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HomeMy WebLinkAboutTR-5564 Albert J.Krupski,Presiden', Town Hall James King,Vice-President 0 53095 Route 25 Artie Foster �� �j P.O.Box 1179 Ken Poliwoda Southold,New York 11971-0959 Ca Peggy A.Dickerson ca Z Telephone(631) 765-1892 Fax(631) 765-1366 BOARD OF TOWN TRUSTEES TOWN OF SOUTHOLD YOU ARE REQUIRED TO CONTACT THE OFFICE OF THE BOARD OF TRUSTEES 72 HOURS PRIOR TO COMMENCEMENT OF THE WORK, TO MAKE AN APPOINTMENT FOR A PRE-CONSTRUCTION INSPECTION. FAILURE TO DO SO SHALL BE CONSIDERED A VIOLATION AND POSSIBLE REVOCATION OF THE PERMIT. INSPECTION SCHEDULE Pre-construction, hay bale line 1st day of construction _/'/2 constructed Project complete, compliance inspection. (�Lu al aCt\.0-d (QUN - nO LL` raro')C�.vn5 1z) c c wo CR cNX\Pt4 D az c ►a`9 I a�1 �- Oc Albert J.Krupski, President ��. QG Town Hall James King,Vice-President 53095 Route 25 Artie Foster Cz 1 P.O.Box 1179 Ken Poliwoda � Southold, New York 11971-0959 Peggy A. Dickerson Telephone(631) 765-1892 1 `1► Fax(631) 765-1366 BOARD OF TOWN TRUSTEES TOWN OF SOUTHOLD TO: Building Dept. FROM: Board of Trustees DATE: December 9, 2004 RE: Jesse Peretz—Wetland Permit#5564 SCTM#31-13-5 Please be advised that Ed Forrester inspected the above-referenced property and found the renovations to the existing single-family dwelling to be complete and in compliance with the Wetland Permit. Thank you. gUffO�,� Albert J.Krupski, President 0�� C� Town Hall James King,Vice-President �'Z` Gy� 53095 Route 25 Artie Foster Co P.O.Box 1179 Ken Poliwoda Z Southold,New York 11971-0959 Peggy A.Dickerson �1� ��� Telephone(631) 765-1892 Fax(631)765-1366 BOARD OF TOWN TRUSTEES TOWN OF SOUTHOLD August 4, 2003 Mr. Frank Uellendahl PO Box 516 Greenport,NY 11944 RE: SCTM#31-13-5 Jesse Peretz 1705 Truman's Path East Marion,NY Dear Mr.Uellendahl: The Southold Town Board of Trustees at their Regular Meeting held on Wednesday, July 23, 2003 took the following action. RESOLVED,that the Southold Town Board of Trustees Approve an Amendment to Permit #5564 transfer ownership demolish existing boat house and wood deck restore waterfront to less urban condition replace with brick patio extend the walls backfill 70 cubic yards of fill to be brought in-hay bales along the,top of the bulkhead line and drywells for the down spouts as per plans prepared by Frank Uellendahl,Architect. dated July 1, 2003 and amended July 31, 2003. If you have any questions,please call our office at 765-1892.- incerely, , � . Albert J. Krupski, Jr. President, Board of Trustees cc: Building Department AJK:cjc J 1 1 - - - Albert J.Krupski,President sufFot���� C� Town Hall James King,Vice-President �� Gy�G 53095 Route 25 Artie Foster o - P.O.Box 1179 co 2 Southold,New York 11971-0959 Ken Poliwoda Peggy A.Dickerson y ��� Telephone(631) 765-1892 Fax(631) 765-1366 BOARD OF TOWN TRUSTEES TOWN OF SOUTHOLD APPLICATION FOR AN AMENDMENT TO A PE Wr 2003 DATE Be f 1u�i as OWNER "R• I����T PHONE 6?1:77 8� ADDRESS F_70"g -MU FfIVIVS TtzTrff AGENT AEI•I'C tAC-LiEP OK GHONE 6�5 I - 444 ADDRESS `t. O trx &PE9-1 pmTI. PROPERTY LOCATION TAX MAP NO. I/We -MAPtf Ual'13XRW�Irequest an Amendment to Permit# _ pl/_ N5 C7F Ck3X)WGH(P otoye - F-CbZLVI-�3 _5 Signed By: n �� NEW OWNER: JESSE PERETZ SCTM # 1000-31-13-05 0 2ND FLOOR ADDITION GRASS] & RENOVATION o OF THE FILL z W V EXIST'G 2ND FL. PROPOSED 2ND FLOOR ADDITION EXISTING BOAT HOUSE TO BE DEMOLISHED N N AND REPLACED BY EXTENSION OF TERRACED SLOPE PERETZ LAND OF CLICK — i saa}snil}o �eog RESIDENCE SCTM # 1000-31—i 2-6 �Mol plowas PROPERTY LINE ; EAST MARION, NY PROPOSED DRY VE�L ; z STAIRS TO REMAIN ' m ARCHITECT 18'-0 1/2" _ awn>;�e+I ' � U 11 ----------L--------------------------- --------- FRANK UELJ_ENDAHL P.O.8OX 316 i GREENPORT, NY 11944 TEL: 631-477 8624 I — ; FAX: 631-477 2997 ! I- ---1 ❑ 1 BATH RM. OWNER i J 1 EXISI�F1 80AT 1-{0 s 1 1 � MASTER BATH MASTER BEDROOM TO BE DEMOLISH::'` ' ` 1 JESSE PERETZ 6,1 x 170055 TRUMAN PATH rn ! yy \ 11 EAST 91N 39 -826 NY 18488 EXISTING DECK --- �«g ETO BE DEMOLISH AND REPLACED -,BY BRICK PATIO — SON GRADE STAIRS TO BE DEMOLISHED E± m • ' N w z W 0 1151 � N ctf PROPOSED FOOTINGS AND o PROPOSED ERECTION OF BALCONY DRY WELL WILL NOT BE EXECUTED l�lco (IAOT BUILDING PERMIT WILL BE AMENDED 1 A PROPOSED BACKFILL = CA 70 CU YARD ' 1 11 E5 11 , , CA- LAND OF BOLLMAN — E1lIS�G gOA� HOUSE 1 1 ,1 ,\ SCTM # 1000-31-13-4 PROPERTY LINE DATE: 07/01/2003 �Z SCALE: 1/8" - 1'-0" 3 Q PARTIAL SITE PLAN Y O O V� SECTION DWG. NAME A - 1 © DWG. NO y suFFot�r Albert J.Krupski,President ��,� C� Town Hall James King,Vice-President �`Z` Gym 53095 Route 25 Artie Foster o =� P.O.Box 1179 Ken Poliwoda y = Southold, New York 11971-0959 Peggy A. Dickerson y � O�� Telephone(631)765-1892 Fax(631) 765-1366 BOARD OF TOWN TRUSTEES TOWN OF SOUTHOLD APPLICATION FOR AN AMENDMENT TO A P C ll U E i JUL - L �� Southold Town DATE !.�(J U:J Board of Trustees OWNER t�l[z.. _J C-SSE ?e96T_Z'-PHONE I b,2 9+80 ADDRESS I�D S TQ.Ui--I�I�JS AGENT K �Gl WHONE ADDRESS 'i O. X (P �d��T� PROPERTY LOCATION F�05;✓ I CMAICE TAX MAP NO. I(We -4f-APtf WSJ- M-M-Crequest an Amendment to Permit# �O "fd C - Signed By: (0 '2 f . �i �:7,� ; ✓�"' 1. l 1. y r' ' �. 4'� r v 4 1 ;roll s J f 1 Y2003 lof, t �,, •V q Rya. , 7GWa1MtY114i,�:. `vi vt .. - � / �f. ♦ ` F" ! MWT�.. � m M j o��$�f F01/( G Town Hall Albert J.Krupski,President 53095 Route 25 James King,Vice-President o� y P.O.Box 1179 Artie Foster COD = Southold,New York 11971-0959 Ken Poliwoda • !� Peggy A.Dickerson ,f. Telephone(631) 765-1892 A01 Fax_(631) 765-1366 BOARD OF TOWN TRUSTEES TOWN OF SOUTHOLD BOARD OF TRUSTEES: TOWN OF SOUTHOLD --------------------------------------------------- In the Matter of the Application of -- L------------------------- UNTY OF SUFFOLK) STATE OF NEW YORK) AFFIDAVIT OF POSTING �&siding at 12, E -being duly sworn, depose and say: T That on the // day of Ly ,200,3, I personally posted the property known as by placing the Board of Trustees official poster where it can easily be seen, and that I have checked to be sure the poster has remained in pla or eight days prior to the date of the public hearing. Date of hearing noted thereon to be held 1. -d 3 r Dated: F 1 j f , 'fure) Swam to efore me this ,�J day o 2003 U � Notary Pu�Ic LINDAJ.COOPER Notary►Public,State Of N6W York OCR No.giros December Suffolk 39,��. VW 41 1 Board Of Southold Town Trustees at SOUTHOLD, NEW YORK b DATE: 2002 J� .. �• PERMIT NO. ... ........+ar..� '�, ...,......- - i •x._ •,. ANTHONY & LOUISE GAMBINO ,^ ................................................ ISSUEDTO .....................:........ . .. ...:.......................................... fit} t ♦trtN #� Pursuant to the provisions of Chapter 615 of the Laws of. u the State of New York, 1893; and Chapter 404 of the Laws of the t« State of New York 1952; and the Southold Town Ordinance en- " titled ."REGULATING AND THE PLACING OF OBSTRUCTIONS IN AND ON TOWN WATERS AND PUBLIC LANDS and the REMOVAL OF SAND, GRAVEL-OR OTHER MATERIALS FROM LANDS UNDER TOWW WATERS;':': and in accordance with the / Resolution of The Board adopted at a meeting held on ...May...2- ..... _ 20a2 and in consideration of the sum of ......._..2a.;.p0.. paid by ....................................., ...... An ..:.. tha'rny..;.&...Lo6se...Ganlvino.................... `> the reverse o t of .. E..ast.._Marion........ ...................................... N. Y. and subject t he ` side hereof, Terms and Conditions listed on a R u y� of Southold Town Trustees authorizes and permits the following: « 1 Wetland Permit construct second story addition on house -. �- (bedroom) with the stipulation that there be a staked row of h _ ' haybales prior to construction with the addition of gutters for roof-alp- a. well ag `d� all in accordance wi ` h� iled specifications as presented in « the originating application. Sr _ IN- WITNESS WHEREOF, The said Board of Trustees here- i by causes its Corporate Seal to be affixed, and these resents to p subscribed by a majority of the said Board as of this date. Y be su ,. Trustees - r rim RA TERMS and CONDITIONS The Permittee .'' . 1.,705 Truman's Path, East Marion N. y., as residingat 4 part' of the consideration for the issuance of the ,.Permit does' and presctr�be to the fol- lowing: 1. That the said Board of Trustees and the Town of Southold are released from any and all damages, or claims for damages, of suits &rising directly or indirectly as a result of any open- - adon performed pursuant to this permit, cad the said Permittee will, at his of her own expense, defend any and all such suits initiated by third pStties, and the said Permittee assumes full liability with. respect thereto, to the complete'exclusion of the Board of Trustees of the Town of Southold 2. That this Permit is valid for a period of 24 mo& which is considered to be the estimated time'required to complete the work involved, but'should.drembstances warrant, request for an mmension may be made to the Board at a later daft 3. That this Permit should be retained indefinitely, or as long as the said Permitter wishes to*maintain the structure or project involved, to provide evidence to anyone concerned that or& Iorization was originally obtained. 1 4. That the work-involved will be subject to the inspection and approval of the Board or its agents, and non-compliance-with.the provisions of the originating application. may be cause for revocation of this Pemut by resolution of the said Board. 5. That there will be no unreasonable interference with navigation as a result of the wodc herein authorized. I 6. That there shall be no interference with the right of the public to pass and repass along the beach between high and low water marks. 7. That if future operations of the Town of Southold require the.removal and/or alterations . in the location of the work herein authorized, or if, in the opinion of the Board of Trustees, the. work shall cause unreasonable obstruction to free navigation, the said Permittce will be requlfed, upon die notice, to remove or alter this work or project herein stated without expenses to the Tows . of Southold. 8. That the said Board will be notified by the Permittee of the completion,of the work with- . orized. f 9. . That the Permittee will obtain all other permit and ousenttttt t obtain tame.&xt nay be required � plemental to this permit which may be subject to upon FROM :JENNIFER B GOULD FAX -NO. :631=477-2601 13 2002 10:59RM P1 JENNIFER B. GOULD A#or„ey at 1AEv Z 10 Main Strccr • P.O. Box 177 Greenport, New York 11944 Telephone 6.41.477.8607 • Fax 631-4774(,01 February 13, 20(.')2 Southold Town Trustees PO Box 1179 Southold, NY 11971 �'; Anthony Gambino Premises: ..1705 Truman's Path, East Marion,NY SCTM#1000.31-13.5 Dear Town Trustees: Please be advised that I represent Anthony and Louise Gambino. Evidently, they have misplaced or never received copies of the Trustee permit and resolution that were issued in May 2002 authorizing an addition to their Single family dwelling at the above premises. Kindly send me copies of the Trustec permit and resolution. Ver truly yours, J inifer B. Gould Albert J.Krupski,President Town Hall James King,Vice-President ` QSV �C 53095 Route 25 Artie Foster �54�' D�j P.O.Box 1179 � y Southold,New York 11971-0959 Ken Poliwoda o Peggy A.Dickerson y Z Telephone(631) 765-1892 Fax(631) 765-1366 �01 � Sao BOARD OF TOWN TRUSTEES TOWN OF SOUTHOLD May 30, 2002 Crowley Marine Construction c/o Susan E. Long Permits PO Box 46 East Marion,NY 11934-0046 RE: SCTM#31-13-5 Anthony &Louise Gambino 1705 Truman's Path, East Marion,NY Dear Ms. Long: The following action as taken by the Board of Town Trustees during a Regular Meeting,held on May 22, 2002,regarding the above matter. WHEREAS, Susan E. Long Permits on behalf of Anthony &Louise Gambino applied to the Southold Town Trustees for a permit under the provisions of the Wetland Ordinance of the Town of Southold,.application dated April 29, 2002 WHEREAS, said application was referred to the Southold Town Conservation Advisory Council for their findings and recommendations, and WHEREAS, a Public Hearing was held by the Town Trustees with respect to said application on May 22, 2002 at which time all interested persons were given an opportunity to be heard, and, WHEREAS, the Board members have personally viewed and are familiar with the premises in question and the surrounding area, and, WHEREAS,the Board has considered all the testimony and documentation submitted r concerning this application, and, WHEREAS, the structure complies with the standard set forth in Chapter 97-18 of the Southold Town Code. WHEREAS, the Board has determined that the project as proposed will not affect the health, 2 i safety and general welfare of the people of the town, NOW THEREFORE BE IT. RESOLVED, that the Board of Trustees approved the application of Anthony&Louise Gambino for a Wetland Permit to construct second story addition on house(bedroom) With the stipulation that there be a staked row of haybales prior to construction with the addition of gutters for roof—run off—as well as drywells. BE IT FURTHER RESOLVED that this determination should not be considered a determination made for any other Department or Agency,which may also have an application pending for the same or similar project. Fee must be paid, if applicable and permit issued within six months of the date of this notification. If inspections are required, at a fee of$5.00 per inspection(See attached schedule). FEES: None Very truly yours, Albert J. Krupski, Jr. President,Board of Trustees AJK/cjc cc DEC Building Department Albert J.Krupski,President Town Hall James King,Vice-President OSQFF�(�C 53095 Route 25 Artie Foster P.O.Box 1179 'y Southold,New York 11971-0959 Ken Poliwoda co Peggy A.Dickerson y Z Telephone(631) 765-1892 Qy �.LC Fax(631) 765-1366 col � Sao BOARD OF TOWN TRUSTEES TOWN OF SOUTHOLD COASTAL EROSION MANAGEMENT PERMIT Permit Number: 5564 Date: May 29,2002 Name of Applicant/Agent: Crowley Construction—Susan E. Long Permits Name of Permittee: Anthony&Louise Gambino Address of Permittee: 1705 Truman's Path East Marion,NY Description of Activity: Construct second story addition on house(bedroom)with the stipulation that there be a staked row of haybales prior to construction with the addiion of gutters for roof— run off as well as drywells. Date of Permit Issuance: May 22, 2002 This permit is valid for a period of two years from the dates of issuance. SPECIAL CONDITIONS: ------Bluff restoration through a re-vegetation agreement is a necessary special condition of this permit. A relocation agreement is attached hereto and is a necessary special condition to this permit. A maintenance agreement as attached with application and is a necessary special condition of this permit. Albert J. Krupski, Jr. President,Board of Trustees AJK:cjc Town Hall. 53095 Main Road cpn P.O. Box 1179 Telephone O Southold, New York 11971 (631) 765-1892. SOUTHOLD TOWN CONSERVATION ADVISORY COUNCIL At the meeting of the Southold Town Conservation Advisory Council held Monday, May 20, 2002,.the following recommendation was made: Moved by Drew Dillingham, seconded by Jason Petrucci, it was RESOLVED to recommend to the Southold Town Board of Trustees-APPROVAL of the Wetland Permit Application of ANTHONY L. & LOUISE GAMBI,NO`to-construct-a� second-story addition onto the dwelling Located: 1705 Truman's Path, East Marion. SCTM#31-13-5 Vote of Council: Ayes: All Motion Carried APPt-1 CAN T; LAND or o s cTM # l oaD-J1-Id- ANTFtON� L . GAMBINb ( `I I'lo5 -ravMAN PATH 25 RlGt4Tr F-A5r MAF, ON, � II4,39 TRU Mrs N "S 'PAT H PKEPARE.D BY: .SOSAN E. LDNG Po.80 x �L EAST MARiLN . Ny i193Q o 2 PRep�sEn : ; C� CoNST RUCT AND o ^7 a M v STbm ADD IrtbN ou z r' �7 V) J F� h Q' V rr v Dr) oh� �Y U7� Qom. CY Q�►.o �r'P�R 4 1L4 X�d z STE-P5 / ORoI Nock,R.'Y HIGH v,/^�F Fi MAN.k — scA t- l = 30 0o SHEET 1 �' �t "��{ �•.Tip _ �� 4 5.•!Y, � �• '� ` �A�� �4 l'/�_t'C + � � ,�I�� *+!.1A�IpM.vr��-6'r-��.i� +a�.�., .� �'Y�3. ��e^.' �, Q��.i � �^ , {}y� �•:,'G�y a yr�/ u i lwk �y L i � ! ` 4b � �\ a "�� •(^ �� � ,*� �� a7� _ ..fit ..,, Nil 1 F �' T :'C �; 1�• i' :fit a n J Krupski, President ,4,11 F O(,, Town Hall ling, Vice-President 53095 Route 25 Henry Smith P.O. Box 1179 Cm Asue Foster C4 tier. Poliwoda C4 Southold, New York 11971-0939 Telephone (631) '765-1892 0 Fax (631) 765-1366 BOARD OF TOWN TRUSTEES O R I GINA L TOWN OF SOUTHOLD Office Use Only L/Coastal Erosion Permit Applicati n Welland Permit ApplicationV Major Minor WaP,-er/ArnendmwTha,nApplication: 0 yes,,/ Received Application: /04 _._Rece1VedFee1 Completed Application qNk Incomplete SEQRA Classification 2 920 'l)pe l_Type ll_Unlisted__ Coordination.(date sent) L to—m:'i CAC Referral Sent. L _ Date of Inspection: __Receipt of CAC Report — Lead Auency Determination: Technical Review:- Public HearingHeld:_T* _Resolution Name ot'.Applicant ARTROmm (;hMalut) A d d ve s S 15 50U-VH vimplic ^UTM PL#(Ca 'T ----------- Phone Number-( S-..'-'T01fk C'Wfflty I-R.N.flap Number. 1000 - P.-Open.\ Location MA N I S FWr fi i o tj K 1-4 11 q 3 7 provide Ll LCO Pole 9, distance to cross streets, and location) V AGENT U� SUSC__hr�m jJT' ( I Capplicable) Address Y, Board of Trustees Application WETLAND/TRUSTEE LANDS APPLICATION DATA Purpose of the proposed operations: 0 Area of wetlands on lot: /� square feet Percent coverage of lot: /- Closest distance between nearest existing structure and upland edge of wetlands: M feet r=-Y45r/f4 4 P U l,k 4 K-}4,D Closest distance between nearest proposed structure and upland edge of wetlands: N f} feet Does the pr ject involve excavation or filling? No Yes If yes, how much material will be excavated?. cubic yards How much material will be filled? _cubic yards Depth of which material will be removed or deposited: feet Proposed slope throughout the area of operations: y-p -- - Manner in which material will be removed or deposited: 2002 ISPLA N l7 �M 5TkU / N i lM,f3F 122;Pi rl � 1p] Statement of the effect, if any, on the wetlands and tidal waters of the town that may result by reason of such proposed operations.(use attachments if appropriate): Ma K r 5F_ t Ko N M ANT Board of Trusteos Application GENERAL DATA Land Area (in square feet):_ (b, D O d Area Zoning: �l:-S (> .t! K) T/ U) FR-Or)T - SfP6Gr� FAM1t✓y Previous use of property: RFS 1 D 6 N Cl✓ Intended use of property: IJp Cif ,g J Prior permits/approvals for site improvements: Agency Date No prior permits/approvals for site improvements. Has any permit/approval ever been revoked or suspende by a governmental agency? No Yes If yes, provide explanation: Tr. Project Description (use attachments if necessary): . -- - CC>KS`CT� T S�caN� ST'aRl, AWA IT1du o u S APR 2002 OR HIfAl 0F S0 T 6H0L Board of Trustees Application COASTAL EROSION APPLICATION DATA Purposes of proposed activity: S E-CO M b 57D R�4 b D-b(T In !� �B�bRoaM� Are wetlands presentwithin 100 feet of the proposed activity? No ✓/Yes Does the project involve excavation or filling? No Yes If Yes, how much material will be excavated?--Cam— (cubic yards) How much material will be filled? -- o — (cubic yards) Manner in which material will be removed or deposited: Describe the nature and extent of the environmental impacts reasonably anticipated resulting from implementation of the project as proposed. (Use attachments if necessary) NO :Z B VACT `rQ EM Ul M K) LAE�KT (3-P L.A-N C-C)N ST K U cT i 0 N UH APR 2602 I PROOF OF MAILI J OF NOTICE (r`. ATTACH CERTIFIED-- MAIL RECEIPTS r . • ce Name: f i' (DomesticCERTIFIED MAIL RECEIPT Only; Provided) rri . ru b a SOUTH00, NY 11W1 j \ Postal • ' e $ 0.34 UNIT ill: 0939 Service � �{ ■ ■ ■ CERTIFIED ~ a�� 2■10 Postmark irance,Coverage Provide (Domestic mail only;No Insurance • r 9 C/) ��eceipt Fe Here ru .(End r nt4equired) rn cJ3 :Article Sent To: C3 Res icted le IN e Clerk: KZWHO M 0 (Endo ement R e C0 lid 1193 0 Pf) =�� Total( ge CI s 244 OS/15/0Z 'G a $ 0.34 U� �'� �e . i34 UNIT ID: 0939 / CI Name((PPle�a(s/e�rint Clearly)(to be completed Iby mailer) jutifi 2.10 C3 ---�-11UQf-----'l..t-6-LUM„1�----- 10 Postmark C to>j y Street,A t.No.;or PO Box No. Here GR�irn R tEe � G A 6 F._... 4 a1� _ Brld�rsement R e 0 ...-t te,---- icted very ee C sirs tarUziP+a��� ` R Clerk: KZMHO ,,(En or red) .0 �� , 44 O5/15/02 o _. � 2.44 0� i � --Reverse- p Total Postage&Fees —a CI Name(Please Print Clearly)(to be completed by mailer) O Name(Please Print Clearly)(to be completed by mailer) ' �L(^ � �� ------- ------------------------------------------ Street,Apt.No or P--Box No ---- II l�K------------------------------- Street,Pt.No.;or PO Box No. 6 O �Il�` I -------------------------- ' City,State,ZIP+4 City,State,ZIP+4tp- R 1b n N l �l 3 EP�sT M A mod :,, Sea Reverse for Instructions PAU K-E , residing at NV EED FOR b h)V c being duly sworn, deposes and says that on khe 1S, day of 1 , ,� , deponent mailed a true copy of the Noticekset forth in the Board of Trustees Application, directed to each of the above named persons at the addresses set opposite there respective names; that the addresses set opposite the names of said persons are the address of said persons as shown on the current assessment roll of the Town of 'Southold; that said Notices were mailed at the United States Post Office at that said Notices were mailed to each of said persons by (certified) (registered) mail . SUSAN E.LONG Sworn to before me this Notary Public,State of New York ^ No.01 L0495634�3 day of ,d062 Qualified in Suffolk County Commission Expires November 6,301o5 A A K'q otary Public �b� 6 NOTICE TO ADJACENT PROPERTY OWNER BOARD OF TRUSTEES TOWN OF SOUTHOLD In the matter of applicant: rt ont 1, l'�nnr51 N'b SCTM#1000 31 �3 S YOU ARE HEREBY GIVEN NOTICE: 1 . That it is the. intention of the undersigned to request a Permit from the Board of Trustees to: CoNs'cRUcT SGCDNd 5TOKI AbAITIbN 2 . That the property which is the subject of Environmental Review—is located adjacent. to your property and is described as follows : 3 . That the project which is subject to Environmental Review under Chapters 32 , 37 , or 97 of the Town Code is open to public comment on: M �. you may contact the Trustees Office at 765-1892 or in writing. The above referenced proposal is under review of the Board of Trustees of the Town of Southold and does not reference any other agency that might have to review same proposal . OWNERS NAME: AN-t-140K L., C,,q•MR►No MAILING ADDRESS :T 50SANI f^ 1:6WC TE-pM n-S 1173 7-OCR 4L PHONE # : (_4:2 7 Enc . : Copy of •"sketch or plan showing proposal for your convenience. S �ar, Trustees Applicati� County of Suffolk State of New York SUSA R F- 0 N C; BEING DULY SWORN DEPOSES AND AFFIRMS THAT HE/SHE IS THE APPLICANT FOR THE ABOVE DESCRIBED PERMITS) AND THAT ALL STATEMENTS CONTAINED HEREIN ARE TRUE TO THE BEST OF HIS/HER KNOWLEDGE AND BELIEF, AND THAT ALL WORK WILL BE DONE IN THE MANNER SET FORTH IN THIS APPLICATION AND AS MAY BE APPROVED BY THE SOUTHOLD TOWN BOARD OF TRUSTEES. THE APPLICANT AGREES TO HOLD THE TOWN OF SOUTHOLD AND THE TOWN TRUSTEES HARMLESS AND FREE FROM ANY AND ALL DAMAGES AND CLAIMS ARISING UNDER OR BY VIRTUE OF SAID. PERMIT(S) , IF GRANTED. IN COMPLETING THIS APPLICATION, I HEREBY AUTHORIZE THE TRUSTEES, THEIR AGENT(S) OR REPRESENTATIVES(S) , TO ENTER ONTO MY PROPERTY TO INSPECT THE PREMISES IN CONJUNCTION WITH REVIEW OF THIS APPLICATION. Signature SWORN TO BEFORE ME THIS �I CI DAY OF oZ on Notary Public CLAIRE L.GLEW Notary public,State of Now York No.01GL4879505 Qualified in Suffolk County ,1 Commission Expires Dec.8,�SdL(1 7 �G AUTHORIZATION FORM Date: Da, L " ( owner of f �Os 1 PuM��S name) Rrh located at E 5 0� /V (street address) (town & state) do hereby give ;1 j ('',� and Susan E. Long the authority to act as agent on my behalf in applying co tractor) for all necessary Permits for work to be done on my property described above. Signature In, ; , 2y APR 2G02 i r� 14-16-2 (9/95)-7c 61716 S EQ R Appendix A State Environmental Quality Review FULL ENVIRONMENTAL ASSESSMENT FORM Purpose: The full EAF is designed to help applicants and agencies determine, in an orderly manner, whether a project or action may be significant.The question of whether an action may be significant is not always easy to answer. Frequent- ly, there are aspects of a project that are subjective or unmeasureable. It is also understood that those who determine significance may have little or no formal knowledge of the environment or may 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 whereby 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 TiProvid'es objective data and information about a given project and its site. By-identifying basic project,. data, it assists a reviewer in the analysis that takes place in Parts 2 and 3. Part 2: Focuses on Identifying the range of possible impacts that may occur from a project or action. It provides guidance as,to whether an•impact is likely to be considered small to moderate or whether it is a potential ly- large impact. The form also Identifies whether an impact can be mitigated or reduced. Part 3:. If any impact in Part 2 is identified as potentially-large, then Part 3 is used,to evaluate whether or not the impact is actually important. DETERMINATION OF SIGNIFICANCE—Type 1 and Unlisted Actions Identify the Portions of EAF completed for this,project: ❑ Part 1 0 'Part 2 OPart 3 Upon review of the information recorded on this EAF(Parts 1 and 2 and 3 if appropriate), and any other supporting information, and considering both the magnitude and importance of each impact, it is reasonably determined by the lead agency that: O 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. O 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, 1. therefore a CONDITIONED negative declaration will be prepared.* O C. The project may result in`one'or'mo',e'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 yalid for Unlisted Actions Name of Action , In i:s Is, Name of Lead Agency 6,UL i kTf V%9 ice" a�e N Print or Type Name of Responsible Officer in Lead Agency Tittle-jof-aResPoii nhVee-Officer Signature of Responsible Officer in Lead Agency Signature of Preparer(If different from responsible officer) Date ' . 1 01 PART 1—PROJECT INFORMATION Prepared by Project Sponsor NOTICE: This document is designed to assist in determining whether the action proposed may have a significant effect on the environment. Please complete the entire form, Parts A through E. Answers to these questions will be considered as part of the application for approval and may be subject to further verification and public review. Provide any 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 or investigation. If information requiring such additional work is unavailable, so indicate and specify each instance. NAME OF ACTION ANT46 ! D LOCATION OF ACTT N onclude Slreel Add(ess, Municipality and County) rr O NAME OF APPLICANTISPONSOR C BUSINESS TELEPHONE cKnWLr_ I o a 6 PE jT'S (6 ) 7 ADDRESS �,� STATE. ZIP CODE NAME OF OWNER of different) BIJSINEdS ITELEPHONE T 0 L• Pr 9 13 f -0 ADDRESS S V l U1J ,fPO STATE.z, ZIP CODE ClT C'PCKI.F_ CS! DESCRIPTION OF ACTION Cb14sTX\) cr ND 3TOKZ }�U1�lT IOl�l © t�ouSC . Please Complete Each Question—Indicate N.A. if not applicable A. Site Description Physical setting of overall project, both developed snd undeveloped areas._ 1. Present land use: 00rban Olndustrial OCommercial ®Residential(suburban) ORural(non-farm) ❑Forest OAgriculture ®Other ATE R fi IZo K1, 2. Total acreage of project area: acres. APPROXIMATE ACREAGE PRESENTLY AFTER COMPLETION Meadow or Brushland (Non-agricultural) acres acres Forested acres acres Agricultural (Includes orchards, cropland, pasture, etc.) acres acres Wetland (Freshwater or tidal as-per Articles 24, 25 of ECL) acres acres Water Surface Area acres acres Unvegetated (Rock, earth or fill) acres acres Roads, buildings and other paved surfaces acres acres Other (Indicate type) Rrz510"I'LAL_. L.OT acres ' aS acres 3. What is predominant soil type(s) on project site?. ' a. Soil drainage: "VWell drained % of site OModerately well drained _— % of site OPoorly drained % of site b. If any agricultural land 1s involved, how many acres of soil are classified within soil group 1 through 4 of the NYS Land Classification System? . No/A , acres. (See 1 NYCRR 370). 4. Are there bedrock outcroppings on project site? Oyes ONO a. What is depth to bedrock? -arA,(in feet) 2 5. Approximate percentage of proposed project site with slopes: N0-10% % 010-15% 015% or greater % 6. Is project substantially contiguous;to;',or contain a building, site, or district, listed on the State or the National Registers of Historic Places? : OYes. ' ®No 7. Is project substantially contiguous to a site listed on the Register of National Natural Landmarks? OYes (&No 8. What is the depth of the Water table? (in feet) 9. Is site located over a primary, principal, or sole source aquifer? OYes ®No 10. Do hunting, fishing or shell fishing opportunities presently exist in the project area? CdYes ONo 11. Does project site contain any species of plant or'anirnal life that is identified as threatened or endangered? OYes ®No According to S_ SAN 17K LONG Identify each species 12. Are there any unique or unusual land forms on the project site? (i.e., cliffs, dunes, other g.eological.formations) OYes ®No Describe At 13. Is the project site presently used by the communit or neighborhood as an open space'or recreation area? OYes ®No . If yes, explain JV A 14. Does the present site include scenic views known to be important to the community? OYes 0No 15. Streams within or contiguous to project area: /V A a: Name of Stream and name of River to which it is tributary AIA s• 16. Lakes, ponds, wetland areas withI6 or'-contiguous to project area: a. Name l N t<-R S• A b. Size (In acres) 000-1- 17. Is the site served by existing public utilities? ®Yes ONo a) If Yes, does sufficient capacity exist to allow �onnectlon? O.Yes ONo (Y/A b) If Yes, will improvemdnts be necessary to allow connection? Oyes , ONo NIA 18. Is the site located in an agricultural district certified pursuant to Agriculture and Markets Law, Article 25-AA, Section 303 and 304? Oyes IgNo 19. If.the site located in or substantially contiguous to a Critical Environmental Area designated pursuant to Article 8 of the ECL, and 6 NYCRR 617? OYes ®No ' 20. Has the site ever been used for the disposal of solid or hazardous wastes? OYes ONo B. Project Description 1. Physical dimensions and scale of project(fill in dimensions as appropriate) a.,Total contiguous acreage owned or controlled by projectsponsor ^o acres. b. Project acreage-to be developed: , 2 acres initially; acres ultimately. c. Project acreage to remain undeveloped o acres.. d. Length of project, in miles: (If appropriatd. e. -If the project is an expansion, indicate percent of expansion proposed dA f. Number of off-street parking spaces existing ; proposed N(A g. Maximum vehicular trips generated per hour (upon completion of project)? h. If residential: Number and type of housing units: tt One Family Two Family Multiple Family Condominium Initially ' Ultimately 1. Dimensions (in feet) of largest proposed structure height; width; length. j. Linear feet of frontage along a public thoroughfare project will occupy.is? ft. 3 2. How much natural material (i.e., rock, earth, etc.) will be removed from the site? "a= tons/cubic yards 3. Will disturbed areas be reclaimed? OYes ONo ®N/A I a. If yes, for what intended purpose is,the site being reclaimed? N b. Will topsoil be stockpiled for reclamation? Oyes ONO c. Will upper subsoil be stockpiled for reclamation? OYes ONO 4. How many acres of vegetation (trees, shrubs, ground covers) will be removed4rom site? "d "' acres. 5. Will any mature forest (over 10.0 years old) or other locally-important vegetation be removed by this project? OYes ®No 6. If single phase project: Anticipated period of construction ON.E• months, (including demolition). 7. If multi-phased: a. Total number of phases anticipated (number). b. Anticipated date of commencement phase 1 month year, (including demolition). c. Approximate completion date of final phase month..' year. . d. Is phase 1 functionally dependent.on subsequent phases? Oyes ONO 8. Will blasting occur during construction? Oyes ONO 9. Number'of jobs generated: during construction `� ; 'after project is complete 10. Number of jobs eliminated by this project ��- 11. Will project require relocation of any projects or facilities?,, OYes ®No If-yes, explain N JA 12. Is surface liquid waste disposal involved? Oyes ONO CIA a. If yes, indicate type of waste (sewage, industrial, etc.) and amount b. Name of water body into which effluent will be discharged HI-A 13. Is subsurface liquid waste disposal involved? Oyes ONO Type N proposal? DYes ONO 14. Will surface area of an existi9 water body increase or decrease by p p Explain N!A 15. Is project or any portion of project located in a 100 year flood plain? OYes ONO 16. Will the project generate solid waste? OYes ®No a. If yes, what is the amount per month tons b. If yes, will an existing solid waste facility be used? Oyes ONO c. If yes, give name location d. Will any wastes not go into a sewage disposal system or into a sanitary landfill? OYes JINo e. If Yes, explain N 17. Will the project involve the disposal of solid waste? OYes ONO a. If yes, what is the anticipated rate of disposal? _I. tonstmonth. b. If yes, what is the anticipate&site life? 1A _years. 18. Will project use herbicides or pesticides? OYes MNo 19. Will project routinely produce odors (more than one hour per day)? OYes ®No 20. Will project produce operating noise exceeding the local ambierit noise levels? . OYes ®NO 21. Will project result in an increase in energy use? OYes ONO If yes , indicate type(sj N A 22. If water supply is from wells, indicate pumping capacity __hJA— gallons/minute. 23. Total anticipated water usage per day tj 1A gallons/day. 24. Does project involve Local, State or Federal funding? - OYes 14No ' If Yes, explain 4 25. Approvals Required: Submittal Type Date City, Town, Village Board 'OYes IgNo City, Town, Village Planning Board OYes IgNo City, Town Zoning Board OYes 9No City, County Health Department OYes R§No ov o�- u Other Local Agencies lgYes ONo wyi- zQ :ri2kim n1LbjN6 602, Other Regional Agencies. . OYes ®'No State Agencies OYes 19No Federal Agencies OYes XNo C. Zoning and Planning Information 1 . Does proposed action involve a planning or zoning decision? OYes ®No If Yes, indicate decision required: Ozoning amendment Ozoning variance Ospecial use permit Osubdivislon Osite plan Onew/revision of master plan Oresource management plan Oother N JA 2. What is the zoning classification(s)of the site? MS I nE14T j A L U1 a�TEiZ R >MT 3. What is the maximum potential development of the site if developed as permitted by the present zoning? 4. What is the proposed zoning of the site? N I A 5. What is the maximum potential development of the site if developed as permitted by the proposed zoning? NIA 6. Is the proposed action consistent with the recommended uses in adopted local land use plans? ®Yes ONo 7. What are the predominant land use(s) and zoning classifications within a 1/4 mile radius of proposed action? RSA 1 D1"hIT1PrL I11AT9-K Rr.n8-r 8. Is the proposed action compatible with adjoining/surrounding land uses within a '/ mile? ®Yes ONo 9. If the proposed action is the subdivision of lands how many.lots are proposed? -Lj JA a. What is the minimum lot size proposed? q A 10. Will proposed action require any authorization(s) for the formation of sewer or water districts? OYes MNo 11. Will the proposed action create a demand for any community provided services (recreation, education, police, fire protection)? OYes WNo a. If yes, is existing capacity sufficient to handle projected demand? OYes ONo 12. Will the proposed action result in the generation of traffic significantly above present levels? OYes' NNo a. If yes, is the existing road network adequate to handle the additional traffic? OYes ONo D. Informational Details w it Attach an additional information as ma be needed to clarify }y y y yo>Jr project. (here are or may be any adverse impacts associated with your proposal, please discuss such impacts and the measures w�hi �oQ)pj8gpse;to.mitigate or s fl avoid them. f E. Verlfication li;y @ n I.certify that the information provided above is true to the best of my knowledge:— y �" Applicant/S nsor Name N -5 Date C)°2 Signature Title :J�10_VNA0A If the action is in the Coastal Area,and you are a state agency,complete the Coastal Assessment Form before proceeding with this assessment. , ' S Part 2—PROJECT IMPACTS AND THEIR MAGNITUDE . Responsibility of Lead Agency General Information (Read Carefully) • In completing the form the reviewer should be guided by the question:Have my responses and determinations been reasonablei' The reviewer is not expected to be an expert environmental analyst. • The Examples provided are to assist the reviewer by showing types of impacts and wherever possible the threshold of magnitude that.would trigger a response in-column 2.-The examples are generally applicable throughout the State and for most situations.'But, for any specific'.project.or site other examples and/or lower thresholds may be appropriate for a Potential Large Impact response, thus requiring evaluation in Part 3. • The impacts of each project, on each site, in each locality, will vary. Therefore, the examples are illustrative and have been offered as guidance.They do not constitute an exhaustive list of'iinpacts and thresholds to answer each question. • The number of examples per question does not indicate the importance of each question. • In identifying impacts, consider long term, short term and cumlative effects.. Instructions (Read carefully) a. Answer each of the 20 questions In PART 2. Answer Yes If there will be any impact. b. Maybe answers should be considered as Yes answers. c, If answering Yes to a question then check the appropriate box (column 1 or 2) to indicate the potential size of the impact. If Impact threshold equals or exceeds any example provided, check column 2. If impact will, occur but threshold Is lower than example;,check column 1. d. Identifying that an Impact will be potentially large (colurrin�2)does not mean that It is also necessarily significant. Any large Impact must be evaluated In PART 3 to determine significance.Identifying an impact In column 2 simply asks that It'be looked at further. 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 mitigatedby.change(s)In the project to a small to moderate impact, also check the Yes box in column 3. A•No response indicates that such a reduction is not possible. This must be explained In Part 3. 1 2 3 Small to Potential' .Can Impact Be Moderate Large, Mitigated By IMPACT ON LAND " Impact impact Project Change 1. Will the proposed-action result Ina physical change to the project site? ONO OYES Examples that would apply to column 2 • Any construction on slopes of 15% or greater, (15 fdot Ytse per 100 ❑ ❑ QYes ❑No foot of length), or where the general slopes in the project area exceed 10%. • Construction on land where the depth to the water table is less than ❑ ❑ ❑Yes ❑No 3 feet. • Construction of paved parking area for 1,000 or more vehicles. ❑ ❑ ❑Yes ❑No • Construction on land where bedrock is exposed or general ly'within ❑ ❑ ❑Yes - ❑No 3 feet of existing ground surface. • Construction that will continue for more than 1 year or involve more ❑ ❑ ❑Yes ❑No than one phase or stage. • Excavation for mining purposes that would remove more than 1,0.00 ❑ ❑ ❑Yes ❑No tons of natural material (i.e., rock or soil) per year. • Construction or expansion of a sanitary landfill. ❑ ❑ ❑Yes ❑No • Construction in a designated floodway. ❑ Q ❑Yes ❑No • Other impacts ❑ ❑ ❑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.)ONO OYES • Specific land forms:. ❑ ❑ ❑Yes ❑No 6 1 2 3 Small to Potential Can Impact Be IMPACT ON WATER Moderate Large Mitigated By 3. Will proposed action affect any water body designated as protected? Impact Impact' Project Change (Under Articles15,24,25 of the Environmental Conservation Law, ECL) ONO OYES Examples that would apply to column•2 • Developable area of site contains a protected water body. ❑ ❑ ❑Yes ❑No • Dredging more than 100 cubic yards of material from channel of a ❑ ❑ ❑Yes []No protected stream. • Extension of utility distribution facilities through a protected water body. ❑ ❑ ❑Yes ❑No • Construction in a designated freshwater or tidal wetland. ❑ ❑ ❑Yes ❑No • Other impacts: ❑ ❑ ❑Yes ❑No 4. Will proposed action affect any non-protected existing or new body of water? ONO ' .OYES Examples that would apply to column 2' • A 10% increase or decrease in the surface area of any body of water ❑ ❑ ❑Yes ❑No or more than a 10 acre increase or decrease. • Construction of a body of water that exceeds 10 acres of surface area. ❑ ❑ ❑Yes ❑No • Other impacts: O ❑ ❑Yes ONo 5. Will Proposed Action affect surface or groundwater quality or quantity? ONO OYES Examples that would apply to column 2 • Proposed Action will require a discharge permit. ❑ ❑ ❑Yes ❑No • Proposed Action requires use of a'source of water that does not ❑ ❑ ❑Yes ❑No have approval to serve proposed (project) action. • Proposed Action requires water supply from wells with greaterthan 45 ❑ O ❑Yes ❑No gallons per minute pumping capacity. • Construction or operation causing any contamination of a water ❑ ❑ Dyes ❑No supply system. • Proposed Action will adversely affect groundwater. ❑ ❑ ❑Yes ❑No • Liquid effluent will be conveyed off the site to facilities which presently ❑ ❑ ❑Yes DNo do not exist or have inadequate capacity. • Proposed Action would use water in excess of 20,000 gallons per ❑ ❑ ❑Yes ❑No day. • Proposed Action will likely cause siltation or other discharge into an ❑ ❑ ❑Yes ❑No existing body of water to the extent that there"Will be an obvious visual contrast to natural conditions. • Proposed Action will require-the storage'of petroleum or chemical ❑ ❑ Oyes ❑No products greater than 1,100 gallons. • Proposed Action will allow residential uses in areas without water ❑ ❑ ❑Yes ❑No and/or sewer services. • Proposed Action locates commercial and/or industrial uses which may ❑ ❑ ❑Yes ❑No require new or expansion of eAsting waste treatment and/or storage facilities. • Other impacts- - ❑ ❑ OYes ❑No 6. Will proposed action alter drainage flow or patterns, or surface water runoff? ONO OYES Examples that would apply to column 2 • Proposed Action would change flood water flows. 7 ❑ ❑ . ❑Yes ❑No 1 2 3 Small to Potential Can Impact Be Moderate Large Mitigated By Impact. Impact Project Change Proposed Action may cause substantial. erosion. ❑ ❑ ❑Yes ONo Proposed Action is incompatible with existing drainage patterns. ❑ ❑ . ❑Yes ❑No Proposed Action will allow development in a designated floodway. ❑ ❑ ❑Yes ❑No Other impacts: ❑ ❑ ❑Yes ❑No IMPACT ON AIR Will proposed action affect air quality? ONO OYES Examples that would apply to column 2 Proposed Action will induce 1,000 or more vehicle trips in any given ❑ ❑ ❑Yes ❑No hour. Proposed.Action will result in the incineration of more than 1 ton of ❑ ❑ ❑Yes ❑No refuse per hour. Emission rate of total contaminants will exceed 5 lbs. per hour or a ❑ ❑ ❑Yes ❑No heat source producing more than-10 million BTU's per hour. Proposed action will allow an increase in the amount of land committed ❑ ❑ ❑Yes ❑No to industrial use. Proposed action will allow an increase in the density of industrial .❑ ❑ OYes ❑No development within existing industrial areas. Other impacts: ❑ ❑. ❑Yes ❑No IMPACT ON PLANTS AND ANIMALS f. Will Proposed Action affect any threatened or endangered species? ONO OYES Examples that would apply to column 2 Reduction of one or more species listed on the New York or Federal ❑ ❑ ❑Yes ❑No list, using the site, over or near site or found on the site. Removal of any portion of a critical or significant wildlife habitat. ❑ ❑ ❑Yes ❑No Applicafion of pesticide or herbicide more than twice a year, other ❑ ❑ ❑Yes ❑No than for agricultural purposes. ' Ofher impacts: ❑ ❑ ❑Yes QNo ►. Will Proposed Action substantially affect non-threatened or non-endangered species? ONO OYES Examples that would apply to column 2 Proposed Action would substantially., interfere with any resident or ❑ ❑ ❑Yes ❑No migratory fish, shellfish or wildlife species. Proposed Action requires the removal of more than 10 acres ❑ ❑ ❑Yes ❑No of mature forest (over 100 years of, age) or other locally important vegetation. IMPACT ON AGRICULTURAL LAND RESOURCES ' 0. Will the Proposed Action affect agricultural land resources?.. ONO OYES Examples that would apply to column 2 ❑No The proposed action would sever, cross or limit access to agricultural ❑ ❑ ❑Yes land (includes cropland, hayfields, pasture,' vineyard, orchard, etc.) 8 1 2 3 Small to Potential Can Impact E Moderate Large Mitigated B� Impact Impact Project Chan( • Construction activity would excavate or compact the soil profile of ❑ ❑ ❑Yes ON. agricultural land. • The proposed action would irreversibly convert more than 10 acres ❑ ❑ ❑.Yes ❑N, of agricultural land or, if located in an Agricultutal District, more than 2.5 acres of agricultural land. • The proposed action would disrupt or prevent installation of agricultural ❑ ❑ ❑Yes ❑N, land management systems (e.g., subsurface drain lines, outlet ditches, strip cropping); or create a need for such measures (e.g. cause a farm ' field to drain poorly due to increased runoff) • Other impacts: ❑ ❑ [)Yes ON IMPACT ON AESTHETIC RESOURCES 11. Will proposed action affect aesthetic resources? ONO OYES (If necessary, use the Visual EAF Addendum in Section 617.20, Appendix B.) Examples that would apply to column 2 • Prdposed land uses, or project components obviously different from . ❑ ❑ Dyes ❑N< or in sharp contrast to current surrounding land use patterns, whether man-made or natural. • Proposed land uses, or project components visible to users of ❑ ❑ ❑Yes ON( aesthetic resources which will eliminate or.significantly reduce their enjoyment of the aesthetic qualities of that resource. ❑ ❑Yes ❑N( • Project components that will result in the elimination or significant ❑ screening of scenic views known to be important to the area. Q ❑ ❑Yes ON( • Other impacts: IMPACT ON HISTORIC AND ARCHAEOLOGICAL RESOURCES 12. Will Proposed Action impact any site or structure of historic, pre- historic or paleontological importance? ONO OYES Examples that would apply to column 2 • Proposed Action occurring wholly or partially within or substantially ❑ ❑ ❑Yes ON( contiguous to any facility or site listed on the State or National Register of historic places._ ❑ ❑Yes ❑N( • Any impact to an archaeological site or fossil bed located within the El project site. ❑ ❑Yes ❑Nc • Proposed Action will occur in an area designated as sensitive for ❑ archaeological sites on the NYS Site Inventory. ❑ Oyes ❑Nc • Other impacts: ❑ IMPACT ON OPEN SPACE AND RECREATION 13. Will Proposed Action affect the quantity or quality of existing or future open spaces or recreational opportunities? Examples that would apply to column 2 ONO OYES ❑ ❑ OYes ❑N< • The permanent foreclosure of a future recreational opportunity. ❑ ❑Yes ❑N` • A major reduction of an open space important to the community. Q ❑ ❑Yes ❑N` • Other Impacts: 9 1 2 3 Small to Potential Can Impact Be Moderate Large Mitigated By Impact Impact Project Change IMPACT ON CRITICAL ENVIRONMENTAL AREAS 4. Will Proposed Action impact the. exceptional or unique character- istics of a critical environmental area (CEA) established pursuant to subdivision 6 NYCRR 617.14(g) ? ONO OYES List the environmental characteristics that caused the designation of the CEA. Examples that would apply to column 2 Proposed Action.to locate within the CEA? ❑ ❑ ❑Yes ❑No rce? ❑ ❑ Dyes ❑No Proposed Action will result in a reduction in the quantity of the resou ❑ ❑Yes ❑No Proposed Action will result in a reduction in the quality of the resource? ❑ Proposed Action will impact the use, function or enjoyment of the ❑ ❑ ❑Yes ❑No resource? ❑ ❑ Dyes ❑No Other impacts: IMPACT ON TRANSPORTATION 5. Will there be an effect to existing transportation systems? ONO OYES Examples that would apply to column 2 Alteration of present patterns of movement of people and/or goods. ❑ ❑ Yes ❑No Proposed Action will result in major traffic problems. ❑ ❑ ❑Yes ONo Other impacts: ❑ ❑ Dyes ❑No IMPACT ON ENERGY 6 Will proposed action affect the community's sources of fuel or energy supply? . ONO OYES Examples that would apply to column 2 ❑ ❑Yes ❑No Proposed Action will cause a greater than 5% increase in the use of ❑ any form of energy in them'unicipality. ❑ Dyes ❑No Proposed Action will requirethe creation or extension of an energy ❑ transmission or supply system to serve more than 50 single or two family residences or to serve a major commercial or industrial use. ❑ ❑ Dyes ❑No Other impacts: 10 1 2 3 NOISE AND ODOR IMPACTS Small to Potential Can Impact Be 17. Will there be objectionable odors, noise, or vibration as a result Moderate Large Mitigated By of the Proposed Action? ONO OYES Impact Impact Project Change Examples that would apply to column 2 • Blasting within 1,500 feet of a hospital, school or other sensitive ❑ ❑ ❑Yes ❑No facility. • Odors will occur routinely (more than one hour per day). ❑ ❑ Dyes ❑No • Proposed Action will produce operating noise exceeding the local ❑ ❑ Dyes ❑No ambient noise levels for noise outside of structures. • Proposed Action will remove natural barriers that would act as a ❑ ❑ Dyes ❑No noise screen. • Other impacts: ❑ ❑ Dyes ❑No IMPACT ON PUBLIC HEALTH 18. Will Proposed Action affect public health and'safety? . ONO OYES ' Examples that would apply to column 2 •. Proposed Action may cause a risk of explosion or release of hazardous ❑ ❑ Dyes ❑No substances(i.e.oil,pesticides,chemicals, radiation,etc.)in the event of accident or upset conditions, or there may be a chronic low level discharge or emission. • Proposed Action may result in the burial of"hazardous wastes"in any ❑ ❑ Dyes ❑No form (i.e. toxic, poisonous, highly reactive, radioactive, irritating, infectious, etc.) • Storage facilities for one million or more gallons of liquified natural ❑ ❑ ❑Yes ❑No gas or other flammable liquids. • Proposed action may result in the excavation or other disturbance ❑ ❑ Dyes. ONO within 2,000 feet of a site used for the disposal of solid or hazardous waste. • Other impacts: ❑ ❑ ❑Yes ❑No IMPACT ON GROWTH AND CHARAQTER OF COMMUNITY OR NE16HBORHOOD 19. Will proposed action affect the character of the existing community? ONO OYES Examples that would apply to column 2 • The permanent population of the city, town or village in which the ❑ ❑ ❑Yes ❑No project is located is likely to grow by more.than S%. • The municipal budget for capital expenditures or operating services ❑ ❑ ❑Yes ❑No will increase by more than!5% per year as a result of this project. • Proposed action will conflict with officially adopted plans or goals. ❑ ❑ ❑Yes ❑No • Proposed action will cause a change in the density of land use. 11 ❑ ❑Yes ❑No • Proposed Action will replace or eliminate existing facilities, structures •❑ ❑ ❑Yes ❑No or areas of historic importance to the community. • Development will create a demand for additional community services ❑ ❑ Dyes ❑No (e.g. schools, police and fire, etc.) • Proposed Action will set an important precedent for future'projects. ❑ ❑ Dyes. ❑No • Proposed Action will create or eliminate employment. ❑ ❑ ❑Yes ❑No • Other impacts: ❑ ❑ ❑Yes ❑No 20. Is there, or is there likely to be, public controversy related to potential adverse environmental Impacts? ONO OYES If any action In Part 2 Is Identified as a potential large Impact or It you cannot determine the magnitude of Impact, proceed to Part 3 11 Part 3—EVALUATION OF THE IMPORTANCE OF IMPACTS Responsibility of Lead Agency Part 3 must be prepared if one or more impact(s) is considered to be potentially Large, even if the impacts) may be mitigated. Instructions Discuss the following for each impact identified in Columri 2 of Part 2: I . Briefly describe the impact. t could be mitigated ated or reduced to a small to moderate impact by project change(s). 2 Describe(if applicable)how the impac 3. Based on the information available, decide if it is reasonable to conclude that this impact is important. To answer the question of importance, consider: • The probability of the impact occurring • The duration of the impact • Its irreversibility, including permanently lost resources of value • Whether.the impact can or will be controlled • The regional consequence of the impact • Its potential divergence from local needs and goals • Whether. known objections .to the project relate to this impact. (Continue on attachments) 12 b i • , 14.14.11 (9/95}-9c 6.17.20 SEAR Appendix B State Environmental Quality Review Visual EAF Addendum This form ,may be used to provide additional information relating to Question 1 1 of Part 2 of the Full EAF. (To be completed by Lead Agency) Distance Between Visibility Project and Resource (in Miles) 1. Would the project be visible from: 0.1/4 1/4.1/2 1/2.3 3.5 5+ • A parcel of land which is dedicated to and available ❑ ❑ ❑ ❑ ❑ to the public for the use, enjoyment and appreciation of natural or man-made scenic qualities? • An overlook,or parcel of land dedicated to public ❑ ❑ El ❑ observation, enjoyment and appreciation of natural or man-made scenic qualities? • A site or structure listed on the National or State ❑ ❑ ❑ ❑ ❑ Registers of Historic Places? • State Parks? ❑ ❑ ❑ ❑ ❑ • The State Forest Preserve? ❑ ❑ Cl ❑ ❑ • National Wildlife Refuges and state game refuges? ❑ ❑ ❑ ❑ ❑ • National Natural Landmarks and other outstanding ❑ ❑. ❑ ❑ -❑ naturalfeatures? • National bark Service lands? ❑ ❑ ❑ ❑ ❑ • Rivers designated as National or State Wild, Scenic. ❑ ❑ ❑ ❑ ❑ or Recreational? • Any transportation corridor of high exposure, such ❑ ❑ ❑ ❑ ❑ as part of the interstate System, or Amtrak? • A govemmentally established or designated interstate ❑ ❑ ❑ ❑ ❑ or Inter-county foot trail, or one formally proposed for establishment or designation? • A site, area, lake, reservoir or highway designated as . ❑ ❑ ❑ ❑ ❑ scenic? • Municipal park, or designated open space? ❑ ❑ ❑ ❑ ❑ • County road? ❑ ❑ ❑ ❑ ❑ • State? ❑ ❑ ❑ ❑ ❑ • Local road? ❑ ❑ ❑ ❑ ❑ 2. Is the visibility of the project seasonal?(i.e.,screened by summer foliage, but visible during other seasons) OYes ❑No 3. Are any of the resources checked In question 1 used by the public during the time of year during which the project will be visible? ❑Yes ❑No 1 DESCRIPTION OF EXISTINCI VISUAL ENVIRONMENT ' 4. From each item checked in question 1, check those which generally describe the surrounding environment. Within •'/, mile •1 mile Essentially undeveloped D D Forested D D Agricultural D ❑ Suburban residential D D Industrial D D Commercial ❑ D Urban ❑ D River, Lake, Pond D Cliffs, Overlooks D Designated Open Space ❑ Flat El El Hilly . ❑ D Mountainous ❑ D Other El El NOTE:.add attachments as needed 5. Are there visually similar projects within: •1h mile D Yes ❑No '1 miles El Yes No •2 miles ❑Yes ❑No •3 miles DYes ❑No • Distance from project site are provided for assistance.Substitute other distances as appropriate EXPOSURE 6. The annual number of viewers likely to observe the proposed project is NOTE: When user data Is unavailable or unknown, use best estimate. CONTEXT 7. The situation or activity In which the viewers are engaged while viewing the proposed action is FREQUENCY Holidays/ Activity Daily Weekly Weekends Seasonally Travel to and from work ❑ D D ❑ Involved In recreational activities ❑ D ❑ D Routine travel by residents ❑ ❑ D D At a residence D D D At worksite D ❑ D D Other ❑ D 2