HomeMy WebLinkAbout1000-142.-1-26 OFFICE LOCATION: �QF SO(/�y MAILING ADDRESS:
Town Hall Annex ��� Ol0 P.O. Box 1179
54375 State Route 25 Southold, NY 11971
(cor. Main Rd. &Youngs Ave.)
Southold, NY N ar Telephone: 631 765-1938
pwww.southoldtownny.gov
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PLANNING BOARD OFFICE
TOWN OF SOUTHOLD
MEMORANDUM
To: Leslie Kanes-Weisman, ZBA Chairperson
Members of the Zoning Board of Appeals
Cc: Julie McGivney, Assistant Town Attorney
From: James H. Rich III, Chairman
Members of the Planning Board
Date: April 24, 2026
Re: ZBA#8098, Mattituck Plaza(Walgreens)
Located at 10095 Main Road, Mattituck
SCTM#1000-142.-1-26
The Planning Board has reviewed your request for comments regarding the above-referenced
application, and provides the following for your consideration.
1. Use Variance/ Relief from 4280-48 A(2)(a)f 11 f dl
The applicant is requesting relief from §280-48 A(2)(a)[l][d], which prohibits buildings
containing a drive-through or drive-up window within the General Business (B) Zoning
District. The proposal is to install a drive-up prescription window accessory to the existing
Walgreens pharmacy within the Mattituck Plaza shopping center.
Drive-through facilities are expressly prohibited in this zoning district to ensure that
commercial uses are compatible with the hamlet-scale, rural character of the Town. Local
Law No. 9 of 1994 encouraged economic vitality in traditional hamlet centers while requiring
formula or commercial uses to be adapted to the Town's scenic and community character.
Local Law No. 8 of 2006 reinforced these objectives, establishing additional design and scale
controls and explicitly reaffirming the prohibition of drive-up windows.
The Planning Board notes that granting relief in this instance may have implications beyond
the subject property. Approval of a drive-up window for a pharmacy could be cited by
similar businesses seeking comparable relief, and may set a precedent that gradually weakens
the Code's prohibition on drive-up facilities.
The Planning Board also notes that many pharmacies and retail establishments have
successfully implemented curbside pick-up operations through the designation of specific
parking spaces for customer use. These arrangements provide a viable and less intensive
alternative to drive-up facilities, allowing businesses to accommodate customers with
mobility limitations or other needs without introducing permanent, vehicle-oriented
infrastructure that is otherwise prohibited by the Town Code.
While the proposal is located within an existing shopping center and a drive-up facility was
previously approved and operated on this portion of the site in connection with a former bank
use (1992),that approval predates Local Law No. 9 of 1994,which amended the Town Code
to prohibit drive-through and drive-up facilities. As such,the prior existence of a drive-up
facility does not, in itself,justify the reintroduction of a now-prohibited feature.
2. Comprehensive Plan Consistency
The Town of Southold Comprehensive Plan emphasizes preservation of hamlet character,
reduced reliance on vehicle-oriented design, and safe site circulation. The proposed drive-up
window has the potential to increase on-site vehicle stacking and internal circulation
conflicts; while also detracting from pedestrian safety and overall site functionality.
More broadly, incremental approvals of drive-up facilities may contribute to a shift toward
more vehicle-dependent development patterns over time. This cumulative effect is an
important consideration in evaluating whether such relief aligns with the long-term vision of
the Comprehensive Plan.
The Board acknowledges that Chapter 11: Human Services of the Comprehensive Plan
supports improving access to essential services for seniors and underserved populations.
However, while these considerations are important in the broader planning context, they are
not unique to this site and do not in themselves justify a use variance.
The Planning Board is also concerned with maintaining equitable application of the Town
Code among similarly situated businesses. Many existing local businesses, including smaller
or independently operated pharmacies and service providers, do not have the physical ability
or site configuration to accommodate a drive-up facility. Granting relief in this instance could
create an inconsistency in the application of the Code by conferring a site-specific
operational advantage on properties capable of accommodating such features, while other
properties remain subject to the same restrictions without comparable opportunity for relief.
Curbside service models, including designated pick-up parking spaces, represent a more
flexible and less intensive approach that is generally more consistent with the Comprehensive
Plan's goals of minimizing vehicle-oriented site design while still allowing businesses to
meet customer needs.
3. Site Circulation and Operational Considerations
If the ZBA decides to grant the requested relief, the Planning Board recommends careful
review of:
• Vehicle stacking capacity and potential interference with parking aisles and access
drives;
Page 12
• Pedestrian circulation and safety, particularly connections between storefronts and
parking areas;
• Any modifications to curbing, striping, or signage needed to clearly delineate drive-
up operations;
• Hours of operation and potential impacts on adjacent uses within the plaza.
4. Recommendation
Given the explicit and longstanding prohibition of drive-up facilities in the Town Code, the
Planning Board has significant concerns regarding the requested relief. The Board finds that
the rationale presented,primarily convenience and accessibility, does not rise to the level of
hardship typically required to justify a use variance,particularly where such conditions are
not unique to the subject property and where reasonable, code-compliant alternatives, such as
designated curbside pick-up, are available.
The Board further emphasizes that granting the requested relief would likely establish a
precedent for similar applications throughout the General Business District. Pharmacies,
financial institutions, and other service-oriented retail uses could reasonably seek comparable
approvals, making it increasingly difficult for the Town to uphold the intent of the Code.
Over time, such incremental approvals could result in a proliferation of drive-up facilities,
undermining the planning objectives that led to their prohibition and altering the character of
the Town's commercial areas in ways that may not have been intended by prior legislative
actions.
Notwithstanding the above concerns,the Board recognizes the site's established development
pattern and the prior existence of a drive-up facility in this general location. If the ZBA
determines that the benefit to the applicant outweighs the potential impacts, the Planning
Board recommends that any approval be subject to conditions addressing site circulation,
pedestrian safety, and operational controls to minimize broader impacts.
Thank you for the opportunity to provide these comments. Should you have any questions or
require additional information,please do not hesitate to contact the Planning Department.
Page: 13
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N.Y.S. Lic. No. 50467
r UNAUTHORIZED ALTERATION OR ADDITION
}, TO THIS SURVEY IS A VIOLATION OF t�Jathan Taft Corwin III
SECTION 7209 OF THE NEW YORK STATE
EDUCAnON LAW.
COPIES THE LANDFSU THIS
RVEYORSURVEY
S INKED SEAL OR
MAP NOT Land Surveyor
EMBOSSED SEAL SHALL NOT BE CONSIDERED
TO BE A VAUD TRUE COPY.
CERTIFICATIONS INDICATED HEREON SHALL RUN Successor To: Stanley J. Isaksen, Jr. L.S.
ONLY TO THE PERSON FOR WHOM THE SURVEY Joseph A. Ingegno L.S.
J, IS PREPARED, AND ON HIS BEHALF TO THE
TILE COMPANY, GOVERNMENTAL AGENCY AND Tiitle Surveys — Subdivisions — Site Plans — Construction Layout
LENDING INSTITUTION LISTED HEREON, AND
TO THE ASSIGNEES OF THE LENDING INSTI- PHONE (631)727-2090 Fax 631 7 TUION. CERTIFICATIONS ARE NOT TRANSFERABLE. 27-17Z7
THE EXISTENCE OF RIGHT OF WAYS OMCES LOCATED AT MAILING ADDRESS
I AND/OR EASEMENTS OF RECORD, IF 1586 Main Road P.O. Box 16
ANY, NOT SHOWN ARE NOT GUARANTEED. Jamesport, New York 11947 Jamesport, New York 11947
9—
BOARD MEMBERS ��
f s Southold Town Hail
Leslie Kanes Weisman Chairperson "� 53095 Main Road • P.O.Box 1179
Patricia Acampora Southold,NY 11971-0959
Robert Lehnert, Jr. c E-fice Location:
Str
Town Annex/First Floor
Nicholas Planamento
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Margaret Steinbugler 54375 Main Road (at Youngs Avenue)
Southold,NY 11971
http://southoldtownny.gov
ZONING BOARD OF APPEALS
TOWN OF SOUTHOLD
Tel. (631)765-1809
MEMO P131 HL, , 13C/MO
M�[E 0 W N=3
TO: Planning Board .BAN 1 2 2026
SOUTHOLD TOWN
FROM: Leslie K. Weisman, ZBA ChairpersonBOARD
DATE: January 12, 2026
SUBJECT: Request for Comments ZBA# 8098 — Mattituck Plaza (Walgreens)
The ZBA is reviewing the following application. Enclosed are copies of Building
Department's Notice of Disapproval, ZBA application, current map on file. Your review
and comments are requested at this time.
The file is available for review of additional documentation at your convenience for
reference if needed.
APPLICANT Mattituck Plaza (Walgreens)
TAX #ZONE ITT 142.-1-26
ZBA# 8098
HEARING DATE April 2, 2026
CODE SECTION Art XI Sec 280-48A(2)[d]
DATE OF STAMPED SURVEY/SITE PLAN February 7, 2020
PRE PARER OF SURVEYISITE PLAN Nathan Taft Corwin III
Thank you.
Ends.
GOGGINS
ASSOCIATES
13235 Main Road, P.O. Box 65
Mattituck, New York 119 5 2
(631) 298-4818
o ainslaw gib,,i . :0111
December 24, 2025
Southold Town.Zoning Board of Appeals
53095 Main Road
Southold,New York 11971
Re
10095 Main Road, Mattituck,New York; Mattituck Plaza, LLC
SCTM No. 1000-042.00-01.00-026.000
Handicap Prescription Delivery Access (HPDA).
Dear Sir/Madam.:
Enclosed please find origin l and seven sets of the following:
1. Notice of Disapproval with Building Permit Application;
2. Original variance application;
3. ZBA questionnaire;
4. Applicant's Project Description;
5. Transactional Disclosure Form;
6. Owner and Agent Transactional Disclosure forms;
7. Photos of property;
8. Full Environmental Assessment;
9. Current Site Plan and Building Plan;
10. LwRP;
11. AG Data;
12. Assessors Card;
13. Owner Authorization;
14. Prior Certificates of Occupancy;
15. Survey;
16. Co paiiy Filing Proof; and
17. A check in the amount of$2,000.00.
If you have any questions, please do not hesitate to contact the undersigned.
Very truly yours,
William C. Goggins
wCGldmp
enclosures
FORM NO. 3
TOWN OF SOUTHOLD
BUILDING DEPARTMENT
SOUTHOLD,N.Y.
NOTICE OF DISAPPROVAL
DATE: July 11, 2025
To: William C. Goggins (Mattituck Plaza LLC)
PO Box 65
Mattituck, NY 11952
Please take notice that your application received November 17, 2023:
For permit to: Construct alterations to an existing storefront at:
Location of property: 10095 Main Road. Mattituck.
Mattituck Plaza. `wal rees
County Tax Map No. 1000--Section 142 Block 1 Lot 26
Is returned herewith and disapproved on the following grounds:
The proposed construction alterations. to an existin shop-oing center store front. on this
conf ng� .65 acre lot in the General Business District i
rins not permitt rsuant to
Article XI., Chapter 2 0- A(2)f d], which states: `Buildings containing a drive-throtr.
or drive-up window are prohibited.
The drawings show a proposed drive up—pick u window and canopy on the pharmacy
fMade.
Authorized Signature
Note to Applicant: Any change or deviation to the above referenced application may
require further review by the Southold Town Building Department.
CC: file, Z.B.A.
Page 4—Use Variance Application,Revision Nov.2023
APPI...I.CATION TO THE SOUTHOLDI'M-Ne',N) ZONING BOARD OF APPEALS,
ITS VARIANCE
House No. 10095 Street: Main Road Hamlet: Mattituck
SCTM 1000 Section 142 Block 1 Lot(s) 26 Lot Size 8*7 ac Zone, B
I I
I(WE) APPEAL TBE WRITTEN DETERMJNATION OF TB:E BUMDING INSPECTOR
DATED July 11 2025 BASED ON STJRVEY/S1TE PLAN DATED June 28, 2023_.
Applicant(s)/Owner(s): Mattituck Plaza, LLC
Mailing Address: P.O. Box 1256, Mattituck, New York 11952
Telephone:631-298 818 Fax:631 .298.4214 Email:.-,, gogginslaw@gmail.com
NOTE: In addition to the above, please complete below if application is signed by applicant's attorney,agent,
architect,builder,contract vendee,etc.and name of person who agent represents:
Name of Representative: William C. Cog ins - for�) Owner ( )Other,.,
Mailing Address: P.O. Box 65, Mattituck, New York 11952
Telephone: 631,298*4818—Fax: 631 a 298.4214 Email: W@E,;mail.com
Please check to specify who you wish correspondence to be mailed to,from the above names:
{ ) Applicant/Owner(s), k)Authorized Representative, Other Name/Address below:
WHEREBY TIH BUILDING INSPECTOR REVIEWED SURVEY/SITE PLAN
DATED June 28, 2023 and DENIED AN APPLICATION DATED- 11/16/23 'FOR:
�) Building Permit
{ } Certificate of Occupancy Pre-Certificate of Occupancy
( ) Change of Use
( }Permit for As-Built Construction
( } Other:
Provision of the Zoning Ordinance Appealed. (indicate Article,Section,Subsection of Zoning Ordinance
by numbers.Do not quote the code.)
Article:
XI Section. 280-48A(2)(d) Sul section:
0
A prior appeal (x) has, has not been made at any time with respect to this vropertv,UNDER
,Vply�rz,IX%WXxxxxxxXXXX-U �XI�4 -:See, below (Please be sure to research before
File Numbers:3029 2 9 8 T'_ 2576 2636SE, 1680, 28 9, 12 31 1250, 6635z'
1715, 2530,
Page 5—Use Variance Application,Revision Nov.2023
I
REASONS FOR USE VARLkNCE: An applicant for a Lise variance MUST demonstrate
unnecessary hardship by satisfying ALL of ffie following four tests: (Please consult your Attorney
before completing, attach additional sheets as needed, and submit related doctimentation as required)
1. The applicant cannot realize a reasonable return, for each and every permitted use under the zoning
regulations for the particular zone district where the property is located, as demonstrated by substantial
and competent financial evidence because: The issue is not to increase income or to
realize a reasonable return. It is to dispense prescriptions for handi-capped
residents in accordance with the Americans with Disabilities Act.
2. The alleged hardship relating to the property is unique and does not apply to the majority of parcels
in the same zoning district or neighborhood because: it is a drug store serving the residents
of Southold Town inclusive of Nandi-capped people living in our community.
3. The requested use variance, if granted,will not alter the essential character of the neighborhood
because: the application merely provides access to a limited part of society,
and will have a de minimus effect on the charactor of the neighborhood.
4. The alleged hardship has not been self-created because: the need is to give access to those
who have difficulty ambulating, and the less fortunate among us with physical
limitations.
In addition to the above standards. the Board of Appeals must also find that:
5. The requested relief is the minimum relief necessary to avoid unnecessary hardship, while at the
same time preserving and protecting the;-, character of neighborhood and the health, safety and welfare
of the community because: -the health, safety, and welfare of handi-capped people
will he enhanced by easy access to prescription pick-up
6. The spirit of the ordinance will be observed,public safety and welfare will be secured, and
substantial justice will be done because: all people should have equal access to
services available in the community.
By signing below, I certify all information is true and correct to the best of my knowledge.
Signature of Applicant or Authorized Agent
(Agent must submit written Authorization from Owner)
William C. Goggins
PrintName
Al
Sworn to before me this. n -�3
day of . 20—
(I otary Public)
BRIAN A, ANDREWS
Notary Public, State Of New York.
No. 02AN5014.509
Qualified In Suffolk County
Commission Exphres 07/15/ 97.o
TOWN OF S4IJTHOLD--BUILDING DEPARTMENT
d N,Y 11 71-095 9
c0t Town lull Annex 54375 Main Road.P. 0. Box 1179 Southol , 9
r' Telephone (631) 765--1802 Fax (631) 765-9502httips://www.soutlioldtoxvnnv-crov
Date Received
APPLICATION FOR BUILDING PERMIT
For Office Use Only
PERMIT NO. Building Inspector UN L I\0 N
Applications and forms must be filled out in their entirety. Incomplete
00
applications will not be accepted. Where the Applicant is not the owner,an �� +' 'r •—•
Owner's Authorization form (Page 2)shah be completed. Y ,.
Date:November 16, 2023
OWNER(S)OF PROPERTY:
Narne:Mattituck Plaza, LLC SCTM # 1000-42-1-26
Project Address:10095 Main Road, Mattituck, New York 11952
Phone#:631.298.4818 Ernail:gogginslaw@gmai1.com
Mailing Address:P.O. Box 65, Mattituck, New York. 11952
CONTACT PERSON:
•Vllilliam C. Goggins
Name. gg
Mailing Address:P.O. Box 65, Mattituck, New York 11952
Phone#:631,298.4818 Email:gogginslaw@gmaiI.corn
DESIGN PROFESSIONAL INFORMATION:
Name:
Mailing Address:
Phone#: Email:
CONTRACTOR INFORMATION:
Name:
Mailing Address:
Phone#: Email:
DESCRIPTION OF PROPOSED CONSTRUCTION
❑New Structure ❑Addition WAlteration ❑Repair ❑Demolition Estimated Cost of Project:
❑Other $
Will the lot be re-graded? ❑Yes *No Will excess fill be removed from premises? ❑Yes �i No
PROPERTY INFORMATION
Existing use of property:COMmercial Intended use of property:Commercial
Zone or use district in which premises is situated- Are there any covenants and restrictions with respect to
Business this property? E]YesgNo IF YES., PROVIDE A COPY.
0 Check Box After Reading: The owner/contractor/design professional is responsible for all drainage and storm water issues as provided by
Chapter 236 of the Town Code. APPLICATION IS HEREBY MADE to the Building Department for the issuance of a Building Permit pursuant to the Building Zone
Ordinance of the Town of Southold,Suffolk,County,New York and other applicable Laws,Ordinances or Regulations,for the construction of buildings,
additions,alterations or for removal or demolition as herein described.The applicant agrees to comply with all applicable laws,ordinances,building code,
housing code and regulations and to admit authorized inspectors on premises and in building(s)for necessary inspections.False statements made herein are
punishable as a Class A misdemeanor pursuant to Section 210.45 of the New York State Penal Law.
William C. Goggins
Application Submitted By(prim name): iOAuthorized Agent ElOwner
j it - I
-F I
Signature of Applicant: Date: November 17, 2023
STATE OF NEW YORK)
SS:
COUNTY OFSUFFOLK
William C. Goggins
being duly sworn, deposes and says that (s)he is the applicant
(Name of individual signing contract) above named,
Attorney/Agent
(S)he is the
(Contractor, Agent, Corporate Officer, etc.)
of said owner or owners, and is duly authorized to perform or have performed the said work and to make and file this
application;that all statements contained in this application are true to the best of his/her knowledge and belief; and
that the work will be performed in the manner set forth in the application file therewith.
Sworn before me this
1 6th November 23
It
day of 120
Notary Public
PROPERTY OWNER AUTHORIZATION WMAM.
401,y Pdbi•iat WS t W-ya'
(Where the applicant is not the owner) L NO.0monots
Alan A. Cardinale Cutchogue, New York
residing at
William C. Goggins
do hereby authorize to apply on
my behalf to the Town of Southold Building Department for approval as described herein.
November 16, 2023
Owner's Signature Date
Alan A. Cardinale
Print Owner's Name
2
Page 6—Use Variance Application,Revision Nov.2023
Zoning Board of Appeals
APPLICANT'S PROJECT DESCRIPTION
APPLICANT: Mattituck Plaza, LLC SCTM No. — A n—oi nn_n!)A non
1-0,00 1 2,
1. For Demolition of Existing Building Areas
Please describe areas being removed:
11.New Construction Areas (New Dwelling or New Additions/Extensions):
Dimensions of first floor extension: N/A
Dimensions of new second floor:
Dimensions of floor above second level:
Height(from existing natural grade):
Is basement or lowest floor area being constructed? If yes, please provide height(above ground) measured
from natural existing grade to first floor:
1H. Proposed Construction Description (Alterations or Structural Changes)
(Attach extra sheet if necessary). Please describe building areas:
Number of Floors and General Characteristics BEFORE Alterations: one
Number of Floors and Changes WITH Alterations:
ZD
one
IV. Calculations of building areas and lot coverage,GFA, sky plane (From Surveyor, Design
Professional): I
Existing square footage of buildings on your property: 8_2 000 s_q f t
Proposed increase of building coverage: no increase
Square footage of your lot: — 8.7 acres
Percentage of coverage of your lot by building area(lot coverage) N/A no change,
Gross Floor Area (GFA) of single family dwelling including the attached garage and/or habitable detached
accessory structure: (Please refer to Chapter 280, Section 280-207 of the Town Code)
N/A
For Residential lots, is project within the allowable Skv Plane? (.Please refer to Chapter 280, Section 280-
208 of the Town Code): N/A
V. Purpose of New Construction: Install 53.5"�b 40Ibi—parting window with canopy.
V1.Please describe the land contours (flat, slope %, heavily wooded, marsh area, etc.) on your land and
how it relates to the difficulty in meeting the code requirement (s): Describe on separate page if
needed: NIA
Please submit 8 sets of photos,labeled to show different angles of yard areas after staking corners for
new construction, and photos of building area to be altered with yard view.
11/2023
Page 7—Use Variance Application,Revision Nov.2023
QUESTIONNAIRE
FOR FILING WITH YOUR ZBA APPLICATION
A. Is the subject premises currently listed on the real estate market for sale?
Yes XX No
B. Are there any proposals to change or alter land contours?
XX No XX Yes,please explain on separate sheet.
C. 1.) Are there areas that contain sand or wetland grasses? No
2.) Are those areas shown on the survey submitted with this application?
3.)Is the property bulk headed between the wetlands area and the upland building area?
4.)If your property contains wetlands or pond areas,have you contacted the Office of the
BOARD OF r rRT_js"rEES for its determination of jurisdiction? N,
Please confirm ftatus of your inquiry or application with the Board of Trustees:
If issued,p lease attach copies of your permit listing conditions of approval with a copy of
the approved survey.
D. Is there a depression or sloping elevation near the area of proposed construction at or
below five feet above mean sea level? No
E. Are there any patios,, concrete barriers, bulkheads or fences that exist that are not shown
on the survey that you are submitting? No
If any of the aforementioned items exist on your property,,please show them on a site
plan.
F. Are there any construction projects currently in process on your property? No
If yes, please submit a copy of your building pen-nit and survey as approved by the Building
Department and please describe scope of work:
G. Please attach all pre-certificates of occupancy and certificates of occupancy for the subject
premises. If none exist, please apply to the Building Department to obtain them or to obtain an
Amended Notice of Disapproval.
H. Do you or any co-owner also own other land adjoining or close to this parcel? No
If yes, please label the proximity of your lands on your survey and identify the Suffolk
County Tax Map No.
I. Please list present use or operations conducted at your property, and/or the proposed use
retail
J. (examples:existing single family,proposed:same with garage,pool or other)
14
September 2, 2-25
Authorized signature Date
Page 11 —Use Variance Application,Revision Nov.2023
AGENT/REPRESENTATIVE
TRANSACTIONAL DISCLOSURE FORM
The Town of Southold's Code of Ethics prohibits conflicts of interest on the part of town officers and em lovees.Th e u r ose of
this form is to provide information which can alert the tow of ossible conflicts of interest and allow it to take whatever actioin is
necessary to avoid same.
YOUR NAME : Goggins, William C.
(Last name,first name,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.)
TYPE OF APPLICATION: (Check all that apply)
Tax grievance Building Permit
Variance X Trustee Permit
Change of Zone Coastal Erosion
Approval of Plat Mooring
Other(activity) Planning
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 person employed by the Town of Southold
Title or position of that person
Describe the relationship between yourself(the applicant/agent/representative)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 spouse,sibling,parent,or child is(check all that apply):
A)the owner of greater that 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 non-corporate 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 day ofS t mb r2025�
Signature L el V/
Print Name William C. G "zina
.A►.PPLICANVOWNER
TRANSACTIONAL DISCLOSURE FORM
e jawp.of,,Southoldly Cipde of Ethicsr I i n flies of interest on#h ice and em to e".The or os
Qf this form is to provide information which can Merl the town of 2p"ible conflicts_ f interest an d allow it to to a rah
IStion i _ne + -a to avoid same.
Y UR NAME: Alan Cardinale
(Ltst name,first name,middle initial,unless you ire applying in the name of someone else or other eatity,such as a
company.If so,indicate the other person's or company's name.)
TYPE OF APPLICATION:(Check all that apply)
Tax grievance Building Permit
Variance X Trustee Permit
Change of Zone _ _ Coastal Erosion
Approval of Plat Mooring
Other(activity) Planning
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
If you answered"ICES",complete the balance of this form and date and sign where indicated.
Name of person employed by the Town of Southold w
Title or position of that person.
Describe the relationship between yourself(tbe applicaatlagentlrepresentative)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 spouse,sibling,parent,or child is(check all that apply)
A)the owner of greater that 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 non-corporate entity(when the Applicant is not a corporation)
Q an officer,director,partner,or employee of the applicant;or
D)the actual applicant
DESCRIPTION OF RELATIONSHIP
Submitted this 2nd day of eptemb r-yo 25
Signature
Print Name Alan Cbardinale
Town of Southold
LNITY CONSISTENCY ASSESSMENT FORM
A. INSTRUCTIONS
I All app licants for permits* including Town of Southold agencies, shall complete this CCAT 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 HazardArea.
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 significant
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", then the proposed action may affect the
achievement of the LWRP policy standards and conditions contained in the consistency review law.
Thus, the action should be analyzed in more detail and, if necessary, modified prior to making a
determination that it is consistent to the maximum extent practicable with the LVW policy
standards and conditions. If an action cannot be certified as consistent with the LVvW policy
standards and conditions it shall not be unjortaken.
A copy of the LVW 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# 142 1 _- 26
The Application has been submitted to (check appropriate response):
Town Board Planning Dept. EF- 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
construction,planning activity, agency regulation, land transaction)
(b) Financial assistance (e.g. grant, loan, subsidy)
(c) Permit, approval, license, certification:
Nature and extent of action:
Install Handicap Prescription Delivery Access
Location of action: 10095 Main Road, Mat tom.New York-
Site aore cc 8.7 acres
Present land usel: Commercial
Present zoning classification: Bus i rye ss District
2. If an application for the proposed action has been Tiled with the Town of Southold agency, the following
information shall be provided:
(a) Name of applicant: Mattituck Plaza, LLC
(b) Mailing address: P.0, Box 1256
Mattituck, New York 11952
(c) Telephone number:Area Code 631-298-4200
(d) Application number,if any:
Will the action be directly undertaken,require funding, or approval by a state or federal agency?
Yes No If yes,which state or federal agencv?
DEVELOPED COAST POLICY
Policy 1. Foster a pattern of development M* 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 LWR.P Section 111—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
LNVRP Section III—Policies Pages 6 through 7 for evaluation criteria
Yes No Not Applicable
Attach additional sheers if necessary
NATURAL COAST POLICIES
Policy 4. Minimize loss of life, structures, and natural resources from flooding and erosion. See LVVRP
Section III--Policies Pages 8 through 16 for evaluation criteria
Yes No 2 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 Not Applicable
Attach additional sheets if necessary
Policy 6. Protect and restore the duality 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.
i
Yes No Not Applicable
Attach additional sheets if necessary
Policy 7. Protect and improve air quality in the Town. of Southold. See LN'VRP Section III — Policies
Pages 32 through 34 for evaluation criteria.
Yes No3 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 L'VVRP Section III—Policies; Pages 34 through 38 for evaluation criteria.
Yes No 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 LVVW Section III —Policies; Pages 38 through 46 for evaluation
criteria.
Ye No 9 1 Not Applicable
Attach additional sheets if necessary
WORKING COAST POLICIES
Policy 1.0. Protect Southold's water-dependent uses and promote siting of new water-dependent uses in
suitable locations. See LV�RP Section III--Policies; Pages 47 through 56 for evaluation criteria.
�37- Yes No 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 LVVRP Section III Policies; Pages 57 through 62 for evaluation criteria.
Yes No 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
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
Created on 5125105 11:20 AM
Page 8—Use Variance Application, Revision Nov.2023
AGRICULTURAL DATA STATEMENT
ZONING BOARD OF APPEALS
TOWN OF SOUTHOLD
WHEN TO USE THIS FORM: This form must he completed by the applicant for any special use
permit, site plan approval, use variance, area variance or subdivision approval on property within
an agricultural district OR within 500feet of afarm operation located in an agricultural district.
All applications requiring an agricultural data statement must be referred to the Suffolk County
Department of Planning in accordance with Section 239m and 239n of the General Municipal Law.
1, Name of Applicant: Mattituck Plaza. LLC
2. Address of Applicant: 10095 Main Road, Mattituck_, New York - 11952
3. Name of Land Owner(if other than Applicant):,
4. Address of Land Owner: 10095 Main Road, Matti tuck, New York 11952
5. Description of Proposed Project: Handicap_Prescription Delivery Access
6. Location of Property: (Road and Tax map Number)—same as above
1000-142.00-01.00-025.000
7. Is the parcel within 500 feet of afarm operation? } Yes {x � No
S. Is this parcel actively farmed? { ) Yes {XjNo
9. Name and addresses of any owner(s) of land within the agricultural district containing active farm
operations. Suffolk County Tax Lot numbers will be provided to you by the Zoning Board Staff,
it is your responsibility to obtain the current names and mailing addresses from the Town
Assessor's Office (765-193 7) or from the Real Property Tax Office located in Riverhead.
NAME and ADDRESS
I N/A
2.
'I
J.
4.
5.
6.
(Please use the back of this page if there are additional property owners)
09 02 2025
Signature of Applicant T Date
Note:
1. The local Board will solicit comments from the owners of land identified above in order to consider the
effect of the proposed action on their farm operation. Solicitations will be made by supplying a copy of
this statement.
2. Comments returned to the local Board will be taken into consideration as part as the overall review of
this application.
3. Copies of the completed Agricultural Data Statement shall be sent by applicant to the property owners
identified above. The cost for mailing shall be paid by the Applicant at the time the application is
submitted for review.
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Board of Zonine Appeals Application
AUTHORIZATION
(Where the Applicant Fs not the owner)
L Met—tit. T. residing t P:0, Ra— 1256
(Print property owner's name) (Mailing Address)
Mattituc, New York 11952 do hereby authorize William C. Goggins
(Agent)
to apply for varianc a(s) on my behalf from the
Southold Zoning Board of Appeals.
(d"mees Signature)
Alan Cardinale
(Print Owner's Name)
From: "Toth,Vicki"<vlcki.toth @ftwn.south old.ny.0 s>d?
Subject: matt plaza
Date: February 7,2013 3:24:15 PM EST
To: <Mlliamgogg1ns@yahoo.com>
1 Atta
38 KS
<<I 5661-Z.pdt>>
FORM NO.4
TOWN OF SOUTHOLD
BUILDING DEPARTMENT
Office of the Building Inspector
To"Hall
Southold,N.Y.
Certificate Of Occupancy
No. ........ Date
THIS CERTIFIES that the building A.eA 4
10305 Rt. 25 6 Factory Ave. Matt tuck
Location of Propexty d�6...I.I...........a a..-**0 4 V 0..0 0 0 0 i#........... ..I I.....
ai
No. sroor
2 6
County Tax Map No.1000 Section . -Block P.1...........Lot .
Subdivision.S t pre t19
conforms substantially to the Application for Building Permit heretofore fifled in this office dated
Jan. 29, l987 15661Z
..1...I ........ pursuant to which Building Permit No. ...... ...
dated .. Feb. 3t..1987
..*0 0.. .04............ 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
RETAIL DRUG STORE--GENOVESE DRUGS, INC.
The certificate is issued to ..G E NOVESE DRUG STORES, INC.
...... ... ...
A. CARDINALE-owner
of the aforesaid building.
Suffolk County Department of Health Approv2l
UNDERWRITERS CERTIFICATE NO. N798096 March 12, 1987
PLUMBERS CR&TIFICATION DATED:---N/A
re
d(3 0444;0 a 0 a 1 9
Building Inspenor
Rev.1/21 RECEIVED
FEB-2 8 2 013
BOARD OF APPEALS
From: "Toth,Vicki"<vicki.tothC&town.southold.ny.us>�
Subject: matt plaza
Date: February 7,2013 3:26:38 PM EST
To: <wll I]amgoggin s(9 yahoo com>
1 Attachment,36 KB
<<12073-Z,pdf>>
FORM NO.4
TOWN OF SOUTHOLD
BUILDING DEPARTMENT
Office of the Building inspector
Town Hall
Southolde N.Y.
Certificate Of Occupancy
No. W-7A9......... Datr, J"y,J 3.........
THIS CERTIFIES that the building
10605 State Road 25 mattituck
Location of Property ... ......*.....r--..I.4,--a. •.--0..,.a h#0 6 a**.5.. 1 6 1 0 P.a
mom N .,
o. WS t- Homlet
County Tax Map No.10W Section ..Block
x x
Subdivision...A Xiled Map No. ...Lot No. 0 0 P 0 0-a a 9 0 a 0 a
conforms substantially to the Application for Building permit heretotbre fled In this office dated
120 p Aqqipper 6 19 pursuant to which Building Permit No. 73• Z
dated 19B?. was issued,and conforms to all of the requirements
of the applicable provisions of the law.The.occupancy for which this ocrtificiate is issued is .........
a drive-up banking facility for North Fork Bank & Trust Co.
.0..a.&S W I I. a*.b 2 0.0.4..0.0 a a. W 4 0.P.*0 0 9 1 0*&1 4 P 1 0 6 9 4*11 1*a I.4 1 W 0 9 0 0 4 4
The certificzteis issued to ....NORTH FORK BARK & TRUS! CO.
k"Vr,
of the aforesaid building.
Suffolk County Deparbnent of Health Approval MA20A
UNDERWRrMRS CERTIFICATE NO. .N..6...04080 ......
Building inspector
pvv.1/81 93
RECEIVED
ILE) 2 8 M3
80ARD OF APPEALS
.�- ..�..a•i.Y a i - i F -
From: "Toth,Vicki"<vioki.toth@town.southold.ny.us>
Subject: matt plaza
Date: February 7,2013 3:20:07 PM EST
To: <wi1liamgoggins9yahoo.com>
1 Attachment,38 KB
.. .. .-. ..aaaa• + ••s:e•r ..a• r r - •• . i, ! •• f•••+;•.•i rt • i •• • .-- y +•. .•r
<E21 M-Z_pdf�*>
r
FORM N0. 4
TOWN OF SOU'T'SOLD
BUILDING DEPARTMW
office of the Building In"ctor
Town Hal `
smthold, N.Y.
CKRTIFICATE OF OCCUPANCY
NO Z-22175 Date MA.RCH 4 1993
THIS CnTIFIES that the building AL ATION
Locution of Property 10095 Storms 1 MA14 ROAD MA TT1TU N.'Y.
House No- 5.-re et
County Tax Map No, 1000 Section�142,_ Block 2 Lot 26
Subdivision Filed Kap NO.—�„�t No.
conforms substantially to the Application for Building Permit heretofore
filed in this office dated OCTORKE 29, 1993 pursuant to which
Building Permit NO- 210 -Z dated NO ES 6
was issued, and conform to all of the requirements: of the aPPlicable
provisions of the law. The occupancy for which this certificate is
issued la AL LTIONTo CONSTRUCT F0�_L ME CE BANX 'i[Tg DRIn-TLIRU
NIA IN E STX:KG SSopp ITS cMCM AS APFL.r= MR.
.
They certificate is issued to ALM A- D
(owner)
of the aforesaid building.
SUFFOLK COUNTY DEPARTKENT OF EiP.ALTH PROP# d1 -
UNDERWRITERS CERTIFICATE NO. pZ ING - yw kUARY 25 1593 -
pLUMBZRS CERTMcATION DATED C 3 lg93 111MCK PLUMB. ATI1
(T -.1 tl
Buiing nspetor RECEIVED
Rev. 1/81 FEB-2 8 2013
BOARD OF APPEALS
a
Southold Town
e" MAIN ROAD - STATE ROAD 25 SOUTHOLD, L.E.. N.Y. 11971
�'L ti d L, -
I:LCEIVED AND FILED BY
ACTION OF THE ZONING_BOARD OF -'d,P5 SOUTHOLD TOWN CLERK
Appeal No. 3029 DATE/ i y d HOUR '.5 6 f'
Application .Gated August 26, 1982
TO: Abigail A. Wickham, Esq. for NORTH FORK BtINK
Main Road, Box 1424 own Clerk, Tow 0 U
Mattituck, NY 11952 -
At a Meeting of the Zoning Board of Appeals held on November 18, 1982
the above appeal was considered, and the action indicated below was taken
on your C ] Request for Variance Due to Lack of Access to Property
New York Town Law, Section 280-a
? Request for Special Exception under the Zoning Ordinance
Article Section
[X ] Request for Variance to the Zoning Ordinance
Article VII Section 100-71
[ ] Request for
The public hearing on this application was held on October 21, 1982.
Upon application for NORTH FORK BANK AND TRUST COMPANY, by Wickham,
Wickham & Bressler, P.C. , Main Road, Mattituck, NY for a Variance to the
Zoning Ordinance, Article VII, Section 100-71 for permission to construct
drive--in banking facility with canopy extending into the frontyard area
at the Mattituck Shopping Center, North Side of Route 25, Mattituck, NY;
bounded north by Bethany Cemetery Association; west by Factory Avenue;
south by Ardprop Inc. and Main Rd. ; east by New Bethany Cemetery; County
Tax Map Parcel No. 1000-142-1-26.
The board made the following findings and determination:
By this application, appellant seeks permission to construct a
27-foot canopy attached to a proposed drive-in banking facility at the
old Grants Building in the Mattituck Shopping Center. Appellant states
that the 27--f,00t extension will not be a solid structure, but rather a
"floating canopy" and is needed to protect the customers during bad
weather when transactinq business. Appellant proposes a reduction in
landscaping necessary for the two-lane 12-car stacking area to avoid
traffic problems and a proposed new curb cut for bank--customer egress
at the southeasterly corner of the premises. Ingress is proposed at
the proposed new curb cut for deliveries into the loading area of the
old Grants Building only.
In considering this appeal, the board determines that the variance
request is not substantial; that the circumstances are unique; that by
allowing the variance no substantial detriment to adjoining properties
will be created; that the difficulty cannot be obviated by a method
feasible to appellant other than a variance; that the relief requested
will be in harmony with and promote the general purposes of zoning; and
in view of the manner in which the difficulty arose and in consideration
of all the above factors, the interest of justice will be served by
allowing the variance.
On motion by Mr. Sawicki, seconded by Mr. Doven, it was
RESOLVED, that the relief requested in Appeal No. 3029, applica-
tion for NORTH FORK BANK & TRUST COMPANY for permission to construct
floating canopy extension from the proposed banking facility with a
setback from the front property line at 14 feet, as shown on the site
Plan revised October 29, 1982, be and hereby IS APPROVED SUBJECT TO
THE FOLLOWING:
(CONTINUED_ ON PAGE TWO)
DATED: December 13, 1982. CHAIRMAN, SOUTHOLD TOWN ZONING BOARD
OF APPEALS
Form ZB4 (rev. 12/81)
Page 2 - Appeal No. 3029
Matter of NORTH FORK BANK & TRUST CO.
Decision Rendered November 18, 1982
1. Review by the Suffolk County Planning Commission pursuant to
Sections 1323, et seq. of the Suffolk County Charter;
2. Approval by the Southold Town Planning of the site plan.
Vote of the Board: Ayes: Messrs. Goehringer, Doyen, Douglass
and Sawicki. (Member Grigonis was absent. ) This resolution was
unanimously adopted.
APPROVED
r
TOWN OF SOUTHOLD,NEW YORK DATE january. 2. 196 9
ACTION OF TIM ZON-LING BOARD OF APPEALS
Appeal No. 12 2 6 Dated December 12, 1968
ACTION OF THE ZONING BOARD OF APPEALS OF THE TOWN OF SOUTHOLD
To Cassella Builders, Inc. Appellant
504 Walt -Whitman Road
&untjagt_cm__$-tat ign a New YQXk_
at a meeting of the Zoning Board of Appeals on JcinUa* 2,, 1969 the appeal
was considered'and the action indicated below was tak4n on"Your
) Request for variance due to lack of access to"property
) Request for a special Exception under the Zoning Ordinance
X) Retest for a variance to the Zoning Ordinance
1. SPECIAL EXCEPTION. By resolution of the Board it was determined that a special exception be
granted ( ) be denied pursuant to Article- . ,___ .. Section .... ............. Subsection paragraph
.................. of the Zoning Ordhiance, and the decision of the Building Ins-pectDr ( ) be reversed ( ) be
confirmed because 8:00 PJ4. (E,,ST,), -upon &PPlicatIon of�M,T, Ca6sella
Builders, Inc., 504 Walt Whitman Road, Huntington Station, New York,,
for a variance in accordance with the Zoning Ordinance Article IV,
Section 440-6 as it, applies to Article IV* Section 4,00-1,r for reduction
in- landscape area-and increase -in -parking area for proposed Hattituck
Shopping Center.D- Location -of property-. north ed-at corn6r-of Faictory
Avenue and Route 25 (Main- -Road), Mattltuck# Newk York„ bodnded north
by Bethany Cemetery Assoc.,, east by Bethany Cemetery Assoc..* south
by Main Road, west by Factory Avenue*
2. VARIANCE. By resolution of the Board it was determined that
(a) Strict application of the Ordinance (would) (would not) produce practical difficulties or unnecessary
hardship because
SEE REVERSE
(b) The hardship created (is) (is not) unique and (would) (would not) be shared by all properties
alike in the immediate vicinity of this property and in the same use district because
SEE RBVERSE
(c) The variance (does) (does not) observe the spirit of the Ordinance and (would) (would not)
change the character of the district because
SEE REVERSE
and there-fore, it was further deter-mined that the requested variance be granted be denied
and that the previous decisions of the Building Inspector be confirmed be reversed.
NV
ZONING BOARD OF APPEALS
FORM ZB4
h
clha1
BetIt N6vjjje* Secretary
After investigation- -and inspection the Board finds that the
applicant requests a reduction in landscaped area and increase in
parking area for proposed M,attituck Shopping Center, in accordance
with the Zoning Ordinance, Article Iv, ?section 440-6 a-9 ;Lt applies
to Article Iv, Section 400-1. The Board finds that the preset
parking layout of the proposed shopping certtizr may be obselete due
to the present populations growth, and summer tourists. The Shopping
Center layout will presently accomodate 387 cars as required by the
Town ordinance. If the ordinance can be amended by the Board applicant
would seek to gain 150 to 250 additional parking spaces. Therefore
alleviating any possibility of inadequate parking, and avoiding any
congested parking on the public streets. A perimeter reduction of
40 ft., on the northerly property line.
The Board finds that strict appl icat ion of the ordinance will
produce practical difficulties or unnecessary hardship: the hardship
created is unique and would not be shared by all properties alike
in the immediate vicinity of this property and in the same use
district; and the variance does observe the spirit of the Ordinance
and will not ph-ange__the character oaf. tlie. 4istr_ict.
` X • -
Thexeforft it was RESOLVED that, aseella Builders t ,T.nr-., 5 04
Walt Whitman Bade Rukntingtcn StationjL New York,,. be a
reduction in land ape area and increase in parking .area as applied
fad an property _located on north east corner o-f Factory Avenue &
Route 25 (MaiR Road+, Mitt-Stuck. New yarke j
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An official website of New York State.
tjere's bow y_Qu_knoyy v
<"EW
YORK Ck
STABTr
A
Department of State
Di 0
visi on of Corporations
Entity Information
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Return to ReSUItS Return to Search
Entity Details A
ENTITY NAME:MATTITUCK PLAZA LLC DOS ID:2751294
FOREIGN LEGAL NAME: FICTITIOUS NAME:
ENTITY TYPE:DOMESTIC LIMITED LIABILITY COMPANY DURATION DATE/LATEST DATE OF DISSOLUTION:
SECTIONOF LAW:203 LLC-LIMITED LIABILITY COMPANY LAW ENTITY STATUS:ACTIVE
DATE OF INITIAL DOS FILING:04/04/2002 REASON FOR STATUS:
EFFECTIVE DATE INITIAL FILING:05/01/2002 INACTIVE DATE:
FOREIGN FORMATION DATE: STATEMENT STATUS:PAST DUE
COUNTY:SUFFOLK NEXT STATEMENT DUE DATE:04/30/2022
JURISDICTION:NEWYORK,UNITED STATES NFP CATEGORY:
ENTITY DISPLAY
Service of Process on the Secretary of State as Agent
The Post Office address to which the Secretary of State shall mail a copy of any process against the corporation served upon the
Secretary of State by personal delivery:
Name: MATTITUCK PLAZA LLC
Address: 10095 MAIN ROAD,UNIT#4,MATTITUCK,NY,UNITED STATES, 11952
Electronic Service of Process on the Secretary of State as agent: Not Permitted
Chief Executive Officer's Name and Address
Name:
Address:
Principal Executive Office Address
Address:
Registered Agent Name and Address
Name:
Address:
Entity Primary Location Name and Address
Name:
Address:
617.20
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. Frequently, there are aspects of
a project that are subjective or unmeasurable. It is also understood that those who determine significance may have little or no formal
knowledge of the environment or may not 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 w hereby applicants and agencies can be assured that the determination process
has been orderly, comprehensive in nature, yet flexible enough 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 agiven 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 w het her an impact is likely to be considered small to moderate or w het her it is a potentially-large impact. The
form also identifies whether an impact can be mitigated or reduced.
Part 3: If any i m pact in Part 2 is ident if ied as pot ent ial ly-large, t hen Part 3 is used t o evaluat e w het her or not t he impact is
actually important.
THIS AREA FOR LEAD AGENCY USE ONLY
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 I and 2 and 3 if appropriate), and any other supporting information, and
considering both the magnitude 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
Handig,ap Pr4.:1scriFjt1' on Delivery Access (HPDA)
Name of Action
Zoning Board of Appeals Town of Southold
Name of Lead Agency
Print or Type Name of Responsible Officer in Leaci Agency Title of Responsible Officer
EEEEEP�
Signature of Responsible Officer in Lead Agency Signature of Preparer (If different from responsible officer)
website Date
Page 1 of 21
PART 1^-PROJECT INFORMATION
Prepared
Project Sponsor
by 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 bo considered oo part ofthe
application for approval and may be subject to further verification and public review. Provide any additional 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 orinvestigation. If information requiring such additional work is unavailable, so indicate and specify each instance.
Name ofAction Handicap
Location of Action (include Street Address, Municipality and County)
10095 Main Road, Mattitook, New York
Name ofApplicant/Sponsor Mattltook Plaza , I^I.0
Address 10095 Maio Road MatLitook New Yozlx 11952
City/pO Mattitook State NY Zip Code 11952
Business Telephone 631 ~ 298 .8494
Name of Owner(if different)
Address
City/PO State Zip Code
Business Telephone
Description ofAction:
Tnstallation of a window to provide handicap prescriptior. delivey to
handicapped people needing access .
Page 2of 21
Please Complete Each Quest ion--I ndic%ate N.A. if not applicable
A. SITE DESCRIPTION
Physical setting cf overall pnoject, both developed and undeveloped areas.
P~~1 [�l
1. PresentPresent �dU�: ��U�� ��|�u�d� gCommercial Residential (suburban) Rural (non-f arm)
Forest L_JAgriculture �_�Other
2 Total acreage of project area: _�_�__ eooam
APPROXIMATE ACREAGE PRESENTLY AFTEROOMPBT|ON
��
Meadow orBruoh(ond (Non-agr|ou|tur�) ��es ocres
Forested L/ acres acres
Agricultural (Includes orcharda, crop|amd, pasture, etc.) 0 acres acmo
Wetland (Freshwater ortidal as per Articles 24.25 of EOL) acres acres
Water Surface Area aoe acrese
r�7
L� �'
Unvegats�ed (Rook. ea�horfill) oc�s eores
Roedo, buildings and other paved surfaces _`^�� eores " ^ acres
Other (Indicate type) ecma ____���_mcreo
3. What is predominant aoi| type(o) on project site?
o- Soil drainage: Well drained % 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 NYB Land
Classification System? eoreo (oee1 NYCRR 37O).
4 Are site? �-7 Yes ��� No
.
a. VVho1 ie depth to bedrock (in feet)
5. Approximate percentage of proposed project site with slopes:
0'10% % L]10' 15%__% 15% or greater__%
0. Is project substantially contiguous to contain a bui|ding, site, or dio\dot. listed on the State or National Registers of
Historic Places? i ) Yea No
7. Is project substantially contiguous to a site(listed on the Register of National Natural Landmarks? �_�Yee No
8. What is the depth of the water tab|e? (|n feet)
[�~� KN9. |a o|te |oca1ed over aprlmary. principa|. or so|e oourceoquifer? � �Yeo o
10. Do hunting' fishing or shell fishing opportunities presently exist in the project area? �_�Yee No
Page 3of21
P17
1 1. Does project site contain an species of plant or animal life that is identified as threatened or endangered? Yes No
p 1 Y p P g
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?
OYes ONo
Describe:
13. Is the project site presently used by the community or neighborhood as an open space or recreation area?
Yes r o
If yes, explain
14. Does the present site include scenic views known to be important to the community? ' Yes tVINo
TF
15. Streams within or contiguous to project area:
a. Name of Stream and name of River to which it is tributary
15. Lakes. ponds, wetland areas within or contiguous to projec-tt area:
f
b. Size (in acres):
Page 4 of 21
17. Is the site aened by existing publicutiutilities? �cJo? Yaa E] No
a. If YES, does sufficient capacity exist to allow connection? PqYes No
b. If YES. will improvements be necessary to allow connection? |�|Yea No
18. Is the site located in an agricultural dist rict certified pursuant to Agriculture and Markets Law, Artio|e25-AA. Section 803 and
304? 171 Yes No
19. |a the site located in or b t n\ia[1 t�guuuatoaCrb|ca| Environmental Area designated pursuant 1oA�|do8of the BCL,
and 6NYCRRG17? 'wo No
'
20. Has the site ever been used for the disposal of solid or hazardous wastes? 17 Yes KNo
B. Project Description
1. Physical dimensions and scale of project 0i|| in dimensions as appropriate).
�
�
a. Total contiguous acreage owned or controlled �� /\
^L/
controlled by project sponsor: acres.
b. Project acreage to be developed: acres initially; roe ultimately.
o. Project acreage to remain undeveloped:_ acres.
�
d. Length of project. in miles: (if appropriate)
s. If the project is an expansion, indicate percent of expansion proposed. 96
f. Number of off-street parking spaces existing `�U U � proposed
g. Maximum vehicular trips generated per hour: (upon completion of prcdooU?
��/h. |f res|den1ia|: Number and type of housing un|to: /= / i4_
One Family Two Family M uUip|o Family Condominium
Initially
Ultimately
i Dimensions (|n feet) of largest proposed structure- height; vvidth; |ength.
]. Linear feet or frontage along a public thoroughfare project wi|| occupy is? Yt.
yl �T
2 How much natural material (i.e. mck, earth' etc.) will be removed from the site? _�L�� tons/cubic yarda.
3. Will disturbed areas be reclaimed L_�Yae L_]No N/A
a. If|f ymo, for what intended purpose is the site being reclaimed?
b. Will topsoil be stockpiled for reclamation? F]Yes rNo
�^�l �7� —
o. Will upper subsoil be stockpiled for reclamation? L_�Yee L�_ko
tJ ' �/
4 How many acres of vegetation (trees, ohruba, ground covers) will be removed from site? � acres.
Page 5of21
5. Will any mature forest (over 100 years old) or other |ooelyimport ant vegetation be removed by this project?
Yeo No y
6. If single phase project: Anticipated period of construction: "m��-h-a. (including demolition)
7. If multi-phased:
I
o- Total number of phases anticipated (number)
�� �/
b. A�|c�� d�m� commencement �w n�h � � year. (including demolition)
o. Approximate completion ��et� offin ���ae� kV month _���� year.
�~�l
Ind. |o phase 1 functionally dependent� �noubeequent ph��oo? L � Ye� No
8. Will blasting occur during construction? L_�Yes LLfNJo
g. Number of jobs generated: during construction 0 | after project is complete
10. Number of jobs eliminated by this project
11 . Will project require relocation of any projects or facilities? L_�Yes � �No
If yes. explain:
12. Is surface liquid waste disposal involved? L_�Yea 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? � J Yes No Type
^�*
�~~l
14. VV||| surf ace area of an exist|ng vv ater body increase or decrease by proposal? L_�YeeMNo
/
If yes, explain:
15. Is project or any portion of project located in e 100 year flood plain? L |Yeo o
��T Y���—
16. Will the project generate solid vv��e? L_� Yes ���No
a. If yea, what is the amount per month? tons
b. If yeo, will an existing solid waste facility be used? � �Yes L_J No
c. If yea, give name location
1171Yes F71
d. Willi|| eny wastesoetea not go |nto a oewage dispoaa| system or into a aonitary |andfi||Y No
Page 8of21
e. If yes, explain:
0
17. Will the project involve the disposal of solid waste? Yes No
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 a , No
19. Will project routinely produce odors (more than one hour per day}? Yes ' o
l ambient noise levels? Yes UINIO
20. Will project produce operating noise exceedingthe loca
21, Will project result in an increase in energy use? Yes MN 0
If yes, indicate type(s)
22. If water supply is from wells, indicate pumping capacity gallons/minute.
(7)-
23. Total anticipated water usage per day gallons/day.
24. Does project involve Local, State or Federal funding? Yes No
If yes, explain:
i
i
Page 7 of 21
25. Approvals Required:
Type Submittal Date
City, Town, Village
Board Yes No
City, Town Village l l a e Planning n i n Board Yes No
g 9
City, Town Zoning Board Yes No
City, County Health Department Yes No
Other Local Agencies Yes No
Other Regional Agencies Yes ,. No
oth �.
9 9
i
f
State Agencies Yes No
Federal Agencies Yes No
r
C. Zoning and Planning Information
1. Does proposed action involve a planning or zoning decision? 9Yes No
If Yes, indicate decision required:
Zoning amendment Zoning variance Newirevision of master plan Subdivision
l e permit Resource management Ian � other
Site Ian Special use p � g p
p
Page 8 of 21
2. What is the zoning classification(s) of the site?
P
� r
r
Y
3. What is the maximum potential development of the site if developed as perrrnitted by the present zoning?
4. What is the proposed zoning of the site?
61�-1 t
a
Ul /
5. What is the maximum potential development of the site if developed as permitted by the proposed zoning?
C,
6, Is the action consistent with the recommended uses in adopted local land use plans? Yes No
proposed
7 What are the predominant land use(s) and zoning classifications within a 1/4 mile radius of proposed action?
8. Is the proposed action compatible with adjoin inglsurrounding land uses with a '/4 mile? Yes No
f
9. if the proposed action is the subdivision of land, how many lots are proposed?
a. What is the minimum lot size proposed?
Page 9of21
•
1 0. Will proposed action require any authorization(s)
for the formation of sewer or water districts? Yes No
11 Will the proposed acti
on create a demand for any community provided services (recreation, education, police, fire protection?
E]Yes No
r
' '� �
a. If yes, is existing capacity sufficient to handle projected demand? Yes Na
�
12. Will the proposed action result in the generation of traffic significantly above present levels? Yes No
a. If yes, is the existing road
network adequate to handle the additional traffic. Yes aN o
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,ro osai, please discuss such impacts and the measures which you propose to mitigate or avoid them.
E. Verification
l certify that the information pro ided above is true to t best of my knowledge. j
Date
Applicant/Spon
sor Name '
Signature
Title
If the actio
n n is in the Coastal Area, and you are a state agency, complete the Coastal Assessment Form before proceeding with this
assessment.
Page 10 of 21
PART 2 ~ PROJECT IMPACTS AND THEIR MAGNITUDE
Responsibility of Lead Agency
General Information (Read Carefully)
< |n 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.
1 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 apeoifioproject 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, mn each site, in each locality,will vary. Therefore, the examples are illustrative and have been
offered aoguidance, They do not constitute an exhaustive list ofimpacts 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 cumulative effects.
Instructions (Read carefully)
n. Answer each of the 2O questions in PART 2. Answer Yes if there will ba any impact.
b. Maybe answers should bo considered ae 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. |f impact will occur but threshold io lower than
example, check column 1.
d. 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 3to determine significance. Identifying on impact in column 2 simply asks that it
be looked etfurther.
e. If reviewer has doubt about size of the impact then consider the impact as potentially large and proceed to PART 3.
f. 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. ANm response indicates that such a reduction ia not possible. This must be
explained in Port3.
1 2 3
Small to Potential Can Impact Be
Moderate Large Mitigated by
Impact Impact Project Change
Impact onLand
1. Will the Proposed Action result ina physical change tothe project
site?
NO [—� YE8 [—�
L_J �—�
Examples that would apply to column 2 �~� El1:1y� ��)NC Anyconstrmotionone|opeoof1596 orgreater. (15foot � J m �_� o
rise per 1OO foot of|ength) or where the general slopes
in the project area exceed 1O96.
o Construction on land where the depth to the water table E] Yes E7No
is |eaa than 3foet.
o Construction of paved parking area for 1.00Oormore E] Yes No
vehicles.
o Construction on land where bedrock|a exposed or �~1 El CYes ONo
generally within 3 feet of existing ground surface.
El
El
0Yes
E]No
o Conotructionthatvvi|| continuaformorathan1yeeror
involve more than one phase orstage.
o Excavation for mining purposes that would remove 17 El 171 Yea M No
more than 1`000 tons of natural material(|.e., rock or
soil) per year.
Page 11of 21
1 2 3
Small to Potential Can Impact Be
Moderate Large Mitigated by
Impact Impact Project Change
C Construction or expansion of a santary landfill. El Q F3 Yes E:3 No
C Construction in a designated floodway. El E] E]Yes ❑No
C Other impacts: E]Yes No
2. Will there be an effect to any unique or unusual land forms found on
the site?(i.e., cliffs, dunes,geological formations,etc.)
7NO F I YES
c Specific land forms: ❑ � Yes MNo
Impact on Water
3. Will Proposed Action affect any water body designated as protected?
(Under Articles 15, 24, 25 of the Environmental Conservation Law,
ECL)
1:1 NO 17 YES
Examples that would apply to column 2
c Developable area of site contains a protected water body. El F]Yes No
c Dredging more than 100 cubic yards of material from channel of El D E]Yes E]No
a protected stream.
C Extension of utility distribution facilities through a protected water � F E]Yes a No
body.
C Construction in a designated freshwater or tidal wetland. El Yes 11 No
C Other impacts: El F] []Yes EJNo
4. Will Proposed Action affect any non-protected existing or new body of
water?
[:]NO YES
Examples that would apply to column 2
c A 10% increase or decrease in the surface area of any body of El Yes EIN o
water or more than a 10 acre increase or decrease.
C Construction of a body of water that exceeds 10 acres of surface 0 � MYes EIN o
area.
C Other impacts El- 0 FYes E]No
Page 12 of 21
1 2 3
Small to Potential Can Impact Be
Moderate Large Mitigated by
Impact Impact Project Change
6. Will Proposed Action alter drainage flow or patterns, or surface water
runoff?
El
L_��-�N[> YES
Examples that would apply to column 3 EJ
El
yeu No
c PropoaadActionwou|dohonge Dood vvoter�ovvo o=~J �_�
K�~� k~� K�� E]No
c PropoaedActionmayoausesubstontia| nrooion. � � K_�! U=~�Tmo
c Proposed Action ia incompatible with existing drainage patterns. Yea No
E]Yes
���C PropoaadActionwi||a\|ovv deve\opmentinedemignated �_� L_� No
floodvvey.
El
El
E]Yes
El
c Otherimpaota- No
IMPACT ONAIR
7 Will Proposed Action affect air quality?
1:1 ENO YE8
Examples that would apply to column 2 ��l El
ElYes
E]No
o PropoeedA��ionwi|| induoo1.QOOormonaveh|o|etripoinany � ]
given hour.
El
[ � E]Yes
F��o PropooedAotionwi|| reau|tintheinoinerationofmorathen1ton �_� L_�No
of refuse per hour.
[—� F�� E]Yes
El
c Emiaeionrotaoftota| oontaminonto vvi||exoeed5 \be, perhour �_� �_� JNo
ora heat source producing more than 1O million BTU's per
hour.
[�� �~� []Yes
E]No
c PropoaodActionwil|e||owonincreaoeintheamountof|and L_] L_J
committed to industrial use.
��l �~7 E]Yes
0No
o PropoeodActionwil|e||ovv aninoreaaminthadenai\yof � � L �
industrial development within existing industrial areas.
��� [�� F71Yes E]No
o Otherimpooty� �_� �_�
IMPACT ON PLANTS AND ANIMALS
8 Will Proposed Action affect any threatened or endangered species?
L
��7 ElNO YES
�
Examples that would apply to column 2 F71c Reduction of one or more species listed on the New York or _ E]Yes E:1No
Federal list, using the site, over ornear
the site, or found on the site.
Page 14of21
1 2 3
Small to Potential Can Impact Be
Moderate Large Mitigated by
Impact Impact Project Change
C Removal of an portion of a critical or significant wildlife habitat. []Yes El No
any 9
f pesticide or herbicide more than twice a year, F1 E]Yes ED No
C Application o p t Y
other than for agricultural purposes.
C Other Impacts,
E]Yes 1:1 No
WIM
g. Will Proposed Action substantially affect non-threatened or non-
endangered species?
E NO 0 YES
Examples that would apply to column 2
c Proposed Action would substantially interfere with any resident 171 []Yes El No
or migratory fish, shellfish or wildlife species.
C Proposed Action requires the removal of more than 10 acres of El El Yes 11 No
mature forest(over 100 years of age)or other locally important
vegetation.
C Other impacts,
E]Yes El No
ownu
IMPACT CAN AGRICULTURAL LAND RESOURCES
10. Will Proposed Action affect agricultural land resources?
D NO 1 -1 YES
Examples that would apply to column 2
c The Proposed Action wou
ld sever, crass or limit access to ,Yes [71No
agricultural land(includes cropland, hayfields, pasture,vineyard,
orchard,etc.)
C Construction activitywould excavate or compact the soil profile of F] E]Yes 1:1 No
P
agricultural land.
C The Proposed Action would irreversibly convert more than 10 E]Yes E] No
0
acres of agricultural land or, if located in an Agricultural District,
more than 2.5 acres of agricultural land.
Page 15 of 21
1 2 3
Small to Potential Can Impact Be
Moderate Large Mitigated by
Impact Impact Project Change
o The Proposed Action would disrupt or prevent installation of D Yes � No
agricultural land management systems(e.g, subsurface drain
lines, outlet ditches, strip oroppinQ); or create e need for such
measures (e.g.cause e farm field to drain poorly due to
increased runoff).
��� �~7
C Other impacts: L_� �_� L_JYes [_] No
IMPACT ON AESTHETIC RESOURCES
11. Will Proposed Action affect aesthetic resources? (If necessary, use
the Visual EAF Addendum in Section 017.2O.Appendix B.)
L_J
F—1 EIYESNO
Examples that would apply to column 2 �~� El
FYes
1:1
0 pro»ooed |enduses'orprojeo1oomponentoobvioue|ydifferent � J No
from orin sharp contrast to current surrounding land use
petterns,whether man-made or natural.
o 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.
El
c Projaotoomponentmthatwi|| reou|tinthem|iminationor Yea No
significant screening of scenic views known to be important to
the area.
o Other impacts- Yes No
ra
IMPACT ON HISTORIC AND ARCHAEOLOGICAL RESOURCES
12. Will Proposed Action impact any site or structure ofhistoric,
prehistoric orpaleontological importance?
[7]NO [�l YES
��
Examples that would apply to column 2 �� M E] No
o PropoaedAotionoocurring vvho||yorpa�ie||y vvithinor L_J �_J Yoa
substantially contiguous to any facility or site listed on the State
or National Register ofhistoric places.
El El
0YesElc Anyimpeoltoanarchaeo|ogico| eiteorfoaei|bed |oca1edwithin No
the project site.
��7 �� �~7
o Proposed Action will occur inon area designated aasensitive �_� �_J EYes L_� No
for archaeological sites onthe NYS8ite Inventory.
Page 18of21
1 2 3
Small to Potential Can Impact Be
Moderate Large Mitigated by
Impact Impact Project Change
F-1 El
E]Yes
E]No
o Ot erimpec�s: L_�
IMPACT ON OPEN SPACE AND RECREATION
13. Will proposed Action affect the quantity or quality of existing orfuture
open spaces or recreational opportunities?
[:] NO [7]YES
Examples that would apply to column 2 [�� ��l [71
yea E]No
C Thepermonentforeo|oouneofafuiurenaoreationo|oppo�unity. L � � �
UNoc Am�orroduotionofanopenspeoeimpo�enttotheoommuni1y �~�F��l F~^l Yea
F�� El
FlYes
No
o �therimpootm� �-� �-/
IMPACT ON CRITICAL ENVIRONMENTAL AREAS
14. Will Proposed Action impact the exceptional orunique
characteristics ofa critical environmental area(CEA)established
pursuant to subdivision 8NYCRRG17.14(g)?
El
1:1NOyE8
List the environmental characteristics that caused the designation of
the CEA.
Examples that would apply to column 2 �`7 �~� [~7ye� [~-1No
c Proposed Action to locate vvithinthe CEA? �_J L_J L_] L-�
��l El
E] Yes
��10 PmpooedAotionvvi||remu|tinareductioninthequentityofthe L � [_�No
resource?
�~� ��� [71
F]No
c PropooedAotionwi||resu|tina eduotioninthequa|ityoftha L � �_� Yae
resource?
El
[71
E]Yes
��lo PmpouedAotionvvi|{impaoYthouaa.funutionorerjoymen1ofthe L_�No
resource? -
[~� �-� E]Yes
c O1herirnpaots: L_� L_� No
Page 17of 21
1 2 3
Small to Potential Can Impact Be
Moderate Large Mitigated by
Impact Impact Project Change
IMPACT ON TRANSPORTATION
15. Will there be an effect to existing transportation systems?
a NO [7YES
Examples that would apply to column 2
c Alteration of present patterns of movement of people and/or El
� �Yes El No
goods.
c Proposed Action will result in major traffic problems. El E] Yes F-1 No
c Other impacts: El 0 MYes El No
IMPACT ON ENERGY
16, Will Proposed Action affect the community's sources of fuel or
energy supply?
11NO YES
Examples that would apply to column 2
C Proposed Action will cause a greater than 5% increase in the � El E]Yes El No
use of any form of energy in the municipality.
C Proposed Actin will require the creation or extension of an Q E] Yes No
energy transmission or supply system to serve more than 50
single or two family residences or to serve a major commercial
or industrial use.
e Other impacts: � 0 DYes N o
NOISE AND ODOR IMPACT
17. Will there be objectionable odors, noise,or vibration as a result of
the Proposed Action?
[]NO YES
Examples that would apply to column 2
C Blasting within 1,500 feet of a hospital, school or other sensitive El El E]Yes Q No
facility.
c Odors will occur routinely(more than one hour per day). 0 Yes EIN o
e Proposed Action will produce operating noise exceeding the 7Yes No
local ambient noise levels for noise outside of structures.
c Proposed Action will remove natural barriers that would act as a Li Yes No
noise screen.
e Other impacts: El 0 F-1 Yes El No
1 2 3
Small to Potential Can Impact Be
Moderate Large Mdigatedby
|mpeot Impact Project Change
IMPACT ON PUBUC HEALTH
10. Will Proposed Action affect public health and safety?
F I NO F—lYES
_ �-�
El
El
FlYes
F-�C PropoaodA��ionmmyoeuueeriakofexp|oeionorre|aaaeof L_�No
hazardous substances(i.a.oil, pesticides,chemicals, radiation,
etc.)in the evont ofeocident or upset conditione,or there may be
a chronic low level discharge or emission.
C�l F�� F7]Yes
F~L_J�C PropomadAotionmayreaultintheburia|of^hazordoueweatea^ LJ L � No
in any form (i.e.toxic, poioonouo, highly reactive, radioactivo,
irritating,infectious, etc.)
��) ��1 D
��lc 8toregefaoi|itYeeforonami||ionormorega||onoof|ique�ed �_� K_� Ymo L_�No
natural gas or other flammable liquids.
��l ��
c Proposed Action may result in the excavation orother L_� k_� E]Yes No
disturbance within 2.000 feet of site used for the disposal of
solid or hazardous waste.
o Other impacts: LJYes No
IMPACT ON GROWTH AND CHARACTER
OF COMMUNITY OR NEIGHBORHOOD
19. Will Proposed Action affect the character of the existing community?
L-�
F—�NO E71 YES
Examples that would apply tocolumn 2 ��] [�7 DYes
E]No
o Thepermanentpopu|ationoftheoity.tmwnorvi||oQein vvhich tho �-� L_J
project is located is likely to grow by more than 5%.
�—� [~�
u The municipal budget for capital expenditures oroperating L_� �_J []Yes No
services will increase by more than 596 per year oao result of
this project.
c Proposed Action will conflict with officially adopted plans or Yes No
goals.
�~� �~7 []Yesc PropoamdAc�ion vvi||cauaeochangeinthedenaityof|ondueo L_J L_� No
El
F]Yes
E]No
C proposadAotionvv|||rep!aoeore|iminotaex\uU ngfoo�|itioo. �_�
structures or areas of historic importance to the community.
o Development will create o demand for additional community EJ F1 E]Yes ONo
services (e.g. oohoo|a, police and fire, etc.)
Page 1Bof21
2 3
Small to Potential Can Impact Be
Moderate Large Mitigated by
Impact Impact Project Change
C Proposed Action will set an important precedent for future El r7Yes E No
projects.
C Proposed Action will create or eliminate employment. 0Yes Q No
C Other impacts: 0El Yes a No
20. Is there,or is there likely to be, public controversy related to potential
adverse environment impacts?
ENO EYES
It 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
Page 20 of 21
Part 3 - EVALUATION OF THE IMPORTANCE OF IMPACTS
Responsibility of Lead Agency
Part 3must be prepared if one or more impact(s) iaconsidered to be potentially large, even Uthe impact(s) may
be mitigated.
Instructions (if you need more space, attach additional sheets)
Discuss the following for each impact identified |n Column 2of 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
pnojcotohange(e)
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 ofvalue
| Whether the impact can or will becontrolled
| The regional consequence of the impact
! Its potential divergence from local needs and goals
/ Whether known objections tothe project relate tothis impact.
Poge21 of21
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