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DESCRIBED PROPERTY
SITUATE
PECONIC
TOWN OF SOUTHOLD
SUFFOLK COUNTY, N.Y.
N
TAX MAP NO.: 1000-069.00-04.00.01 1.000 a
LOT AREA:401,665.92 S.F.(9.221 ACRES) o
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DATE SURVEYED:MAY 16,2022 0
REVISED:MARCH 17,2023 '^
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UPDATED:OCT.24, 2025 0
REVISED: DECEMBER 1,2025
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PROPOSED SANITARY:DECEMBER 2,2025 0
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TOWN OF SOUTHOLDDEC 19 2025 >
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SUFFOLK COUNTY, N.Y. SOUTHOLD TOWN
PLANNING BOARD
TAX MAP NO.: 1000-069.00-04.0&0 1 1.000 0
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LOT AREA:401,665.92 S.F.(9221 ACRES)
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DATE SURVEYED:MAY 16,2022
0
REVISED:MARCH 17,2023
UPDATED:OCT.24,2025
REVISED:DECEMBER 1,2025 KEY MAP SCALE: 1"=soo' PROPERTY LINE $
PROPOSED SANITARY:DECEMBER 2, 2025
SUFFOLK COUNTY DEPARTMENT OF HEALTH SERVICES
0
-ELEVATIONS REFER TO NAVD88.
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PROPERTY IS ZONED AC AS PER TOWN OF SOUTHOLD ZONING MAP. THIS IS TO CERTIFY THAT THE PROPOSED REALTY SUBDIVISION OR DEVELOPMENT °� 1 O'MIN.
FOR MAP OF KARRAS UPSTATE LLC IN THE e 1
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TEST HOLE 2,(NOTToscALE) o
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Feet CONSTRUCTION AND ARE SUBJECT TO SEPARATE PERMITS PURSUANT TO THOSE �r . ° to'MIN, a '
0 o i/ASEPTIC GRADE ELEV. GRADE ELEV.
SCALE: 1 INCH- 40 FEET t OF Ntt STANDARDS. THIS APPROVAL SHALL BE VALID ONLY IF THE REALTY a n"� I 3 0
�C L. o SUBDIVISION/DEVELOPMENT MAP IS DULY FILED WITH THE COUNTY CLERK WITHIN o I t 1 i ML SILT LOAM ML SILT LOAM
305 ' `7 'Q� ONE YEAR OF THIS DATE. CONSENT IS HEREBY GM?J FOR THE FILING OF'THIS MAP 8'MIN. 3 3 2'9
LEGAI NOTES y o"I 'j� ON WHICH THIS ENDORSEMENT APPEARS IN THE OFFICE OF THE COUNTY CILERK IN 8' 5' °
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2 UNAUTHORIZED ALTERATION UR ACIUIiION TOTHf55URVEV MAP BEARING ALICENSEDLANDSURVEYORSSEALISAVIOLATIONOFSEOf1UN'1209 ACCORDANCE WiTH PROVISIONS OF THE PUBLIC HEALTH LAW AND THE SUFFOLK COARSE SAND
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0
PATRICIA C. MOORE
Attorney at Law
51020 Main Road
Southold,New York 11971
Tel: (631) 765-4330
Fax: (631) 765-4643
Betsy Perkins Paralegal
Madison Messina, Paralegal
June 5,, 2026 S..b P
14
Planning Board
Town Hall Annex
54375 State Route 25
Southold,NY 11971 sou'WoLo tQ
,0
KANNIN,G 6,02 pid
By Hand
Re: James Karras standard subdivision 1000-69-4-11
Dear Brian:
I have not received any correspondence from the Board, however, based on my
notes from the May 18, 2026 work session the Board agreed to waived the ERSAP
requirement. Enclosed please 12 prints of the "Yield Map" (as requested) and a
copy of the Doroski deed from 1971 to show that the subject lot is a recognized
parcel.
My client has a pending Health Department application for a new sanitary for the
existing dwelling. Once he receives Health Department he will submit as built
building plans for the existing dwelling. The potatoe storage building was
renovated (siding, roofing, interior cleaned up but it is a "dry building"))
The file should be complete and ready for referrals. Please advise when we can
schedule the map for sketch plan approval.
Ve , urs',
'cia C. Moore
Cc: Karras
#'F 29(x01T0)Standard N.Y.B..T.U.Farm 9002 Btrgla and 9mIe doed�with Car•aiat i`iYp1t Grootor r ActsW Iadh
il Of 00rpora1Aou§1,s,*,. -,
CONSULT YOUR LAWYER BEFORE SIGNING THIS INSTRU'dENT--THIS INSTRUIMA NT SHOULD OR USKO oY LAWYiRS ONLY.
O
n�
,I I 1 '10#1 - 1,
� �
1
�
THIS INDENTURE. made the .L L day of D e c emb a r,nineteen hundred quad S e ve n ty o n e
a
EI "YVEN SKI and FRANCE S DORO SKY his wife
STEPHEN J� DC3RU ,
No Number North Road
Southold, New York 11971
pity of the first part,and
THEODORE SZCZOTKA and BARBARA SZCZOTKA , his wife
M
No Number North Road
Southold, New York 11971
patty of the second pact,
er vlluablecon-
of the first part
ia ,consideration of Ten Dollars and oth
unto,release e f the
sidet,adon, pad of e d � hereby, grant
or sucoe=rs and, a sii� w of the party, f the second part fore°
ALL that o p� "`
, and p rot thereon erw
parcel, of land the hd�°oTown of Sou .hold County`
sf t , in Southwld in
M
7
of S."ffl ap S tat o New York, our�d .. n4 do i� d as fc�3 La11
ws,
BEGINNING at a point 135 feet distant from the westerly line
of land of the grantor which line adjoins the easterly side of land
form,erly of John Dixon where the Said line intersects the Northerly
line of Land of the grantor an
d land formerly of John Dixon and which
. a
said line adjoins th.e Southerly side of North Road; running thence
'1 4 5, feet, easterly along the southerly side of North Road ; thence
at right angle 420 feet more o, less along the easterly side of
other land of the grantor to the northerly line of land of Long
Island Railroad thence; 145 feet along the Northerly lime of Long
Island Railroad to the easterly side of other land of the grantor
C1 thence; a distance Northerly along the easterly side of other land
of ..the grantor to the point or place of beginning.
Bf2NG AND INTENDED To BE a portion of the parcel of land of Stephen
1943
J. Doroski and Frances Doroski his wife in deed dated January 22
and rbcorded January 7, 1943 in Liber 2269 page 112 Suffolk County
", Clerk's pff ice, State of New York.
t.", c
m w
anJ
R
to a,a streets
TOGETHER with afl rilglht�, title and interest if anylt of the party,of the ` t a
d al u a deg w re a to, a renter, iiM� , then , tie
d e to t of the �n an t '�d r fists
iapYrtle= Ces � f the first �"
VE AND TO, HOLD a pr ern t unto, e rt of the sMee d „ tJe hei
rn s of the f the � nd , forever.
� or, -sum sore d
--- AND the of the
o f e
first,
p not do> o or
� r% y ,wherebythe d, r have ay whatever, afore
nfi Section, f.3 of the Lli��mow. �
t�tparty,
ANT the,i1xuty of tbt,grot,
a
'Id the night
t to r u� e and, will
o thefirst Y� a �
t
icor �de� o� a. trust, f of pa e t of a h before us wy of
f the swoe ton ' the ie
nt
t a the,"'t o e e fCr
=y, er �
The,
word,
s �nst� It Y , "parties" wbeneve�r the sense of this indenture +o
Ce:QuiteB. ,
IN WITNESS WNEREC"iI~, the party of the, first part haul duly executed this deed the: dap and year first
ri above: written.
". m IN PRISEN'CI ON
Ste hen . Doroski
OFFICE LOCATION: �"" r�r MAILING ADDRESS:
Town Hall Annex P.O. Box 1179
54375 State Route 25 Southold, NY 11971
(cor. Main Rd. &Youngs Ave.)
Southold, NY Telephone: 631 765-1938
www.southoldtownny.gov
PLANNING BOARD OFFICE
TOWN OF SOUTHOLD
June 3, 2026
Ms. Patricia Moore, Esq.
51020 Main Road
Southold, NY 11971
Re: Sketch Plat Application
Karras Standard Subdivision
Located at 2675 Ackerly Pond Lane, Southold
SCTM#1000-69.4-11 Zoning District: A-C
Dear Ms. Moore:
I am writing as a follow-up to the Planning Board Work Session held on May 18, 2026.
The Board determined that the above-referenced Sketch Plat application is incomplete
for review and requires the following revisions and submissions.
1. Yield Plan: provide a Yield Plan pursuant to §240-10(B)(2) of the Town Code.
2. Calculations table: provide a calculations table on the sketch plan pursuant to
§240-10(L). This table shall identify the area of the parcel(s) to be set aside for
cluster and/or preservation purposes; and, the area to be developed.
3. Cover letter: provide a cover letter describing the proposed action on the subject
site and the applicant's intentions regarding open space.
Please submit these items directly to this department. If you have any questions
regarding this application or the review process, please do not hesitate to contact this
office at (631) 765-1938.
Sincerely,
_:6VA OX\ �
Brian Cummings
Senior Planner
Southold Town Plannina Board Work Session — May 18. 2026 — Page 3
Project Name: I Old Town Farm Standard Subdivision SCTM#- 1000-78.-1-10.23
Location., 2355 Main Bayview Road, Southold
Description-. This proposal is for the standard subdivision of a 17.46-acre parcel into
5 lots, where Lot 1 through 3 are 0.8 acres, Lot 4 is 1 acre, and Lot 5 is
13.68 acres including a 3-acre development area, 10.6 acres of open
space in the R-40 Zoning District,
Status- I Conditional Preliminary Plat Approval
Action Review for Final Plat Comp leteness
Attachments- I Staff Report
Project Name, Karras Standard Subdivision SCTM#-. 1000-69.-4-11
Location.- 2765 Ackerly Pond Lane, Southold
Description This proposal is for a clustered four-lot standard subdivision of 9.2 acres,
where Lot 1 is 6.05 acres inclusive of 3.2 acres of open space, and Lots
t-2 through-4 are 1 acre in the A-C Zoning District.
Status: I New Application
Action. Review for Corgi leteness
Attachments: Staff Report
-71
Project Name- Saint John's Episcopal SCTM#. 1000-9.-5-14 & 16.1
Resubdivision
_Location: 664 & 806 Oriental Avenue, Fishers Island
Description: This proposed resubdivision application is to transfer ± 9,886 sq. ft. from
SCTM#1 000-9.-5-14 to SCTM#1 000-9.-5-16.1 resulting in the decrease
of SCTM#1 000-9.-5-14 from ± 41,132 sq. ft. to ± 31,246 sq. ft. and the
increase of SCTM#1 000-9.-5-16.1 from ± 54,457sq. ft. to ± 64,343 sq. ft.
in the R-40 Zoning_ District.
Status: I New Application
1 Action: 1 Review for Completeness
I Attachments: l Staff Report
Discussion:
SPUD (Site Plan Use Determination):
0 Church of the Redeemer, 13225 Sound Ave., Mattituck, SCTM#1000-141.-4-27
0 53995 Route 25 LLC7 53995 Route 25, Southold, SCTM#1000-61.-1-20
0 Hardy Building Use Change, 13520 Route 25, Mattituck, SCTM#1 000-114.-11-5
Southold Planning Department Staff Report
Subdivision Application Work Session Review
Date May 18, 2026
Prepared By: Brian Cummings
1. APPLICATION INFORMATION
Project Title: Karras Standard Subdivision
Applicant- 2765 Ackerly Pond Lane, Southold, NY
Date of Submission. December 19, 2025
Tax Map Number: 1000-69.-4-11
11. LOCATION & DESCRIPTION OF PROJECT
This proposal is for a clustered four-lot standard subdivision of a 9.2 acres, where Lot 1
is 6.05 acres inclusive of 3.2 acres of open space, Lot 2 is 1.0 acre, Lot 3 is 1.01 acre,
and Lot 4 is 1.1 acre in the A-C Zoning District.
III: ACTION TO REVIEW
New Application — Sketch Plan Completeness
IV: HISTORY
The subject parcel was formerly farmed (now discontinued) for nursery stock and used
as a migrant farm labor camp for Doroski Nursery. It includes four existing buildings off
of Ackerly Pond Lane with two of the existing buildings as proposed to be removed.
V: ANALYSIS
A Pre-Submission Meeting was held in July 2021 with the previous owner. Based on
preliminary discussions, the estimated yield is approximately four lots; however, the
actual yield would need to be confirmed through preparation of a conceptual yield plan
demonstrating compliance with Town Code requirements, including lot size, width,
depth, and road specifications (Chapter 280 — Bulk Schedule, Chapter 240 —
Subdivisions, and Chapter 161 — Highway Specifications).
Because the property exceeds 7 acres, the development would be subject to cluster
subdivision requirements. Under these regulations, the total number of permitted lots
must be accommodated within 40% of the property, while the remaining 60% must be
preserved.
Preserved land may be utilized for agricultural purposes or maintained as open space.
1
Southold Planning Department Staff Report
Public Water exists on Old North Road. Gas and PSEG Electric are available both on
Old North Road and Ackerly Pond Lane. A 1" domestic water line with new meter
connection is proposed from Old North Road to connect to existing 1 story 2 bedroom
frame building which also proposes to construct/connect anew I/A OWTS Hydro-Action
AN-500 system and remove/abandon existing sanitary on proposed Lot 1.
No road is proposed. All proposed lots will have direct driveway access to the nearest
street. Lot 1 —Ackerly Pond Lane; Lots 2-4 — Old North Road
Completeness Review
• Refer to the Sketch Plan Application Completeness table for a checklist of items.
SKETCH PLAN COMPLETENESS
REQUIRED SUBMITTED NOTES
Cover Letter&Subdivision Sketch Application Form No Cover letter not
provided
Authorization Letter&Transaction Disclosure Form Yes
Standard Subdivision Conservation Subdivision Yes,,$3,250 New fees have been
Fees Fees adopted since the
• $11000—flat fee 0 $500—flat fee submission of this
• $750—per lot 0 $350—per lot application and do not
apply.
Property Deed(s) & Certificates of Occupancy(COs) Yes Deed submitted, Pre
CO for two existing
dwellings and farm
building (1974) (Z-
46009) altered w/o
proper permits as of
8/2024
Copies of Easements, C&Rs, and decisions from other No
agencies with conditions restricting this property
FEAF or SEAF for SEQRA(Part 1) Yes FEAF
Required Cluster if 7 acres or greater Yes Subject parcel is
9.2ac; cluster required
Lot Recognition Yes
ERSAP (5 copies) No
Yield Plan (5 copies)—STANDARD SUBDIVISION ONLY No
Yield Plan checked for compliance with Town Code No See above.
5 copies of the Primary and Secondary Conservation N/A
Area Plan & Field Survey
5 copies of the Sketch Plan Yes 10
2
Southold Planning Department Staff Report
LWRP Consistency Assessment Form Yes
Table of buildable land area and open space areas as No
applicable
Lot conforms with depth and width requirements No Lot 4 shows a width of
174.77 where 175 is
required
Existing buildings conform with front, rear, and side No Existing buildings on
yard requirements proposed Lot 1 have
pre-existing non-
conforming front yard
setbacks
ROW,flags, cul-de-sac radii in conformance N/A
Application meets cluster design requirements No Must be verified
V1. Planning Board Considerations
1. Consider finding the Sketch Plan application as incomplete for review and require
the following:
a. ERSAP
b. Yield Plan
c. Calculation Table
d. Cover Letter
SUTItOLD
PLANNING II'1;: 19
5
AllDEPARTMENT PLANNING 80kRID
Subdivision Application on Form Sketch Approval,
APPLICATION IS HEREBY MADE to the Town of Southold Planning Board for
SKETCH APPROVAL for the subdivision described herein.
1. Name of Subdivision '�J-A , S
2, Suffolk County Tax Map# [ Op0 " L/ -
3. Type of Subdivision Standard ] Conservation [ ]
4, Hamlet S
5. Street Address/
d ��1 LN• S6 Kliq 0
Project Location
6. Acreage of Site _ _2-z-I
7. Proposed Yield f f L �
8. Number of Lots Proposed r t
9. Zoning District �.
10. Date of Submission — l Z Z
11. Please provide the names, addresses and phone numbers for the following
people:
Applicant: S �s
Agent: C m-
J
Co (- �� �f 33�
Sketch Plan Application Form
Property Owner(s) .. '"
Surveyor.- A C'.
� 7
Engineer:
Attorney,
12. Has an application for subdivision ever been filed for this property? If so, please
indicate when and whether or not approval was granted by the Planning Board.
°
13.
p held with the Planning board? If s , vide
date Has a pre-submission conference been w P o pro� � � � „ °
14. Does the parcel(s)meet the Lot Recognition standard in Town Code §280-9 Lot
Recognition? Yes . No . If"yes", explain how.
15. Has the owner/applicant met with Land Preservation? If so, provide
date. MSC
16. Is any part of the property in agricultural use? If so,how many acres? . . ,N n,t,
17. Is there an existing or proposed sale of development rights on the property?
18. Does the owner own any adjacent properties? If so, please indicate the properties by
SCTM#.
19. Are there any building permits cun•entl.y pend°n o11 the roperty? If yes,please
prow�ide perm it nurater(s). '"� �� ( �)' .
2
20. The site will be serviced by the following special districts or utility companies:
Fire District 5tI"~ C>
Post Office t' �_ v
School District 4 e
Water S-Q-
21. Has the relevant Electric Utility Company been notified of the proposed subdivision? —N o
If so, please provide proof that service will be
provided. l") 1� a &". 't. .5'l
22. Please indicate the type of open space proposed and how it will be managed?
U '4Xt Of / o L c& �
23. Are there any existing structures oii the property? If so, please medicate the type of
structure and its use(s). WiII these structures remain, be removed or altered?
24. Based on the parcel yield and the affordable housing requirement of the Town Code,
how many Moderate Income Family Dwelling Units are proposed? If the number that
will be built is less than 20% of the yield,please indicate how you intend on satisfying
the requirement (see Town Code §240-10 B (2)(c) for options).
25. Application completed by [ ] owner All,
gent [ ] other
. � �
Signature of Prep�arer Date 7-
3
Southold Planning Department
Applicant
Transactional Disclosure Form
The Town of Southold's Code of Ethics prohibits conflicts of interest on the part of town officers
and employees. The purpose of this form is to provide information which can alert the town of
possible conflicts of interest and allow it to take whatever action is necessary to avoid same.
Your Name: S
Last,First,middle initial
unless you are applying in the name of someone else or other entity, such as a company. If so,
indicate the other person's or company's name.
Nature of Application: (Check all that apply)
Subdivision or Re-subdivision X Site Plan
Other(Please name other activity)
Do you personally(or through your company, spouse, sibling,parent or child)have a relationship with any officer or
employee of the Town of Southold? "Relationship includes by blood,marriage or business interest. "Business
interest"means a business,including a partnership,in which the town officer or employee has even a partial
ownership of(or employment by)a corporation in which the town officer or employee owns more than 5%of the
shares.
Yes No X
If you answered"Yes"complete the balance of this form and date and sign where indicated.
Name of the person employed by the Town of Southold
Title or position of that person_.._......................
Describe the relationship between yourself(the applicant)and the town officer or employee. Either check the
appropriate line A through D and/or describe in the space provided.
The town officer or employee or his or her souse,sibling,parent or child is(check all that apply):
A.the owner of greater than 5%of the shares of the corporate stock of the applicant(when the
applicant is a corporation);
B.the legal or beneficial owner of any interest in a noncorporate entity(when the applicant is not
a corporation);
................. C.an officer,director,partner or employee of the applicant; or
................ D.the actual applicant
Description of Relationship:
Ubmit°ted this i day ol' 20A
Signature
Print Name ',:;.
Disclosure Form
SOUTHOLD PLANNING DEPARTMENT
Applicant
Transactional Disclosure Form
The Town of Southold's Code of Ethics prohibits conflicts of interest on the part of town officers
and employees. The purpose of this form is to provide information which can alert the town of
possible conflicts of interest and allow it to take whatever action is necessary to avoid same.
Your Name: V L/ p a 'i. ��
Last,First,middle initial
unless you are applying in the name of someone else or other entity, such as a company. If so,
indicate the other person's or company's name.
Nature of Application: (Check all that apply)
Subdivision or Re-subdivision X Site Plan
Other(Please name other activity)
Do you personally(or through your company,spouse,sibling,parent or child)have a relationship with any officer or
employee of the Town of Southold? "Relationship includes by blood,marriage or business interest. "Business
interest"means a business,including a partnership,in which the town officer or employee has even a partial
ownership of(or employment by)a corporation in which the town officer or employee owns more than 5%of the
shares.
Yes o_y_.
If you answered"Yes"complete the balance of this form and date and sign where indicated.
Name of the person employed by the Town of Southold
Title or position of that person
Describe the relationship between yourself(the applicant)and the town officer or employee. Either check the
appropriate line A through D and/or describe in the space provided.
The town officer or employee or his or her souse,sibling,parent or child is(check all that apply):
.... A.the owner of greater than 5%of the shares of the corporate stock of the applicant(when the
applicant is a corporation);
B.the legal or beneficial owner of any interest in a noncorporate entity(when the applicant is not
a corporation);
_......— C.an officer,director,partner or employee of the applicant;or
D.the actual applicant
Description of Relationship:
Submitted this !o day of 4c, 202ts
Signature ;
Print leid,ef
,�•
µ .
fi*a Roh--t
Disclosure Form
PLANNING BOARD AUTHORIZATION
I, Karras U state LLC b Jart�es Karras, owner of the property identified as
SCTM# 1000-69-4-11 in Southold.NY,hereby authorize Patricia C. Moore to act as my
agent and handle all necessary work involved in the subdiwisionlsite plan process with the
Southold Planning Beard.
Signature: °
Sworn before me this L day of "� 025
M ft p
Not ;ry Stamp
MADISON MESSINA
Notary Public,State of NewYork
No.01 ME6370536
Qualified in Suffolk County
Commission Expires February 05,200
I II�III III IIII IIII III I II�� III�I III 11 II Illl I1�1
III I�ILlI�IIIII�IIIII�II
SUFFOLK COUNTY CLERK
RECORDS OFFICE
RECORDING PAGE
Type of Instrument: DEED Recorded: 10/04/2021
Number of Pages: 4 At: 11 :23:39 AM
Receipt Number : 21-0173062
TRANSFER TAX NUMBER: 21-06741 LIBER: D00013122
PAGE: 533
District: Section: Block: Lot:
1000 069.00 04.00 011.000
EXAMINED AND CHARGED AS FOLLOWS
Deed Amount: $0 .00
Received the Following Fees For Above Instrument
Exempt Exempt
Page/Filing $20 .00 NO Handling $20 .00 NO
COE $5 .00 NO NYS SRCHG $15. 00 NO
EA-CTY $5. 00 NO EA-STATE $125. 00 NO
TP-584 $5.00 NO Notation $0.00 NO
Cert.Copies $0.00 NO RPT $200. 00 NO
Transfer tax $0.00 NO Comm.Pres $0 . 00 NO
Fees Paid $395.00
TRANSFER TAX NUMBER: 21-06741
THIS PAGE IS A PART OF THE INSTRUMENT
THIS IS NOT A BILL
JUDITH A. PASCALE
County Clerk, Suffolk County
1 2
Number of pages RECORDED
2021 Oct 04 11:23:39 AM
JUDITH R. PASCALE
OF
This document will be public SUFFFILKKCOUNTY
record.Please remove all L D00013122
Social Security Numbers P 533
prior to recording. DTii 21-06741
Deed/Mortgage Instrument Deed/Mortgage Tax Stamp Recording/Filing Stamps
3 1 FEES Mortgage Page/Filing Fee 1.Basic Tax mt.
Handling 20 2. Additional Tax
Th-584 SubTotal
Notation Spec/Assit.
or
EA-52 17(County) Sub Total, Spec./Add.
EA-5217(State) __
TOT.MTG.TAX
Dual Town Dual County
R.P.T.S.A. Held forA'ppointment
Comm.of Ed. S, 00 Transfer Tax
Affidavit + Mansion Tax
The property covered by this mortgage is
Certified Copy or will be improved by a one or two
NYS Surcharge 15. 00 family dwelling only.
Sub Total YE5 orNO
Other �(��
Grand Total ` Il
f ee appropriate tax clause on
ageIR of tws�Inxt nt.
4 Dist. p vanity Preservation Fund
21051218 1000 0e900 Daoo ol.i000
Real Property , Consideration Amount$
Tax Service IiEl1
Agency
WII CPF Tax Due $
Verification
Improved
6 Satisfactilons/17ischarg s 9Re s sRVf jf pgtyOwners allingAddress Vacant Land
Cy TD
Z� 3 melrv1 C�— b TD�U Il V
TD
Mall to:Judith A. Pascale,Suffolk County Clerk Title Company Information
310 Center Drive, Riverhead, NY 11901 Co.Name 11 C-
www.suffolkcauntyny.gov/clerk ntte a o
8 Suffolk County Re1 11 cor ing & Endorsement page
This page forms part of the attached made
by: (SPECIFY TYPE OF INSTRUMENT)
cz The premises herein is situated In
SUFFOLK COUNTY,NEW YORK.
TO In the TOWN of hn
�-LC— In the VILLAGE
or HAMLET of
BOXES 6 THRU 8 MUST BE TYPED OR PRINTED IN BLACK INK ONLY PRIOR TO RECORDING OR FILING.
over
BARGAIN AND SALE DEED WITH COVENANT AGAINST GRANTOR'S
ACTS(INDIVIDUAL OR CORPORATION)
FORM 8007
CAUTION:THIS AGREEMENT SHOULD BE PREPARED BY AN ATTORNEY AND REVIEWED BY ATTORNEYS FOR SELLER AND
PURCHASER BEFORE SIGNING.
THIS INDENTURE,made this 14"Day of September,2021
1
between James Karras
140 East Shore Drive,Massapequa, NY 11758
party of the first part,and
Karras Upstate LLC
200 East Shore Drive,Massapequa,N.Y. 11758
party of the second part,
WITNESSETH,that the party of the first 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,
0� ALL that certain plot,piece or parcel of land,with the'buildings and improvements thereon erected,
01A.00situa'te,lying and being in the Town of Southold,Suffolk.County and State of New York,and more particularly
described in schedule A attached hereto and made a part hereof.
bi.t0
Being and intended to be the same premises conveyed to grantor by deed dated 1" � _from Barbara
1��• Szczrotka&Theodore Szczrotka and Joan S.Jenkins&Robert H.Jenkins to be recorded in the Suffolk County
Clerk's office. Said premises also known as 250 County Road 48,Peconic, NY 11958;District 1000;Section
069.00;Block 04.00;Lot 011.000;
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 HAVEAND 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 patty 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 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 word"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.
es Karras
IN PRESENCE OF.•
NYSBA's Residential Real Estate Forms(9/00) 0 2002 Maulzw•Bender R Co„a member orthe tcrisNe cis Group.
First American Title Insurance Company
Title Number. Para-54180 Page 1
SCHEDULE A DESCRIPTION
EMENDED AS QF 9/2012021
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, Suffolk County, New York, bounded
and described as follows:
BEGINNING at a point on the westerly side of Ackerly Pond Lane (Bowery Lane) and the
southerly side of Old North Road;
RUNNING THENCE along the westerly side of Ackerly Pond Lane, South 60 degrees 22
minutes 50 seconds East, 428.95 feet to a point;
THENCE South 46 degrees 15 minutes 18 seconds West, 570.00 feet to a point;
THENCE North 43 degrees 44 minutes 42 seconds West, 18 feet to a point;
THENCE South 46 degrees 15 minutes 18 seconds West, 614.41 feet to a point;
THENCE Noirth 43 degrees 59 minutes 41 seconds West, 387.75 feet to a point on the
southerly side of Old North Road;
THENCE along Old North Road, the following five courses and distances:
1. North 65 degrees 01 minutes 32 seconds East, 185.20 feet;
2. North 50 degrees 25 minutes 39 seconds East 148.81 feet;
3. North 45 degrees 53 minutes 49 seconds East, 96.48 feet;
4. North 41 degrees 47 minutes 46 seconds East, 95.68 feet;
5. North 39 degrees 12 minutes 50 seconds East, 551.85 feet to a point on the westerly side of
Ackerly Pond Lane (Bowery Lane), the point or place of BEGINNING.
Acknowledgment by a Person Within New York State(RPL§309-a)
STATE OF NEW YORK )
COUNTY OF NASSAU )ss.:
On the 14th day of September in the year 2021,before me,the undersigned,personally appeared James
Karras personally known tome or proved tome on the basis of satisfactory evidence to be the individuals whose
names are subscribed to the within instrument and acknowledged to me that they executed the same in their
capacities,and that by their signatures on the instrument,the individuals,or the person upon behalf of which the
individuals act exec uuteedd thhe inpent..
(signature and office of individual ta�ig ackt...wledgment) CMg,ISMS RWA
0"MmiumawNyou
Title No.PARA-54180
Section 069.00
James Karras Block 04.00
Lot 011.000
To County or Town Suffolk/Southold
Street Address 250 County Road 48
Karras Upstate LLC Peconic,NY 11958
Return RX Mail To:
Harry F.George,Esq.
2631 Merrick Rd,suite 406
Bellmore,NY 11710
Reserve This Space For Use Of Recording Office
m
NYSE19s Residential Real EV, Fonw(9/00) 0 2002 Matthew Bender&Co..a member of the LedsNods Group.
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I �I�I�11�1 Iiil Iil II
SUFFOLK COUNTY CLERK
RECORDS OFFICE
RECORDING PAGE
Type of Instrument: DEED Recorded: 10/04/2021
Number of Pages: 4 At: 11:23 :39 AM
Receipt Number : 21-0173062
TRANSFER TAX NUMBER: 21-06740 LIBER: D00013122
PAGE: 532
District: Section: Block: Lot:
1000 069.00 04.00 011 .000
EXAMINED AND CHARGED AS FOLLOWS
Deed Amount: $765,000.00
Received the Following Fees For Above Instrument
Exempt Exempt
Page/Filing $20.00 NO Handling $20.00 NO
COE $5.00 NO NYS SRCHG $15.00 NO
FA-CTY $5 .00 NO EA-STATE $125.00 NO
TP-584 $5 .00 NO Notation $0.00 NO
Cert.Copies $0.00 NO RPT $200.00 NO
Transfer tax $3,060.00 NO Comm.Pres $13,800.00 NO
Fees Paid $17,255.00
TRANSFER TAX NUMBER: 21-06740
THIS PAGE IS A PART OF THE INSTRUMENT
THIS IS NOT A BILL
JUDITH A. PASCALE '
County Clerk, Suffolk County
Town of Southold 3/10/2025
53095 Main Rd
Southold,New York 11971
n
A
IkP "
PRE EXISTING
CERTIFICATE OF OCCUPANCY
No: 46009 Date: 3/2/2025
THIS CERTIFIES that the structure(s) located at: 2765 Akerly Pond Ln, Southold
SCTM#: 473889 Sec/Block/Lot: 69.-4-11
--- --- ----
Subdivision: Filed Map No. Lot No.
conforms substantially to the requirements for a built prior to
APRIL 9, 1957 pursuant to which CERTIFICATE OF OCCUPANCY NUMBER Z- 46009
dated 3/2/2025 was issued and conforms to all the requriements of the applicable provisions of the law.
The occupancy for which this certificate is issued is:
Acces oj:y_building#l is a wood frame one sto farm labor dwelling with cement block foundation full basement
and eats_ cqa ss ry l ��ild_a #ZjsITa.)otato bard with stot-g e above.*
'violations: Accesso Build"— #l BLlildjjM Permit witlt aonroved Suffolk County 1-lealth Department septic system
required for farm labor dwelling conversion to a two bedroom apartment.Accessoybuildng#2 has been renovated
without first obtaining a Building Peranit. Zoning Board of Appeals relief required for both strUCtures.
The certificate is issued to Karras Upstate LLC
(OWNER)
of the aforesaid building.
SUFFOLK COUNTY DEPARTMENT OF HEALTH APPROVAL
ELECTRICAL CERTIFICATE NO.
PLUMBERS CERTIFICATION DATED
------- --
*PLEASE SEE ATTACHED INSPECTION REPORT.
__ ... rt a .. �' . ..
BUILDING DEPARTMENT
TOWN OF SOUTHOLD
HOUSING CODE INSPECTION REPORT
LOCATION: 2765 Akerly Pond Ln,Southold
.................... ........ .......................... . . .-_ -- _--- _____-......_ .. .... ..... .....
SUFF.CO.TAX MAP NO.: 69.-4-11 SUBDIVISION:
.--- ----... ........�...
NAME OF OWNER(S): Karras Upstate LLC
..................................--_..... ...__ --------------- . _..............
OCCUPANCY:
. ...... ........ ----.... ....................... ........ .....
ADMITTED BY:
SOURCE OF REQUEST: Karras Upstate ---
Q pate LLC _..
DATE. 3/2/2025
DWELLING:
#STORIES: #EXITS:
FOUNDATION: CELLAR: CRAWL SPACE:.
BATHROOM(S): TOIL.... _.... ...._.
ET ROOM(S): UTILITY ROOM(S):
PORCH TYPE: DECK TYPE: PATIO TYPE:
BREEZEWAY: FIREPLACE: G
_.._._
ARAGE:
DOMESTIC HOTWATER: _.....__ TYPE HEATE.R...............................................— _...
AIR CONDITIONING:
TYPE HEAT: WARM AIR: HOT WATER:
#BEDROOMS: #KITCHENS... .. BAS. _____....
EMENT TYPE:
OTHER:
ACCESSORY STRUCTURES:
GARAGE,TYPE OF CONST: STORAGE,TYPE OF CONST:
SWIMMING POOL: GUEST,TYPE OF CONST:
OTHER:
VIOLATIONS:
Violations to Southold Town Code 144-8A :
Accessory building#I converted to an apartment without first obtaining a building permit.
Accessory building#2 was altered without first obtaining a building permit.
Zoning Board of Appeals relief is required for both structures.
REMARKS:
INSPECTED BY: JOHNJ DATE OF INSPECTION: 8/5/2024
TIME START: 9:15am END: 10:00am
1 2
Number of pages 4
RECORDED
.2021 Oct 04 11:23:39 1411
This document will be public JUDITH 13. PASCALE
CLERK OF SIIF
record. Please remove all FOLK COUNTY
Social Security Numbers L DOOO13122
prior to recording. P 532
DT# 21-06740
Deed/Mortgage Instrument Deed/Mortgage Tax Stamp Recording/Filing Stamps
FEES
Page/Filing Fee Mortgage Amt,
Basic1.
Handling 20. 00 2. Additional Tax
TP-584 SubTotal
Notation Spec./Assit.
or
EA-52 17(County) SubTotal Spec./Add.
EA-5217(State)
TOT.MTG.TAX
Dual Town Dual County
R.P.T.S.A. Held forAppointment
Comm.of Ed. S. 00_ Transfer Tax 30��
Affidavit r . Mansion Tax
The property covered by this mortgage Is
CertifledCopy or will be Improved by a one or two
NYS Surcharge 15. 00 family dwelling only.
Sub Total YES orNO
Other15P " If fh ee appropriate tax clause on
Grand Total,
pa eg of this Instrument.
0a
4 1 Dist'0DO 21051217 10o0 06900 0400 011000 -eafimunity Preservation Fund
Real Property P T Consideration Amount$1(95,' 00
Tax Service /{
Agency CPF Tax Due $
Verification
Improved
Satisfactions/Dischar s� RrN 4y Owners Malling Address
6 � R Vacant Land
T'o TO
e,Ir I .l
TO
TD
Wlor/e,.t
Mall to:Judith A.Pascale,Suffolk County Clerk 7 Title Company Information
310 Center Drive, Riverhead, NY 11901 Co.Name t ir" r; F
wwwsLrffolkcountyny.gov/clerk e 4
8 Suffolk County Recording & Endorsement Page
This page forms part of the attached
by MENT)
(SPECIFY TYPE OF INS7RU made
Vie• 0 The premises herein is situated in
SUFFOLK COUNTY,NEW YORK.
TO In the TOWN of
In the VILLAGE
or HAMLET of
BOXES 6 THRU 8 MUST BE TYPED OR PRINTED IN BLACK INK ONLY PRIORTO RECORDING OR FILING.
over..
TOWN OF SO OLD
BUi1 lNG DFPARTN3 1`
To Clerra
S , N. Y.
Cedicate OF Occupancy
No. • 462" Date . . . . . .. . .3 . . .11f . . . . . : . :. .;.19.75.
THIS CERTW= that the building located at .dc • -Pond- •♦ • • . S
Map No. Block No. . . . . . . .Lot No.
. . . . . . . . ti3ald. . .g.Y•.
conforms substantially to the Application for Building Pomit heretofore filed in this office
dated . . . . . . . . . . . .oot. . 2.5., 19.74 pursuant to which Building Permit No. . . 7603y
dated . . . . . . . . . .Oct. . .25. . . . .. 19 J4 ., was issued, and conforms to all of the
ments of the applicable proviatons of the law. The occupancy for which this cajWcate is
issued is . riev� 1• + �eit ( o! •a •bi+ig) ba11d itia
The certificate is issued to .S sit •Ine. . . der
(owner, lessee or tenant)
of the aforesaid building.
Suffolk County Department of Health Approval .X.•H!. . . . . . . . . . . . . .. . . . . .. . . . . . . . . .
UNDERWRITERS CIRTMCATZ Na N.H. .. . . ... .. . . . . . . . . . .. . . . . . . . . . . .. . . . . . . .
ROUSE NUMBER . . , w . .. .. . . . Street . . . . .. ........ . . . . .. .. . . . . . . . . . . . . . . . . . .. . . .
. . . .. w. w . x . +x. .e • ♦ . • . . . . .. . . . • .... . ... .. . ..... .. . . . . w . . w . . x . . . . .. ♦. .
Bull �tor
M06 s
T Of
hUJILDI" DPARTMIINT
CI
T Lbl I6 Y.
BUILDING IT
(THIS PERMIT MUST BE KEPT ON THE PREMISES UNTIL FULL
COMMMON OF THE WORK AUTHORIZED)
,fib° 7603 Z Date .......................... ......... ..... 19. J`
Permission Is homby gmnftd to:
................................................................................
to ......... .D. .....».QN T 0...... .. ! -.. ..... . l..�... .. C �� .. ..... ..
L i N Cs.—
...............................................
of pnrnises at ......... ". ..'.' - .....,... ., ...,.....,fit .� A
Sov -rfloL- fl
............................................................................................... .............................................................
pursuant to application +riled .......................................................'fir. 19( c.,.and.approved by the
Building Inspector.
J%
Fee $........................
....... ... Bulldtrg.Io"�`'........ ...........
tNwleeee >fee� >t
T
a
SOUTH",
Examined .... ..,....... ,' Aspilartlan N4L
,,,gored .................. ..4 ?`17,Z No ,..7 .. - _.. ......,._...
Disopprov.d a/c ...... ,. ...... ,...,,
APPUCATM41W
Doh.............. C�5_
mmm"nom
a, TN e lication meat Ira filled In Ink and�' In to Ihsj owrlldk q
JaMP dor,� We Of �1Fe ar mi Ntw
rig Itrd "fin promises,ral t f<r
Plot�rle et�e.Fee
!. Plot awhwrrwi l�of lot�of whip sat j twr puNgwl&c e1�ro
areas,� i a detou deactiptfoea of k rout of f tars*be draw on the dxoiprwrsta r�t la i o!thls Qkl;OW
c. The work tworod by this,application"I not be commonced before i +� ��,
', of this slppt'laotirrrn ttte 1►titpwwe star wllll i3saNldlstiyl mrlf tsm tlwst rp kUni,fir Permit _
slholi be an tine pwromila e
e. No buiWhv shoM be occupied or used in in part for any purpose whotMr untq a Ciettflooft of Owxtitpancy
shod how basset granted Iry tho Ilulldlntt Inspodw.
a+hpPlIns; Is H � �h NBaaNErlN N�urtrner+ot f+srr iNhww +�a �1MIMwrw� �w�
Rdabrtilrrwtisrce of tlhaor ra crarwrtraw 'I*atxr amrrrmp
zed moors aws aehwd In bwrldlrt�wt Itarr Imwwpsc#Irarsr.
SMvE DW4W1 WO. -zMf-
_... .. .. . -�q ........
... PA v-H(Address of;j6;;jj;;W
. ...
I I"/
State whether applicant is owns►,letter, apenf,architect, onginem general contractor, el ion,
Pkwh'hber or builder.
.
Nome of owner of promises............ �
If opir11 ant is o ca a,s e of duly ewaeFtarlsad trfflar. ,...
.(Nom�.+enrd. �MMerrpo e►�rrflicer�F�''��l
Bulkkes License No. ...............................................
Plumbers License Na. .......
Electrician's License Na
Other Trade's License No........................._...._.............
1 Location of land an which Proposed work will be dons Map No
Street and Nurthber ,•....,.,,.... �c, .T ...... P «,. L9 i°J . s»a '.
Municipality
2. State axisthhg use and occupancy of promises and ireended use and occupancy of proposed tkx%
o. Exisiting use and occupancy ..._.....LpABo ,CA ......... E L L I N_Cr_
b. Intended verse and oc�4rahCr .........S A!''! ...._ _.!!'/!TN .....+t�D7�tr t'1.0!y__ .._..........«._
3. Nature of work (check which applicable): New Building ..........._..... Addition .............•.... Alteration ..............
Repair .................. Removal ............. Dernalltio...................... Other Work ......................_........................ .,..
4. Estimated Cost ............................... .......... a„ ...Fee ......��r 9r_ (Deocrtptfon)
Ito be paid an filling this application)»
5. If dwelling, number of dwelling units ...........................Number of dwelling units an each flow...........................
Ifgarage,number of cars..._..............._....................__.................._..................._..« ...«......................................
6. If business, commercial or mixed occupancy, specify nature and extent of each type of use ..............._...........
7. Dimensions of existing structures,if any:Front............................ Rear ...... ».,....,..... . ,»,». Depth ..._..............
.
Height ........................ Number of Storiea ..........................................................................................................
.
Dimensions of sorne structure with aherotiorts or additions: Front ...........................„...... Rear ............................
Depth ................................ Height ............................Number of Stories ................................
S. Dimensions of entire new construction: Front ....................... ._.._..Rear............................Depth........................
Height ............. Number of Stories ..... ...
9. Size of lot: Front ........ Jar .> ' ., ........ Rear..................................... Depth..... ........
10. Date of Purchase ......................... .Name of Former Owner
11. Zane or use district in which promises are situated ....................... ;..',.( ..
12. Does proposed construction violate any zoning low,ordinance or regulation: ✓c
13. Will lot be reg ....... Will excess fill be removed from p 'Yee 4
p �" .�,. .j...........Asides sra 7u* ..«. «100
14. Nome of Or of reminds...»„».'. ., ". hfgs «.........
Nome of Architect .................. ........Add ...«...........«...._.....« N& . ..
Nome of Contractor ...................,lHVM
.w. , . ��',.....--Addreas...._......................... No.«..........
»......
PLCFr DIAGRAM
Locate clearly and distinctly all bulldings,whether exislinilp or proposed, and k9 kaM all 5004mcils 41knionsiorts tnor"
rty°Ilmas. Give street and block number or description occordkV to deed, and show strest names and inclic rte
'+ether tnWkw or cornor tot.
N 4-
O�p NoR ir4
k
FF
I'
r."
L =STATE O .
COUNTYFOF NEWYOR,I�, f S.S
....... � x� .......,...being duly sworn,deposes and says that he is the applicant
(Name of individual srgnbmy contract ra
above named.
He is the ....................��012 ....
i tractor, oyes%to officer,etc.) "« »...,.. ., „.............
of word owner or owners, and is duly authorized to perform or have perforr sod the sold work and to make and file
this application, that all stotenu mts contabod In this application are true to the best of his knWWOOR and belief,and
immar the work will be performed In the rnommer'set lux%In the opplicatiom filed+*A"V*ttr.
Swam to before me tfmts
��atibw of 7 ), ,....... .._..,...
Notary Public, ........... ... .,...
tSigm lcaunt)
NV RTKL s-
p(itINR"i ttIt6LM:..00,•t Twit
rtw•st,assists .')rot '
cwr jutinww f OU01 Niw
BARGAIN AND SALE DEED WITH COVENANT AGAINST GRANTOR'S
ACTS(INDIVIDUAL OR CORPORATION)
STANDARD NYBTU FORM 9007
CAUTION:THIS AGREEMENT SHOULD BE PREPARED BY AN ATTORNEY AND REVIEWED BY ATPORNEYS FOR SELLER AND
PURCHASER BEFORE SIGNING.
THIS INDENTURE,made the I I�day of SCp}(,rrl W 2021
between Theodore Szczotka and Barbara Szczotka residing at 2800 Depot Lane,Cutchogue,NY H 93 5 and
Robert Jenkins and Joan Jenkins residing at 190 North Road,Peconic,Ny 11958
party of the first part,and James Karras,residing at 140 East Shore Drive,Massapequa,NY 11758
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,
1000 ALL that certain plot,piece or parcel of land,with the buildings and improvements thereon erected,
/� situate,lying and being in the
Du l.�i�
SEE SCHEDULE A ATTACHED(DESCRIPTION OF PREAUSES)
04.09
�l BEING AND INTENDED TO BE PART OF THE premises in Liber 12538 Page 565 and premises in
Libor 12515 Page 691 Conveyed to the party in the first part.
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 HAVEAND TO HOLD the premises herein granted unto the party of the second part,the heirs or
successors and assigns of the parry 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 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 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 word"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.
IN PRESENCE OF:
Wcbdoriftudi:ka
�LUVAo✓
zswzta a
w �
bertJenkins
krikins
NYSBA RcW m-,i Red Es do Foms on HGLDocs't91op} Copynalt Cap-r Devdo-
-t-
First American Title Insurance Company
Title Number: Para-54180 Page 1
SCHEDULE A DESCRIPTION
AMENDED AS OF 9120/2021
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, Suffolk County, New York, bounded
and described as follows:
BEGINNING at a point on the westerly side of Ackerly Pond Lane (Bowery Lane) and the
southerly side of Old North Road;
RUNNING THENCE along the westerly side of Ackerly Pond Lane, South 60 degrees 22
minutes 50 seconds East, 428.95 feet to a point;
THENCE South 46 degrees 15 minutes 18 seconds West, 570.00 feet to a point;
THENCE North 43 degrees 44 minutes 42 seconds West, 18 feet to a point;
THENCE South 46 degrees 15 minutes 18 seconds West, 614.41 feet to a point;
THENCE Noirth 43 degrees 59 minutes 41 seconds West, 387.75 feet to a point on the
southerly side of Old North Road;
THENCE along Old North Road, the following five courses and distances:
1. North 65 degrees 01 minutes 32 seconds East, 185.20 feet;
2. North 50 degrees 25 minutes 39 seconds East 148.81 feet;
3. North 45 degrees 53 minutes 49 seconds East, 96.48 feet;
4. North 41 degrees 47 minutes 46 seconds East, 95.68 feet;
5. North 39 degrees 12 minutes 50 seconds East, 551.85 feet to a point on the westerly side of
Ackerly Pond Lane (Bowery Lane),the point or place of BEGINNING.
State of New York )
)ss:
County of Suffolk )
On this 3rd day of September 2021,before me,the undersigned,personally appeared
Barbara Szczotka and Theodore Szczotka,personally known to me or proved to me on the basis of
satisfactory evidence to the be individuals whose names are subscribed to the within instrument and
acknowledged to me that they executed the same in their capacities,and that by their signatures on the
instrument,the individuals,or the person upon behalf of which the individuals acted,executed the
instrument.
o Public
JUUA RAE SPAMMOH
ors41o1a9
ComState of New York ) �
ss:
County of Suffolk )
On this I Oh day of September 2021,before me,the undersigned,personally appeared
Joan Jenkins and Robert Jenkins,personally known to me or proved to me on the basis of satisfactory
evidence to the be individuals whose names are subscribed to the within instrument and acknowledged
to me that they executed the same in their capacities,and that by their signatures on the instrument,the
individuals,or the person upon behalf of which the individuals acted,executed the instrument.
?otaryublic ,_
JUUA RAE SPPMURGH
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Town of Southold
LWRP CONSISTENCY ASSESSMENT FORM
A. INSTRUCTIONS
1„ All applicants for permits* including Town of Southold agencies, shall complete this CCAF for
proposed actions that are subject to the Town of Southold Waterfront Consistency Review Law. This
assessment is intended to supplement other information used by a Town of Southold agency in
making a determination of consistency. *Except minor exempt actions including Building Permits
and other ministerial permits not located within the Coastal Erosion Hazard Area.
2. Before answering the questions in Section C, the preparer of this form should review the exempt
minor action list, policies and explanations of each policy contained in the Town of Southold Local
Waterfront Revitalization Program. A proposed action will be evaluated as to its si niflcanl
beneficial and adverse effects upon the coastal area which includes,all of Southold Town�._
3. If any question in Section C on this form is answered "yes" or "no", then the proposed action will
affect the achievement of the LWRP policy standards and conditions contained in the consistency
review law. Thus each answer must be explained in detail listing both supporting and non-
supporting facts. If an action cannot be certified as consistent with the LWRP policy standards and
conditions, it shall not be undertaken.
A copy of the LWRP is available in the following places: online at the Town of Southold's website
(southoldtown.northfork.net), the Board of Trustees Office, the Planning Department, all local
libraries and the Town Clerk's office.
B. DESCRIPTION OF SITE AND PROPOSED ACTION
SCTM# '��
PROJECT NAME Zh lam'PS G . Y A S
The Application has been submitted to(check appropriate response):
Town Board ❑ Planning Board❑ Building Dept. ❑ Board of Trustees
1. Category of Town of Southold agency action(check appropriate response):
(a) Action undertaken directly by Town agency(e.g. capital LJ
construction, planning activity, agency regulation, land transaction) D
(b) Financial assistance(e.g. grant, loan, subsidy)
(c) Permit, approval, license, certification: El
Nature and extent of action:
' cuncl Lot I
Location of action:— IT q ..." ..._ b06 11
Site acreage- r .....................................
Present land use: e�
Present zoning classification:
2. If an application for the proposed action has been filed with the Town of Southold agency, the following
information shall be provided:
(a) Name of applicant: � � S jfa , .. LLC'
(b) Mailing address
E... 5 i �`. �� V q
(c) Telephone number: Area Code s9 ^
(d) Application number, if any:
Will the action be directly undertaken, require funding, or approval by a state or federal agency?
Yes ❑ No S If yes, which state or federal agency?
C. Evaluate the project to the following policies by analyzing how the project will further support or not
support the policies. Provide all proposed Best Management Practices that will further each policy.
Incomplete answers will require that the form be returned for completion.
DEVELOPED COAST POLICY
Policy 1. Foster a pattern of development in the Town of Southold that enhances community character,
preserves open space, makes efficient use of infrastructure, makes beneficial use of a coastal location, and
minimizes adverse effects of development. See LWRP Section III—Policies; Page 2 for evaluation
criteria.
Yes ❑ No ❑ Not Applicable
Attach additional sheets if necessary
Policy 2. Protect and preserve historic and archaeological resources of the Town of Southold. See LWRP
Section III—Policies Pages 3 through 6 for evaluation criteria
Yes ❑ No ❑ Not Applicable
--- ....— ____ ....
Attach additional sheets if necessary
Policy 3. Enhance visual quality and protect scenic resources throughout the Town of Southold. See
LWRP Section III—Policies Pages 6 through 7 for evaluation criteria
RY Yes ❑ No ❑ Not Applicable
.. .....
Attach additional sheets if necessary
NATURAL COAST POLICIES
Policy 4. Minimize loss of life, structures, and natural resources from flooding and erosion. See LWRP
Section III—Policies Pages 8 through 16 for evaluation criteria
Yes ❑ No IN Not Applicable
..........
Attach additional sheets if necessary
Policy 5. Protect and improve water quality and supply in the Town of Southold. See LWRP Section III
—Policies Pages 16 through 21 for evaluation criteria
Yes ❑ No R Not Applicable
Attach additional sheets if necessary
Policy 6. Protect and restore the quality and function of the Town of Southold ecosystems including
Significant Coastal Fish and Wildlife Habitats and wetlands. See LWRP Section III— Policies; Pages 22
through 32 for evaluation criteria.
R Yes ❑ No Not Applicable
.... .......
............ . ......................... ......................
...................................................
Attach additional sheets if necessary
Policy 7. Protect and improve air quality in the Town of Southold. See LWRP Section III — Policies
Pages 32 through 34 for evaluation criteria.
F] Yes ❑ No V Not Applicable
............ .................
...............
...........................
.............................
......................Attach additional sheets if necessary
Policy 8. Minimize environmental degradation in Town of Southold from solid waste and hazardous
substances and wastes. See LWRP Section III—Policies; Pages 34 through 38 for evaluation criteria.
1:1 Yes ❑ No N Not Applicable
.....................
PUBLIC COAST POLICIES
Policy 9. Provide for public access to, and recreational use of, coastal waters, public lands, and public
resources of the Town of Southold. See LWRP Section III—Policies; Pages 38 through 46 for evaluation
criteria.
1:1 YesE] No X Not Applicable
Attach additional sheets if necessary
WORKING COAST POLICIES
Policy 10. Protect Southold's water-dependent uses and promote siting of new water-dependent uses in
suitable locations. See LWRP Section III—Policies; Pages 47 through 56 for evaluation criteria.
Yes ❑ No M Not Applicable
Attach additional sheets if necessary
Policy 11. Promote sustainable use of living marine resources in Long Island Sound, the Peconic Estuary
and Town waters. See LWRP Section III—Policies; Pages 57 through 62 for evaluation criteria.
❑ Yes 1:1 No IZI Not Applicable
Attach additional sheets if necessary
Policy 12. Protect agricultural lands in the Town of Southold. See LWRP Section III—Policies; Pages 62
through 65 for evaluation criteria.
Yes ❑ No❑ Not Applicable
x
Attach additional sheets if necessary
Policy 13. Promote appropriate use and development of energy and mineral resources. See LWRP
Section III—Policies; Pages 65 through 68 for evaluation criteria.
Yes ❑ No Not Applicable
PREPARED BY TITLE DATE
Amended on 811105
Full Environmental Assessment Form
Part 1 -Project and Setting
Instructions for Completing Part 1
Part I is to be completed by the applicant or project sponsor. Responses become part of the application for approval or funding,
are subject to public review,and may be subject to further verification.
Complete Part 1 based on information currently available. If additional research or investigation would be needed to fully respond to
any item,please answer as thoroughly as possible based on current information;indicate whether missing information does not exist,
or is not reasonably available to the sponsor;and,when possible,generally describe work or studies which would be necessary to
update or fully develop that information.
Applicants/sponsors must complete all items in Sections A&B. In Sections C,D&E,most items contain an initial question that
must be answered either"Yes"or"No". If the answer to the initial question is"Yes",complete the sub-questions that follow. If the
answer to the initial question is"No",proceed to the next question. Section F allows the project sponsor to identify and attach any
additional information. Section G requires the name and signature of the applicant or project sponsor to verify that the information
contained in Part lis accurate and complete.
A.Project and Applicant/Sponsor Information.
............ ............ .................
[—Name of Action or Project: _ `
(-as \ VISI
Project Location(describe,and attach a general location nap)
LN
_._._ .......... ..................
Brief Description of Proposed Action include purpose or need):
Pop oS(d arse--czCM 0-n � rve0_�n )Eo
..............
Name of Applicant/Sponsor: Telephone: �G g(
_ Q '(G S , E-Mail: -yy)n, !
'.......� o
11vl hu aicy _ �1 0 .G®��Y)
Address: � t�f
Y1
City/PO: /�/� (k v State: Zi fCode:
' " 1 _....._..._._.
Project Contact(if not same 6 spAsor,;give name and title/role): Telephone
..................... .......
E-Mail:
Address:
�l 0-2_0 l Vl
City/PO: 1 } State: Zip Code.:
nld t( l
Property Owner (if not same as sponsor): Telephone:
CL S 5 E-Mail:
Address.
City/PO: State: Zip Code:
........ ........ _ ......................................................... ... _ ...............�
Page 1 of 13
FEAF 2019
B.Government Approvals
....................... ...............................
B.Government Approvals,Funding,or Sponsorship. ("Funding"includes grants, loans,tax relief,and any other forms of financial
assistance.)
Government Entity If Yes: Identify Agency and Approval(s) Application Date
Required (Actual or projected)
a.City Council,Town Board, ❑YesNo
or Village Board of Trustees
b. City,Town or Village NYesnNo 'S b b (a n h n`
Planning Board or Commission
c. City,Town or ❑YesINo
Village Zoning Board of Appeals
d.Other local agencies E]YespoNo
e. County agencies I es❑No cL7
f.Regional agencies ❑YesV]No
g. State agencies ❑YesQ3No
h.Federal agencies ❑Yes[4No
i. Coastal Resources.
i. Is the project site within a Coastal Area,or the waterfront area of a Designated Inland Waterway? ❑Ye `4No
ii. Is the project site located in a community with an approved Local Waterfront Revitalization Program? ` Yes❑No
iii. Is the project site within a Coastal Erosion Hazard Area? ❑YespNo
I
C.Planning and Zoning
C.1.Planning and zoning actions.
Will administrative or legislative adoption,or amendment of a plan,local law,ordinance,rule or regulation be the ❑Yes' No
only approval(s)which must be granted to enable the proposed action to proceed?
• If Yes,complete sections C,F and G.
If No,proceed to question C.2 and complete all remaining sections and questions in Part I
C.2.Adopted land use plans.
a.Do any municipally-adopted (city,town,village or county)comprehensive land use plan(s)include the site Yes❑No
where the proposed action would be located?
If Yes,does the comprehensive plan include specific recommendations for the site where the proposed action ❑YesC@ No
would be located?
b.Is the site of the proposed action within any local or regional special planning district(for example: Greenway; ❑Yes "No
Brownfield Opportunity Area(BOA); designated State or Federal heritage area;watershed management plan;
or other?)
If Yes,identify the plan(s):
c. Is the proposed action located wholly or partially within an area listed in an adopted municipal open space plan, ❑YesNo
or an adopted municipal farmland protection plan?
If Yes,identify the plan(s):
... ....._ ........ ............ ....................._......
Page 2 of 13
C.3. Zoning
a. Is the site of the proposed action located in a municipality with an adopted zoning law or ordinance. M ''es❑No
If Yes,what is the zoning classification(s)including any applicable overlay district?
b. Is the use permitted or allowed by a special or conditional use permit? ❑Yes o
c. Is a zoning change requested as part of the proposed action? ❑YesNo
If Yes,
i. What is the proposed new zoning for the site? _ n .. ,,.. ........
CA.Existing community services.
a. In what school district is the project site located?
b.What police or other public protection forces serve the project site?
� ao�
c.Which fire protection and emergency medical services serve the project site?
o II.
d. What parks serve the project site? 0
D.Project Details
D.1.Proposed and Potential Development
a.What is the general nature of the proposed action(e.g.,residential,industrial,commercial,recreational;if mixed,include all
components)? +- - CW 1 skVU C+U�U
b. a.Total acreage of the site of the proposed action? 1 10 acres
b.Total acreage to be physically disturbed? ® acres
c.Total acreage(project site and any contiguous properties)owned
or controlled by the applicant or project sponsor? 9, 0 acres
c. Is the proposed action an expansion of an existing project or use? ❑Yc"pNo
i. If Yes,what is the approximate percentage of the proposed expansion and identify the units(e.g.,acres,miles,housing units,
square feet)? % _m Units:_ITITIT
d. Is the proposed action a subdivision,or does it include a subdivision? Yes❑No
If Yes,
i. Purpose or type of subdivision?(e.g.,residential,industrial,commercial,if mixed,specify types)
_.
ii. Is a cluster/conservation layout ro used'? es❑No
iii. Number of lots proposed?
iv. Minimum and maximum proposed lot sizes? Minimum Maximum
e.Will the proposed action be constructed in multiple phases? E]YesgNo
i. If No,anticipated period of construction: months
ii. If Yes:
• Total number of phases anticipated
• Anticipated commencement date of phase 1 (including demolition) month year
• Anticipated completion date of final phase month _year
• Generally describe connections or relationships among phases,including any contingencies where progress of one phase may
determine timing or duration of future phases:
Page 3 of 13
f.Does the project include new residential uses? ❑Yes❑No
If Yes,show numbers of units proposed.
One Family Two Famil Three Family Multiple Family four or more
Initial Phase ..... .
At completion
of all phases
g.Does the proposed action include new non-residential construction(including expansions)? [:]Yesp&No
If Yes,
i. Total number of structures
U. Dimensions )of largest feet('in "".....p
gest proposed structure: height; width; and length
iii. Approximate extent of building space to be heated or cooled: —square feet
h.Does the proposed action include construction or other activities that will result in the impoundment of any ❑Yes No
liquids, such as creation of a water supply,reservoir,pond,lake,waste lagoon or other storage?
If Yes,
ii. If water impoundment,theprincipal source of the water: Ground water i. Purpose of the impoundment:
F Surface water streams []Other specify:
iii. If other than water,identify the type of impounded/contained liquids and their source._....
_. .....
iv. Approximate size of the proposed impoundment. Volume: m million gallons; surface area: acres
v. Dimensions of the proposed dam or impounding structure: height; length
vi. Construction method/materials for the proposed dam or impounding structure(e.g.,earth fill,rock,wood,concrete):
D.2. Project Operations
a.Does the proposed action include any excavation,mining,or dredging,during construction,operations,or both? "yes o
(Not including general site preparation,grading or installation of utilities or foundations where all excavated
materials will remain onsite)
If Yes:
i.What is the purpose of the excavation or dredging?
ii. How much material(including rock,earth,sediments,etc is..,r..p .........r.._. ���' ( g ) proposed to be removed from the site?
• Volume(specify tons or cubic yards):
• Over what duration of time?_
iii. Describe nature and characteristics of materials to be excavated or dredged,and plans to use,manage or dispose of them.
iv. Will there be onsrte dewatering or process' ing of excavated materials? Yes No
If yes,describe.
....................._.
v. What is the total area to be dredged or excavated? ...... ..........,--acres
y acres
vi. What is the maximum area to be worked at an one time. � ��,,,,..__
vii. What would be the maximum depth of excavation or dredging? feet
viii. Will the excavation require blasting? ❑Yes❑No
ix. Summarize site reclamation goals and plan: _ ........
b.Would the proposed action cause or result in alteration of,increase or decrease in size of,or encroachment []Yes o
into any existing wetland,waterbody,shoreline,beach or adjacent area?
If Yes:
i. Identify the wetland or waterbody which would be affected(by name,water index number,wetland map number or geographic
description):
Page 4 of 13
ii. Describe how the proposed action would affect that waterbody or wetland,e.g. excavation,fill,placement of structures,or
alteration of channels,banks and shorelines. Indicate extent of activities, alterations and additions in square feet or acres:
iaa.Will the proposed act._ ........ ....._ ............._.._. ....... .............
ii ion cause or result in disturbance to bottom sediments? ❑Yes❑No
If Ye thdescribe:
_..�....... ........_....... _......... ............. ........
iv. _.
proposed d action cause or result in the destruction or removal of aquatic vegetation? ❑Yes❑No
If Yes:
• acres of aquatic vegetation proposed to be removed: _ ._.._ ...
• expected acreage of aquatic vegetation remaining after project completion:
• purpose of proposed removal e. beach clearing,invasive species control boat access):P rP P P ( g• g P s): _...__.. ..�
_.._...._ ......_ ..........
• proposed method of plant removal:
• if chemical/herbicide treatment will be used,specify product(s):„ _ ...
v. Describe any proposed reclamation/mitigation following disturbance: ...........
c.Will the proposed action use,or create a new demand for water? AYes❑No
If Yes:
i. Total anticipated water usage/demand per day: _ _. gallons/day
ii. Will the proposed action obtain water from an existing public water supply? Yes❑No
If Yes:
• Name of district or service area:
__........ ........_ _...... —
• Does the existingpublic water supply have capacity to serve the proposal? Yes❑No
P PP Y P tY P P
• Is the project site in the existing district. Yes❑No
• Is expansion of the district needed? ❑YesNo
• Do existing lines serve the project site? 4 YCSQ No
iii. Will line extension within an existing district be necessary to supply the project? ❑YesONO
If Yes:
• Describe extensions or capacity expansions proposed to serve this project:
_...................
• Source(s)of supply for the district:
iv. Is a new water supply district or service area proposed to be formed to serve the projectsite? ❑Yes❑No
If,Yes:
• Applicant/sponsor for new district„
PP P M...._. .......
• .... ............
Date application submitted or anticipated: m_
• Proposed source(s)of supply for new district:
v. If a public water supply will not be used,describe plans to provide water supply for the project:
._...... ...............
vi.If water supply will be from wells(public or private),what is the maximum pumping capacity gallons/minute.
d.Will the proposed action generate liquid wastes? EgYe ,No
If Yes:
i. Total anticipated liquid waste generation per day: _ _. gallons/day
ii. Nature of liquid wastes to be generated(e.g.,sanitary wastewater,
volumes or proportions of each): i combination,
industrial;if com ,describe all components and
r, ns o^
iii. Will the proposed action use any exist ITIT.r p p � w'm existing public wastewater treatment facilities? ❑YesNo
If Yes:
• Name of wastewater treatment plant to be used: _._..._
• Name of district: ........ _.
• Does the existing wastewater treatment plant have capacity to serve the project? [:]Yes[]No
• Is the project site in the existing district? ❑Yes❑No
• Is expansion of the district needed? ❑Yes❑No
Page 5 of 13
• Do existing sewer lines serve the project site? ❑Yes 'No
• Will a line extension within an existing district be necessary to serve the project? ❑Yes❑No
If Yes:
• Describe extensions or capacity expansions proposed to serve this project:m
iv. Will a new wastewater(sewage)
____--.sewa ga)treatment district be formed to__ _ _
..
serve the project site? ❑Yes❑No
If Yes:
• Applicant/sponsor for new district: .......................................................
• Date application submitted or anticipated: .,.
• What is the receiving water for the wastewater discharge?
v. If public facilities will not be used,describe plans to provide wastewater treatment for the project,including specifying proposed
receiving water(name and classification if surface discharge or describe subsurface disposal plans):
vi. Describe any plans or designs to capture,recycle or reuse liquid waste: _
e.Will the proposed action disturb more than one acre and create stormwater runoff,either from new point []YesDfNo
sources(i.e. ditches,pipes,swales,curbs,gutters or other concentrated flows of stormwater)or non-point
source(i.e. sheet flow)during construction or post construction?
If Yes:
i. How much impervious surface will the project create in relation to total size of project parcel?
Square feet or acres(impervious surface)
Square feet or acres(parcel size)
ii. Describe types of new point sources.
iii. Where will the stormwater runoff be directed i.e. on-site stormwater management facility/structures,/s
"' ( g ty/structures,adjacent properties,
groundwater,on-site surface water or off-site surface waters)?
...., ........
• If to surface waters,identify receiving _.
water bodies or wetlands
......... ....... ... ......................
• Will stormwater runoff flow to adjacent properties? ❑Yes❑No
iv. Does the proposed plan minimize impervious surfaces,use pervious materials or collect and re-use stormwater? ❑Yes❑No
f. Does the proposed action include,or will it use on-site,one or more sources of air emissions,including fuel ❑Yes No
combustion,waste incineration,or other processes or operations?
If Yes,identify:
i.Mobile sources during project operations(e.g.,heavy equipment,fleet or delivery vehicles)
.._ .... ....... _-
ii. Stationary sources during construction(e.g.,power generation,structural heating,batch plant,crushers)
........... .. .......�
iii. Stationary sources during operations(e.g.,process emissions,large boilers,electric generation)
.. ...... .......
g.Will any air emission sources named in D.2.f(above),require a NY State Air Registration,Air Facility Permit, ❑Yes No
or Federal Clean Air Act Title IV or Title V Permit?
If Yes:
i. Is the project site located in an Air quality non-attainment area? (Area routinely or periodically fails to meet []Yes❑No
ambient air quality standards for all or some parts of the year)
ii. In addition to emissions as calculated in the application,the project will generate:
• Tons/year(short tons)of Carbon Dioxide(CO2)
« Tons/year(short tons)of Nitrous Oxide(NZO)
• "Fons/year(short tons)of Perfluorocarbons(PFCs)
• Tons/year(short tons)of Sulfur Hexafluoride(SF6)
• Tons/year(short tons)of Carbon Dioxide equivalent of Hydroflourocarbons(HFCs)
• Tons/year(short tons)of Hazardous Air Pollutants(HAPs)
Page 6 of 13
h.Will the proposed action generate or emit methane(including,but not limited to, sewage treatment plants, ❑"des No
landfills,composting facilities)?
If Yes:
i. Estimate methane generation in tons/year(metric):
ii.Describe any methane capture,control or elimination measures included in project design(e.g.,combustion to generate heat or
electricity,flaring):
.ww...._
i.Will the proposed action result in the release of air pollutants from open-air operations or processes,such as ❑;Yes No
quarry or landfill operations?
If Yes:Describe operations and nature of emissions(e.g.,diesel exhaust,rock particulates/dust):
j.Will the proposed action result in a substantial increase in traffic above present levels or generate substantial El'Yes No
new demand for transportation facilities or services?
If Yes:
i. When is the peak traffic expected(Check all that apply): ❑Morning ❑Evening ❑Weekend
❑Randomly between hours of. to
ii. For commercial activities only,projected number of truck trips/day and type(e.g.,semi trailers and dump trucks):
iii. Parking spaces: Existing _ Proposed Net increase/decrease
iv. Does the proposed action include any shared use parking? ❑Yes❑No
v If the proposed action includes any modification of existing roads,creation of new roads or change in existing access,describe:
...... ........
vi. Are public/private transportation service(s)or facilities available within'/z mile of the proposed site? ❑Yes❑No
vii Will the proposed action include access to public transportation or accommodations for use of hybrid,electric ❑Yes❑No
or other alternative fueled vehicles?
viii.Will the proposed action include plans for pedestrian or bicycle accommodations for connections to existing ❑Yes❑No
pedestrian or bicycle routes?
k.Will the proposed action(for commercial or industrial projects only)generate new or additional demand F]YespNo
for energy?
If Yes:
i. Estimate annual electricity demand during operation of the proposed action:..................
ii. Anticipated sources/suppliers of electricity for the project(e.g.,on-site combustion,on-site renewable,via grid/local utility,or
other):
.................... _ ........
iii. Will the proposed action require anew,or an upgrade,to an existing substation? ❑Yes❑No
1.Hours of operation. Answer all items which apply.
i. During Construction: ii. During Operations:
• Monday-Friday: • Monday-Friday: ...
• Saturday: Saturday:.
• Sunday: • Sunday: _
• Holidays........_ • Holidays:
Page 7of13
in.Will the proposed action produce noise that will exceed existing ambient noise levels during construction, ❑YIPN`o
operation,or both?
If yes:
i. Provide details including sources,time of day and duration:
....... ...........
ro _...._
ii. Will the proposed action remove e .
...._.._. _..
p p existing natural barriers that could act ass ....-.
a noise barrier or screen? ❑Yes No
Describe:
........ ........
n.Will the proposed action have outdoor lighting? ❑Yes No
If yes:
i. Describe source(s),location(s),height of fixture(s),direction/aim,and proximity to nearest occupied structures:
e action proposed
ii. Will ro r.
p p move existing natural barriers that could act as a light barrier or screen? El Yes No
Describe: ...
o. Does the proposed action have the potential to produce odors for more than one hour per day? ❑Yes No
If Yes,describe possible sources,potential frequency and duration of odor emissions,and proximity to nearest
occupied structures:
p.Will the proposed action include any bulk storage of petroleum(combined capacity of over 1,100 gallons) ❑Yes o
or chemical products 185 gallons in above ground storage or any amount in underground storage?
If Yes:
i. Product(s)to be stored
ii. Volumes er unit time .......� e. ,month, _,....."
( ) p ( g. h,year)
iii. Generally,describe the proposed storage facilities
.-................... ............................� _..._.......� _. _....�
q.Will the proposed action(commercial,industrial and recreational projects only)use pesticides(i.e.,herbicides, Yes ❑No
insecticides)during construction or operation?
If Yes:
a. rnent s):
(
Describepa^opostreat.c9 1�' 9""
.......
H. Will the proposed action use lnte rated Pest 1'ana erneirt Practices? Yes ❑No
r.Will the proposed action(commercial or industrial projects only)involve or require the management or disposal E Yes JgNo
of solid waste(excluding hazardous materials)?
If Yes:
i. Describe any solid waste(s)to be generated during construction or operation of the facility:
• Construction: tons per (unit of time)
• Operation: tons per ....._, (unit of time)
ii. Describe any proposals for on-site minimization,recycling or reuse of materials to avoid disposal as solid waste:
• Construction: _... ......
_............... ......... ... .........._........ ------- ...
• Operation:
iii. Proposed disposal methods/facilities for solid waste generated on-site:
• Construction: .............. m.....".
• Operation:
Page 8 of 13
s.Does the proposed action include construction or modification of a solid waste management facility? ❑Yes No
If Yes:
i. Type of management or handling of waste proposed for the site(e.g.,recycling or transfer station,composting,landfill,or
other disposal activities).
ii. Anticipated rate of disposal/processing:
Tons/month,if transfer or other non-combustion/thermal treatment,or
Tons/hour,if combustion or thermal treatment
iii. If landfill,anticipated site life: _ „ __
years
t.Will the proposed action at the site involve the commercial generation,treatment,storage,or disposal of hazardous❑Yes No
waste?
If Yes:
i.Name(s)of all hazardous wastes or constituents to be generated,handled or managed at facility:
ii._.. _..... _ __
Generallydescribe processes or activities involvinghazardous wastes or constituents:. __ _.._
.... .... _.... ......................... _ ...... ..... _.�.
iii. Specify amount to be handled or generated tons/month
iv. Describe any proposals for on-site minimization,recycling or reuse of hazardous constituents:mw
.._ .. ....... ...... ...........
V. Will any hazardous wastes be disposed at an existing offsite hazardous waste facility? Yes No
If Yes:provide name and location of facility:
.............._ ....__ ..
If No: describe proposed management of any hazardous wastes which will not be sent to a hazardous waste facility.
E.Site and Setting of Proposed Action
E.1.Land uses on and surrounding the project site
_.. ......... ........
a.Existing land uses.
i. Check all uses that occur on,adjollung and tt Ir the project site.
Forest Agriculture
(suburban) ❑ Rural(non farm)
❑ Urban ❑ Industrial ❑ ��"o����n�ereial Residential �
❑ ❑ grmculture [] Aquatic Other(spec,i fy) �........ ....... .................
ii. If mix of uses,generally describe:
rtyp project ._....._ .�... � ___..
�b.Land uses and cove es on the site.
Land use or Current Acreage After Change
Covertype Acreage Project Completion (Acres+/-)
0 Roads,buildings,and other paved or impervious
surfaces
Forested
. Meadows,grasslands or brushlands(non-
agricultural including abandoned agricultural) =I'I, acw S
o Agricultural
(includes active orchards,field,greenhouse etc.)
..... ......
0 Surface water features
(lakes,ponds,streams,rivers,etc.) NIA
• Wetlands(freshwater or tidal) ,
Non-vegetated(bare rock,earth or fill) N On
......-_ ....._....
• Other
Describe:
Page 9of13
site presently used b members o
..�......
c.Is the project y f the community for public recreation? ❑Ye No
i. If Yes: explain: _..
d.Are there an facilities serving children,the elderly,people with disabilities(e.g.,schools,hospitals,licensed ❑Yes o
day care centers,or group homes)within 1500 feet of the project site?
If Yes,
i. Identify Facilities:
........... ............. ........ ........_. ...... .
........ _ ......... ..... _....... ....... ........ _.._._.
....._ ....... ...... _ _._. WW.. ....._.._ ..........m.
e. Does the project site contain an existing dam? ❑Yes No
If Yes:
i. Dimensions of the dam and impoundment:
• Dam height: feet
• Dam length: feet
• Surface area: acres
• Volume impounded: gallons OR acre-feet
ii. Dam's existing hazard classification:
iii. Provide date and summarize results of last inspection:
project site ever been used as a municipal,commercial or industrial solid waste management facility,�P g tY � - ..._.
f or does theHas the project site adjoin property which is now,or was at one time,used as a solid waste management facility.
If Yes:
i. Has the facility been formally closed? ❑Yes❑ No
• If yes,cite sources/documentation: �, _....m,.. _._.
ii. Describe the location of the project site relative to the boundaries of t p � he solid waste management facility:
iii. Describe an develo ment' y p constraints due to the prior solid waste activities:„ _ _wwww_.............
Have hazardous wastes been generated,treated and/or disposed of at the site, r ........._.sit -mmITmITmIT g. g p or does the project site adjoin Yes N
property which is now or was at one time used to commercially treat,store and/or dispose of hazardous waste?
If Yes:
i. Describe waste(s)handled and waste management activities,including approximate time when activities occurred:
h. Potential contamination history. Has there been a reported spill at the proposed project site,or have any MTelX No
remedial actions been conducted at or adjacent to the proposed site?
If Yes:
i. Is any portion of the site listed on the NYSDEC Spills Incidents database or Environmental Site ❑Yes❑No
Remediation database? Check all that apply:
❑ Yes—Spills Incidents database Provide DEC ID number(s):
❑ Yes—Environmental Site Remediation database Provide DEC ID number(s):
❑ Neither database
ii. If site has been subject of RCRA corrective activities,describe control measures
....... _.... ..... .....
iii. Is the project within 2000 feet of any site in the NYSDEC Environmental Site Remediation database? ❑Yes❑No
If yes,provide DEC ID number(s):
iv. If yes to(i),(ii)or(iii)above,describe current status of site(s):
Page 10 of 13
. . ...... ........_ ................ __...... ..... ....... ........ _...._.
v. Is the project site subject to an institutional control limiting property uses? El Ye o
• If yes,DEC site ID number:.. ............ .......................... ....... �
• Describe the type of institutional control(e.g.,deed restriction or easement):
• Describe any use limitations: _......... _ ........�
• Describe any engineering controls
o Will the project affect the institutional or engineering controls i ..
p j g g m place? ❑Yes❑No
e Explain:__... ............... _.� .
ct Site
a.What is the average depth to bedrock on t _m
E.2. Natural Resources nor ear ro e
g p he project site? �feet
_._. ..... .........
b.Are there bedrock outcroppings on the project site? QYesNo
If Yes,what proportion of the site is comprised of bedrock outcroppings?
__•._. _ .. __._.._.. ...........
c.Predominant soil type(s)present on project site: __ %
........ .........
d.What is the average depth to the water t .
g p able on the project site? Average: feet 7e)D & ( H 0C 1-r Y k I'el"
�............ ..-....... .......... ....... _.
e.Drainage status of project site soils:KT Well Drained: 1tx_) %of site
❑ Moderately Well Drained: %of site
❑ Poorly Drained ....%of site
£Approximate proportion of proposed action site with slopes: 0-10%: t CK)__"/°of site
❑ 10-15%: %of site
❑ 15%or greater: %of site
Are there an unique - _,._..
g. y q geologic features on the project site? Yes o
If Yes,describe:
_._.. .......... .... .......
h. Surface water features.
i. Does any portion of the project site contain wetlands or other waterbodies(including streams,rivers, ❑YesNo
ponds or lakes)?
H. Do any wetlands or other waterbodies adjoin the project site? ❑Ye,, N'o
If Yes to either i or ii,continue. If No,skip to E.2.i.
iii. Are any of the wetlands or waterbodies within or adjoining the project site regulated by any federal, ❑YeNo
state or local agency?
iv. For each identified regulated wetland and waterbody on the project site,provide the following information:
as Streams: Name .... _ Classification
Lakes or Ponds: Name Classification
Wetlands: Name _ Approximate Size
Wetland No. (if regulated by DEC)
v. Are any of the above water bodies listed inthe most recent compilation of NYS water quality-impaired ❑Yes E]No
waterbodies?
If yes,name of impaired water body/bodies and basis for listing as impaired:
i.Is the project site in a d _ ..
' p j designated Floodway� ❑Yes o,
....... ........ _.
j. Is the project site in the 100-year Floodplain? ❑Yes o
..._._.
_....... _ .......
k.Is the project site in the 500-year Floodplain? ❑Yeso(o
..... .......... ............... ... ................. ........�
1. Is the project site located over,or immediately adjoining,a primary,principal or sole source aquifer? yeS❑NO
If Yes:
i.Name of aquifer: ......._.,jMyj1AQC �......... l �......
Page 11 of 13
in. Identify Idemttit the predominant wildlife species that occupy or use the project site
' . ._...._ _...._ ................. ---- ._ .........__-
n.Does the project site contain a designated significant natural community? ❑Yeso
If Yes:
i. Describe the habitat/community(composition,function,and basis for designation):
ii. Source(s)of description or evaluation:
-_..........._
iii. Extent of community/habitat: _
• Currently: acres
• Following completion of project as proposed ........ acres
• Gain or loss(indicate+or-): acres
o.Does protects_ ....... __�_. _....__..
ite contain any species of plant or animal that is listed by the federal government or NYS as ❑Yc) 'o
endangered or threatened,or does it contain any areas identified as habitat for an endangered or threatened species?
If Yes:
i. Species and listing(endangered or threatemied): _ITITIT_ m, _r,,., ..
p. Does the project site contain any species of plant or animal that is listed by NYS as rare,or as a species of Yes No
special concern?
If Yes:
i. Species and listing_..... _._...._- ._ ... .....
...... ...... .
7q. s the project site or adjoining area currently used for hunting,trapping,fishing or shell fishing? QYeso
es,give a brief description of how the proposed action may affect that use:
E.3. Designated Public Resources On or Near Project Site
a. Is the project site,or any portion of it,located in a designa ......._
__._....._ ........
ted agricultural district certified pursuant to Yes❑No
Agriculture and Markets Law,Article 25-AA, Section 303 and 304?
If Yes, provide county plus district name/number: ❑ l� — �' inlet'
- ..
g g g p ITIT_
b. Area agricultural lands consisting of high[ pi soils present? [Ayes
i. If Yes: acreage(s)on project! t. 6 r
ii. Source(s)of soil rating(s): _.....
c. Does the project site contain all or art of,or is it substantial) contiguous to,a registered National
p I p y gu g 'onal E]YeszNo
Natural Landmark?
If Yes:
i. Nature of the natural landmark: ❑Biological Community ❑ Geological Feature
ii. Provide brief description of landmark,including values behind designation and approximate size/extent:
d. Is the project site located in or does it adjoin a state listed Critical E
.. ...
p I nvironmental Area? ❑Yes No
If Yes:
i. CEA name:
ii. Basis for designation:
iii. Designating agency and date:
Page 12 of 13
Does
roject site contain,or is it
e.which sell t d on the National or State Register substantially of His oric Places building,
thathas been determined by t district h Commissioner of not the NY S
Office of Parks,Recreation and Historic Preservation to be eligible for listing on the State Register of Historic Places?
If Yes:
i. Nature of historic/archaeological resource: ❑Archaeological Site ❑Historic Building or District
ii. Name:
iii. Brief description of attributes on which listing is based:
f Itasite, r an portion of it,located in or ad:acent to an area d)si ated asgsensitive for e
project y p J gn ❑YesONo
archaeological s on the NY State Historic Preservation Office(SHPO archaeological site inventory?
.. ...... ........ ._ ... ..._.__
g.Have additional archaeological or historic site(s)or resources been identified on the project site? E]YeslANo
If Yes:
i.Describe possible resource(s):
ii. Basis for identification:
—Is
_ .. ...�.... _...._... _ .........
h.
Is the project site within fives miles of any officially designated and publicly accessible federal,state,or local Yes❑No
scenic or aesthetic resource?
If Yes:
u.Nature f,or basis forr,des ation µ(—e.g' - sl d zw overlook, s b
i. Identify resource:
gn , g y ate or local park,state historic trail or scenic byway,
etc.) _
id. Distance between protect and resource:a —miles.
i. Is the project site located within a designated river corridor under the Wild, Scenic and Recreational Rivers ❑Yeso
Program 6 NYCRR 666?
If Yes:
i. Identify the name of the river and its designation:.„ _„ ........ ........._......
ii. Is the activity consistent with development restrictions contained in 6NYCRR Part 666? ❑Yes❑No
F.Additional Information
Attach any additional information which may be needed to clarify your project.
If you have identified any adverse impacts which could be associated with your proposal,please describe those impacts plus any
measures which you propose to avoid or minimize them.
G. Verification
I certify that the information provided is true to the best of my knowledge.
Applicant/Sponsor Name _.v r-e— _ Date
Si-ratur Titled
PRINT FORM Page 13 of 13
OFFICE LOCATION: MAILING ADDRESS
Town Hall Annex �� '° P.O.Box 1179
54375 State Route 25 : Southold,NY 11971
(cor.Main Rd.&Youngs Ave.) Telephone: 631-765-1938
Southold,NY www.southoldtownny.gov
PLANNING BOARD OFFICE
TOWN OF SOUTHOLD
MEMORANDUM
To: Accounting
From: Planning Department
Date: December 19, 2025
Re: Check
Please deposit the attached check into B691: Deferred Revenue. Fee is for a
Subdivision Sketch Plan Application not yet accepted by the Planning Board.
___ ... ........---- ...._. ......
Applicant/Project Name & Type Tax Map # Amount check Date/NO.
._........... ........
Karras Standard Subdivision 69.-4-11 $3,250.00 12/10/2025
Sketch Plan #1189
ALP
Att.