HomeMy WebLinkAbout1000-19.-1-1.3 & 1.4 SEPARATION 015TANGE REQUIREMENTS FOR 5TORMWATER STORM HATER CAST IRON FRAME AND COVER TO 6RADE
LEACHING STRUCTURE5 AN ) PIPING (OTHER THAN RESIDENTIAL): LEACHING STRUCTURE NOTES: CAMPBELL 102 G OR APPROVE[)EQUAL BLDG INFO AREA COVERAGE
I.COLLAR DEPTH 15 NOT REQUIRED WHEN
HORIZONTAL SEPARATION 015TANCE5 FOP,
FINAL CRAVE EXISTING PROPOSED PROPOSED PROP.CVR(5
STORM DRAINAGE LEACHING POO-5: RATEABLE MATERIAL EXISTS FOR FULL DEPTH. 7 1
2.COLLAR MATERIAL SHALL BE CLEAN 6RAVEL 101 DE516.: STRUCTURE USE: UNDER SEPARATE PERMI1
PROPERTY LINE = 10 MINIMUM HORIZONTAL SEPARATION DISTANCES FOR CE,
-7E NON -7 STRUCTS: MIN. -I-
BUILOINC75 WITH CELLAR= 10'MINIMUM STORM DRAINAGE -LEAGHINC ONLY. b"THK CONG COVER Ist FL. 151;FL. 1st FL.
BUILDINGS ON SLAB = 10'MINIMUM WATER SERVICE LINE5A-ATERAL5/MAI 5' 3.ALL DRAINAGE STRUCTURES MUST BE MAPPED I I y
WATER SERVICE LINE/LATERALS/MAIN5 10 MIN. MIN. WITH FILTER FABRIC. 15'PIPE PIA.MIN. EX. I STY FR.BUILDING, N/A N/A ±155 5F
9
UNDERGROUND UTILITIES=5'MINIMUM UNDERGROUND UTILITIES= 5'MINIMUM 4.L15E 15'DIA CORRI&6ATEP HIGH DENSITY 1%MIN.(AS REQUIRED) WRAP STRUCTURES EQUIPMENT STORAGE I'll,5F of NEW YORE CITY
POLYETHYLENE(HDPE)HEAVY PUTY PIPE FOR L'U &LONG ISLAND
SANITARY SEPTIC TANK =20'MINIMUM 6REA5E TRAP=5'MINIMUM 1 31 MIN. 01 3'MIN. WITH FILTER FABRIC
INTERCONNECTION OF ON SITE STORM HATER Fz� F�7�fl EX. I STY FR.BUILDING, 167 5F N/A WA ±bl 5F
SANITARY LEACHING POOL= 20 MINIMUM PUMP STATION= 5'MINIMUM PIPE: I;U_U 17=�q I NSE eCOTEX 351,BY @ GARDEN SHED
C-REA5E TRAP= 20 MINIMUM MANHOLE=5'MINIMUM LEACHING POOLS HIGH DENSITY POLYETHYLENE(HDPE) 83 PROPEX) 800-272-4480 1811
SANITARY 5EPTIG TAW=5'MINIMUM A.HOPE PIPE SPECIFICATION(AA5HT0"4) W EX. I STY FR.BUILDING, illb 5F N/A N/A ±116 5F
PUMP STATION= 20'MINIMUM B.INSTALLATION OF HOPE 5PErIFIGATION(ASTM 1 X5 G
U_ HORSE STALL
MANHOLE = 20'MINIMUM VERTIGA_SEPARATION P15TANCE5 FOR D-2321) ORN INLET TO 50 CONN= 10"0 MIN I E�Q F=_=7a NON-RATEABLE www.dignetnycli.com
PRIVATE WELLS = 50'MINIMUM 5P TO 50 CONN 15%)MIN EX. I STY FR.BUILDING-5,
RETAINING HALLS= 10'MINIMUM STORM CRAINAC7E LINES: G.WATER-TIGHT JOINT TESTING SPECIFICATION 501L 1142 5F N/A WA 1'742 5F or
ROOF LDR CONN 41 MIN 10' @
FUEL 5TORACE TANKS(BELOW 6ROUNP) 20'MIN HATER SERVICE LIKES= lb-MINIMUM (ASTM D-3212) -0' DIA. CHICKEN COOP www.cal[811.com
SANITARY WASTE LINES= lb"MINIMUM P.6A5KET SPECIFICATION(ASTM F-47U 1 4 1142 STY STEEL BUILDIN6, N/A bfob4 5F bk64 5F 8664 5F (for other states)
5
LANDER SEPARATE PERMIT)
6'MIN.
EAST WING-LIVESTOCK WEST WING-=ARM EQUIPMENT, By law, excavators and contractors working in the
6NO WTR C_ COLLAR MATERIAL (PENETRATION) SITE
RATEABLE 501E CENTER-FEED 4 HAY STORAGE five boroughs of New York City and Nassau and
Suffolk Counties on Long Island must contact
.1 1 LOCATION
I STY GREENHOUSE BUILDING-7 N/A 1,440 5F 1,440 5F 1,440 5F
20X40 WOOD FRAME LANDER SEPARATE PERMIT)
0 DigNet, 1-800-272-4480 or 811,at least 48 hours
STAKE 0
e an working days(excluding I
UNDERLYING SAND AND GRAVEL STRATA PLANT PROPAhATIDN but no
0 6Raa*IIOUSE weekends and legal holidays)prior to beginning
FABRIC 1 STY BUILDING N/A 5jb4 5F 5j&4 SF any mechanized digging or excavation wo kto X_
TYP16AL STORM HATER (PROP.UNDER THIS APPLICATION)
ensure underground lines are marked.
LE66HIN& POOL (50) DETAIL Excavators and contractors can also submit
PLANT PROPAC7ATION
ARE locate requests online,through ITIC.Ifyou do not
U (FOR HICM 6ROUND HATER) A TOTALS: ±1,132 5F 10,104 5F 152bb 5F 17,020 5FQ .
I I I I currently use please ca1-800-524-7603
KIII v SCALE
NOT TO E for Qre information.
17 EXISTING 51TE COVERAGE: 1,132 S.F. (0.12%, 0.0012)
DROP INLET 4
GATE -10)
WITH C PROP05ED UNDER SEPARATE PERMIT: 10,104 S.F. (0.10%,0.00
IIII= For safety reasons, homeowners are strongly
VV
FRAME V V PROP05ED UNDER TH15 APPLICATION: 5,04 S.F. (0.3b%,0!!1�03�6) ncouraged to call as well when planning any Isr Eagle Pt
type of digging on their property.Homeowners
PROPOSED 51TE COVERAGE: 11,020 S.F. (I.Iq%,0.0119)
-800-272-4480 or by
-732 S.F.)
BURIED FABRIC can contact us directly at 1
AREA OF DISTURBANCE: EXISTING F.A.R. = 0.0012 (1,
Z� 04 calling 811,the national call before you dig
V PROPOSED F.A.R. O.OIIq (11020 5.FJ
lb,%4 50.FT. (0.4354 ac) number. For excavation workcompleted on L fig Beach[Liy
NOTE: AREA INGLUVE5 IO'HIDIE MACHINE ACCESS DIRT ROAD. personal property,it is the contractors
M
responsibility--NOT the homeowners-to contact
M
DigNet. Having utility lines marked priorto
GATHER EXCESS digging is free of charge.
IM
AT CORNERS SCOPE OF WORK:
I. INSTALL PROPOSED ER015ION CONTROL MEASURES PRIOR TO
START OF CON5TRLV_,TION RECEIVED
2. INSTALL PROPOSED STORM DRAINAGE SYSTEM
3. BUILD PROPOSED GREENHOUSE (ITEM '69. JAN 16 2020 1 Browns Pr
6ON5TRUCTION SPECIFICATIONS POND
4. PROPOSED GREENHOUSE 15 A 'DRY BUILDING, I
Soutnold Fown
1.FILTER FABRI(,SHALL HAVE AN E05 OF 40-b5.BURLAP MAY BE U5ED FOR SHORT TERM APPLICATIONS. 5. PROP05ED &REENHOU5E 15 NOT PROPOSED WITH ANYo I
LAO Planning Board
2.CUT FA13RIG FROM A CONTINUOU5 ROLL TO ELIMINATE JOINT5.IF JOINT5 ARE NEEDED THEY WILL13E OVERLAPPED TO THE NEXT STAKE. RVI ED
3.STAKE MATERIALS HILL BE STANDARD 2"x 4'WOOD OR EQUIVALENT. METAL WITH A MINIMUM LENGTH OF 3 FEET. FLAG 4 FLAr7
NO COMMUNICATION AND NO HEAT. Peters Nock Pt
4.51FAGE STAKE5 EVENLY AROUND INLET 3 FEET APART AND DRIVE A MINIMUM I&INCHES DEEP.SPANS GREATER THAN 3 FEET MAY 13E 13RI06M 5.1. NO POWER, FLA6 5
WITH THE USE OF HIRE MESH BEHIND THE FILTER FABRIC FOR SUPPORT.
5.FABRIC SHALL BE EMBEDDED FOOT MINIMUM BELOW GROUNDAND BAGKFILLED.IT SHALL BE SECURELY FASTENED TO THE 5TAKE5 AND FRAME. L 0 C.A T N MAP:
b.A 2'x 4'HOOD FRAME SHALL BE C4MPLETEI?AROUND THE CRE5T OF THE FABRIC FOR OVER FLOW STABILITY. 0 FLA6 6 N.T.5.
10 Ar
MAXIMUM DRAINAGE AREA I ACRE xI.O' •
LANDWARD EDGE OF FRESHWATER WETLANDS Al
AS DELINEATED BY SUFFOLK ENVIRONMENTAL lah
U.S. DEPARTMENT OF AGRICULTURE FILTER FABRIC CON5ULTIK ING.ON NOVEMBER b,200 FLA6 I PROPOSED SITE PLAN:
NATURAL RESOURCES CONSERVATION SERVICE73
ILL 0 SITUATE AT: ORIENT ZONIN6 DISTRICT: 'R
DROP RES.
LL
NEW YORK STATE DEPARTMENT OF ENVIRONMENTAL CONSERVATION DROPINLET \0FOPOTOOF SOUTHOLD CURRENT USE: FARM V_
PRSED
NEW YORK 5TATE50IL 4 WATER CONSERVATION COMMITTEE PROTECTION SUFFOLK COUNTY,NEW YORK PROPOSED USE: N.C.
EROSION CONTROL WASURE: 7 SCTM NO.: 1000-19-01-13 AND 1.4 FEMA FLOOD ZONE: N/A
111,
PROVIDE STABILIZED - 7
SYMBOL- CON5TRUCTION ENTRANCE b 51TE DATA:
U�2L F-XISTINC7: PROP05ED:
WOVEN HIRE FENCE (MIN. • 0 OCCURS AT PROP05ED SITE ACCESS OVERALL 51TEs FARM :0,505,144 5F. (34552 AC) KC.
14 1/2 GAUGE W/MAX. b" MESH 5PAGING) e INSTALL PER DETAIL ON DW-7 Nol 0 HETILAIND AREA- HETILANQ -70564 S.F. (Ih2 AC) N.C. LU
UPLAND AREA: FARM ±1,434,580 S.F.(32A3 AC) N.G. X Z
S
36 MIN. LENGTH FENCE POSTV'\P IL
IO' MAX. G. To G. T5 AL - (3 7-
-
DRIVEN MIN. 16' INTO GROUND. S.C. TAX No. 1000-19-01-1.4 PROPOSED METAL IBUILVIN(5 q IMPERVIOUS SURFACE,
DEVELOPMENT RIGHTS CONVEYED (UNDER SEPARATE PERMIT) < US
EXISTING AREA, IM2 S.F.(0.12%) hit O
rn AREA: &,664 50.FT.
TO TOWN OF SOUTHOLD 10,104 S.F.(0.770%) LU
FIN.FL.EL. = 5.0' PROPOSED AREA UNDER SEPARATE PERMIT:
Is, Ol
PROPOSED AREA UNDER TH15 APPLICATION: 5,04 S.F.(036%)
- USE: A61RIGULTURAL BARN LL
TOTAL AREA, 1-1020 S.F.(0.120)
0
FL*
(PERCENTA6E5 BASED ON UPLAND AREA(1,434,5bO S.F.] T_
HEIGHT OF FILTER
POSTAL DISTRICT. SOUTHOLD
Lk
16 MIN. XTO' WORK UNDER SEPARATE PERMIT
`x�x\ \ /�
FLA6 11 4\\ SCHOOL 015MCT- OYSTER PONDS UFS0
5 \,-- SEE DRAWINGS BY FIRE DISTRICT: ORIENT FIRE DEPT.
ILI
eta V ELECTRICAL SERVICE. PSG LI
ZONING INFORMATION:
JEFFREY T. BUTLER,P.E.,P.C. VZ-1 FLOOD ZONE- N/A 'P,200' LOW-DENSITY RESIDENTIAL
0�. LOT SIZE,200,000 5.f.MIN
PERSPECTIVE VIF.1d 36" MIN. FENCE P05T DATED: 03-22-2017,LAST RE -01-2019
WOVEN HIRE FENCE (MIN. 4/2 0 UE APPLICANT. EXISTING OA: 1,505,144 S.F.04-55 x)
1:5 EX15TIVo WETLAND:105b4 S.F.(b2 a)
60N5TRQC.TI0N5F`E6IE1 ATION5 6AU6E W MAX. 6" MESH P\ROP05ED GREENHOUSE l �, MORTON BUILDINC-6 EX15TIN57 UPLAND: 1,434�bo 5F.(32.013 m)
I. WOVEN HIRE FENCE TO 13E FASTENED SPACING) H/ FILTER CLOTH (TH15-APPLICATION) 22355 COX LANE,UNIT N0.4 PROPOSED:NL.
10 'j, 1. PROP05ED UTCHOC-UE,NY II935 ENGINEER:
SECURELY TO FENCE P05T5 WITH WIRE TIES AREA: 5,Ie54 50.FT. b-0i MIN
OR STAPLES.POSTS SHALL 13E STEEL EITHER 631-134-4060 LOT WIDTH;210
I-, \ FIN.FL.EL. � 5.0' U16,POWER EX15TIN& 033' of: New
'T'OR T'TYPE OR HARDWOOD. N/O/F USE: PLANT\PROPA&ATION PROP05ED:N.C.
2. FILTER CLOTH TO BE TO BE FASTENED FLOW UNDISTURBED COLLEEN MG[)OHOU6H
SECURELY TO WOVEN HIRE FENCE WITH TIES GROUND HELEN HOOKE
SPACED EVERY 24'AT TOP AND MID SECTION. PROPOSED C) LOT DEPTH;400'MIN
FENCE SHALL BE WOVEN HIRE,121/2 GAUGE, COMPACTED 501L 5 PROP05ED:N.G.1" RATER SERV. EX15TIN5: 1,044.11'
b'MAXIMUM MESH OPENING. EMBED FILTER CLOTH LLj
3. WHEN TWO SECTIONS OF FILTER CLOTH ADJOIN LANDINARD EX;)E Of FRE5HKATER WETLANDS 4&5.5' B11,11FIFER NO3 0
RA6 b V FRONT YARD 5ETBACK,60'MIN
EACH OTHER THEY SHALL BE OVER-LAPPED A MIN.OF 6' IN GROUND. 4119 A5 DELINEATED BY SUFFOLK ENVIRONMENTAL CENTER WETLAND FINGER 1",3
BY 51X INCHES AND FOLDED. FILTER CLOTH 2 CONSULTING,INC.ON NOVEMBER b,200 1 LIVABLE FL.AREA OW-6 UNIT: D50 S.F.MIN EX15TIN5:520.0' N C7
SECTION VIEW R, 71�� EXISTING: N.A. PROPOSED:53b3'
SHALL BE EITHER FILTER X,MIRAFI IOOX, PHR SOURCE:L\5\ Y_
5TA131LINKA T140N,OR APPROVED EQUAL. \ P� EX XFRM PROP05ED:N.A.
4. PREFABRICATED UNITS SHALL BE 6EOFAB,ENVIROFENGE,OR APPROVED EQUIVALENT. 1 -1 FLA&7 i3.15'x 0S REAR YARD SETBACK: IOO'MIN
MAXIMUM PERMITTED DIMENSIONS:
EXISTING: 580.4'
5. MAINTENANCE SHALL BE PERFORMED AS NEEDED AND MATERIAL REMOVED WHEN LOT COVERAGE:5%MAX,11,129 S.F. PROP05ED: 165A'
'BULGES"DEVELOP IN THE SILT FENCE. 100" . r LANDWARD EDGE OF TIDAL MILW AREA) JEFFREY T. BUTLER, P.E.
_N' EX.ELE6.MTR 0
SITE PLAN BASED ON ORIGINAL SURVEY BY: POND EX.FR.131_06 WETLAN05 AS DELINEATED 13Y EXISTING: llb3b S.F.(0,53%) 51DE YARD SETBACK:30'MIN
ef- EX.XFRMR SUFFOLK ENVIRONMENTAL GWALTIN6,ING.
PZ-160.3' RA6 b ON NOVEMBER e�,201b tK PROP05ED: 11,020 5.F.(1.064%) EXISTING:655'
NATHAN TAFT CORWIN,LAND SURVEYOR EXISTING WELL EX.FF..BLD(5 123x A
U.S. DEPARTMENT OF AGRICULTURE 15bb MAIN ROAD b.4'x 103 AREA: 142 S.F. Cj PROP05ED: 209�.O'
4 BLDG HEIC7HT. 35 FT./2Y2 5TY5 MAX
AREA:bl 5.F.
NATURAL RESOURCES CONSERVATION SERVICE SILT JAME5PORT,NY 116141 IL \SCFI
NEW YORK STATE DEPARTMENT OF ENVIRONMENTAL CONSERVATION
SURVEYED:JAN.25,2011 t�5 15 EX.FR.BLDG 0 0 EX15TIN& +2b5'1 1142 STY SIDE YARD SETBACK CUMULATIVE: 6o'MIN
FENCE LAST UPDATED: DEG.1,200 C ro 115'X 103 L=62.1, PROP05ED: II&V I 51Y EX15TIN5:5102'
NEW YORK STATE 501L 4 HATER CONSERVATION COMMITTEE PROP05ED:b54.2' M
ELEVATIONS BASED ON TOP06RAPHY MAP- Q0 41 �3 AREA: IIS 5.F. P4
lz� ILLO
4- < c
50' MIN. 5 EASTERN TOWNS,SUFFOLK COUNTY, 3�-
T(,NY Q0 EX.FR.BLDG
lo EXISTING DATED: 10-03-IM5 90.0 243'x 325 01
CQ
PROFILE NAL) PAVEMENT
DATUM:ELEVATIONS ARE REFERENCED To VERTICAL DATUM N/O/F AREA: 1b5 S.F. LL
MOUNTABLE BERM (OPTIO BASED ON MEAN SEAL LEVEL OF MCI AS ESTABLISHED BY CAROL LEE TAYLOR '5 Y, 6 FLA6 q PRDPOSED Z (3 C�
7 F A q, Z LU
THE U5.COAST AND 6EODETIG SURVEY AT 5ANI?Y HOOK N.J. EROSION CONTROL MEASURE:`\ EX.WIRE Z
*PROVIDE SILT FENCE BARRIER >
NOTF-5: AROUND •rARDEN 9 APPROX.650 LIN.FT. K Z
EXI5TII` FILTER JQ c: V 2
6ROUN4(5CLOTH 1.ELEVATIONS ARE REFERENOW TO * MAINTAIN THROUGHOUT CONSTRUCTION
FIVE EASTERN TOWNS TOPOGRAPHICAL MAPx3.5'
N/O/F PROP. GREENHOUSE e INSTALL PER DETAIL(THIS PHS:5) < Q_
EX15TIN6 ELEVATIONS ARE SHOWN THUS: x5.0 JOHN N.5ABATINO <
" PLA612
50 MIN. EXI5TIN3 CONTOUR LINES ARE 5HOHN THUS: - 5 - $LINDA A.5ABATINO UNDER SEPARATE PERMIT -P < I
24'x 60 0 <
A -
7 FLA6 11 AREA: 1,440 S.F. QPCSEQ GREENHOUSE u)
PLAN VIEW LANDWARD E06E OF TIDAL WETLANDS
AS DELINEATED BY SUFFOLK ENVIRONMENTAL (THIS APPLICATION) 7 (N
GON5ULTINC7,INC.ON NOVEMBER b,201b H-Ab 10 AREA: 5,184 50.FT.
EXISTING S.C. TAX No. -0, FIN.FL.EL. = 5.0' C, W
GROUND R-A6
STORM DRAINAGE GALG: 1000-19-01-1. USE: PLANT PROPAGATION Y--"
I FLA6 q C51)
-------- -) LU
STORM HATER DRAINAGE STRUCTURES PROVIDE FOR WW UNDER SEPARATE PERMIT 611Q A.
EVELOPMENT F
x25'
t
12 MIN. EXISTING RUNOFF FROM PROPOSED STRUCTURES ONLY. SEE DRAWINGS BY RI RE TA INED FLA5 (N
- :� LL
PAVEMENT
FLM 7
PROPOSED
C)
VOLUME = AREA X RAINFALL X COEFFICIENT JEFFREY T.-BUTLER,P.E. P.C.
IL <) STORM DRAINAGE 51STIENs
RAINFALL = 2"/HR'= O.Ibl' C)q
COEFFICIENT OF ROOF = 1.0 DATED: 03-22-21�,LAST REV. 07-01-2019 ILL IA, C)Z. \Q SIZED FOR ROOF RUNOFF OF C) ('10 LL (N
Flab b PROP05ED C7REENHOU5E ONLY
50'ALON&W§-J, -0
NE 00 0 • (4)10'(P x 4'LIQ.VP STORM WATER LEACHING POOLS
PROPERTY LINE
CONSTRUCTION SPECIFI!CeATION5 PROPOSED FLA& U) O USE:
I. STONE 51ZE-USE 2"STONE,OR RECLAIMED OR RECYCLED CONCRETE EQUIVALENT. i' .%P Pq Z
2. LENGTH-NOT LE55 THAN 50 FEET(EXCEPT ON A SINGLE RESIDENCE LOT WERE A 30 FOOT MINIMUM LENGTH WOULD APPLY). ARGHITEGTURAL STORAGE BARN 'E' JK 5 * OPEN COVER(TYP) CD
PROPOSED UNDER SEPARATE PERMIT b ")ER SYSTEM
3. THICKNESS-NOT I F55 THAN SIX(6) INCHES. L=1&45, s INTERGONNEGT TO GUTTER AND LEADER Z
USE: .71 0 5EE STORM WATER LEACHING <
4. WIDTH-TWELVE(12)FOOT MINI",BUT NOT LE55 THAN THE FULL HIPT14 AT POINTS WHERE INORE55 OR EORE55 OCCURS. N/O/F x2.0' HINC7 POOL DETAIL,TH15 5HT
W 10'(Px5LIGUIP DEPTH.LEACHING POOL STATE OF IIEN YORK �L_ -
THENTY-FOUR(24)FOOT IF 51NOLE ENTRANCE TO SITE. tK
5. FILTER CLOTH-HILL BE PLACED OVER THE ENTIRE AREA PRIOR TO PLACING OF STONE. (OPEN COVER) ILI
6. SURFACE WATER-ALL SURFACE WATER FLOWINGOR DIVERTED TOWARD CON-CON5TRUGTION ENTRANCES SHALL BE PIPED VOLUME PROVIDED = 1,642 GU.FT. C) S EROSION CONTROL MEASURE:
ACROSS THE ENTRANCE. IF PIPING 15 IMPRACTICAL,A MOUNTABLE BERM WITH 5:1 SLOPES WILL 13E PERMITTED. PROVIDED FOR INLET PROTECTION
CONDITION WHICH WILL PREVENT TRACKING OR FLOWIN&OF SEDIMENT INTERCONNECT AS SHOWN PROPOSED 0 OCaR5 AT ALL OPEN COVER DRAINAGE1. MAINTENANCE-THE ENTRANCE SHALL BE MAINTAINED IN A r TED ONTO PUBLIC RIGHTS-0F-WAY MUST 13E AROHII C-A�IENHOL)SE 'C7' ILI, VE(9ETATM 5
ONTO PUBLIC RIGHTS-OF-WAY,ALL SEDIMENT SPILLED,DROPPED,WASHED OR TRAC IFLA6 4 STRUCTURES
REMOVED IMMEDIATELY. PROPOSED ROOF AREA = 5,04 S.F. 5 BUFFER NO.1 0 SEE DETAIL ON VHC5 Not
PA(5E :
b. WHEN WASHING REQUIRED,IT SHALL 13E DONE ON A AREA STABILIZED WITH STONE AND WHICH DRAINS INTO AN APPROVED ARGHITEGTURAL OREENHOU51E 'F' 5,04 S.F. x 0.167' x 1.0 = 865.13 C.F. VOL. REQV 5W CORNER
SEDIMENT TRAPPING DEVICE. PROPOSED UNDER SEPARATE PERMIT Ob QPT. /bb.42 S.F. (10'0 L.P) = l2bb VERT FT. REQ!D IL X X .
q. PERIODIC INSPECTION AND NEEDED MAINTENANCE SHALL 13E PROVIDED AFTER EACH USE: LUME RE6VIRED: bbb U.FT. 0VERALL SITE PLAN ILL FLA6 2\+
+\ PARTIAL SITE PLAN PROPOSED D R A I N A O E
(1) 10'�Px4' LIQUID DEPTH LEACHING POOL USE. I I I I I ILI I I I I
DEPARTMENT OF AGRICULTURE STABILIZED (OPEN COVER) (4) IO'0x4' LIQUI0 DEPTH LEACHING POOL (OPEN COVER) 1 4
U.S. DEPAP VOLUME PROVIDED IOq4 GU.FT. 111171
NATURAL RE50URrE5 CONSERVATION SERVICE CONSTRUCTION VOLUME PROVIDED 2*73 GU.FT. \+\
NEW YORK STATE DEPARTMENT OF ENVIRONMENTAL CONSERVATION PIPE AS SHOW DED
PIPE AS 514OHN 100 50 0 100 200 300 1 40 20 0 40 50 120
NEW YORK STATE 501L 4 WATER CONSERVATION COMMITTEE ENTRANCE GRAPHI(f, Sr-ALE 1 100'_0 ORAPHIG 5GALE 1 40'-0
0 f I
L
THESE PRANIN65 AND ACCOMPANYING 5PEGIFICATION5,AS INSTRUMENTS OF SERVICE,ARE THE EXCLUSIVE PROPERTY OF THE ARCHITIEGT AND THEIR USE AND PUBLICATION SHALL BE RESTRICTED TO THE ORIGINAL SITE FOR WHICH THEY WERE PREPARED.REUSE,REPRODUCTION OF,PUBLICATION BY ANY METHOD,IN WHOLE OR IN PART, 15 PROHIBITED EXCEPT BY WRITTEN PERMISSION FROM THE'ARGHITEGT.TITLE TO THESE PLANS SHALL REMAIN WITH THE ARLHITEGT. VISUAL CONTACT WITH THEM SHALL CONSTITUTE PRIMA FACIE EVIDENCE OF ACCEPTANCE OF THESE RESTRICTIONS.,
FORM NO. 3 RE.
p
`0A Oyu 2 2
TOWN OF SOUTHOLD
BUILDING DEPARTMENT w� (
SOUTHOLD, N.Y. -.. ..mm.Pl&'inu rig BoErd
...._. ..
NOTICE OF DISAPPROVAL
DATE: February 28, 2020
TO: Patricia Moore (Fresh and Co Farm LLC)
51020 Main Road
Southold, NY 11971
Please take notice that your application dated February 11, 2020:
For permit to: cion trust cl gr at:
Location of property: 28410 Route 2; , Ori( i TAT"
County Tax Map No. 1000— Section 19 Block 1 Lot 1.4
Is returned herewith and disapproved on the following grounds:
Pursuant to Article XXIII Section 280-127,the pwposed use requires site plan approval
from the Southold Town Planning Board..
You may nowappl to these agencies directly.
Autho nature
Note to Applicant: Any change or deviation to the above referenced application,
may require further review by the Southold Town Building Department.
CC: file, Planning Board
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a � OFFICE LOCATION:
MELISSA A. SPIRO 1�f sl Annex
LAND PRESERVATION COORDINATOR :. 54375 e75 Sta Route 25
melissas iro@town.southold.n us `""
p Y• (comer of Main Road&Youngs Avenue)
Southold, New York
Telephone(631)765-5711
MAILING ADDRESS:
www.southoldtownny.govr
COU � P.O. Box 1179
N Southold, NY 11971-0959
DEPARTMENT OF LAND PRESERVATION -91
TOWN OF SOUTHOLD � '
2020
VIA electronic mail:
l"aowd
February 11, 2020
Fresh & Co Farm, LLC
10 Cambridge Place
Englewood Cliffs, NJ 07632
Re: SCTM #1000-19.-1-1.4
FRESH & CO FARM LLC
Request for greenhouse on property subject to a Town Development Rights Easement
Gentlemen:
The Land Preservation Committee members, in accordance with Section 70-5 C. (2) [3] of the
Town Code reviewed your request dated 1/27/2020 to construct a 36'x144' greenhouse for farm
vegetables (seedlings) on the west side of the property (see sketch attached) that lies within a
Town Development Rights Easement.
The Town purchased the development rights on May 22, 2002, and a Deed of Development
Rights (Deed) dated May 22, 2002 was recorded on June 6, 2002. The recorded Deed includes
restrictions, including but not limited to:
o Restricting the use of the premises "exclusively for agricultural production as that term in
presently defined in Chapter 25 of the Town Code of the Town of Southold, and the right
to prohibit or restrict the use of the premises and any structures thereon for any purpose
other than agricultural production..."
o Requiring that "The use of this property shall be consistent with both the agricultural
value and the scenic value of the property. Use of the property shall be conducted in a
manner that does not detract from, or adversely affect the open space and scenic value
that is protected by this development rights purchase and easement."
At its regular meeting held on Tuesday, February 4, 2020, the Land Preservation Committee
members reviewed the request and found that the proposed 36'x144' greenhouse is consistent
with the terms and conditions of the recorded easement.
Please note that the Committee's approval of this use within the easement area does not mean
that such use will be approved or permitted by other departments or agencies. The Committee's
approval allows you to proceed with pursing any applicable approvals that are required by Town
Code.
Please feel free to call me if you have any questions regarding the above.
Sincerely,
14"10-
Melissa Spiro
Land Preservation Coordinator
MS:md
cc.: Planning Department
Building Department
Patricia C. Moore, Esq. (pcmocgg!,, jjj!,, q
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OFFICE LOCATION: �� MAILING ADDRESS:
Town Hall Annex P.O. Box 1179
54375 State Route 25 �` " Southold, NY 11971
(cor. Main Rd. &Youngs Ave.) G
Southold, NY Telephone: 631 765-1938
www.s outholdtownny.gov
COWN '
PLANNING BOARD OFFICE
TOWN OF SOUTHOLD
February 10, 2020
Ms. Patricia C. Moore, Esq.
51020 Main Road
Southold, NY 11971
Re: Proposed Site Plan for Tenedios Farm Amended 2
28410 NYS Route 25, s/w corner of Narrow River Road & NYS Route 25,
Orient SCTM#1000-19.-1- 1.3 & 1.4
Dear Ms. Moore:
The Planning Department is in receipt of the Amended Site Plan Application
regarding the above-referenced project. Pursuant to §280-130A and our standard
application review procedures, a Building Permit Application and subsequent
Notice of Disapproval from the Building Department is required before any further
steps can be taken on the matter by this department.
If you have any questions regarding this Site Plan or its process, please do not
hesitate to call this office.
Respectfully,
Brian Cummings
Planner
S bf ission Clfithout a Cove® Letter
'WMI
Nanning IBo and
Subject- 'A'
±"
SCTM#. 1000 -
Date: �i ...
Comments:
C ..
�_ _ e
RECEI
SOUT 1OLD PLANNING BOARD ... R:_l
SITE PLAN APPLICATION FORM 1. 6 02()
Site Plan Name and Location _a
- e aClr+�Na�... vi .._�
Nanrfli,ig Board
Site Plan Name: 4 L Application Date.
Suffolk County Tax Map#1000- - -t n - Otner SCTM#s [ - 6 f I
Street Address: 11_ ITITITITm � Lod Hamlet: L1 r-cn
Distance to nearest intersection: ,�� „.a w J "1 Qoarl
Type of Site Plan: New„ K-Amended Residential Zoning District
Owners/A ent Contact:Information
Please list neinie, nmadin addr exy, andphone number for the people below:
Property Owner ._ 5 k ..... - -
Street L 9,6 . � .
City State - p
Home TelephoneOther ......
Applicant ..._...._-.....�. .. '........_.
Street Z.5f "11,
City .�..�.......-................._...........State p ..._ .....
( °-
Home Telephone Other
_ Applicant's Agent or Representative.-
Contact
epresentative:Contact Persons)*
.,,... �. C, _..
Street I z \ -- .......... t .
city_IT x " < c! StateZip �
Office Telep'o _ Other
*Unless otherwise requested, correspondence will be sent only to the contact person noted here.
Site Plan Applicaffon Form 211812010
Site Data
Proposed construction type: New Modification of Existing Structure Agricultural
% Change of use
F
,Property total acreage or square footage i ....................... bac./sal. ft. u a L4
Site Plan build-out acreage or sqt are footage4 ac./sq, ft.
.........................................................................................
Is there an existing or proposed Sale of Development Rights on the property? Yes No
If yes, explain:
...............
.................................. ............= .1 a................
Does the parcel(s) meet the Lot Recognition standard in Town Code §280-9 Lot Recognition? YL< N_�
If"yes", explain(and attach any necessary documentation–title report, subdivision approval, etc.)
............ ........----------.....................................
...............................
Building Department Notice of Disapproval Date:
Is an application to the Southold Town Zoning Board of Appeals required? Yes—No_X
If yes, have you submitted an application to the ZBA? Yes—_ No
If yes, attach a copy of the application packet.
................ ......
Show all uses proposed and existing. Indicate which building will have which use. If more then one use is
proposed per building, indicate square footage of floor area per use.
List all existing property uses:Ptle-V k'o' U 5 kcky) irA - ?,L(
66
List all proposed property uses:
Other accessory uses: xn
Existing lot coverage: Proposed lot coverage: I %
Gross floor area of existing structure(s): sq. ft. Gross floor area of proposed structure(s):
....................................................... .......................................................................................... ..................................................
...........[ r.....
V ve�"G C'n ANO
Parking Space Data: of existing spaces: #of proposed spaces-, Loading Berth: Yes NoX
.............
–ITITITITITITIT
e`C2Z FjtA— ..............
Landscaping Details: Existing landscape coverage: % Proposed landscape coverage:_
...................................................................................... ...........................................
Wetlands: Is this property within 500' of a wetland area? Yes No_Maybe ....................................
.............
I,the undersigned, certify that all the above information is true.
Signature of Preparers ..... Date:
2
Site Plan Application Form 2,7812010
E "E a[V E U
B 1, 00", l
I7 I _
P.b�a�,,.�4 I(',)Id �1.Ai iL
I, Steve Tenedios, managing member of fresh & co farm LLC, deposes and says that
S � m HC
he resides at 10 Cambridge Place, Englewood Cliffs NJ and that the LLC is the owner `
of property identified as SCTM: 1000-19-1-1.3 & 1.4 28410 Main Road, Orient, in the
State of New York and hereby authorize Patricia C. Moore, Esq., to act as my agent and
handle all necessary work involved with the site plan application process for this
property with the Town of Southold Planning Board.
fresh 8 co Far k
0
by:
Steve Tenedios,� madaging member
Sworn to before me this
Day of January, 2020
Notary Pub '
V
Konstantinos Zamfotis
Notairy Public, State of NY
No, 0't 214090
Qualified In NY County
Corninission Exp, May 14, 2023.
Town of Southold
LWRP CONSISTENCY ASSESSMENT FORM
A. INSTRUCTIONS
1. All applicants for permits* including Town of Southold agencies, shall complete this CCAF for
proposed actions that are subject to the Town of Southold Waterfront Consistency Review Law. This
assessment is intended to supplement other information used by a Town of Southold agency in
making a determination of consistency. *Except minor exempt actions including Building Permits
and other ministerial permits not located within the Coastal Erosion Hazard Area.
2. Before answering the questions in Section C, the preparer of this form should review the exempt
minor action list, policies and explanations of each policy contained in the Town of Southold Local
Waterfront Revitalization Program. A proposed action will be evaluated as to its significant
beneficial and adverseT fTects upon the coastal area (which includes all of Southold Townie
3. If any question in Section C on this form is answered "yes" or "no", then the proposed action will
affect the achievement of the LWRP policy standards and conditions contained in the consistency
review law. Thus,.each answer must be explained in detail listing both supporting and non-
supporting facts. If an action cannot be certified as consistent with the LWRP policy standards and
conditions, it shall not be Undertaken.
A copy of the LWRP is available in the following places: online at the Town of Southold's website
(southoldtown.northfork.net),the Board of Trustees Office,the Planning Department, all local
libraries and the Town Clerk's office.
B. DESCRIPTION OF SITE AND PROPOSED ACTION
SCTM# - C - 1• n
PROJECT NAME _ i,.._ ' -
The Application has been submitted to(check appropriate response):
Town Board ❑ Planning Board Building Dept. ❑ Board of Trustees
1. Category of Town of Southold agency action(check appropriate response): gry
(a) Action undertaken directly by Town agency(e.g. capital
construction, planning activity, agency regulation, land transaction) ❑
(b) Financial assistance(e.g_grant, loan, subsidy)
(c) Permit, approval, license, certification: ❑
Nature and extent of action: ro
Location of action: a " CA _�c _... . _ _....___......
Site acreage: . p 5 .waw
Present land use: AZ:, .m _� '� _..... ......................�
Present zoning classification: �ITITITITIT _ m
2. If an application for the proposed action has been filed with the Town of Southold agency, the following
information shall be provided:
(a) Name of applicant; _
(b) Mailing address:._ ..... �..s2 ..__ ...... C `rx c'° `- � a
(c) Telephone number: Area Code( ) m - 7 -
(d) Application number, if any:
Will the action be directly undertaken, require funding, or approval by a state or federal agency?
Yes ❑ No IN If yes,which state or federal agency?,.....
C. Evaluate the project to the following policies by analyzing how the project will further support or not
support the policies. Provide all proposed Best Management Practices that will further each policy.
Incomplete answers will require that the form be returned for completion.
DEVELOPED COAST POLICY
Policy 1. Foster a pattern of development in the Town of Southold that enhances community character,
preserves open space, makes efficient use of infrastructure, makes beneficial use of a coastal location,and
minimizes adverse effects of development. See LWRP Section III—Policies; Page 2 for evaluation
criteria.
1Z Yes ❑ No ❑ Not Applicable
.............. �� . it
„, —
_IT .
.....
d
a
Attach additional sheets
. is if necessary
Policy 2. Protect and preserve historic and archaeological resources of the Town of Southold. See LWRP
Section III—Policies Pages 3 through 6 for evaluation criteria
Yes ❑ No Not Applicable
Attach additional sheets if necessary�..._. .......—.
Policy 3. Enhance visual quality and protect scenic resources throughout the Town of Southold. See
LWRP Section HI—Policies Pages 6 through 7 for evaluation criteria
ZYes ❑ No ❑ Not Applicable
........................ ......
Attach additional sheets if necessary
NATURAL COAST POLICIES
Policy 4. Minimize loss of life, structures, and natural resources from flooding and erosion. See LWRP
Section HI—Policies Pages 8 through 16 for evaluation criteria
E] ,'
Yes No Not Applicable
Attach additional sheets
if necessary
Policy 5. Protect and improve water quality and supply in the Town of Southold. See LWRP Section III
—Policies Pages a;.
gees 16 through 21 for evaluation criteria
x
Yes -1 No Not Applicable
Attach additional sheets if ,
necessary
Policy 6. Protect and restore the quality and function of the Town of Southold ecosystems including
Significant Coastal Fish and Wildlife Habitats and wetlands. See LWRP Section HI—Policies; Pages 22
through 32 for evaluation criteria_
❑ Yes ❑ No Not Applicable
Attach additional sheets if necessary
Policy 7. Protect and improve air quality in the Town of Southold. See LWRP Section III — Policies
Pages 32 through 34 for evaluation criteria.
Yes F—] No Not Applicable
�... .. ..........
Attach additional sheets if necessary
Policy 8. Minimize environmental degradation in Town of Southold from solid waste and hazardous
substances and wastes. See LWRP Section III—Policies; Pages 34 through 38 for evaluation criteria.
Yes 1:1 No Not Applicable
PUBLIC COAST POLICIES
Policy 9. Provide for public access to, and recreational use of, coastal waters, public lands, and public
resources of the Town of Southold. See LWRP Section III—Policies; Pages 38 through 46 for evaluation
criteria.
Yes No Not Applicable
Attach additional s _...........
sheets if necessary
WORKING COAST POLICIES
Policy 10. Protect Southold's water-dependent uses and promote siting of new water-dependent uses in
suitable locations. See LWRP Section III—Policies; Pages 47 through 56 for evaluation criteria.
Yes D No ' "Not Applicable
.. �....................
� �.�.
Attach additional sheets if neces
Policy 11. Promote sustainable use of living marine resources in Long Island Sound,the Peconic Estuary
and Town waters. See LWRP Section III—Policies; Pages 57 through 62 for evaluation criteria.
�—q
M "
Yes V —J No Not Applicable
Attach additional sheets if necessary
Policy 12. Protect agricultural lands in the Town of Southold. See LWRP Section III—Policies; Pages 62
through 65 for evaluation criteria.
21'Yes ❑ No❑ Not Applicable
Attach additional sheets if necessary
Policy 13. Promote appropriate use and development of energy and mineral resources. See LWRP
Section III—Policies; Pages 65 through 68 for evaluation criteria.
Yes No Not Applicable
..
PREPARED BY ; ` ._...o. �. �.. ..�_,,,,,. TrFLE �;�� , �,.e.� .. DATE /
Short Environmental Assessmentr
Part I -Project Information
Instructions for Coin letin
Part 1—Project Information. The applicant or project sponsor is responsible for the completion of Part 1. Responses become part of the
application for approval or funding,are subject to public review,and may be subject to further verification. Complete Part 1 based on
information currently available. If additional research or investigation would be needed to fully respond to any item,please answer as
thoroughly as possible based on current information.
Complete all items in Part 1.You may also provide any additional information which you believe will be needed by or useful to the
lead agency;attach additional pages as necessary to supplement any item.
Part 1—Project and Sponsor Information �y
Name of Action or Project: L L 17 Y '. ffi
Project Location(describe,and attach a location map):
Brief Description of Proposed Action:
r� b
'S(, / ),
Name of Applicant or Sponsor: Telephone: q' 1— 19 6, —Ti Z
S��q C L L E-Mail:
Address: ..... .. ..
(�6rtd e �a c�
City/PO: _ State: ZipEC;de�::,:1. Does the r ••.. o�—
o osed action PPonl involve the legislative adoption of a plan,local I\C C7 bCt t
.............. ........
p p y gi p ' p al law,ordinance, NO YES
administrative rule,or regulation?
If Yes,attach a narrative description of the intent of the proposed action and the environmental resources thatrj(
may be affected in the municipality and proceed to Part 2. If no,continue to question 2.
If YeDsolis................. � � �,r �'g :• �� �...•
A enc NO YES
t agency(s)name jand peumut ora provalprovaNl or funding from any other government ,O �j'
_ ❑ LJ
g� y y n. _ �
3. a.Total acreage of the site of the proposed action. ,�.� ) es
b.Total acreage to b physically disturbed? (��, v� 1 acres A � �f
c.Total acreage(project site and any contiguous properties)owned
or controlled by the applicant or project sponsor? 3 LA.5 S&res
4. Check all land uses that occur on,are adjoining or near the proposed action:
5. El Urban Rural(non-agriculture) Industrial Commercial El Residential(suburban)
El Forest Agriculture Aquatic Other(Specify):
El Parkland
1'am, U Of "u SEAF 2019
5. Is the proposed action, NO YES N/A
a. A permitted use under the zoning regulations? El� Z
b. Consistent with the adopted comprehensive plan? EZ" El
.
NO YES
6. Is the proposed action consistent with the predominant character of the existing built or natural landscape?
�j'
F-1 LJ
7. Is the site of the proposed action located in,or does it adjoin,a state listed Critical Environmental Area? NO YES
If Yes,identify:
NO YES
8. a. Will the proposed action result in a substantial increase in traffic above present levels? E
b. Are public transportation services available at or near the site of the proposed action?
c. Are any pedestrian accommodations or bicycle routes available on or near the site of the proposed F-1action?
El
Ifth9. Doeos theproposed
atioon wall exceed requirements,ction meet or exceed a state energy coel�.requirements' NO YES
proposed q ,describe design fcatures and technologies:
.... ❑ ❑
10. Will thero osed action connect to an existing public/private water
P P g P P supply? NO YES
r
If No,describe method for providing potable water:
11.�Will the proposed action connect to existing wastewater utilities? NO YES
If No,describe method for providing wastewater treatment: _............_....................
❑
12. a.Does the project site con ......
tain,or it substantially contiguous to,a building,archaeological site,or district ' NO YES
which is listed on the National or State Register of Historic Places,or that has been determined by the
Commissioner of the NYS Office of Parks,Recreation and Historic Preservation to be eligible for listing on the
State Register of Historic Places?
b.Is the project site,or any portion of it,located in or adjacent to an area designated as sensitive for
archaeological sites on the NY State Historic Preservation Office(SHPO)archaeological site inventory?
13. a. Does any portion of the site of the proposed action,or lands adjoining the proposed action,contain NO YES
wetlands or other waterbodies regulated by a federal, state or local agency?
b.Would the proposed action physically alter,or encroach into,any existing wetland or waterbody? _..
If Yes,identify the wetland or waterbody and extent of alterations in square feet or acres:
P glue,; 2 4t-3
�......m ._ ... ...-._.- ..
14. Identify the typical habitat types that occur on,or are likely to be found on the project site. Check all that apply:
El Shoreline ❑ Forest E?rAgricultural/grasslands ❑ Early mid-successional
Wetland ❑ Urban ❑ Suburban
15. Does the site of the proposed action contain an s of animal,or assoc
y species p fated habitats,listed by the State or NO ' YES
Federal government as threatened or endangered? J
16. Is the project site located in the 100- ear flood plan? lug
P J Y P ? NO ....YES
E5
17. Will the proposed point or action create storm water discharge,either from p p nt non- of sources? _ NO YES
If Yes,
a. Will storm water discharges flow to adjacent properties? 0—
b. Will storm water discharges be directed to established conveyance systems(runoff and storm drains)? El ET
�If Yes, bri,efly
a� describe: �Az
18. Does the proposed action include construction or other activities that would result in the impoundment of water NO YES
or other liquids(e.g.,retention pond,waste lagoon,dam)?
If Yes,explain the purpose and size of the impoundment: EEr El
J 9. Has the.... ..... _ -................
site of the proposed action or an adjoining property been the location of an active or closed solid waste NO YES
management facility?
If Yes,describe:
20.Has the site of the proposed action or an adjoining property been the subject of remediation(ongoing or NO YES
completed) for hazardous waste?
If Yes,describe:
I CERTIFY THAT THE INFORMATION PROVIDED ABOVE IS TRUE AND ACCURATE TO THE BEST OF
MY KNOWLEDGE
A)�p'��ca��r�"sp�oa�so.�l�����w��e: ._ �""•° «� � ;� � ��. "m� ... Date: ���� ...
Signatur' :.., Title: , t,,("
PRINT FORM )67c' ; M")
Full Environmental Assessment Form
Part I -Project and Setting
Instructions for Completing Part 1
Part 1 is to be completed by the applicant or project sponsor. Responses become part of the application for approval or funding,
are subject to public review,and may be subject to further verification.
Complete Part 1 based on information currently available. If additional research or investigation would be needed to fully respond to
any item,please answer as thoroughly as possible based on current information;indicate whether missing information does not exist,
or is not reasonably available to the sponsor;and,when possible,generally describe work or studies which would be necessary to
update or fully develop that information.
Applicants/sponsors must complete all items in Sections A&B. In Sections C,D&E,most items contain an initial question that
must be answered either"Yes"or"No". If the answer to the initial question is"Yes",complete the sub-questions that follow. If the
answer to the initial question is"No",proceed to the next question. Section F allows the project sponsor to identify and attach any
additional information. Section G requires the name and signature of the applicant or project sponsor to verify that the information
contained in Part lis accurate and complete.
A.Project and Applicant/Sponsor Information.
Name
............
of Action or Project:
. 61 LLC
Project Locationdescribe,and attach a .... mm..
( general location map):
K�
�........ ... ...... . .............
Brief Description of Proposed Action(include purpose or need):
1
1 y 1ti�cs-u� rc C�ckA7 6-U
s ..........
_ ..
Name of Applica
nt/Sponor: Telephone: -7 7 ct(a_ -7 Z_,Z)
L E-Mail. 0
Address:
" State: Zip Code:
0-1
ProjectOContact if not sahie asmmmm�
City
/PO:
sponsor;give name an dtille/role): Telephone:
..........................
E-Mail:
......�._
Address:
102
0
City/PO:
OVA 0 State: B Zip�OAe: l
..... ...._ '`I
Property Owner (if not same as sponsor): Telephone:
Gv E-Mail:.
... ...........
Address:
..........
..� ....
City/PO; State: Zip Code:
Page 1 of 13
FEAF 2019
B.Government Approvals
B.Government Approvals,Funding,or Sponsorship. ("Funding"includes grants,loans,tax relief,and any other forms of
' financial
assistance.)
Government Entity If Yes: Identify Agency and Approval(s) Application Date
Required (Actual or projected)
a.City Counsel,Town Board, ❑Yes❑No
or Village Board of Trustees
b.City,Town or Village es❑No '2
Planning Board or Commission
c.City,Town or ❑Yes❑No
Village Zoning Board of Appeals
d.Other local agencies ❑Yes❑No
e.County agencies es❑Nod C P ,,,
f.Regional agencies ❑Yes❑No
g. State agencies DYes❑No � _ ,vy'yiz�._
h.Federal agencies ❑Yes❑No
ro ect site within a . Designated y?
i. Coastal Resources
i. Is the r
project i Coastal Area,or the waterfront area of a Desi ated Inland Waterway? ❑"ti�,s C�' t�
U. Is the project site located in a community with an approved Local Waterfront Revitalization Program? 13"<es0N1'
iii. Is the project site within a Coastal Erosion Hazard Area? ❑"yes O
C.Planning and Zoning
C.1.Planning and zoning actions.
Will administrative or legislative adoption,or amendment of a plan,local law,ordinance,rule or regulation be the O'`r"es o
only approval(s)which must be granted to enable the proposed action to proceed?
a If Yes,complete sections C,F and G.
• If No,proceed to question C.2 and complete all remaining sections and questions in Part 1
C.2.Adopted land use plans.
a.Do any municipally-adopted (city,town,village or county)comprehensive land use plan(s)include the site Yes'❑No
where the proposed action would be located?
If Yes,does the comprehensive plan include specific recommendations for the site where the proposed action ❑Yes❑No
would be located?
b.Is the site of the proposed action within any local or regional special planning district(for example: Greenway; YesCINo
Brownfield Opportunity Area(BOA);designated State or Federal heritage area;watershed management plan;
or other?)
If Yes,identify the plan(s):
c. Is the proposed action located wholly or partially within an area listed in an adopted municipal open space plan, ❑Yes . o
or an adopted municipal farmland protection plan?
If Yes,identify the plan(s):
Page 2 of 13
C.3. Zoning
a. Is the site of the proposed action located in a municipality with an adopted zoning law or ordinance. &KesElNo
If Yes,what is the zoning classification(s)including any applicable overlay district?
........... ........
............--................
b. Is the use permitted or allowed by a special or conditional use permit? El Yes
c.Is a zoning change requested as part of the proposed action? Oyescogo
If Yes,
i. What is the proposed new zoning for the site?
CA Existing community services.
a.In what school district is the project site located?
b.What police or other public protection forces serve the project site?
c. Which fire protection and emergency medical services serve the project site?
yv
d.What parks serve the project site?
....................................—-—---------------
D.Project Details
D.I.Proposed and Potential Development
a.What is the general nature of the proposed action(e.g.,residential,industrial,commercial,recreational;if mixed,include all
components)?
b. a.Total acreage of the site of the proposed action? acres
b.Total acreage to be physically disturbed? acres
c.Total acreage(project site and any contiguous properties)owned
or controlled by the applicant or project sponsor? Li — acres
c.Is the proposed action an expansion of an existing project or use? El YelET&-
i. If Yes,what is the approximate percentage of the proposed expansion and identify the units(e.g.,acres,miles,housing units,
square feet)? % Units:
d.Is the proposed action a subdivision,or does it include a subdivision? E]y 0
If Yes,
I. Purpose or type of subdivision?(e.g.,residential,industrial,commercial;if mixed,specify types)
ii.is—a"cluster/conserv,a""t-ion layout-p-r'"oposed? Elyes E]Ko
iii.Number of lots proposed?
iv. Minimum and maximum proposed lot sizes? Minimum Maximum
e.Will the proposed action be constructed in multiple phases? E]YesEgiqo
I. If No,anticipated period of construction: months
ii. If Yes:
• Total number of phases anticipated
• Anticipated commencement date of phase I (including demolition) month year
• Anticipated completion date of final phase month _year
• Generally describe connections or relationships among phases,including any contingencies where progress of one phase may
determine timing or duration of future phases:
. ......... ............
Page 3 of 13
f.Does the project include new residential uses? EI'i'es "o
If Yes,show numbers of units proposed.
One Family Two Family Three Family kluultuple Family four or more
Initial Phase
At completion
of all phases
g.Does the proposed action include new non-residential construction(including expansions)? []YesMKo
If Yes,
i.Total number of structures
ii. Dimensions(in feet)of largest proposed structure: height; width; and length
iii. Approximate extent of building space to be heated or cooled: . square feet
h.Does the proposed action include construction or other activities that will result in the impoundment of any ❑yes o
liquids,such as creation of a water supply,reservoir,pond,lake,waste lagoon or other storage?
If Yes,
i. Purpose of the impoundment:
ii. If a water impoundment,the principal source of the water: ❑Ground water❑Surface water streams ❑Other specify:
ff. If other than water,identify the type of impounded/contained liquids and their source.
iv.Approximate size of the proposed impoundment. Volume: million gallons;surface area: acres
v. Dimensions of the proposed dam or impounding structure: height; length
vi. Construction method/materials for the proposed dam or impounding structure(e.g.,earth fill,rock,wood,concrete);
D.2. Project Operations
a.Does the proposed action include any excavation,mining,or dredging,during construction,operations,or both? FiiYes o
(Not including general site preparation,grading or installation of utilities or foundations where all excavated
materials will remain onsite)
If Yes:
i.What is the purpose of the excavation or dredging? _
ii. How much material(including rock,earth,sediments,etc.)is proposed to be removed from the site?
• Volume(specify tons or cubic yards) _...._.
• Over what duration of time?
iii. Describe nature and characteristics of materials to be excavated or dredged,and plans to use,manage or dispose of them.
iv. Will there be onsite dewatering or processing of excavated materials?
g P g Yes Edo
If yes,describe. �.....
v. What is the total area to be dredged or excavated? acres
vi. What is the maximum area to be worked at any one time? ..... acres
vii. What would be the maximum depth of excavation or dredging? �................... feet
viii. Will the excavation require blasting? ❑Yes❑No
ix. Summarize site reclamation goals and plan:
b.Would the proposed action cause or result in alteration of,increase or decrease in size of,or encroachment Yes " o
into any existing wetland,waterbody,shoreline,beach or adjacent area?
If Yes:
L Identify the wetland or waterbody which would be affected(by name,water index number,wetland map number or geographic
description)°
Page 4 of 13
ii. Describe how the proposed action would affect that waterbody or wetland,e.g.excavation,fill,placement of structures,or
alteration of channels,banks and shorelines. Indicate extent of activities,alterations and additions in square feet or acres:
.�.�........
iia.Will the proposed action cause or result in disturbance to bottom sediments? E]YesQNO
If Yes,
prolb11
iv. Will the sed action cause or result in the destruction or removal of aquatic p p ..q tic vegetation? OYcs[Rf�o
If Yes:
• acres of aquatic vegetation proposed to be removed:
• expected acreage of aquatic vegetation remaining after project completion
• purpose of proposed removal(e.g.beach clearing,invasive species control,boat access):
• pro..... .......... ..�. .� .... ...�
posed method of plant removal:
• if chemical/herbicide treatment will be used specify roduct s : �
v. Describe any proposed reclamation/mitigation following disturbance:
c.Will the proposed action use,or create a new demand for water? JwM,, o
If Yes:
ii. Will the proposed action obtain water from an exist p lic atter supply? gallons/day
a. Total anticipated water usage/demand per day: e-�� er^
pply? ❑Yes UK
If Yes:
• Name of district or service area:
• Does the existing public water supply have capacity to serve the proposal? ❑Yes❑No
• Is the project site in the existing district? ❑Yes❑No
• Is expansion of the district needed? ❑Yes❑No
• Do existing lines serve the project site? ❑Yes❑No
iii. Will line extension within an existing district be necessary to supply the project? ❑Yes❑No
If Yes:
• Describe extensions or capacity expansions proposed to serve this project:
•
iv. Is a new water supply 1 d to be formed to
( ofpp Y districtorserve a area propose
serve the project site? � E]Yes o�
If,Yes:
• Applicant/sponsor for new district:
• Date application submitted or anticipated
• Proposed source(s)of supply for new district
v. If a public water supply will not be used,describe plans to provide water supply for 1 � _
the project:
(p .private),
)... .....__.. pumping p��
vi.If water supplywill be from wells(public or rivate what is the maximumcapacity: 1cnsJ111nnute.
d.Will the proposed action generate liquid wastes? ❑Yes EUKO
If Yes:
i. Total anticipated liquid waste generation per day: gallons/day
ii.Nature of liquid wastes to be generated(e.g.,sanitary wastewater,industrial;if combination,describe all components and
approximate volumes or proportions of each)
iii. Will the proposed action use
o any existing public wastewater treatment facilities? E]YesEwo
If Yes:
• Name of wastewater treatment plant to be used:
• Name of district:
Does the existing wastewater treatment plant have capacity to serve the project. � ❑Yes❑No
• Is the project site in the existing district? ❑Yes❑No
• Is expansion of the district needed? ❑Yes❑No
Page 5 of 13
• Do existing sewer lines serve the project site? ❑Yes No
• Will a line extension within an existing district be necessary to serve the project? ❑Yes❑No
If Yes:
• Describe extensions or capacity expansions proposed to serve this project:
iv. Will a new wastewater(sewage)treatment district be formed to serve the project site? ❑Yes o
If Yes:
• Applicant/sponsor for new district:
• Date application submitted or anticipated:
• What is the receiving water for the wastewater discharge?
v. If public facilities will not be used,describe plans to provide wastewater treatment for thero'ect including proposed
P J gseci iP f1'�ngP P d
receiving water(name and classification if surface discharge or describe subsurface disposal plans):
Vi. Describe any plans or designs to capture,recycle or reuse liquid waste:
e.Will the proposed action disturb more than one acre and create stormwater runoff,either from new point ❑Yes o
sources(i.e. ditches,pipes, swales,curbs,gutters or other concentrated flows of stormwater)or non-point
source(i.e.sheet flow)during construction or post construction?
If Yes:
L How much impervious surface will the project create in relation to total size of project parcel?
Square feet or acres(impervious surface)
Square feet or acres(parcel size)
ii. Describe types of new point sources.
iii. Where will the stormwater runoff be directed(i.e.on-site stormwater management facility/structures,adjacent properties,
groundwater,on-site surface water or off-site surface waters)?
• If to surface waters, identifyreceiving eiving water bodies or wetlands;
• Will stormwater runoff flow to adjacent properties? YesNo
iv. Does the proposed plan minimize impervious surfaces,use pervious materials or collect and re-use stormwater? ❑Yes❑No
f. Does the proposed action include,or will it use on-site,one or more sources of air emissions,including fuel Oyesm4o
combustion,waste incineration,or other processes or operations?
If Yes,identify:
i.Mobile sources during project operations(e.g.,heavy equipment,fleet or delivery vehicles)
ii. Stationary sources during construction(e.g.,power generation,structural heating,batch plant,crushers)
iii. Stationarysources during operations(e.g.,process emissions,large boilers,electricgeneration) -
g.Will any air emission sources named in D.2.f(above),require a NY State Air Registration,Air Facility Permit, ElYesMKo
or Federal Clean Air Act Title IV or Title V Permit?
If Yes:
i. Is the project site located in an Air quality non-attainment area? (Area routinely or periodically fails to meet ❑Yes❑No
ambient air quality standards for all or some parts of the year)
ii. In addition to emissions as calculated in the application,the project will generate:
• Tons/year(short tons)of Carbon Dioxide(CO,)
• Toiis/year(short tons)of Nitrous Oxide(N20)
• Tons/year(short tons)of Perfluorocarbons(PFCs)
• Tons/year(short tons)of Sulfur Hexafluoride(SF6)
• ..... "r'om/year(short tons)of Carbon Dioxide equivalent of Hydroflourocarbons(HFCs)
• Tonslyeai-(short tons)of Hazardous Air Pollutants(HAPS)
Page 6 of 13
h.Will the proposed action generate or emit methane(including,but not limited to,sewage treatment plants, ❑�'es 1' o
landfills,composting facilities)?
If Yes:
i. Estimate methane generation in tons/year(metric): _
ii.Describe any ane capture,ture control or elimination measures included in project design(e.g.,combustion ustion to generate heat or
electricity,flaring):._.. - .. �.....-. _.
i.Will the proposed action result in the release of air pollutants from open-air operations or processes,such as D'es Nca
quarry or landfill operations?
If Yes:Describe operations and nature of emissions(e.g.,diesel exhaust,rock particulates/dust):
j.Will the proposed action result in a substantial increase in traffic above present levels or generate substantial ❑Yes O o
new demand for transportation facilities or services?
If Yes:
i. When is the peak traffic expected(Check all that apply): ❑Morning El Evening ❑Weekend
❑Randomly between hours of _ to
ii.For commercial activities only,projected number of truck trips/day and type(e.g.,semi trailers and dump trucks): ...........................�
iii. Parking spaces: ExistmgPro p....
osed .. Net increase/decrease
iv.Does the proposed action include any shared use parking? YesNo
v If the proposed action includes any modification of existing roads,creation of new roads or change in existing access,describe:
Vi. Are via Will t .._
proposed P p Y ❑.. �......�..
p blic/pnvate transportation service(s)or facilities available within/z mile of the proposed site? YesQNo
he ro osed action include access to public transportation or accommodations for use ofh hybrid,electric Yes❑No
or other alternative fueled vehicles?
viii.Will the proposed action include plans for pedestrian or bicycle accommodations for connections to existing YesNo
pedestrian or bicycle routes?
k.Will the proposed action(for commercial or industrial projects only)generate new or additional demand Yes o
for energy?
If Yes:
L Estimate annual electricity demand during operation of the proposed action:
ii. Anticipated sources/suppliers of electricity for the project(e.g.,on-site combustion,
....... on-site renewable,via grid/local utility,or
other):
iii. Will the proposed action require a new,or an upgrade to an existing substation? QYes N,..... ....
> o
1.Hours of operation. Answer all items which apply.
i. During Construction: / ii. During Operations:
M• Monday-Friday:_ �3 A - • Monday-Friday: Z
r_ 6 IM
• a 4% y • Saturday: a cn — ..... ..
• Sunday: �� Sunda
• Holidays: • Holidays:
Page 7of13
m.Will the proposed action produce noise that will exceed existing ambient noise levels during construction, ❑Yes No
operation,or both?
If yes:
i. Provide details including sources,time of day and duration:
ii. Will the proposed action remove existing natural barriers that could act as a noise barrier or screen? ❑Yes[]No
Describe:
n.Will the proposed action have outdoor lighting? El Yes o
If yes:
i. Describe source(s),location(s),height of fixture(s),direction/aim,and proximity to nearest occupied structures:
ii. Will proposed action remove existing natural barriers that could act as a light barrier or screen? El Yes❑No
Describe:
o.Does the proposed action have the potential to produce odors for more than one hour per day? ❑Yes QX4
If Yes,describe possible sources,potential frequency and duration of odor emissions,and proximity to nearest
occupied structures:
p.Will the proposed action include any bulk storage of petroleum(combined capacity of over 1,100 gallons) ❑Yes o
or chemical products 185 gallons in above ground storage or any amount in underground storage?
If Yes:
i. Product(s)to be stored_
ii. Volumes per unit time e. . month,
O P ( g•, ,Year)
iii. Generally,describe the proposed storage facilities:
q.Will the proposed action(commercial,industrial and recreational projects only)use pesticides(i.e.,herbicides, ❑Yes ❑No
insecticides)during construction or operation? `T
If Yes: '
a.
Describe proposed treatment(s):
-� m Management Practices? ❑ Yes ❑No .._..
n. Will the proposed action use Irate ated Pest ..._
r.Will the proposed action(commercial or industrial projects only)involve or require the management or disposal ❑ Yes
of solid waste(excluding hazardous materials)?
If Yes:
i. Describe any solid waste(s)to be generated during construction or operation of the facility:
• Construction: tons per (unit of time)
• Operation: tons per (unit of time)
ii. Describe any proposals for on-site minimization,recycling or reuse of materials to avoid disposal as solid waste:
• Construction:
• Operation
iii. Proposed disposal methods/facilities for solid waste generated on-site:
• Construction:
• Operation:
Page 8 of 13
s.Does the proposed action include construction or modification of a solid waste management facility? Yes BNo
If Yes:
i. Type of management or handling of waste proposed for the site(e.g.,recycling or transfer station,composting,landfill,or
other disposal activities):
ii. Anticipated rate of disposal/processing:
• Tons/month,if transfer or other non-combustion/thermal treatment,or
• Tons/hour,if combustion or thermal treatment
iii. If landfill,anticipated site life: years
t.Will the proposed action at the site involve the commercial generation,treatment,storage,or disposal of hazardous E1Yes o
waste?
If Yes:
i.Name(s)of all hazardous wastes or constituents to be generated,handled or managed at facility:
ii. Generally describe processes or activities involving hazardous wastes or co .-
nstituents:
iii. Specify amount to be handled or generated tons/month
iv. Describe any proposals for on-site minimization,recycling or reuse of hazardous constituents:
v.Will any hazardous wastes be disposed at an existing offsite hazardous waste facility? Yes' No
If Yes:provide name and location of facility:
If No: describe proposed management of an hazardous wastes which will not be sent to a hazardous ww..... �
p p g y este facility:
E.Site and Setting of Proposed Action
E.I.Land uses on and surrounding the project site
a.Existing land uses.
i. Check all uses that occur on,adjoining and near the project site.
® Urban ) dustrsa'l Coimnercial E] Residential suburban
Forest Agriculture Aquatic Other(specify): (.....
❑ ❑ 1 ❑ ) Rural non-farm) .
ii. If mix of uses,generally describe:
rid uses and covertypes on the project site.
Land use or Current Acreage After Change
... Covertype ._....._ _. m... .......... Acreage..........�
Project...Comp
letion (Acres
® nbuildings,and other paved or impervious 0)
. c � 1 �rface
..... ....
• Forested ..
• Meadows grasslands or brushlands(non- W
agricultural,including abandoned agricultural)
.... ........ ._._..._..... �...
• Agricultural
nc udes active orchards,field greenhouse etc.) -L-( S'�-
• Surface water features
(lakes,ponds,streams,rivers,etc.)
(
�. .
• Wetlands freshwater or tidal
• Non-vegetated(bare rock,earth or fill)
• Other
Describe:
Page 9 of 13
c.Is the project site presently used by members of the community for public recreation? -
❑Yeo
i. If Yes:e...,explain:
i..� .
d.Are there any facilities serving children,the elderly,people with disabilities(e.g.,schools,hosp.i.tals alicensed ❑Ycs
1" r
day care centers,or group homes)within 1500 feet of the project site?
If Yes,
i. Identify Facilities:
e.Does the .. .�
project site contain an existing dam? E]YesEZNo
If Yes:
i. Dimensions of the dam and impoundment:
• Dam height: feet
• Dam length: feet
• Surface area: acres
• Volume impounded: gallons OR acre-feet
ii. Dam's existing hazard classification:
iii. Provide date and summarize results of last inspection:
.f.Has..._.
the project site ever been used as a municipal,commercial or industrial solid waste management facility, ❑yes[3$40,
or does the project site adjoin property which is now,or was at one time,used as a solid waste management facility?
If Yes:
i. Has the facility been formally closed? ❑Yes❑ No
• If yes,cite sources/documentation:
ii. Describe the location of the project site relative to the boundaries of the solid waste management facility:
wm
W. Describe any development constraints due to the prior solid waste activities: -
g.Have hazardous wastes been generated,treated and/or disposed of at the site,or does the project site adjoin El Yes2F4o
property which is now or was at one time used to commercially treat,store and/or dispose of hazardous waste?
If Yes:
i.Describe waste(s)handled and waste management activities,including approximate time when activities occurred:
h. Potential contamination histo Has there be r - �
history. been a reported spill at the proposed project site,or have any �Ye� , oa
remedial actions been conducted at or adjacent to the proposed site?
If Yes:
i. Is any portion of the site listed on the NYSDEC Spills Incidents database or Environmental Site ❑Yes❑No
Remediation database? Check all that apply:
El Yes—Spills Incidents database Provide DEC ID number(s):
❑ Yes—Environmental Site Remediation database Provide DEC ID number(s): ..
❑ Neither database
ii. If site has been subject of RCRA corrective activities,describe control measures:
iii. Is the project within 2000 feet of an site m the NYSDEC Environmental Site Remediat'... .......... �� ��
p ] y .ion database? ❑Yes❑No
If yes,provide DEC ID number(s):.
iv. If yes to(i),(ii)or(iii)above,describe current status of site(s):
Page 10 of 13
v. Is the project site subject to an institutional control limiting property uses? yes�N®
If yes,DEC site ID number:
Describe the e of institutional control a
type ( .g.,deed restriction or easement):
Describe any use limitations:
Describe any engineering controls:
.... ... .... .. ...
Will the project affect the institutional or engineering controls in place? '°es❑No
Explain: O`:. " .. t
E.2. Natural Resources On or Near Project Site
a.What is the average depth to bedrock on the project site? feet
b.Are there bedrock outcroppings on the project site? YesmKo
If Yes,what proportion of the site is comprised of bedrock outcroppings? %
c.Predominant soil type(s)present on project site:e _ " ®/®
®/0
d.What is the average depth to the water table on thero'ect site? Average:p j c?- % feet
e.Drainage status of project sites ❑' .'ell Drained:
%�%of site
oils: W
Moderately Well Drained: %of site
Poorly Drained %of site
f.Approximate proportion of proposed action site with sl
p � - ° ZOO ® site
10-15%: %of site
15%or greater: ..............%of site
_j.—Are q geologic he project site? ❑Yes o
Are there an unique eolo is features on t
If Yes,describe;
h. Surface water features.
i. Does any portion of the project site contain wetlands or other waterbodies(including streams,rivers, YesNo
ponds or lakes)?
ii. Do any wetlands or other waterbodies adjoin the project site? esNo
If Yes to either i or ii,continue. If No,skip to E.2.i,
iii. Are any of the wetlands or waterbodies within or adjoining the project site regulated by any federal, Eryes❑No
state or local agency?
iv. For each identified regulated wetland and waterbody on the project site,provide the following information:
• Streams: Name 'n
�"�"t ' ..> �' ..., Classification e
® Lakes or Ponds: Name Classification VI W
Wetlands: Name
Approximate Size ( ul
_.
v. Are an of the above water bodiesp �,�
• Wetland No,(if regulated lisDted�n the most recent compilation of NYS water quality-impaired ❑Yes!moo
waterbodies?
If yes,name of impaired water body/bodies and basis for listing as impaired:
i.Is the project site in a designated Floodway? ❑Yes o
j.Is the project site in the 100-year Floodplain? ❑Yes R<O
k.Is the project site in the 500-year Floodplain? "es❑No
1.Is the project site located over,or immediately adjoining,a primary,Y9 princi al or sole source a uifer? � es
o
If Yes:
i.Name of aquifer:
Page 11 of 13
in. Identify the predominant wildlife species that occupy or use the project site:
n.Does the project site contain a designated significant natural community? ❑yes o
If Yes:
i.Describe the habitat/community(composition,function,and basis for designation):
ii. Source(s)of description or evaluation:
W. Extent of community/habitat:
• Currently: acres
• Following completion of project as proposed: acres
Gain or loss(indicate+or-): acres
o.Does project site contain an species of plant or animal that is listed bmmmmmmh V ..
p j y p p y the federal government or NYS as Yes o
endangered or threatened,or does it contain any areas identified as habitat for an endangered or threatened species?
If Yes:
i. Species and listing(endangered or threatened):
p. Does the project site contain any species of plant or animal that is listed by NYS as rare,or as a species of cc,� o
special concern?
If Yes:
i. Species and hsfl¢a,g'
q.Is the project site or adjoining area currently used for hunting,trapping,fishing or shell fishing? ❑Yes®'l�it
If yes,give a brief description of how the proposed action may affect that use:
E.3. Designated Public Resources On or Near Project Site
a.Is the project site,or any portion of it,located in a designated agricultural district certified pursuant to EXesNo
p county p � 03 and 304?
Agriculture an Markets Law ice 5-
If Yes, provide coup plus district name/number Section is 1 � k� C y� c
n �
�v-
....._.-.............m..............
_..... ..__..
b.Are agricultural lands consisting of highly productive soils present? ❑'.'es❑No
i. If Yes:acreage(s)on project site?
ii. Source(s)of soil rating(s); ... ..
c. Does the project site contain all or part of,or is it substantially contiguous to,a registered National ❑jYes�o
Natural Landmark?
If Yes:
i. Nature of the natural landmark: Biological Community Geological Feature
U. Provide brief description of landmark,including values behind designation and approximate size/extent:
d.Is the project site located in or does it adjoin a state listed Critical Environmental Area? ElyesMKo
If Yes:
i. CEA name:
ii. Basis for designation:
iii. Designating agency and date:
Page 12 of 13
e.Does the project site contain,or is it substantially contiguous to,a building,archaeological site,or district El Yes'Qf�o
which is listed on the National or State Register of Historic Places,or that has been determined by the Commissioner of the NYS
Office of Parks,Recreation and Historic Preservation to be eligible for listing on the State Register of Historic Places?
If Yes:
i.Nature of historic/archaeological resource: E3 Archaeological Site E]Historic Building or District
ii.Name:
............._.....i
...................
iii. Brief description of attributes on which listing is based:
f.Is the project site,or any portion of it,located in or adjacent to an area designated as sensitive for []Yes4a�
archaeological sites on the NY State Historic Preservation Office(SHPO)archaeological site inventory?
g.Have additional archaeological or historic site(s)or resources been identified on the project site? F1Yes[_q$,10
If Yes:
i.Describe possible resource(s): ...........
ii. Basis for identification:
h.Is the project site within fives miles of any officially designated and publicly accessible federal,state,or local E]Yes[2fro
scenic or aesthetic resource?
If Yes:
i. Identify resource:
ii.Nature of,or basis for,designation(e.g.,established highway overlook,state or local park,state historic trail or scenic byway,
etc.): .................
iii. Distance between project and resource: miles�
i. Is the project site located within a designated river corridor under the Wild, Scenic and Recreational Rivers EJ YcscaN/o
Program 6 NYCRR 666?
If Yes:
i. Identify the name of the river and its designation:
ii. Is the activity consistent with development restrictions contained in 6NYCRR Part 666? []Yes[]No
-- ..................................................... —-------......................
F.Additional Information
Attach any additional information which may be needed to clarify your project.
If you have identified any adverse impacts which could be associated with your proposal,please describe those impacts plus any
measures which you propose to avoid or minimize them.
G. Verification
I certify that the information provided is true to the best of my knowledge.
Applicant/Sponsor Name 2*5 Date—
Signature
PRINT FORM Page 13 of 13
APPLICANT'S AFFIDAVIT
APPLICANT'S AFFIDAVIT
STATE OF NEW YORK
COUNTY OF SUFFOLK
.......... ___" _being duly sworn.,deposes and says that he
resides at � UrA V irl the
V V
State of New York, and that he is the owner of property located at C, M(,',\Y,\
el", L3 V11r,� �I L.1
' Scrim or that he is tht�;
—T
the h
(Title) (Specify whether Partnership or Corp.)
and said Corporation is the owner of the above property, which is hereby making a Site Plan
application;that there are not existing structures or improvements on the land which are not
shown on the Site Plan; that the title to the entire parcel, including all rights-of-way,has been
clearly established and is shown on said Plan; that no part of the Plan infringes upon any duly
filed plan which has not been abandoned both as to lots and as to roads; that he has examined all
rules and regulations adopted b 0' anning Board for the filing of Site Plans and will comply
with same; that the plans st hile as approved,will not be alter or changed in any manner
without the approval of, la iing Board; and that the actual physical improvements will be
installed in strict acco ane ply 4m"a
�proved by the Planning Board.
Signed
0
Signed
(Partner or Corporate "ices and Title)
Sworn,to me this
`�---day of ww Jehi
m.
N ary Public
6,,-.7T'53,Y X PERMS
Notary Sade o[New York
1 - 6
k�0 0 11&''::..,f�3036, J
Cornrn�s,'Ran
Southold Planning Departni.ent
Applicant
Transactional Disclosure Form
The To of Southold's Code of Ethics prohibits conflicts of interest on the part of to of
and employees. The purpose of this form is to provide information which can alert the to of
possible conflicts of interest and allow it to take whatever action is necessary to avoid same.
Your Name: 'y (YI
Last,First,middle initial
unless you are applying in the name ofsomeone else or other entity,such as a company. Ifso,
indicate the other person's or company's name.
Nature of Application: (Check all that apply)
Subdivision or Re-subdivision Site Plan Vr A
""A' 4,
Other(Please name other activity)
Do you personally(or through your company,spouse,sibling,parent or child)have a relationship with any officer or
employee of the Town of Southold? "Relationship includes by blood,marriage or business interest. "Business
interest"means a business,including a partnership,in which the town officer or employee has even a partial
ownership of(or employment by)a corporation in which the town officer or employee owns more than 5%of the
shares.
Yes No
If you answered"Yes"complete the balance of this form and date and sign where indicated.
Name of the person employed by the Town of Southold
Title or position of that person
Describe the relationship between yourself(the applicant)and the town officer or employee. Either check the
appropriate line A through D and/or describe in the space provided.
The town officer oremployee or his or her spouse,sibling,parent or child is(check all that apply):
A.the owner of greater than 5%of the shares of the corporate stock of the applicant(when the
applicant is a corporation);
B.the legal or beneficial owner of any interest in a noncorporate entity(when the applicant is not
a corporation);
C.an officer,director,partner or employee of the applicant;or
D.the actual applicant
Description of Relationship:
Submitted this ,�day a G
Signefiir—c
ire
Pi 0nt NajTi(,,,_
Disclosure Form
OFFICE LOCATION: c � MAILING ADDRESS:
Town Hall Annex rg sol/," P.O. Box 1179
54375 State Route 25 � � Southold, NY 11971
(cor. Main Rd. &Youngs Ave.)
Southold, NYS„ Telephone: 631 765-1938
ww .southoldtownny.gov
� cou
PLANNING BOARD OFFICE
TOWN OF SOUTHOLD
MEMORANDUM .
To: Accounting
From: Planning Department
Date: January 16, 2020
Re: Check
Please deposit the attached check into B691: Deferred Revenue. Fee is for a Site
Plan Application not yet accepted by the Planning Board.
. . ..... ._.....__
...._.........
Applicant/Project Name & Type Tax Map # Amount Check Date/No.
.....
...........----------
_ _.... _.-_....._._ ._._..........
Tenedios 19-1-1.4 $500.00 1/7/20 - #0000267
Amended Site Plan Application (2) 19-1-1.3 Patricia Moore,
Esq.
JAM
Att-
,• ',�-, '„i ,,,•,,/ ,.,'�,,,�„ � �„ ”,,,, ;', ° TAC RW`flTem 6C'�TI�6A.[I/N5v�9�fl183v1 WAW
FRESH-'&"CO FARM VALLEY"NATIONAL BANK "
130 W 37TH STREEET loo PARKAVENUE 0000267
NEW YORK°FVEW YORK"10018 NEWYORK,,NEwYOR goo r
212-983-7474 1/7/2020
'POAE Town,of Southold, - `$500.00
Five Fiuraclyd and 00/10 ' � �� � � ��� D Ll-AR
,Town"of Southold
53095 Route 25
PO Box 1409
Southold, NYI1971-0499
w�.
MEMO a
SECURRY FEATURES INCLUDED.DETAILS ON BACK �o
110000000 26 70 1:0 2L 20 L 38 31: 4 L 9 2 38 1 20