Short Environmental Assessment Form Part 1 - Project Information

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

Name of Action or Project:

87 E Market St

Project Location (describe, and attach a location map):

87 E Market St Red Hook, NY 12571

BriefDescription of Proposed Action:

e scope of work includes an addition to the existing structure and the construction of a new accessory building

==> picture [126 x 14] intentionally omitted <==

----- Start of picture text -----

Name of Applicant or Sponsor: ----- End of picture text -----

ristina Dousharm Architecture PLLC

==> picture [101 x 14] intentionally omitted <==

----- Start of picture text -----

Telephone: (845)758-2724 ----- End of picture text -----

E-Mail: sg@kdousharm.com

==> picture [539 x 265] intentionally omitted <==

----- Start of picture text -----

Address: 531 N Brodway City/PO: State: Zip Code: Red Hook NY 12571

1. [Does the proposed action only involve the legislative adoption ofa plan, local law, ordinance 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 government Agency? NO YES If Yes, list agency(s) name and permit or approval: Sanica
3. a. [otalacreageof the site of the proposed action! 1.64acres b. Total acreage to be physically disturbed? 0.28acres c. [Total acreage (project site and any contiguou perties) owned lor controlled by the applicant or project sponsor? _ 1.64 acres
4. (Check all land uses that occur on, are adjoining or near the proposed action:
5. (Urban [1] Rural (non-agriculture) [1 Industrial Commercial [4] Residential (suburban) Forest [[] Agriculture [[] Aquatic [(] Other(Specify): [_] Parkland ----- End of picture text -----

Page | of 3

==> picture [541 x 698] intentionally omitted <==

----- Start of picture text -----

« ’ 5. Is the proposed action, ———————E————————— OM)O) OfW!O) 6. [Is the proposed action consistent with the predominant character ofthe existing built or natural landscape? ow 7. [is the siteof the proposed action located in, or doesit adjoin,a state listed Critical Environmental Area?| No If Yes, identify: fa) 8. a. icin b. Are public transportation services available at or near the site ofthe proposed action? Mm) O c. Are any pedestrian accommodations or bicycle routes available on or near the site ofthe proposed falic action? 5. If the proposed action will exceed requirements, describe design features and technologies: Ma a 10. |Will the proposed action connect to an existing public/private water sup ply? If No, describe method for providing potable water: P SS 11. [Will the proposed action connect to existing wastewater utilities? If No, describe method for providing wastewater treatment: _ ee 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 archaeological sites on the NY State Historic Preservation Office (SHPO) archaeological site inventory? | 13. a. [Doesany portion ofthe site ofthe proposed action, or lands adjoining the proposed action, contain! in] b. Would the proposed action physically alter, or encroach into, any existing wetland or waterbody? iain IfYes, identify the wetland or waterbodyand extent ofalterations in square feet or acres: aR ----- End of picture text -----

Page 2 of3

==> picture [541 x 553] intentionally omitted <==

----- Start of picture text -----

t 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 [7] Urban J Suburban 15. [Does the site ofthe proposed action contain any species of animal, or associated habitats. listed by the State o [Federal covernment as threatened or endangered? (ca) im] [is the [project] site locatedin the100-year [flood] plan] LJ 17. a. Will storm water discharges flow to adjacent properties? caja ConnectIf Yes,intobrieflyb. existingWilldescribe: storm waterdrainage storm water dischargessystem be directed to established conveyance- systems (runoff—— and storm drains)?” inital| 18. [Does the proposed action include construction or other activities that would result in the impoundment of water If Yes, explain the purpose and size of the impoundment: 19. [Has the site of the proposed action or an adjoining property been the location of an active or closed solid waste If Yes, describe: ———————————— 20.Has the site of the proposed action or an adjoining property been the subject of remediation (ongoing o If Yes, describe: oo ICERTIFY THAT THE INFORMATION PROVIDED ABOVE IS TRUE AND ACCURATE TO THE BEST OF MY KNOWLEDGE Applicant/sponsor/name: Kristina Dousharm Architecture PLLC Date: 08/28/25 Stacey Guerrero Title: ----- End of picture text -----

Page 3 of3

PRINT FORM