NY 74 originates at exit 28 of the Adirondack Northway (I-87) in the town of Schroon. The starting interchange is close to local landmark Severance Hill, which reaches an elevation of . NY 74 intersects the north–south U.S. Route 9 (US 9) shortly after the northbound ramps of the Adirondack Northway. It then meets Stowell Road just before crossing the Schroon River. The highway meets a few local road intersections just south of Goosebury Hill before encountering Paradox Lake. NY 74 runs mostly parallel to the lake and intersects with a local campground entrance road as it continues eastward from Schroon.