NEW YORK STATE WELL LOCATION PLAT DEPARTMENT OF ENVIRONMENTAL CONSERVATION DIVISION OF MINERAL RESOURCES SNYDER E 1A WELL LOCATION PLAT (MARCELLUS FORMATION)

IMf' Ulfl.UU-1-D

0 F S P E N C E R Tt..lf 09 .00

T 0 W N 0 F BARTON

TM# 102.00-1-1.21

l i:j I I 0 0

Tit.II 102_00-1-2 T~* 102.00­ 1-6

N ~

!

NOTE: This plat is for well location purposes only and does not represent a complete boundary survey. Comers and lines pertinent to locating the well are from field survey. Other lines and features are from tax maps, aerial photographs and/or deeds.

Survey was prefonned with dual-frequency (L1+L2) GPS equipment. lv1 RTK unit was used and processed against a NYSDOT CORS-correcled network base to achieve x,y coordinates with accuracy of :1:1 foot.

TM# 091 .00-1 - 34.

TM-I 102.00 -1

NAO 83 (0.000001" :!:)

True Latitude: NORTH Surface 42.144879"

True Longib..ide: WEST

Surface -76.454102°

True Latitude: NORTH Bottom 42.152963°

True Longib..ide: WEST

Bottom

zl J r-

TMI 102.00-1-7.12 -76.458247°

6--­~~·1. TM# 102 .00 - 1-28 .11

~I r Tiii# 102.00-1-28.1 2

~I I

~I TM#102.0p

™' 102.00­ 2-6

~

"'N "'I N N

I I I

8 ~ ~ N D N N0 0

.... ..." ~ 2'

N/F ERNEST J. SNYDER

233 HAMILTON VALLEY ROAD L. 6 17 D.PG. 286 TM# 102.00-1-24

I/) I/) w 0 0 <i:

TM# 102.00-1·

TM# 10200-1-1 0 .2

TM# 102.00-1-23

Appllcanl I Wall Oplnllnr Namo TIOGA ENERGY PARTNERS, LLC c/o ADAM SCHULlZ, ESQ.

Wall (Fmm)Nama SNYDERE

Wall# 1A

Unll Acraaga 53.86ACRES

P.O. BOX 22222 ALBANY, NEW YORK 12201

County~ TIOGA

T""'1 BARTON

Surface L.and111fmar I Lamar ERNEST J. SNYDER

USGS 7112 Quadrangle Map Nama SPENCER NY QUADRANGLE

MapSacllon H

233 HAMILTON VALLEY RD. LOCKWOOD, NY 14859

Angla I. Coo1118 of Dll'llallon (D~lllng)

N20"58'20"W Surface Elavallon

1345 Antlclpalad Total Depth

TVD 3653; TMD 6800

Surface Owner or Water Purveyor with a Water Supply within 1,000 ll

Approximate Course and Distance le Water Supply

Su""'Y"ror Engl.­ ROBERT J.AVERY

DEC USE

ONLY

Pennll#

Projocl# t--~~~~~~~~~~~~~~~~

Flald Nmne

PLS #049743

""°"'l><'lnt Land Sinayora 1255 Unlvanslty Avarut, Sultll 2'40,

Roohular, NY 14807 (686) 766-0408

DlllB: MAY18, 2015 REVISION>

s...1a: 1" ~ 1200'

TM# 102.00-1-1.21

TM# 091.00-1-9.1

TM# 091.00-1-B

0 F S P E N C E R

TO~ 0 F

BOTIO M OF

FpRMATION

B A R T 0 N

TM# 102.00-1-3

™· .,,,,_,. ,L TM# 102.00-1-6

I 0 0

"' D

I : l~~ ~LJ _J I

N

!1 ;;;;

I

'CI <»

+1 8 N 0

TM# 102.00-1-28.11

I I TM# 102.00-1-28.12

"' N I

N/F ERNEST J. SNYDER

233 HAMILTON VALLEY ROAD L. 617 D.PG. 286

TM# 102.00-1-24

TM# 102.00-1-7.12

.,..___,_TOP

[/) [/) w u

~

OF F~RMATION

TM# 091.00-1-35

TM# 091 .00-1-34.11

TM# 102.00-1-5

TM# 102.00-1-9

TM# 102.00-1-10.2

z 0

0:::

<(

[l]

(_'.)

0

TM# 102.00-1-23 TM#

N I

TM# 102.00-2-6 TM# 102. 00-1-22

TM# TM#

1ODO 0 1ODO 2000 3000 4000 SPACING MAP SNYDER E 1A ~~~-~-;J~~~I~-1~~1--~1 (MARCELLUS FORMATION)

Scale: 1" 1000' SNYDER E 1A TOWN OF BARTON TIOGA COUNTY NY

~ PROPOSED !.£ASE PROPOSED SURFACE HOLE LOCATION: 42.144879", - 76.454102" (NAO 83)

~ TAXPARCEL PROPOSED BOTTOM HOLE LOCATION: 42.152963", - 76.458247" (NAO 83) TARGET FORMATION: MARCELLUS

LEGEND PROPOSED TRUE VERTICAL DEPTH OF BOTTOM HOLE LOCATION: 3653 ft.

PROPOSED TRUE MEASURED DEPTH OF BOTTOM HOLE LOCATION: 6600 ft.

PLANNED INTERSECTION with TOP OF PROPOSED TARGET FORMATION LOCATION: 42.145568", - 76.454455" (NAO 83) TVD: 3602 ft. TMD: 3690ft.

DISCLAIMER

THE GEOLOGICAL FEAnJRES AND BOUNDARIES OF Tl-llS MAP ARE Tl-IE SOLE INTERPOlATION OF ARROWPOINT LAND SURVEYORS, FOR URDA ENGINEERING, PLLC WHICH WAS BASED UPON THE MOST RECENT SOURCES AVAL.ABLE AT THE TIME.

ARROWPOINT LAND SURVEYORS, AND URDA ENGINEERING, PLLC EXPRESSLY DISCLAIMS RESPONSIBILrTY FOR ANYACTION, ACTNITY, OR DECJSJON UNDERTAKEN BYA THIRD PARTY ON THE BASIS OF Tl-IE INFORMATION DEPICTED ON THIS MAP.

CALL OR WRITE: URDA ENGINEERING, PLLC ARROWPOINT LAND SURVEYORS POBOX142 1255 UNIVERSITY AVENUE, SUITE 240 DATE: WINDSOR, NY 13865 ROCHESTER, NY 14607 MAY15, 2015 (607) 760-6545 (585) 755-0408 REYISION2

85-16-5 (1/07)-10b NEW YORK STATE DEPARTMENT OF ENVIRONMENTAL CONSERVATION

DIVISION OF MINERAL RESOURCES ~­ ENVIRONMENTAL ASSESSMENT FORM - Attachment to Drilling Permit Application WELL NAME AND NUMBER SNYDER E 1A NAME OF APPLICANT 'BUSINESS TELEPHONE NUMBER TioQa Enernv Partners, LLC { 518 \ 426-4600

ADDRESS OF APPLICANT P.O. Box 22222

CITY/P.O. I STATE 'ZIP CODE Albany, NY 12201

DESCRIPTION OF PROJECT (Briefly describe type of project or action)

Utilize same bore hole as Utica formation Snyder E 1 Well and drill horizontal natural gas well in the Marcellus Shale. Utilize existing farm/landowner road with improvements.

Well Pad and Well Top Hole location: 233 Hamilton Valley Rd, Town of Barton, Tioga County, NY; TM#102.00-1-24; Owner: Ernest J. Snyder

Access Rd.: Hamilton Valley Rd, Town of Barton, Tioga County, NY; TM#102.00-1-22 & 2-16.1; Owner: Howard & Beryl Chrisfield

PROJECT SITE IS THE WELL SITE AND SURROUNDING AREA WHICH WILL BE DISTURBED DURING CONSTRUCTION OF SITE, ACCESS ROAD, and PIT AND ACTIVITIES DURING DRILLING AND COMPLETION AT WELLHEAD.

(PLEASE COMPLETE l=dCH QUESTION-Indicate N.A. if not 8""1icable) LAND USE AND PROJECT SITE

1528961. Project Dimensions. Total Area of Project Site sq. ft. Approximate square footage for items below:

During Construction (sq. ft.) After Construction (sq. ft.)

a. Access Road (length x width) NIA 58747

b. Well Stte (length x width) N/A 28350

2. Characterize Project Site Vegetation and Estimate Percentage of Each Type Before Construction:

3 0~%Agricultural (cropland, hayland, pasture, vineyard, etc.) ---% Forested ___ o/o Wetlands

__o_ 0/o Meadow or Brushland (non agricultural) _6__ % Non vegetated (rock, soil, fill)

3. Present Land Use(s) Within Xi Mile of Project (Check all that apply)

IZ!Rural Osuburban IZI Forest Durban (ZJ Agricultural DCommercial D Park/Recreation

lZf Industrial Oother

4. How close is the nearest residence, building, or outdoor facility of any type routinely occupied by people at least part of the day? 2~00 ft.

Describe NEAREST RESIDENCE IS 2800 FEET FROM WELL SITE AND >250 FEET FROM ACCESS ROAD.

ENTRANCE ON HAMILTON VALLEY ROAD

ENVIRONMENTAL RESOURCES ON/NEAR PROJECT SITE 5. The presence of certain environmental resources on or near the project site may require additional permits, approvals or mitigation measures-ls any part

of the well site or access road located: a. Over a primary or principal aquifer? Oves IZ]No 0NotKnown

b. \l\lithin 2,640 feet of a public water supply well? Oves 12JNo 0NotKnown

c. Within 150 feet of a surface municipal water supply? Oves IZ]No 0NotKnown

d. \l\lithin 150 feet of a lake, stream, or other public surface water body? Oves IZ]No 0NotKnown

e. \l\lithin an Agricultural District? (0'1- G\.c:.-t..<;) 0ves 0No 0NotKnown

f. l/v'ithin a land parcel having a Soil and Water Conservation Plan? Oves [ZINo 0NotKnown

g. In a 100 year flood plain? Oves IZJ No 0NotKnown

h. In a regulated wetland or its 100 foot buffer zone? Oves [ZINo 0NotKnown

i. In a coastal zone management area? Oves [ZINo 0NotKnown

j. In a Critical Environmental Area? Oves IZ]No 0NotKnown k. Does the project site contain any species of animal life that are listed as threatened

or endangered? Oves IZ]No 0NotKnown

Jf yes, identify the species and source of information

I. \/Viii proposed project significantly impact visual resources of statewide significance? Oves IZ]No 0NotKnown

If yes, identify the visual resource and source of information

--- ---

CULTURAL RESOURCES 6. Are there any known archeological and/or historical resources which will be affected by

driRing operations? Oves IZJNo 0NotKnown

7. Has the land within the project area been previously disturbed or altered (excavated, landscaped, filled, utilities installed)?

G'.lves 0No 0NotKnown

If answer to Number 6 or 7 is yes, briefly descrbe Farming

EROSION AND RECLAMATION PLANS 73 10 ___%8. Indicate percentage of project site within: 0-1 Oo/o slope % 10-15o/o slope % greater than 1So/o slope 17

9. Are erosion control measures needed during construction of the access road and well site? IZJYes 0No 0NotKnown

Consistent with NYSDEC SPDES GP-0-15-002 and If yes, describe and/or sketch on attached photocopy of plat

required Storm Water Pollution Prevention Plan (SWPPP)

(e.g. check dams, sediment traps, control blankets, etc.)

10. Will the topsoil which is disturbed be stockpiled for reclamation use? G'.lves 0No

11. Does the redamation plan include revegetation? [ZJYes 0No

If yes, what plant materials will be used? GRASS MIX.

12. Does the reclamation plan include restoration or installation of surface or subsurface [ZJYes 0No drainage features to prevent erosion or conform to a Soil and Water Conservation Plan?

Grassed diversion swales. If yes, describe

ACCESS ROAD SITING AND CONSTRUCTION 13. Are you going to use existing or common corridors when building the access road? !21Yes 0No

Lncate access road on attached nhotoco-" of rilat. DRILLING

814. Anticipated length of drilling operations? days.

WASTE STORAGE AND DISPOSAL 15. How will drilling fluids and stimulation fluids:

DRILLING WILL BE CLOSED LOOP USING STEEL TANKS a. Be conta·1ned?

TAKEN TO CHEMUNG COUNTY LANDFILL, LOWMAN, NEW YORK b. Be disposed of?

16. Will production brine be stored on site? .If Nont.. "-'\\\d f"'-M , hv1- (f (\l.,(L..<;~, IZJves 0No

If yes: STEEL TANKS ON SITE How will it be stored?

TAKEN TO HYDRORECOVERY, BLOSSBURG, PENNSYLVANIA How will it be disposed of?

17. Will the drill cuttings and pit liner be disposed of on site? Oves !21No

If yes, expected burial depth? feet

ADDITIONAL PERMITS 18. Are any additional State, Local or Federal permits or approvals required for this project? [ZJYes 0No

Date Application Date Application Submitted Received

Stream Disturbance Permit (DEC) I I I Wetlands Permit (DEC or Local) I I I Floodplain Permit (DEC or Local) I I I

NYSDEC SPDES GP-0-15-002 (STORMWATER) Other I I I SRBC -APPROVAL BY RULE I I I (both will be submitted prior to any site operations) I I I

I I I PREPARER'S SIGNATUR 'I' /}

NAMEfTITLE (Please prin Clav Smith 17

REPRESENTING Tioaa Enernv Partners, LLC

(, I I

IDATE Julv7 2015

Full Environmental Assessment Form Part I - Project and Setting

Instructions for Completing Part 1

Part 1 is to be completed by the applicant or project sponsor. Responses become part ofthe 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; indicate whether missing information does not exist, or is not reasonably available to the sponsor; and, when possible, generally describe work or studies which would be necessary to update or fully develop that information.

Applicants/sponsors must complete all items in Sections A & B. In Sections C, D & E, most items contain an initial question that must be answered either ''Yes" or "No". Ifthe answer to the initial question is "Yes", complete the sub-questions that follow. Ifthe answer to the initial question is "No", proceed to the next question. Section F allows the project sponsor to identify and attach any additional information. Section G requires the name and signature of the project sponsor to verify that the information contained in Part !is accurate and complete.

A. Project and Sponsor Information.

Name of Action or Project: SNYDERE 1A

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

233 Hamilton Valley Road, Town of Barton, Tioga County, TM# 102.00-1-24

Brief Description of Proposed Action (include purpose or need):

Utilize same bore hole as Utica formation Snyder E 1 Well and complete horizontal natural gas well using LPG fracturing in the Marcellus Shale. Utilize existing farm/landowner road with improvements.

Well Pad and Well Top Hole location: 233 Hamilton Valley Rd, Town of Barton, Tioga County, NY: TM#102.00-1-24; Owner: Ernest J. Snyder

Access Rd.: Hamilton Valley Rd, Town of Barton, Tioga County, NY; TM#102.00-1-22 & 2-16.1; Owner: Howard & Beryl Chrisfield

Name of Applicant/Sponsor: Telephone: 518 426-4600

Tioga Energy Partners, LLC E-Mail: aschultz@couchwhite.com

Address: P.O. Box 22222

City/PO: Albany

Project Contact (if not same as sponsor; give name and title/role):

(same as above)

Address:

State: NY

Telephone:

E-Mail:

\ Zip Code: 12201

City/PO: State: IZip Code:

Property Owner (if not same as sponsor):

See Description Above

Address:

Telephone:

E-Mail:

City/PO: State: \ Zip Code:

Page I of 13

B. Government Approvals

B. Government Approvals Funding, or Sponsorship. ("Funding" includes grants, loans, tax relief, and any other forms of financial assistance.)

Government Entity IfYes: Identify Agency and Approval(s) Required

Application Date

(Actual or projected)

a. City Council, Town Board, DYesJ;Z]No or Village Board ofTrustees

b. City, Town or Village DYesJ;Z]No Planning Board or Commission

c. City Council, Town or DYesJ;Z]No Village Zoning Board of Appeals

d. Other local agencies DYesJ;ZlNo

e. County agencies oYesJ;Z]No

f. Regional agencies J;Z]YesDNo SRBC - Approval By Rule

g. State agencies

h. Federal agencies

J;Z]YesONo

DYesJ;Z]No

NYSDEC Minerals Division Drilling Permit; NYSDEC SPDES GP-0-15-002 IStormwaterl

i. Coastal Resources. i. Is the project site within a Coastal Area, or the waterfront area of a Designated Inland Waterway? DYesJ;ZlNo

ii. Is the project site located in a community with an approved Local Waterfront Revitalization Program? DYesJ;ZlNo iii. Is the project site within a Coastal Erosion Hazard Area? DYesJ;Z]No

C. Planning and Zoning

C.I. Planning and zoning actions.

Will administrative or legislative adoption, or amendment of a plan, local law, ordinance, rule or regulation be the DYesJ;Z]No only approval(s) which must be granted to enable the proposed action to proceed?

• If Yes, complete sections C, F and G .

• IfNo, proceed to question C.2 and complete all remaining sections and questions in Part I

C.2. Adopted land use plans.

a. Do any municipally- adopted (city, town, village or county) comprehensive land use plan(s) include the site DYesJ;ZlNo where the proposed action would be located?

IfYes, does the comprehensive plan include specific recommendations for the site where the proposed action OYesDNo would be located?

b. Is the site of the proposed action within any local or regional special planning district (for example: Greenway DYesJ;Z]No Brownfield Opportunity Area (BOA); designated State or Federal heritage area; watershed management plan; or other?)

IfYes, identify the plan(s):

c. Is the proposed action located wholly or partially within an area listed in an adopted municipal open space plan, DYesJ;Z]No or an adopted municipal farmland protection plan?

IfYes, identify the plan(s):

Page 2of13

--

--

C.3. Zoning

a. Is the site of the proposed action located in a municipality with an adopted zoning law or ordinance. OYesi;zJNo IfYes, what is the zoning classification(s) including any applicable overlay district?

b. Is the use permitted or allowed by a special or conditional use permit? 0Yes0No!ll/A

c. Is a zoning change requested as part ofthe proposed action? 0Yes0No ti/It IfYes,

i. What is the proposed new zoning for the site?

C.4. Existing community services.

a. In what school district is the project site located? SP.:encer Van Etten

b. What police or other public protection forces serve the project site? Tioga Count~ Sheriff State Police

c. Which fire protection and emergency medical services serve the project site? Tiona Center; Halsev Valley

d. What parks serve the project site? None

D. Project Details

D.1. Proposed and Potential Development

a. What is the general nature ofthe proposed action (e.g., residential, industrial, commercial, recreational; ifmixed, include all components)? Industrial.

b. a. Total acreage ofthe site ofthe proposed action? 3.51 acres b. Total acreage to be physically disturbed? O acres c. Total acreage (project site and any contiguous properties) owned

or controlled by the applicant or project sponsor? 53.86 acres

c. Is the proposed action an expansion of an existing project or use? D Yesi;zJNo i. IfYes, what is the approximate percentage ofthe proposed expansion and identify the units (e.g., acres, miles, housing units,

square feet)? % Units:

d. Is the proposed action a subdivision, or does it include a subdivision? OYesi;zJNo IfYes,

i. Purpose or type of subdivision? (e.g., residential, industrial, commercial; if mixed, specify types)

ii. Is a cluster/conservation layout proposed? OYesDNo iii. Number of lots proposed? iv. Minimum and maximum proposed lot sizes? Minimum Maximum

e. Will proposed action be constructed in multiple phases? OYesONoN/4 i. IfNo, anticipated period of construction: months

ii. IfYes:

• Total number of phases anticipated - ­• Anticipated commencement date of phase I (including demolition) month __ year

• Anticipated completion date of final phase __ month __year

• GeneraIIy describe connections or relationships among phases, including any contingencies where progress of one phase may determine timing or duration of future phases:

Page 3of13

f. Does the project include new residential uses? OYeslZ]No IfYes, show numbers of units proposed.

One Family Two Family Three Family Multiple Family (four or morel

Initial Phase At completion

ofall phases

g. Does the proposed action include new non-residential construction (including expansions)? OYeslZ]No IfYes,

i. Total number of structures ii. Dimensions (in feet) of largest proposed structure: height; width; and length

iii. Approximate extent of building space to be heated or cooled: square feet

h. Does the proposed action include construction or other activities that will result in the impoundment of any 0YeslZ]No liquids, such as creation ofa water supply, reservoir, pond, lake, waste lagoon or other storage?

IfYes, i. Purpose of the impoundment: ii. Ifa water impoundment, the principal source ofthe water: D Ground water D Surface water streams OOther specify:

iii. Ifother than water, identify the type of impounded/contained liquids and their source.

iv. Approximate size ofthe proposed impoundment. Volume: million gallons; surface area: acres v. Dimensions ofthe proposed darn or impounding structure: height; length

vi. Construction method/materials for the proposed dam or impounding structure (e.g., earth fill, rock, wood, concrete):

D.2. Project Operations

a. Does the proposed action include any excavation, mining, or dredging, during construction, operations, or both? 0Yesfl1No (Not including general site preparation, grading or installation ofutilities or foundations where all excavated materials will remain onsite)

IfYes: i. What is the purpose ofthe excavation or dredging?

ii. How much material (including rock, earth, sediments, etc.) is proposed to be removed from the site?

• Volume (specify tons or cubic yards}:

• Over what duration oftime? iii. Describe nature and characteristics of materials to be excavated or dredged, and plans to use, manage or dispose ofthem.

iv. Will there be onsite dewatering or processing of excavated materials? 0Yes0No !fyes, describe.

v. What is the total area to be dredged or excavated? acres vi. What is the maximum area to be worked at any one time? acres vii. What would be the maximum depth of excavation or dredging? viii. Will the excavation require blasting?

feet 0Yes0No

ix. Summarize site reclamation goals and plan:

b. Would the proposed action cause or result in alteration of, increase or decrease in size of, or encroachment LJYesli!No into any existing wetland, waterbody, shoreline, beach or adjacent area?

IfYes: i. Identify the wetland or waterbody which would be affected (by name, water index number, wetland map number or geographic

description):

Page 4of13

ii. Describe how the proposed action would affect that waterbody or wetland, e.g. excavation, fill, placement of structures, or alteration ofchannels, banks and shorelines. Indicate extent of activities, alterations and additions in square feet or acres:

iii. Will proposed action cause or result in disturbance to bottom sediments? 0Yes0No IfYes, describe:

iv. Will proposed action cause or result in the destruction or removal of aquatic vegetation? 0Yes0No IfYes:

• acres of aquatic vegetation proposed to be removed: • expected acreage of aquatic vegetation remaining after project completion: • purpose ofproposed removal (e.g. beach clearing, invasive species control, boat access):

• proposed method of plant removal:

• if chemical/herbicide treatment will be used, specify product(s): v. Describe any proposed reclamation/mitigation following disturbance:

c. Will the proposed action use, or create a new demand for water? DYesi;zJNo IfYes:

i. Total anticipated water usage/demand per day: gallons/day ii. Will the proposed action obtain water from an existing public water supply? DYes[]No

IfYes:

• Name of district or service area:

• Does the existing public water supply have capacity to serve the proposal? 0Yes0No

• Is the project site in the existing district? 0Yes0No

• Is expansion of the district needed? 0Yes0No

• Do existing lines serve the project site? 0Yes0No iii. Will line extension within an existing district be necessary to supply the project? 0Yes[]No IfYes:

• Describe extensions or capacity expansions proposed to serve this project:

• Source(s) ofsupply for the district: iv. Is a new water supply district or service area proposed to be formed to serve the project site? 0Yes0No

If, Yes:

• Applicant/sponsor for new district:

• Date application submitted or anticipated:

• Proposed source(s) of supply for new district: v. !fa public water supply will not be used, describe plans to provide water supply for the project:

vi. Ifwater supply will be from wells (public or private), maximum pumping capacity: gallons/minute.

d. Will the proposed action generate liquid wastes? DYesi;zJNo;t' IfYes:

i. Total anticipated liquid waste generation per day: gallons/day ii. Nature of liquid wastes to be generated (e.g., sanitary wastewater, industrial; if combination, describe all components and

approximate volumes or proportions ofeach): 4'None anticiQated; if necessa!}:'., will be disQosed of at facilit~ Qermitted for such QLirQoses

iii. Will the proposed action use any existing public wastewater treatment facilities? 0Yes0No IfYes:

• Name of wastewater treatment plant to be used:

• Name ofdistrict:

• Does the existing wastewater treatment plant have capacity to serve the project? DYesDNo

• Is the project site in the existing district? 0Yes0No

• Is expansion ofthe district needed? 0Yes0No

Page 5of13

• Do existing sewer lines serve the project site? 0Yes0No • Will line extension within an existing district be necessary to serve the project? 0Yes0No

IfYes:

• Describe extensions or capacity expansions proposed to serve this project:

iv. Will a new wastewater (sewage) treatment district be formed to serve the project site? 0Yes0No IfYes:

• Applicant/sponsor for new district:

• Date application submitted or anticipated:

• What is the receiving water for the wastewater discharge? v. Ifpublic facilities will not be used, describe plans to provide wastewater treatment for the project, including specifying proposed

receiving water (name and classification ifsurface discharge, or describe subsurface disposal plans):

vi. Describe any plans or designs to capture, recycle or reuse liquid waste:

e. Will the proposed action disturb more than one acre and create stonnwater runoff, either from new point DYesbZJNo sources (i.e. ditches, pipes, swales, curbs, gutters or other concentrated flows ofstormwater) or non-point source (i.e. sheet flow) during construction or post construction?

IfYes: i. How much impervious surface will the project create in relation to total size of project parcel?

__ Square feet or __ acres (impervious surface) __ Square feet or __acres (parcel size)

ii. Describe types of new point sources.

iii. Where will the stormwater runoff be directed (i.e. on-site stormwater management facility/structures, adjacent properties, groundwater, on-site surface water or off-site surface waters)?

• Ifto surface waters, identify receiving water bodies or wetlands:

• Will stormwater runoff flow to adjacent properties? 0Yes0No iv. Does proposed plan minimize impervious surfaces, use pervious materials or collect and re-use stormwater? 0Yes0No

f. Does the proposed action include, or will it use on-site, one or more sources of air emissions, including fuel bZIYesONo combustion, waste incineration, or other processes or operations?

IfYes, identify: i. Mobile sources during project operations (e.g., heavy equipment, fleet or delivery vehicles)

DeliverY_ of [!rO[!ane; Heayy egui[!ment and [!Ower generation to comQlete well and haul waste ii. Stationary sources during construction (e.g., power generation, structural heating, batch plant, crushers)

iii. Stationary sources during operations (e.g., process emissions, large boilers, electric generation)

g. Will any air emission sources named in D.2.f(above), require a NY State Air Registration, Air Facility Permit, DYesbZINo or Federal Clean Air Act Title IV or Title V Permit?

IfYes: i. Is the project site located in an Air quality non-attainment area? (Area routinely or periodically fails to meet 0Yes0No

ambient air quality standards for all or some parts ofthe year) ii. In addition to emissions as calculated in the application, the project will generate:

• Tons/year (short tons) of Carbon Dioxide (C02)

• Tons/year (short tons) ofNitrous Oxide (N20)

• Tons/year (short tons) ofPertluorocarbons (PFCs)

• Tons/year (short tons) of Sulfur Hexafluoride (SF6)

• Tons/year (short tons) of Carbon Dioxide equivalent ofHydroflourocarbons (HFCs)

• Tons/year (short tons) of Hazardous Air Pollutants (HAPs)

Page 6of13

• • • •

h. Will the proposed action generate or emit methane (including, but not limited to, sewage treatment plants, DYesbZINo landfills, composting facilities)?

IfYes: i. Estimate methane generation in tons/year (metric):

ii. Describe any methane capture, control or elimination measures included in project design (e.g., combustion to generate heat or electricity, flaring):

i. Will the proposed action result in the release of air pollutants from open-air operations or processes, such as OYesbZINo quarry or landfill operations?

IfYes: Describe operations and nature of emissions (e.g., diesel exhaust, rock particulates/dust):

j. Will the proposed action result in a substantial increase in traffic above present levels or generate substantial 0Yesb21No new demand for transportation facilities or services?

IfYes: i. When is the peak traffic expected (Check all that apply): D Randomly between hours of to

0Moming D Evening 0Weekend

ii. For commercial activities only, projected number of semi-trailer truck trips/day: iii. Parking spaces: Existing Proposed 'N'etincrease/decrease iv. Does the proposed action include any shared use parking? 0Yes0No v. Ifthe proposed action includes any modification of existing roads, creation of new roads or change in existing access, describe:

vi. Are public/private transportation service(s) or facilities available within Y, mile ofthe proposed site? 0Yes0No vii Will the proposed action include access to public transportation or accommodations for use ofhybrid, electric 0Yes0No

or other alternative fueled vehicles? viii. Will the proposed action include plans for pedestrian or bicycle accommodations for connections to existing 0Yes0No

pedestrian or bicycle routes?

k. Will the proposed action (for commercial or industrial projects only) generate new or additional demand OYesbZINo for energy?

IfYes: i. Estimate annual electricity demand during operation ofthe proposed action:

ii. Anticipated sources/suppliers ofelectricity for the project (e.g., on-site combustion, on-site renewable, via grid/local utility, or other):

iii. Will the proposed action require a new, or an upgrade to, an existing substation? 0Yes0No

I. Hours of operation. Answer all items which apply. i. During Construction: ii. During Operations:

• Monday - Friday: NIA • Monday - Friday: variable and intermittent

Saturday: Saturday: "(flowback)

Sunday: Sunday: "(flowback)

• Holidays: • Holidays: "(flowback)

Page 7of13

m. Will the proposed action produce noise that will exceed existing ambient noise levels during construction, ll!YesDNo operation, or both?

Ifyes: i. Provide details including sources, time of day and duration:

COMPLETION AND TRUCKING DURING QAYLIGHT HOURS FOR SHORT DURATIONS

ii. Will proposed action remove existing natural barriers that could act as a noise barrier or screen? OYeslllNo Describe:

n.. Will the proposed action have outdoor lighting? ll!Yes0No Ifyes: i. Describe source(s), location(s), height offixture(s), direction/aim, and proximity to nearest occupied structures:

Down directional safet~ lighting. Nearest residence> 1/2 mile.

ii. Will proposed action remove existing natural barriers that could act as a light barrier or screen? DYeslllNo Describe:

o. Does the proposed action have the potential to produce odors for more than one hour per day? 0Yesll!No IfYes, describe possible sources, potential frequency and duration of odor emissions, and proximity to nearest occupied structures:

p. Will the proposed action include any bulk storage of petroleum (combined capacity ofover 1,100 gallons) OYesll!No or chemical products 185 gallons in above ground storage or any amount in underground storage?

IfYes: i. Product(s) to be stored ii. Volume(s) ___ per unit time (e.g., month, year)

iii. Generally describe proposed storage facilities:

q. Will the proposed action (commercial, industrial and recreational projects only) use pesticides (i.e., herbicides, OYes ll!No insecticides) during construction or operation?

IfYes: i. Describe proposed treatment(s):

ii. Will the orooosed action use Integrated Pest Manal!ement Practices? 0 Yes 0No r. Will the proposed action (commercial or industrial projects only) involve or require the management or disposal D Yes ll!No

of solid waste (excluding hazardous materials)? IfYes:

i. Describe any solid waste(s) to be generated during construction or operation ofthe facility:

• Construction: tons per (unit of time)

• Operation: tons per (unit of time) ii. Describe any proposals for on-site minimization, recycling or reuse of materials to avoid disposal as solid waste:

• Construction:

• Operation:

iii. Proposed disposal methods/facilities for solid waste generated on-site:

• Construction:

• Operation:

Page 8of13

s. Does the proposed action include construction or modification of a solid waste management facility? IfYes:

D Yes i;zJ No

i. Type ofmanagement or handling ofwaste proposed for the site (e.g., recycling or transfer station, composting, landfill, or

other disposal activities):-:-:----,---------------------------------­ii. Anticipated rate of disposal/processing:

• Tons/month, if transfer or other non-combustion/thermal treatment, or • Tons/hour, if combustion or thermal treatment

iii. Iflandfill, anticipated site life: years

t. Will proposed action at the site involve the commercial generation, treatment, storage, or disposal of hazardous waste?

IfYes:

0Yesi;z]No

i. Name(s) of all hazardous wastes or constituents to be generated, handled or managed at facility: -----------­

ii. Generally describe processes or activities involving hazardous wastes or constituents: ---------------­

iii. Specify amount to be handled or generated __ tons/month iv. Describe any proposals for on-site minimization, recycling or reuse of hazardous constituents:------------­

v. Will any hazardous wastes be disposed at an existing offsite hazardous waste facility? 0Yes0No IfYes: provide name and location offacility:-------------------------------­

IfNo: describe proposed management ofany hazardous wastes which will not be sent to a hazardous waste facility:

E. Site and Setting of Proposed Action

E.1. Land uses on and surrounding the project site

a. Existing land uses. i. Check all uses that occur on, adjoining and near the project site.

D Urban IZJ Industrial D Commercial D Residential (suburban) i;zJ Rural (non-farm) IZI Forest IZJ Agriculture D Aquatic D Other (specify):

ii. Ifmix ofuses, generally describe:

b. Land uses and covertypes on the project site.

Land use or Covertype

Current Acreage

Acreage After Project Completion

Change (Acres+/-)

• Roads, buildings, and other paved or impervious surfaces 1.35 1.35 0

• Forested 0 0 0

• Meadows, grasslands or brushlands (non­agricultural, including abandoned agricultural) 0 0 0

• Agricultural (includes active orchards, field, greenhouse etc.)

3.5 3.5 0

• Surface water features (lakes, ponds, streams, rivers, etc.) 4 4 0

• Wetlands (freshwater or tidal) 0 0 0

• Non-vegetated (bare rock, earth or fill) 0 0 0

• Other Describe: Gravel Pad 0.65 0.65 0

Page 9of13

c. Is the project site presently used by members ofthe community for public recreation? i. IfYes: explain:

UYes!ZINo

d. Are there any facilities serving children, the elderly, people with disabilities (e.g., schools, hospitals, licensed day care centers, or group homes) within 1500 feet of the project site?

IfYes, i. Identify Facilities:

OYesllJNo

e. Does the project site contain an existing dam? OYeslllNo IfYes:

i. Dimensions ofthe dam and impoundment:

• Dam height: feet

• Dam length: feet

• Surface area: acres

• Volume impounded: gallons OR acre-feet ii. Dam's existing hazard classification: iii. Provide date and summarize results of last inspection:

f. Has the project site ever been used as a municipal, commercial or industrial solid waste management facility, OYesllJNo or does the project site adjoin property which is now, or was at one time, used as a solid waste management facility?

IfYes: i. Has the facility been formally closed? 0Yes0No

• Ifyes, cite sources/documentation: ii. Describe the location of the project site relative to the boundaries ofthe solid waste management facility:

iii. Describe any development constraints due to the prior solid waste activities:

g. Have hazardous wastes been generated, treated and/or disposed of at the site, or does the project site adjoin OYeslllNo property which is now or was at one time used to commercially treat, store and/or dispose of hazardous waste?

IfYes: i. Describe waste(s) handled and waste management activities, including approximate time when activities occurred:

h. Potential contamination history. Has there been a reported spill at the proposed project site, or have any 0Yeslll No remedial actions been conducted at or adjacent to the proposed site?

IfYes: i. ls any portion of the site listed on the NYSDEC Spills Incidents database or Environmental Site 0Yes0No

Remediation database? Check all that apply:

D Yes - Spills Incidents database Provide DEC ID number(s): D Yes - Environmental Site Remediation database Provide DEC ID number(s): D Neither database

ii. If site has been subject ofRCRA corrective activities, describe control measures:

iii. ls the project within 2000 feet of any site in the NYSD EC Environmental Site Remediation database? 0Yes0No Ifyes, provide DEC ID number(s):

iv. Ifyes to (i), (ii) or (iii) above, describe current status of site(s):

Page 10of13

v. ls the project site subject to an institutional control limiting property uses? 0Yes0No

• lfyes, DEC site ID number:

• Describe the type of institutional control (e.g., deed restriction or easement):

• Describe any use limitations: • Describe any engineering controls: • Will the project affect the institutional or engineering controls in place? 0Yes0No • Explain:

E.2. Natural Resources On or Near Project Site

a. What is the average depth to bedrock on the project site? 6 lt>IQ~ES TO 6 FEET feet

b. Are there bedrock outcroppings on the project site? OYesl;z'JNo IfYes, what proportion ofthe site is comprised of bedrock outcroppings? %

c. Predominant soil type(s) present on project site: FremonWolusia channery silt loam 85 % Lordstown" " " 6% Woostern " " " 9%

d. What is the average depth to the water table on the project site? Average: >1.5 feet

e. Drainage status of project site soils:l;z'J Well Drained: D Moderately Well Drained: Ill Poorly Drained

__9_% of site __%ofsite ~%ofsite

f. Approximate proportion of proposed action site with slopes: Ill 0-10%: l;z'J 10-15%: Ill 15% or greater:

___B_.% of site _!Q_% of site ____!I_% of site

g. Are there any unique geologic features on the project site? 0Yes!l1No IfYes, describe:

h. Surface water features. i. Does any portion ofthe project site contain wetlands or other waterbodies (including streams, rivers, OYesl;z'JNo

ponds or lakes)? ii. Do any wetlands or other waterbodies adjoin the project site? 0Yes!l1No IfYes to either i or ii, continue. IfNo, skip to E.2.i. iii. Are any of the wetlands or waterbodies within or adjoining the project site regulated by any federal, 0Yes0No

state or local agency? iv. For each identified regulated wetland and waterbody on the project site, provide the following information:

Streams: Name Classification•• Lakes or Ponds: Name Classification • Wetlands: Name Approximate Size • Wetland No. (if regulated by DEC)

v. Are any ofthe above water bodies listed in the most recent compilation ofNYS water quality-impaired 0Yes0No waterbodies?

Ifyes, name of impaired water body/bodies and basis for listing as impaired:

i. ls the project site in a designated Floodway? OYesllJNo

j. ls the project site in the I 00 year Floodplain? OYesllJNo

k. ls the project site in the 500 year Floodplain? OYesllJNo

I. Is the project site located over, or immediately adjoining, a primary, principal or sole source aquifer? llJYesONo IfYes:

i. Name of aquifer: Clinton Street Ballpark SSA

Page 11of13

m. Identify the predominant wildlife species that occupy or use the project site: DEER TURKEY

n. Does the project site contain a designated significant natural community? OYesllJNo IfYes:

i. Describe the habitat/community (composition, function, and basis for designation):

ii. Source(s) of description or evaluation: iii. Extent of community/habitat:

• Currently: acres

• Following completion of project as proposed: acres

• Gain or loss (indicate+ or-): acres

o. Does project site contain any species of plant or animal that is listed by the federal government or NYS as D YesllJNo endangered or threatened, or does it contain any areas identified as habitat for an endangered or threatened species?

p. Does the project site contain any species of plant or animal that is listed by NYS as rare, or as a species of OYeslZINo special concern?

q. Is the project site or adjoining area currently used for hunting, trapping, fishing or shell fishing? IZIYesONo Ifyes, give a brief description of how the proposed action may affect that use: DEER HUNTING - PROPOSED ACTION WILL NOT AFFECT USE EXCEPT DURING DEVELOPMENT- Qrivate landowner onl~

E.3. Designated Public Resources On or Near Project Site

a. Is the project site, or any portion of it, located in a designated agricultural district certified pursuant to IZIYesDNo Agriculture and Markets Law, Article 25-AA, Section 303 and 304?

IfYes, provide county plus district name/number: TIOG001

b. Are agricultural lands consisting ofhighly productive soils present? OYesllJNo i. IfYes: acreage(s) on project site?

ii. Source(s) of soil rating(s):

c. Does the project site contain all or part of, or is it substantially contiguous to, a registered National OYeslZINo Natural Landmark?

IfYes: i. Nature ofthe natural landmark: D Biological Community D Geological Feature ii. Provide brief description of landmark, including values behind designation and approximate size/extent:

d. Is the project site located in or does it adjoin a state listed Critical Environmental Area? OYesllJNo IfYes:

i. CEA name: ii. Basis for designation:

iii. Designating agency and date:

Page 12of13

e. Does the project site contain, or is it substantially contiguous to, abuilding, archaeological site, or district OYesJ;zlNo which is listed onJ or has been nominated by the NYS Board ofHistoric Preservation for inclusion on, the State or National Register ofHistoric Places?

lfYes: I. Nature ofhistoric/archaeological resource: 0Archacological Site OHistoric Building or District

ii. Name: iii. Briefdescription of attributes on which Jirung is based;

f. Is the project site, or any portion of it, located in or adjacent to an area designated as sensitive for OYesJ;zINo archaeological sites on the NY State Historic PrescJVation Office (SHPO) archaeological site invenlocy'/

g. Have additional archaeological or historic site(s) or resources been identified on the projec~ site? OYcslZJNo rfYes:

I. Describe possible resource(s): If. Basis for identification:

h. Is the project site within fives miles of any officially designated and publicly aCccssible federal, state, or local OYesllJNo scenic or aesthetic resource? ·

IfYes: I. Identify resource:

II. Nature of, or basis for, designation (e.g., established highway overlook, state or local park, state historic trail or scenic byway, etc.):

Iii. Distance between project and resource: mites. i. Is the project site located within a designated river corridor under the \Viid1 Scenic and Recreational Rivers WYesllJNo

Program 6 NYCRR 666? IfYes:

i. Identify the name oftho river and its designation: ii. Is the activity consistei;it with development restrictions contained in 6NYCRR Part 666? OYcsONo

F. Addition•! Information Aua.ch any additional information which may be needed to clarify your project.

Ifyou have identified any adverse impacts which could be associated wi1h your proposal, please describe those impacts plus any measures which you propose to avoid or minimize them.

G. Verification I certify that the infonnation provided is true to tho best ofmy knowledge.

Date.__7-'-lll...:.·rj..,_..f-""5____Applicant/Sp~~

Titlc.___H_t..~'M~~-1.;_r______-Signatu~,..~...__..,.,.'----~-------------

...

PRINT FORM Page 13 ofl3