o
MAKE CH'�CKS PAYABL�T(? TO PAY�IY P�RSON TAX CO�L�C`rOR SHE�u SAUPE
S�rBtbga Springs City SD Schaol 7ax Offtce M-F 9-3:30 bistrict websike: Saratogaschools.org
PO Box 37S 3 61ue Streak Bl�d- HS Campus Receipts 8�QnGns payments: Infotaxonline.com
Saratoga 5prir�gs, NY 12866 OR ON TIME wifh cofored STUBS E-mai{: Tax_office@saratvgaschnols.org
New Online Payment Option at Adirondack Trust Co�sr P�one: (5t8}693-1455
Infotaxoniine.com 5aratoga Natianal Bank R�1gTALLMEN7 1 -DUE OCTOBER 4,2D19
INSTALLMENT 2-DUE FEBRUARY 4,2020
Waite Theodore J III
Waite Barbara J
2 Stable Ln
Saratoga Spnngs, NY 12866
Pra ert Tax a er's Bill of Ri hts
Full Marke#Value as of July 1,201$: $���,��6
Total Assessed Value as af March 1, 2p19: $4i3,�00
The Uniform Percentage af Value used to establish assessments was: 63.(30%
F�emption T Value Tax Puroose Fulf yalue Est. Tt�tal 5chpoG$udget: $129,447,782
Total �istrict Tax Le�ry: $86,321,878
Estimated State Aid: $33,063,033
�fYS 7axation and Finance Schoal District Code 562
P#iOPER7Y TAXES %Change from Rate per 5100�
'Taxing Purpose Total 7ax Levy Prior Year `Caxable Vafue or Units or Per Unit Tax Amount
Saratoga Springs CS� 86,321,878 3.Q% 413,�Oa.00 tfi.$24346 6,948.45
LibraryTax 5,2p�,516 2.0%a 413,440.40 1.p14t7@ 41$.86
S/BIL 4'E 15Q1 179.21-2-19
Address: 8�P�elson Aue
Town of: Sara#oga Sprin�s
Schnol: 41150�-Sarata�a Springs CSD
�°��,�: �-������ ? �oTa�. r�cEs
Acres: 0.35 �o�� se�t�o�: i $7,367.31
Bank:
Xc�r Fiscal Year 0l/Qt/202p ro 12/31/2020 2��a CITY & CpUNTY TAX BILL
' �warrant E7ate i2J31/2019 CiTY aF S.4R.4TOGA SPRIIVI�$
81��.�]O.: 005533
I�IAKE CHECKS PAYABLE TO TO PAY IPV P�RSON PROPERTY ADDRESS&LEGAL D�SCRIPTTON
C4NIMISSIONER OF FINAir{CE S'W�+S� 41���� ��$/[, l79.21-2-[9
PO BOX 328 SARATOGA SPRINGS REC CEi�}TER A��Fess: 85►���son Ave
M 9AM - SPM T-F 9AM - 4:30PM
SARAT6(`,A 3FRINGS NY WiVW.SARATpC,A-SPRTNGS.flRG Cityof: SaratogaSprings
12866-p328 ANY ApFRq�DACK TRUST Cp
sie-ss�_3ssa Sc�oo�: SaratogaSpringsGsd
2�3 Fam�y R�s �/'
179.21-2-[9 Ro11 Sect. � i
Waite Theodore J Ili Acreage. ,35
Waite Barbara J
2 Stabfe Ln
Saratoga Springs,NY 12866 Estimated 5tate Aid: Cnty: 3s,�9s,935
Ci�+: 1,649,T01
PRQP�RT`Y TAXPAYER'S �ILL�F RIGHTS
Thc assessor estimates tl�e Full Market Va�ue of thi5 property as pf JULY 1,2018 was; 8550�56
The Total Assessed Va2ue of this property as: 413,000
The i]nifarm Percenfage o#'Value used to establish assessmeats in your mun�cipality was: 63.�0°,6
If you feel your assessment is too l�igh,yau have the right to seek a reduction in the future. A publication en6t�ed "C'ontestieg
�•our assessm�r�t"is available at thc assessor's affice and oNine at +vr�vw.tax.ny.�o� Piease Qate fihat the period for fling
camplaints on the a�hove assessment t�as passed. Apply for Third Party Notificarion By: �i1011202�
����srnon v,u.� r,�cauHeos� ru��vniuee�+avnow �xentPnor�
� . V'u"� T'1%P�3Rk'pS� FU(.L VALUE EXFMPtYON
PROPE�TY TAXES
%Levy�'hange raxable Assessed Val�e Rates pe;r$�(H]p
Taxing k"urpose Total Tax laevy From Prior Year or Units or per Uni[ Tax Amaunt
3ENERAL COUNTY 2.1g0.293 -7.4 913.00�.00 .236148
�YS MANDATES 97.53
b2,927,257 3.8 413,000.0{l 3.569792 1,474.32
lENSRAF, CITY 19,849,713 1,2 413,OOO.QO 5.070900 �,507,zA
IF RECEIP'C[S REQUIR�L]SENI}SFLF ADDRESSED ��A�Y
TAJCTOTAL
S'FAMPED ENVELOPE AND Et*#CLflSE'T'HI5 BILL. $4,079.13
iF FULL YEARLY TAX TOTAI�IS FAID TN pA'�pA}rnlElyT` ntSCOUNTED
ev n�nu��w��.rrr�nrsrnrr�vTFr�T�mnr,wnTrr,D gF ror`�,
$3,987.35
E 2ozo sau�rocA
�ity� ��,�nr� T;,x�i��
SB/L
179.21-2-19
4�QUARTER
�AYMENT
1,019.78
DiJE LIECENiBER l, z020
ff uot paid by December f�'
penalties wi!!accrue.
See reveis�side
for g�enally schedvle.
IR�TCfRN 1"�f{IS STL1R'WITFf PAY\�iF.NT
5ho��t Envi�onmental Assessment FoYm
Par�t 1 - Project I�tforfnation
instructions for Completin�
Part 1—Pr�ject Infurmation. The applicant or praject sponsur is responsible fur the c�mpletion of Part 1. Res�onse5 become part of tUe
applicatian fo��approval or funding, are subyect to pub3ic e-eview,ancS may be subject t� fi�rther verifcc�tion. Cc�mplete Part t based on
information currently available. if additional research or investigation would be neecied tc� fully resp�n�to any item, please answer as
thoroughly as possible based on current informat'son.
Com�lete all items in F'art l. You may aksc�provide any additional inf�rmatian which you believ�e will be needec!by o�useful to the
lead agency;attach aciditional pages as necessary to supplement any item.
Part l —Project and Sponsor Inf'or�nation
Theodore Waite III
Name of Action or Project:
Waite Zoning Application
Praject Location(describe,and attach a location map).
85 IVeisoR Avenue,5araioga Springs,NY 12866
Brief Description of Proposed Action:
Applicatian for use variance ta permit premises to be used es a three famly rasidence.
Name of`A�plicant or Sponsor: Telephone: $�8-441-6939
Theodore Waite III
E-Mail: theowaite@aol.com
Address:
85 Nelsan Avenue
City1P0: State: Zip Code:
5arataga 5prings NY 12866
1. Daes the pro�rosed action only involve the legislative adoption ofa plan, local law, ardinas�ce, NO YE5
��ministrative rule, or r�gulativn?
�f Yes,attach a narrative description of the intent of the proposed action and the environmental resources that � �
may be affectec�sn the municipality and praceed to Part 2. If no, continue ta question 2.
2. �oes the praposed action require a permit, approval or funding from any other government Agency? NO YE5
If Y�s, list agency(s}name anc�permit or a�proval: a �
3, a.Total acrea�e of the site of the proposed action? �35 acres
b. Total acreage to ba physically disturbed? 0 acres
c. Total acreage(project site and any contigtsous �rope�rties}owned
or controlled by the applicant or project sponsor? ���acres
4. Check ali land uses that occur on, are adjoining or near the proposed action:
Q Urban C] Rural (noi7-�griculture) ❑ industrial � Commercial ❑ Residentia] (suburban)
❑ Forest Q A�riculture [] Aquatic ✓[� Other{Specify): Ra�eTrack,Commercial Parking, Restaurant,
❑Parkland
�'�1�?� 1 crf .3 SEAF 2419
5. Is the proposed actian, NO YES N/A
a. A permiti�ci use under the zoning regulations'? � ❑ �
b. Consistent with the adc�pte�l con�prehensive plan? � � ❑
NO YES
6. 1s the proposed action consistent with the predominant character of the existing bui{t or natural landscape`?
❑ �
7. Is the site of the praposed actic�n located in, or does it adjoin, a state listed Critieal Enviranmental Area'? �p YES
IfYes, ulentify: � �
NO YES
8. a. Will the proposed action result in a subscantiaf increase ir�traffic above present le;vels? ❑ ❑
b. Are public transportation services available at or near the site of the pro�osed actic�n? —��— ❑
c. Are any pedestrian accorr�modativns or bicyele routes ar�ailable on or near the site of the proposed � ❑
action?
9. Does the proposed action meet or exceed the state energy code requirements? NO YES
Tf the pr�posed action wil! exceed requirem�nts, describe design features anci techni�lagies:
❑ �
10. Will the praposed action c�nneck ta an existing publi�lprivate water supply? NO YES
If Nc�, describe method tor providing potable water:
❑ ❑�
I l. Will the proposed action cannect to existing wastewater utilities? Np y��
If No,describe metho�i for providing wastewater treaEment:
❑ �
12. a. Does the project site cvA�tain,or is it substa�rtially conti�uous to, a building,archaeological site,or district NO YES
which is listed oi� the Na[ional or Stake 12egist�r of Historic Plaees, or that has been determined by the ❑ �
Commissioner af the NYS Office af Parks, Recreatian an+�I-Iistoric Pres�,n•atio� ta he eligible for listin�on the
State Register of Fiistoric Places?
b. Is the project site,or any portion of it, located in or adjacent to an area designated as sensitive for � �
archaeologicaf sites on the NY State Historic Preser�atinn Office(SHPO)arch�ieolo�ica!site inv��it�ry'?
13. a. Ds�es any portion of khe sits of the proposed action,or lands adjoining the propased action, contain NO YES
wetlanc�s or other waterbodies regulatcd by a federal, state or local agency? � ❑
b. Woulcl the propose�i action physically alter,or encroach into,any existing wetlanc�or waterbody7 a �
[f Yes,identify dhe wetland or waterbody and extent of alterations in sqttare feet or acres.
Pat�c Z ts'I'3
l4. Identify the typical habitat types that oc�:ur on, or are likely to be found on the projecE site. Check all that apply:
❑Shoreline ❑ Forest ❑Agricultural/grasslands ❑ Early mid-successiona!
❑Wetland ❑ Urban ❑ Subur6an
15. Does the site of the proposed action c�ntain any species�f�nimal, ar associated habitats, listed by the State or NQ YES
Federal gc�vernment as threatened or endangercd? � ❑
1 b. Is the project site located in the 100-year flood plan? NO Y�S
❑� ❑
17. Will the praposed action create storm water discharge,eitl3er frorn p�int or non-poir�t sources? NO YES
If Yes, O �
a. Will storm water discharges flow to ac�jaccnt prc�perties`? � �
b. W�ll storm water c�ischarges be directed Ea established conveyance systems(runoff and ston�n drains)? � �
�f Yes, brietly describe:
E$. Does the �roposed actian include constn�ctinn or other activities that would result in the impoundment of waEer NO YES
or other liquids{e.g., retentian pond,waste lagoon,cfam)`?
If Yes, explain the purpase and size of the impoundment:
� �
19. Has the site of the proposed action or an adjoining pro}�erty been the location of an active or closeci sofid waste NO YE5
rr►anagement facility7
If Yes,tiescrib�:
� �
20.Has the sit�of the propased action or an adjoining praE�erty been the subject of remediakion(ongoing ar NO YES
completed) for hazardous waste?
If Yes, c�escribe:
� �
I CERTIFY THAT TFiE iN�'�RMATI�N PROViDED aBQVE IS TRUE AND ACCURATE"�O THE BEST OF
MY KNO��LEDGE
�^' F
Applicant/sponsorin . Date:
Signature: Title:
PR1f�T FORM �>�,�� � �,��_3