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1000-45.-2-10.2
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I I � . i[ I � � I � I I I . . I .1 - ) I.. I TOWN OF SOUTHOLD, 'COUNTY OF SUFFOLK ' � � 1. ; I :.,; . i I I I : R. JACOBSON ON SEPT. 13, 1992 PARCEL TO BE - 287.241 SO.',. FT. OR 6.594 AC. . I I . 1� , I t, I- I - � . I I I- . ; . � . I I - � . I I � . . ---CONVEYED: �� I I _ S — EXIS' . ., AN TARY LINE � . i � I :1 . A � SECTION 45, BLOCK Z P/ LOT 103 ' - � � ; - S I , I 1� �\ . . %, . . . I I i 1 I 2.- METES AND BOUNDS� ARE THE RESULT OF . . � - . � � . I I � � 0,1� . - � . : !, � , � � � I , . I . I ., A COMPILATION OF IDEEDS AND A MAP I OVERALL PARCEL: 1.635,914 SO.� FT. OR 37.555 AC. I I I— , 1 1 . �'.,... I . I L -i ']), I � I - �f i EW, X , � _ i� I I I 11 I I ! I � . I I I W----� EXISi, WATER SERVICE . . , . � .. I I � I . � I . . . . . �, - . .:. . . I � . . , � -756-8000 N I I � ENTITLED *SURVEY FOR SAN SIMEON I � I � . I I * . I . � � ., .. . I . 11b 516 1 1 1 . I � % : I � � P ,,, . I I I . I . 1, I I I � I I 11 . - .., I � I _� � I . 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I A �, , , ,f,;, 5 1 ," , , �,�,,� � ,1� � L� ,,� 1 ��. ., I , ', t`,'5 _,�`�, , - , ,� � , , , i - � I �- ,-;� "',, "I ,., � ., -�7 - ,� ,_Z�:"I. .4.'-. _I - �. .&I I �. -. _ - .1,- ;-,,.- -)�1 : , , I I I I k - , , � r . . - -L_ , - I� �-.- -- - -_ � � A -,,, 1.1,,., � I ____.-.---� '-_ .-_ -1--,�,�___��____;__ ..----I-- ___ . - __-_,___ �_�__________- ---..--_p___- ___ .______________ _ - -- --- -I --- __- .., -- I - ,.-,.1�,1! �- L- - _ ___1_1_.__.____._-___ - - -.- -__-___- __ __- - - - - - I � � - .--�I I---- - � - I __ - . -----.---- __ - .-__ -,L--. - � __, - __ - , - - .-�_. --" �_ , , __ - �- � - , - _ . - - - -, .__---.. _ ___ _______T__._____ __. PLANNING BOARD MEMBERS 't.: i' ' ` SCOTT L. HARRIS Bennett Orlowski, Jr., Chairman Supervisor George Ritchie Latham, Jr. �,! w3 � Richard G. Ward w' Town Hall, 53095 Main Road Mark S. McDonald P.O. Box 1179 Kenneth L. Edwards PLANNING BOARD OFFICE Southold, New York 11971 Telephone (516) 765-1938 TOWN OF SOUTHOLD Fax (516) 765-1823 June 15, 1993 Joseph Fischetti, Jr. , P.E. Hobart Rd. Southold, NY 11971 Re: Proposed lot line change for San Simeon Retirement Community & Nursing Home County Rd. 48, Greenport SCTM# 1000-45-2-2 & p/o lot 10. 3 Dear Mr. Fischetti: The following took place at a meeting of the Southold Town Planning Board on Monday, June 14, 1993: The final public hearing which was held at 7:35 P.M. was closed. The following resolution was adopted: WHEREAS, the .San Simeon Retirement Community, Inc. is the owner of the property known and designated as SCTM# 1000-4572-2 & p/o lot 10.3, located at the northeast corner of Rt. 25 and Chapel Lane in Greenport; and WHEREAS, this lot line, to be known as proposed lot line change for the San Simeon Retirement Community, Inc. is for a lot line change to subtract 6,5-14 acres from a 37.555 acre parcel and add it to a 3 . 581 acre parcel; and WHEREAS, the Southold Town Planning Board, pursuant. to the State Environmental Quality Review Act, (Article 8) , Part 617, declared itself Lead Agency and issued a negative declaration on May 24, 1993 ; and Page 2 San Simeon lot line change June 15, 1993 WHEREAS, a final public hearing was closed on said subdivision application at Town Hall, Southold, New York on June 14, 1993; and WHEREAS, all the requirements of the Subdivision Regulations of the Town of Southold have been met; and be it therefore RESOLVED, that the Southold Town Planning Board approve and authorize the Chairman to endorse the final survey dated March 1993 . Enclose please find a copy of the map which was endorsed by the Chairman. Please contact this office if you have any questions_ regarding the above. - Vch ly, G. Ward Chairman enc. cc: Building Dept. Assessors Office SAN SIMEON RETIREMENT COMMUNITY, INC. Chapel Lane Greenport, New York 11944 April 5, 1993 Southold Town Planning Board Town Hall Southold, New York 11971 Re: San Simeon Lot Line Change Gentlemen: The following statements are offered for your consideration in the review of the above referenced lot line change. The undersigned, being the owner of 37.5 acres, more or less, located on C.R. 25 (North Road) , Chapel Lane and Main Road, Greenport, and known as San Simeon Retirement Community, requests the proposed lot line change be approved. The parcel to be affected by the lot line change consists of approximately 6.5 acres adjacent to the San Simeon Nursing Home Facility, and fronts on the North Road. This parcel was not included in the San Simeon Retirement Community Site Plans for development for residences, but was always considered as set aside for future expansion of the Nursing Home Facility. At this time San Simeon by the Sound, Inc. , which intends to purchase the nursing home facility this year under the terms of its present lease, confirmed its on-going interest in purchasing the 6.5 acre parcel which surrounds the nursing home. Upon receipt of the Town' s approval, it is anticipated the parties will enter into an agreement, satisfactory to both, for the conveyance of the 6. 5 acre parcel to the Nursing Home Facility. Your applicant agrees that a condition of closing will be that an affidavit be executed by the adjacent owner and delivered to the Town of Southold to the effect that the 6.5 acre parcel will be merged with the property which now constitutes the Nursing Home Facility. Southold Town Planning Board Page Two The undersigned understands and agrees that if the 6.5 acre parcel is not conveyed to the adjacent owner of the Nursing Home Facility, then this approval of a lot line change will be null and void and of no further force or effect. Your attention to this request is appreciated. San Simeon Retirement Community, Inc. By �. STATE OF NEW YORK) ) . :ss COUNTY OF SUFFOLK) On the day of April, 1993, before me personally came Ins i l l ,a w- P\USch to me known, who being by me duly sworn, did depose and say that he resides at So"kl-k o l ; that he is the s of y, heb which executed the foregoing instrument•+ thaw lrrnrx the +c�l of ir7 .r i r- j-evil t- a .,t _���� �to CeaI tom` iL ���by order of the Board of Directors of said corporation, and that he signed his/her name thereto by like order. Notary Public ANTOINETTE 130AZ Notary Public,State of New York No.,4782474 Qualified in S Ik ounty Commission Expires jr 14-16-4(2/87)—Text 12 PROJECT I.D. NUMBER 617.21 SEAR Appendix C State Environmental Quality Review SHORT ENVIRONMENTAL ASSESSMENT FORM For UNLISTED ACTIONS.Only PART I—PROJECT INFORMATION (To be completed by Applicant.or Project sponsor.) APPLICANT O SOR 2. PROJECT NAME of 3. PROJECT LOCATION: �� �� Municipality CT/ �+�1 �A'+� County `K 4. PRECISE LOCATION(Street address and road intersections,prominent landmarks,etc.,or provide map) Me e A/,V,, ak% to chiwph 4" 5. IS PROPOSED ACTION: ❑New ❑Expansion Modification/alteration 6. DESCRIBE PROJECT BRIEFLY: 7. AMOUNT OF AF 2CT : �- Initially ' acres Ultimately acres B. WILL PROPOSED ACTION COMPLY WITH EXISTING ZONING OR OTHER EXISTING LAND USE RESTRICTIONS? XYes ❑No If No,describe briefly 9. WHAT IS PRESENT LAND USE IN VICINITY OF PROJECT? Residential ❑Industrial ❑Commercial E.]Agriculture ElPark/Forest/Open space ❑Other Describe: 10. DOES ACTION INVOLVE A PERMIT APPROVAL,OR FUNDING, NOW.OR ULTIMATELY FROM ANY OTHER GOVERNMENTAL AGENCY(FEDERAL, STATE OR LOCAL)?�,{ El Yes pLJ No If yes, list agency(s)and permit/approvals 11. DOES ANY ASPECT OF THE ACTION HAVE A CURRENTLY VALID PERMIT OR APPROVAL? ❑Yes IRSJ No If yes,list agency name and permit/approval 12. AS A RESULT OF PROPOSED ACTION WILL EXISTING PERMIT/APPROVAL REQUIRE MODIFICATION? ❑Yes No I CERTIFY THAT THE INFORMATION PROVIDED ABOVE IS TRUE TO THE BEST OF MY KNOWLEDGE e� G bow b Applicant/spons r n e: r� sG �PE Date: ) 3 Signature f �• PROFESSiO1AL E-NG. ,1 ER s nn I u .L� the action is in the Coastal Area, and you are a state age c F cow mplete t e 9�j Coastal Assessment Form before proceeding with thi s1 ess nit I L� f OVER SOLITHOLD TO PLAKIIiNG� BOARD. . PART II—ENVIRONMENTAL ASSE.-?" =NT (To'be completed by Agency)' A` A. DOES ACTION CEED ANY TYPE I TH,", '`TOLD IN 6 NYCRR, PART 617.12? If yes,coordin a review process and use the FULL•EAF. ❑Yes No B. WILL ACTION RECEIVE COORDINATED REVIEW AS PROVIDED FOR UNLISTED ACTIONS IN 6 NYCRR,PART 617.6? If No;a negative declaration may be superseded by another involved agency. Yes . ❑No C. COULD ACTION RESULT IN ANY ADVERSE EFFECTS ASSOCIATED WITH THE FOLLOWING:(Answers may be handwritten, if legible) C1. Existing air quality, surface or groundwater quality or quantity, noise levels, existing traffic patterns, solid waste production or disposal, potential for erosion,drainage or flooding problems? Explain briefly: C2. Aesthetic,agricultural,archaeological,historic,or other natural or cultural resources;or community or neighborhood character? Explain briefly: N o: C3. Vegetation or fauna, fish,shellfish or wildlife species,significant habitats,or threatened or endangered species? Explain briefly: IV O. C4. A community's existing plans or goals as officially adopted,or a change In use or Intensity of use of land or other natural resources?Explain briefly. NO. C5. Growth, subsequent development,or related activities likely to be induced by the proposed action? Explain briefly. `Y£S - POS5IBLfc; _EXPAwSI8N OF EXISTIN62 N085tNCB: MDMLe FAG1L1--6F_S . C6. Long term,short term,cumulative,or other effects not Identified in C1-05?Explain briefly. MCI* C7. Other impacts(including changes in use of either quantity or type of energy)? Explain briefly. Nn. D. IS THERE, OR IS THERE LIKELY TO BE, CONTROVERSY RELATED TO POTENTIAL ADVERSE ENVIRONMENTAL IMPACTS? ❑Yes ANo If Yes,explain briefly PART III—DETERMINATION OF.SIGNIFICANCE (To be completed by Agency) INSTRUCTIONS: For each adverse effect identified above,determine whether it is substantial,large,important or otherwise significant. Each effect should be assessed in connection with its (a) setting (i.e. urban or rural); (b) probability of occurring; (c) duration; (d) Irreversibility; (e) geographic scope; and (f) magnitude. If necessary, add attachments or reference supporting materials. Ensure that explanations contain sufficient detail to show that all relevant adverse impacts have been identified and adequately addressed. ❑ Check this box if you have identified one or more potentially large or significant adverse impacts which MAY occur. Then proceed directly to the FULL EAF and/or prepare a positive declaration.- Check this box if you have determined, based on the information and analysis above and any supporting documentation, that the proposed action WILL NOT result in any.significant adverse environmental impacts AND provide on attachments as necessary, the reasons supporting this determination. Name of Lead Agency Print or Type Name of Responsible Officer in Lead Agency Title Of icer Signature of Responsible Officer in Lead Agency Signature of Preparer(it different from responsible officer) Date 2 APPLICATION FOR APPROVAL OF PLAT To the Planning Board of the Town of Southold: The undersigned applicant hereby applies for (tentative) (final approval of a subdivision plat in accordance with Article 16 of the Town Law and the Rules an egulations of the Southold Town Planning Board, and represents and states as follows: 1. The applicant is the owner of record. of the. land under application. (If.the applicant is not the owner of record of the land under application, the applicant shall state his interest in said land underr application.) 2. The name.of the subdivision is to be . .. .. . . .. .. . . . .. . . ... . .. .. . . .. . . . .. ... ... . . . . .. . . . .. .. .. .. . . .. .. .... . . .. . . .. ..... . ... .. . .. . ... .. .. .. . . . . . . . . . .. . . .. . . .. .. .. . . ... .. . . . . .. . . . . . . 3. The entire land under application is described in Schedule "A" hereto annexed. (Copy of deed suggested.) 4. The land is held by the applicant under deeds recorded in Suffolk County Clerk's office as follows: // /D Liber 7 0.�. .. .. . . .. . Page . . . .`....... . .. . . . . .. . On . . ' /.. . .v . . . . ; Liber .!. .c.? .!.. . ... .. .. ... Page . . .! . . . On . ..3/. .�`�./73.. . . . Liber . . . .. .... . .. .. .. .. .. ... .. . Page . . On . . . .. .. .. . . .. .. . . .. .. . Liber . .. .. .. .. .. .. . . .. . . . . .. . Page On . .. .... . . . ... .. .. . . . . . , Liber . .... .. ... .. .............. Page . .. On . . . .. .. .... .. .. . . .. . . . ,,.as devised under the Last Will and Testament of . . . . . .. .. .. . . .. .. .. .... .. .. .. .. .. . . .. . . or as distributee . .. . ... .. .. .. .... . ... .. . . .. . . . . .. .. . . . . . . .. .. .. . . .. ..... ........ . . ... . .5. The area of the land s .."57 . .. .. . acres. CPria4 k 44kv C4. ••.e, 6. All taxes which are .lien on the land at the (late hereof have been paid except . .. . . . . .. . . . . . . .. . . .. . . . . . . .. . . .. . 9 . 9. . .. . . .. .. . ... . . . . 3 7. The land is encumbered by .. . . . ...!....5. . . . .. .. .. . . . . .. . . .. . . .. . . .. ... ..... ... . . . . . . . . mortgage (s) as follows: (a) Mortgage recorded in Liber �g�� �. .: . Page . . . .6.�. . . .. . . .. . in original arnount of $j 3SOj DO9 . unpaid amount $ .. . . . . . . . .. . . . . . . . held by ..... . . ...... . address . . . S /?')!3..n /20�9�� . . (b) Mortgage recorded in Liber . .. .. .. .. Page . . . .. . . . . .... .. . .. . . .. . in original amount of . .. .. . . .. . . .. . unpaid amount $. .. . . . . . . . . . . . . . . . . .. . held by . .. . . . .... .. .. .. . address . .. ....... .. . .... . . . . . . (c) Mortgage recorded in Liber . .. . . . . . . . . . . . Page . . . . . ... .. . . .. .. . in original amount of . .. .. . . . . . . . . . unpaid amount $. . . . . . . . . .. . . . . . . . . . . . held by . . . .. . . .. .. . . ..... . . .. ... .... .. . . .. .. .. . . . . . address . . . . . ... . . . . . . .. ... . . . . . . . . .... . . . . . . . . . . .. . . . . . . . . . . . . . ... 8. There are no other encumbrances or liens against the land except :. . .. .. . . . . .. . . .. . . .. . . . Alo�� . . . . . . ... ..... .. .. .. . . .. .. ..... ....... . . . . .. .. .. . . 9. The land lies in the. following zoning use districts . . . .. . . . . ..... . . .... .. . . .. .. .. .. .... . .. .. . . . . .... . .. .. . . . . . . .. . . .. . . . .. . . . . . . . . . . . . ... .. . . .. . . .. .. .. . . . ..... . .. .. . . . . . . 10. 'No part of the land lies tinder water whether tide water, stream, pond water or otherwise, ex- cept . . . .. .. .. . . .. .. . . .. .. .. . . . .. . . . . .. .. .. .. .. . .. .... .. .. . . . . . .. .. . . . . . . 11. The applicant shall athis expense install all required public improvements. 12. The land does))(does not) lie.in a Water District or Water Supply District. Name of Dis- trict, if within a District, is j�;M7 e ,-r. . . . . . . . . . . . . .. . . . . . . . .. .. . . .. . . . . . . . .. .. . . .. . 13. Water mains will be laid' . .. . by vie kA . .. . . . . .. . . . . . . . . .. . . .. . . .. . . . . .. . . . . . . .. . . . . ... .. . . ... . and (a) C3 charge will be made for installing said inai4is. 14. Electric lines and standards will be installed by 1.1leo. .. . . . . . . . . .. .. . . .. . . .. . . . . .. lines.es.• .. .. .. . . .. .. .. .. .. .. . .. . . .. . . ... . an d (a) no charge will be made for installing said 15. Gas mains will be installed by . .. . . .. . A�e4f,.. . . .. .. . . .. . . . . . . . . .. . . . . . . . . . .. . . . .. . . . . . . . and (a) (no) charge will be made for installing said mains. 16. If.streets shown on the plat are claimed by the applicant to be existing public streets in the Suffolk County Highway system, annex Schedule "B" hereto, to show same. 17. If streets shown on the plat are claimed by the applicant to be existing public streets in the Town of Southold Highway system, annex Schedule "C" hereto to show same. 18. There are no existing buildings or structures on the land which are not located and shown on the plat. 19. Where the plat shows proposed streets-which are extensions of streets on adjoining sub- division maps heretofore filed, there are no reserve strips at the end of the streets on said existing maps at their conjunctions with the proposed streets. 20. In the course of these proceedings, the applicant will offer proof of title as required by Sec. 335 of the Real Property Law. 21. Submit a copy of proposed deed for lots slio-%N.ing all restrictions, covenants, etc. Annex Schedule "D". 22. The applicant estimates that the cost of grading and required public improvements will be $. . .!K���!' as itemized in Schedule "E" hereto annexed and requests that the maturity of the Performance Bond be fixed at . .. �. . . . . . years. The Performance Bond will be written by a licensed surety company unless.otherwise shown on Schedule "F". DATE . . . .. ... . .. . 1 1�03e p� SG�e. . . . . . . . . . ., 9.�3 (Name of . . . .licant.. .. ........ .. .. . . . .. . PP ) l.'C, Byr,6/974 .. .. .. ..... . . . . . . . . (Signat re /7Z. . . /2o.cg�+ J Sdv (Address) STATEOF lv'EW L'ORK. COUNTY OF Sd .�. .. .. . . ., ss: On the . . . .! .`.. . . .. . day of. . . .. . . �. i( ! �. . . . . . :. ., 19.q ., before me personally came • ••J• • •�S �•�• . • �•s.G. ...vJ. to me known to be the individual described in and who executed the foregoing instrument, and acknowledged that . . . .. . executed the same. ELIZABETH ANN NEVILLE ` Notary Public,State of New York :2 No.52-8125850,Suffolk Cau y Term Expires October 81, 19 Notar Public STATE OF NEW YORK, COUNTY OF . . . .. . . . ... . . . . . . . . . . . . . . . . . ss: y On the . . . . . . . . . .. . . .. . day . . . .. . . .. ... . of . . . . . . . ... .. . ., 19. .. . . .. before me personally came . . . . . . . . . . . . . . . . . .. . ... . to me known, who being by me duly sworn did de- pose and say that resides at, No. . . . .. .. . . . . . . .. . . .. . . . . . . .. .. . . .. .. . .. .. . ... .. . . . . . . . . that . .. .... . . . . . . ... . . . .. . . . . . . . is the . .. . . .. .. . . . . .. .. . of . .. .. .. . . . . . . . . . . . .. : . . . .. . . . . . . . . .. . . . . . . . . .. . . .... .. . . . . .... . . . ..... . . . the corporation described in and which executed the foregoing instrument; that . .. .. . . .. .. . knows the seal of said corporation; that the seal affixed by.order of the board of directors of said corporation. and tliat . . . . . . . .. . . . signed . .. .. .. .. . . .. . name thereto by like order. Notary Public. . . . . . . . .. .. . . .. .. . ... . . . .. .. ... . 14-16-4(2/87)—Text 12 PROJECT I.D.NUMBER 617.21 SEOR Appendix C State Environmental,Quality Review SHORT ENVIRONMENTAL ASSESSMENT FORM : For UNLISTED ACTIONS Only PART I—PROJECT INFORMATION (To be completed by Applicant.or Project sponsor) APPLICANT ONSOR 2. PROJECT NVE I► eem Y " 4- ev�+, wI aI 3. PROJECT LOCATION: Municipality V'r/'Cg4l p eno County / 4. PRECISE LOCATION(Street address and road intersections, prominent landmarks,etc.,or provide map) R+ 5. IS PROPOSED ACTION: ❑New ❑Expansion Modification/alteration 6. DESCRIBE PROJECT BRIEFLY: �0 �IvtF Cti4-si�J e .� v 7. AMOUNT OF tq AF Initially /4 acres Ultimately 37 acres 8. WILL PROPOSED ACTION COMPLY WITH EXISTING ZONING OR OTHER EXISTING LAND USE RESTRICTIONS? ((Yes ❑No If No,describe briefly 9. WHAT IS PRESENT LAND USE IN VICINITY OF PROJECT? eSResidential ❑Industrial ❑Commercial ❑Agriculture ElPark/Forest/Open space ❑Other ,6esoribe: 10. DOES ACTION INVOLVE A PERMIT APPROVAL,OR FUNDING, NOW.OR ULTIMATELY FROM ANY OTHER GOVERNMENTAL AGENCY(FEDERAL, STATE OR LOCAL)? ❑Yes KNo If yes, list agency(s)and permit/approvals 11. DOES ANY ASPECT OF THE ACTION HAVE A CURRENTLY VALID PERMIT OR APPROVAL? ❑Yes IRSJ No If yes, list agency name and permit/approval 12. AS A RESULT OF PROPOSED ACTION WILL EXISTING PERMIT/APPROVAL REQUIRE MODIFICATION? ❑Yes No CERTIFY THAT THE INFORMATION PROVIDED ABOVE IS TRUE TO THE BEST OF MY KNOWLEDGE Applicant/spons r e: `S SC� zT�e�� J Date: `)el3 JOSEPH p�.. PROFESS IOI\,AL E;VGI, DER Signature: ti �Aufi�c�lr1 ...j Y the action is in the Coastal Area, and you are a state agency, complete the Coastal Assessment Form before proceeding with this assessment OVER F PART II—ENVIRONMENTAL ASS_ ,MENT (To be completed by Agency)' A. DOES ACTION EXCEED ANY TYPE I THRESHOLD IN 6 NYCRR, PART 617.12? If yes,coordinate the review process and use the FULL EAF. ❑Yes 13 No B: WILL ACTION RECEIVE COORDINATED REVIEW AS PROVIDED FOR UNLISTED ACTIONS IN 6 NYCRR,PART 617.6? If No,'a negative declaration may be superseded by another Involved agency. ❑Yes . ❑No C. COULD ACTION RESULT IN ANY ADVERSE EFFECTS ASSOCIATED WITH THE FOLLOWING:(Answers may be handwritten, if legible) C1. Existing air quality, surface or groundwater quality or quantity, noise levels, existing traffic patterns, solid waste production or disposal, potential for erosion,drainage or flooding problems? Explain briefly: C2. Aesthetic,agricultural,archaeological, historic,or other natural or cultural resources;or community or neighborhood character? Explain briefly: C3. Vegetation or fauna, fish,shellfish or wildlife species, significant habitats,or threatened or endangered species? Explain briefly: C4. A community's existing plans or goals as officially adopted,or a change in use or Intensity of use of land or other natural resources?Explain briefly. C5. Growth,subsequent development, or related activities likely to be induced by the proposed action? Explain briefly. C6. Long term,short term,cumulative,or other effects riot identified in C1-05? Explain briefly. C7. Other Impacts(including changes in use of either quantity or type of energy)? Explain briefly. D. IS THERE,OR IS THERE LIKELY TO BE,CONTROVERSY RELATED TO POTENTIAL ADVERSE ENVIRONMENTAL IMPACTS? ❑Yes ❑No If Yes,explain briefly PART III—DETERMINATION OF.SIGNIFICANCE (To be completed by Agency) INSTRUCTIONS: For each adverse effect identified above,determine whether it is substantial,large,important or otherwise significant. Each effect should be assessed in connection with its (a) setting (i.e. urban or rural); (b) probability of occurring; (c) duration; (d) irreversibility; (e) geographic scope; and (f) magnitude. If necessary, add attachments or reference supporting materials. Ensure that explanations contain sufficient detail to show that all relevant adverse impacts have been identified and adequately addressed. ❑ Check this box if you have identified one or more potentially large or significant adverse impacts which MAY occur. Then proceed directly to the FULL EAF and/or prepare a positive declaration. ❑ Check this box if you have determined, based on the information and analysis above and any supporting documentation, that the proposed'action WILL NOT result in any,significant adverse environmental impacts AND provide on attachments as necessary, the"reasons supporting this determination: 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 responsib e o icer) Date 2 INc PLA;N'NI�'G 'I30" RD TO.WN:0 ,HQID SU.M0L �/ K~CO TY . Southold, N.Y. 11971 (516) 765-1938 QUESTIONNAIRE TO- BE COMPLETED AND SUBMITTED WITH YOUR APPLICATIONS FOItr11S TO TfiE PLtiN.NING BOARD Please complete,- sign and return to the Office of the Planning Board with your completed applications forms . If your answer to any of the following .questions is. es ,, cate these o� your guar.anteed survey or submit othereappropria evidence: appropriate 1. Are there any wetland grass"es on this parcel? Yes (Attached is a list- o-f the. wetland grasses defined No by the Town. Code, Chapter -97, for your reference) 2. Are there .any other pre abutting this parcel? mises under your ownership Yes No 3. Are there -any building permits pending on this .parcel? - Yes ONIO 4. Are. .there any other: applications pending concerning this property before any other department. cr agency?(Town_. ,- . State, County, etc. ) Des No 5. Is. there any application pending before any other agency with regard to a different project on this parcel;, Yes No 6.. Was this property the subject of any prior application to the . Planning Board? Yes No 7. Does this property have a valid certificat6 of occupancy, - if .yes please submit .a copy of same YeS No Jon Nte that the a ve tatements are true and �;�Plan ing B and ri cons derin his �� i11 'be relied 9 pplicat 'on. r property owner or auth �orJzed agent de PROFESS/ J 1L EVGJ tt2 11971 ' Attachment to questionnaire* for:.•the Planning Board STATE OF NEW YORK, COUNTY .OF SUFFOLK, .ss : On the �,C'-�{� day of- r� 19 before me personally came_ Ch W '—T( to me known to be the individual described: in• and who executed the foregoing instrume and acknowledged. that k e- executed the sa e. No ry Public ELIZABETH ANN NEVILLE Notary Public,State of New York IVo:52-8125550,Suffalk Co my Term Expires October 31, 1 THIS LOT LINE 1.—ANGE BETTVEEN AND IS LOCATED ON IN SCTM# 1000- LOT LINE CHANGE Complete application received S _ 73 Application reviewed at work session I � oK oK IMro. Applicant advised of necessary revisions aoo•� Revised submission received AW oK ,goo� OK Inro. Lead Agency Coordination Z ' 73SO SEQRA determination sly NPa - Dec. Sent to County Planning Commission _xl- 93 Iro.` oK FAW-19L , • Inro. �� . .. Review of SCPC report Draft Covenants and Restrictions received Iro` oK A_W Draft Covenants and Restrictions reviewed lero, oK Filed Covenants and Restrictions received Final Public Hearing S`,t_ it - U, 1 I4. Approval of Lot Line -with conditions Endorsement of Lot Line (�j►4��� ms 1/1/90 y Ilk Southold Town Planning Board Town Hall Southold, New York 11971 Re: �jQo PoS,�% � J-6 % r 1-1,4 iY 6 C F® Gentlemen: S/g1y 'sio":ory R�7.166 WEiYTCd6s9�rAn/!I` c:Mp"CL '1 s, The following statements are offered for your consideration in the review of the above-mentioned minor subd * vision and its referral "to the Suffolk County Planning Commission: (1) No grading, other than foundation excavation for a residential building is- proposed. (2) No new roads are proposed and no changes will be made in the grades of the existing roads . (3) No new drainage structures or alteration of existing structures are proposed. r trul , 6 . EMM APPROVED BY i o PLANNING BOARD 0 \ TOWN OF SOUTHOLD S 38323 W - cp 1 41 ::sOU?3�OLD?041}'N PLN JP?1 0 BOARD 7esigned By. Project No: — : NFByC 92-01 NORTH F )rawnKAK PDX MAP DWG ORK BANK & TRUST ;hecked By. scan1;, - 60' PROPERTY SITUATE AT ?eviewed By. Dare: SAN SIMEON RETIREMENT COMMUNITY MARCH 1993 Revisions: GREENPORTI- NEW YORK TOWN OF SOUTHOLD,.COUNTY OF SUFFOLK - SECTION 45,' BLOCK 2, P/O LOT 10.3 ". . �OF NE 516-756-8000 0 p 2017256-5454 ❑ �� 11 A' ° i v Holzmah6r MMcLendon & urrell RC: CONSULTING ENGINEERS.-.ARCHITECTS ,. PLANNERS SCIENTIS MELMLLE, N.Y TS ,• SURVEYORS u N� E 3 �� I - F r>> � TOTOWA`Wt.°'� 'sheet Title PARTIONING �IVIAP�. AITE p��Of�'lAe�t A T �.• k r DfC£PTOY A gee; ' Is FLIECAI. - �s.�'�'�',c�:._.'a�.,x,ea�;�--'e]=:�tz^-.t=a.:?::-�5.. 1 r LAW OFFICES Rf WICKHAM, WICKHAM & BRESSLER, P.c. MAIN ROAD, P.O. BOX 1424 MATTITUCK, LONG ISLAND WILLIAM WICKHAM MORTGAGE OFFICE ERIC J.BRESSLER NEW YORK 11952 516-298-5300 ABIGAIL A.WICKHAM 516-298-8353 TELEFAX NO.516-298-2012 LYNNE M.GORDON TELEFAX NO.516-298-8565 - JOSEPH C.SAVINO HUBERT F.SULLIVAN JANET GEASA JEFFREY STARR September 13, 1994 Southold Town Planning Board Southold Town Hall Main Road Southold, New York 11971 Re: San Simeon Community Retirement, Inc. Lot Line Change. Att: Mr. Robert Kassner Dear Bob: Enclosed is a copy of the recorded deed for the conveyance of the northerly parcel to the nursing home. Very cordially yours, �- Ibigail A. Wickham AAW:mh encl. i� SEP 151994 PiANNt G BO RD tlRECEWED K�:t�y aFl itl�' 1tnEl� lJ��'. 1 ��� ► , MrAiL ESTATE �1 M!:1TER TAX i� f,• �tppp�v Page 11 ,• J•� t, r ' {Si, K 1 g Fe )t�JG1"; 1 wV 1.Basic Tax +4";,P 4. 1•r+.r� h )r1}19uNotation Still TotalEA-51.17(County Suit Tnizi l. ✓ m TOT.MTG 1lit.:e r1,wh1 t •i�. UP' Dual Town � l tru —Dual County �i; N field for Apportionment Comm.of Ed. lk Transfer Tax ct� "llY f' �17�••ia�' .1% Mansion Tax ncoverc*11 by this murigage I, R�! is or ifl1l he Improved hy a one or two r, S��'r�riiyy�"d or • YES f 3 a Ff 5L �I 1�}•4�'11 1 acc apprultriatc tax clause on pngc N if this a �•,<rt, fit. •� - ---------- - -- - -- — -- -- - - ,1, COM nionwealth III Land Title Instirance Company Ito YY uYjj%I. •/ 1 Name sh x r rf Title-Numher $7� 4 -k Ink ifN. �rf{4�;�. r 1 Y{ This L •r;!�,r�l!%J t�1°p•JI. forms1the partvittaclictl I rtt'�3a i • Mortgnge, rif�i�'4}y�t�• i�� � i•, '� �I�GH• y1��� f r1 tf, SUFFOLK COUNTY,NEW YO l tj�?5•a s� G }lt:it 11�K lj 1 � 1 _ ,apR,rarFl t ,/�rrffffll{ rA llIn the VILLAGE 41 /uLkr-15 e-O.Le or HAM LET or yl fib a y� ,Sri/X,y{fy'��'i\i'r t.t'�rtt.'d.�,ul 1G'I fl•'f`yl�.�nl ±fir}I •,414r 14 , A L"i�l;.l, LP` •n:('4 (".:.1.�.. �. �f{�"� f 1.y, ..r 1.�, `r-l:�"�` ir141�III.ilEM& '"1 '�`1�lt1\� ,�.y. �-r t� •� lir� ,�ti1� h� N1 V� ,J , f � . , .+1 " t rys 1�,� "� .1f, +a'., a a;�J ���: � �] r F : �LSr+, J t r�} r iylK ii rJl rr�f�,,I `•�l�`fi6tif� �s'•��t yS{�r IV +1T 1 .�y�. frfNli�t • 111��f1� . if, IN �r�l si��♦r•��pi r -rlrrr 130 Ail '� e ;,� ,t �,�, 1 r t {I, .� !h ,U•>( tJ A 'h.t#S A ,. 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I tJ,�' �1�•' j 4• 4p[�7 �t d, *5'• �'4'd•1 r•,'iA f lf�;. t'L L� L,i:7(r �� �J r I� 'if l,f '�g 7',. 2��r �°;�}:'�4;ry,�}�� U}, � 4^;(` .4� ,� ��� �j�y..r yi �tA i�5,Gr7'"�•��� !�s.t� `N �• �K°�r S,r• i'1�1`Jtl�t i+l,tl t' �14a�� 1, �!k, L .� + �h •' �`j 1�tft44 tii 7f ��%'�'� :�I.ii� )�ti r�R.+t'SRF�,,�'+ �+i9 F'F'�'�i �l ���.?'r,l+��+;,�i 4" d�;�s�L��j�+ E'�,�r .��,�L .� a a,,,��r., f.ai Mt•� :' :v:���,'f v`.,gkr'..a ,� r �jc ,t v d 1P ��; rf I ��' :y' il'' a 5 :i ur �'� R�NN,1I i •p gt7 �" 1 i iii' v � `.t'�� ��^} i✓ r} ;�� 4, ''IdX`, I ,l � • ui • , r1,, .rt,. f l • , I J ! RUNNING THENCE Nortti'66�d`egrees 25 minutes 39 seconds West,.,71'.97 ,feet, •� u,��} „�z t,J �: �• k�. 21 RUNNING THENCE South' 73 degrees 10 minutes 10 aeconds ,' . r west 240.61 feet to the Northeasterly side of Chapel Lane; �� ;'RUNNING THENCE along the Northeasterly aide of Chapel '. Lane' 'North 16.degrees 49,,minutes 50. seconds"west 328.32 feet to.,the point of. lace of',be innin bein and intended to ber :those premises.as'outlined and shown•as a portion of the map huh x?i prepared by Holzmocker,_ MeLendon &•Murrell,..P.C. dated.March .« ' „ ✓i Reserving, however;',to the'party of`• the first part it's • ) successors, heirs and assigns the right'to maintain, ; q install, repair, replace,, and otherwise service the usual public utility easements including but not limited toy . sewer, water, telephone, cable, electricity and gas over, under, 'along, through and as necessary above a parcel s' approximately 40 feet in width adjoining the premises now or formerly owned by Abraham Shames and more particularly n described as follows: y t BEGINNING at a point'on, the easterly side of Middle Road, County Road 25. (North•Road) which point mar":i the point of intersection of the boundary line .between lands now or ' formerl of San Simeon Retirement: Community Inc. and Abraham Shames and others; .,RUNNING THENCE from','said pcint','of beginning along land now'or formally of,'Shames South.65. degrees 57 minutes 10 i • �: seconds East �99--ei feet;-..' r 1 f 4�t.oS:•,: :: FV RUNNING THENCE'South 53 degrees 18 minutes 38 `seconds ;t West, 45.85 feet;' y. ' RUNNING THENCE North '65 degrees '57 minutes 10 seconds •hx`,.. . West. 420Al feet to the easterly side of Middle Road; h RUNNING THENCE along the easterly side of Middle Road a, in a Northerly direction along the,arc of the curve bearing to the left having a radius of 74.9.20 feet a distance of 40.02 feet to the point. or lace of beginning. P P fr, descrip:mtp .,. ., ,. dJ J...at - t,'f" ,• ,1 r-tir. .. rc.EZ' iJtk.0 'bp• rva'1 .:a n. ,. Ry , I I 5i .t �. " for •' 1 - ,. t ttl,:",, )•,n 'F' ! - �; "f '7 II Yl.i �,$1r1t'+ <o .'•.' 'W'!tla t:•43•- I:I+ :F , , - '., 'a- TOGETHER with a1I'lieh.t title and interest,II"any,'o(the party of the first part to and to any streets:and goads abutting the above described p)remiies to the center lines thereof, TOGETHER with the appurtenances pnd all the estate and rights of the party of the first part in to ,t+ sa(d'premises, '! TO HAVE AIND TO HOLD the premises herein jrinted unto the party of the'sti part, the"heirs or zt„ „t . successors and assigns of the party of the second part forever. t � r, Eli i ✓.tf,Z0.'' 1 I 1 itYPtfr?t�',JAtrfa.l f5 ) .1{ ) iv,( K tral � ` f, :,.' "i Ir -�J f +�IF ht 'r r, ,.I) Fi 1 , f i , 't '! Z } J; f. t; Cr tE ,t I nil �u)v7 S 91.�rr T t t4ti !a � xi ' r �.`3��1������'� �rlt �"�1,,� 5.ryfK}' S 4`4 SS j 'al ' r iL...t •.;I �r�111•�. - .l,r at 1 1 k� ,ea r. .tEry`� •,,�• ,i tr,y1 ; p J , + ,. it n { d cr,J !. u t r••- r 'f , J. fytjjr i ti i//fir +r ?f 1r, i r t�,> > t'.! ii p r r'•:7' r ttz �. ; 1 "!, I'" t ti SJt 1 { I >ti CF t>i d4 5'4�1 i�oare i, e'U,� / 1 r . .�1 7•r r th7',n Jni)t,: tfasYt 141 emtS�i1Cu9 .3,• ttnv�CSc+Od' fD ofl Y+ N : feQ1 me,2Ale SSSA ii 'y AND the party of the first part covenants that :he party of the first part h:s not done or suffered anything whereby.the said premises have been Incumbered In my way whatever, except as aforesaid, I' AND"the party of the first.part,.in compliance with Section IJ of the Lien Law,covenants that the parry of 3' the first part'wiil receive the consideration for this,tonveyanee and will hold,the right to receive such totisid- h eration as a trust fund to be applied first for the purpose of paying the cost'o['&'improvement and will a�ply the same first to the payment of the cost of the Improvement before using any 1part of the total of the sami for sa} any'a her purpose. The word"piny' shall be construed as if It read parties whenever the sense of this indenture to re4�lres. IN FS$WHEREOF,the party of the first part has duty executed it i deed I ie day'ind year first above f 1 .. :_. ... .written.,: irr ratseNcti or ISAA SIMEON RETIREMENT COMMUNITY, INC," >' • I 'R, � Pff". .,Ms` K 4\.P11•v� I `�..1?(�{4 •„ J'Qr�3 'a ? ', {" h RTATI of NRw TORR,COUN' sit STATI of ARW YORK,COUNTY 19: ;;before me On.the day.of•. 19 .bx(ore On the day of ;i• " k. personally Came personally cone t c a to me knewn to be the indwidual described'in'an� who 'to me known to be the indiadual described in and who �'- . •:. � executed the (ongoing instrument, and acknowledged that ezauted the foregoing instrument-,. acknowledged that!,, •. executed the same. ' I i .' ." ,executed the same,i; t t' .'.ini IJi lr•oaf Ii.1• Ir+ I f Ce'i1 �r :,° j)°f!t +�i t t qtp t11 1i r Y} �h:'I' 4lkl 1 ,t fTATL OF NIW PORK,COUNTY OF SUFFOLK t ;.' us SyAyt OF NRW YORK.COUNTY OF . r une 1 93 before me On the day of 19 ,before me On the 30th dax' / e personally came ((' y _.�✓1 r�� personally came ; to me known,who,bang y me duly sworn,di�depose ind to me known,who.being by me duly sworn,did depose arid''; say that he resides at No.,7�06/jQ•�/nftrN!/r/%)�! say that he resides at o.' ";.' i•e fr that he is theYfta r�tsA J� ����" /r ,91y' that ,he is the '• of San Simeon Retirement Community, Inc. .. of ,the corporation aescnbed the corporation described •,Fa in and which executed the foregoing instrument; that he in and which executed the foregoing instrument; that he knows h seal c said corporation: that the seal affixed knows the seal of said corporation: that the seal affixed to said instrument is such corporate seal; that it was so to said instrument is such corporate seal; that it was so { affixed by order of the board of directors of said corpora- affixed by order of the board of directors of y like hc; tion, and that, he.signed h . name thereto by like order, tion, and that he signed h name thereto by NOTARY' BLIC I'_• LYTdNE i�oftr p a COI y1,101 `�S 4i, �argaln ani! Bale �eea SECTION WITH COVINANT AOAINIT CRANTOIIY ACT1 BLOCK TrcLE N:.' LOT y4 SAN SIMEON RETIREMENT COtti"lUNITY, INC COUNTY ox TOWN :f SAN SIMEON,BY THE SOUND NURSING HOME, INC. , J+Ir ( Ravded At Req.esi of Anierlren Thl,1nw lm ce.peer iil;, PJ. RETURN BY MAIL TO: f, {f AMDAeO/GAM Or NM YOAf/OA AO 0,TITIR U40{RwA1T1I11 OnrnnmrJ Dr s r y• i amorloan title Insurance cornpenv northeast region Jp/� i.,.r to NJ�s`f .'� A MrnOrr of The C"11.m l l,wrener G„peAlri iia s,,G,;d ,'fli;';ry'. I+ ,. ,.?.s,'i a.',•f' i i7 t•S, - l i { ' ' -A tl 61 . s. . •I ,+.1, 1,. •..�4., °i+ 'i'+ +Y..':� AY, �r. -.t.t a' �Pf., „� ,r ! 1 �.• t SOUTHOLD TOWN PLAN G BOARD 3 JUNI 4, 1993 2. The installation of drainage structures to prevent runoff from entering Ackerly Pond Lane. Additional information must be presented in regard to the drainage structures. as per the Engineering Inspector' s report dated May 20, 1993. A performance bond estimate must also be calculated for the cost of the construction. The drainage structures must be installed prior to endorsement of the final map, or a performance bond must be presented. An administration fee of 6 0 of the total bond estimate amount will also be required prior to endorsement of' the subdivision. 3. The Planning Board is awaiting additional information from the Southold fire District in regard to their firewell recommendation. You will be notified under separate cover if the Planning Board determines that a firewell is required. If one is required, the cost of such must also be included in the bond estimate. Mr. Orlowski: Second. Mr. Ward: Motion seconded. All those in favor? Ayes: Mr. Ward, Mr. Latham, Mr. Orlowski, Mr. Edwards, Mr. McDonald. Mr. .Ward: Opposed? Motion carried. Mr. Ward: 7:35 p.m. San Simeon Retirement Community & NursingHome. This proposal is to convey 6.594 acres from a vacant 37.555 acre parcel to be merged with a 3.581 acre parcel, containing a nursing home. Both parcels are zoned Hamlet Density. SCTM #1000-45-2-p/o 10. 2. Is there anybody here this evening that would like to address. the Board regarding this lot line change. If not, does the Board have any questions? Board: No questions. Mr. Ward: What is the pleasure of the Board? Mr. McDonald: Mr. Chairman, I would like to make a motion to — close this hearing. Mr. Edwards: Motion seconded. All those in favor? Ayes: Mr. McDonald, Mr. Latham, Mr. Orlowski, Mr. Edwards, Mr. Ward. Mr. Ward: Opposed? Motion carried. Mr. McDonald: , Mr. Chairman, I would like to make a further motion. SOUTHOLD TOWN PLAN 1G BOARD 4 JUN] 4, 1993 WHEREAS, the San Simeon' Retirement Community, Inc. is the owner of the property known and designated as SCTM #1000-45-2-2 and .p/o lot 10.3, located at the northeast corner of Route 25 and Chapel Lane in Greenport; and WHEREAS, this lot line, to be known as proposed lot line change for the San Simeon Retirement Community, Inc. is for a lot line change to subtract 6,594 acres from a 37.555 acre parcel and add it to a 3.581 acre parcel; and WHEREAS, the Southold Town Planning Board, pursuant to the State Environmental Quality Review Act, (Article 8) , Part 617, declared itself Lead Agency and issued a negative declaration on May 24, 1993 ; and WHEREAS, a final public hearing was closed on said subdivision application at Town Hall, Southold, New York on June 14, 1993; and WHEREAS, all the requirements of the Subdivision Regulations of the Town of Southold have been met; and be it therefore RESOLVED, that the Southold Town Planning Board approve and authorize the Chairman to endorse the final survey dated March 1993 . Mr. Edwards: Second. Mr. Ward: Motion seconded. All those in favor? Ayes: Mr. Edwards, Mr. Ward, Mr. Latham, Mr. McDonald, Mr. Orlowski. Mr. Ward: Opposed? Motion carried. Hearings Held Over From Previous Meetings: Mr. Ward: Hillcrest Estates - Section 2 - This major _ subdivision is for twenty lots on 22. 9 acres located in Orient. SCTM #1000-13-2-8.5. Mr. McDonald: Mr. Chairman, I make a motion that this hearing be held open because at the last minute we received a call from a representative of Hillcrest Estates indicating that they were out of the country and were not able to come and plead their case so I would like to hold it open for one more meeting. Mr. Latham: Did they know it was going to be on the agenda? Were they notified? LEGAL NOTICE .Y ` .. .. Notice of Public Hea.r.,, COUNTY OF SU.FFOLtc . ` f S'l'A'fLO1:;NEW .YORK " ss: " NOTICE IS HEREBY , GIVEN that pursuant to Sec tion 276 of the Town Law, a public hearing will be held by y the Southold Town Planning ` Patricia _Wood;' being- duly,,,sworn,•' says that. she is the,. 1 Board,at the Town Hall Main ' Editor, of THE LONG ISLAND- TRAV.EL.Ef2=WATCHMAN; Road, Southold,New York in a public newspaper,printed at Southold, in.Suffolk County; said Town on the 14th day of and that, the notice of which the annexed is a',printed copy, June 1993,on the question of the following: I has`.;h�en •published hi'said d' l.orig Islan Traveler Watchman 7:30 P.M.Final approval for cnc'c .each week'for weeks the minor subdivision for Puritan Farms,at Southold,in •` suc,c"es5iv.ely, commencuig on.the . the Town of Southold, Coun- ty of Suffolk, State of New York. Suffolk County Pax . . , 19 : X3 . day of Map Number 1000-69-5-7. The property is bordered on __ -- ----- --- . . . . . . . . . . . the northeast by land nrw or formerly of J.C.&.A.Cornell; ; by land now or formerly of r C.W. & N.S. Wright; by land . now or formerly of E. & A. Sworn to before me this . . . ... . . . . . . . . . . . . . . . day of Marvin; by Ackerly Pond Lane;on the east by land now 1 •93 or formerly of RE & D.J. �. . . • Swenkowski; on the southeast by land now or formerly of Edwin Smith; on the southwest by land now or formerly. of. John Rastegar , Assoc., on the northwest by i Notary Public land now or formerly of + , Christian Frederick Baiz III. BARBARA A. SCHNEIDER 7:35 P.M.Final approval for NOTARY PUBLIC, State of New York the lot line change for San Si- No. 4806E146 mEon Retirement Community Qualified in Suffolk County and Nursing Home,at Green- ' Commission Expires 8/31/gy port,in the Town of Southold, E County of Suffolk, State of New York. Suffolk County I Tax Map Number 1000 45-2-2 and 10.3. The property is bordered on the north by County Road 48; k on the west by;Chapel Lane; on the.south by land now or t' 'f ' formerly of San Simeon ' Retirement Community and i "the Village of Greenport;and f f on the east by land now or ,4 formerly of John J.Siolas and t i Chatiner Tsounis. t;E Any person desiring to be l heard on the above matter t :; r should appear at the'time and , place above specified. } Dated: June 8, 1993 ""` t N BY,ORDER OF THE SOUTHOLD TOWN JUN,I7,4 1993 e PLANNING BOARD FAD tr Richard C. Ward, �' S4 fHOLD TOyb'N Chairman PLANNING BOARD 1X-6/10/93(40) _- COUNTY OF SUFFOLK � ( Vi ROBERT J. GAFFNEY SUFFOLK COUNTY EXECUTIVE DEPARTMENT OF PLANNING ARTHUR H. KUNZ DIRECTOR OF PLANNING June 10, 1993 Plat Name: San Simeon Retirement Community (Lot Line Change) Richard Ward, Chairman Tax Map No. : 1000-45-2-2 & P/0 10.3 Town of Southold Planning Board SCDP File No. : S-SD-93-05 Main Road Southold, NY 11971 Dear Mr. Ward: Pursuant to the requirements of Section A14-24, Article XIV of the Suffolk County Administrative Code, the above captioned proposed final plat which has been referred to the Suffolk County Planning Commission is considered to be a matter for local determination; however, this shall not be construed that the Commission has either approved or disapproved this particular plat. Very truly yours, Arthur H. Kunz Director of Planning S/s Frank Dowling, Senior Planner Subdivision Review Division FD:bh � C� G � O Y JUN I 11993 SOLE"fHOLD"01NN PUMNiNG 60 110 H.LEE DENNISON BUILDING ■ VETERANS MEMORIAL HIGHWAY ■ HAUPPAUGE. NEW YORK 11788 ■ (516) 853-5192 COUNTY OF SUFFOLK JUNK 71993 SOUTHOLD TOWN •;` PLANNING BOARD ROBERT J. GAFFNEY SUFFOLK COUNTY EXECUTIVE DEPARTMENT OF PLANNING ARTHUR H. KUNZ DIRECTOR OF PLANNING June 3, 1993 Richard Ward, Chairman Town of Southold Planning Board Main Road Southold, NY 11971 Preliminary Final X Plat Name: San Simeon Retirement Community Tax Map #: 1000-45-2-2 & p/o 10.3 SCPD File No. : 1333-INC-93-14 Dear Mr. Ward: Please be advised that pursuant to Section A14-24, Article XIV of the Suffolk County Administrative Code, the above referral will not be reviewed by the Suffolk County Planning Commission because of noncompliance with requirements for notice and maps as stipulated in Informational Bulletin #9 of the Suffolk County Planning Commission. The staff has checked the above referenced referral and find that it is incomplete and that the following items are required: 3 copies of final map with acceptable title and lot numbers. Very truly yours, Arthur H. Kunz Director of Planning S/s Frank Dowling, Sr. Planner Subdivision Review Division FD:mb NOTE: Please consult Suffolk County Department of Planning Informational Bulletin No. 9 for complete referral requirements. H.LEE DENNISON BUILDING ■ VETERANS MEMORIAL HIGHWAY ■ HAUPPAUGE. NEW YORK 11788 ■ (516) 853-5192 PLANNING BOARD MEMBERS SCOTT L. HARRIS w Bennett Orlowski, Jr., Chairman ,������., � .,-'��� Supervisor George Ritchie Latham, Jr. Richard G. Ward Town Hall, 53095 Main Road Mark S. McDonald P.O. Box 1179 Kenneth L. Edwards PLANNING BOARD OFFICE Southold, New York 11971 Telephone (516) 765-1938 TOWN OF SOUTHOLD Fax (516) 765-t 823 June 10; 1993 Frank Dowling, Senior Planner Suffolk County Department of Planning H. Lee Dennison Building Veterans Memorial Highway Hauppauge, NY 11788 RE: Lot Line Change for San ,Simeon Retirement Community Route 48 & Chapel Lane, Greenport SCTM# 1000-45-2-2 & p/o 10. 3 Dear Mr. Dowling: The Planning Board has received your letter of June 3 , 1993, regarding the above referenced project. As discussed with staff member Robert Kassner, attached are maps with the changes requested. The Board would appreciate a letter of "Local Determination" in order -to proceed with this application. If you have any questions, or require further assistance, please contact this office. Sinc �p s is rd G. Ward Chairman � JtJbJ. 5 7- COUNTY OF SUFFOL'K f bµ,y SOUTHQLDTG,;k,'N ! �� PLA{VNU� G BOWRO a ROBERT J. GAFFNEY SUFFOLK COUNTY EXECUTIVE DEPARTMENT OF PLANNING ARTHUR H. KUNZ DIRECTOR OF PLANNING June 3, 1993 Richard Ward, Chairman Town of Southold Planning Board Main Road Southold, NY 11971 Preliminary Final X Plat Name: San Simeon Retirement Community Tax Map #: 1000-45-2-2 & p/o 10.3 SCPD File No. : 1333-INC-93-14 Dear Mr. Ward: Please be advised that pursuant to Section A14-24, Article XIV of the Suffolk County Administrative Code, the above referral will not be reviewed by the Suffolk County Planning Commission because of noncompliance with requirements for notice and maps as stipulated in Informational Bulletin #9 of the Suffolk County Planning Commission. The staff has checked the above referenced referral and find that it is incomplete and that the following items are required: 3 copies of final map with acceptable title and lot numbers. Very truly yours, Arthur H. Kunz Director of Planning S/s Frank Dowling, Sr. Planner Subdivision Review Division FD:mb NOTE: Please consult Suffolk County Department of Planning Informational Bulletin No. 9 for complete referral requirements. H.LEE DENNISON BUILDING 0 VETERANS MEMORIAL HIGHWAY 0 HAUPPAUGE. NEW YORK 11788 ■ (516) 853-5192 Su 6F 64 PROFESSIONAL ENGINEER HOBART ROAD SOUTHOLD, NEW YORK 11971 516-765-29S4 June 8, 1993 Southold Planning Board Main Road Southold, NY 11971 ATT: Bob Kassner RE: San Simeon Lot Line Change SCTM #45-2-10.3 "'-'Vh6 Dear Mr. ssner, Please find attached the three additional copies of the site plan showing the lot line change you requested. If you have any questions regarding this matter, please call me at my office. r uly, Joe h Fischetti, P.E. S' USR1i]� C �; 1 ILIC ' pt�s-r— ie* � ,::::: :::::::ADD NEW NEGATIVE DECLARATION .....:::::::::05 27 93:::;::E:].6 ::::E ::::::: sHollfiR _ ii 11 Ir -ILE.,•N,U,MBER NJ 473800-0086? Town of SOUTHOLD, SUFFOLK County ............ EAD AGENCY•......,..... ................................ 473800:::::::E::::::::E:;:;:E;::E:f:::Town of SOUTHOLD, SUFFOLK County FFICE ...... or BOARD ,..., ....Planning Board ................................................................................................................................................ .: ........................................................................................................................................:::::::::::GLASS:::.. .... ........ ......... ::::::::::::::::::::::::::::::::::::::::::::::::::........................:::::::............................... a s t e d:....;;,:::::.........,..,.....,..............,.,...........,.,.......................,......... ........................... rITLE:;:::Lot line Chge San Simeon .........................................................�. e .,...,...,.,..,..........,......................,.....,..,,...,..,,...,,,,..............,..,.....,...... Y p 1:::::::::::::::::::: ......... i ..... ........................................................ ....... ....... ^.. � Modification of lot lines for San Simeon Retirement Community and ' ..................... ' Nursing Home on Cor Rt 25 & Chapel s n 4. ��.......................................................................................................... ,f� . .6 ,.... ;� .; . .�,, n.. III) . ..................................................................................................... ,.,,... .,...,...............,.,..,.,.,............. .....,.,. ........,,,..............,....�,............................. . .....................................................................................................:: :::DATA RECEIVE ...,........,........,,.............,...,....,.,.......,.,.,..........,...,...,,...,.....,,,.,...............,........................,.......... D .• I. TATUS • .:.. ..................................... ......,...,.,,.,.,,..,.,....,.,.,.,,,,,.,,....,...,.,.,,,..,..........,.,.,.,...............,..,.,...,..........,.....,......,........,.....,..,..,...,,,.............,.,.,.......,........................ .. ::N: ................................................. :: N orma�l� void: d III ::::::::::::::::::::::::Conditioned:::;:::::::::::::::::: Resci ndedi:i:iiE;EiiE iiii ? '' iii i'' ii................................ ? ` ` I ..............................::' Curre ................................................................................................................::::::::::: n t Record ..................,............................................................. :EMPORTP_IVT > > JE' i 1 � 1V-Li mbe�r W1- - 473800 - 008G7 Use the above number in all correspondence about this action! To the Lead Agency: The above information confirms that filings on the described Negative Declaration were officially received by, and entered in the SEOR Repository on the date(s) shown in the box headed DATE RECEIVED above. The date and time in the second line show when this document was printed. Please check the information above carefully. For corrections or questions contact Charles Lockrow, (518)457-222e,., or, write to: SEAR Repository NYSDEC Division of Regulatory Affairs 50 Wolf Road, Room 514 Albany, NY 12233 Town of SOUTHOLD JUN 41993 Planning Board 53095 Main Road-P. O. Box 1179 SOUTI-I00TOWN Southold, NY 11971 PLANNIti6BOF1RD COUNTY OF SUFFOLK ROBERT J. GAFFNEY SUFFOLK COUNTY EXECUTIVE DEPARTMENT OF PUBLIC WORKS STEPHEN G. HAYDUK,P.E. COMMISSIONER May 17, 1993 Torn of Southold Planning Board Office 53095 Main Road P.O. Box 1179 Southold, New York 11971 Attention: Richard G. ward RE: C.R. 48, Middle Road - SAN SIMEON RETIREMENT COMMUNITY NURSING HOME SCTM #1000-45-2-p/o 10.3 SCTM #1000-45-2-2 Gentlemen: This Department has reviewed the above referenced project. Specifically note that: A permit from this Department will not be required. We have reviewed this development and find that no additional improvements within the County right-of-vay in the vicinity of this site will be required. If you have any questions, kindly contact this office at 852-4099. Thank you for your cooperation in this matter. Very truly yours, Richard J. LaValle, P.E. Chief Engineer tBy M. Paul Campagnola Permits Engineer RJL/MPC/J fb nn 14AY 2 61993 C SOUTNOID TOWN PLANNING BOARD SUFFOLK COUNTY IS AN EQUAL OPPORTUNITY/AFFIRMATIVE ACTION EMPLOYER 335 YAPHANK AVENUE ■ YAPHANK.N.Y. 11980 ■ (516) 852-4000 FAX (516)852-41 50 'PLANNING BOARD MEMBERS A SCOTT L. HARRIS �, i1IG Bennett Orlowski, Jr., Chairman .r��9�=�.r � wo Supervisor George Ritchie Latham, Jr. Richard G. Ward Town Hall, 53095 Main Road Mark S. McDonald P.O. Box 117.9 Kenneth L. Edwards PLANNING BOARD OFFICE Southold, New York 11971 Telephone (516) 765-1938 TOWN OF SOUTHOLD Fax (516) 765-1823 May 25, 1993 Joseph Fischetti, Jr. Professional Engineer . Hobart Rd. Southold, NY 11968 Re: Proposed lot line change for San -Simeon-Retirement Community and Nursing Home -County- Road -4 8 Greenport, NY 11944 Dear Mr. Fischetti: The following resolutions were adopted by the Southold Town Planning Board at a meeting held on Monday, May 24, 1993 : BE IT RESOLVED that the Southold Town Planning Board, acting under the State Environmental Quality Review Act, established itself as lead agency, and as lead agency makes a determination of non-significance and grants a Negative Declaration on this unlisted action. BE IT RESOLVED that the Southold Town Planning Board set Monday, June 14, 1993 at 7: 35 P.M. for a final public hearing on the maps dated March 1993 . Enclosed please find a copy of the Negative Declaration for. your records. Sincerely, q1104J h, �S Richard G. Ward Chairman enc. ca t F PLANNING BOARD MEMBERS ,;e , rkfi SCOTT L. HARRIS Bennett Orlowski, Jr., Chairman �aa ``mac Supervisor George Ritchie Latham, Jr.Richard G. Ward Town Hall, 53095 Main Road �g Mark S. McDonald P.O. Box 1179 Kenneth L. Edwards Southold, New York 11971 PLANNING BOARD OFFICE Telephone (516) 765-1938 TOWN OF SOUTHOLD Fax (516) 765-1823 State Environmental Quality Review NEGATIVE DECLARATION Notice of Determination Non-Significant May 24, 1993 This notice is issued pursuant to Part 617 of the implementing regulations pertaining to Article 8 (State Environmental Quality Review Act) of the Environmental -Law. The Southold Town Planning Board, as lead agency, has determined that the proposed action described below will not have a significant effect on the environment and a Draft Environmental Impact Statement will not be prepared. Name of Action: Lot line change for San Simeon Retirement Community & Nursing Home SCTM# : .1000-45-2-p/o lot 1Q. 2 Location: Northeast corner Rt. 25 and Chapel Lane, Greenport SEQR Status: Type I ( ) Unlisted ( X ) Conditioned Negative Declaration: Yes ( ) No ( X ) Description of Action: This proposal is to convey 6. 594 acres from a vacant 37. 555 acre parcel to be merged with 3 .581 acre parcel containing a nursing home. Both parcels are zoned hamlet density. Page 2 San Simeon lot line change - SEQR Negative .Declaration May 24, 1993 Reasons Supporting This Determination: Both lots are in the Hamlet Density District. The existing nursing home is on 155,999 square feet and the parcel to be conveyed is 287,241 square feet, thus the merged parcel will be 1,635,914 square feet; more than the required 20,000 square foot minimum for this district. The applicant will have to comply with the requirements of the Suffolk County Sanitary Code (SCSC) and all relevant standards of water supply and sewage disposal systems. This impact is not considered significant due to the anticipated project compliance with established requirements of the SCSC and the Suffolk County Department of Health Services (SCDHS) and the required obtainment of the relevant permits. Because there has been no correspondence received from the New York State Department of Environmental Conservation in the allotted time, it is assumed that there -are no comments or objections from that agency. For Further Information: Contact Person: Robert G. Kassner Address: Planning Board Telephone Number: (516) 765-1938 cc: Suffolk County Deparment of Health Services Suffolk County Planning Commission Dave Morrell, DEC Commissioner Judith Terry, Town Clerk Building Department Applicant oSu,t3�i� -� COUNTY OF SUFFOLK ROBERT J. GAFFNEY SUFFOLK COUNTY EXECUTIVE DEPARTMENT OF HEALTH SERVICES MARY E. HIBBERD, M.D., M.P.H. COMMISSIONER May 12, 1993 Robert G.Kassner Town of Southold Town Hall-53095 Main Road P.O.Box 1179 Southold,New York 11971 RE: Lot Line change for San Simeon Retirement Community&Nursing Home SCf M#: 1000-45-2-p/o 10.3& 1000-45-2-2 Dear Mr.Kassner: The Suffolk County Department of Health Services(SCDHS)has received your letter dated April 12, 1993, concerning the above-referenced application,and has no objection to the Town's designation as lead agency.- This correspondence is intended primarily to expedite the procedural requirements of SEQRA pertaining to the establishment of lead agency.The comments provided below are,therefore,general in nature,representing several of our most common concerns regarding Suffolk County projects.The department wishes,however,to reserve its right to provide more detailed information within the comment period(s)established for this action. 1. Suffolk County Sanitary Code(SCSC) 1. The SCDHS maintains jurisdiction over the final location of sewage disposal and water supply systems,pursuant to the authority and requirements of Articles 4,5,6 and 7 of the SCSC. Applications must comply with all relevant density and construction standards for water supply and sewage disposal. Applicants should not undertake the construction of,or connection to,either system without Health Department approval. 2. Where applicable,the department regulates the storage,handling and discharge of restricted toxic and hazardous materials pursuant to the requirements of Articles 7& 12 of the SCSC. 3. If an application has not yet been submitted to the SCDHS,one should be filed at the earliest date to allow for the technical review of the proposed action.Project designs submitted to the department should be fully consistent with any action currently under review through the SEQRA process. 4. Design and flow specifications,information regarding subsurface soil conditions,water supply information,and complete design details are essential to the review of this project,and are evaluated fully at the time of application review.Should the town require additional environmental information(such as a DEIS),discussion of the compliance requirements of the SCDHS should be required. 5. Of particular concern to the department are those areas which because of elevated groundwater conditions,or soils which are not conducive to the proper functioning of conventional subsurface sanitary sewage disposal systems.Your agency should be aware that such conditions frequently require the use of fill or the excavation of subsurface soils to accommodate subsurface sanitary disposal systems constructed in conformance with thep_quiremebts othe,-SCSC TAJ DIVISION OF ENVIRONMENTAL QUALITY I R COUNTY CENTER RIVERHEAD, N.Y. 1 1 901-3397 C 852-2100 MAC > 7 1993 Fd SOUT6iOLD TOVV'N PU*�'ti IING BOkBD .z - Letter to Robert G.Kassr,_ May 12, 1993 Page 2 6. The department is also significantly concerned with areas where access to potable water may be constrained by unacceptable groundwater quality and the lack of an available public water supply.All private water supply systems must be constructed in conformance with requirements of the SCSC. H. NATURAL RESOURCES: 1. The SCDHS fully supports all efforts to maximize protection of natural resources which may be impacted upon by construction and development activities.It is the position of the department that the SEQRA review process provides the greatest opportunity for comprehensive consideration of these resources,and that all practicable planning measures should be employed to help ensure their protection. Of particular concern to department is the adequate protection of wetlands,surface waters,natural communities, contiguous natural habitats,and rare,threatened and endangered species.In addition,efforts to protect sensitive physical resources such groundwaters,dunes,bluffs,shorelines,natural drainage channels,groundwater recharge areas,and steep slopes are fully supported and encouraged by the SCDHS. In general,the department encourages the following land use measures be considered(where appropriate)to actions being reviewed pursuant to SEQRA. 1.Maximum practicable setbacks from all wetlands,surface waters,dunes,and bluffs. 2.Non-disturbance buffers between wetland limits and required structural setbacks. 3.Clustering of subdivision lots to provide for maximum preservation of large contiguous areas of dedicated open space. 4.Stringent clearing limitations which can reduce potential impacts to wildlife habitats,vegetative communities,and unconsolidated soils. 5.Maximum practicable confinement of development to areas with slopes of less than 10%. 6.Maximum use of native species for landscaping purposes. 7.Construction of recharge areas,so as to minimize the amount of disturbance and structural modification to the site. 8.Maximum use of land-banked parking on commercial sites. 9.Minimal use of fertilizer-dependant turf and landscaping. 10.Employment of stormwater runoff control measures necessary to maintain runoff on-site. The department appreciates the opportunity to participate in the SEQRA review of this proposal.Additional information may be provided prior to the close of the established comment period.Should you have any questions or require additional information,please feel free to contact the Office of Ecology at 852-2078. Sincerely, Made J.Reuschle Environmental Planner Office of Ecology MJR/amf cc: Vito Minei,P.E. Stephen Costa,P.E. o000 PLANNING BOARD MEMBERS `". ;aw T SCOTT L. HARRIS Bennett Orlowski, Jr., Chairman �i �� Supervisor George Ritchie Latham, Jr. ® Richard G. Ward Town Hall, 53095 Main Road Mark S. McDonald P.O. Box 1179 Kenneth L. Edwards Southold, New York 11971 PLANNING.. BOARD OFFICE Telephone (516) 765-1938 TOWN OF SOUTHOLD Fax (516) 765-1823 � 9 ,19y� Suffolk County Planning Commision - H.. Lee Dennison Executive Office Building- 12th Floor Veterans ,Memorial Highway Hauppauge, New York 11788 Attention: Mr. Frank Dowling, •Senior .Planner . Subdivision Review Division Gentlemen: Pursuant to Section A14-24', Suffolk County Administrative Code, the Southold Town Planning Board hereby refers the following proposed say/' iGto tqp Su folk County Planning COMMISS10 Map of - RAWHamlet/Locali 1 S.C.D.P.W. Topo No. : Zoning -(Lru> S.C. Tax Map No. : cc p - Gjt - _ f 0 ,3 G 6T- Major Sub. Minor Sub. _Site 'Plan Cluster MATERIAL SUBMITTED: rA �na; Preliminar Pla 3 t/ y t ( . copies) Profiles (1) Drainage Plans (1) Topogroaphical Map (1) Site Plan (1) Grading Plan (1) Other materials (specify and give number of copies) Waiver of Subdivision Requirements - See attached sheet •!/ CONTINUED REFERRAL CRITERIA: SE RA STATUS: 1. The project is a (Unlisted) (Type I) (Type II)Action. 2. A (Negative Declaration) (Positive Declaration) (Determ. of Non-Significance) has been adopted by the Planning Board. 3. 1' E.I.S. statement enclosed. (Yes) (No) . 4. The proposed division has received .approval from the S.C. Dept of Health. (Yes) (No) .. Comments: L E,9 r) 1&GE/1e, We request acknowledgement of receipt of this referral. (Yes)' (No) Referral received —19 by Suffolk County Planning Commission and assigned File NO. yJI, .ly yours, Richard G. Ward Chairman �SUffatk�� �Fic RAYMOND L. JACOBS c�t� r�r, JA ES A. RICHTER SUPERINTENDENT OF E'NGIINMR-ING HIGHWAYS �.ly�1 � ��0� INSPECTOR 763-3140 763-3070 OFFICE OF THE ENGIN=t- TOWiv OF SOUTHOLD M E M O R A N D U M TO: RICHARD G. WARD Chairman -- Planning Board FROM: JAMES A. RICHTER� SUBJECT: Short Environmental Form jP N S 1 M f.O N W-rm -w /©®o- �5'- 02- F/0 1D•3 DATE: �-15- 7 3 As per your request, enclosed please find_ the short environmental assessment form for the above referenced project. Please be advised that Part III of this form still requires your signature and related information. If you have any questions, please contact my office at your earliest convefiience.: Enc: dq NPLAAPR ! 5 1993 �1�rPiFlt,11;fp1!u sClttr'`� f"rU L1L)All D PLANNING BOARD MEMBERS t ,:. ,�-- �;� � SCOTT L. HARRIS Bennett Orlowski, Jr., Chairman e'; ` .�`� Supervisor George Ritchie Latham, Jr. Richard G. Ward Town Hall, 53095 Main Road Mark S. McDonald P.O. Box 1179 Kenneth L. Edwards PLANNING BOARD OFFICE Southold, New York 11971 Telephone (516) 765-1938 TOWN OF SOUTHOLD Fax (516) 765-1823 MEMORANDUM TO: James Richter, Engineering Inspector FROM: Richard G. Ward, Chairman - Rwl �� RE: Review of Short Environmental Assessment Form for Lot-Line Change for San Simeon Retirement Community & Nursing _Home, Route 48 Greenport SCTM# 1000=15-3-1 DATE: April 13, 1993 Please review the attached Short Environmental Form (SEAF) If you have any questions, please contact Robert Kassner of this office. Enc. cc: Raymond Jacobs, Highway Superintendent �FFDI/( . PLANNING BOARD MEMBERS SCOTT L. HARRIS Bennett Orlowski, Jr., Chairman ®y t �� Supervisor George Ritchie Latham, Jr. �,( �® Richard G. Ward Town Hall, 53095 Main Road Mark S. McDonald P.O. Box 1179 Kenneth L. Edwards Southold, New York 11971 PLANNING BOARD OFFICE Telephone (516) 765-1938 TOWN OF SOUTHOLD Fax (516) 765-1823 April 13, 1993 Joseph Fischetti, Jr. Professional Engineer Hobart Road Southold, NY 11971 RE: Proposed Lot Line Change for San Simeon Retirement Community and Nursing` Home, County Road 48 ' Greenport SCTM## 1000-45-2, P/O 'lot 10. 2 Dear Mr. Fischetti: The following resolution was adopted by the Southold Town. Planning Board at a meeting held on Monday, April 12, 1993 : BE IT RESOLVED that the Southold Town Planning Board start the lead agency coordination process on this. unlisted action. Please do not hesitate to contact this office if you have any questions regarding the above. Sincerely, Richard G! Ward Chairman 14-16-4(2/87)=Text 12 PROJECT I.D. NUMBER 617.21 SEOR Appendix C State Environmental Quality Review SHORT ENVIRONMENTAL ASSESSMENT FORM For UNLISTED ACTIONS Only PART 1-PROJECT INFORMATION (To be completed by Applicant-or Project sponsor) - APPLICANT O�SOR 2. PROJECT N E 3. PROJECT LOCATION: /L Municipality Ct+/�e�J eJ>" County �v �[/� / 60 1 4. PRECISE LOCATION(Street address and road intersections, prominent landmarks,etc.,or provide map) AA 5. IS PROPOSED ACTION: ❑New ❑Expansion Modification/alteration 6. DESCRIBE PROJECT BRIEFLY: Ad ilm-e V . 7. AMOUNT OF. AF eG"Yf='D: �•-/� �� Initially ' acres Ultimately acres 8. WILL PROPOSED ACTION COMPLY WITH EXISTING ZONING OR OTHER EXISTING LAND USE RESTRICTIONS? XYes ❑No If No,describe briefly 9. WHAT IS PRESENT LAND USE IN VICINITY OF PROJECT? Residential. ❑Industrial ❑Commercial ❑Agriculture ❑Park/Forest/Open space ❑Other escribe: 10. DOES ACTION INVOLVE A PERMIT APPROVAL,OR FUNDING, NOW.OR ULTIMATELY FROM ANY OTHER GOVERNMENTAL AGENCY(FEDERAL, STATE OR LOCAL)? �{ El Yes D�J No If yes, list agency(s)and permit/approvals 11. DOES ANY ASPECT OF THE ACTION HAVE A CURRENTLY VALID PERMIT OR APPROVAL? ❑Yes I2y No If yes, list agency name and permit/approval 12. AS A RESULT OF PROPOSED ACTION WILL EXISTING PERMIT/APPROVAL REQUIRE MODIFICATION? ❑Yes No' CERTIFY THAT THE INFORMATION PROVIDED ABOVE IS TRUE TO THE BEST OF MY KNOWLEDGE Applicantlspons r n e: �s �SC � Date: Mel 3 • Signature: �. PROFE-SSIONAL ENG ' ER SCIU .1 r u. 1 the action is in the Coastal Area, and you are a state agency, complete the Coastal Assessment Form before proceeding with this assessment OVER ,. PART II—ENVIRONMENTAL ASS IENT (To be completed by Agency)' A. DOES ACTION EXCEED ANY TYPE I Tr`n-4wHOLD IN 6 NYCRR, PART 617.12? If yes,coordi'.-:o the review process and use the FULL EAF. ❑Yes 0 No B: WILL ACTION RECEIVE COORDINATED REVIEW AS PROVIDED FOR UNLISTED ACTIONS IN 6 NYCRR,PART 617.6? If No,'a negative declaration may be superseded by another involved agency. ❑Yes . ❑No C. COULD ACTION RESULT IN ANY ADVERSE EFFECTS ASSOCIATED WITH THE FOLLOWING:(Answers may be handwritten, if legible) 'Cl. Existing air quality, surface or groundwater quality or quantity, noise levels, existing traffic patterns, solid waste production or disposal, potential for erosion,drainage or flooding problems? Explain briefly: C2. Aesthetic, agricultural,archaeological,;historic,or other natural or cultural resources;or community or neighborhood character? Explain briefly: C3. Vegetation or fauna, fish,shellfish or wildlife species, significant habitats,or threatened or endangered species? Explain briefly: C4. A community's existing plans or goals as officially adopted,or a change In use or Intensity of use of land or other natural resources?Explain briefly. C5. Growth, subsequent development,or related activities likely to be induced by the proposed action? Explain briefly. 06. Long term,short term,cumulative,or other effects not identified in C1•C5?Explain briefly. C7. Other impacts(including changes in use of either quantity or type of energy)? Explain briefly. D. IS THERE,OR IS THERE LIKELY TO BE, CONTROVERSY RELATED TO POTENTIAL ADVERSE ENVIRONMENTAL IMPACTS? ❑Yes ❑No If Yes,explain briefly PART 111—DETERMINATION OF SIGNIFICANCE (To be completed by Agency) INSTRUCTIONS: For each adverse effect identified above,determine whether it is substantial,large,important or otherwise significant. Each effect should be assessed in connection with its (a) setting (i.e. urban or rural); (b) probability of occurring; (c) duration; (d) Irreversibility; (e) geographic scope; and (f) magnitude. If necessary, add attachments or reference supporting materials. Ensure that explanations contain sufficient detail to show that all relevant adverse impacts have been identified and adequately addressed. ❑ Check this box if you have identified one or more potentially large or significant adverse impacts which MAY occuL Then proceed directly to the FULL EAF and/or prepare a positive declaration.' Check this box if you have determined, based on the information and analysis above and any supporting documentation, that the proposed action WILL NOT result in any.significant adverse environmental impacts AND provide on attachments as necessary, the"reasons supporting this determination: 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 2 ` 14-16.4(2/87)—Text 12 PROJECT I.D. NUMBER .617.21 SEAR Appendix C State Environmental Quality Review SHORT_ENVIRONMENTAL ASSESSMENT FORM .,For UNLISTED ACTIONS Only PART I—PROJECT INFORMATION (To be completed by Applicant or Project sponsor.) ��n�w� APPLICANTl�i•�h{�Oj�SOR 2. PROJECT NAME �E • � r•�•-� Cam, wrwfi 401 .���.,' Cf�' 3: PROJECT LOCATION:C!'+/�/"S �� ���� Municipality ."i �� County / 4. PRECISE.LOCATION(Street address and road intersections,prominent landmarks,etc.,or provide map) • lUorr�i/��s�' CC1vr . o� �2+ ZS. �a ch>apl� ��� 5. IS PROPOSED ACTION: ❑New ❑Expansion Modification/alteration 6. DESCRIBE PROJECT BRIEFLY: el 7. AMOUNT OFL4kbqAF �— Initially ' acres Ultimately ✓ acres 8. WILL PROPOSED ACTION COMPLY WITH EXISTING ZONING OR OTHER EXISTING LAND USE RESTRICTIONS? VYes ❑No If No,describe briefly 9. WHAT IS PRESENT LAND USE IN VICINITY OF PROJECT? Residential ❑Industrial ❑Commercial ❑Agriculture ❑Park/Forest/Open space ❑Other Describe: 10. DOES ACTION INVOLVE A PERMIT APPROVAL,OR FUNDING, NOW OR ULTIMATELY FROM ANY OTHER GOVERNMENTAL AGENCY(FEDERAL, STATE OR LOCAL)?�{ El Yes BLJ No If yes, list agency(s)and permit/approvals 11. DOES ANY ASPECT OF THE ACTION HAVE A CURRENTLY VALID PERMIT OR APPROVAL? ❑Yes ICI No If yes, list agency name and permit/approval 12. AS A RESULT OF PROPOSED ACTION WILL EXISTING PERMIT/APPROVAL REQUIRE MODIFICATION? ❑Yes No I CERTIFY THAT THE INFORMATION PROVIDED ABOVE IS TRUE TO THE BEST OF MY KNOWLEDGE e•' G Applicant/spons r n e: bs FSC � ' � � � � Date: +1 Si;P;••1 i 1SC�•:'fi'it :1n Signature: N,U1114 I ��• PROFESSIO.NIAi the action is in the Coastal Area, and you are a state agency, complete tfie Coastal Assessment Form before proceeding with thi' assessment � . OVER t 0 i5�.�1 P#1gPl�•sli<fl E3fliFi! 7 PART II—ENVIRONMENTAL ASSESSMENT (To'be completed by Agency)' ti A. DOES ACTION GEED ANY TYPE I TK OLD IN 6 NYCRR, PART 617.12? If yes,eoordina ,. ' review process and use the FULL EAF. ❑Yes No F B: WILL ACTION RECEIVE COORDINATED,REVIEW AS PROVIDED FOR UNLISTED ACTIONS IN 6 NYCRR,PART 617.6? If No;'a negative declaration may be superseded by another involved agency. Yes . ❑No C. COULD ACTION RESULT IN ANY ADVERSE EFFECTS ASSOCIATED WITH THE FOLLOWING:(Answers may be handwritten, if legible) C1. Existing air quality, surface or groundwater quality or quantity, noise levels, existing traffic patterns, solid waste production or disposal, potential for erosion,drainage or flooding problems? Explain briefly: C2. Aesthetic, agricultural,archaeological, historic,or other,natural or cultural resources;or community or neighborhood character? Explain briefly: C3. Vegetation or fauna, fish,shellfish or wildlife species,significant habitats,or threatened or endangered species? Explain briefly: C4. A community's existing plans or goals as officially adopted',or change In use or Intensity of use of land or other natural resources?Explain briefly. NO. C5. Growth,subsequent development,or related activities likely to be induced by the proposed action?Explain briefly. YES - �OS518LE: f.XPANSION DF . >CXIsTIN� fUURSrNC� �ID M E FA G I L 1'(1 rK S . C6. Long term, short term,cumulative,or other effects not identified in C1-05? Explain briefly. C7. Other impacts(including changes in use of either quantity or type of energy)? Explain briefly. N r7. D. IS THERE,OR IS THERE LIKELY TO BE,CONTROVERSY RELATED TO POTENTIAL ADVERSE ENVIRONMENTAL IMPACTS? ❑Yes VS�No If Yes,explain briefly a . b PART III—DETERMINATION OF.SIGNIFICANCE (ro be completed by Agency) -INSTRUCTIONS: For each adverse effect identified above,determine whether it is substantial,large,important or otherwise significant. Each effect should be assessed in connection with its (a) setting (i.e. urban or rural); (b) probability of occurring; (c) duration; (d) Irreversibility; (e) geographic scope; and (f)magnitude. If necessary, add attachments or reference supporting materials. Ensure that explanations contain sufficient detail to show that all relevant adverse impacts have been identified and adequately addressed. ❑ Check this box if you have identified one or more potentially large or significant adverse impacts which MAY occuL Then proceed directly to the FULL EAF and/or prepare a positive declaration. Check this box if you have determined, based on the in and analysis above and any supporting documentation, that the proposed action WILL NOT result in any-significant adverse environmental impacts AND provide on attachments as necessary, the reasons supporting this determination, Name of Lead Agency Print or Type Name of Responsible Officer in Lead Agency Title o Re po ible Of icer Signature of Responsible Officer m Lead Agency Signature of reparer(I i ferent from responsible officer) Date 2 LZ • r �1,�Uur P ANN B*6- RD SUFFOLK-,c01 , TY Southold, N.Y. 11971 (516) 765-1938 QUESTIONNAIRE TO BE COMPLETED AND SUBMITTED WITH YOUR APPLICATIONS FOI2��IS TO THE PL,,N.NI;iG BOARD Please: complete, sign and return to the Office of the -planning Board with your completed applications 'forms. If your answer to any of the following questions is. yes these oTf your guaranteed survey or submit evidence: othereappropriate 1. Are there any wetland grasses on this parcel? (Attached is a list• o.f the. wetland grasses defined Yes� No by the Town. Code, Chapter -97, for your reference) 2. Are there -any other abutting this parcel'? premises 'under your ownership Yes . No 3. Are there any building permits pending on this .parcel? Yes No 4. Are- there any other: applications concerning this property before - any other ing department. cr agency?-(Town.-,,.State,, County, etc. ) Des No 5. Is. there any application pending before any other agency with regard to a different project on this parcel? 6.. Wa Yes No s this property the subject of any prior application to the . Planning Board? Yes No 7. Does this property have a valid certificat6 Of occupancy, - if .yes please submit .a copy of same Yes No I e fy that the a ve tatements are true and will be , on y t e Plan ing B and n consideringrelied 7/1t;7 his application. Si a ure or ro property Z q. 5 P P y owner or autr.or 3. iced agent date JOSEPF'1 PROFESSIOIJAL E,VG1,V_2 /Z Southold,:IV: .Y, 11971, Attachment to questionnaire for:..-the Planning Board STATE OF NEW YORK, COUNTY .OF SUFFOLK, .ss: On the -_da Yof• . r� 195, before me personally came_ �) o.Sonh ;S G� to me known to be the individual described'. in- and who executed the foregoing instrumE and acknowledged. that executed the sa e. No ry Public ELIZABE TH ANN NEVILLE Alotary Public,State of New York No..5278125850,Suffolk C my Terre Expires October 31, 1 Y Y' s PLANNING BOARD MEMBERS SCOTT L. HARRIS Bennett Orlowski, Jr., Chairman .a'� `cam . hs Supervisor George Ritchie Latham, Jr. � y' d Richard G. Ward Town Hall, 53095 Main Road Mark S. McDonald P.O. Box 1179 Kenneth L. Edwards Southold, New York 11971 PLANNING BOARD OFFICE Telephone (516) 765-1938 TOWN OF SOUTHOLD Fax (516) 765-1823 April 12, 1993 . RE: Lead Agency Coordination Request Dear Reviewer: The purpose of this request is to determine under Article 8 (State Environmental Quality Review Act-SEQRA) of the Environmental Conservation Law and 6 NYCRR Part 617 the following: 1. Your jurisdiction in the action described below; 2. Your interest in assuming the responsibilities of lead agency; and 3.. Issues of concern which you believe should be evaluated. Enclosed please find a copy of the proposal and a completed Environmental Assessment Form (EAF) to assist you in your response. Project Name: Lot Line Change for San Simeon Retirement Community & Nursing Home SCTM #1000-45-2-p/o 10. 3 SCTM #1000-45-2-2 Requested Action: This proposal is to convey 6. 594 acres from a vacant 37. 555 acre parcel to be merged with 3 . 581 acre parcel containing a nursing home. Both parcels are zoned hamlet density. SEQRA Classification: ( ) Type I (x ) Unlisted Contact Person: . R. G. Kassner ( 516)-765-1938 The lead agency will determine the need for an environmental impact statement (EIS) on this project. Within thirty (30) days of the date of this letter, please respond in writing whether or not you have an interest in being lead agency. � L Planning Board Position: (x ) This agency wishes to assume lead agency status for this action. ( ) This agency has no objection to your agency assuming lead agency status for this action. ( ) other. ( See comments below) . Comments r Please feel free to contact this office for further information. Sincerely, Richard G. Ward;, Chairman cc: *Building Department Southold Town Board *Suffolk County Dept. of Health Services 4 NYSDEC - Albany *S.C. Dept. of Public Works * Maps are enclosed for your review Coordinating agencies Su�c� 6A� PROFESSIONAL ENGINEER HOBART ROAD SOUTHOLD, NEW YORK 11971 516-765-2954 April 8, 1993 Southold Planning Board Main Road Southold, NY 11971 RE: San Simeon Lot Line Change SCTM #45-2-10.3 Gentleman, Please find attached the April 5, 1993 letter from the San Simeon Retirement Community, Inc. confirming the merging of the parcel in question upon approval of the lot line change. ry, chetti, P.E. Wr APR - 8 W3 i. I, 1 N.,(N FLrS dY _ GVILFSV diWwALRGEt[T -• ••g•••-p_-.-•-...-`-."•.".-.-.•..•..., SuflF'J LE� RK. PROFESSIONAL ENGINEER HOBART ROAD SOUTHOLD,'NEW YORK 11971 516-765-2954 April 7, 1993 Southold Planning Board Main Road Southold, NY 11971 RE: San Simeon Lot Line Change SCTM #45-2-10.3 Gentleman, Please find attached eight sets of site plans showing the proposed lot line change. These plans have been revised from prior plans reviewed by you to include, zoning lines, tax map numbers, and adjacent property owners as requested by Bob Kasner. If you have any questions regarding this matter, please call me at my office. i Jtru y, Fischetti, P.E. APR - T M93 E Sol°T,Ir3L ;rnlrlyd C4ILESXAFlSM61ME.1[T Rf nl NiiVta vi•.n •�a r _ US _ N 6A� PROFESSIONAL ENGINEER HOBART ROAD SOUTHOLD, NEW YORK 11971 516-765-2954 April 5, 1993 Southold Town Planning Board Main Road Southold, New York, 11971 RE: San Simeon Retirement Community - Lot Line Change SCTM# 045-2740.3 and oqs--a - zt Gentleman, Please find attached the following for your consideration in approving the lot line change as referenced above. 1. Eight copies of the site plan prepared by the HZM Group (to follow) 2. Questionnaire 3. Fee of $50.00 4. Completed Application 5. Short Form Environmental Assessment 6. Copy of Affidavit and Statement that the properties will marge (signed copy to follow) We would like to be considered to be placed on the Board's agenda for the April 12, 1993 meeting date. If there is any questions concerning this submission, please call. TAgefor lly yours, A schetti, P.E. APR — 6 1993 b San Simeon Retirement Community tis;Dtp1j;" a r a f✓ J 0095 50-791/214 /aae ---------------- NORTH FORK BANK Southold,NY 11971 1:0 2 1i4079'k 2i:u'0 L 261113 II. I �, � Cowt�uwl /emu-tesinl No i - SCT-M '`O q S Z -/0,3 d r Fi I E .TERRY,TOWN CLERK RECEIPT 046512 wn of Southold old,New York 11971 ne:516-T65-180i DATE % f1 19 y �~��� $ �Q00 It pBY-�v G� O � i