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1000-5.-2-10.8
- --------- -- 7-3 -,f 1 O1-17 - - •,-• s, •-] 4 - Nsio / -_ --- -_-- SITE _-_ > POLE M01/ eCpCt� W. F°SHAY RPI�O��ED ' 685 ssno r` - 26 8 R1.ANNING EOARD _.. MON. ROAD N25004'od'w a�Q62 �� f S 20474011 E� 1 ' TOWN OF SOUTHOLD MON. 5.83 s2�IZ --� 291.80'_' � S 84004,1011 E MON. �i.o3' � � \ \ � � � � � � � / !�T t�IaR 2 719 5 S 03054'501f W 16G.04 MON•\ �, \ \ / / 5.00 w s f 9 B.68 r: �r N 250 04'00°W �� / r l / S ---- LOCATION MAP 77 N 241.77 - i r: ` / / Q7 p E e13.OfHOUSE CV rn S 05°32 42 E .o'r:... MON• \\\ / �3Q 600 300 0 600 nl \ �i 52.8 GRAPHIC SCALE IN FEET \ LO Z EXIST. WELL * \� ) O S 09 12 40 W 37.48 NOTES: / T- O 10 O oo'� 1) OWNERS: LOT #9 HENRY L. KING & MARGARET G. KING FISHERS ISLAND, NEW YORK ,� v� � 06390 +0 \ \ e`. �,.s�, / LOT #10 SUSANNA VON DER SCHULENBURG 21 TITE ST / AUGUSTUS COURT FLAT G Xb Nell LONDON SW3 ENGLAND ��� AREA TO BE DEEDED FROM LOT lO 2) LOTS ARE LOCATED IN THE TOWN OF SOUTHOLD, COUNTY OF SUFFOLK, STATE \� `�� OF NEW YORK DISTRICT 100a SECTION 005 BLOCK 2 LOTS 10.8 & 10.9. " � TO LOT 9 = 0.'75% ACRES , 3) UTILITIES ARE EXISTING ON LOT 9. LOT 10 IS TO BE SERVICED BY MUNICIPAL \ ' WATER & ON SITE SEWAGE SYSTEM. \ w' �P�o"��' 4) PROPERTY IS LOCATED IN ZONING DISTRICT R-120. P DPP E o S o o t� /� C ?:`;`: ".r:''r•: i S 450 37 45 W ` 5) COORDINATE DISTANCES ARE MEASURED FROM U.S. COAST AND GEODETIC o j ��5. SURVEY TRIANGULATION STATIION "EAST END 2". 10 0 5�8�\/� oo Q ��OF N14v Y 6) LOT AREAS: \G��� ��Pp H.sT9oO.p� BLOCK & LOT EXISTING PROPOSED 25 \ \� / _ r� G BLK 1, LOT 9 3.24f AC. 3.99f AC. Ig P1yR l: G ,I�,, ,w � BLK 1, LOT 10 4.21f AC. 3.46f AC. 5 .,n o• (14952 ��� r S 68048120°W 73.18' F OPOSED LOT LINE GHANcirz P'REPARE17 F:OR t MAR%6A"rl"l-,'.-"mT . KIN6 AND 5ZANINAVON SCHU�"N%r' 100 50 0 100 Q GRAPHIC SCALE IN -FEET LOCK i, LOTS IO LEGEND: SH -RS 15LAN7, NEW PORK I.P. IRON PIPE REVISIONS MON. MONUMENT �""°"'"""'"• rl �''"" CHANDLER. PALMER 8e KING DATE DESCRIPTION N/F NOW OR FORMERLY =l � <� " �, 7 !05 94 REVISIONS `�:�'"�'°"""•'' E"""�'"=-'="•^' � '�;`� Architecture, Engineering and Surveying f 110 BROADWAY NORPACi1,'CT 06380 203-889-3397 FAX 203-888-7801 S.F. SQUARE FEET 'EXIST. EXISTING 0 w N AC. ACRE DATE: MARCH 1, 1994 SEP 2 SCALE: 1" = 100' F i SOUTHOLD TOV..,N SHEET 1 OF 1 r PLarlr�Irss BOARD r '�•F r e. n.,a o tY•pfi.0 . l .. . •. ... .. V v ,•H•.11Cd PLANNING BOARD MEMBERS Richard G.Ward Chairman Town Hall, 53095 Main Road George Ritchie Latham,Jr. P. O. Box 1179 Bennett Orlowski,Jr. " '' Southold, New York 11971 'w'. . *. Mark S. McDonald °Q�� .��� Fax(516)765-3136 Kenneth L. Edwards I Telephone(516)765-1938 PLANNING BOARD OFFICE TOWN OF SOUTHOLD March 28, 1995 Stephen L. Ham, III Matthews and Ham 45 Hampton Rd. Southampton, NY 11968 Re: Proposed lot line change for Susanna von der Schulenburg and i Henry L. King & Margaret King j SCTM# 1000-5-2-10.8 & 10.9 Dear Mr. Ham: i i i The -following resolution was adopted by the Southold Town Planning Board at a meeting held on Monday, March 27, 1995: i i BE IT RESOLVED that the Southold Town Planning Board authorize the Chairman to endorse the final surveys dated July 5, 1994. Conditional final approval was granted on October 24, 1994. All conditions have been fulfilled. i Enclosed please find a copy of the survey which was endorsed by the Chairman. Please contact this office if you have any questions regarding the above. Sincerel 1 ichard Ward Chairman enc. cc: Tax Assessors Building Dept. MATTHEWS & HAM ATTORNEYS AND COUNSELLORS AT LAW 45 HAMPTON ROAD SOUTHAMPTON,N.Y.11968 ' 516-283-2400 PH=B.MATTHEWS TELECOPLER 516-287-1076 IIB32.19921 e STEPHEN L.HAM,III March 17, 1995 Planning Board Town of Southold 53095 Main Road P.O. Box 1179 Southold, NY 11971 Re: Lot Line Change for von der Schulenburg and King SCTM # Is 1000-5-2-10.8 & 10.9 Dear Board Members: I have enclosed a certified copy of the deed by which the referenced parties effected their lot line change that you approved on October 24, 1994 . In satisfaction of the condition set forth in your resolution, the deed contains language providing for the merger of the .75-acre parcel with other premises of the Kings adjoining on the east. Please now endorse the final map and mail me an original print of the same. Very truly yours, Stephen L. Ham, III SLH:cc Enclosure RIM TH 2 01,395 sc���rsL BOXES 5 THAU 9 MUST BE TYPED OR INTED IN BLACK INK ONLY PR TO RECORDING OR FILING. 1 SUFFOLK"COUNTY CLERK 2 l 3 R +�11 r C�' �� AV tzo Number of pages M VID `E. , ,Qij w TORRENS FEB 15 1995 .., Serial# TRAAW&Fffl TAX D Certificate# TY Prior Ctf# 22072 Deed/Mortgage Instrument Deed/Mortgage Tax Stamp Recording/Filing Stamps 4 FEES Page/Filing Fee l� . Mortgage Amt. 5 Handling 1.Basic Tax TP-584 2. SONYMA Notation Sub Total EA-5217(County) Sub Total 3. Spec./Add. EA-5217(State) �.� TOT.MTG.TAX RP.T.S.A. `,y�� Dual Town Dual County Held for Apportionment Comm.of Ed. 5— oU Transfer Tat Affidavit 9hD IN9EQ� �Oo Mansion Tax i Certified Copy The property covered by this mortgage is or will be improved by a one or two Reg. Copy _ Sub Total IV . family dwelling only. YES or NO Other GRAND TOTAL W. _ If NO,see appropriate tax clause on page# of this instrument. Real Property Tax Service Agency Verification Title Company Information eypcaK Dist Section Block Lot aou 1000 005.00 02.00 r 10.0'i .;: Fidelity National Title Insurance Co. a—ILV—V Company Name Date 2012189 Title Number FEE PAID BY: X Davis Polk & Wordwell Es s Cash Check Charge q 450 Lexington Avenue Payer same as R&R_ New York, New York 10017 OR: Fidelity National Title Insurance Co. Att: Patricia Doran, Esq. RECORD & RETURN TO I`I Suffolk County Recording & Endorsement Page This page forms part of the,attached DEED . made by: (Deed, Mortgage, etc.) Susanna von der Schulenbarg, as nominee The premises herein is situated in SUFFOLK COUNTY, NEW YORK. TO In the TOWN of Southold Henry L. King and Margaret�(ing husband and wife G• In the VILLAGE .-or HAMLET of Fishers Island page 1 of 4 pages Form 8002*—Bargain and Sale Deed,with Covenant against Grantor's Acts—Individual or Corporation.(single sheet) CONSULT YOUR LAWYER BEFORE SIGNING THIS INSTRUMENT—THIS INSTRUMENT SHOULD BE USED BY LAWYERS ONLY. 1 THIS INDENTURE, made the' / day of , nineteen hundred and 1tA*Ae— BETWEEN SUSANNA von der SCHULENBURG, as nominee, now residing at 21 Tite Street , Augustus Court, Flat G, London SW 3 , England party of the first part, and HENRY L. KING and MARGARET G. KING, husband and wife, now residing at 960 Park Avenue, New York, New York 10028 R party of the second part, WITNESSETH,that the party of the first part, in consideration of Ten Dollars and other valuable consideration paid by the party of the second part, does hereby grant and release unto the party of the second part,.the heirs or successors and assigns of the party of the second part forever, ALL that certain plot, piece or parcel of land, with the buildings and improvements thereon erected, situate, lying and being imxVxx at Fishers Island , Town of Southold, County of Suffolk and State of New York, as more particularly bounded and described on Schedule A hereto . BEING AND INTENDED TO BE a portion of the same premises conveyed to the party of the first part by deed, dated June 16, 1994 and recorded in the Office of the Suffolk County Clerk on June 29, 1994 in Liber 11683 page 273 . By accepting this deed, the party of the second part agrees that , upon the recording of this deed , the premises conveyed hereby will merge with and become a part of other premises owned by the party of the second part adjoining on the east and will not constitute a separate building lot under the Zoning Ordinance of the Town of Southold, said other premises having .been acquired by the party of the second part by deed, dated October 30, 1991 and recorded in the Office of the Suffolk County Clerk on November 8 , 1991 in Liber 11366 page 251 and bearing the Suffolk County Tax Map designation of District 1000, Section 005 . 00 , Block 02 . 00 , Lot 010 . 009 . SUBJECT TO the following covenant and restriction : The party of the second part , their successors and assigns may not build any structure on the premises conveyed hereby, with the exception of a tennis court and/or a swimming pool and other customary improvements ancillary to a tennis court and/or swimming pool, without the prior written consent ! of the party of the first part , her successors or assigns . It is the specific intent of the parties hereto that such consent shall not be required with regard to such tennis court and/or swimming pool and such customary ancillary improvements . J TOGETHER with all right, title and interest, if any, of the party of the first part in and to any streets and roads abutting the above described premises to the center lines thereof; TOGETHER with the appurtenances and all the estate and rights of the-pa rty of the first part in and to said premises; TO HAVE AND TO HOLD the __________- _ _ _ .__ L-,_-�-..,,,.�e....,.,.�STATE OF NEW YORK �n,l acc;vns of the party of the COUNTY OF SUFFOLK SS. I,EDWARD P. ROMAINE,CLERK OF THE COUNTY OF SUFFOLK AND CLERK OF THE SUPREME COURT OF THE STATE OF NEW YORK IN AND FOR SAID COUNTY(SAID COURT BEING A COURT OF RECORD)DO HEREBY CERTIFY THAT I HAVE COMPARED THE ANNEXED COPY OF DEED 1/-7/4 AT PAGE , RECORDED a s %�_ AND THAT IT IS A JUST AND TRUE COPY OF SUCH ORIGINAL EE AND OF THE WHOLE THEREOF. IN TESTIMONY WHEREOF,I HAVE HEREUNTO SET MY HAND AND AFFIXED THE SEAL OF SAID COUNTY AND COURT THIS /03 DAY OF 1994— �W a. V CLERK .. ACKNOWLEDGMENT STATE OF NEW JERSEY ) ss. . COUNTY OF MERCER ) On this � &SA- day of February, 1995, before me personally came G. Nicholas Miller, to me known and known to me to be the attorney-in-fact of Susanna von der Schulenburg, the individual described in and who by her said attorney-in-fact executed the foregoing instrument, and duly_ acknowledged before me that he executed the same as the act and deed of Susanna von der Schulenburg therein described, and for the purposes therein mentioned by virtue of a powers of attorney duly executed by the said Susanna von der Schulenburg dated the 14th day of November, 1983 to be recorded in the Office of the Suffolk County Clerk simultaneously herewith. (4 otary Public CArZINIA M. SAIVYER NO TARy pUELIC OF NEW JERSEY My COMndssion Expires Apr. 16, 1990 z 0 O cc U. O W IX ¢ O LL W U Q a dl y S F W ¢ W fA W 11'714K* SCHEDULE A TO DEED Party of the First Part: Susanna von der Schulenburg Party of the Second Part: Henry L. King and Margaret G. King Deed Dated: FE6ROARY I, i igs7 ALL that certain plot, piece of parcel of land, situate, lying and being at Fishers Island, in the Town of Southold, County of Suffolk and State of New York, being more particularly bounded and .described as follows: BEGINNING at a point on the southerly side of a road, said point being 224. 61 feet north of a point which is 978.16 feet East of a monument marking the United States Coast and Geodetic Survey Triangulation Station "East End 2" (which said "East End 2" monument is located on the summit of the highest hill East of East Harbor on Fishers Island, N.Y. , and lies South 54 minutes West of Latimer Reef Light in Fishers Island Sound) ; RUNNING THENCE South 05 degrees 32 minutes 42 seconds East, 52.86 feet; THENCE South 29 degrees 52 minutes 28 seconds East, 478.52 feet to the shore of Block Island Sound; THENCE with the meanders of said Sound, North 56 degrees 23 minutes 00 seconds East 120. 00 feet; THENCE North 42 degrees 23 minutes 10 seconds West, 473 .59 feet to a stone monument; and THENCE North 25 degrees 04 minutes 00 seconds East, 56.77 feet to the point or place of BEGINNING. Submission Without A Cover Letter Date: 31 qs- Sender: l�5�e-�so 'S O f f i c.-. Subject: Sc-h,-,,Iunbu.r J - K in I- SCTM#: Y 000- S-2- l 0 8 "r ►o •� Comments: �e corr�ecQ deed MAR 17 1995 SOUTHOLD TOWN PLANNING BOARD BO)tES 5 THRU 9 MUST BE TYIILL. OR PRINTED IN BLACK INK ONLY PRIOR TO RECORDING OR FILING 1 SUFFOLK COUNTY CLERK 2 _ 3 22072 f,roof Ar p f 117149866 , Number of pages ToRRENS -133E c 4 FEB 15 1995 ry F Serial# T OF TRAWRFEIR TA Certificate# &J§-:MK ~'O' CQU rY i Prior Ctf# Deed/Mortgage Instrument Deed/Mortgage Tax Stamp Recording/Filing Stamps 4 — FEES Page/Filing Fee y Mortgage Amt. Handling MAR 1 7 1995 1 1. Basic Tax TP-584 v 2. SONYMA f SOU E Hi1L©TFVtrf! Notation PLANNIL�'r BWARD Sub Total EA-5217(County) Sub Total - 3. Spec./Add. EA-5217(State) s TOT.MTG. TAX i R.P.T.S.A. Dual Town Dual County • Held for Apportionment Comm.of Ed. 5_._00_ s Transfer Tax D INDbP� Mansion Tax Certified Copy .-- The property covered by this mortgage I is or will be improved by a one or two Reg. Copy _ Sub Total ___l2 family dwelling only. i r YES or NO Other GRAND TOTAL If NO,see appropriate tax clause on page# of this instrument. 5'F *ADp Real Property Tax Service Agency Verification »>6 > Title Company Information Dist Section Block Lot '•��,o�.�•+ 1000 005.00 02.00 Fidelity National Title Insurance Co. m )2-1475 AEly duoleElz Company Name Date 2012189 Title Number FEE PAID BY: X Davis Polk & Wordwell Es s Cash Check Charge q 450 Lexington Avenue Payer same as R&R_ New York, New York 10017 OR: Fidelity National Title Insurance Co. Att: Patricia Doran, Esq. RECORD & RETURN TO (ADDIZESS) Suffolk County Recording & Endorsement Page This page forms part of the attached DEED made by: (Deed, Mortgage, etc.) Susanna von der Schulenbarg, as nominee The premises herein is situated in- SUFFOLK COUNTY, NEW YORK TO In the TOWN of Southold Henry L. King and Margaretfing husband and wife G• In the VILLAGE or HAMLET of Fishers Island ECORDED FEB 15 1995 CLERKRK O OFF D ROMAlNE SUFFOLK Ct?MTY Form 8002•—Bargain and Sale Deed,with Covenant against Grantor's Acts—Individual or Corporation.(single sheet) k VLb CONSULT YOUR LAWYER BEFORE SIGNING THIS INSTRUMENT—THIS INSTRUMENT SHOULD BE USED BY LAWYERS ONLY. THIS INDENTURE, made the / , day of J nineteen hundred and BETWEEN SUSANNA von der SCHULENBURG, as nominee, now residing at 21 Tite Street , Augustus Court, Flat G, London SW 3 , England party of the first part, and HENRY L. KING and MARGARET G. KING, husband .and wife, now residing at 960 Park Avenue, New York, New York 10028 party of the second part, WITNESSETH,that the party of the first part,in consideration of Ten Dollars and other valuable consideration paid by the party of the second part, does hereby grant and release unto the party of the second part, the heirs or successors and assigns of the party of the second part forever, ALL that certain plot, piece or.parcel of land, with the buildings and improvements thereon erected, situate, lying and being inxxex at Fishers Island•, Town of Southold, County of Suffolk and State of New York, as more -particularly bounded and described on Schedule A hereto . . BEING AND INTENDED TO BE a portion of the same premises conveyed to the party of the .first part by deed, dated June 16, 1-994 and recorded in the Office of the Suffolk County Clerk on June 29, 1994 ii Liber 11683 page 273 . By accepting this deed, the party of the second part agrees that, upo: the recording of this deed, the premises conveyed hereby will merge w: and become a part of-. Other premises owned by the party of the second part adjoining on the east and will not constitute a separate building lot under the Zoning . Ordinance of the Town of Southold, said other premises having been acquired .by the party of the second part. by dee( dated October 30, 1991 and recorded in the Office of the Suffolk Coun Clerk on November 8, . 1991 in Liber 11366 page 251 and bearing the Suffolk County Tax Map designation of District 1000, Section 005 . 00, Block 02 .00, Lot 010 . 009 . SUBJECT TO the following covenant and restriction : The party of the second part, their successors and assigns may not build any structure on the premises conveyed hereby, with the exception of a tennis court and/or a swimming pool and other customary improvements ancillary to a tennis court and/or swimming pool, without the prior written consen- of the party of the first part, her successors or assigns . It is the specific intent of the parties hereto that such consent shall not be required with regard to such tennis court and/or swimming pool and• . su( customary ancillary improvements . TOGETHER with all right, title and interest, if any, of the party of the first part in and to any streets and roads abutting the above described premises to the center lines thereof; TOGETHER with the appurtenances and all the estate and rights of the party of the first-part in and to said premises; TO HAVE AND TO HOLD the premises herein granted unto the party of the second part, the heirs or successors and assigns of the party of the TAX MAP DESIGNATION second part forever. Dist.1000 AND the party of the first part covenants that the party of the first part has not done or suffered anything whereby the said premises have been encumbered in any way whatever, except as aforesaid. see.0 0 5 . 0 0 AND the party of the first part, in compliance with Section 13 of the Lien Law, covenants that the party of the first part will receive the consideration for this conveyance and will hold the right to receive such consideration Blk.02 . 00 as a trust fund to be applied first for the purpose of paying the cost of the improvement and will apply the same first to the payment of the cost of the improvement before using any part of the total of the same for any other Lot(s4�_Ae purpose. o±8-.0$ The word "party" shall be construed as if it read "parties" whenever the sense of this indenture so requires. O/O- O/I IN WITNESS WHEREOF, the party of.the first part has duly executed this deed the day and year first above written. IN PRESENCE OF: Alwi Susann von de S ule rg RECORDED FEB 15 1995 PKriP.EDWAR IP.ROK(%f r (y FRK(1F SI IFFnI K(`111 pt4N Is;;" f-�• ix 714PG$66 SCHEDULE A TO DEED Party of the First Part: Susanna von der Schulenburg Party of the Second Part: Henry L. King and Margaret G. King Deed Dated: FE6RQARr I, 1'195 ALL that certain plot, piece of, parcel of land, situate, , lying and being at Fishers Island, in the Town of Southold, County of Suffolk and State of New York, being more particularly bounded - and described as follows: BEGINNING at a point on the southerly side of a road, -said point being 224.61 feet north of a point which is 9'78. 16 feet East of a monument marking the United States Coast and Geodetic Survey Triangulation Station "East End 2" (which said "East End 2" monument is located on the summit of the highest hill East of East 'Harbor on Fishers Island, N.Y. , and lies South 54 minutes West of Latimer Reef Light in Fishers Island Sound) ; RUNNING THENCE South 05 degrees 32 minutes 42 seconds East, 52 .86 feet; THENCE South 29 degrees 52 minutes 28 seconds East, 478.52 feet to the shore of Block Island Sound; THENCE with the. meanders of said Sound, North 56 degrees 23 minutes 00 seconds East 120. 00 feet; THENCE North 42 degrees 23 minutes 10 seconds West, 473 .59• feet to a stone monument; and THENCE North 25 degrees 04 minutes 00 seconds East, 56.77 feet to the point or place of BEGINNING. 7 4 - .D E C O R D E D FEB 15 1995 CLERK OF SUFFOLK CCO{}MV PLANNING BOARD MEMBERS '�f Richard G.Ward, Chairman Town Hall,53095 stain Road George Ritchie Latham,Jr. =3 P. O. Box 11;79 Bennett Orlowski,Jr. Southold, Newlfark 11971 y,.. Mark S.McDonald �? � ,p�>> Fax(516)765-3136 Kenneth L. Edwards Telephone(516)765-1938 PLANNING BOARD OFFICE TOWN OF SOUTHOLD October 25, 1994 Stephen L.Ham, III Matthews and Ham 45 Hampton Road Southampton, NY 11968 . Re: Proposed lot line change for Susanna von der Schulenburg and Henry L. King & Margaret King SCTM# 1000-5-2-10.8 & 10.9 Dear Mr. Ham: The following took place at a meeting:of the Southold Town Planning Board on Monday, October 24, 1994: A final public hearing for the lot line change for Susanna von der Schulenburg and Henry L. King & Margaret King was closed. WHEREAS, Susanna von der Schulenburg and Henry L. King and Margaret King are the owners of the property known and designated as SCTM# 1000- 5-2-10.8 & 10.9 located on Oriental Ave. on Fishers Island; and WHEREAS, this lot line change is to subtract 0.75 acres from a 4.21 acre parcel and add it to a 3.24 acre parcel; and WHEREAS, the Southold Town Planning Board, pursuant to the State Environmental Quality Review Act, (Article 8), Part 617, declared itself lead agency and issued a Negative Declaration on August 22, 1994; and WHEREAS, a final public hearing was closed on said lot line change application at Town Hall, Southold, New York on October 24, 1994; and Page 2 Lot line.change for Susanna von der Schulenburg & Henry L IGng and Margaret IGng October 25, 1994 WHEREAS, all the requirements of the Subdivision Regulations of the Town of Southold have been met; be it therefore RESOLVED, that the Southold Town Planning Board grant conditional final approval on the surveys dated July 5, 1994 and authorize the Chairman to endorse the final surveys subject to fulfillment of the following condition. This condition must be met within six (6) months of the date of this resolution. 1. The filing of new deeds pertaining to the merger of the 0.75 acres from the 4.21 acre parcel SCTM# 1000-5-2-10.9 with the 3.24 acre parcel SCTM# 1000-5-2-10.8. A copy of the recorded deed must be presented to the Planning Board prior to endorsement of final survey. Please contact this office if you have any questions regarding the above. Sincerely, Richard G. Ward Chairman Su,BF' �K ...... .. ................................................................... ...... ............ > ADD NEW:: DECLARATION:>: :> « <' <<:z : <:<< `:'<><<<« :<>:z :zz« :<«:z :: z 10 14 94« s0 FILE NUMBER:::*".N1473800-00908Town of SOUTHOLD, SUFFOLK County ...................................:::..........................................::::::................................................................................................................................................... LEAD...AGENCY:<">"> ��473800 Town:: of...SOUTHOLD:;;.:.:;SUFFOLK...Count:;.::.:;............................................... :.::.::::.:.::.....................; ;>.................................................r...........................................Y................................................... .......................................................................................................................................................................................................................................... ......................................................................................................................................................................................................................................... .......................................................................................................................................................................................................................................... ......................................................................................................................................................................................................................................... .......................................................................................................................................................................................................................................... ......................................................................................................................................................................................................................................... OFFICE or BOARD: Plannin Board g .. :::CLASS: �<�Unlisted> < '> .............................................................. ................................................. TITLE.:..:::.5.•....von...der...Schulenbur>::.:<;.... >>T e 1 > > < >>s s « << ` g YP DESCRIPTION: Lot line change to subtract . 75 of an ac from a 4.21 ac ���arcel & g P dd to 3 .24 ac arcel loc E End Rd. :::DATE RECEIVED::.:- ............... <> <« «< < >> > > >< < < »> > .... ative Declaration<><> 10 14 94 > < » g / / ... STATUS: <N<><> < > < < < < < ....Normal Void :::: <:<:z: :< : : Condit Toned< "'** Rescinded Current Record 11 IMPORTANT >> File Number: N1-473800-00908 00 Use the above number in all correspondence about this action! To the Lead Agency: The above information confirms that filings on the described Negative -Decla..ra -J o..n. were ffi ni a_l l��A!�pl VP.[� h jY; .,ir entered ,7 T.he SEQR Repository on the date(s) yshown in the box headed DATE RECEIVED . above. The date -and time in the second line show when this document was printed. Please check the information above carefully. For corrections or questions contact Charles Lockrow, (518) 457-2224, or write to: SEQR Repository NYSDEC Division of Regulatory Affairs 50 Wolf Road, Room 514 Albany, NY 12233 Town of SOUTHOLD Planning Board � y 53095 Main Road-P.O. Box 1179iN;v. Southold, NY 11971 kAF PUBLISHER'S CERTIFICATE State of Connecticut ) County of New London, ) ss. New London On this 19th day of October A.D. 1994, personally appeared before the undersigned, a Notary Public, within and for said County and State, LEGAL 594 Town of Southold J. L. Zielinski, Legal Advertising Rep. Notice of Public Hearing NOTICE IS HEREBY GIVEN that pursuant to Section 276 of the Town Law,a public hearing will be held ou Town PlanningyB the d,Safihthe of THE DAY, a daily old Town Hall,Main Road,Southold New York in said Town on the 24th day of October,1994 on the question of the following: 7:40 P.M. Final public nearing newspaper published at New London, County of Nei or the proposed lot line change or Henry L.King and and Mar- garet G.King,and Susanna von der Schulenburg, on Fishers Is- ofnSuffolk,TowrStof ate Coun New London, State of Connecticut, tivhO:being duly s�hrorn, Suffolk County Tax Map Num-. ber 1000-5-2-10.8 and 10.9. The property Is bordered on the north bEnd Road and by land nowast or formerly of states on oath, that the Order of Notice in the case of Foshay; on the east and south- east by Block Island Sound,.on the southeast by land now or formerly Ad. tt 594 rmerly of Miller,et al;and an the northwest by land now of formerly of Miller. Dated:October 11,1994 By Order of the Southold Town Planning Board Richard G.Ward Chairman a true copy of which is hereunto annexed, was published in said newspaper in its issues of the 13th days of October A.D. 19 94. J Subscribed and sworn to beCoe me this 19th day of October A.D. 19 94 OCT 2 1994 1_7 Notary Public. IiTl�C I D' 'A' YANNOULA T. ,B,4LLASSI PLANNINIG IRCIIIRD NOTARY PUBLIC My COMMISSION EXPIRES DEC. 31, 1997 STATE OF NEW YORK) - - ) SS: _ _ COUNTY OF SL ILK ) LEGAL NOTICE Notice of Public Hearing - NOTICE IS HEREBY GIVEN that i 1 Of Mattituck, Law, apublic-hearing willll be held by n saidCounty, � Y sworn, pursuant to Section 276 the Town In C , bet dui says that he/she is the Southold Town Planning Board,at Principal Clerk of THE SUFFOLK TIMES, a Weekly the Town Hall, Main Road, Southold, New York in said Town on the'24th Newspaper, published at Mattituck, in the Town of day.of October,'1994 on the ggestion Southold, County of Suffolk and State of New York, of the following: ; 7:30 P.M. Final public hearing for and that the Notice Of which the annexed is a the proposed minor subdivision for printed copy, has been regularly publis ed in said Bayview/South Harbor Limited Partnership, in Southold, Town of Newspaper once each week for weeks Southold, County of Suffolk, State of g CesSI eIy Commng on the day of New York. Suffolk County Tax Map Number 1000-75-4-22.1. 1 'The property is bordered,on the jnorth by land now or formerly of Buonaiuto,by land now or formerly of Deconciliis,by land now or formerly of Thompson,by land now or formerly- CHRISTINA VO INSKI of Amone,.by land now or formerly of Notary Publir;Stf Now York Long,,by land now or formerly of Nli.}SQpels$$4 f Principal Clerk Standish, by land now or formerly of Qualified in Suffolk COW Vanworkum and by the Town of Commission Expires November 2 , t 7 Southold; on the east by Main Bayview Road and by land now of for- n �� / Vn( 4 merly of Stepnoski; on the south by '� L'/ 1 I (((/L_� lid) land now or formerly of Southold Fire Notary Public District; and on the west_by South Harbor-Road._ 7:35 P.M. Final public hearing for I the proposed lot line change for James Sworn t0 tLefore me this ano aviary Hnn HDoott, in Mattituck, Town of Southold,_County of Suffolk, I day of 9 State of New York. Suffolk County Tax Map Number 1000-126-5-2 P.3. The property is bordered on the north by Peconic Bay Blvd.; on the east by land now or formerly of Downs;on the south by Peconic Bay; and on the west by land now or for- merly_of Petrie. 7:40 P.M. Final public hearing for the proposed lot line change for Heiiry= L -Kingarid-Margaret-G.-King;and; Susanna.-,Yon der_Schulenbdrg�on Fishers Island, Town of Southold, County of Suffolk,State of New York. -Suffolk County Tax Map Number 1000=5-240.8 and 10.9. The property is bordered on the north by East End Road, and.by land now or formerly of Foshay;on the east and southeast by Block Island Sound; on the southwest by land now or for-' merly of Miller, et al; and on the northwest by land now or formerly of Miller. Dated:October 11,1994 BY ORDER OF THE SOUTHOLD TOWN PLANNING BOARD Richard G.Ward Chairman 8099-1T013 r i COUNTY OF SUFFOLK LEGALS NOTICE The property is bordered STATE OF NEW YORK ss s Notice of Public Hearing on the north by Peconic Bay ` Blvd.,;• on the east by land NOTICE IS HEREBY nowzor formerly of,Downs; GIVEN that pursuant to on the south by Peconic Bay; Patricia Wood , being duly sworn, Section 276 of the Town Law, and on the west by land now says that she is the Editor, of the a public hearing will be held or formerly of'Petrie. TRAVELER-WATCHMAN, a public by the Southold Town Plan- 7:40- P.M. Final public newspaper printed at Southold, in ning Board, at the Town ! hearing for the proposed lot Suffolk Count Hall, Main Road, Southold, i line change for Henry L. y; and that the notice { New York in said Town on King and Margaret G. King, of which the annexed is a printed the 24th day of October . and Susanna von der copy, has been published in said Schulenbur Traveler-Watchman once each week 1994' on the question of the � g, on Fishers f o r following: Island, Town of Southold, --- County of Suffolk, State of • . . • . • . . . . . . . . . . . . . . . . . . .weeks 7:30 P.M. Final public i New York. Suffolk County hearing for the proposed Tax Ma Number szcce v�l minor subdivision for p y, commencing on the 1000-5-2-10.8.and 10.9. � . , •/r�• • , , , , , Bayview/South Harbor' The property is bordered Limited Partnership, in on the north by East End =- Southold,Town of Southold, Road" and'bylnd now or County of Suffolk, State of formerly''of��Fosllay; on e day C of . . . . . . . . . . . . . . . . . . . . . . . New York. Suffolk County ! east and sduthe st by lock 19 ' .' . . Tax Map 'Number Island Sound; on '- the 1000-75-4-22.1. sout est by land' now or The property is bordered for erly of Miller, et al;and • • • • • • • • • • on the north by land now Qn the northwest by...land or formerly of Buonaiuto,by now or formerly of'Miller. land now or formerly of Dated: October 11, 1994 Deconciliis, by land now'or BY ORDER OF THE formerly of Thompson, by SOUTHOLD.TOWN Swo to before me on this land now or formerly of Ar- PLANNING BOARD J,3 •d ay of none by land now or former- Richard G. Ward ly of Long, by land now or Chairman formerly of Standish, by IX-10/13/94(8) landnow or formerly of - - - • • . • • • • . • . • . . . . . .. . . . . . . . . . . Vanworkum and by the Town . . . . . . . of Southold; on the east by Main Bayview Road and by land now or formerly of Stepnoski; on the south by land now- or formerly of { Southold Fire District; and • • • • . Notary Public on the west by South Harbor Road. BARBARA A. SCHNEIDER 7:35 P.M. Final public j NOTARY PUBLIC, State of New York hearing for the proposed lot No. 4306646 line change for James,and Qualified in Suffolk County Mary Ann Abbott, in Mat- Commission Expires 6/31/16 tittuck, Town of Southold, County of Suffolk, State of New York. Suffolk County Tax Map Number 1000-126-5-2 & 3. _ikFOGT 11994 { SOUT,1OL D TOWN PLANNING BOARD J PLANNING BOARD MEMBERS Richard G.Ward, Chairman t . zz Town Hall,53095 Main Road George Ritchie Latham Jr. P. O. Box 1179 Bennett Orlowski,Jr. { 'y l`4•P Southold, New York 11971 �r?a,` : . .., Mark S. McDonald -yes' -� Fax(516)765-3136 Kenneth L. Edwards ;�� Telephone(516)765-1938 PLANNING BOARD OFFICE TOWN OF SOUTHOLD October 4, 1994 Stephen L. Ham, III Matthews and Ham 45 Hampton Rd, Southampton, NY 11968 Re: Lot line change for Susanna von der Schulenburg and Henry L. King & Margaret G. King SCTM# 1000-5-2-10.8 & 10.9 Dear Mr. Ham: The following resolutions were adopted by the Southold Town Planning Board at a meeting held on Monday, October 3, 1994: BE IT RESOLVED that the Southold Town Planning Board, acting under the State Environmental Quality Review Act, established itself as lead agency, and as lead agency makes a determination of non-significance and grants a Negative Declaration on this Type I action. BE IT RESOLVED that the Southold Town Planning Board set Monday, October 24, 1994 at 7: 40 p.m. for a final public hearing on the maps dated July 5, 1994. Enclosed please find a copy of the Negative Declaration for your records. Sincerely Richard G. Ward Chairman enc. PLANNING BOARD MEMBERS Richard G.Ward, Chairman t` ZZ, Town Hall,53095 Main Road George Ritchie Latham Jr. P. O. Box 1179 Bennett Orlowski Jr. r�,`°-, .` Southold, New York 11971 gin`- .':- r .,'a' Mark S. McDonald Fax(516)765-3136 Kenneth L. Edwards tire' Telephone(516)765-1938 PLANNING BOARD OFFICE TOWN OF SOUTHOLD State Environmental Quality Review NEGATIVE DECLARATION Notice of Determination Non-Significant October 3, 1994 This notice is issued pursuant to Part 617 of the implementing regulations pertaining to Article 8 (State Environmental Quality Review Act) of the Environmental Law. The Southold Town Planning Board, as lead agency, has determined that the proposed action described below will not have a significant effect on the environment and a Draft Environmental Impact Statement will not be prepared. Name of Action: Proposed lot line change for Susanna von der Schulenburg and Henry L. King & Margaret G. King SCTM#: 1000-5-2-10.8 & 10.9 Location: East End Rd., Fishers Island i SEQR Status: Type I ( X ) Unlisted ( ) Conditioned Negative Declaration: Yes ( ) No ( X ) Description of Action: This proposed lot line change is to subtract .75 of an acre from a 4.21 acre parcel; and add it to a 3.24 .acre parcel. - Page 2 SEQRA Negative Declaration -von der Schulenburg & King October 3, 1994 Reasons Supporting This Determination: Both lots are conforming in area. This change will increase the size and width of the smaller conforming lot so they both are more in keeping with the R-120 zoning in this area. There has not been any correspondence from the New York State Department of Environmental Conservation in the allotted time. Therefore, it is assumed that there are no comments or objections from that agency. The applicant will have to comply with the requirements of the Suffolk County Sanitary Code (SCSC) and all relevant standards of water supply and sewage disposal systems. Design and flow specification, subsurface soil conditions and site plan details will have to be approved by the Suffolk County Department of Health Services (SCDHS). This impact is not considered significant due to the anticipated project compliance with established requirements of the SCSC and the SCDHS and the required relevant permits. For Further Information: Contact Person: Robert G. Kassner Address: Planning Board Telephone Number: (516) 765-1938 cc: Langdon Marsh, DEC Albany Suffolk County Dept. of Health Suffolk County Planning Commission Judith Terry, Town Clerk Southold Town Building Dept. Southold Town Zoning Board of Appeals Fishers Island Water Company Applicant F. I.D. C.0. �'...� '.'.ise-��_.•: ...,, .._...ir,.,. :. ._aa..v-.:>s�u.:..5 •.: ..:':...�_ ,. .-a.. .-... ..ti..-•-. .. .._ ..... .u. _ "--s.Y::.a.,:�eo-ta�:t:....n�e..,:_ uT�.4..:i.:tf.cd:....u..kri':v........+:Na."-ZT.'.1 CHANDLER, R, --,IER & KING KEVUIM (D)IF 4WQMMUMM —LF—=— Architecture, Engir ing & Surveying 110 BROADWAY NORWICH, CONNECTICUT 06360-4452 PH. 203-889-3397 FAX 203-886-7801 DM ep t . 16 , 1994 cos No. ATTE TION RI ert Kassner Planning Board RE: TO Town of Southold VonderSchulenberg/King Main Road Fishers Island, NY Southold, NY 11971 WE ARE SENDING YOU ® Attached ❑ Under separate cover via the following items: ❑ Shop drawings ❑ Prints ❑ Plans ❑ Samples ❑ Specifications ❑ Copy of letter ❑ Change order ❑ COPIES DATE NO. DESCRIPTION 6 Prints of Lot Line Change Plan THESE ARE TRANSMITTED as checked below: ❑ For approval ❑ Approved as submitted ❑ Resubmit copies for approval ❑ For your use ❑ Approved as noted ❑ Submit copies for distribution ❑ As requested ❑ Returned for corrections ❑ Return corrected prints ❑ For review and comment ❑ ❑ FORBIDS DUE 19 ❑ PRINTS RETURNED AFTER LOAN TO US REMARKS These are sent at the request of Steve Ham. LG 48 0 Zj WWI J 1 SOU{HOLD Tl;'VNI COPY TO SIGNED: Richard H. Strouse N B002987.FDB 84038.EPS If enclosures are not as noted,kindly notify us at once. PLANNING BOARD MEMBERS Richard G.Ward, Chairman Town Hall 53095 Main Road George Ritchie Latham,Jr. P. O. Box 1179 Bennett Orlowski,Jr. Southold, New York 11971 Mark S. McDonald Fax(516)765-3136 Kenneth L. Edwards Telephone(516)765-1938 PLANNING BOARD OFFICE TOWN OF SOUTHOLD A Re: Lead Agency Coordination Request Dear Reviewer: The purpose of this request is to determine under Article 8 (State Environmental Quality Review Act-SEQRA) of the Environmental Conservation Law and 6 NYCRR Part 617 the following: 1. Your jurisdiction in the action described below; 2. Your interest in assuming the responsibilities of. lead agency; and 3. Issues of concern which you believe should be evaluated. Enclosed please find a copy of the proposal and a completed Environmental Assessment Form (EAF) to assist you in your response. Project Name: 7- CJ77edi'g Fa g S al 5-,1 r1 'irll //0// jet. 6-C:#U1-e;,Y #41Y,4 lei17 - r"1996AP.,6 c—. K41145- Requested Action: -G T �H,45IX ee SEQRA Classification: ( Type I O Unlisted Contact Person: (516) 765-1938 Page 2 Lead Agency Coordination Request The lead agency will determine the need for an environmental impact statement (EIS) on this project. Within thirty (30) days of.the date of this letter, please respond in writing whether or not you have'an interest in being lead agency. Planning Board Position: ( ) This agency wishes to assume lead agency status for this action. ( ) This agency has no objection to your agency assuming lead agency status for this action. ( ) Other (see comments below) Comments: CH FZ .L 4 <� T/ ��' s eq 7-,�-;7� Vj4 o li mc"i{ 7-4 Z- /9 �c r/9) � Please feel ee to contact this office for further information. St c rely, , /) lt/ 4 �Ri ar G. and Chairman cc: Beafd-ef-Appeals . Board of Trustees Building Department Southold Town Board Suffolk County Department of Health Services NYSDEC - Stony Brook NYSDEC - Albany Suffolk-County-Department-,of-Publie-Works d-S-rmy-Corp-of-Engineers. New York-State-Department-of-T-ransportation- *Maps are enclosed for your review rev. 4/94 14-16-2 (2/87)-7c 617.21 SEAR Appendix A State Environmental Quality Review • FULL ENVIRONMENTAL ASSESSMENT FORM Purpose: The full EAF is designed to help applicants and agencies determine; in an orderly manner, whether a project or action may be significant. The question of whether an action may be significant is not always easy to answer. Frequent- ly, there are aspects of a project that are.subjective or unmeasureable. It is also understood that those who determine significance may have little or no formal knowledge of the environment or may be technically expert in environmental analysis. In addition, many who have knowledge in one particular area may not be aware of the broader concerns affecting 'the question of significance. The full EAF is intended to provide a method whereby applicants and agencies can be assured that the determination process has been orderly, comprehensive in nature, yet flexible to allow introduction of information to fit a project or action. Full EAF Components: The full EAF is comprised of three parts: Part 1: Provides objective data and information about a given project and its site. By identifying basic project data, it assists a reviewer in the analysis that takes place in Parts 2 and 3. Part 2: Focuses on identifying the range of possible impacts that may occur from a project or action. It provides guidance as to whether an impact is likely to be considered small to moderate or whether it is a potentially- large impact. The form also identifies whether an impact can be mitigated or reduced. Part 3: If any impact in Part 2 is identified as potentially-large, then Part 3 is used to evaluate whether or not the impact is actually important. DETERMINATION OF SIGNIFICANCE—Type 1 and Unlisted Actions Identify the Portions of EAF completed for this project: ❑ Part 1 ❑ Part 2 ❑Part 3 Upon review of the information recorded on this EAF(Parts 1 and 2 and 3 if appropriate), and any other supporting information, and considering both the magitude and importance of each impact, it is reasonably determined by the lead agency that: ❑ A. The project will not result in any large and important impact(s) and, therefore, is one which will not have a significant impact on the environment, therefore a negative declaration will be prepared. ❑ B. Although the project could have a significant effect on the environment, there will not be a significant effect for this Unlisted Action because the mitigation measures described in PART 3 have been required, therefore a CONDITIONED negative declaration will be prepared.* ❑ C. The project may result in one or more large and important impacts that may have a significant impact on the environment, therefore a positive declaration will be prepared. * A Conditioned Negative Declaration is only valid for Unlisted Actions • Name of Action Name of Lead Agency 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) Date 1 'CART 1—PROJECT INFORMAL N Prepared by Project Sponsor NOTICE: This document is designed to assist in determining whether the action proposed may have a significant effect on the environment. Please complete the entire form, Parts A through E. Answers to these questions will be considered —as part of the application for approval and may be subject to further verification and public review. Provide any additionalc information you believe will be needed to complete Parts 2 and 3. It is expected that completion of the full EAF will be dependent on information currently available and will not involve new studies, research or investigation. If in requiring such additional work is unavailable, so indicate and specify each instance. NAME OF ACTION .Lot Line Change for HenryL. King & Margaret G. King and Susanna von der Schulenbur LOCATION OF ACTION(Include Street Address, Municipality and County) East End Road Fishers Island Town �of Southold County of Suffolk NAME OF APPLICANT/SPONSOR BUSINESS TELEPHONE Stephen L. Ham III as authorized agent (516 )28 -2400 ADDRESS 45 Hampton Road CITY/PO STATE ZIP CODE- Southampton NY 11968 NAME OF OWNER(If different) BUSINESS TELEPHONE Susanna von der Schulenburg (516 )283-2400 ADDRESS c/o Matthews & Ham, 45 Hampton Road CITY/PO STATE ZIP CODE Southampton NY 11968 DESCRIPTION OF ACTION lot line change between two properties (SCTM #Is 1000-5-2-10.8 & 10.9) to be effected by the transfer of a .75-acre parcel from tax lot 10.8 to tax lot 10.9 Please Complete Each Question—Indicate N.A. if not applicable A. Site Description Physical setting of overall project, both developed and undeveloped areas. 1. Present land.use: ❑Urban ❑Industrial ❑Commercial ❑Residential (suburban) ®Rural (non-farm) ❑Forest ❑Agriculture ❑Other 2. Total acreage of project area: .75 acres. APPROXIMATE ACREAGE PRESENTLY AFTER COMPLETION Meadow or Brushland (Non-agricultural) .75 _ acres 75 acres Forested acres, acres Agricultural (Includes orchards, cropland, pasture, etc.) acres acres Wetland (Freshwater or tidal as per Articles 24, 25 of ECL) acres acres Water Surface Area acres acres Unvegetated (Rock, earth or fill) acres acres Roads, buildings and other paved surfaces acres acres Other (Indicate type) acres acres 3. What is predominant soil,type(s) on project site? Riverhead sandy loam a. Soil drainage: ❑Well drained 100 % of site ❑Moderately well drained % of site ❑Poorly drained - % of site b. If any agricultural land is involved, how many acres of soil are classified within soil group 1 through 4 of the NYS� Land Classification System? N/A acres. (See 1 NYCRR 370). 4. Are there bedrock outcroppings on project site?. ❑Yes EXNo ' a. What is depth to bedrock? c _ hnn (in feet) 2 5. Approximate percentage of pro. !d project site,with slopes: ❑0=10% % 010-15% % ®15% or greater _ % 6. Is project substantially contiguous to, or contain a building, site, or district, listed on the State or the National Registers of Historic Places? ❑Yes EXNo 7.'As project substantially contiguous to a site listed on the Register of National Natural Landmarks? ❑Yes ❑No 8. What is the depth of the water table? »7 (in feet) 9. Is site located over a primary, principal, or sole source aquifer? MYes ❑No 10. Do hunting, fishing or shell fishing opportunities presently exist in the project area? ®Yes , ❑No 11. Does project site contain any species of plant or animal life that is identified as threatened or endangered? ❑Yes X]No . According to Identify each species 12. Are 'there any unique or unusual land forms on the project site? (i.e., cliffs, dunes, other geological formations) ®Yes ❑No Describe cliffs 13. Is the project site presently used by the community or neighborhood as an open space or recreation area? ❑Yes KJNo If yes, explain 14. Does the present site include scenic views known to be important to the community? ❑Yes ffNo 15. Streams within or contiguous to project area: none a. Name of Stream and name 'of River to which it is tributary N/A 16. Lakes, ponds, wetland areas within or contiguous to project area: a. Name none b. Size (In acres) 17. Is the site served by existing public utilities? ( Yes []No a) If Yes, does sufficient capacity exist to allow connection? ®Yes ❑No b) If Yes, will improvements be necessary to allow connection? ❑Yes INNo 18. Is the site located in an agricultural district certified pursuant to Agriculture and Markets Law, Article 25-AA, Section 303 and 304? ❑Yes ®No 19. Is the site located in or substantially contiguous to a Critical Environmental Area designated pursuant to Article 8 of the ECL, and 6 NYCRR 617? EXYes ❑No 20. Has the site ever been used for the disposal of solid or hazardous wastes? ❑Yes [ANo B. Project Description 1. Physical dimensions and scale of project (fill in dimensions as appropriate) a. Total contiguous acreage owned or controlled by project sponsor 7.45 acres. b. Project acreage to be developed: 0 acres initially;,,, 0 acres ultimately. c. Project acreage to remain undeveloped 7.25 acres. d. Length of project, in miles: N/A (If appropriate) e. If the project is an expansion, indicate percent of expansion proposed N/A %; f. Number of off-street parking spaces existing N/A proposed N/A g. Maximum vehicular trips generated per hour N/A (upon completion of project)? h. If residential: Number and type of housing units: One Family Two Family Multiple Family Condominium Initially one* Ultimately two* i. Dimensions (in feet) of largest proposed structure N/A height; N/A width; N/A length. j.Linear feet of frontage along a public thoroughfare project will occupy is? _ 400* ft. *on both contiguous parc3els (tax lots 10.8 and 10.9) 2. How much natural material (i.c: . )ck, earth, etc.) will be removed from c':: ;;ite? n tons/cubic yards 3. Will disturbed areas be reclaimed? ❑Yes ONo 57N/A , a. If yes, for what intend_' purpose is the site being reclaimed? b. Will topsoil be stockpiled for reclamation? OYes K]No c. Will upper subsoil be stockpiled for reclamation? ❑Yes tONo 4. How many acres of vegetation (trees, shrubs, ground covers) will be removed from site? 0 acres. 5. Will any mature forest (over 100 years old) or other locally-important vegetation be removed by this project? OYes 47No 6. If single phase project: Anticipated period of construction N/A months, (including demolition). 7. If multi-phased: a. Total number of phases anticipated N/A (number). b. Anticipated date of commencement phase 1 N/A month N/A year',,(including demolition). c. Approximate completion date of final phase N/A month N/A year. d. Is phase 1 functionally dependent on subsequent phases? OYes ONo �N/A 8. Will blasting occur during construction? OYes - LNNo 9. Number of jobs generated: during construction N/A after project is complete N/A 10. Number of jobs eliminated by this project N/A 11. Will project require relocation of any projects or facilities? OYes IXNo If yes, explain 12. Is surface liquid waste disposal involved? ❑Yes ®No a. If yes, indicate type of waste (sewage, industrial, etc.) and amount b. Name of water body into which effluent will be discharged 13. Is subsurface liquid waste disposal involved? Dyes k]No Type 14. Will surface area of an existing water body increase or decrease by proposal? OYes nNo Explain 15. Is project or any portion of project located in a 100 year flood plain? UYes ONo 16. Will the project generate solid waste? ❑Yes ®No a. If yes, what is the amount per month tons b. If yes, will an existing solid waste facility be used? ❑Yes ONo c. If yes, give name location d. Will any wastes not go into a sewage disposal system or into a sanitary landfill? OYes ONo e. If Yes, explain 17. Will the project involve the disposal of solid waste? OYes CXNo a. If-yes, what is the anticipated rate of disposal? tons/month. b. If yes, what is the anticipated site life? years. 18. Will project use herbicides or pesticides? OYes MNo 19. Will project routinely produce odors (more than one hour per day)? OYes [�No 20. Will project produce operating noise exceeding the local ambient noise levels? OYes CANo 21. Will project result in an increase in energy use? OYes nNo If yes , indicate type(s) 22. If water supply is from wells, indicate pumping capacity N/A gallons/minute. 23. Total anticipated water usage per day N/A gallons/day. 24. Does project involve Local, State or Federal funding? ❑Yes f1No •,If Yes, explain 4 . 25.^ Approvals Required: Submittal • I ype Date City, Town, Village Board Dyes ENo City, Town, Village Planning Board ®Yes ❑No lot line change 7-25-94 City, Town Zoning Board Dyes ®No City, County Health Department Dyes CONo Other Local Agencies ❑Yes ®No Other Regional Agencies Dyes IONo State Agencies ❑Yes 129No Federal Agencies ❑Yes ®No C. Zoning and Planning Information 1. Does proposed action involve a planning or zoning decision? ElYes ❑No If Yes, indicate decision required: ❑zoning amendment ❑zoning variance Ospecial use permit ❑subdivision ❑site plan ❑new/revision of master plan ❑resource management plan [Mother lot 1 i ne change 2. What is the zoning class ification(s)of the site? R-1 0 single family residential 3. What is the maximum potential development of the site if developed as permitted by the present zoning? one single-family dwelling w/ accessory structures on each of tax lot 10.8 and 10.9 4. What is the proposed zoning of the site? same 5. What is the maximum potential development of the site if developed as permitted by the proposed zoning? 6.- Is the proposed action consistent with the recommended uses in adopted local land use plans? CNYes ❑No 7. What are the predominant land use(s) and zoning classifications within a '/, mile radius of proposed action? R-120 single—family residential 8. Is the proposed action compatible with adjoining/surrounding land uses within a '/, mile? [ Yes ❑No 9. If the proposed action is the subdivision of land, how many lots are proposed? N/A a. What is the minimum lot size proposed? N/A 10. Will proposed action require any authorization(s) for the formation of sewer or water districts? Dyes XNo 11 . Will the proposed action create a demand for any community provided services (recreation, education, police, fire protection)? Dyes ):]No a. If yes, is existing capacity sufficient to handle projected demand? Dyes ❑No 12. Will the proposed action result in the generation of traffic significantly above present levels? Dyes [No a. If yes, is the existing road network adequate to handle the additional traffic? Dyes ❑No D. Informational Details Attach any additional information as may be needed to clarify your project. If there are or may be any adverse impacts associated with your proposal, please discuss such impacts and the measures which you propose to mitigate or avoid them. E. Verification I certify that the information provided above is true to th best of my knowledge. Henry L. King & Marggaret G. °King Applicant/Sponsor Name / Susanna von der Schulenburg Date July 22, 1994 Signature '&__ _ L• (5a-Gr,,, ep en afr, 111 Title authorized agent If the action is in the Coastal Area, and you are a state agency, complete the Coastal Assessment Form before proceeding with this assessment. 5 Part 2--- EJECT IMPACTS AND THEIR GNITUDE Responsibility of Lead Agency General Information (Read Carefully) • In completing the form the reviewer should be guided by the question: Have my responses and determinations been reasonable? The reviewer is not expected to be an expert environmental analyst. •-Identifying that an impact will be potentially large (column 2) does not mean that it is also necessarily significant. Any large impact must be evaluated in PART 3. to determine significance. Identifying an impact in column 2 simply asks that it be looked at further. • The Examples provided are to assist the reviewer by showing types of impacts and wherever possible the threshold of magnitude that would trigger a response in column 2. The examples are generally applicable throughout the State and for most situations. But, for any specific project or site other examples and/or lower thresholds may be appropriate for a Potential Large Impact response, thus requiring evaluation in Part 3. • The impacts of each project, on each site, in each locality, will vary. Therefore, the examples are illustrative and have been offered as guidance. They do not constitute an exhaustive list of impacts and thresholds to answer each question. • The number of examples per question does not indicate the importance of each question. • In identifying impacts, consider long term, short term and cumlative effects. _ Instructions (Read carefully) a. Answer each of the 19 questions in PART 2. Answer Yes if there will be any impact. b. Maybe answers should be considered as Yes answers. c. If answering Yes to a question then check the appropriate box (column 1 or 2) to indicate the potential size of the impact. If impact threshold equals or exceeds any example provided, check column 2. If impact will occur but threshold is lower than example, check column 1. d. If reviewer has doubt about size of the impact then consider the impact as potentially large and proceed to PART 3. e. If a potentially large impact checked in column 2 can be mitigated by change(s) in the project to a small to moderate impact, also check the Yes box in column 3. A No response indicates that such-a reduction is not possible. This must be explained in Part 3. 1 2 3 . Small to Potential Can Impact Be IMPACT ON LAND Moderate Large Mitigated By 1. Will the proposed action result in a physical change to the project site? Impact Impact Project Change ONO OYES Examples that would apply to column 2 • Any construction on slopes of 15% or greater, (15 foot rise per 100 ❑ ❑ ❑Yes ❑No foot of length), or where the_general slopes in the project area exceed 10%. • Construction on land where the depth to the water'table is less than ❑ ❑- ❑Yes ❑No 3 feet. • Construction of paved parking area for 1,000 or more vehicles. ❑ ❑ ❑Yes ❑No • Construction on land where bedrock is exposed or generally within ❑ ❑ ❑Yes ❑No . 3 feet of existing ground surface. • Construction that will continue for more than 1 year or involve more ❑ ❑ ❑Yes ❑No than one phase or stage. • Excavation for mining purposes that would remove more than 1,000 ❑ ❑ ❑Yes ❑No tons of natural material (i.e., rock or soil) per year. • Construction or expansion of a sanitary landfill. ❑ ❑ ❑Yes ❑No • Construction in a designated floodway. ❑ ❑ ❑Yes ❑No • Other impacts ❑ ❑ El Yes ❑No 2. Will there be an effect t.. _..iy u.,;que or unusual land forms found on the site?(i.e., cliffs, dunes, geological formations, etc.)❑NO OYES' • Specific Land forms: ❑ ❑ ❑Yes ❑No � 6 1 2 3 Small to Potential Can Impact Be Moderate' Large 'Mitigated By Impact Impact Project Change •- Qroposed Action may cause substantial erosion. ❑ ❑ ❑Yes ❑No • Proposed Action is incompatible with existing drainage patterns. ❑ ❑ ❑Yes ❑No • Proposed Action will allow development.in a designated floodway. ❑ ❑ Dyes ❑No • Other impacts: ❑ ❑ ❑Yes ❑No IMPACT ON AIR 7. Will proposed action affect air quality? ONO OYES Examples that would apply to column 2 • Proposed Action will induce 1,000 or more vehicle trips in any given ❑ ❑ ❑Yes El No hour. • Proposed Action will result in the incineration of more than 1 ton of ❑ ❑ ❑Yes []No refuse per hour. • Emission rate of total contaminants will exceed 5 lbs. per hour or a ❑ ❑ ❑Yes ❑No heat source producing more than 10 million BTU's per hour. • Proposed action will allow an increase in the amount of land committed ❑ ❑ ❑Yes ❑No to industrial use. • Proposed action will allow an increase in the density of industrial ❑ ❑ ❑Yes []No development within existing industrial areas. • Other impacts: ❑ ❑ ❑Yes' ❑No IMPACT ON PLANTS AND ANIMALS 8. Will Proposed Action affect any threatened or endangered species? ONO OYES Examples that would apply to column 2 • Reduction of one or more species listed on the New York or Federal ❑ ❑ Dyes ❑No list, using the site, over or near site or found on the site. • Removal of any portion of a critical or significant wildlife habitat. ❑ ❑ ❑Yes ❑No • Application of pesticide or herbicide more than twice a year, other ❑ ❑ []Yes ❑No than for agricultural purposes. • Other impacts: ❑ ❑ ❑Yes ❑No 9. Will Proposed Action substantially affect non-threatened or non-endangered species? ONO DYES Examples that would apply to column 2 • Proposed Action would substantially interfere with any resident or ❑ ❑ Dyes ❑No migratory fish, shellfish or wildlife species. • Proposed Action requires the removal of more than 10 acres ❑ ❑ ❑Yes El No of mature forest (over 100 years of age) or other locally important vegetation. IMPACT ON AGRICULTURAL LAND RESOURCES 10. Will the Proposed Action affect agricultural land resources? Examples that would apply to column 2 ONO OYES • The proposed action would sever, cross or limit access to agricultural ❑ ❑ El Yes ❑No land (includes cropland, hayfields, pasture, vineyard, orchard, etc.) + 8 2 3 IMPACT ON WATER Small to Potential Can Impact Be 3. Will proposed action affect any water body designated as protected? Moderate Large Mitigated By Impact Impact Project Change . (Under Articles 15, 24, 25 of the Environmental Conservation Law, ECL) ONO DYES Examples that would apply to column 2 • Developable area of site contains a protected water body. ❑ ❑ El Yes ❑No • Dredging more than 100 cubic yards of material from channel of a ❑ ❑ ❑Yes ❑No protected stream. • Extension of utility distribution facilities through a protected water body. ❑ ❑ ❑Yes ❑No • Construction in a designated freshwater or tidal wetland. ❑ ❑ ❑Yes ❑No • Other impacts: ❑ ❑ ❑Yes ❑No 4. Will proposed action affect any non-protected existing or new body of water? ONO DYES ` Examples that would apply to column 2 • A 10% increase or decrease in the surface area of any body of water ❑ ❑ El Yes ❑No or more than a 10 acre increase or decrease. • Construction of a body of water that exceeds 10 acres of surface area. ❑ ❑ ❑Yes []No • Other impacts: ❑ ❑ El Yes ❑No 5. Will Proposed Action affect surface or groundwater quality or quantity? ONO DYES Examples that would apply to column 2 • Proposed Action will require a discharge permit. ❑ ❑ ❑Yes El No C • Proposed Action requires use of a source of water that does not El El El Yes ❑No have approval to serve proposed (project) action. • Proposed Action requires water supply from wells with greater than 45 ❑ ❑ El Yes []No gallons per minute pumping capacity. • Construction or operation causing any contamination of a water ❑ ❑ ❑Yes ❑No supply system. • Proposed Action will adversely affect groundwater. ❑ ❑ ❑Yes ❑No • Liquid effluent will be conveyed off the site to facilities which presently ❑ ❑ El Yes ❑No do not exist or have inadequate capacity. • Proposed Action would use water in excess of 20,000 gallons per ❑ ❑ ❑Yes ❑No day. _ • Proposed Action will likelv cause siltation or other discharge into an ❑ ❑ ❑Yes []No existing body of water to the extent that there will be an obvious visual contrast to natural conditions. • Proposed Action will require the storage of petroleum or chemical ❑ ❑ ❑Yes ❑No products greater than 1,100 gallons. • Proposed Action will allow residential uses in'areas without water ❑ ❑ ❑Yes ❑No and/or sewer services. • Proposed Action locates commercial and/or industrial uses which may ❑ ❑ ❑Yes ❑No require new or expansion of existing waste treatment and/or storage facilities. • Other impacts: v ❑ ❑ ❑Yes ❑No 6. Will proposed action alter drainage flow or patterns, or surface water runoff? ONO DYES Examples that would apply to column 2 —Proposed Action would change flood water flows. ❑ ❑ ❑Yes ON 7 1 2 3 • Small to Potential Can Impact Be Moderate Large Mitigated By .Impact Impact Project Change • Construction activity would excavate or compact the soil profile of ❑ ❑ ❑Yes ❑No agricultural land. • 'The proposed action would irreversibly convert more than 10 acres ❑ ❑ ❑Yes ❑No of agricultural land or, if located in an Agricultutal District, more than 2.5 acres of agricultural land. - • The proposed action would disrupt or prevent installation of agricultural ❑ ❑ ❑Yes ❑No land management systems (e.g., subsurface drain lines, outlet ditches, strip cropping); or create a need for such measures (e.g. cause a farm field to drain poorly due to increased runoff) • Other impacts: ❑ ❑ El Yes ❑No IMPACT ON AESTHETIC RESOURCES 11. Will proposed action affect aesthetic resources? ONO OYES (If necessary, use the Visual EAF Addendum in Section 617.21, Appendix B.) Examples that would apply to column 2 • Proposed land uses, or project components obviously different from ❑ ❑ El Yes ❑No or in sharp contrast to current surrounding land use patterns, whether man-made or natural. • Proposed land uses, or project components visible to users of ❑ ❑ Dyes ❑No aesthetic resources which will eliminate or significantly reduce their enjoyment of the aesthetic qualities of that resource. • Project components that will result in the elimination or significant ❑ ❑ ❑Yes []No screening of scenic views known to be important to the area. • Other impacts: ❑ ❑ ❑Yes ❑No IMPACT ON HISTORIC AND ARCHAEOLOGICAL RESOURCES -12. Will Proposed Action impact any site or structure of historic, pre- historic or paleontological importance? ONO DYES Examples that would apply to column 2 • Proposed Action occurring wholly or partially within or substantially ❑ ❑ ❑Yes ❑No contiguous to any facility or site listed on the State or National Register of historic places. • Any impact to an archaeological site or fossil bed located within the ❑ ❑ ❑Yes ❑No project site. • Proposed Action will occur in an area designated as sensitive for ❑ ❑ ❑Yes []No archaeological sites on the NYS Site Inventory. • Other impacts: ❑ ❑ El Yes ❑No IMPACT ON OPEN SPACE AND RECREATION 13. Will Proposed Action affect the quantity or quality of existing or future open spaces or recreational opportunities? Examples that would. apply to column 2 ONO DYES • The permanent foreclosure of a future recreational opportunity. ❑ ❑ El Yes ❑No • A major reduction of an open space important to the community. El El ❑Yes ❑No • Other impacts: ❑ ❑ ❑Yes ❑No 9' 2 3' IMPACT ON TRANSPORTATION Small to Potential Can Impact Bq• 14. Will there be an effect to existing transportation systems? Moderate Large Mitigated By ONO DYES Impact Impact Project Change Examples that would apply to column 2 • Alteration of present patterns of movement of people and/or goods. ❑ ❑ ❑Yes ❑No • Proposed Action will result in major traffic problems. ❑ ❑ ❑Yes ❑No • Other impacts: ❑ ❑ ❑Yes ❑No IMPACT ON ENERGY 15. Will proposed action affect the community's sources of fuel or energy supply? ONO DYES Examples that would apply to column 2 • Proposed Action will cause a greater than 5% increase in the use of ❑ ❑ ❑Yes ❑No any form of energy in the municipality. • Proposed Action will require the,creation or extension of an energy ❑ ❑ ❑Yes ❑No transmission or supply system to serve more than 50 single or two family residences or to serve a major commercial or industrial use. • Other impacts: ❑ ❑ ❑Yes ❑No NOISE AND ODOR IMPACTS 16. Will there be objectionable odors, noise, or vibration as a result of the Proposed Action? - ONO DYES Examples that would apply to column 2 • Blasting within 1,500 feet of a hospital, school or other sensitive ❑ ❑ ❑Yes ❑No facility, • Odors will occur routinely (more than one hour per day). ❑ ❑ El Yes ❑No • Proposed Action will produce operating noise exceeding the local ❑ ❑ ❑Yes El No ambient noise levels for noise outside of structures. • Proposed Action will remove natural barriers that would act as a ❑ ❑ El Yes ❑No noise screen. • Other impacts: ❑ ❑ El Yes ❑No IMPACT ON PUBLIC HEALTH 17. Will Proposed Action affect public health and safety? ONO DYES Examples that would apply to column 2 • Proposed Action may cause a risk of explosion or release of hazardous ❑ ❑ ❑Yes ❑No substances(i.e. oil, pesticides, chemicals, radiation, etc.) in the event of accident or upset conditions, or there may be a chronic low level discharge or emission. • Proposed Action may result in the burial of "hazardous wastes" in any ❑ ❑ ❑Yes ❑No form (i.e. toxic, poisonous, highly reactive, radioactive, irritating, infectious, etc.) • Storage facilities for one million or more gallons of liquified natural ❑ ❑ El Yes ❑No gas or other flammable liquids. • Proposed action may result in the excavation or other disturbance ❑ '❑ ❑Yes ❑NO within 2,000 feet of a site used for the disposal of solid or hazardous waste. • Other impacts: ❑ ❑ ❑Yes ❑No 10 .. � 1 2 3 IMPACT ON GROWTH AND CHARACTER Small to Potential Can Impact Be OF COMMUNITY OR NEIGHBORHOOD Moderate Large Mitigated By 18. Will proposed action affect the character of the existing community? Impact Impact Project Change ❑NO. ❑YES Examples that would apply to column 2 • The permanent population of-the city, town or village in which the ❑ ❑ ❑Yes ❑No project is located is likely to grow by more than 5%. • The municipal budget for capital expenditures or operating services ❑ ❑ ❑Yes ❑No will increase by more than 5% per year as a result of this project. • Proposed action will conflict with officially adopted plans or goals. ❑ ❑ ❑Yes ❑No • Proposed action will cause a change in the density of land use. ❑ ❑ ❑Yes ❑No • Proposed Action will replace or eliminate existing facilities, structures ❑ ❑ ❑Yes ❑No or areas of historic importance to the community. • Development will create a demand for additional community services ❑ ❑ ❑Yes El No (e.g. schools, police and fire, etc.) • Proposed Action will set an important precedent for future projects. ❑ ❑ ❑Yes ❑No • Proposed Action will create or eliminate employment. ❑ ❑ ❑Yes ❑No • Other impacts: ❑ ❑ El Yes ❑No 19. Is there, or is there likely to be, public controversy related to potential adverse environmental impacts? ❑NO ❑YES If Any Action in Part 2 Is Identified as a Potential Large Impact or If You Cannot Determine the Magnitude of Impact, Proceed to Part 3 Part 3—EVALUATION OF THE IMPORTANCE OF IMPACTS Responsibility of Lead Agency Part 3 must be prepared if one or more impact(s) is considered to be potentially large, even if the impact(s) may be mitigated. Instructions Discuss the following for each impact identified in Column 2 of Part 2: 1 . Briefly describe the impact. 2. Describe(if applicable)how the impact could be mitigated or reduced to a small to moderate impact by project change(s). 3. Based on the information available, decide if it is reasonable to conclude that this impact is important. To answer the question of importance, consider: • The probability of the impact occurring • The duration of the impact • Its irreversibility, including permanently lost resources of value • Whether the impact can or will be controlled • The regional consequence of the impact • Its potential divergence from local needs and goals • Whether known objections to the project relate to this impact. (Continue on attachments) 11 • 14-14T1 (2!87)-9c 617.21 S EQ R . Appendix B - '. State Environmental Quality Review Visual EAF Addendum This form may be used to provide additional information relating to Question 11 of Part 2 of the Full EAF. (To be completed by Lead Agency) Distance Between Visibility Project and Resource (in Miles) 1. Would the project be.-visible from: 0-1/4 1/4-1/2 1/2-3 3-5 5+ • A parcel of land which is dedicated to and available ❑ ❑ ❑ ❑ ❑ to the public for the use, enjoyment and appreciation of natural or man-made scenic qualities? • An overlook or parcel of land dedicated to public ❑ ❑ 0 ❑ ❑ _ observation, enjoyment and appreciation of natural or man-made scenic qualities? • A site or structure listed on the National or State ❑ ❑ ❑ ❑ ❑ Registers of Historic Places? • State Parks? ❑ ❑ ❑ ❑ ❑ • The State Forest Preserve? ❑ ❑ ❑ ❑ ❑ • National Wildlife Refuges and state game refuges? ❑ ❑ ❑ ❑ ❑ • National Natural Landmarks and other outstanding ❑ ❑ ❑ ❑ ❑ natural features? • National Park Service lands? ❑ ❑ ❑ ❑ ❑ • Rivers designated as National or State Wild, Scenic ❑ ❑ ❑ ❑ ❑ or Recreational? • Any transportation corridor of high exposure, such ❑ ❑ ❑ ❑ ❑ as part of the Interstate System, or Amtrak? • A governmentally established or designated interstate ❑ ❑ ❑ ❑ ❑ or inter-county foot trail, or one formally proposed for establishment or designation? • A site, area, lake, reservoir or highway.designated as ❑ ❑ ❑ ❑ ❑ scenic? • Municipal park, or designated open space?. ❑ ❑ ❑ ❑ ❑ • County road? ❑ ❑ ❑ ❑ ❑ • State? ❑ ❑ ❑ ❑ ❑ • Local road? ❑ ❑ ❑ ❑ ❑ 2. Is the visibility of the project seasonal? (i.e., screened by summer foliage, but visible during other seasons) El Yes El No 3. Are any of the resources checked in question 1 used by the public during the time of year during which the project will be visible? ❑Yes ❑No DESCRIPTION OF EXIS'i ni%3 VISUAL ENVIRONMENT 4. From each item checked in question 1, check those which generally describe the surrounding- ' environment. Within �- _-_ *1/4 mile *1 mile Essentially undeveloped ❑ ❑ Forested ❑ ❑ Agricultural ❑ ❑ Suburban residential ❑ ❑ Industrial ❑ ❑ Commercial ❑ ❑ Urban ❑ ❑ River, Lake, Pond ❑ ❑ Cliffs, Overlooks ❑ ❑ Designated Open Space ❑ ❑ Flat ❑ ❑ Hilly ❑ ❑ Mountainous ❑ ❑ Other ❑ ❑ NOTE: add attachments as needed 5. Are there visually similar projects within: *1/z mile ❑Yes ❑No *1 miles ❑Yes ❑No *2 miles El Yes ❑No *3 miles ❑Yes ❑No * Distance from project site are provided for assistance. Substitute other distances as appropriate. EXPOSURE 6. The annual number of viewers likely to observe the proposed project is NOTE: When user data is unavailable or unknown, use best estimate. CONTEXT 7. The situation or activity in which the viewers are engaged while viewing the proposed action is FREQUENCY Holidays/ Activity Daily Weekly Weekends Seasonally Travel to and from work ❑ ❑ ❑ ❑ Involved in recreational activities ❑ ❑ ❑ ❑ Routine travel by residents ❑ ❑ ❑ ❑ At a residence ❑ ❑ ❑ ❑ At worksite . ❑ ❑ ❑ ❑ Other ❑ ❑ ❑ ❑ `'� 2 S�'r- PLANNING BOARD MEMBERS ` Richard G.Ward, Chairman r J7z Town Hall,53095 Main Road c George Ritchie Latham,Jr. 3 P. O. Box 1179 a ,� -.V ..:.1"-pit,�+• �"�u Bennett Orlowski,Jr, ar�� '. T'' Southold, New York 11971 Mark S. McDonald : ._ y Fax(516)765-3136 Kenneth L. Edwards Telephone(516)765-1938 PLANNING BOARD OFFICE TOWN OF SOUTHOLD August 23, 1994 Stephen L. Ham, III Matthews & Ham 45 Hampton Rd. Southampton, NY 11968 Re: Proposed lot line change for Susanna von der Schulenburg and Henry L. King & Margaret G. King SCTM# 1000-5-2-10.8 & 10.9 Dear Mr. Ham: . The following resolution was adopted by the Southold Town Planning Board at a meeting on Monday, August 22, 1994: BE IT RESOLVED that the Southold Town Planning Board, acting under the State Environmental Quality Review Act, start the coordination process on this Type I action. This is a Type I action because the property is located on Fishers Island. Please contact this office if you have any questions regarding the above. Sincerely, Richard G. Ward Chairman :OUNTY OF SUFFOLK ROBERT J. GAFFNEY /} � SUFFOLK COUNTY EXECUTIVE /x- DEPARTMENT OF PLANNING STEPHEN M. JONES, A.I.C.P. DIRECTOR OF PLANNING August 22, 1994 Richard Ward, Chairman Town of Southold Planning Board Main Road Southold, NY 11971 Plat Name: Subdivision Lot Line H & M King & S. Von Der Schulenburg .Tax Map No. : 1000-5-2-10.8 & 10.9 SCDP File No. : S-SD-94-10 Dear Mr. Ward: Pursuant to the requirements of Section A14-24, Article XIV of the Suffolk County Administrative Code, the above captioned proposed final plat which has been referred to the Suffolk County Planning Commission 'is considered to be a matter for local determination; however, this shall not be construed that the Commission has either approved or disapproved this particular plat. Very truly yours, Stephen M. Jones Director of Planning S/s Frank Dowling, Principal Planner Subdivision Review Division FD:mb AUG 2 31994 ,: .:. jm SOUTHOLD TOW14 -` PLANNING BOARD H. LEE DENNISON BUILDING ■ VETERANS MEMORIAL HIGHWAY ■ HAUPPAUGE.NEW YORK 11788 ■ (516) 853-5192 FAX (516) 853-4044 Fishers Island Development Corporation P.O. Drawer E Fishers Island, New York 06390 Robert B. Calhoun, Jr. Thomas F. Doherty, Jr. President Manager August 8, 1994 Mr. Kenneth Edwards Southold Planning Board Southold Town Hall Southold, NY 11971 Re: King/Von Der Schulenburg-Lot Line Change Dear Ken, The Fishers Island Development Corporation has no objection to the proposed �lot` line change-between Henry & Margaret King and Susanna Von Der Schulenburg, per the plans of Chandler, Palmer & King, dated March 1 , 1994. Should you require any additional information, or have any questions or comments, please feel free to contact us at any time. Sincerely, Thomas F. Doherty Jr. Manager cc: R. Calhoun H. King S. Von Der Schulenberg CPK Southold Plaririing Board ( 0 AUG I I I= SOU MOLD TOWN PLANNING BOARD PLANNING BOARD MEMBERS Richard G.Ward, Chairman - Town Hall,53095 Main Road a`George Ritchie Latham,Jr. P. O. Box 1179 Bennett Orlowski,Jr. y :_: ;, Southold, New York 11971 Mark S. McDonald .` '.�r Fax(516)765-3136 Kenneth L. Edwards ,. Telephone(516)765-1938 PLANNING BOARD OFFICE TOWN OF SOUTHOLD ��. 1994 Suffolk County Planning Commission H. Lee Dennison Executive Office Building - 12th Floor Veteran's Memorial Highway Hauppauge, NY 11788 Attention: Mr. Frank Dowling, Senior Planner Subdivision Review Division Gentlemen: Pursuant to Section A14-24, Suffolk County Administrative Code, the Southold Town Planning Board hereby refers the following proposed subdivision to the Suffolk County Planning Commission: Map of �ar�.K�,�G•�;d�i3Rv�f1: 7•Cv d<<; � Hamlet/Locality S.C.D.P.W. Topo No.: Zoning—/w.--2 jjl-X i iaiye S.C. Tax Map No.: 1000 - �� - �— - /Q S� -- /a, Major Sub. Minor Sub. Site Plan Cluster Lot Line Change MATERIAL SUBMITTED: Preliminary Plat (3 copies) ►i Road Profiles (1) Drainage Plans (1) Topographical Map (1) Site Plan (1) Grading Plan (1) Other materials (specify and give number of copies) Waiver of Subdivision Requirements - See attached sheet i/ Page 2 Southold Town Planning Board Referral Referral Criteria: SEQRA STATUS: 1. The project is an ( ) Unlisted Action (�C) Type I Action ( ) Type II Action 2. A ( ) Negative Declaration ( .) Positive Declaration ( ) Determination of Non-significance has been adopted by the Planning Board. 3. E.I.S. statement enclosed. ( ) Yes, ( ) No Comments: S L TE' We request acknowledgement of receipt of this referral ( ) Yes ( ) No Referral received 1994 by the Suffolk County Planning Commission and assigned File No. Sincerely, is ar G. &ard Chairman cc: Frank Cichanowicz rev. 6/94 July 22, 1994 Southold Town Planning Board Town Hall Southold; New York 11971 Re: Proposed Lot Line Change for Henry L. King & Margaret G. King. and Susanna von der Schulenburg Gentlemen: (SCTM #Is 1000-5-2-10.8 & 10.9) The following statements are offered for your consideration in the review of the above-mentioned minor subdivision and its referral �fo the Suffolk County Planning Commission: (1) No grading, other than foundation excavation for a residential building is- proposed. (2) No new roads are proposed and no changes will be made in the grades of the existing roads . (3) No new drainago structures or alteration of existing structures are proposed. Yours truly, Stephen L.. Ham, III, authorized agent MATTHEWS HAM' ATTORNEYS AND COUNSELLORS AT LAW 45 HAMPTON ROAD SOUTHAMPTON,N.Y.11968 516-283-2400 Pnn B.MATTHEWS TELECOPIER 516-287-1076 aeiz•iesa� STEPHEN L.HAM,III �Pr-- July 25, 1994 Planning Board Town of South , JUL Southold i 2 61199 . Main Road Southold, NY 11971 �°;GtJ s ti}Ln 1�Jf a Re: Proposed Lot Line Change - Properties of Susanna von der Schulenburg and Henry L. King & Margaret G. King (SCTM # Is 1000-5-2-10.8 & 10.9) Dear Sirs: In connection with the referenced application for a lot line change, I have enclosed the following: 1. Letters of authorization for Stephen L. Ham, III to act as agent for the applicants, Susanna von der Schulenburg and Henry L. King and Margaret G. King. 2 . Letter approving the lot line change and setting forth its purpose, executed by Stephen L. Ham, III. 3 . Affidavit regarding merger, executed and sworn to by Stephen L. Ham, III. 4 . Photocopies of deeds recorded in Liber 11366 page 25, and Liber 11683 page 273. 5. Form letter regarding drainage, roads, etc. 6. Long Environmental Assessment Form. 7. Application for Approval of Plat. 8. Our check 'to the Town of Southold in the amount of $50. 9. Questionnaire, duly acknowledged, together with copies of three Certificates of Occupancy for tax lot 10.9. 10. Eight prints of the plan showing the proposed lot line change. Please review the enclosed documents and notify me immediately if. any further information or documentation will be required before you can begin your review of this application. Very trulyyours, Stephen L. Ham, III Enclosures MATTIIEWS & HAM ATTORNEYS AND COUNSELLORS AT LAW 45 HAMPToN ROAD SOUTHAMPTON,N.Y.11968 516-283-2400 PHILLP B.MATTHEWS TELEGOPIER 516-287-1076 (1912.1992) STEPHEN L.HAM,III July 25, 1994 Planning Board Town of Southold Main Road Southold, NY 11971 Re: Proposed Lot Line Change for Henry L. King & Margaret G. King Susanna von der Schulenburg (SCTM # 's 1000-5-2-10. 8 & 10.9) Dear Board Members: As authorized agent of Henry L. King and Margaret G. King (the "Kings") and of Susanna von der Schulenburg ("Mrs. von ,der Schulenburg") , I have submitted an application to you for approval of a proposed lot line change. The lot line change will be effected by the transfer of a . 75-acre portion of Mrs. von der Schulenburg' s property (SCTM # 1000-5-2-10.8) to the Kings property (SCTM # 1000-5-2-10. 9) . The purpose of the lot line change is to provide the Kings with additional protection for their existing home on tax lot 10.9 from any new construction that may take place on tax lot 10. 8 . The Kings also desire to acquire fee title to the land on which is located an existing well that services their property. The Kings and Mrs. von der. Schulenburg have entered into a contract of sale pursuant to which the .75-acre parcel will be transferred after approval of the proposed lot line change by your Board. This will confirm that the Kings and Mrs. von der Schulenburg approve the proposed lot line change and, upon your approval, will be legally bound to carry it out. Finally, I wish to point out that, while both lots are conforming under existing zoning, the smaller of the two (tax lot 10.9) exceeds the minimum area requirement for this R-120 Zone District by 21, 134 square feet or about 17 . 6%. If the lot line change is carried out, the smaller of the two lots will be tax lot 10.8 less the . 75-acre parcel to be transferred to tax lot 10. 9 ; that new lot will have an area of 3 . 46 acres or 150,718 square feet which will exceed the minimum area requirement by 25. 6%. The larger of the two resulting lots (tax lot 10.9 plus the .75-acre parcel) will have an area of 3 . 99 acres or 173,804 square feet which will exceed the minimum area requirement by 44 .8%. Very truly yours, I,Svt 4 St Tien L. Ham III p , ` FORM NO. 4 TOWN OF SOUTHOLD BUILDING DEPARTMENT Office of the Building Inspector Town Hall Southold, N.Y. CERTIFICATE OF OCCUPANCY No Z-20317 Date OCTOBER 29, 1991 THIS CERTIFIES that the building ADDITION Location of Property EAST END PRIVATE ROAD FISHERS ISLAND N.Y. House No. Street Hamlet County Tax Map No. 1000 Section 5 Block 2 Lot 10.9 Subdivision Filed Map No. Lot No. conforms substantially to the Application for Building Permit heretofore filed in this office dated AUGUST 16, 1988 pursuant to which Building Permit No. 17489-Z dated AUGUST 16, 1988 was issued, and conforms to all of the requirements of the applicable provisions of the law. The occupancy for which this certificate is issued is ADDITION TO EXISTING DECK The certificate is issued to KATHLEEN METZ (owner) of the aforesaid building. SUFFOLK COUNTY DEPARTMENT OF HEALTH APPROVAL N/A UNDERWRITERS CERTIFICATE NO. N/A PLUMBERS CERTIFICATION DATED N/A 401 Building Inspe for Rev. 1/81 FORM NO. 4 TOWN OF SOUTHOLD .BUILDING DEPARTMENT Office of the Building Inspector Town Hall Southold, N.Y. CERTIFICATE OF OCCUPANCY No Z-20316 Date OCTOBER 29, 1991 THIS CERTIFIES that the building ADDITION Location of Property _ EAST END, PRIVATE ROAD FISHERS ISLAND, N.Y. House No. Street Hamlet County Tax Map No. 1000 Section 5 Block 2 Lot 10.9 Subdivision Filed Map No. Lot No. conforms substanti-'�Ily to the Application for Building Permit heretofore filed in this office dated SEPTEMBER 10, 1986 pursuant to which Building Permit No. 15272-Z dated SEPTEMBER 17, 1986 was issued, and conforms to all of the requirements of the applicable provisions of the law. The occupancy for which this certificate is issued is DECK ADDITION TO EXISTING ONE FAMILY DWELLING The certificate is issued to KATHLEEN METZ (owner) of the aforesaid building. SUFFOLK COUNTY DEPARTMENT OF HEALTH APPROVAL N/A UNDERWRITERS CERTIFICATE NO. N/A PLUMBERS CERTIFICATION DATED N/A J Building Ins a for Rev. 1/81 BUI:DI:. TO";'vl OF SOUT11OLD, N. Y. HOUSI::G CODE Ii•iSF7-CTION R-E ORT Location EMT END, PRIVATE ROAD FISHERS ISLAND, N.Y. � umoer & street) ki•1uniC1.pal1t7) Subdivision iNap No. Lot( ) Name of Owner(s) KATHLEEN METZ Occupancy R-1 ktype owner-Lenanz) Ad,,mitted by: SELF Accompanied by: Key available Suffolk Co. Tax No. 5-2-10.9 Source of request BAGLEY REID Date OCT. 28, 1991 D!'IELLING: Type of construction WOOD FRAMED `stories 2 Foundation CONCRETE Cellar 1/2 Crawl space Total rooms, 1st. Fl 9 2nd. F1 10 3rd. F1 Bathroom(s) 6 Toilet room(s) 1 Porch, type OPEN Deck type Patio, type-MASONARY Breeze,aay Garags ATTACHED Utility room Type Heat OIL FIRED -+Farm Air XX Hotwater Fireplace(s) 1 No. Exits 5 Aircor_ditioning Domestic ho twater YES Type heater OIL FIRE Other ACCESECRY STRUCTURES: Garage, type const. Storage, type const. Swimming pool 1 WITH FENCE Guest, type const. Other POOL CABANA S ATTACHED DECKS VIOLATIONS: CHAPTER 45—N.Y. STATE UNIFORM FIRE PREVENTION 6 BUILDING CODE Location I DP1-crir11ion I Art Sec NO VIOLATIONS THIS INCLUDES BUILDING PERMIT #15272-Z CO Z-20316 FOR A DECK, BUILDING PERMIT'017489-Z CO Z-20317 FOR AN ADDITION TO EXISTING DECK. I . i I I Remarks: Inspected by: ROBERT E. WALL Date of Insp. OCT.28, 1991 .Time start end FORM NO. 4 TOWN OF SOUTHOLD BUILDING DEPARTMENT Office of the Building Inspector Town Hall Southold, N.Y. PRE EXISTING CERTIFICATE OF OCCUPANCY No Z-20318 Date OCTOBER 29, 1991 THIS CERTIFIES that the building ONE FAMILY DWELLING Location of Property EAST END, PRIVATE ROAD FISHERS ISLAND, NY House No. Street Hamlet County Tax Map No. 1000 Section 5 Block 2 Lot 10.9 Subdivision Filed Map No. Lot No. conforms substantially to the Requirements for a One Family Dwelling built Prior to: APRIL 9, 1957 pursuant to which CERTIFICATE OF OCCUPANCY NUMBER Z-20318 dated OCTOBER 29, 1991 was issued, and conforms to all of the requirements of the applicable provisions of the law. The occupancy for which this certificate is issued is ONE FAMILY DWELLING WITH ACCESSORY SWIMMING POOL & FENCE POOL CABANA & ATTACHED DECKS. * The certificate is issued to KATHLEEN METZ (owner) of the aforesaid building. SUFFOLK COUNTY DEPARTMENT OF HEALTH APPROVAL N/A UNDERWRITERS".CERTIFICATE N0. N/A PLUMBERS CERTIFICATION DATED N/A *PLEASE SEE ATTACHED INSPECTION REPORT. zdaI2 -4j6% Building ns ector Rev. 1/81 THIS LOT LINE CHANGE BET-M is fr) s"tract o-ys acres fr6m 0, '{•L( acre pare! t Add i t f n Q 3-2-4 acre parce.F /oca ted 6n d)_ Fishers rs and. SCTM# 1000-s-Z-�c�•s't- �0 9 LOT LINE CHANGE Complete application received Application reviewed at work session _ .` oK intro.` OK Applicant advised of necessary revisions Revised sub mission received �,-,` oK Poo L oK IM Lead Agency Coordination SEQRA determination 1013M Nnz Sent to County Planning Commission .` [OK uoI , 0K Review of SCPC report Draft Covenants and Restrictions received ,�o.` OK Draft Covenants and Restrictions reviewed .` oK Filed Covenants and Restrictions received Final Public Hearing (io)3 s t Approval of Lot Line - -with conditions Endorsement of Lot Line ms 1/1/90 14-16-2 (2/87)-7c 617.21 SEAR Appendix A State Environmental Quality Review _ FULL ENVIRONMENTAL ASSESSMENT FORM Purpose: The full EAF is designed to help applicants and agencies determine; in an orderly manner, whether a project or action may be significant. The question of whether an action may be significant is not always easy to answer. Frequent- ly, there are aspects of a project that are subjective or unmeasureable. It is also understood that those who determine significance may have little or no formal knowledge of the environment or may be technically expert in environmental analysis. In addition, many who have knowledge in one particular area may'not be aware of the broader concerns affecting the question of significance. The full EAF is intended to provide a method whereby applicants and agencies can be assured that the determination process has been orderly, comprehensive in nature,yet flexible to allow introduction of information to fit a project or action. Full EAF Components: The full EAF is comprised of three parts: Part 1: Provides objective data and information about a given project and its site. By identifying basic project data, it assists a reviewer in the analysis that takes place in Parts 2 and 3. Part 2: Focuses on identifying the range of possible_impacts that may occur from a project or action. It provides guidance as to whether an impact is likely to be considered small to moderate or whether it is a potentially- large impact. The form also identifies whether an impact can be mitigated or reduced. Part 3: If any impact in Part 2 is identified as potentially-large, then Part 3 is used to evaluate whether or not the impact is actually important. DETERMINATION OF SIGNIFICANCE—Type 1 and Unlisted Actions Identify the Portions of EAF completed for this project: 1 Part 1 Part 2 ❑Part 3 Upon review of the information recorded on this EAF(Parts 1 and 2 and 3 if appropriate), and any other supporting information, and considering both the magitude and importance of each impact, it is reasonably determined by the lead;aency that: A. The project will not result in any large and important impact(s) and, therefore, is one which will not have a significant impact on the environment, therefore a negative declaration will be prepared. ❑ B. Although the project could have a significant effect on the environment, there will not be a significant effect for this Unlisted Action because the mitigation measures described in PART 3 have been required, therefore a CONDITIONED negative declaration will be prepared.* ❑ C. The project may result in one or more large and important impacts that may have a significant impact on the environment, therefore a positive declaration will be prepared. *.A Conditioned Negative Declaration is only valid for Unlisted Actions Name of Action Name of Lead gency Print or Type Na e of Responsible Officer in Lead Agency Title of Responsible Officer Signature of Responsible Officer in Lead Agen y Signature of Preparer(If different from responsible officer) Date 1 a PART 1—PROJECT INF0RMAT1(,_ Prepared by Project Sponsor NOTICE: This document is designed to assist in determining whether the action proposed may have a significant effect on the environment. Please complete the entire form, Parts A through E. Answers to these questions will be considered as part of the application for approval and may be subject to further verification and public review. Provide any additiona! information you believe will be needed to complete Parts 2 and 3. It is expected that completion of the full EAF will be dependent on information currently available and will not involve new studies, research or investigation. If information requiring such additional work is unavailable, so indicate and specify each instance. NAME OF ACTION .Lot Line Change for HenryL. King & Mar aret 'G. King and Susanna von der Schulenbur LOCATION-OF ACTION(Include Street Address, Municipality and County) East End Road Fishers Island Town of Southold, County of Suffolk NAME OF APPLICANT/SPONSOR BUSINESS TELEPHONE Stephen L. Ham III as authorized agent (516 )28 —2400 ADDRESS 45 Hampton Road CITY/PO STATE ZIP CODE Southampton NY 11968 NAME OF OWNER(If different) BUSINESS TELEPHONE Susanna von der Schulenburg (516 )2831=2400 ADDRESS c/o Matthews & Ham, 45 Hampton Road - CITY/PO STATE ZIP CODE Southampton NY 11968 DESCRIPTION OF ACTION lot line change between two properties (SCTM Vs 1000-5-2-10.8 & 10.9) to be effected by the transfer of a .75—acre parcel from tax lot 10.8 to tax lot 10.9 Please Complete Each Question—Indicate N.A. if not applicable A. Site Description Physical setting of overall project, both-developed and undeveloped areas. 1. Present land use: ❑Urban ❑Industrial ❑Commercial ❑Residential (suburban) ®Rural (non-farm) ❑Forest ❑Agriculture ❑Other 2. Total acreage of project area: .75 acres. APPROXIMATE ACREAGE PRESENTLY AFTER COMPLETION Meadow or Brushland (Non-agricultural) .75 acres -75 acres Forested acres acres Agricultural (Includes orchards, cropland, pasture, etc.) acres acres Wetland (Freshwater or tidal as per Articles 24, 25 of ECL) acres acres Water Surface Area acres acres Unvegetated (Rock, earth or fill) acres acres Roads, buildings and other paved surfaces acres acres Other (Indicate type) acres acres 3. What is predominant soil type(s) on project site? Riverhead sandy loam a. Soil drainage: ❑Well drained 100 % of site ElModerately well drained % of site ❑Poorly drained % of site b. If any agricultural land is involved, how many acres of soil are classified within soil group 1 through 4 of the NYS Land Classification System? N/A acres. (See 1 NYCRR 370). 4. Are there bedrock outcroppings on project site?. ❑Yes EXNo a. What is depth to bedrock? n_ Fnn (in feet) 2 5. Approximate percentage of pr,__ :ed project site with slopes: ❑0-10% _ % 010-15% % ®15% or gr.__..-r % 6. Is project substantially contiguous to; or contain a building, site, or district, listed on the State or the, National Registers of Historic Places? ❑Yes EXNo l . 7. Is project.substantially contiguous to a site listed on the Register of National Natural Landmarks? []Yes ❑No 8. What is the depth of the water table? ?1 7 (in feet). 9. Is site located over a primary, principal; or sole source aquifer? [ Yes ❑No 10. Do hunting, fishing or shell fishing opportunities presently exist in the project area? ®Yes ❑No 11. Does project site contain>:any species of plant or animal life that is identified as threatened or endangered? ❑Yes :7Nb According-to Identify each ,species 12. Are 'there any unique or unusual land forms on the project site? (i.e., cliffs, dunes, other geological formations) ®Yes ❑No Describe cliffs 13. Is the project site presently used by the community or neighborhood as an open space or recreation area? ❑Yes„ XJNo If yes, explain 14. Does the present site include scenic views known to be important to the community? ❑Yes LYN0 15. Streams within or contiguous to project.area: none a. Name of Stream and name of River to which it is tributary N/A 16. Lakes, ponds, wetland areas within or contiguous to project area: a. Name none b. Size (In acres) 17. Is the site served by existing public utilities? MYes ❑No a) If Yes, does sufficient capacity exist to allow connection? ®Yes _ ❑No b) If Yes, will improvements be necessary to allow connection? ❑Yes ®No 18. Is the site located in an agricultural district certified pursuant to Agriculture and Markets Law, Article 25-AA; Section 303 and 304? ❑Yes ®No 19. Is the site located in or substantially contiguous to a Critical Environmental Area designated pursuant to Article 8 of the ECL, and 6 NYCRR 617? EXYes ❑No 20. Has the site ever been used for the disposal of solid or hazardous wastes? ❑Yes [2No B. Project Description 1. Physical dimensions and scale of project (fill in dimensions as appropriate) a. Total contiguous acreage owned or controlled by project sponsor 7.45 acres. b. Project acreage to be developed: 0 acres initially; 0 acres ultimately. c. Project acreage to remain undeveloped 7.25 acres. d. Length of project,. in miles: N/A (If appropriate) e. If the project is an expansion, indicate percent of expansion proposed N/A %; f. Number of off-street parking spaces existing N/A proposed N/A g. Maximum vehicular trips generated per hour N/A (upon completion of project)? h. If residential: Number and type of housing units: One Family Two Family Multiple Family Condominium Initially one* Ultimately two* i. Dimensions (in feet) of largest proposed structure N/A height; N/A width; N/A length. j. Linear feet of frontage along a public thoroughfare project will occupy is? 400* ft. *on both contiguous parcels (tax lots 10.8 and 10.9) 2. How much natural material (i. ;)ck, earth, etc.) will be removed from the 0 tons/cubic ,yards 3. Will disturbed areas be reclairneu ❑Yes ❑No ON/A a. If yes, for what intend,-' purpose is the site being reclaimed? b. Will topsoil be stockpiled for reclamation? ❑Yes K]No c. Will upper subsoil be stockpiled for reclamation?. ❑Yes R]No 4. How many acres of vegetation (trees, shrubs, ground covers) will be removed from site? 0 acres. 5. Will any mature forest (over. 100 years old) or other locally-important vegetation be removed by this project? ❑Yes )7No 6. If single phase project: Anticipated period of construction N/A months, (including demolition). 7. If multi-phased: a. Total number of phases anticipated N/A (number). b. Anticipated date of commencement phase 1 N/A month N/A year, (including demolition). c. Approximate completion date of final phase N/A month N/A year. d. Is phase 1 functionally dependent on subsequent phases? ❑Yes ❑No N/A 8. Will blasting occur during construction? ❑Yes - 1XNo 9. Number of jobs generated: during construction N/A ; after project is complete N/A 10. Number of jobs eliminated by this project N/A 11. Will project require relocation of any projects or facilities? ❑Yes LXNo If yes, explain 12. Is surface liquid waste disposal involved? ❑Yes ®No a. If yes, indicate type of waste (sewage, industrial, etc.) and amount b. Name of water body into which effluent will be discharged 13. Is subsurface liquid waste disposal involved? ❑Yes IX]No Type 14. Will surface area of an existing water body increase or decrease by proposal? ❑Yes UNo Explain 15. Is project or any,portion of project located in a 100 year flood plain? X]Yes ❑No 16. Will the project generate solid waste? ❑Yes ®No a. If yes, what is the amount per month tons b. If yes, will an existing solid waste facility be used? ❑Yes ❑No c. If yes, give name ; location d. Will any wastes not go into a sewage disposal system or into a sanitary landfill? ❑Yes ❑No e. If Yes, explain 17. Will the project involve the disposal of solid waste? ❑Yes IXNo a. If yes, what is the anticipated rate of disposal? tons/month. b. If yes, what is the anticipated site life? years. 18. Will project use herbicides or pesticides? ❑Yes IK]No 19. Will project routinely produce odors (more than one hour per day)? ❑Yes ENNo 20. Will project produce operating noise exceeding the local ambient noise levels? ❑Yes [�No 21. Will project result in an increase in energy use? ❑Yes nNo If yes , indicate type(s) 22. If.water supply is from wells, indicate pumping capacity N/A gallons/minute. 23. Total anticipated water usage per day N/A gallons/day. 24. Does project involve Local, State or Federal funding? ❑Yes 11=1No If Yes, explain 4 25. Approvals Required: Submittal • z Date r City, Town, Village Board ❑Yes,, 9:N0 City, Town, Village Planning Board ®Yes ONO lot line change 7-25-94 City, Town Zoning Board ❑Yes ®No City, County Health Department ❑Yes IX-1No Other Local Agencies ❑Yes ®No Other Regional Agencies ❑Yes [ANo State Agencies ❑Yes LANo Federal Agencies ❑Yes ®No C. Zoning and Planning Information 1 . Does proposed action involve a planning or zoning decision? CJ(Yes ONO If Yes, indicate decision required: ❑zoning amendment ❑zoning variance Ospecial use permit ❑subdivision ❑site plan ❑new/revision of master plan ❑resource management plan [Mother " lot line ne change 2. What is the zoning classification(s)of the site? R-120 single family residential 3. What is the maximum potential development of the site if developed as,permitted by the present zoning? one single—family dwelling w/ accessory structures on each of tax lot 10.8 and 10.9 4. What is the proposed zoning of the site? same 5. What is the maximum potential development of the site if developed as permitted by the proposed zoning? Game 6.- Is the proposed action consistent with the recommended uses in adopted local land use plans? [ Yes ONO 7. What are the predominant land use(s) and zoning classifications within a '/, mile radius of proposed action? R-120 single—family residential 8. Is the proposed action compatible with adjoining/surrounding land uses within a '/ mile? [ Yes ONO 9. If the proposed action is the subdivision of land, how many lots are proposed? N/A a. What is the minimum lot size proposed? N/A 10. Will proposed action require any authorization(s) for the formation of sewer or water districts? ❑Yes l:]No 11 . Will the proposed action create a demand for any community provided services (recreation, education, police, fire protection)? ❑Yes )ONO a. If yes, is existing capacity sufficient to handle projected demand? ❑Yes ONO 12. Will the proposed action result in the generation of traffic significantly above present levels? ❑Yes LNNo a. If yes, is the existing road network adequate to handle the additional traffic? ❑Yes ❑No D. Informational Details Attach any additional information as may be needed to clarify your project. If there are or may be any adverse impacts associated with your proposal, please discuss such impacts and the measures which you propose to mitigate or avoid them. E. Verification I certify that the information provided above is true to th bes of my knowledge. Henry L. King & Margaret Ge. ICing� 1994 Applicant/Sponsor Name Susanna von der Schulenburg Date July 22, Signature I, Title authorized agent ep en am', M If the action is in the Coastal Area, and you are a state agency, complete the Coastal Assessment Form before proceeding with this assessment. 5 Part 2—PROJECT IMPACTS AND THEIR W ]ITUDE Responsibility of Lead Agency General Information (Read Carefully) • In completing the form the reviewer should be guided by the question: Have my responses and determinations been reasonable? The reviewer is not expected to be an expert environmental analyst. • Identifying that an impact will be potentially large (column 2) does not mean that it is also necessarily significant. Any large impact must be evaluated in PART 3 to determine sign if icance.'Identifying an impact in column 2 simply asks that it be looked at further. • The Examples provided are to assist the reviewer by showing types of impacts and wherever possible the threshold of magnitude that would trigger a response in column 2. The examples are generally applicable throughout the State and for most situations. But, for any specific project or site other examples and/or lower thresholds may be appropriate for a Potential Large Impact response, thus requiring evaluation in Part 3. • The impacts of each project, on each site, in each locality, will vary. Therefore, the examples are illustrative and have been offered as guidance.They do not constitute an exhaustive list of impacts and thresholds to answer each question. • The number of examples per question does not indicate the importance of each question. • In identifying impacts, consider long term, short term and cumlative effects. Instructions (Read carefully) _ a. Answer each of the 19 questions in PART 2. Answer Yes if there will be any impact. b. Maybe answers should be considered as Yes answers. c. If answering Yes to a question then check the appropriate box (column 1 or 2) to indicate the potential size of the impact. If impact threshold equals or exceeds any example provided, check column'2. If impact will occur but threshold is lower than example, check column 1. d. If reviewer has doubt about size of the impact then consider the impact as potentially large and proceed to PART 3. e. If a potentially large impact checked in column 2 can be mitigated by change(s) in the project to a small to moderate impact, also check the Yes box in column 3. A No response indicates that such a reduction is not possible. This must be explained in Part 3. 1 2 3 Small to Potential Can Impact Be Moderate Large Mitigated By IMPACT ON LAND Impact Impact Project Change 1 . Will the proposed action result in a physical change to thp project site? NO [--]YES that would apply to column 2 • Any construction on slopes of 15% or greater, (15 foot rise per 100 ❑ ❑ ❑Yes ❑No foot of length), or where the general slopes in the project area exceed 10%. • Construction on land where the depth to the water-table is less than ❑ ❑ ❑Yes ❑No 3 feet. • Construction of paved parking area for 1,000 or more vehicles. ❑ ❑ ❑Yes ❑No • Construction on land where bedrock is exposed or.generally within ❑ ❑ ❑Yes El No 3 feet of existing ground surface. • Construction that will continue for more than 1 year or involve more ❑ ❑ El Yes El No than one phase or stage. • Excavation for mining purposes that would remove more than 1,000 ❑ ❑ ❑Yes ❑No tons of natural material (i.e., rock or soil) per year. • Construction or expansion of a sanitary landfill. ❑ ❑ El Yes' ❑No • Construction in a designated floodway. ❑ ❑ ❑Yes ❑No • Other impacts ❑ ❑ ❑Yes ❑No 2. Will there be an effect t.. _.,iy u.-s;que or unusual land for s found on the site? (i.e., cliffs, dunes, geological formations, etcNO DYES C" • Specific land forms: ❑ ❑ ❑Yes ❑No 6 2 3 Si.-_. to. Potential Can Impact Be Moderate' Large 'Mitigated By Impact Impact Project Change • Proposed Action may cause substantial erosion:- ❑ ❑ Dyes ❑No • Proposed Action is incompatible with existing drainage patterns. ❑ ❑ ❑Yes ❑No • Proposed Action will allow development',in a designated floodway. ❑ ❑ ❑Yes ❑No • Other impacts: ❑ ❑ El Yes El No IMPACT.ON AIR 7. Will proposed action affect air quality? XNO DYES Examples that would apply to column 2 • Proposed Action will induce 1,000 or more vehicle trips in any given ❑ ❑ El Yes ❑No hour. • Proposed Action will result in the incineration of more than 1 ton of ❑ ❑ ❑Yes El No refuse per hour. • Emission rate of total contaminants will exceed 5 lbs. per hour or a ❑ ❑ ❑Yes ❑No heat source producing more than 10 million BTU's per hour. • Proposed action will allow an increase in the amount of land committed ❑ ❑ ❑Yes ❑No to industrial use. • Proposed action will allow an increase in the density of industrial ❑ ❑ ❑Yes ❑No development within existing industrial areas. • Other impacts: ❑ ❑ ❑Yes ❑No IMPACT ON PLANTS AND ANIMALS 8. Will Proposed Action affect any threatened or endanp red species? NO DYES Examples that would apply to column 2 • Reduction of one or more species listed on the New York or Federal ❑ ❑ ❑Yes ❑No list, using the site, over or near site or found on the site. • Removal of any portion of a critical or significant wildlife habitat. ❑ ❑ ❑Yes ❑No • Application of pesticide or herbicide more than twice a year, other ❑ ❑ []Yes ❑No than for agricultural.purposes. • Other impacts: ❑ ❑ ❑Yes ❑No 9. Will Proposed Action substantially affect non-threatened or non-endangered species? O DYES Examples that would apply to column 2 • Proposed Action would substantially interfere with any resident or ❑ ❑ ❑Yes ❑No migratory fish, shellfish or wildlife species. • Proposed Action requires the removal of more than 10 acres ❑ ❑ ❑Yes ❑No of mature forest (over 100 years of age) or other locally important vegetation. IMPACT ON AGRICULTURAL LAND RESOURCES 10. Will the Proposed Action affect agricultural land resources? -:�A0 DYES Examples that would apply to column 2 _ • The proposed action would sever, cross or limit access to agricultural ❑ ❑ ❑Yes ❑No land (includes cropland, hayfields, pasture, vineyard, orchard, etc.) 8 • 1 2 3 . IMPACT ON WATER Small to Potential Can Impact Be Moderate Large Mitigated By , 3. Will proposed action affect any water body designated as protected? Impact Impact Project Change (Under Articles 15,24,25 of the Environmental Conservati n1aw, ECL) 10 ❑YES Examples that would apply to column 2 • Developable area of site contains a protected water body. ❑ ❑ El Yes El.No • Dredging more than 100 cubic yards of material from channel of a ❑ ❑ ❑Yes ❑No protected stream. • Extension of utility distribution.facilities through a protected water body. ❑ ❑ El Yes El No • Construction in a designated freshwater or tidal wetland. ❑ ❑ ❑Yes El No • Other impacts: ❑ ❑ El Yes El No 4. Will proposed action affect any non-protected existiT r new body of water? � ❑YES Examples that would apply to column 2 • A 10% increase or decrease in the surface area of any body of water ❑ ❑ ❑Yes El No or more than a 10 acre increase or decrease. • Construction of a body of water that exceeds 10 acres of surface area. ❑ ❑ ❑Yes El No • Other impacts: ❑ ❑ ❑Yes ❑No 5. Will Proposed Action affect surface or groundwater quality or quantity? groundwater quality ❑YES Examples that would apply to column 2 • Proposed Action will require a discharge permit. ❑ ❑ ❑Yes El No C • Proposed Action requires use of a source of water that does not ❑Yes ❑No have approval to serve proposed (project) action. • Proposed Action requires water supply from wells with greater than 45 ❑ ❑ ❑Yes ❑No gallons per minute pumping capacity. • Construction or operation causing any contamination of a water ❑ ❑ ❑Yes ❑No supply system. • Proposed Action will adversely affect groundwater. ❑ ❑ ❑Yes ❑No • Liquid effluent will be conveye::l off the site to facilities which presently El El ❑Yes El No do not exist or have inadequate capacity. • Proposed Action would use water in excess of '20,000 gallons per ❑ ❑ ❑Yes []No day. • Proposed Action will likely cause siltation or other discharge into an ❑ ❑ ❑Yes ❑No existing body of water to the extent that there will be an obvious visual contrast to natural conditions. _ • Proposed Action will require the storage of petroleum or chemical ❑ ❑ ❑Yes []No products greater than 1,100 gallons. • Proposed Action will allow residential uses in areas without water ❑ ❑ ❑Yes ❑No and/or sewer services. • Proposed Action locates commercial and/or industrial uses which may ❑ ❑ ❑Yes ❑No require new or expansion of existing waste treatment and/or storage facilities. • Other impacts: ❑ ❑ ❑Yes ❑No 6. Will proposed action alter drainage flow or patt n or surface water runoff? MO OYES Examples that would apply to column 2 • Proposed Action would change flood water flows. ❑ ❑ ❑Yes ❑No 7 2 3 Small to ` Potential Can Impact Be Moderate Large Mitigated By Impact Impact Project Change • Construction activity would excavate or compact the soil profile 'of ❑ ❑ ❑Yes El No agricultural land. • The proposed action would irreversibly convert more than 10 acres ❑ ❑ El Yes El No of agricultural land or, if located in an Agricultutal District, more than 2.5 acres of agricultural land. • The proposed action would disrupt or prevent installation of agricultural ❑ ❑ ❑Yes ❑No land management systems (e.g., 'subsurface drain lines, outlet ditches, strip cropping); or create a need for such measures (e.g. cause a farm field to drain poorly due to increased runoff) • Other impacts: ❑ ❑ El Yes ❑No IMPACT ON AESTHETIC RESOURCES 11 . Will proposed action affect aesthetic resources? NO ❑YES (If necessary, use the Visual EAF Addendum in Se tion 617.21, Appendix B.) Examples that would apply to column 2 • Proposed land uses, or project components obviously different from ❑ ❑ ❑Yes El No or in sharp contrast to current surrounding land use patterns, whether man-made or natural. • Proposed land uses, or project components visible to users of ❑ ❑ El Yes ONO aesthetic resources which will eliminate or significantly reduce their enjoyment of the aesthetic qualities of that resource. • Project components that will result in the elimination or significant ❑ ❑ ❑Yes El No screening of scenic views known to be important to the area. • Other impacts: ❑ ❑ ❑Yes El No IMPACT ON HISTORIC AND ARCHAEOLOGICAL RESOURCES 12. Will Proposed Action impact any site or structure of historic, pre- historic or paleontological importance? 't J0 ❑YES Examples that would apply to column 2 • Proposed Action occurring wholly or partially within or.substantially ❑ ❑ El Yes El No contiguous to any facility or site listed on the State or National Register of historic places. • Any impact to an archaeological site or fossil bed located within the ❑ ❑ Dyes ❑No project site. • Proposed Action will occur in an area designated as sensitive for ❑ ❑ ❑Yes ❑No archaeological sites on the NYS Site Inventory. • Other impacts: ❑ ❑ ❑Yes ❑No IMPACT ON OPEN SPACE AND RECREATION 13. Will Proposed Action affect the quantity or quality of existing or future open spaces or recreational opportunities? Examples that would apply to column 2 MO ❑YES • The permanent foreclosure of a future recreational tunity. ❑ ❑ ❑Yes ❑No • A major reduction of an open space important to the community. ❑ ❑ ❑Yes ❑No • Other impacts: ❑ ❑ ❑Yes ❑No 9 IMPACT ON T____ASPORTATION 2 3�, Small to Potential Can Impact Be 14. Will there be an effect to existing transportation ste s? Moderate Large Mitigated By* O DYES Impact Impact Project Change Examples that would apply to column 2 • Alteration of present patterns of movement of people and/or goods. ❑ ❑ El Yes []No • Proposed Action will result in major traffic problems. ❑ ❑ El Yes El No • Other impacts: ❑ ❑ ❑Yes El No IMPACT,.ON ENERGY 15. Will proposed action affect the community's sourc s of fuel or energy supply? NO DYES Examples that would apply to column 2 • Proposed Action will cause a greater than 5% increase in the use of ❑ ❑ ❑Yes ❑No any form of energy in the municipality. • Proposed Action will require the,creation or extension of an energy ❑ ❑ ❑Yes El No transmission or supply system to serve more than 50 single or two family residences or to serve a major commercial or industrial use. • Other impacts: ❑ ❑ ❑Yes El No NOISE AND ODOR IMPACTS 16. Will there be objectionable odors, noise, or vibratio, as a result of the Proposed Action? - NO DYES Examples that would apply to column 2 • Blasting within 1,500 feet of a hospital, school or other sensitive ❑ ❑ ❑Yes ❑No facility. • Odors will occur routinely (more than one hour per day). ❑ ❑ ❑Yes ❑No • Proposed Action will produce operating noise exceeding the local ❑ ❑ El Yes El No ambient noise levels for noise outside of structures. • Proposed Action will remove natural barriers that would act as a ❑ ❑ ❑Yes ❑No noise screen. • Other impacts: ❑ ❑ ❑Yes El No IMPACT ON PUBLIC HEALTH 17. Will Proposed Action affect public health and safety? N 1O DYES Examples that would apply to column 2 • Proposed Action may cause a risk of explosion or release of hazardous ❑ ❑ El Yes ❑No substances(i.e.oil, pesticides, chemicals, radiation, etc.)in the event of accident or upset conditions, or there may be a chronic low level discharge or emission. • Proposed Action may result in the burial of "hazardous wastes" in any ❑ ❑ ❑Yes ❑No form (i.e. toxic, poisonous, highly reactive, radioactive, irritating, infectious, etc.) • Storage facilities for one million or more gallons of liquified natural ❑ ❑ ❑Yes El No gas or other flammable liquids. • Proposed action may result in the excavation or other disturbance ❑ ❑ El Yes ❑NO within 2,000 feet of a site used for the disposal of solid or hazardous waste. • Other impacts: ❑ ❑ El Yes ❑No 10 2 3 IMPACT ON GROWTH AND CHARACTER Small to ' Potential Can Impact Be OF COMMUNITY OR NEIGHBORHOOD Moderate Large Mitigated By 18. Will proposed action affect the character of the exis^ti�g community? Impact Impact Project Change NNNO ' DYES Examples that would apply to column 2 V11 • The permanent population of:'the city, town or village in which the ❑ ❑ ❑Yes El No project is located is likely to grow by more than 5%. • The municipal budget for capital expenditures or operating services ❑ ❑ El Yes El No will increase by more than 5% per year as a result of this project. • Proposed action will conflict.with officially adopted plans or goals. ❑ ❑ ❑Yes ❑No • Proposed action will cause a change in the density of land use. ❑ ❑ ❑Yes No • Proposed Action will replace or eliminate existing facilities, structures ❑ ❑ ❑Yes El No or areas of historic importance to the community. • Development will create a demand for additional community services ❑ ,❑ ❑Yes ❑No (e.g. schools, police and fire, etc.) • Proposed Action will set an important precedent for future projects. ❑ ❑ ❑Yes ❑No • Proposed Action will create or eliminate employment.' ❑ ❑ ❑Yes ❑No • Other impacts: ❑ ❑ El Yes El No 19. Is there, or is there likely to be, public controversy related to potential ,adverse environmental impacts? O DYES If Any Action in Part 2 Is Identified as a Potential Large Impact or If You Cannot Determine the Magnitude of Impact, Proceed to Part 3 Part 3—EVALUATION 'OF THE IMPORTANCE OF IMPACTS Responsibility of Lead Agency Part 3 must be prepared if one or more impact(s) is considered to be potentially large, even if the impact(s) may be mitigated. Instructions Discuss the following for each impact identified in Column 2 of Part 2: 1. Briefly describe the impact. 2. Describe(if applicable)how the impact could be mitigated or reduced to a small to moderate impact by project change(s). 3. Based on the information available, decide if it is reasonable to conclude that this impact is important. To answer the question of importance, consider: • The probability of the impact occurring • The duration of the impact. • Its irreversibility, including permanently lost resources of value • Whether the impact can or will be controlled • The regional consequence of the impact • Its potential divergence from local needs and goals • Whether known objections to the project relate to this impact. (Continue on attachments) 11 DESCRIPTION OF EXIS G VISUAL ENVIRONMENT +. 4. From each item checked in question 1, check those which generally describe the surrounding' environment. Within r *'/a mile *1 mile Essentially undeveloped ❑ ❑ Forested ❑ ❑ Agricultural ❑ ❑ Suburban residential ❑ ❑ Industrial ❑ ❑ Commercial ❑ ❑ Urban ❑ ❑ River, Lake, Pond ❑ ❑ Cliffs, Overlooks ❑ ❑ Designated Open Space ❑ ❑ Flat ❑ ❑ Hilly ❑ ❑ Mountainous ❑ ❑ Other ❑ ❑ NOTE: add attachments as needed - 5. Are there visually similar projects within: *1/z mile ❑Yes ❑No *1 miles ❑Yes ❑No *2 miles ❑Yes ❑No *3 miles ❑Yes El No * Distance from project site are provided for assistance. Substitute other distances as appropriate. EXPOSURE 6. The annual number of viewers likely to observe the proposed project is NOTE: When user data is unavailable or unknown, use best estimate. CONTEXT 7. The situation or activity in which the viewers are engaged while viewing the proposed action is FREQUENCY Holidays/ Activity Daily Weekly Weekends Seasonally Travel to and from work ❑ ❑ ❑ ❑ Involved in recreational activities ❑ ❑ ❑ ❑ . Routine travel by residents ❑ ❑ ❑ ❑ At a residence ❑ ❑ ❑ ❑ At worksite ❑ ❑ ❑ ❑ Other ❑ ❑ ❑ ❑ 2 14-14-1-1 c2,87>—gc 617.21 SEAR Appendix B Mate Environmental Quality K-Jew Visual FAF Addendum This form may be used to provide additional information relating to Question 11 of.Part 2 of the Full EAF. (To be completed by Lead Agency) Distance Between Visibility Project and Resource (in Miles) 1. Would the project be.-visible from: 0-'/a Ya-1/z 1/2-3 3-5 5+ • A parcel of land which is dedicated to and available ❑ ❑ ❑ ❑ ❑ to the public for the use, enjoyment and appreciation of natural or man-made scenic qualities? • An overlook or parcel of land dedicated to public ❑ ❑ El ❑ ❑ observation, enjoyment and appreciation of natural or man-made scenic qualities? • A site or structure listed on the National or State ❑ ❑ ❑ ❑ ❑ Registers of Historic Places? • State Parks? ❑ ❑ ❑ ❑ ❑ • The State Forest Preserve? ❑ ❑ ❑ ❑ ❑ • National Wildlife Refuges and state game refuges? ❑ ❑ ❑ ❑ ❑ • National Natural Landmarks and other outstanding ❑ ❑ ❑ ❑ ❑ natural features? • National Park Service lands? ❑ ❑ ❑ ❑ ❑ • Rivers designated as National or State Wild, Scenic ❑ ❑ ❑ ❑ ❑ or Recreational? • Any transportation corridor of high exposure, such ❑ ❑ ❑ ❑ ❑ as part of the Interstate System, or Amtrak? • A governmentally established or designated interstate ❑ ❑ ❑ ❑ ❑ or inter-county foot trail, or one formally proposed for establishment or designation? • A site, area, lake, reservoir or highway designated as ❑ ❑ ❑ ❑ ❑ scenic? • Municipal park, or designated open space?. ❑ ❑ ❑ ❑ ❑ • County road? ❑ ❑ ❑ ❑ ❑ • State? ❑ ❑ ❑ ❑ ❑ • Local road? ❑ ❑ ❑ ❑ ❑ 2. Is the visibility of the project seasonal?(i.e., screened by summer foliage, but visible during other seasons) ❑Yes ❑No 3. Are any of the resources checked in question 1 used by the public during the time of year during which the project will be visible? ❑Yes ❑No 1 APPLICATION FOR APPROVAL OF PLAT r. To the Planning Board of the Town of Southold: agent for the The undersigned/ap licants hereby applies for: ()U9X a7 1kk) (final) approval of a subdivision plat in accordance with Article 16 of the Town Law and the Rules and Regulations of the Southold Town Planning Board, and rep,'resents and states as follows: 1. The applicant is.the owner of record of the land under application. (If the applicant is not the owner of record ofthe land under application, the applicant shall state his interest in said land under application.) 2. The name of the subdivision is to be - , Lot. Line Change for Henry L.: King and Margaret G: King and Susanna von der Schulenburg 3. The entire land under application is described in Schedule "A" hereto annexed. (Copy of deed suggested.) 4. The land is held by the applicant under deeds recorded in Suffolk County Clerk's office as follows: Liber . .. . . .11366. .. . . .. .. .. . Page . . . ..25]. .. . . .. .. .. .. . On .NOverQW-r. 8,.19.91. . . ; Liber . .... . -);03. .. . ..... ... Page . .. ..?? . .. .. . . . . .. .. . On June .29 .l99b... . . . Liber . .. .. .. . . . . .. . . .. .. . . .. . Page . . . .. .. .. .. . . .. .. On . . . .. .. . . . . .. .. . . .. . ... ; Liber . .. .. .. . . .. .. . . .. . .. . .. . Page . .. .. .... . . . . .. .. .. .. . On . .. .. . . .. .. . . .. . . . . . . . Liber . .. .. .. .. .. .. ........ ... Page . .. .. . . .. .. . . .. . . . . ... On . . . .. .. . . .. .. .. . . .. . . . axxduvlmdK=idff x)tkx)kimx7QnDcxxdxTmx.& €gxgfc . . . . . .. .. . . .. .. .. . . .. .. . . .. .. .. ... . .. . . oXXc§ t� 3 # c. ...... .... .. .. . . .. .... .. . . . . . . . . .. . . .. .. . ... .. .. . . .. .......... . .. . . . . . . . . . . . .. .. .. .. .. .. .. .. .. .. .... ................... . . . . . . . . . .. .. .. .. .. .. .. .. . . .. .. . ..... . .... . . . . . . 5. The area of the land is . .. .7.45. .. , .. . acres. , of which .75 acre is the subject of the lot line change. 6. All taxes which are liens on the land at the (late hereof have been paid.xxxeq=xx. . . . . .. . . . . . . .. . . . . . . . . . . .. .. .. . . .. . . .. .. .. . .. . ..... . . . .. . . . . . . . . . . .. . . . . .. . . . . . . .. .. .. .. .. . .. .. .... . . . . . 7. The land is encumbered by . .. .??Q.. .. .. .. . . . . . . . . .. . . . . .. . . .... .. . . .. .. ...... .. . . . . . . . . . mortgage (s).aaKimU mxxx (a) Mortgage recorded' in Liber . .. .. . . . . . . .. . Page . . . .. . . .. . . .. . . .. . in original amount of $. .. .. .. . . . . .. . unpaid amount $ . .. .. . . . . . . . .. . . . . . . . held by. . .. .. . . .. .. .. . . ... .. .. . . .. .. .... .. . . . ad' dress . .. ...... ... . . .. .. . . . . . . . . . . . . . . .. . . . . . . .. . . .. .. . . . . .. . : . . . . . . . . . (b) Mortgage recorded in Liber . .. . . .. . . Page . . . .. . . . . .. .. ... . . . . ... in original amount of . .. .. . . .. . . .. . unpaid amount $. .. . . . . .. . . . . .. . . .. .. . held by . .. .. .... .... .. .. .. . .. ... .. .. .. .. .. . address . .. ...... :. .. . .. . . . . . . . .. . . . . . . .. . . .. . . .. .. .. .. .. . ... . .. . . . . .. . (c) Mortgage recorded in Liber . . . .. . . . . . . . . . Page . . . . . . . .. . . .. .. . in original amount of . .. .. . . . . . . . . . unpaid amount $. . . . . . . . . . . . . ... . . . .. . held by . .. .. . . .. .. . . ..... . . . . ... .... .. .. .. .. . ... .. . address .. . . . . .. .. . . .. . . . . . . . . . .. . .. .. S. There are no other encumbrances or liens against the land. xx. . .. .. .. .. .. .. .. .. .... . . .. .. .. . . .. .. .. .. . . .. . . .. .. . . .. . . . . .. . . .. . . . . . . . . .. . . . . .. .. . . . . .. . . .. .... . ... . . . .. ...... 9. The land lies in the following zoning use districts . . . . . .Residential R-120 . . . . ... . . .. .. .. .. .. .. .. .. .. . . .. .. .. . . . . .. . . . . . . .. . . . . .. . . . . .. .. .. . . .. . ... . ... . .. ... . . . . . 10. TKo part of the land lies under water whether tide water, stream, pond water or otherwise:)ff- MW . . . .. .. .. .. .. .. .. . . .. ... . .. .. .. . . . .. . . . . . . .. . . . . . . .. . . .. .. .. ...... . .. .. .. .. ... . . . . . 11. The applicant shall at his expense install all required public improvements. 12. The land (does) (XXMi?fXO( lie in a Water District or Water Supply District. Name of Dis- trict, if within a District, is k�7,S1}�KS Island•Water, Works.. . . . . .. . . .. .. . . . . . . , . . . . .. . 13. Water mains will be laid by . .. .. , existing. . . . . . . . . . . . . . . .. . . . . . . and (a) (no) charge will be made for installing said mains. 14. Electric lines and standards will be installed by . .. . . . .existing. . . .. .. .. . . . . .. . . .. ... . . •• •• •• •• •• •• •• • • .• • . .. .. . .. . . .. . . . . . and (a) (no) charge will be made for installing said lines. 15. Gas mains will be installed by . .. . . . . .NIA. . . .. . . . . .. . . . . . . . . . . . . .. . . . . . . . . ... . . . . .. .. . . . and (a) (no) charge will be made for installing said mains. 16. If streets shown on the plat are claimed by the applicant to be existing public streets in the Suffolk County Highway system, annex Schedule "L" hereto, to show same. 17. If streets shown on the plat are claimed by the applicant to be existing public streets in the Town of Southold Highway system, annex Schedule "C" hereto to show same. 18. There are no existing buildings or structures on the land which are not located and shown on the plat. 19. Where the plat shows proposed streets which are extensions of streets on adjoining sub- division maps heretofore filed, there are no reserve strips at the end of the streets on said existing maps at their conjunctions with the proposed streets. 20. In the course of these proceedings, the applicant will offer proof of title as required by Sec. 335 of the Real Property Law. 21. Submit a copy of proposed deed for lots showing all restrictions, covenants, etc. Annex Schedule "D". 22. The applicant estimates that the cost of grading and required public improvements will be NIA,, ,, , as itemized in Schedule "E" hereto annexed and requests that the maturity of the Performance Bond be fixed at . .. .N/.A.. . . . years. The Performance Bond will be written by a licensed surety.company unless otherwise shown on Schedule "F". Henry L. King & Margaret G. King and DATE ..Judy.?.Z ., .. ., 19.94 Susanna von der Schulenburg . .. .. .. . . . . . . .. .. . . .. .. .... ..... .......... . .. .. . (Name of Applicant) By . . L.. .. . . . . . . . . . . . (Signature and Title) Stephen L. Ham, III, authorized agent 45 Hampton Road, Southampton, NY 11968 . . . .. .. . . .. . . .. . . . . .. . . .. . ... . . .. . .. . . . .. . . . . . . . (Address) STATE OF NEW YORK, COUNTY OF . . . .. . . . . . SUFFOLK.. .. . . .. . . . . .. ss On the . . . .. .. .. .. .. .... . day of. .. .. .. . . .. ..July. .. . . . . . . . . .. 19.94 . . , before me personally came ,Step .hen L. Ham, III .,, , , , , . , to me known to be the individual described in and who executed the foregoing instrument, and acknowledged that . . . . .he. . .. . executed the same. Ala Notary Public i�u�fiti���+lM�Xdtl� STATE OF NEW YORK, COUNTY OF . . . .. . . . . .. . . .. .. .. .. . . .. .. . ss: On the . . . . . . . . . .. . . . . . day . . . .. .. .. .. . of . . . . . . . . . . . . . .. 19. .. . . .. before me personally came • • . • • • • . . . . . . . . . . . . . . . . . to me known, who being by me duly sworn did de- pose and say that . . . .. .. .. .. . resides at No. . . . .. .. . . . . . . . . . . . . . . . . .. . . .. . . .. .. . . . .. . . . . .. . . . . . . . . . . . . . . . . . . . . . . . . . . .. . . . . . . . . . . . that . .. . . . . . . .. . . .. .. .. . . .. .. . is the . . . . .. . .. . . . . . .. .. . . .. . . . of . .. .. . , . . . . . . . . . . . .. . . . . .. . . . . . . . . . . . . .. .. . . .. . ... .. .. .. .... .. . . . .. . . . . . . the corporation described in and which executed the foregoing instrument; that . .. .. .. ... .. . knows the seal of said corporation; that the seal affixed by order of the board of directors of said corporation. :in�l that . . . . . . . .. . . . signed . .. .. .... . . .. . name thereto by like order. . .. . . . . .. . . .. . . .. .. . . .. .. .. .. ... ... . . . .. . . ... . Notary Public r ff11) 4 CUCi(��C PIAi'vIiV'G''I30" RD .. T0.WN 'p i'SOU .HOLD ' SUFFOL�C�'CO��, TY Southold, N.Y. 11971 (516) 765-1938. QUESTIONNAIRE TO BE COMPLETED AND •SUBMITTED WITH YOUR APPLICATIONS FORMS TO THE PLANNING BOARD Please complete, sign and return to the Offi.ce of' the -Planning Board with your completed applications forms . ' If your answer to any of the following questions is yes these on your guaranteed survey or submit " othereappropriate evidence: 1. Ar•e *there any wetland grasses on this parcel? Yes(Attached is a list- o-f the wetland grasses defined No by the Town Code, Chapter -97, for your reference) 2. Are there -any other premises under your ownership abutting this parcel? Yes No 3. Are there any building permits pending on this parcel? Yes No 4. Are- there any other applications pending concerning this property before - any other department. o.r agency? (Town_. ,-. State, County, etc. ) Yes No 5. Is there any application pending before any other agency with regard to a different project on this parcel? Yes No 6.. Was this property the subject of any prior application to the Planning Board? Yes No 7. Does this properti have a valid certificate of occupancy, if yes please submit .a copy of same yeS " No I certify that • t,he above statements are true and will .be relied on by the Planning Board -in considering this application. Sig-nature o property owner or authorized a cn.t - July 22., -1994 Stephen L,- Ham, ,III, _authorized agent g date Attachment to questionnaire for::-the Planning Board STATE OF NEW YORK, COUNTY OF SUFFOLK, ss: On the asA dayof / .Tu1,y 19 94, before me personally came_ Stephen L. Ham, III to me known to be the individual described in- and who executed the foregoing instrume and acknowledged that he executed the same. /[ ttRR A,,`` ME IA PORUC,swv of N o t a Public , 52-491661�i6 14-16-2 (2/87)-7c 617.21 S EQ R Appendix A State Environmental Quality Review • FULL ENVIRONMENTAL ASSESSMENT FORM Purpose: The full EAF is designed to help applicants and agencies determine; in an orderly manner, whether a project or action may be significant. The question of whether an action may be significant is not always easy to answer. Frequent- ly, there are aspects of a project that are subjective or unmeasureable. It is also understood that those who determine significance may have little or no formal knowledge of the environment or may be technically expert in environmental analysis. In addition, many who have knowledge in one particular area may'not be aware of the broader concerns affecting the question of significance. The full EAF is intended to provide a method whereby applicants and agencies can be assured that the determination process has been orderly, comprehensive in nature, yet flexible to allow introduction of information to fit a project or action. Full EAF Components: The full EAF is comprised of three parts: Part 1: Provides objective data and information about a given project and its site. By identifying basic project, data, it assists a reviewer in the analysis that takes place in Parts 2 and 3. Part 2: Focuses on identifying the range of possible impacts that may occur from a project or action. It provides guidance as to whether an impact is likely to be considered small to moderate or whether it is a potentially- large impact. The form also identifies whether an impact can be mitigated or reduced. Part 3: If any impact in Part 2 is identified as potentially-large, then Part 3 is used to evaluate whether or not the impact is actually important. DETERMINATION OF SIGNIFICANCE—Type 1 and Unlisted Actions Identify the Portions of EAF completed for this project: ❑ Part 1 ❑ Part 2 ❑Part 3 Upon review of the information recorded on this EAF(Parts 1 and 2 and 3 if appropriate), and any other supporting information, and considering both the magitude and importance of each impact, it is reasonably determined by the lead agency that: ❑ A. The project will not result in any large and important impact(s) and, therefore, is one which will not have a significant impact on the environment, therefore a negative declaration will be prepared. ❑ B. Although the project could have a significant effect on the environment, there will not be a significant effect for this Unlisted Action because the mitigation measures described in PART 3 have been required, therefore a CONDITIONED negative declaration will be prepared.* ❑ C. The project may result in one or more large and important impacts that may have a significant impact on the environment, therefore a positive declaration will be prepared. * A Conditioned Negative Declaration is only valid for Unlisted Actions Name of Action Name of Lead Agency 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) Date 1 PART 1—PROJECT INFORMA'. .—N ,- Prepared by Project Sponsor NOTICE: This document is designed to assist in determining whether the action proposed may have a significant effect on the environment. Please complete the entire form, Parts A through E. Answers to these'questions will be considered as part of the application for approval and may be subject to further verification and public review. Provide any additionalc information you believe will be needed to complete Parts 2 and 3. It is expected that completion of the full EAF will be dependent on information currently available and will not involve new studies, research or investigation. If in requiring such additional work is unavailable, so indicate and specify each instance. NAME OF ACTION .Lot Line Change for HenryL. King & Mar aret 'G. King and Susanna von der Schulenbur LOCATION OF ACTION(Include Street Address, Municipality and County) East End Road Fishers Island Town of Southold County of Suffolk NAME OF APPLICANT/SPONSOR BUSINESS TELEPHONE Stephen L. Ham III as authorized agent ( 16 )28 -2400 ADDRESS 45 Ham ton Road CITY/PO STATE ZIP CODE Southampton NY 11968 NAME OF OWNER(If different) BUSINESS TELEPHONE Susanna von der Schulenburg (516 )283-2400 ADDRESS c/o Matthews & Ham, 45 Hampton Road CITY/PO STATE ZIP CODE Southampton NY 11968 DESCRIPTION OF ACTION lot line change between two properties (SCTM #Is 1000-5-2-10.8 & 10.9) to-be effected by the transfer of a .75-acre parcel from tax lot 10.8 to tax lot 10.9 Please Complete Each Question—Indicate N.A. if not applicable A. Site Description Physical setting of overall project, both developed and undeveloped areas. 1. Present land use: ❑Urban ❑Industrial ❑Commercial ❑Residential (suburban) ®Rural (non-farm) ❑Forest ❑Agriculture ❑Other 2. Total acreage of project area: .75 acres. APPROXIMATE ACREAGE PRESENTLY AFTER COMPLETION Meadow or Brushland (Non-agricultural) .75 acres -75__ acres Forested acres acres Agricultural (Includes orchards, cropland, pasture, etc.) acres acres Wetland (Freshwater or tidal as per Articles 24, 25 of ECL) acres acres Water Surface Area acres acres Unvegetated (Rock, earth or fill) acres acres Roads, buildings and other paved surfaces acres acres Other (Indicate type) acres acres 3. What is predominant soil type(s) on project site? Riverhead sandy loam . a. Soil drainage: ❑Well drained 100 % of site ❑Moderately well drained % of site ❑Poorly drained % of site , b. If any agricultural land is involved, how many acres of, soil are classified within soil group 1 through 4 of the NYS� Land Classification System? N/A acres. (See 1 NYCRR 370). 4. Are there bedrock outcroppings on project site?. ❑Yes ERNo a. What is depth to bedrock? n- hnn (in feet) 2 5. Approximate percentage of proL__ _ J project site with slopes:' 110-10% % 010-15% % .®15% or greater . % 6. Is project substantially contiguous to, or contain a building, site, or district, listed on the State or the National Registers of Historic Places? []Yes t2No 7. Is project substantially contiguous to a site listed on the Register of National Natural Landmarks? ❑Yes []No 8. What is the depth of the water table? >1 7 (in feet) ' 9. Is site located over a primary, principal; or sole source aquifer? MYes ❑No 10. Do hunting, fishing or shell fishing opportunities presently exist in the project area? ®Yes ❑No 11. Does project site contain any species of plant or animal life that is identified as threatened or endangered? ❑Yes $]No According to Identify each species 12. Are 'there any unique or unusual land forms on the project site? (i.e., cliffs, dunes, other geological formations) ®Yes []No Describe cliffs 13. Is the project site presently used by the community or neighborhood as an open space or recreation area? ❑Yes X]No If yes, explain 14. Does the present site include scenic views known to be important to the community? ❑Yes CANo 15. Streams within or contiguous to project area: none a. Name of Stream and name of River to which it is tributary N/A 16. Lakes, ponds, wetland areas within or contiguous to project area: a. Name none b. Size (In acres) 17. Is the site served by existing public utilities? XlYes ❑No a) If Yes, does sufficient capacity exist to allow connection? ®Yes ❑No b) If Yes, will improvements be necessary to allow connection? ❑Yes ®No 18. Is the site located in an agricultural district certified pursuant to Agriculture and Markets Law, Article 25-AA, Section 303 and 304? []Yes ®No 19. Is the site located in or substantially contiguous to a Critical Environmental Area designated pursuant to Article 8 of the ECL, and 6 NYCRR 617? EXYes ❑No 20. Has the site ever been used for the disposal of solid or hazardous wastes? ❑Yes CMNo B. Project Description 1. Physical dimensions and scale of project (fill in dimensions as appropriate) a. Total contiguous acreage owned or controlled by project sponsor 7.45 acres. b. Project acreage to be developed: 0 acres initially; 0 acres ultimately. c. Project acreage to remain undeveloped '7.25 acres. d. Length of project, in miles:_ N/A (If appropriate) e. If the project is an expansion, indicate percent of expansion proposed N/A %; f. Number of off-street parking spaces existing N/A proposed N/A g. Maximum vehicular trips generated per hour N/A (upon completion .of project)? h. If residential: Number and type of housing units: One Family Two Family Multiple Family Condominium Initially one* Ultimately two* i. Dimensions (in feet) of largest proposed structure N/A height; N/A width; N/A length. j. Linear feet of frontage along a public thoroughfare project will occupy is? 400* ft. ion both contiguous parcels (tax lots 10.8 and 10.9) 2. How much natural material (LE �ck, earth, etc.) will be removed from t Ite? tons/cubic.yards 3. Will disturbed areas be reclaimed? ❑Yes ❑No SIN/A a. If yes, for what intend.,: purpose is the site being reclaimed? b. Will topsoil be stockpiled for reclamation? ❑Yes K]No c. Will upper subsoil be stockpiled for reclamation? ❑Yes g7No 4. How many acres of vegetation (trees, shrubs, ground covers) will be removed from site? 0 acres. 5. Will any mature forest (over 100 years old) or other locally-important vegetation be removed by this project? ❑Yes )7No - 6. If single phase project: Anticipated period of construction N/A months, (including demolition). 7. If multi-phased: a. Total number of phases anticipated - N/A (number). b. Anticipated date of commencement phase 1 N/A month N/A year, (including demolition). c. Approximate completion date of final phase N/A month N/A year. d. Is phase 1 functionally dependent on subsequent phases? '❑Yes ❑No N/A 8. Will blasting occur during construction? ❑Yes L�No 9. Number of jobs generated: during construction N/A ; after project is complete N/A 10. Number of jobs eliminated by this project N/A 11. Will project require relocation of any projects or facilities? ❑Yes LXNo If yes, explain 12. Is surface liquid waste disposal involved? ❑Yes ®No a. If yes, indicate type of waste (sewage, industrial, etc.) and amount b. Name of water body into which effluent will be discharged 13. Is subsurface liquid waste disposal involved? ❑Yes VCC]No Type 14. Will surface area of an existing water body increase or decrease by proposal? Dyes UNo Explain 15. Is project or any portion of project located in a 100 year flood plain? XOYes ❑No 16. Will the project generate solid waste? ❑Yes ®No a. If yes, what is the amount per month tons b. If yes, will an existing solid waste facility be used? ❑Yes ❑No c. If yes, give name location d. Will any wastes not go into a sewage disposal system or into a sanitary landfill? ❑Yes ❑No e. If Yes, explain 17. Will the project involve the disposal of solid waste? ❑Yes nNo a. If yes, what is the anticipated rate of disposal? -tons/month. b. If yes, what is the anticipated site life? years. 18. Will project use herbicides or pesticides? OYes IMNo 19. Will project routinely produce odors (more than one hour per day)? ❑Yes [29No 20. Will project produce operating noise exceeding the local ambient noise levels? Dyes LNNo 21. Will project result in an increase in energy use? ❑Yes nNo If yes , indicate type(s) 22. If water supply is from wells, indicate pumping capacity N/A gallons/minute. 23. Total anticipated water usage per day N/A gallons/day. 24. Does project involve Local, State or Federal funding? El Yes %]No If Yes, explain 4 25. Approvals Required: Submittal i ype Date City, Town, Village Board Dyes ITNo City, Town, Village Planning Board ®Yes ❑No lot line change 7-25-94 City, Town Zoning Board ❑Yes ®No City, County Health Department Dyes WNo Other Local Agencies ❑Yes ®No Other Regional Agencies ❑Yes 12No State Agencies Dyes IJNNo Federal Agencies ❑Yes ®No C. Zoning and Planning Information 1 . Does proposed action involve a planning or zoning decision? E)'es ❑No If Yes, indicate decision required: ❑zoning amendment ❑zoning variance Ospecial use permit ❑subdivision ❑site plan ❑new/revision of master plan ❑resource management plan 12other l o . line change 2. What is the zoning classification(s)of the site? R-1 20 single family residential 3. What is the maximum potential development of the site if developed as permitted by the present zoning? one single—family dwelling w/ accessory structures on each of tax lot 10.8 and 10.9 4. What is the proposed zoning of the site? same 5. What is the maximum potential development of the site if developed as permitted by the proposed zoning? Same 6.- Is the proposed action consistent with the recommended uses in adopted local land use plans? [NYes ❑No 7. What are the predominant land use(s) and zoning classifications within a '/, mile radius of proposed action? R-120 single—family residential 8. Is the proposed action compatible with adjoining/surrounding land uses within a '/ mile? [�Yes ❑No 9. If the proposed action is the subdivision of land, how many lots are proposed? N/A a. What is the minimum lot size proposed? N/A 10. Will proposed action require any authorization(s) for the formation of sewer or water districts? Dyes' 1:]No 11 . Will the proposed action create a demand for any community provided services (recreation, education, police, fire protection)? ❑Yes )DNo a. If yes, is existing capacity sufficient to handle projected demand? ❑Yes ❑No 12. Will the proposed action result in the generation of traffic significantly above present levels? Dyes [�No a. If yes, is the existing road network adequate to handle the additional traffic? ❑Yes ❑No D. Informational Details Attach any additional information as may be needed to clarify your project. If there are or may be any adverse impacts associated with your proposal, please discuss such impacts and the measures which you propose to mitigate or avoid them. E. Verification I certify that the information provided above is true to th bes of my knowledge. Henry L. King & Margaret King Applicant/Sponsor Name Susanna von der Schulenburg Date July 22, 1994 Signature — L-• T Title authorized agent Step en ant,�111 If the action is in the Coastal Area, and you are a state agency, complete the Coastal Assessment Form before proceeding with this assessment. 5 Part 2— r'rIOJECT IMPACTS AND THEIR 1GNITUDE Responsibility of Lead Agency - General Information (Read Carefully) ' • In completing the form the reviewer should be guided by the question: Have my responses and determinations been reasonable? The reviewer is not expected to be an expert environmental analyst. • Identifying that an impact will be potentially large (column 2) does not mean that it is also necessarily significant. Any large impact must be evaluated in PART 3 to determine significance.'Identifying an impact in column 2 simply asks that it be looked at further. • The Examples provided are to assist the reviewer by showing types of impacts and wherever possible the threshold of magnitude that would trigger a response in column 2. The,examples are generally applicable throughout the State and for most situations. But, for any specific project or site other examples and/or lower thresholds may be appropriate for a Potential Large Impact response, thus requiring evaluation in Part 3. • The impacts of each project, on each site, in each locality, will vary. Therefore, the examples are illustrative and have been offered as guidance.They do not constitute an exhaustive list of impacts and thresholds to answer each question. • The number of examples per question does not indicate the importance of each question. • In identifying impacts, consider long term, short term and cumlative effects. Instructions (Read carefully) ~ a. -Answer each of the 19 questions in PART 2. Answer Yes if there will be any impact. b. Maybe answers should be considered as Yes answers. c. If answering Yes to a question then check the appropriate box (column 1 or 2) to indicate the potential size of the impact. If impact threshold equals or exceeds any example provided, check column'2. If impact will occur but threshold is lower than example, check column 1. d. If reviewer has doubt about size of the impact then consider the impact as potentially large and proceed to PART 3. e. If a potentially large impact checked in column 2 can be mitigated by change(s) in the project to a small to moderate impact, also check the Yes box in column 3. A No response indicates that such-a reduction is not possible. This must be explained in Part 3. 1 2 3 �. Small to Potential Can Impact Be IMPACT ON LAND Moderate Large Mitigated By -1 . Will the proposed action result in a physical change to the project site? Impact Impact Project Change ❑NO • DYES - Examples that would apply to column 2 • Any construction on slopes of 15% or greater, (15 foot rise per 100 ❑ El Dyes ❑No foot of length), or where the general slopes in the project area exceed 10%. • Construction on land where the depth to the water-table is less than ❑ ❑ ❑Yes ❑No 3 feet. • Construction of paved parking area for 1,000 or more vehicles. Cj ❑ ❑Yes ❑No • Construction on land where bedrock is exposed or generally within ❑ ❑ ❑Yes ❑No 3 feet of existing ground surface. • Construction that will continue for more than 1 year or involve more ❑ ❑ ❑Yes []No than one phase or stage. • Excavation for mining purposes that would remove more than 1,000 ❑ ❑ ❑Yes ❑No tons of natural material (i.e., rock or soil) per year. • Construction or expansion of a sanitary landfill. ❑ ❑ El Yes' []No • Construction in a designated floodway. ❑ ❑ El Yes ❑No • Other impacts ❑ ❑ ❑Yes El No 2. Will there be an effect t: _..ly ur;;que or unusual land forms found on , the site? (i.e., cliffs, dunes, geological formations, etc.)❑NO DYES C^ • Specific land forms: ❑ ❑. ❑Yes ❑No 6 2 3 Small to Potential Can Impact Be Moderate' Large .'Mitigated By Impact Impact Project Change • Proposed Action may cause substantial erosion. ❑ ❑ El Yes ❑No • Proposed Action is incompatible with existing drainage patterns. ❑ ❑ ❑Yes ❑No • Proposed Action will allow development,in a designated floodway. ❑ ❑ El Yes ❑No • Other impacts: ❑ ❑ ❑Yes ❑No IMPACT. ON AIR 7. Will proposed action affect air quality? ONO OYES Examples that would apply to column 2 • Proposed Action will induce 1,000 or more vehicle trips in any given ❑ ❑ ❑Yes ❑No hour. • Proposed Action will result in the incineration of more than 1 ton of ❑ ❑ ❑Yes ❑No refuse per hour. • Emission rate of total contaminants will exceed 5 lbs. per hour or a ❑ ❑ ❑Yes []No heat source producing more than 10 million BTU's per hour. • Proposed action will allow an increase in the amount of land committed ❑ ❑ ❑Yes ❑No to industrial use. • Proposed action will allow an increase in the density of industrial ❑ ❑ ❑Yes ❑No development within existing industrial areas. • Other impacts: ❑ ❑ ❑Yes []No IMPACT ON PLANTS AND ANIMALS 8. Will-Proposed Action affect any threatened or endangered species? ONO DYES Examples that would apply to column 2 • Reduction of one or more species listed on the New York or Federal ❑ ❑ El Yes ❑No list, using the site, over or near site or found on the site. • Removal of any portion of a critical or significant wildlife habitat. ❑ ❑ ❑Yes ❑No • Application of pesticide or herbicide more than twice a year, other ❑ ❑ El Yes ❑No than for agricultural.purposes. • Other impacts: ❑ ❑ ❑Yes ❑No 9. Will Proposed Action substantially affect non-threatened or -non-endangered species? ONO OYES Examples that would apply to column 2 • Proposed Action would substantially interfere with any resident or ❑ ❑ El Yes ❑No migratory fish, shellfish or wildlife species. • Proposed Action requires the removal of more than 10 acres ❑ ❑ El Yes ❑No of mature forest (over 100 years of age) or other locally important vegetation. IMPACT ON AGRICULTURAL LAND RESOURCES 10. Will the Proposed Action affect agricultural land resources? ONO DYES Examples that would apply to column 2 _ • The proposed action would sever, cross or limit access to agricultural ❑ ❑ ❑Yes ❑No land (includes cropland, hayfields, pasture, vineyard, orchard, etc.) 8 2 3. IMPACT ON WATER Small to Potential Can Impact Be Moderate Large Mitigated By 3. Will proposed action affect any water body designated as protected? Impact Impact Project Change (Under Articles 15, 24, 25 of the Environmental Conservation,Law, ECL) ❑NO ❑YES Examples that would apply to column 2 • Developable area of site contains a protected water body. ❑ ❑ ❑Yes ❑No • Dredging more than 100 cubic yards of material from channel of a ❑ ❑ ❑Yes ❑No protected stream. • Extension of utility distribution facilities through a protected water body. ❑ ❑ ❑Yes ❑No • Construction in a designated freshwater or tidal wetland. ❑ ❑ El Yes ❑No • Other impacts: ❑ ❑ ❑Yes ❑No 4. Will proposed action affect any non-protected existing or new body of water? ❑NO ❑YES ` Examples that would apply to column 2 • A 10% increase or decrease in the surface area of anybody of water ❑ ❑ ❑Yes ❑No or more than a 10 acre increase or decrease. • Construction of a body of water that exceeds 10 acres of surface area. ❑ ❑ El Yes ❑No • Other impacts: ❑ ❑ El Yes ❑No 5. Will Proposed Action affect surface-or groundwater quality or quantity? ❑NO ❑YES Examples that would apply to column 2 • Proposed Action will require a discharge permit. ❑ ❑ El Yes ❑No • Proposed Action requires use of a source of water that does not ❑ ❑ El Yes El No have approval to serve proposed (project) action. • Proposed Action requires water supply from wells with greater than 45 ❑ ❑ ❑Yes ❑No gallons per minute pumping capacity. • Construction or operation causing any contamination of a water ❑ ❑ ❑Yes ❑No supply system. • Proposed Action will adversely affect groundwater. ❑ ❑ ❑Yes ❑No • Liquid effluent will be conveyed off'the site to facilities which presently ❑ ❑ ❑Yes ❑No do not exist or have inadequate capacity. • Proposed Action would use water in excess of 20,000 gallons per ❑ ❑ El Yes El No day. • Proposed Action will likelv cause siltation or other discharge into an ❑ ❑ El Yes ❑No existing body of water to the extent that there will be an obvious visual contrast to natural conditions. • Proposed Action will require the storage of petroleum or chemical ❑ ❑ ❑Yes ❑No products greater than 1,100 gallons. • Proposed Action will allow residential uses in areas without water ❑ ❑ ❑Yes El No ,and/or sewer services. • Proposed Action locates commercial-and/or industrial uses which may ❑ ❑ ❑Yes ❑No require new or expansion of existing waste treatment and/or storage facilities. • Other impacts: ❑ ❑ ❑Yes ❑No 6. Will proposed action alter drainage flow or patterns, or surface water runoff? ❑NO ❑YES Examples that would apply to column 2 • Proposed Action would change flood water flows. ❑ ❑ ❑Yes ❑No 1 2 3 a Small to Potential Can Impact Be Moderate Large Mitigated By Impact Impact Project Change • Construction activity would excavate or compact the soil profile of ❑ ❑ ❑Yes ❑No agricultural land. • The proposed action would irreversibly convert more than 10 acres ❑ ❑ ❑Yes El No of agricultural land or, if located in an Agricultutal District, more than 2.5 acres of agricultural land. • The proposed action would disrupt or prevent installation of agricultural ❑ ❑ ❑Yes ❑No land management systems (e.g., subsurface drain lines, outlet ditches, strip cropping); or create a need for such measures (e.g. cause a farm field to drain poorly due to increased runoff) • Other impacts: ❑ ❑ ❑Yes El No IMPACT ON AESTHETIC RESOURCES 11 . Will proposed action affect aesthetic resources? ❑NO ❑YES (If necessary, use the Visual EAF Addendum in Section 617.21, Appendix B.) Examples that would apply to column 2 • Proposed land uses, or project components obviously different from ❑ ❑ ❑Yes ❑No or in sharp contrast to current surrounding land use patterns, _whether man-made or natural. • Proposed land uses, or project components visible to users of ❑ ❑ ❑Yes ❑No aesthetic resources which will eliminate or significantly reduce their enjoyment of the aesthetic qualities of that resource. • Project components that will result in the elimination or significant ❑ ❑ ❑Yes ❑No screening of scenic views known to be important to the area. • Other impacts: ❑ ❑ ❑Yes ❑No IMPACT ON HISTORIC AND ARCHAEOLOGICAL RESOURCES 12. Will Proposed Action impact any site or structure of historic, pre- historic or paleontological•importance? ❑NO ❑YES Examples that would apply to column 2 • Proposed Action occurring wholly or partially within or substantially ❑ ❑ ❑Yes ❑No contiguous to any facility or site listed on the State or National Register of historic places. • Any impact to an archaeological site or fossil bed located within the ❑ ❑ ❑Yes ❑No project site. • Proposed Action will occur in an area designated as sensitive for ❑ ❑ ❑Yes ❑No archaeological sites on the NYS Site Inventory. • Other impacts: ❑ ❑ ❑Yes ❑No IMPACT ON OPEN SPACE AND RECREATION 13. Will Proposed Action affect the quantity or quality of existing or future open spaces or recreational opportunities? Examples that would apply to column 2 ❑NO ❑YES • The permanent foreclosure of a future recreational opportunity. ❑ ❑ ❑Yes ❑No • A major reduction of an open space important to the community. ❑ ❑ ❑Yes ❑No • Other impacts: ❑ ❑ ❑Yes ❑No 9 IMPACT ON TRANSPORTATION 2 S_, Small to Potential ,Can Impact Be. 14. Will there be an effect to existing transportation systems? Moderate Large Mitigated By' ONO DYES Impact Impact Project Change Examples that would apply to column 2 • Alteration of present patterns of movement of people and/or goods. ❑ ❑ ❑Yes ❑No • Proposed Action will result in major traffic problems. ❑ ❑ ❑Yes ❑No • Other impacts: ❑ ❑ ❑Yes El No IMPACT.ON ENERGY 15. Will proposed action affect the community's sources of fuel or energy supply? ONO DYES Examples that would apply to column 2 • Proposed Action will cause a greater than 5% increase in the use of ❑ ❑ El Yes ❑No any form of energy in the municipality. • Proposed Action will require the,creation or extension of an energy ❑ ❑ ❑Yes ❑No transmission or supply system to serve more than 50 single or two family residences or to serve a major commercial or industrial use. • Other impacts: ❑ ❑ ❑Yes ❑No NOISE AND ODOR IMPACTS 16. Will there be objectionable odors, noise, or vibration as a result of the Proposed Action? - ❑NO DYES Examples that would apply to column 2 • Blasting within 1,500 feet of a hospital, school or other sensitive ❑ ❑ []Yes ONO facility. • Odors will occur routinely (more than one hour per day).. ❑ ❑ ❑Yes El No • Proposed Action will produce operating noise exceeding the local ❑ ❑ ❑Yes ❑No ambient noise levels for noise outside of structures. • Proposed Action will remove natural barriers that would act as a ❑ ❑ ❑Yes El No noise screen. • Other impacts: ❑ ❑ ❑Yes ❑No IMPACT ON PUBLIC HEALTH 17. Will Proposed Action affect public health and safety? ONO- DYES Examples that would apply to column 2 • Proposed Action may cause a risk of explosion or release of hazardous ❑ ❑ El Yes ❑No substances(i.e. oil, pesticides, chemicals, radiation, etc.)in the event of accident or upset conditions, or there may be a chronic low level discharge or emission. _ • Proposed Action may result in the burial of "hazardous wastes" in any ❑ ❑ ❑Yes ❑No form- (i.e. toxic, poisonous, highly reactive, radioactive, irritating, infectious, etc.) • Storage facilities for one million or more gallons of liquified natural ❑ ❑ El Yes ❑No gas or other flammable liquids. Proposed action may result in the excavation or other disturbance ❑ ❑ ❑Yes ❑NO within 2,000 feet of a site used for the disposal of solid or hazardous waste. • Other impacts: ❑ ❑ ❑Yes ❑No 10 2 3 IMPACT ON GROWTH AND CHARACTER Small to Potential Can Impact Be OF COMMUNITY OR NEIGHBORHOOD Moderate Large 'Mitigated By 18. Will proposed action affect the character of the existing community? Impact Impact Project Change ❑NO ❑YES Examples that would apply to column 2 • The permanent population of the city, town or village in which the ❑ ❑ ❑Yes ❑No project is located is.likely to grow by more than 5%. • The.municipal budget for capital expenditures or operating services ❑ ❑ ❑Yes ❑No will increase by more than 5% per year as a result of this project. • Proposed action will conflict with officially adopted plans or goals. ❑ ❑ ❑Yes ❑No • Proposed action will cause a change in the density of land use. ❑ ❑ El Yes ❑No • Proposed Action will replace or eliminate existing facilities, structures ❑ ❑ El Yes ❑No or areas of historic importance to the community. • Development will create a demand for additional community services ❑ ❑ El Yes El No (e.g. schools, police and fire, etc.) • Proposed Action will set an important precedent for future projects. ❑ ❑ ❑Yes El No • Proposed Action will create or eliminate employment. ❑ ❑ ❑Yes El No • Other impacts: ❑ ❑ ❑Yes ❑No 19. Is there, or is there likely to be, public controversy related to potential adverse environmental impacts? ❑NO ❑YES If Any Action in Part 2 Is Identified as a Poten►ial Large Impact or If You Cannot Determine the Magnitude of Impact, Proceed to Part 3 Part 3—EVALUATION OF THE IMPORTANCE OF IMPACTS Responsibility of Lead Agency Part 3 must be prepared if one or more impacts) is considered to be potentially large, even if the impact(s) may be mitigated. Instructions Discuss the following for each impact identified in Column 2 of Part 2: 1 . Briefly describe the impact. 2. Describe(if applicable)how the impact could be mitigated or reduced to a small to moderate impact by project change(s). 3. Based on the information available, decide if it is reasonable to conclude that this impact is important. To answer the question of importance; consider: • The probability of the impact occurring • The duration of the impact. • Its irreversibility, including permanently lost resources of value • Whether the impact can or will be controlled • The regional consequence of the impact • Its potential divergence from local needs and goals • Whether known objections to the project relate to this impact. (Continue on attachments) 11 14-14-11 (2187)-9c 617.21 SEQR Appendix.B "t-te Environmental Quality Review visual FAF Addendum This form may be used to provide additional information relating to Question 11 of Part 2 of the Full EAF. (To be completed by Lead Agency) Distance Between Visibility Project and Resource (in Miles) 1. Would the project be.-visible from: 0-1/a 1/4-1/2 1/2-3 3-5 5+ • A parcel of land which is dedicated to and available ❑ ❑ ❑ ❑ ❑ to the public for the use, enjoyment and appreciation of natural or man-made scenic qualities? • An overlook or parcel of land dedicated to public ❑ ❑ El ❑ ❑ _ observation, enjoyment and appreciation of natural or man-made scenic qualities? • A site or structure listed on the National or State ❑ ❑ ❑ ❑ ❑ Registers of Historic Places? • State Parks? ❑ ❑ ❑ ❑ ❑ • The State Forest Preserve? ❑ ❑ ❑ ❑ ❑ • National Wildlife Refuges and state game refuges? ❑ ❑ ❑ ❑ ❑ • National Natural Landmarks and other outstanding ❑ ❑ ❑ ❑ ❑ natural features? • National Park Service lands? ❑ ❑ ❑ ❑ ❑ • Rivers designated as National or State Wild, Scenic ❑ ❑ ❑ ❑ ❑ or Recreational? • Any transportation corridor of high exposure, such ❑ ❑ ❑ ❑ ❑ as part of the Interstate System, or Amtrak? • A governmentally established or designated interstate ❑ ❑ ❑ ❑ ❑ or inter-county foot trail, or one formally proposed for establishment or designation? • A site, area, lake, reservoir or highway designated as ❑ ❑ ❑ ❑ ❑ scenic? • Municipal park, or designated open space?. ❑ ❑ ❑ ❑ ❑ • County road? ❑ ❑ ❑ ❑ 0 • State? ❑ ❑ ❑ ❑ ❑ • Local road? ❑ ❑ ❑ ❑ ❑ 2. Is the visibility of the project seasonal? (i.e., screened by summer foliage, but visible during other seasons) ❑Yes ❑No 3. Are any of the resources checked in question 1 used by the public during the time of year C during which the project will be visible? ❑Yes No 1 DESCRIPTION OF EXISTING VISUAL ENVIRONMENT 4. From each item checked in question 1, check those which generally describe the surrounding- environment. Within i~ *1/4 mile *1 mile Essentially undeveloped ❑ ❑ Forested ❑ ❑ Agricultural ❑ ❑ Suburban residential ❑ ❑ Industrial ❑ ❑ Commercial ❑ ❑ Urban ❑ ❑ River, Lake, Pond ❑ ❑ Cliffs, Overlooks ❑ - ❑ Designated Open Space ❑ ❑ Flat ❑ ❑ Hilly ❑ ❑ Mountainous ❑ ❑ Other ❑ ❑ NOTE: add attachments as needed 5. Are there visually similar projects within: *1/2 mile ❑Yes ❑No *1 miles ❑Yes ❑No *2 miles ❑Yes ❑No *3 miles ❑Yes ❑No * Distance from project site are provided for assistance. Substitute other distances as appropriate. EXPOSURE 6. The annual number of viewers likely to observe the proposed project is NOTE: When user data is unavailable or unknown, use best estimate. CONTEXT 7. The situation or activity in which the viewers are engaged while viewing the proposed action is FREQUENCY Holidays/ Activity Daily Weekly Weekends Seasonally Travel to and from work ❑ ❑ ❑ ❑ Involved in recreational activities ❑ ❑ ❑ ❑ Routine travel by residents ❑ ❑ ❑ ❑ At a residence ❑ ❑ ❑ ❑ At worksite ❑ ❑ ❑ ❑ Other ❑ ❑ ❑ ❑ 2 P ' l \ J J AFFIDAVIT STATE OF NEW YORK ) ss. . COUNTY OF SUFFOLK ) STEPHEN L. HAM, III, being duly sworn, deposes and says: 1. I am the authorized agent of Susanna von der Schulenburg and Henry L. King & Margaret G. King, owners of premises designated on the Suffolk County Tax Map as District 1000, Section 5, Block 2, Lots 10. 8 and 10.9, respectively, which premises are the subject of an application to the Planning Board of the Town of Southold for a lot line change. The foregoing lots are shown on a certain map prepared by Chandler, Palmer & King and submitted to the Planning Board of the Town of Southold in connection with such application. 2 . The proposed lot line change will be effected by the transfer of an approximately .75-acre portion of tax lot 10.8 now owned by Susanna von der Schulenburg to tax lot 10.9 now owned by Henry L. King and Margaret G. King. 3 . I hereby affirm on behalf of the owners that, upon approval of the lot line change and upon the property transfer described above, the portion of tax lot 10. 8 transferred to tax lot 10. 9 will merge with and become a part of tax lot 10.9. Such portion of tax lot 10. 8 so transferred will not at any time constitute a separate buildable parcel. 4. . I make this affidavit in order to induce the Planning Board of the Town of Southold to grant its approval to the proposed lot line change in accordance with the application therefor. StepheiA L. Ham, III Subscribed and Swornl)to Before Me this J5- Day of July, Lr DOWRE S.VENAN" NOTARY MJBUe,s"ofNar YINk S. ' LJ'- c mOW In8ufbk Cowry Na 02VE4NM7 Notary Public July 22;' 1994 Southold Town Planning Board Town Hall Southold;-. New York 11971 Re: Proposed Lot Line Change for Henry L. King & Margaret G. King. and Susanna von der Schulenburg Gentlemen: (SCTM Vs 1000-5-2-10.8 & 10.9) The following statements are offered for your consideration in the review of the above-mentioned minor subdivision and its referral "fo the. Suffolk County Planning Commission: (1) No grading, other than foundation excavation for a residential building is. proposed. (2) No new roads are proposed and no changes will be made in the grades of the existing roads . (3) No new drainage structures or alteration 'oi existing structures are proposed. Yours truly, yrj- Stephen L. Ham, III, authorized agent Henry L. King Margaret G. King 960 Park Avenue New York, NY 10028 July l 1994 Planning Board Town of Southold Town Hall Main Road ' Southold, NY 11971 Re: Proposed Lot Line Change for Premises at Fishers Island (Block 1, Lot 9, Map of Fishers Island Development Corporation) Dear Board Members: The undersigned, Henry L. King and Margaret G. King, as owners of premises situate at Fishers Island, NY known as Block 1, Lot 9, Map of Fishers Island Development Corporation (SCTM # 1000-5-2-10.9,,) hereby authorize Stephen L. Ham, III of Matthews & Ham, 45 Hampton Road, Southampton, New York 11968, to act as our agent in making such applications to your Board and in taking any and all incidental actions in regard thereto, including without limitation, completing and executing the required affidavits and forms, giving any required notices and appearing at any public hearings, as he shall deem necessary or advisable in order to obtain approval of the proposed lot line change with respect to such premises and those adjoining on the southwest in accordance with the Map prepared by Chandler, Palmer & King, dated March 1, 1994, as the same may be revised from time to time. Very; ruly yours H my L. King o Marg r t G. King I Susanna von der Schulenburg 21 Tite Street - Augustus Court (Flat G) London SW3 England June 28, 1994 Planning Board Town of Southold Town Hall Main Road Southold, NY 11971 Re: Proposed Lot Line Change for Premises at Fishers Island (Block 1, Lot 10, Map of Fishers Island Development Corporation; SCTM # 1000-5-2-10.8) Dear Board Members: The undersigned, Susanna von der Schulenburg, as owner of premises situate at Fishers Island, NY known as Block 1, Lot 10, Map of Fishers Island Development Corporation (SCTM # 1000-5- 2-10.8) hereby authorizes Stephen L. Ham, III of Matthews & Ham, 45 Hampton Road, Southampton, New York 11968, to act as my agent in ..making such applications to your Board and in taking any and all incidental actions in regard thereto, including without limitation, completing and executing the required forms, giving any required notices and appearing at any public hearings, as he shall deem necessary or advisable in order to obtain approval of the proposed lot line change with respect to such premises and those adjoining on the northeast in accordance with the Map prepared by Chandler, Palmer & King, as the same may be revised from time to time. Very truly yours, Susanna vo der Schulenburg Standard N.Y.B,T.U.Form 8007, — -Bargain and sale Deed, with Covenant against Gr Acts—Individual or Corporation(single W WC82 CONSULT,YOYR'LAWYER BEFORE SIGNING THIS INSTRUMENT-THIS'INSTRUMENT'SHOULD BE USED BY LAWYERS ONLY. r '` � i • 1_41366PC251 '1 •t ���(,jU THLS'INDENTURE,made the 30th day of - October , nineteen hundred and ninety—one HUNTINGTON & KILDARE, INC. , a domestic corporation having BETWEEN:an. offic,e .at 265 ,Sunrise Highway, Rockville Centre, New:.York 1i570 10420 party,of the first part, and HENRY L. KING, and MARGARET G. KING, his wife, a both `;residing, t 960 Park. Avenue, New York, New York 10028' ;;• party o�'the second part, WITNFSSETK-that the party of the first part,in consideration of Ten Dollars and other valuable consideration paid by the party of the second part,does hereby grant and release unto the party of the second part, the heirs or successors and assigns of the party of the second part forever, .� ALL that certain plot, piece or parcel of land, with the buildings and improvements thereon erected, situate, lying and being in the IC* T `. ------ See Schedule "A" Annexed Hereto. 1cC0 :. 10420 J CID • 9a TOGETHER with all right, title and interest, if 'any, of the party of the first part in and to any streets and roads abutting the above described premises to the center lines thereof; TOGETHER with the appurtenances and all,tile estate and rights of the party of the first part in and to said premises; TO HAVE AND TO HOLD the premises herein granted unto the party of the second part, the heirs or successors and assigns of the party of the second part forever. {mac. y� .�;v AND the party of the first part covenants that the party of the first part has not done or suffered anything ` ) whereby the said premises have been encumbered in any way whatever, except as aforesaid. . AND the party of the first part, in compliance with Section 13 of the Lien Law, covenants that the party of the first part will receive the consideration for this conveyance and will hold the right to receive such consid- eration as a trust fund to be applied first for the purpose of paying the cost of the improvement and will apply the same first to the payment of the cost of the improvement before using any part of the total of the same for ` any other.purpose. The «rord "party" shall be construed as if it read "parties" whenever the sense of this indenture so'requires. IN WITNESS WHEREOF, the party of the first part has duly executed this deed the day and year first above written. r \, IN PRESENCE OF: HUNTING N & KILDARE I C A By ` Alicia H. Metz„Pres . 11"166PG252 z, STATE OF NEW YORK, COUNTY OF sas STATE OF NEW PORK, COUNTY OF Ills: On the personally came day of 19 before me On the day of 19 , before me personally came tome known to be the individual described in and who to me known to be.the individual described in and who executed the foregoing instrument, and acknowledged that executed the foregoing instrument, and,acknow•ledged that executed the same. executed the same. STATE OF NEW PORK, COUNTY-OF NEW Y ORK, ss: STATE OF NEW YORK, COUNTY OF ,\ ''I. Ss: . On the 30th day of October, 19 91 before me On)the day of personally came ALICIA H. METZ Y 19 before me personally came to me known;who,;being by me duly sworn did depose and the subscribing witness to the foregoing instrument, with say that she resides at M East 57t' t Street, whom I am personally acquainted, who, being by me duly New York, New York 414 .sworn, did depose and say that he resides at No. that she is the President of HUNTINGTON & KILDARE, INC. , that he knows ' the corporation described in and which executed the foregoing instrument; that she to be the individual knows the seal of said corporation; that the seal,affixed described in and who executed the foregoing instrument; to said instrument is sur, corporate seal; that it was so that he, said subscribing witness, was present and saw affixed by order of the board of directors`of said corpora- execute the same; and that he, said witness, tion, and that she signed hername thereto by like order. at the same time subscribed h name as witness thereto. MICHAEL CLARKE Notary Public, l State of Now York Qualified In Warren County Commission Expires May 31,1992 )Bargain ant bale Meeb WITH COVENANT AGAINST sEt TION 5 GRANTOR'S ACTS a TITLE No. aT I ► 3`1 7 A! a BLOCK 2 LOT 10.9 HUNTINGTON & KILDARE, INC. COUNTY 76XX9% VX Suffolk TawA of s43(A44o�d TO HENRY L. KING and MARGARET G. Recorded At Request of KING First American Title Insurance Company of New York - RETURN BY MAIL-TO: STANDARD FORM OF NEW YORK BOARD OF TITLE UNDERWRITERS PIETER J. de JONG, ESQ. Dirtsibufrd by DAVIS POLK & WARDWELL First American'Title Insurance Company 1 Chase Manhattan Plaza Of New York Fryr� -.i�TeTYork, New York L T I C l•.S� 32 EA T 3 � ' , INC. Zip N,.10005 h STREET NE➢� yORi{, 11 . 10016 599-2170 W V_ Z C M O W N W ' V - st N _N YI _ 1 t t11366PG253 j y41, ......._...... -- PAR III: DIST. 1000 SEC. 5"OUrK 2.PART, OF UOT 10.9) _ ALL:that certain plot, piece or parcel of land, situate, lying-and'being in . the .Town of Southold, County of Suffolk and State of New York, being,a part of that portion of Fishers Island now or formerly belonging to Fishers Island Corporation which portion is hereinafter called the' "Park") lying easterly of .the following line, viz: BEGINNING at the southeasterly corner of land owned by the United States, known as the Fort H.G. Wright Military Reservation, Mount Prospect Tract, on the shore of Block Island Sound or the Atlantic Ocean; and . RUNNING THENCE Northerly following the east boundary of_the said. land.of the United States-to the southerly line of East End Road. (sometimes-called Oriental Avenue) and which point is the northeasterly corner of land of the United States; TWINGE crossing the East,End Road and following the same course as the last to the shore of West Harbor or Fishers Island Sound; said lots or parcel of land being bounded and described as follows: BEGINNING at- a stone monument set on the southerly side of a road forty feet wide, said monument being two hundred and twenty-nine and ninety-hundredths feet north of a point which is nine hundred and seventy-five and sixty-nine hundredths feet east of another monument marking the U.S. Coast and Geodetic Survey Triangulation Station "East End 2" (which said "East Erd-12" monument is . located on the summit of the highest hill east of East Harbor on"Fishers Island N.Y.>`and lies south fifty-four minutes west of Latimer Reef Light in.Fishers Island,Sound) ; and RUNNING THENCE Eastwardly, along the southerly side of. the road (and following the arc of a curve to the left whose radius is one hundred and eighty-five and sixty-six hundredths feet and the direction of whose radius at that point is north .five degrees fifty-five minutes and fifty seconds east) , 'thirty-me and three-hundredths feet to a stone monument; TIENM, South four degrees thirty-three minutes and fifteen seconds west fifty- six and .twenty-six hundredths feet to a stone monument; and TMMM,North twenty-five degrees and four minutes west sixty-tv ;aircl sixty- hum~3redths feet to the point or p"Lace of BEGMING. F`f r 11366r u254 - - PArCM II ,(DIST. 1000 SEC. 5 BLACK 2 PART OF Wr 10.9) 7 . ALL, that":;certain plot, piece or parcel of.land, situate, lying and being in the Town of• .Southold, County of Suffolk .and State of.-New York, being,a .part. of. that port ion-oC;_Fishers Islarxl.,naw or formerly belonging to Fishers Island Corporation :(which portion is hereinafter called the ."Park ') lying Yeasterly of'the;following line," viz: BEGINNING at the southeasterly corner of the land owned by the United States, known as the Fort H.G. Wright Military Reservation,, Mount Prospect Tract, on the shore''6E,`:Block Island .Sound or •the Atlantic Ocean; and a RUNNING .` JENCE Northerly following the east boundary of the said lard of the United "5ttes to the southerly line of East End Read (sometimes called Oriental .� Avenue) and which' point is the nor:thcasterly corner of lard of the United States; o following the same course as the last to THENCE-crossing the East End Road and the shore of West. Harbor or Fishers Island-Sound; said lots or parcel of lard being bounded and described as follows: . BEGINNING at a stone monument set on the southerly seven and forty-seven hurr3redthsde, said monument being eleven hundred and fi y feet. east of a point which," is,three. hundred and twenty-four and ninety-one hundredths. feet north of another monument.marking. the U.S. Coast and Geodetic Survey Triangulation Station "East End 2" (which-said "East End 211, monument is located on the summit of the highest hill east of East Harbor on Fishers Island N.Y. and- 11es south fifty-four minutes west of Latimer .Reef Light in. Fishers Island Sound); and RUNNING TIO CE South fifty-eight- degrees twenty-six minutes and forty seconds east one hundred and five and sixteen-hundredths feet to a stake; THENCE South eighty-two degrees forty-seven minutes and forty seconds east two hundred and ninety-one and eighty-hundredths feet to the shore of Block Island Sound; 11M CE with the meanders of said Sound, south twenty-five degrees thirteen minutes and ten seconds west, eighty-two feet south nine degrees twelve minutes and forty seconds west, thirty-seven and forty-eight hundredths feet; south nineteen degrees thirty-nine minutes and ten seconds west eighty-nine and twenty-hundredths feet, south thirty-two degrees twenty-two minutes and thirty seconds west two hundred and twenty-nine ard. seventy-one hundredths feet and south forty-five degrees thirty-seven minutes and forty-five seconds west twenty-nine and sixty-two hundredths feet to a stake; THENCE. .North forty-two degrees twenty-three minutes and ten seconds west four _— hundred'and seventy-three and fifty-nine hundredths feet to a stake; TI- . North four degrees thirty-three minutes and fifteen seconds 'east fifty- six and twenL•y-six hundredths feet to a stake set on the southerly side of said road; and RUNNING 111mgCE Northeasterwardly along .the southerly side of said,road . (following the arc of a curve to the left whose radius is one hurxlred .and . . eighty-five and sixty-six hunxlredtlis feet and the direction of whose radius at that point is north-three degrees thirty-eight minutes and forty-eight seconds'west) , one hundred and eighty-six and twenL•y-six hundredths feet to the point or place of BOGINNING. • �094 EXHIBIT 6 `. 04 �lU BOXES.5 THRU 9 MUST BE TYPED VRINTED IN BLACK INK ONLY [OR TO RECORDING,.OR FILING. I SUFFOLK COUNTY CLERK 2 a 3 3 .. • Ti"A '�"' r_ Number of patesNA . 29 1994 !? - w } co Serial# T SUFFOLt4 - �-r Certificate# i CCU6o9Yy x, rn' . -cw» 552 Prior Ctf# Deed/Mortgage,Instrument Deed/Mortgage Tax Stamp Recording/Filing Stamps 4 FEES . .' Mort ,, . : . . .. Page/Fd1n1,Fee V gage Amt Handling 1.Basic Tax TP-584 2.SONYMA Notation Sub Total EA-5217(County) . W Sub Total 3.Spec./Add. EA-5217(State) TOT.MTG.TAX R.P.T.S.A. /S ®b� Dual Town Dual County Held for Apportionment Comm.of Ed. Transfer Tax Affidavit 9ko DIDeQ Mansion Tax Certified Copy. The property covered by this mortgage is or will be improved by,a one or two Reg.-Copy _ Sub Total dL family dwelling only YES or-NO Other GRAND TOTAL . If NO,see appropriate tax clause on (� page# of this instrument. Real Property Tax Service Agency Verification I> Title Company Information Dist Section Block Lot tea' v v vv O/D o G-�7-9Q (Remt4P) : .. . Company Name. Date Title Number. FEE PAID BY:,'.r Cash, Cheeky Char e g s�-EP�JE•v �i¢®1 £sat Payer same as R&R $ :RECORD &RETURN TO Iit Suffolk: County Recording'.& ,Endorsem.wit Page This page forms part of the attached \Ag made by: (Deed, Mortgage, etc.) u�o �i:✓co�.y .4n ✓-,SR9K%/ The premises herein is situated in. SUFFOLK COUNTY,NEW YORK. TO In the TOWN of S�algo lip CC `/ In the VILLAGE / JdS�N V,4 r or HAMLET.of'1,S1i'£le s 12.0104..5/93 �•�" Siandard N:Y.B.T.U.Foim 8002 Bargain and Sale Deed,with Covenant alainst Grantor's Acts—Individual or Co"'S lion(Tineie Sheet) Ai CONSULT YOUR LAW, BeFORE SIGNING THIS INSTRUMENT—THIS RUMENT SHOULD BE USED BY LAWYERS ONLY. r . . } THIS INDENTURE,made the da of. June , ninetee�i hundred and 94 BETWEEN 1'Two Lincoln`:Advisory Services, Inc. Platt,A. Paine House P.O.-,'.Box 600 Ida-$(►^(}l•�j.,5f,. Millerton, New York 12546 1 i j party of-the first part,,and Susanna;;von der',Schulenberg, AS /i/0/N II�EE1 c/o Matthews & Ham , �. .... •45...Hahptbhi Road: 1 \ Southold, New, York 11968 party of the second part WITNESSETH; that the party`of the first part,in consideration of ten'dollars and other valuable consideration .. t paid by'the party of the second part, does hereby grant-and release,unto.the party,of the second part, the heirs or,successors and assigns of the party of the second part forever, ALL:`that certain plot; piece'or parcel of land, with the buildings and improvements thereon erected, situate, lying and being-in the Town` of Southold, County„of*;Suffolk, described:on.Schedule A 4 r j Section 5 n` : 'Block.2 ; Lot 10 008::: : Y TOGETHER with all right, title and interest, if any, of the,party of the first part.in;and to any streets and roads abutting the above described premises to the centerlines thereof; TOGETHER with the appurtenances and all'the:estate`and.rights,of the party,of.the first part in'and.to said.premises;,,TO,HAVE AND TO HOLD,the:premises herein ,granted unto the party of•the second part, the heirs or successors and assigns of the;party.of the,second part forever. AND the"'party of the"first part covenants that the party of the first part`has not done:or suffered anything whereby the said.premises have,been encumbered in any way whatever, except as aforesaid: AND the party of the first part, in compliance with Section 13 of the Lien Lae:, covenants that the party of -the first part will receive the consideration for this conveyance a'hd';will-'lib1d�,t-, e'�right to receive such consid- eration as a.trust fund to be applied first for the purp''se'of;payiiig.the,cost of the improvement and will apply the same first to the payment of the cost of the impFovement,, efor0tusing:anVjsirt of the total of the same for any other 'purpose. ��� The word party ,r shall be construed as if it read parties whenever the sense of,this indenture .so requires. IN WITNESS WHEREOF, the party of the first part has duly executed this deed the;day__and year-first above written. IN PRESENCE OF: Two Lincoln Advisory-`Services, Inc. x.. By: STATE;OF NEW YORK, COUNTY,OF sat STATE OF NEW PORK, I, ITY OF= d/t/,cd 1. Bst On the .` day of 19 , before me Oilthe /to da personally Came y of 19 fore rite personally came �� - to me known to be the individual described in and who to me known executed the foregoing-instrument, and acknowledged that executed the foregoing utdtvr icil ascribed l and who executed the same. foregoing :instrumen , and acknowledged that executed the same. DOROTHY a-VERNALE Notary Public tate of New York N 45296" Qualified n Dutchess Courdyq Cc nmtss n Expires Jon31 , eTwrE ne,mew vnsfr_ e•nrury ne k�Ufrl $ r ...,. ..► .. .. . . .. ; A.. tr . n,-COUN r yr On`the �� '"day of ' Uune. 1994 before ine On the dayHof ssr personally'carve /((ery�+ .�� 19 4, before me personally came to me known, who,�being Uy me:duly sworn, did depose and ,the subscribing witness to the foregoing' instrument, cairn say that she resid s at No. /��; w�,l /�.n..f whom I am personally acquainted, who, bein b Inc. dal Qua PcAT-i— k• fAIN� /ypUSEt pi(Lte- `Tb(Of' sworn, did depose and say that he resides at.No.- that f he is the f ctv, 7s� of Two Lincoln Advisory Services, Inc. : that he knows the corporation describedin and which executed the foregoing instrument'; that.,, -he to be the indi�idual knees-tire-seal--of-saic}-earporation -that--thr-sea �fi�l described in and who executed the foregoing Instrument; to-s�idtinstrrnnettt-is �geir•cety�grate_sea}�*}tat_it-was-sue that he' said subscribitig;.witness; was 'preseitt• and. saw mixed-hy-ordereE-tire-beard-ef-c}*rectors-of=sa44arpoi•:r .execute the same; and ,that he, said witness, ti6rt;and that.`..'he signed h name thereto by like order:' at ilia.same time.subscribed h name as,witness thereto. of- the;)Board, of Directors' of the,;. Corporation _ �.. - • KENNETK'JACOdi' � ' <. • '! ".�' Notary Public,State of Now vor+ No.31-4725572 Quailtted In New York Co is Term Expires July 31. 19- KENNETH JACOBS ' Notary Public,State Of New Y0* �ar gal it''a it �a( Bri i No.31-4725b72 duelliled In New York Oo�g}tll' 111'I'II C OVENAN'1'',At.4tNti'1.C;R.4NT'011'S A(TI'gm Expires July 31, 1 SECTION 5 BLOCK 2 LE NO.. LOT 1l1 COUNTY OR TOWN SOUthOld TO ',l RETURN BY MAIL TO: Steven Ham, Esq STANDARD FORM OF NEW YORK BOARD OF TITLE UNDERWRITERS Distributed b1 Matthews & :Ham SECURITY TITL$AND GU.lRA1V?'Y�COMPANY '' ;45 ;Hampton Road , ' '.. r _4 ,6.L4 S Yor Southold New , k 11968. P zi az i.+,r ,•,.. .z ,,. ,.- ,.J.. e 0 , SCHEDULE A f 11683, 273: , ALL that "certain. plot, piece or'parcel of land,.situate,.lying and being,in'thelTown of Southold,','-County of Suffolk and ..State :of; New York,,being"a part of that portion of Fishers .;Island,.now or formerly,belonging..to Fishers Island Estates Inc. (which portion is hereinafter called the "Park"),lying easterly: of the following line,.viz:. BEGINNING at the southeasterly corner of land now:br'formerly owned'by the.United "t States;;`known as,th6 Forth,H.G.`Wright Military Reservation, Mount Prospect Trazct, }; on the shore of Block Island Sound or the Atlantic Ocean (as said Tract, was cons ituted .prior to the extension thereof,by the, acquisition of additional .lands in condemnation proceedings instituted in 1942),'and RUNNING THENCE Northerly, following the East boundary of the said tract of land ...,now; or formerly of. the United States (as same was constituted prior to such extension thereof) to the southerly line of,East End Road,(sometimes,called Oriental.Avenue)'.,and % which::point is .the, northeastelry=;.corner of,"said;tract Hof land now or formerly of)the United States (as'same was.constituted prior,to such extension thereof), THENCE crossing the East End Road and following the same course as the last to'the shore of West Harbor or Fishers Island.Sound; Said lot or pacel of land being bounded and described as follows: BEGINNING at a point 'on" the southerly side of a road, said point being 241.77 feet north .of a, point which is 813.01 feet East of a monument marking the United State Coast and Geodetic Survey Triangulation Station "East End 2" (which said "East End .2" monument is located on the summit of the highest hill East of East Harbor on Fishers Island, N.Y., and lies South 54 minutes West of Latimer Reef Light in Fishers Island Sound) said point of beginning also being located South 3 degrees 54 minutes 50 seconds West, 5 feet from a stone monument set on the formerly southerly side of said road;:: RUNNING THENCE along the newly established southerly side of said road, South 84 degrees 4 minutes 10 seconds East, 166.04 feet; .THENCE South 25 degreese 4 minutes 00 seconds' East 56.77 feet to 'a stone monument; THENCE South 42 degrees 23 minutes 10 seconds East, 473.59 feet to the shore of Block'Island Sound; THENCE with the meanders of said Bound, South 56 degrees 23 minutes 00'seeonds West,'' 385.26 feet and South 68 degrees 48 minutes 20 seconds West 13.18 feet to a stake; THENCE North 14 degrees 29 minutes 50 seconds West, 519.63 feet to a stone monument; and THENCE North '3 degrees 54 minutes 50 seconds East, 155.29 feet to the point or place of BEGINNING TOGETHER with all the right, title and interest of the party of the first part, of, in and to the land lying in the street in front of and adjoining said premises. y _• - _ Ir~ 1 • t - '\ (2). �� SITE WIL M - POLE e-QOk FOSNgY 685 seo�s > !Q 1 8 >' • 6 \ \ MON. ROAD N25°0 w �869 S 8204'7'40° E MON.y 5.83 Z��? \ —� 291.80 / S 84004 10 E MON. = D3' r S 030 54'50"W '166.04 MON.\ �, \ ^ / 5,00 S N 224.61 's N 25004�00"W �� I I / PooL / J c� LOCATION MAP W \ E 978.16 r.; — / 1 I FiJUSE * 241.7756.77 600 300 0 600 E 8/3.01 S 0503242' ELO \�3Q GRAPHIC SCALE IN FEET Lr) LO rb \Z — EXIST WELL S 0 012'4 ' W NOTES: 1 T MON. °� o l ~ � I^��� ��� &°� 0000� 1) OWNERS: LOT #9 HENRY L. KING & MARGARET G. KING FISHERS ISLAND, NEW YORK / v 06390 `' ' LOT #10 SUSANNA VON DER SCHULENBURG Wo 21 TIT E ST / AUGUSTUS COURT FLAT G Q 3 LONDON SW3 ENGLAND rye'°�� AREA TO BE DEEd�EO FROM LOT JO 2) SOTS ARE LOCATED IN IN THE TOWN OF SOUTHOLD, COUNTY OF SUFFOLK, STATE rJ OF NEW YORK, DISTRICT 1000, SECTION 005, BLOCK 2, LOTS 10.8 & 10.9. 3) UTILITIES ARE EXISTING ON LOT #9. LOT #10 IS TO BE SERVICED BY MUNICIPAL ` o sr/ WATER & ON SITE SEWAGE SYSTEM. t0 l oO Pip FF 819 '?;;;j''..:. cn �a_ ��05�0��0.dye // �� '?' '`; ; `:.. i --� S 45037'45"W 4) PROPERTY IS LOCATED IN ZONING DISTRICT R-120. ca / 29 s2 O� 5) COORDINATE DISTANCES ARE MEASURED FROM U.S. COAST AND GEODETIC GGo�N A� /// / / / `� SURVEY TRIANGULATION STATION "EAST END 2". 4o o Q 6) LOT AREAS: `00 �0 6/6 BLOCK & LOT EXISTING PROPOSED /LOG �R10�2� 6`'2 5� BLK 1, LOT 9 3.24t AC. 3.99f AC. O •m jO BLK 1, LOT 10 4.21 t AC. 3.46f AC. 5 NEU,i S 68°48�20"WS��pF Y0 k PROPOSED LOT LINE GHANC71: H I - Npv L. KNIN6 $ MA""AR47 C-7. K..1 N'O* ANL;) 5U5ANNA VUA*%N p""'E"52% 5CPU�*EN5Uf-lrV 100 50 0 100 GRAPHIC SCALE IN FEET BLOG4C I LOTS 10 LEGEND: S RS SLAM;), NE1N YORK I.P. IRON PIPE REVISIONS rol Jm�' CHANDLER, PALMER 8e KING MON. MONUMENT DATE DESCRIPTION - r/- , r r x-\ 7/0 5 �94 REVISIONS `�"�.'�'"°„ �'"'�' "'��' C9 �„*� Architecture, Engineering and Surveying N F NOW OR FORMERLY I 110 BROADWAY NORW M'CT 06380 203-889-3397 FAX 203-886-7801 S.F. SQUARE FEET EXIST. EXISTING AC. ACRE DATE: MARCH 1 1994 " s SCALE: 1" = 100' SHEET 1 OF 1 R i'i s s°_1 s '•'..v