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HomeMy WebLinkAboutTR-5693 � "��^�F'o�"��.% e �.�`�.5.`�r,�q� ��-�� "'eve:�, .•may?,-,�,.. ���`T'"' �- i'�"•x,�•iR •�`• f%,. -�� •,G3,�,r ��' .cis ,,�aF• '�"' � ,�'. � y y a��•;FY- IF pr � H Board Of Southold Town Trustees SOUTHOLD, NEW YORK DATE: Jan. 22, 2003 3. r. I PERMIT NO. ................................. r ' PAUL H ....................... ' ISSUED TO .F�Tz: zALD::............................ ....................... Pursuant to the provisions of Chapter 615 of the Laws of. , w the State of New York, 1893; and Chapter 404 of the Laws of the State of New York I952; and the Southold Town Ordinance en- i_ . z titled ."REGULATING AND THE PLACING OF OBSTRUCTIONS ' IN AND ON TOWN WATERS AND PUBLIC LANDS and the i r .f REMOVAL OF SAND, GRAVEL-OR OTHER MATERIALS FROM LANDS UNDER TOWN WATERS, - ;"• and in accordance with the ; r . Resolution of The Board adopted at a meeting held on ...Januar-.-y...22, F ?: .: i `r and in consideration of the sum of $....200.,.00........ pa d by 4 �, Paul H. Fitzgerald .......................... Green port N. Y. and. subject tote ' of .........................1?.........,......................................... . ` Terms and Conditions listed on the reverse side hereof, of Southold Town Trustees authorizes and permits the following: . Wetland Permit to relocate existing platform, ramp? and float to center of bulkhead - boat slip. ' all in accordance with the detailed specifications as presented in 6 . .the originating application. , IN- WITNESS WHEREOF, The said Board of Trustees Mere- `$ by causes its Corporate Seal to be affixed, and these presents to i be subscribed by a majority of the said Board as of this date. fir. �y,, D rtia Fpg� Trustees }a - r i•- _.. - -- :_2_ i M�: � �' jam''- � Y \t� �• ^ �.�•1.fr., �S••• •`:� '�. � / � TERMS and CONDITIONS The Permittee residing at 255 Osprey Nest Road, Greenport, N. Y., as part-of the consideration for the issuance of the Permit does understand and prescribe to the fol- lowing: i. That the said Board of Trustees and the Town of Southold are released from any and all damages, or claims for damages, of suits arising directly or indirectly as a result of any opeV ation performed pursuant to this permit, and the said Permittee will, at his or her own expense, defend any and all such suits-initiated by third .parties, 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 mos. which is considered to be the estimated time'required to complete the work involved, but should.cirdualstances warrant, request for an extension may be made to the Board at a later date. 3. That this Permit should be retained indefinitely, or as long as the said Permittee wishes to maintain the structure or project involved, to provide evidence to anyone concerned that auth orization was originally obtained. 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 permit by resolution of the said Board. 5. That there will be no unreasonable interference with navigation as a result of the work herein adthorized. 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 Tmstees, the- work shall cause unreasonable obstruction to free navigation, the said Permittee will be required, upon due notice, to remove or.alter this work or project herein stated without expenses to the Town . of Southold 8. That the said Board will be notified by the Permittee or the compledon.cf the work auth- orized. 9. That the Permittee will obtain all other permits and consents that may be rnqurred sup- plemental to this permit which may be subject to revoke upon failure to obtain same. Albs,rt J.Krupski,President Town Hall James King,Vice-President OSVFfO(/�C 53095 Route 25 Artie Foster �Q OG P.O.Box 1179 Ken Poliwoda o 'y Southold,New York 11971-0959 Peggy A.Dickerson H = Telephone(631) 765-1892 Qy �.LC Fax(631) 765-1366 �01 � Sao BOARD OF TOWN TRUSTEES TOWN OF SOUTHOLD January 27, 2003 Crowley Marine c/o Susan E. Long PO Box 46 East Marion,NY 11939-0046 RE: SCTM#35-6-34 Paul H. Fitzgerald 255 Osprey Nest Road Greenport,NY Dear Ms. Long: The Board of Town Trustees took the following action during a Regular Meeting,held on January 22, 2003 regarding the above matter. WHEREAS, Crowley Marine clo Susan E. Long on behalf of Paul H. Fitzgerald applied to the Southold Town Trustees for a permit under the provisions of the Wetland Ordinance of the Town of Southold, application dated December 30t , 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 January 22, 2003 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 concerning this application, and, WHEREAS,the structure complies with the standard set forth in Chapter 97-18 of the Southold Town Code. . 2 WHEREAS, the Board has determined that the project as proposed will not affect the health, Safety and general welfare of the people of the town. NOW THEREFORE BE IT, RESOLVED, that the Board of Trustees approved the application of Paul H. Fitzgerald for a Wetland Permit to relocate existing platform,ramp and float to center of bulkhead-boat slip. 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: $5.00 Very truly yours, a Albert J. Krupski, Jr. President, Board of Trustees AJK/cj c cc DEC Albert J.KruP ski President Town Hall James King,Vice-President OS11FF0���, 53095 Route 25 Artie Foster ° ��j P.O.Box 1179 'y Southold,New York 11971-0959 Ken Poliwoda o= Peggy A.Dickerson ca. Z Telephone(631)765-1892 Qy� �yC Fax(631) 765-1366 BOARD OF TOWN TRUSTEES TOWN OF SOUTHOLD January 27, 2003 Crowley Marine c/o Susan E. Long PO Box 46 East Marion,NY 11939-0046 RE: SCTM#35-6-34 Paul H. Fitzgerald 255 Osprey Nest Road Greenport,NY Dear Ms. Long: The Board of Town Trustees took the following action during a Regular Meeting,held on January 22, 2003 regarding the above matter. WHEREAS, Crowley Marine c%Susan E. Long on behalf of Paul H. Fitzgerald applied to the Southold Town Trustees for a permit under the provisions of the Wetland Ordinance of the Town of Southold, application dated December 30th, 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 January 22, 2003 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 concerning this application, and, WHEREAS,the structure complies with the standard set forth in Chapter 97-18 of the Southold Town Code. 2 WHEREAS,the Board has determined that the project as proposed will not affect the health, Safety and general welfare of the people of the town. NOW THEREFORE BE IT, RESOLVED, that the Board of Trustees approved the application of Paul H. Fitzgerald for a Wetland Permit to relocate existing platform,ramp and float to center of bulkhead-boat slip. 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: $5.00 Very truly yours, Albert J. Krupski, Jr. President,Board of Trustees AJK/cj c cc DEC I Albert J.Krupski,President I �OSVFF®c�CO Town Hall James King,Vice-President 53095 Main Road ti y� P.O.Box 1179 Henry Smith y '� Southold,New York 11971 Artie Foster 2 Ken Poliwoda O Telephone(516) 765-1892 Fax(516)765-1823 BOARD OF TOWN TRUSTEES TOWN OF SOUTHOLD TO: Susan E. Long c/o Crowley Marine Contracting - PAUL H. FITZGERALD Please be advised that your application, dated Dec. 30th, 2002 has been reviewed by this Board, at the regular meeting of January 22, 200*1 and the following action was taken: ( x ) Application Approved (see below) ( ) Application Denied (see below) ( ) Application Tabled (see below) If your application is approved as noted above, a permit fee is now due. Make check or money order payable to the Southold Town Trustees. The fee is computed below according to the schedule of rates as set forth in the instruction sheet. The following fee must be paid within 90 days or re-application fees will be necessary. COMPUTATION OF PERMIT FEES: One inspection @$5.00 TOTAL FEES DUE: $ 5.00 SIGNED: 9 A, - r PRESIDENT, BOARD OF TRUSTEES BY: CLERK, BOARD , F RUSTEE 4/98 Albert J.Krupski,President Town Hall James King,Vice-President �FF04 53095 Route 25 P.O.Box 1179 Artie Foster ®G Ken Poliwoda CC* Southold,New York 11971-0959 Peggy A.Dickerson h Z Telephone(631) 765-1892 py O�.1C Fax(631) 765-1366 BOARD OF TOWN TRUSTEES TOWN OF SOUTHOLD PAUL H. FIa.ZGERALD 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 X Project complete, compliance inspection. Albert J.Krupski,President Town Hall James King,Vice-President OSVFFD(�'C 63095 Route 25 �0�r OG P.O.Box 1179 Artie Foster y� Southold,New York 11971-0959 Ken Poliwoda Peggy A.Dickerson ti = Telephone(631)765-1892 O � � 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 FORA D A VIOLATION AND POSSIBLE REVOCIATION OFT LURE TO DO O SHALL BE CONSIDERED HE PERMIT. INSPECTION SCHEDULE Pre-construction, hay bale line 1 st day of construction 1/2 constructed Project complete, compliance inspection. 'PA U L F} . Y'I T Z. r-F-/-A L D A )SAh Folio Ll , I Io A\16 N IR6 A t LARiL NDNT NJ 1Os38' '?R5 PAR Ft b� Sl35AN E . LbNG PERM lt'S ?o Box � D E AST MAX-Ib N rj1 ! 1.93 j -PRoPasF 1 ; REL_bC/47E, EXfSTINa Z n&r l=oxm, RAMP t RzAT wrrN A.ssbC tA-TFD t°ILJNGS CC t Tb GaN-rr—)L o F' BuLklrl>�Ab D nC s- D ' lsbAT .S L IF ui ` •� �� ry IL 04 M ' � f � � 1 f a � I CST J G B I RA b 5 aE�LT Z 0 F L SEQRA RESOLUTION RE: PAUL H. FITZGERALD SCTM#35-6-34 Resolved by the Board of Trustees of the Town of Southold that the application of PAUL H. FITZGERALD more fully described in the public hearing section #9 of the Trustee agenda dated Wednesday, January 22, 2003 is, pursuant to the SEQRA rules and regulations, an Unlisted Action; and be it Further resolved that the applicant is required to submit Part 1 of the Long Environmental Assessment Form (LEAF); and be it Further resolved that upon receipt of the LEAF the Clerk of the Trustees is hereby directed to commence a coordinated review pursuant to SEQRA. DESCRIPTION OF EXISTiNG VISUAL ENVIRONMENT 4. From each item checked in question 1, check those which generally describe the surrounding environment. Within *1/4 mile *1 mile Essentially undeveloped ❑ ❑ Forested ❑ ❑ Agricultural ❑ ❑ Suburban residential ❑ ❑ Industrial ❑ ❑ Commercial ❑ ❑ Urban ❑ ❑ River, Lake, Pond ❑ ❑ Cliffs, Overlooks ❑ ❑ Designated Open Space ❑ ❑ Flat ❑ ❑ Hilly ❑ ❑ Mountainous ❑ ❑ Other ❑ ❑ NOTE: add attachments as needed 5. Are there visually similar projects within: '1/z mile ❑Yes ❑No '1 miles ❑Yes ❑No •2 miles ❑Yes El No '3 miles ❑Yes ❑No ' Distance from project site are provided for assistance. Substitute other distances as appropriate EXPOSURE 6. The annual number of viewers likely to observe the proposed project is NOTE: When user data Is unavailable or unknown, use best estimate. CONTEXT 7. The situation or activity in which the viewers are engaged while viewing the proposed action is FREQUENCY Holidays/ Activity Daily Weekly Weekends Seasonally Travel to and from work ❑ ❑ ❑ ❑ Involved in recreational activities ❑ ❑ ❑ ❑ Routine travel by residents ❑ ❑ ❑ ❑ At a residence ❑ ❑ ❑ ❑ At worksite ❑ ❑ ❑ ❑ Other ❑ ❑ ❑ ❑ 2 14.14.1 1 c9?95�-9c 617.20 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? ❑ ❑ ❑ ❑ ❑ • National Wildlife Refuges and state game refuges? ❑ ❑ ❑ ❑ ❑ • National Natural Landmarks and other outstanding ❑ O ❑ ❑ ❑ natural features? • National park Service lands? ❑ ❑ ❑ ❑ ❑ • .Rivers designated as National or State Wild, Scenic. ❑ ❑ ❑ ❑ ❑ or Recreational? • Any transportation corridor of high exposure, such ❑ ❑ ❑ ❑ ❑ as part of the interstate System, or Amtrak? • A governmentally established or designated interstate ❑ ❑ ❑ ❑ ❑ or Inter-county foot trail, or one formally proposed for establishment or designation? • A site, area, lake, reservoir or highway designated as ❑ ❑ ❑ ❑ ❑ scenic? • Municipal park, or designated open space? ❑ ❑ ❑ ❑ ❑ • County road? ❑ ❑ ❑ ❑ ❑ • State? ❑ ❑ ❑ ❑ ❑ • Local road? ❑ ❑ ❑ ❑ ❑ 2. Is the visibility of the project seasonal?(i.e., screened by summer foliage, but visible during other seasons) ❑Yes ❑No 3. Are any of the resources checked in question 1 used by the public during the time of year during which the project will be visible? ❑Yes ❑No 1 Part 3-EVALUAT 4 OF THE IMPORTANCE Gel, 'ACTS Responsibility of Lead Agency art 3 must be prepared if one or more impact(s) is considered to be potentially large, even if the impact(s) may be ;mitigated. Instructions Discuss the following for each impact identified in Column 2 of Part 2: t . Briefly describe the impact. 2. Describe(if applicable)how the impact could be mitigated or reduced to a small to moderate impact by project change(s). 3.' Based on the information available, decide if it is reasonable to conclude that this impact is important. To answer the question of importance, consider: • The probability of the impact occurring • The duration of the impact • Its irreversibility, including permanently lost resources of value • Whether.the impact can or will be controlled • The regional consequence of the impact • Its potential divergence from local needs and goals • Whether. known objections to the project relate to this impact. (Continue on attachments) 12 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 tigated By of the Proposed Action? ONO OYES Impact Impact ect 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). ❑ ❑ ❑Yes ❑No • Proposed Action will produce operating noise exceeding the local ❑ ❑ ❑Yes ONO ambient noise levels for noise outside of structures. • Proposed Action will remove natural barriers that would act as a ❑ ❑ ❑Yes ONO noise screen. • Other impacts: ❑ ❑ ❑Yes ONO 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 ❑ ❑ ❑Yes ONO substances(i.e. oil, pesticides,chemicals, radiation,etc.)in the event of accident or upset conditions, or there may be a chronic low level discharge or emission. • Proposed Action may result in the burial of"hazardous wastes" in any ❑ ❑ ❑Yes ❑No form (i.e. toxic, poisonous, highly reactive, radioactive, irritating, infectious, etc.) • Storage facilities for one million or more gallons of liquified natural ❑ ❑ ❑Yes ONO gas or other flammable liquids. • Proposed action may result in the excavation or other disturbance ❑ ❑ ❑Yes ❑NO within 2,000 feet of a site used for the disposal of solid or hazardous waste. • Other impacts: ❑ ❑ ❑Yes ONO IMPACT ON GROWTH AND CHARA¢TER OF COMMUNITY OR NEIGHBORHOOD 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. ONO project is located is likely to grow by more than 5%. 1` • The municipal budget for capital expenditures or operating services ❑ ❑ ❑Yes ❑No will increase by more than 5% per year as a result of this project. • Proposed action will conflict with officially adopted plans or goals. ❑ ❑ ❑Yes ❑No • Proposed action will cause a change in the density of land use. ❑ ❑ ❑Yes ❑No • Proposed Action will replace or eliminate existing facilities, structures .❑ ❑ ❑Yes ONO or areas of historic importance to the community. • Development will create a demand for additional community services ❑ ❑ ❑Yes ONO (e.g. schools, police and fire, etc.) • Proposed Action will set an important precedent for future'projects. ❑ ❑ ❑Yes ONO • Proposed Action will create or eliminate employment. ❑ ❑ ❑Yes ONO • 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 jarge Impact or If you cannot determine the magnitude of impact, proceed to Part 3 11 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 DYES 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? ❑ ❑ Dyes ❑No Proposed Action will result in a reduction in the quantity of the resource? ❑ ❑ ❑Yes ❑No Proposed Action will result in a reduction in the quality of the resource? ❑ ❑Yes ❑No ❑ Proposed Action will impact the use, function or enjoyment of the ❑ ❑ ❑Yes ❑No resource? ❑ ❑ ❑Yes ❑No Other impacts: IMPACT ON TRANSPORTATION 5. Will there be an effect to existing transportation systems? ONO DYES Examples that would apply to column 2 Alteration of present patterns of movement of people and/or goods. ❑ ❑ O.Yes ❑No❑ ❑Yes ❑No Proposed Action will result in major traffic problems. ❑ ❑ ❑ ❑Yes ❑No Other impacts: IMPACT ON ENERGY 6 Will proposed action affect the community's sources of fuel or energy supply? IONO DYES Examples that would apply to column 2 ❑ ❑Yes ONO Proposed Action will cause a greater than 5% increase in the use of ❑ any form of energy in the municipality. Proposed Action will require the creation or extension of an energy El ❑ ❑Yes ONO transmission or supply system to serve more than 50 single or two family residences or to serve a major commercial or industrial use. ❑ ❑ ❑Yes ❑No Other impacts: 10 ' 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 ON. 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: O ❑ ❑Yes ❑N. 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 • Proposed land uses, or project components obviously different from ❑ ❑ ❑Yes ❑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 ❑N( aesthetic resources which will eliminate or significantly reduce their enjoyment of the aesthetic qualities of that resource. • Project components that will result in the elimination or significant ❑ ❑ ❑Yes ❑N( screening of scenic views known to be important to the area. • Other impacts: ❑ ❑ ❑Yes ON( 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 ❑N( contiguous to any facility or site listed on the State or National Register of historic places. • Any impact to an archaeological site or fossil bed located within the ❑ ❑ ❑Yes ❑N( project site. • Proposed Action will occur in an area designated as sensitive for ❑ ❑ ❑Yes ❑N( archaeological sites on the NYS Site Inventory. • Other impacts: ❑ ❑ ❑Yes ❑N( 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 • The permanent foreclosure of a future recreational opportunity. ❑ ❑ ❑Yes ❑N( • A major reduction of an open space important to the community. ❑ ❑ ❑Yes ❑N, • Other Impacts: ❑ ❑ ❑Yes ❑N( 9 1 3 Small to Potential Can Impact Be Moderate Large Mitigated By Impact. Impact Project Change Proposed Action may cause substantial. erosion. ❑ ❑ ❑Yes ❑No Proposed Action is incompatible with existing drainage patterns. ❑ ❑ . ID 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 ❑ ❑ El Yes ❑No refuse per hour. Emission rate of total contaminants will exceed 5 lbs. per hour or a ❑ ❑ ❑Yes -)No heat source producing more than 10 million BTU's per hour. Proposed action will allow an increase in the amount of land committed ❑ ❑ ❑Yes ❑No to industrial use. Proposed action will allow an increase in the density of industrial •❑ ❑ ❑Yes ❑No development within existing industrial areas. Other impacts: ❑ ❑. ❑Yes ❑No IMPACT ON PLANTS AND ANIMALS i. Will Proposed Action affect any threatened or endangered species? ONO OYES Examples that would apply to column 2 Reduction of one or more species listed on the New York or Federal ❑ ❑ Dyes ❑No list, using the site, over or near site or found on the site. Removal of any portion of a critical or significant wildlife habitat. ❑ ❑ ❑Yes ❑No Applicafion of pesticide or herbicide more than twice a year, other ❑ ❑ ❑Yes ❑No than for agricultural purposes. Ofher impacts: ❑ ❑ ❑Yes ❑No i. 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 The proposed action would sever, cross or limit access to agricultural ❑ ❑ ❑Yes ❑No land (includes cropland, hayfields, pasture,' vineyard, orchard, etc.) 8 - s 1 2 3 IMPACT ON WATER Small to Potential Can Impact Be Moderate Large Mitigated By 3. Will proposed action affect any water body designated as protected? Impact Impact Project Change (Under Articles.15, 24, 25 of the Environmental 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: ❑ ❑ ❑Yes ❑No 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 ❑ ❑ OYes ❑No have approval to serve proposed (project) action. • Proposed Action requires water supply from wells with greater than 45 ❑ ❑ ❑Yes —)No gallons per minute pumping capacity. • Construction or operation causing any contamination of a water ❑ ❑ ❑Yes ❑No supply system. • Proposed Action will adversely affect groundwater. ❑ ❑ ❑Yes ❑No • Liquid effluent will be conveyed off the site to facilities which presently ❑ ❑ ❑Yes ONo do not exist or have inadequate capacity. • Proposed Action would use water in excess of 20,000 gallons per ❑ ❑ OYes ❑No day. • Proposed Action will likely cause siltation or other discharge into an ❑ ❑ ❑Yes ❑No existing body of water to the extent that there rWill be an obvious visual contrast to natural conditions. • Proposed Action will require the storage of petroleum or chemical ❑ ❑ ❑Yes ❑No products greater than 1,100 gallons. - • Proposed Action will allow residential uses in areas without water ❑ ❑ ❑Yes ❑No and/or sewer services. • Proposed Action locates commercial and/or industrial uses which may ❑ ❑ ❑Yes ❑No require new or expansion of existing waste treatment and/or storage facilities. • Other impacts: El ❑ ❑Yes ❑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. ❑ O OYes ❑No 7 , 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 reasonable3 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 situation's. But, for any specific, project-or site`other examples and/or.lower thresholds may be appropriate for a Potential Large Impact response, thus requiring evaluation in Part 3. • The impacts of each project, on each site,.in-each locality, will vary. Therefore, the examples are illustrative and have been offered as guidance.They do not constitute an exhaustive list of impacts and thresholds to answer each question. • The number of examples per question does' not indicate the importance of each question. • In identifying impacts, consider long term, short term and cumlative effects. Instructions (Read carefully) a. Answer each of the 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. Identlfying that an Impact will be potentially large (column 2)does not mean that it is also necessarily significant. Any large Impact must be evaluated In PART 3 to determine significance. Identifying an Impact in column 2 simply asks that It be looked at further. e. If reviewer has doubt about size of the impact then consider the impact as potentially large and proceed to PART 3. I. If a potentially large impact checked in column 2 can be mltlgated�by change(s)In the project to a small to moderate impact, also check the Yes box In column 3. A No response Indicates that such a reduction is not possible. This must be explained in Part 3. 1 2 3 Small to Potential Can Impact Be Moderate Large Mitigated By IMPACT ON LAND Impact Impact Project Change 1 . Will the proposed action result in a physical change to the project site? ONO OYES Examples that would apply to column 2 • Any construction on slopes of 15% or greater, (15 foot rise per 100 ❑ ❑ ❑Yes ❑No foot of length), or where the general slopes In the project area exceed 10%. • Construction on land where the depth to the water table is less than ❑ ❑ ❑Yes ❑No 3 feet. • Construction of paved parking area for 1,000 or more vehicles. ❑ ❑ ❑Yes ❑No • Construction on land where bedrock is exposed or generally*within ❑ ❑ ❑Yes - ❑No 3 feet of existing ground surface. • Construction that will continue for more than 1 year or involve more ❑ ❑ ❑Yes ❑No than one phase or,stage. • Excavation for mining purposes that would remove more than 1,000 ❑ ❑ ❑Yes ❑No tons of natural material (i.e., rock or soil) per year. • Construction or expansion of a sanitary landfill. ❑ ❑ ❑Yes ❑No • Construction in a designated floodway. ❑ ❑ []Yes ❑No • Other impacts ❑ ;❑ ❑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"JONO OYES • Specific land forms:. ❑ ❑ ❑Yes ❑No 6 25. Approvals Required: Submittal Type Date City, Town, Village Board 0yes NJ1No City, Town, Village Planning Board OYes 7N0 0 City, Town Zoning Board OYes � City, County Health Department OYes 171No Other Local Agencies 01y,es ONo TOWN TROS I F 15S Other Regional Agencies. OYes &N o State Agencies dyes ONo N�15 d f: C.- 17. f%2. Federal Agencies �R&s ONo ABM COB P3 C. Zoning and Planning Information 1 . Does proposed action involve a planning or zoning decision? OYes ®No If Yes, indicate decision required: Ozoning amendment Ozoniing variance Ospecial use perrnit Osubdivision Osite plan Onew/revision of master plan Oresource management plan Oother N1A 2. What is the zoning classification(s)of the site? PLEB I h9_MT I A L -U)iyrF&F Rn,NT 3. What is the maximum potential development of the site if developed as permitted by the present zoning? rJ th 4. What is the proposed zoning of the site? N I A S. 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 '/ mile radius of proposed action? Ruz I Dt»NT1hL IAJA-rg:_M Fr_>7rtT- 8. Is the proposed action compatible with adjoining/surrounding land uses within a '/ mile? ®Yes ONo 9. If the proposed action is the subdivision of land; how many lots are proposed? —q(1A a. What is the minimum lot size proposed? A! A 10. Will proposed action require any authorization(s) for the formation of sewer or water districts? OYes CNo 11 . Will the proposed action create a demand for any community provided services (recreation, education, police, fire protection)? OYes ®No 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' NNol a. If yes, is the existing road network adequate to handle the additional traffic?.y;.,;",..OYes DNo D. Informational Details Attach any additional information as may be needed to clarify your project. If there are or pi 'y�be ny adverse impacts associated with your proposal, please discuss such impacts and the measures which you propose to mitigate`or avoid them. " E. Verification I.certify that the information provided above is tru to the best of my knowledge. Applicant/Sponsor Name Date Signature. Title If the action is in the Coastal Area, and you e a state agency,complete the Coastal Assessment Form before proceeding with this assessment. 5 , 2. How much natural material (i.e., rock, earth, etc.) will be removed from the site;` tons/cubic yards 3. Will disturbed areas be reclaimed? OYes ONo ON/A a. if yes, for what intended purpose is the site being reclaimed? of 1A 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. S. Will any mature forest (over 100 years old) or other locally-important vegetation be removed by this project? OYes ®No 6. If single phase project: Anticipated period of construction 4N.E. months, (including demolition). 7. If multi-phased: a. Total number of phases anticipated aNI- (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 ®No 9. Number of jobs generated: during construction µ ; after project is complete 10. Number of jobs .eliminated by this project -o— il. Will project require relocation of any projects or facilities? Oyes ®No If yes, explain NIA - 12. Is surface liquid waste disposal involved? Oyes ®No a. If yes, indicate,.type of waste (sewage, industrial, etc.) and amount N1,4 b. Name of water body into which effluent will be discharged 13. Is subsurface liquid waste disposal involved? OYes ONo Type N 14. Will surface area of an existing water body Increase or decrease by proposal? OYes ®No 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 N— tons b. If yes, will an existing solid waste facility be used? OYes CENo c. If yes, give name N���A location N d. Will any wastes not go into a sewage disposal system or into a sanitary landfill? OYes )ONo e. If Yes, explain 17. Will the project involve the disposal of solid waste? Dyes PNo a. If yes, what is the anticipated rate of disposal? NJ�A tons/month. b. If yes, what is the anticipated site life? years. 18. Will project use herbicides or pesticides? OYes MNo - 19. Will project routinely produce odors (more than one hour per day)? OYes ®No 20. Will project produce operating noise exceeding the local ambient noise levels? OYes ®No 21. Will project result in an increase in energy use? OYes ONo. If yes , indicate types) NSA - 22. If water supply is from wells, indicate pumping capacity A gallonslminute. ' 23. Total anticipated water usage per day --N/A gallons/day. 24. Does project involve Local, State or Federal funding? Oyes 14No If Yes, explain tJJA 4 5. Approximate percentage of prod,>�,`,_,�:,'oject site with slopes: C90-10% % 010-15% % 015% or greater % 6. Is project substantially contiguousto;,or contain a building, site, or district, listed on the State or the National Registers of Historic Places? : OYe's ®No 7. Is project substantially contiguous to a site listed on the Register of National Natural Landmarks? OYes (ONo 8. What is the depth of fhe'Water table? A._(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? iRYes ONo 11. Does project site contain any species of plant or-anifnal life that is identified as threatened or endangered; Oyes ®No According to 5 I I SAN E LnN G Identify each species 12. Are there any unique or unusual land forms on the project site? (i.e., cliffs, dunes, other geological formations) OYes ®No Describe A/A 13. Is the project site presently used by the communit or neighborhood as an open space' or recreation area? OYes ®No If yes, explain AtA 14. Does the present site include scenic views known to be important to the community? OYes 5dNo 15. Streams within or contiguous to project area: A a. Name of Stream and name of River to which it is tributary N A il 16. Lakes, ponds, wetland areas withiii or'contiguous to project area: a. Name a'll!� '� b. Size (In acres) 100T 17. Is the site served by existing public utilities? ®Yes ONo a) If Yes, does sufficient capacity exist to allow connection? OYes ONo rf f A b) If Yes, will improvemd-nts be necessary to allow connection.? OYes ONo N/A. 18. Is the site located in an agricultural district certified pursuant to Agriculture and Markets Law, Article 25-AA, Section 303 and 304? OYes QNo 19. If.the site located in or substantially contiguous to a Critical Environmental Area designated pursuant t6 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 project sponsor_ lit acres. b. Project acreage-to be developed: acres initially; acres ultimately. C. Project acreage to remain undev loped acres. d. Length of project, in miles: (If appro riatdi e. -If the project is an expansion, indicate percent of expansion proposed ._%; f. Number of off-street parking spaces existing ; proposed g. Maximum vehicular trips generated per hour (upon"completion of project)? h. If residential: Number and type of housing units: One F mily Two Family Multiple Family Condominium f ; 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 Prig-.�r 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 ' V 4- LOCATION OF ACTION pncluda Street A ress, nIcIpality and County) NAME OF PPLIC T/SPO SOR BUSINESS TELEPHONE iG i 7-3 14Y5 ADD ESS IPO STATE. ]:ZIP CODE NAME OWN R Qf different) BUSINESS TELEPHONE tza ADDRESS C [P0 STATE ;r ZIP CODE DESCRIPTION OF ACTION f 1 t 3� 1 Z t ^J / �✓ �0�� Please Complete Each Question—Indicate N.A. if not applicable A. Site Description Physical setting of overall project, both developed end undeveloped areas. 1. Present land use: 00rban ❑Industrial OCommercial ®Residential(suburban) ❑Rural(non-farm) ❑Forest OAgriculture ®Other I" ATL VEDt`T 2. Total acreage of project area: acres. APPROXIMATE ACREAGE PRESENTLY AFTER COMPLETION Meadow or Brushland (Non-agricultural) --n acres —in,, ^ acres Forested ^r, acres --Q- acres Agricultural (Includes orchards, cropland, pasture, etc.) a acres —o acres Wetland (Freshwater or tidal as per Articles 24, 25 of ECL) acres acres Water Surface Area -�Q 1<<d acres - r x�af acres Unvegetated (Rock, earth or fill) —n r acres ^b acres Roads, buildings and other paved surfaces —6 acres R acres Other (Indicate type) - p — acres _ 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 is involved, how many acres of soil are classified within soil group 1 through 4 of the NYS Land Classification System? _,NI/A acres. (See 1 NYCRR 370). 4. Are there bedrock outcroppings on project site? Oyes SNo a. What is depth to bedrock? (in feet) 2 14-16-2 (9/95)-7c 617.20 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 flexi.ble.en6ugh to.allow,iotroduction pf.'information to fit a,pro.j:ect., or action. Full EAF Components: The full EAF is comprised of three parts: - Part 1: Provides objective data and information about a given project and its site. By identifying basic;project', data, it assists a reviewer in the analysis that takes place in ,Parts 2 and 3. Part 2: Focuses on identifying the range of possible impacts that'may occur from a project or action, I't'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 of reduced. Part 3: If any impact in Part 2 is identified as potentially-large, then Part 3 is used to evaluate whether or not the impact is actually important. DETERMINATION OF SIGNIFICANCE—Type 1 and Unlisted Actions Identify the Portions of EAF completed'for'this.project: ', ❑ Part 1. ❑ Part 2 ❑Part 3 Upon review of the information recorded on this EAF„(Parts:1 and 2 and 3 if appropriate), and any other supporting information, and considering both the magnitude and importance of each impact, it is'-reasonably determined b.y.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 Inone or'moe,e large and important impacts that may have a significantJmpact on the environment, therefore a positive declaration will be prepared. ' A Conditioned Negative Declaration is only valid for Unlisted Actions ________ •; ITl 21 Name of Action Name of Lead Agency Print or Type Name of Responsible Officer in Lead Agency Title of Responsible Officer Signature of Responsible Officer in Lead Agency Signature of Preparer(If different from responsible officer) Date 1 . 4 Town Hall. 53095 Main Road T P.O. Box 1179 Telephone Southold. New York 11971 (631) 765-1892 SOUTHOLD TOWN CONSERVATION ADVISORY COUNCIL At the meeting of the Southold Town Conservation Advisory Council held Wednesday, January 15, 2003, the following recommendation was made: PAUL H. FITZGERALD to relocate existing platform, ramp and float to center of bulkheaded boat slip. Located: 255 Osprey Nest Rd., Greenport. SCTM#35-6-34 The CAC did not make an inspection, therefore no recommendation was made. V x, V 1P + 9 Yw Ot �� " E y C. �, �� n�m $ fr STi�i` r F c�#i �' r fit 5 l t, f` F: ,•` #,+, B; 'S`�� �'' ,1 S 3 AM e ,Ak t 6 1 -NORT 00 35 HASEL- H R d OLS — .1iU55• 356N THOpEASEH R O U�- '� / E ? 5 b 3-r /7 • � 75 70 zos � .. 140 145' CAVA-NAUGH HEANEY PAPAL ONUOS 305 PIRRERA i KA757MATIDES ANGELL Z FITZPATRIgl< 360 N --.'A D I A R T'. 300 38s WIECZ GIANNARISOREK, CASICLO 41s 435 F. FITCH SANEAN- C S60 47O' IEU BOfTO BOUTS ti SHERAIN'4 50 < SEVERINIL FOX F 98'" 1085 1185 1285 AVROED 5B0 WIGGIN5 LANE 715 ®lj, PRATO R.ISRAEL I ZI O 1380 WISSWNN �' 670 f 00 NA11410'A2J CADEDDU D 765 q 194 STErLER 200 NESIN t ts¢AEC W 165 7f0 .250 dMALLEY W..IL'G0X" r MGELROY 1025 TABILE, 810 AUTKOWSKI 275 ® JEZO 1146 370 COLLINS _.'FRAGOCA BABOUKI9 ® 910 FEZ, 405 MOELLER I225 P?YR r<' I�NOIOttf�� WALLIN � BREHM 1075 Z SO.BIESIAK.: 70} 4.70 P 575 010 m 1325 SNYDFR O SUCHER y STOCKER MILLER ^ ` 6G3 WALLIN 50 r �1 11 Yaclzt Club DISK 706 715 GERACI 30o 1425 6y DUGGAN WIEDERSUM WILUAM9 BRENEISEN �cOY' 330 55 Z y P1IkCDq(5 BISHOP 1275 1525 430 Q 35 1316 m HARTOFILIS KOEBELE C LA 450 p 395 GHER FRIES I62S SIMKIN Q- PLIA- IG45 _JO:kES .720 475 CONIs. TRA+10 0. .BECK 1775 "EL 600 a -0_tJEML. SCHOENSTEIH w: h PASSUDEITI STRETCHER Ch1AN:0'NEfLL' s g . SAGE 700 190 70 '{ ` 1576 S.UEl.RO 350 MARINE PLACE KESSLER Boo x 265. 165 65 S%OEN5TEIH 1900 1905 RERISI YARDAtD PATEL RDS50•Haa1N0 QUINTIN AHIERS. VICH ] 755 1865 196o Z ZERWS BASE F. 1160 N OHEN• RODDEN R SUIOENSTEI`1 BRAIDER VESPASIANI RATH• 250 150 50 pSPREY 115 45 355 gETr:: cwue 3329 965 :>1Etv11NG LEil,N1 .GRI64 '•KAAUS.::•-' RO$ENl3AUI21.' I60 75 ERS DURKF, 3327 .I.ACYIA I135 BUTLER MATHER, O 2.70 GEYER 35Z5 805 8'ADAMO' O 255 KAVANAG,H a � '.F.ITZ- . ' DURKA- 745 p ISRAEL 0 GEIWLD TUT HILL ISRAEL '450 335 F Ek'RARA TUTHILL GRRB 85 } N 6 445 STOTLKY 62Y 495 1225 KALUNAS S65 INEEIV I - GEYER S9APIRO 3 =•F77zs;,E;RA;CD� 1240. COOPER 4 - I5RAEL 2 /�'' 5 -FLEMING CLEMPNER 12y SLIPS 6 -GRANDINETTI J 3 7' BADAMO" ' 1000 4 9 _5HAPIRO STOTZKY MANDEL > BEACH f0.-.:B'.$.7..T.I ER 9 f 2 -MANNERS R1GG5 !!/ .870 /0 13.z".YaCHDLIV57E1N" CONANT /31 13.40,SCHOEN9TEIN ti 2 �j 2 13.6 F.SCHOERS(E1N 19.57i;:15Ri4EL F 0 50 100 200 300 400 500 600 taint—�. 5CALE IN FEET bUb DJ 5ADAMO �_ . . ..Tz- I KAVANAC7 745 A ISRAEL 0 -nikALD ISRaEL ' q5O 335 -V'R-AKA lU 685 N E 445 sTDTZk-r GAME 625' �495 S65 GRAND- I - GEYER.- KALVNAS INETTI 2 .D-EMlR•r'Y[AH' 5FlAPIRO a��rx- M-A LP-01 COOPER 4 - 15R.AEL 5 - PEENING v S1.rP5 6 - GRANDINE77i 7 - 5A DAM O - �. S - 5HAPIRO ,S 9 - 5TOTZKY 6 10. --.'&.FT.TJ:ER 6. BEACH ( I 'SCHAAKE�GRJGGS 9 (2 - MANNl:.RS /o r2 13,4 O, SCHOEN.5TEIN 13,6 F, SCHOEN5TEIN )5F ; EL" 70-7�VD-2 i 0 50 IDO 200 -500 4-00 500 600 I 5 CA L-E. 1N FEET �PiZE��R I;� f3DK: T G �N fNQ? PAU L r-1 TZ 6 EZAL b /N STIRLING soTf a DR 'co AINAc FoRb U IIpN P 8 Q 25 48 B LARLi..Ii Iv`Dt7`I" N.J � 1 os38' M11ET 1 -• � 3 � : b f S i R.DN_ c Avv 1O'c Y STIR[I NG °a 9 p g c AIN Y £M.C vE l MARI _.p CnAMO -s V , ai.f • �+ ' �'I.i �� 1 RIUOE A iMlI,�10n SEl n EIi po$YRl• S [ RO� V CE U5AM � �.pNG PERM l'CS J Si A S Ji i @-P f !��'.liti :.w a p^.� - �o NSON 0 �5 �n�Z Si.AGMES i er of BROAD Zm C£M,' � 1 W I1 W�tia s >lf� Sond �O�Qv E�ST ash . OW M PrX» N ly l 1 q3 9 ��NORiN 51 E STEPIIMG.V • �O �hy 7 (� `{7 3 DISOh � SI rff 2 ? V <y Wfrr ENTER S Rm iv°wn A),.ROgy q Q •Q�0� EHa )Ungspl Il PSOOTH Si BAY AV h GREENPORT / 25 D �� I F DL=rtcM � t o, Z Oz sN Ear I o F Z 16 MiA, Town Hall Albert J. Krupski, President'. Cd James King, Vice-President (� (/ 53095 Route 25 y P.O. Box 1179 Henry Smith � =d Southold, New York 11971-0959 Artie Foster w ^ti Ken Poliwoda ®► Telephone (631) 765-1892 Fax (631) 765-1366 Jw ORIGINAL BOARD OF TOWN TRUSTEES TOWN OF SOUTHOLD Office Use Only ,/Coastal Erosion Permit Application _Wetland Permit Application Major Minor _Waiver/Amendm t/Changes Received Application. Received Fee:$ _Completed Application �_�` 0 jAN - 2 _Incomplete SEQRA Classification: Type 1 Type 11 Unlisted_ Coordination:(date s t)_-� 3 _CAC Referral Sent. Date of Inspection: -)0 . _Receipt of CAC Rep Lead Agency Determination: _ Technical Review: __Public Hearing Held: Resolution: Name of Applicant__-PAUI _-1 Address - - - Phone Number.( ! 3 V�g-- ---- Suffolk County Tax Map Number: 1000 - <' + Property Location: ,2 o'e- 0- F-1 (provide LILCO Pole #, distance to cross streets, and location) AGENT. G-,oWL =i-- ( pP ) (,.l0 5US14-Iv Address: -------- -- - ---- -- Phone-.-�-J h— -Y= -( r �-d of Trustees Applicatior.- WETLAND/TRUSTEE LANDS APPLICATION DATA Purpose of the proposed operations: Rgr r r Al:toN.4L, gdA_ 5ME EbR FAMIL, tL BoA-r Area of wetlands on lot: square feet Percent coverage of lot: 100 Closest distance between nearest existing structure and upland edge of wetlands: 1 feet Closest distance between nearest proposed structure and upland edge of wetlands: ) feet Does the project involve excavation or filling? No Yes - - ; JAW - 2 If yes, how much material will be excavated?_cubic yards How much material will be filled? U cubic yards y LL Depth of which material will be removed or deposited: feet Proposed slope throughout the area of operations: (� Manner in which material will be removed or deposited: 4A 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): B�a�d of Trustees Application* GENERAL DATA Land Area (in square feet): I odD Area Zoning. Rt)&I-- A CS&I <os LI P Previous use of property:_ Bp R--r .S L 1 f> Intended use of property: $041` SLIP Prior permits/approvals for site improvements: Agency Date LIN k N DUJ No prior permits/approvals for site improvements. Has any permit/approval ever been revoked or suspended by a governmental agency? No Yes If yes, provide explanation: Project Description (use attachments if necessary): R i n r --r F— r7xf"�T: t A-T wA F a T -C`b S f 14.16•4(2J87)—Text 12 r AROJEC7 Lp. NUMBER 617.21 Appendix C SEC State Environmental Quality Review SHORT ENVIRONMENTAL. ASSESSMENT FORM For UNLISTED ACTIONS Only PART I—PROJECT INFORMATION (To be completed by Applicant or Project sponsor) 1. APPLICANT/SPONSOR I 2. PROJECT NAME J. PROJECT LOCATION: AV Municipality A. PRECISE LOCATION (Street address and roa County d Intersectlong, prominent landmarks, etc.,or provide map) �4REA . MAP SHoW� , OIi pROT.ccr pLAtas S. IS PROPOSED ACTION: ` New ❑Expansion Modification/alteration 6, DESCRIBE PROJECT BRIEFLY: 7. AMOUNT OF LAND AFFECTED: Initially _ — acres Ultimately __ p a, WILL eROPOSED ACTION COMPLY WITH EXISTMIa ZONING OR OTHER EXISTINGaLANO USE RESTRICTIONS? cres Yes ❑No If No,describe briefly 9. WHAT IS PRESENT LAND USE IN VICINITY OF PROJECT? 10 Residential ❑,!ndustrial ❑Commercial I Describe: ❑Agriculture U ParWForesu0oen soace waT E k F Iz-o N-r $�-4 TR) VAS U Other 10. DOESSTATE ACTION INVOLVE A PERMIT APPROVAL 61Ff'Q!QCiRt3, NOW OR ULTIMATELY FROM ANY OTHER GOVERNMENTAL AGENCY(FEDERAL, STATE OR LOCAy? '®'Yes ❑No It yes,list agency(s)and perm!t/approvals �yS �E CUrpS , SoU`�N'DI✓ p `TdW. `('�VS75�� it. DOES ANY ASPECT OF THE ACTION HAVE A CURRENTLY VALID PERMIT OR APPROVAL? r ❑Yei 7No ,If yes, list agency name and permit approval 12. AS A RESUL ❑ T OF PROPOSED ACTION WILL EXISTING PEAMITW-1-HUVAL REOUIRE H001FICATION? Yes ONb I CERTIFY THAT THE INFORMATION PROVIDED ABOVE IS TRUE TO THE BEST OF MY KNOWLEDGE FA0p1.jC.,nt1,pon30r name: Cl I SAT f_ , L /� NJ C p }Z M 1 T S — Date: If the actiodis in the Coastal Area, and /ou are a state agency, complete the Coastal Assessment Form before proceeding with this apes§ment OVER . 1 PROOF OF MAILING OF NOTICE ATTACH CERTIFIED MAIL RECEIPTS Ln m Ir 38 � G�:EENF'latT, NY 1194:; ru .. - • - - ..- • . .-. a d°3? UNIT =- !3°3? Uil1'T49 3' Postage $ p— d' cl] It ' [� Certified Fee MO GREENF'GFiT, NY 11944 °30 ark rl Return Receipt Fee Postage $ ru (Endorsement Required) 10 C37 C1 V-1 rH6N53 ^y Restricted Delivery Fee , r r Certified Fee ,°�� ,�. I ✓ rk (Endorsement Required) Postma r9 Return Receipt Fee r v-Wr99 CO °(1? 01/11/ C7 2°67 01�'1 rU (Endorsement Required) CI Total Postage&Fees $ �� C'1 r Restricted Delivery Fee KH6053 completed by mailer) C7 Name(Please Print Clearly)(to be completed by mailer) d (Endorsement Required) R.r O Total Postage&Fees 22.63? (�i' Street,Ap.No.;or O ox No.a O 9 yy�� ................... ---------------------- C3 -____�b____ ®J'___ •__ ________________________, 0 Name(Please Print Clearly)(to be completed by mailer) Ciry,State,ZIP+4 , Pxv�iN-G - sRE!4 N 65 GO E F— �'' C3 Street,Apt.No.;or PO Box No. • . ° PS o P o Q K--.b-1------------------------------------------ --------- --- r� City,state,ZIP+4 STATE OF NEW YORK m G k'E oR COUNTY OF SUFFOLK I` residing at M r b F Q P_E2 being duly sworn, deposes and says that on the __LLTk day of ;s fJ VAIQ_q , 20_., deponent mailed a true copy of the Notice set 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 6t6r NA-1 0_L/ ,that said Notices were mailed to each of said persons by (certified) (registered)mail. Q, Sworn to before me this AL ! ' Day of , 20 L SUSAN .LONG Notary Public,State of New York ; N0.01LO4958343 _.._. Qualified in Suffolk Coun Commission Expires November Z ty „1a.w, Notary Public i . NOTICE TO ADJACENT PROPERTY OWNER BOARD OF TRUSTEES, TOWN OF SOUTHOLD In the matter of applicant: 1�E1lOk'1C N. 4- 'CAN5,r DIEMIRdiv SCTM#1000- S 7 a N YOU ARE (, GIVEN NOTICE: 1 . That it is the intention of the undersigned to request a Permit from the Board of Trustees to: =NSTA L L 1J (sx g'' PI-ArTF61CM , 3 'X l.Z' KAM F fX,?A� F46,4T 4vl-rd ofssoci-lrob Fit-it4cS TO 5r-, cvRE i=L.oAr 2 . That the property which is the subject of Environmental Review--is located adjacent to your property and is. described as follows : ILpU aSPR�.� N�Sr R��t� 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:_.1-a A�(53 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: JerVbRIc i�j ,�•�p� -1�' D�M11�C,(�IAN MAILING ADDRESS: PHONE #: Enc. : Copy of sketch or plan showing proposal for your .convenience. .S Kt. UURj- N. =ANEr DCMl%r-IYAN '2/6 HEkMAk bI~MtR.c131AtJ N �LDWF-K 1?6AD V ALU�-�( STY F-AM )IN i is81 SUSAN I? LNG PI=z.M )TS AND 5 AS T MSS R 11S N t4j 193 6��� (L3 1) 7 7 .3 q5-S Z PRaQos t:b : . N S T.A.LL y X g ' FLATFO T?A a x 3�X I kAM P t.6x2o ROAT Q a W I T N ASSba LATE b P)1.)NGS ¢ J A oFF CrtJTEk of Buiks4EADFb 3 bhT SLIP NDe L � a ;L o a w a r ry Sal 19 1 a � a 04 ri 'ri x 00 _ X SST G a3u� gAb DECER ar-)z- lot Zoo 2. Albert J. Krupski,President - OcVFFO��C _ Town Hall James King,Vice-President �� �r/y .53095 Route 25 Henry Smith o= P.O.Box 1179 Southold,New York 11971-0959 Artie Foster v� W Ken Poliwoda G Telephone(631)765-1892 Fax(631) 765-1366 �c BOARD OF TOWN TRUSTEES TOWN OF SOUTHOLD BOARD OF TRUSTEES: TOWN OF SOUTHOLD ----------------------------------- In the Matter of the Application of -a_ u__t_ COUNTY OF SUFFOLK) / STATE OF NEW YORK) AFFIDAVIT OF POSTING _ I, �� , residing at &A-AA being duly sx4orn, dep se and say: That on the L3 day of� , 2003, I personally posted the property known as b G by placing the Board of rilsteqs nlfficial pos er wher it can easily be seen, and that I have checked to be sure the poster has remained in place for eight days prior to the date on the public hear". Date of he ring noted thereon to be held � Dated: I - z Z-0 -3 (signature) Sworn to before me this �a day of 2003 Notary Public CLAIRE L.GLEW Notary Public,State of New York No.01 G L4879505 Qualified in Suffolk CO Commission Expires Dec.8, Board of Trustees Applicatior�- County of Suffolk State of New York 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 AIj,Y 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 REPR.ESENTATIVES(S) , TO ENTER ONTO MY PROPERTY TO INSPECT THE PREMISES IN CONJUNCTION WITH REVIEW OF THIS APPLICATION. Signature SWORN TO BEFORE ME THIS o��(l Q DAY OF s 02 on Notary Public CLAIRE L GLEW Notary public,State of New York No.01 GL4879505 Qualified in Suffolk Cou�ypg�,� Commission Expires Dec.8, w ;l 7 PROOF OF MAILING OF NOTICE ATTACH CERTIFIED MAIL RECEIPTS EU.S. Postal ServicePostal CERTIFIED MAIL RECEIPTAdd CERTIFIED MAIL RECEIPT (Donjestic Mail Only;No Insurance Coverage Provided) I /• • No • •- 117 Article Sent To: Article sent To: ra GREE,3F'OftTa NY 11944 -- U.S. Postal Service '9 11J: CERTIFIED . ■ 4? -Postage $ f °37 37 3 CC] (Domestic Mail Only;No Insurance Coverage Provided) Certified Fee n° © °T� Postm M Article Sent To: 7 } (� r R Return Receipt Fee [i- ` H i rLl (Endorsement Required) V I o � � VALLEY STREAM, NY 11581 ; Tt"I Restricted DeliveryFee (Endorsement Reuired) Posta e $ A•37 I�NI* i° `` I a/ 9 O 2.67 Total Postage&Fees �' I — , Certified Fee n° � w -L i � Name Please Print Clearly) to be completed b maile' rtta"ly ( y)( p y i Return Receipt Fee h �.. I�er�'�� o be completed by mailer) C1 (Endorsement Required) o - nr-AVEAV������� �R�P�R T� ; � � G E � ----------------------------------------- 0 Street,Apt.No.;or P Box No. � Restricted Delivery Fee t� "��"` tZPYrJJ (o. � L C3 T6---,b�- 50 (Endorsement(Endorsement Required) v �� � f` City,State,ZIP+4 C3 ?°G7 L�1/i1/0 t3 Total Postage&Fees $ I :1 ...� See leverse for Instructions — O Name(Please Print Clearly)(to be completed by mailer) KEy�Rk �" A7 b�Nl 1 � A ---------------- OStreet,Apt.No.;or PC Box No. r`E3 A. - bb_W a--------------------------------------------- r� Cit,State,ZIP+4 1— STATE OF NEW YORK COUNTY OF SUFFOLK p.�'t�(J KF. , residing at being duly sworn, deposes and says that on the l(Th- day of 11003 , deponent mailed a true copy of the Notice s t 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 SA6r JUq- !0tj , that said Noticejs.,were mailed to each of said persons by (cert fled) (registered) mail . nt _� 11 Sworn to before me this b6 day of f2 ��,��_ SUSAN E.L090 Notary PublIC,State of Now York Ala.01 Lo4958343 Qualified in Suffolk County Notary ubl i ClgjamLWon F.xPires NOVOMbOr fiib NOTICE .TO ADJACENT PROPERTY OWNER s BOARD OF TRUSTEES , TOWN OF SOUTHOLD V1y In the matter of ap plicant: .P,4u L hl- Fr7_6 L-R A L p —�- h I N A Po:ZD SCTM#10 0 0 C5 YOU ARE HEREBY GIVEN NOTICE: 1. That it is. the intention of the undersigned to request a Permit from the Board of Trustees to.. 'R4cCATE. SKIS T'i tirp RAMP , Ft.EST FORM, FLOAT i- A550tJhTF-b NLl1`F65 To C tN r 1Z 2 • That the property which is the subject of Environmental Review.-is located adjacent to your property and is described as follows : a SS' 'OS MEE NG5r ?-OAP 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:_I-A a- b3 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 . LP OWNERS NAME: PAVG N. T'lr7- CE1ZAAL.1h .I• AINA FDfzp MAILING ADDRESS: 14, A VON PHONE #: r .. Enc. : Copy of sketch or plan showing proposal for your convenience. PZE�AcKM fsDK: PA U L. 14 , I=I TZ Q F-ZALD A �x � Ft,lzb U , Il ANJ6t4 Raht LA RL" MDNT N.S 10538' 4 SL55AN E . LbN(; PERM LTS t?D Bb) &4 G �� ��ND EAST MftRroN !y� llg3`f �RoAasF_ � ; REL_ISCA•TE EXISTING z VLAT r-oxM, RR M P t FLOAT WITH AsSoC Itr'rED rIL)NGS Tb CaNTIF-IL OF S13LIKHRADID 24 �- �� 156AT .S L I P w e ts. v G f rc19 S Soy f f �• i n. sC-A E 1• r i r XIST au� �Ab D EC F,Nt 13 N?, lb& z o o 2. Board of Trustees Application _ County of Suffolk State of New York D &j 6 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. C . Signature SWORN TO BEFORE ME THIS �I DAY on Notary Public LAIIRE L.GLEW Notary Public,State of Now York No.01GL4879605 Qualified in Suffolk Counn��yyp�,�'�� commission Expires Dec.8, �.1 7 1.7 14-16-2 (9/95)-7c ! 617.20 SEAR Appendix A State Environmental Quality Review FULL ENVIRONMENTAL ASSESSMENT FORM Purpose: The full EAF is designed to help applicants and agencies determine, in an orderly manner, whether a.project or action may be significant.The question of whether an action may be significant is not always easy to answer. Frequent- ly, there are aspects of a project that are subjective or unmeasureable. It is also understood that those who determine significance may have little or no formal knowledge of the environment or may 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 alloyv introduction.o(information to fitz project; or action. Full EAF Components: The full EAF is comprised of three parts: Part T: Provides objective data and information about a given project and its site.4y.identifyirig 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 impactsthat"may occur from a project or action. l't provides 1.guidance as,to whether an impact is likely to be considered small to moderate or whether it is a potentially- large impact. The form also Identifies whether an impact can be mitigated-or reduced. Part 3: If any impact in Part 2 is identified as potentially-large, then Part 3 is used to evaluate whether or not the impact is actually important. DETERMINATION OF SIGNIFICANCE—Type 1 and Unlisted Actions Identify the Portions of EAF completed for this.,project: . ❑ Part 1 ❑ Part 2 ❑Part 3 Upon review of the information recorded on this E.AF(Parts 1 and 2 and 3 if appropriate), and any other supporting information, and considering both the magnitude a'nd'impor`tance of each impact, it is reasonably determined-by the lead agency that: ❑ A. The project will not result in any large and important impacts) 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.* O C. The project may result tn'one-or'more large and important impacts that may have a significant impact on the environment, therefore a positive declaration will be prepared. • A Conditioned Negative Declaration Is only valid for Unlisted Actions Name of Action Name of Lead Agency Print or Type Name of Responsible Officer in Lead Agency Title of Responsible Officer Signature of Responsible Officer in Lead Agency Signature of Preparer(If different from responsible officer) Date 1 PA1 ., 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 . PAVL r�r'( L.{ Q LOCATION OF ACTION pnclude Street Address, Munlclpallty and County) NAME OF APPLICANTIS ONSOR BUSINESS TELEPHONE L =,. (ba ) 2 r/ AD S r CITYIPO V STATE, ZIP CODE NAME OF OWNER Of dlfferenQ BUSINESS TEL PHONE ( ) ADDRESS CrTY/PO STATE ZIP CODE DESCRIPTION OF ACTION Please Complete Each Question—Indicate N.A. if not applicable A. Site Description Physical setting of overall project, both developed irnd undeveloped areas. 1. Present land use: OOrban ❑Industrial OCommercial ®Residential(suburban) Mural(non-farm) OForest OAgriculture ®Other w N'rV-R V KD RT 2. Total acreage of project area: acres. APPROXIMATE ACREACE PRESENTLY AFTER COMPLETION Meadow or Brushland (Non-agricultural) acres b acres Forested O acres -70, acres Agricultural (Includes orchards, cropland, pasture, etc.) __ (:? acres b acres Wetland (Freshwater or tidal as per Articles 24, 25 of ECL) _ acres acres Water Surface Area Win_x S�U� acres .20 5e TO acres Unvegetated (Rock, earth or fill) O acres a acres Roads, buildings and other paved surfaces C> acres acres Other (Indicate type) 6 acres acres 3. What is predominant soil types) on project site? a. Soil drainage: .-VWell drained % of site OModerately well drained % of site OPoorly drained % of site b. If any agricultural land is Involved, how many acres of soil are classified within soil group 1 through 4 of the NYS Land Classification System? _.6L��— acres. (See 1 NYCRR 370), 4. Are there bedrock outcroppings on project site? ❑Yes ONo a. What is depth to bedrock? _ n1/A-- —On feet) 2 /6. roximate percentage of propo�'�� project site with slopes: NO-10% - % 010-15% 015% or greater % roject substantially contiguousto;,or contain a building, site, or district' listed on the State or the National sters of Historic Places? OYes ®No 7, Is project substantially contiguous to a site listed on the Register of National Natural Landmarks? OYes MNo 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? OYes ONo 11. Does project site contain any species of plant or.-anifnal life that is identified as threatened or endangered? OYes ®No According to __'SUSAN I_. L n N a Identify each species 12. Are there any unique or unusual land forms on the project site? (i.e., cliffs, dunes, other geological formations) OYes ®No Describe N IA 13. Is the project site presently used by the communit or neighborhood as an open space' or recreation area? OYes ®No . If yes, explain Al .4 14. Does the present site include scenic views known to be important to the community? OYes 13No 15. Streams within or contiguous to project aeea: _- N/A a. Name of Stream and name of River to which it is tributary NIA i. 16. Lakes, ponds, wetland areas within or'contiguous to project area: a. Name _ (it I i b. Size (In acres) _j dnT 17. Is the site served by existing p6bl'ac utilities? ®Yes ONo a) If Yes, does sufficient capacity exist to allow connection? OYes ONo N/A b) If Yes, will improvemdnts be necessary to allow connection.? OYes ONo N/A 18, Is the site located in an agricultural district certified pursuant to Agriculture and Markets Law, Article 25-AA, Section 303 and 304? OYes IONo 19. N.the site located in or substantially contiguous to a Critical Envirgnmental Area designated pursuant tb Article 8 of the ECL, and 6 NYCRR 617? ❑Yes ®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 project sponsor acres. b. Project acreage-to be developed: acres initially; acres ultimately. c. Project acreage to remain uncle v loped wharres. 1.1 d. Length of project, in miles: _(If appro nate)' e. 'If the project is an expansion, indicate percent of expansion proposed �l %; f. Number of off-street parking spaces existing A proposed , g. Maximum vehicular trips generated per hour (upon completion of project)? h. If residential: Number and type of housing units: One F mily Two Family M.0 tlp'le Family Condominium Initially s Ultimately I. 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;`earrh, etc.) will be removed from the site? tea.. tons/cubic yards 3. Will disturbed areas be reclaimed? OYes ONo ®N/A 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. Now many acres of vegetation (trees, shrubs, ground covers) will be removedfrom site? 'd " acres. 5. Will any mature forest (over 100 years old) or other locally-important vegetation be removed by this project? OYes ®No 6. If single phase project: Anticipated period of construction ME months, (including demolition). 7. If multi-phased: a. Total number of phases"anticipated dNE (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 ®No 9. Number of jobs generated: during construction 14 ; after project is complete 10. Number of jobs .eliminated by this project "o 11. Will project require relocation of any projects or facilities? OYes ®No If-yes, explain A 12. Is surface liquid waste disposal involved? Oyes ®No a. If yes, indicate.type of waste (sewage, industrial, etc.) and amount NIA b. Name of water body into which effluent will be discharged N A 13. Is subsurface liquid waste disposal involved? OYes ONo Type N 14. Will surface area of an existing water body increase or decrease by proposal? OYes ®No 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 months tons b. If yes, will an existing solid waste facility be used? OYes tNo c. If yes, give name ,IA ; location N d. Will any wastes not go into a sewage disposal system or into a sanitary landfill? OYes )R3No e. If Yes, explain 17. Will the project involve the disposal of solid waste? OYes PNo a. If yes, what is the anticipated rate `of disposal? NIA tons/month. b. If yes, what is the anticipated site life? _ years. 18. Will project use herbicides or pesticides? OYes MNo 19. Will project routinely produce odors (more than one hour per day)? OYes ®No 20. Will project produce operating noise exceeding the local ambient noise levels? OYes ®No 21. Will project result in an increase in energy use? OYes ®No: If yes , indicate types) NSA 22. If water supply is from wells,.indicate pumping capacity NIa___ gallons/minute. ' 23. Total anticipated water usage per day tj�A---' gallonslday. 24. Does project involve local, State or Federal funding? OYes J4No If Yes, explain 4 r 5. Approvals Required: Submittal Type Date �/ City, Town, Village Board C]Yes tlONo City, Town, Village Planning Board OYes !rd o City, Town Zoning Board OYes o City, County Health Department OYes ;NO Other Local Agencies dyes ONo TWO TROS I F'j✓S �. Other Regional Agencies. OYes �No State Agencies 12 Yes ONo NJ 5 h r- C.- Federal Agencies Vyes ONo ---4.R MU r'M . z z C. Zoning and Planning Information 1 . Does proposed action involve a planning or zoning decision? OYes MNo If Yes, indicate decision required: Ozoning amendment Ozonlhg variance Ospecial use permit • Osubdivision Osite plan Onew/revision of master plan Oresource management plan Oother _A)/A 2. What is the zoning classification(s)of the site? PLES 11NF-t JT l tj LI -rEe t=rr...�-r 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? NIA 5. What is the maximum potential development of the site if developed as permitted by the proposed zoning? 6. Is the proposed action consistent with the recommended uses in adopted local land use plans? ®Yes ONo 7. What are the predominant.land use(s) and zoning classifications within a 1/4 mile radius of proposed action? h L 1 h-r p Q r-r p- 8. Is the proposed action compatible with adjoin ing/surround1ng land uses within a 1/ mile? ®Yes ONo 9. If the proposed action is the subdivision of land, how many lots are proposed? — N 1A a. What is the minimum lot size proposed? - AI 1A 10. Will proposed action require any authorization(s) for the formation of sewer or water districts? OYes KINo 11. Will the proposed action create a demand for any community provided services (recreation, education, police, fire protection)? OYes ®No 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' BNo a. If yes, is the existing road network adequate to handle the additional traffic? OYes ONo D. Informational Details Attach any additional' information as may be needed to clarify your project. If there are or may be any adverse impacts associated with your proposal, please discuss such impacts and the measures which you propose to mitigate or avoid them. E. Verification I certify that the information provided above is tru to the best of my knowledge. Applicant/Sp nsor Name Signatur Date 12 - 2 4-b�— Title If the action is in the Coastal Area, and you e a state agency, complete the Coastal Assessment Form before proceeding with this useument. 5 '