HomeMy WebLinkAbout1000-125.-2-1.14 & 2.2 (1)UNAUTHORIZED ALTERATION OR ADDITION TO THIS SURVEY IS A VIOLATION OF SECTION 7209 OF THE NEW YORK STATE EDUCATION LAW.(2)DISTANCES SHOWN HEREON FROM PROPERTY LINES TO EXISTING STRUCTURES ARE FOR A SPECIRC PURPOSE AND ARE NOT TO BE USED TO ESTABLISH PROPERTY LINES OR FOR ERECTION OF FENCES.(S)COPIES OF THIS SURVEY MAP NOT BEARING THE LAND SURVEYORS INKED SEAL OR EMBOSSED SEAL SHALL NOT BE CONSIDERED TO BE A VALID TRUE COPY.(A)CERTIFICATION
INDICATED HEREON SHALL RUN ONLY TO THE PERSON FOR WHOM THE SURVEY IS PREPARED AND ON HIS BEHALF TO THE TITLE COMPANY,GOVERNMENTAL AGENCY AND LENDING INSTITUTION LISTED HEREON,AND TO THE ASSIGNEES OF THE LENDING INSTITUTION.CER1FICATIONS ARE NOT TRANSFERABLE TO ADDITIONAL INSTITUTIONS OR SUBSEQUENT OWNERS (5)THE LOCATION OF WELLS(W),SEPTIC TANKS(ST)k CESSPOOLS(OP)SHOWN HEREON ARE FROM FIELD OBSERVATIONS AND OR DATA OBTAINED FROM OTHERS.
400 Ostrander Avenue, Riverhead, New York I1a01
tel. 631.72-T.2303 fax. 631.727.0144
odm In®youngeng Ineering.c om
Howard W. Young, Land Surveyor
Thomas 0. Wolpert, Professional Engineer
AQ TEST HOLE DATA Douglas E. Adams, Professional Engineer
ow1(�pl-go",I�
Robert 0. Tost, Architect
NO, 1 Robert Stromski, Architect
0.0'
LOAM
(SC)
---_�— "✓ �M 2.0'
ALDRICH
LANE
SITE DATA
SAND&
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2539.83G> GRAVEL TOTAL AREA = 5.8742 ACRES
'
(5W) *OWNER/APPLICANT PECONIC LAND VIII,LLC
c/o Joseph P.Lebkuecher,III
00 y A!„D R 1046 Marshside Way
Z [ICH �q NE Belville,NC 28451
n,o'
TOTAL NUMBER OF LOTS =2
S32055'51"F *ZONING USE DISTRICT =RESIDENTIAL LOW DENSITY(R-80)
z 138.12 cop
LOT 115 CONSISTANT WITH LOT l OF SUBDIVISION MAP"RICHARD J.
x, CRON" FILED IN THE OFFICE OF THE CLERK OF THE COUNTY OF SUFFOLK ON
SEP.30,1985 AS MAP NO.7975.
LOCUS N
� � I
� l
LO l
25'WIDE w
EASEMENT m w
z
NOTES
o LO -
o b *THE APPROVAL OF THIS MAP DOES NOT CONSTITUTE THE ACCEPTANCE OF
In W U oo HIGHWAYS,IF ANY,SHOWN THEREON AS PUBLIC ROADS.
A DECLARATION OF COVE AND RESTRICTIONS HAS BEEN FILED IN THE
SUFFOLK COUNTY CLERKS OFFICE IN LIBER CP
KEY MAP o z z1b51 SF V o *THE LOT LINES OF SUBDIVISION MAPS AS FILED,CANNOT BE ALTERED
SCALE: 1"=600' 3 88 AC N �, r WITHOUT PERMISSION FROM THE PLANNING BOARD,AND LOTS MUST BE
SOLD AS SHOWN ON THE SUBDIVISION MAP.
r I SUFFOLK COUNTY DEPARTMENT OF
o HEALTH SERVICES GREAT RIVER, N.Y.
M .LOT yylDrH o
_ l omu Hjam„
MIN,FINRO— _NT YARD SETBACK V O O
F'— _
' 175.00' DATE
tU :� J THIS IS TO CERTIFY THAT THE PROPOSED REALTY SUBDIVISION OR
1 31 DEVELOPMENT FOR PECONIC LAND VIII, LLC IN THE TOWN OF
°N I l In O SOUTHOLD WITH A TOTAL OF 2 LOTS WAS APPROVED ON THE ABOVE DATE. ENGINEERS CERTIFICATION
i I WATER SUPPLIES AND SEWAGE DISPOSAL FACILITIES MUST CONFORM TO
N "I HEREBY CERTIFY THAT THE WATER SUPPLY(S)AND/OR SEWAGE DISPOSAL
Ao j CONSTRUCTION STANDARDS IN EFFECT AT THE TIME OF CONSTRUCTION AND
2 j I SYSTEM(5)FOR THIS PROJECT WERE DESIGNED BY ME OR.UNpE MY
ARE SUBJECT TO SEPARATE PERMITS PURSUANT TO THOSE STANDARDS.THIS
j I DIRECTION.BASED UPON A CAREFUL AND THOROUGH�• 4 a �'�11.,
S 30°17 APPROVAL SHALL BE VALID ONLY IF THE REALTY SUBDIVISION OR � `
i I SITE AND GROUNNDWATER CONDITIONS,ALL LOTS �! R b E kb, RM
01"E -_.—
SAL DEVELOPMENT MAP I5 DULY FILED WITH THE COUNTY CLERK WITHIN ONE f-- "� '
TO THE SUFFOLK COUNTY DEPARTMENT OF HEALTH'tEAV .6� q°t`Ib�1
34.50' — _ _ _ YEAR OF THIS DATE.CONSENT I5 HEREBY GIVEN FOR THE FILING OF THIS STANDARDS IN EFFECT AS OF THIS DATE." �." '�1''°1`` "i °::r v-l
S 34000'41"E I MAP ON WHICH THIS ENDOLSEMENT APPEARS IN THE OFFICE OF THE COUNTY ti a-� '
5.36' r ' CLERK IN ACCORDANCE WITH PROVISIONS OF THE PUBLIC HEALTH LAW AND ': y'''
— — _ N 3po17, W THE SUFFOLK COUNTY SANITARY CODE. "r Al M-S
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CMF 01 ° , I JP.E. (/'/` G.• �/�/ } `, '9- 'tom3 c�
cMF 202.19 WALTER DAWYDIAK R.,P
S 30017'01 01" DIRECTOR,DIVISION OF ENVIRONMENTAL QUALITY
rn 1 F I HOWARD W.YOUNG,N.Y.S.L.S.NO.45893n �,Y"•,
£ N 1 339 b2, 1p2 93' c I THOMAS C.WOLPERT,N.Y.S.P.E.NO.61483
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C SP SBL
�Rr�EwAY SURVEYOR'S CERTIFICATION
N h ; TYPICAL PLOT PLAN
C4 s9�• I ON I HEREBY CERTIFY THAT ALL LOTS SHOWN ON THIS PLAT COMPLY WITH
ST H
r- L
- i THE BUILDING ZONE ORDINANCE OF THE TOWN OF SOUTHOLD."
a0 � I � SANITARY Q F"I
41 iU j f—SYSTEM ' H TH#1 PROPERTY LINE
N t OcP I �. c�i 5' MIN "I HEREBY CERTIFY THAT ALL LOTS SHOWN OrTH
--V-WITH THE
o j i N WELL WELL BUILDING ZONE ORDINANCE OF THE TOWN OFO 6DIFIED
2 STORY OcP i Y H PURSUANT TO SECTION 278 OF THE N.Y.S.TOWNb
�VJ�i` F
n L N j/ FRAME HOUSE --j 25' 0) THE CODE OF THE TOWN OF SOUTHOLD.J j &GARAGE p Oo 20 �i `' QJ
& HOUSE HOUSE~ 159,230 SFLEGEND o w i 3.6554 AC i t } - — Cr'`,_;A;_",-`_�
41=41Z
j I O wo ;\t2 4 II 93 �1 �
Do
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fI
EOP =EDGE OF PAVEMENT M ! I N 2' UL
!n villi z sEPTIc HOWARD W.YOUNG,N.Y.S.L.S.NO.458
o •zf 1b TANK
S�
N
WDF =WOOD FENCE °v- L._..._._ ---------------------------
_ I °v ►'�
_ _ _
CLF =CHAIN LINK FENCE `o — — SBL N LEACHING POOLS
VLF =VINYL FENCE 2 �,
WIF =WIRE FENCE SUBDIVISION MAP
R =DRAINAGE INLET wsF ROAD PECONIC LAND VIII LLC
O =ROOF OVER
SBL =SETBACK LINE / N 35°37'52" yi/
SP =STONE PAVEMENT 407.93' — — • BOTTOM OF LEACHING POOLS SHALL BE A MINIMUM OF 3 FEET
`�D =UTILITY POLE I ABOVE HIGH EXPECTED GROUNDWATER.
at Laurel, Town of Southold
M CM5 =CONCRETE MONUMENT SET , now or formerly L
Joseph P. Suffolk County, New York
�I CMF =CONCRETE MONUMENT FOUND I p ebkuecher, Jr
N W55 =WOOD STAKE SET
N WSF =WOOD STAKE FOUND
IPF =IRON PIPE FOUND
JX = FINAL PLAT
LIGHT POLE
PLANNING BOARD CERTIFICATION
RCF = REBAR&CAP FOUND 1000 125 02 1.14
o • =BOUNDARY CHANGE IN DIRECTION County Tax Map District 1000 Section 125 Block 02 Lot P/O 2.2
THIS IS TO CERTIFY THAT THIS SUBDIVISION PLAT HAS BEEN APPROVED BY
Q. THE PLANNING BOARD OF SOUTHOLD.
MAP PREPARED JUN.10,2020
DATE OF APPROVAL REVISION Record of Revisions DATE
BY
CHAIRPERSON(TOWN OF SOUTHOLD PLANNING BOARD)
RECEIVED
JUN 2 3 2020
Ld T _ 100 0 50 100 200 300
o Southolown
Planning Board
Scale, 1" = 100'
a
JOB NO.2020-0040
DWG.LE970337_2018_0022_minor_sub_2 1 OF 1
a: ,.._
ED
PATRICIA C. MOORS �. ...w ..._..........
Attorney at Law � � 2 a �Ifl '
51020 Main Road
Southold,New York 11971
�ro�"�4PC°�mNci ru�mri� ...._
Tel: (631)765-4330 �lllaiin4ig IBeard
Fax: (631)765-4643
June 17, 2020
Southold Town Planning Board
Town Hall Annex
54375 Route 25
P.O. Box 1179
Southold,NY 11971
RE: Lebkuecher Lot Line Change
1000-125-02-1.14 and 1000-125-2-2.2
Dear Chairman Donald Wilcenski and Board:
The above property is owned by Joseph and Katherine Lebkuecher
and Peconic Landing VIII, LLC (Joseph Lebkuecher Jr.). The property is a
large farm parcel with 35.7 acres containing the commercial farming
operation, farm greenhouses, and Joe and Katherine's home. The
subdivision ordinance penalizes a farmer who wishes to split off the house.
Both the mandatory cluster and 60% open space becomes applicable to the
farm. In order to avoid this unintended penalty on a farming operation, the
subject lot line change between the previously subdivided conforming lot on
Aldrich Lane (Richard Cron Subdivision filed with the Suffolk County Clerk
on September 30, 1985)has to be merged to the house parcel in a lot line
change application.
Thereafter, the re-subdivision between Lot 1 of the Richard Cron
Subdivision filed which is a filed map with the Suffolk County Clerk on
September 30, 1985 and the proposed lot line change map herein will be
required.
This is a ludicrous process which should be corrected with proper
code revisions. A farm should not be penalized by a "set-off'. This has
been a historical precedent since zoning was adopted in Southold but
eliminated when the "standard" verses "conservation" subdivision
regulations were adopted. The reason set-offs were adopted is to maintain
agriculture. Homesteads were split off due to the needs of farm families
while preserving the farm.
Enclosed are as follows:
1. Lot line change application (application, LEAF and LWRP).
2. Revised forms for the subdivision application which I filed on May
24,2019. Please replace May 19th, 2019 application forms with the
enclosed application, LEAF, and LWRP dated June 9th, 2020. The
filing fee for the subdivision and authorizations are in your file.
3. Revised subdivision map prepared by Howard Young last dated June
10, 2020
The revised subdivision application forms reflect the proposed Lot line
change submitted herein.
Simultaneously, the Planning Board should support and encourage the
Town Board to clean up the subdivision regulations which are full of errors
and inequities, this issue is being brought to your immediate attention.
Kindly acknowledge receipt by date stamping this letter and emailing
back to our office.
Thank you.
,_
ell
V '` u y yours,
atr cia C. Moor
P m/�'
RECEIVED
_...
SOUTHOLD DEPARTMENT
Re-subdivision. (Lot Line Modlification)
Application Form
APPLICATION IS HEREBY MADE to the Town of Southold Planning Beard for the
proposeddescribed
2. Suffolk County Tax Map#(include is involved)
3. Hamlet
a ...._........................._...
5_ Acreage of Site3...�......:.__ "
6. Zoning District
7_ Date of Submission
& Please provide the names, addresses and phone numbers for the following
People:
Applr` ril : fir`! Z,
1
t
c s, addresses and phone numbers for the
Y � r
Agent. �.:.
following
; " -
30
Property ner s .
fl
,w fir ,
a ' . yOlt
!o
1. 112V aoloyr � ���P
w
Engineer: 4MC�
Attorney: �r
9. Briefly or requesting, _
n
At
....�w� ......-_ � � "
� "
�, �� � _ ��P � .��. ,fid���t'"J'�� ........�.....,.�_�.� ,�, r• �., �
_tea .....�.. .�... ... ...._._.........
10.DOES THE PROPOSED MODIFICATION
(a) Affect the street layout in the original subdivision? /(/0
(b) Affect any area reserved for public use? /VV
(c) Diminish the size of any lot? /VD "
(d) Create an additional building lot? /V o
(e) Create a nonconforming lot? /!D
(f) Require a variance from the Zoning Board of Appeals? /V0
(g) Impact the future planning of the subject properties? kv
11.Does the parcel(s) meet the Lot Recognition standard in Town Code §280-9 Lot
Recogi tion? Yes_' _ No If"yes", explain how:
12.Does this application meet the standard in.§24Q-
5.7 waiver, adjustment of prapert
lu`oes to wive the subdivision princess? If so, please provide the name and date of tile
original subdivision.
13�. Application completed by [ owner agent [ ] other
Upon submitting a completed application, the Planning. Board will review the
proposal and determine if the project is eligible for a waiver of subdivision review
pursuant to Town Code§ 210.57. Waiver, ad`ustment of Rrol&rty lines,. If the
application meets the criteria for a waiver, the modification may be authorized by
the Planning Board by areesoluutionand no further review will be required.
If the proposed lot line modification will create substandard lot sizes, lot widths or
make existing structures nonconforming with respect to setbacks,the applicant will
not be able to receive Planning and approval,without first obtaining relief from.
the Zoning Board of Appeals.
Signature of Prepareir PrepareDate ,
3
AUTHORIZATION
Peconic Landing VIII, LLC, by Joseph Lebkuecher, Jr., member, as owner of premises
(sctm: 1000-125-2-1.4) with offices located at 538 Herricks Lane, Jamesport New York
do hereby authorize my attorney, Patricia C. Moore, to act as my agent and handle all
necessary work involved in the subdivision process with the Southold Town Planning
Board and Suffolk County Health Department.
PECONIrC IDIIG V11 ,.
BYW (Owner's signature)
JOSEPH LEBKUECHER "`
AUTHORIZATION
Joseph Lebkuecher,Hl and Katherine Lebkuecher,as owner of premises(sctm: 1000-125-2-2.2)
residing at 3475 Aldrich Lane,Mattituck,New York do hereby authorize my attorney,Patricia
C.Moore,to act as my agent and handle all necessary work involved in the subdivision process
with the Southold Town Planning Board and Suffolk County Health Department.
_(0wn&s signature)
(0 wner's sigmature
,Southold ing Departmen
Applicant
Transactional Disclosure Form
The Town of Southold's Code of Ethics prohibits conflicts of interest on the part of town officers
and employees. The purpose of this form is to provide information which can alert the town of
possible conflicts of interest and allow it to take whatever action is necessary to avoid same.
Your Name: 11hM,;y zs
Last,First,middle initial
unless you are applying in the name of someone else or other entity,such as a company. If so,
indicate the other person's or company's name.
Nature of Application: (Check all that apply)
Subdivision or Re-subdivision x Site Plan
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 or employee or his or her souse,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 4 day of
Signal ai r
Print Name
t'
Disclosure Form
APPLICANT
TRANSACTIONAL DISCLOSURE FORM
(FOR SUBMISSION BYOWNER and OWNER'S AGENT)
The Town of Southold's Code of Ethics prohibits conflicts of interest on the oart of Town officers and
pniR�Dygqs, The purpose of this form is to provide information,which can alert the Town of Possible conflicts
of interest and allow it to take whatever action is necessary to avoid!same.
YOUR NAME:
(Last name,first name, middle initial, unless you are applying in the name
ofsomeone else orother entity, such auacompany. |fso, indicate the
other person orcompany name.)
NATURE OFAPPLICATION: (Check all that opp|y.)
Tax Grievance
Variance
Special Exception
If"Other",
name the activity:
Trustees:
Change ofZone
Approval ofPlat
Exemption from Plat
or Official Map
Other
Do you personally, (or through your company, spouse, sibling, parent, or child) have a relationship with any
officer oremployee ofthe Town ofSouthold? ''Ro|etionohip^includes byblood,marriage,orbusiness interest.
"Business interest" means o buxineuu, including o partnomhip, in which the Town officer or employee has
even o partial ownership of(or employment by) o corporation in which the Town officer or employee owns
more than 596ofthe shares.
YES N
Complete the balance nfthis form and date and sign below where indicated.
Name ofperson employed bythe Town ufSouthold:
Title orposition ofthat person:
Describe that relationship between yourself(the applicant) and the Town officer oremployee. Either check
the appropriate line A through D (below)and/or describe the relationship in the space provided.
The Town officer or employee or his or her spouse, sibling, parent, or child is(check all that apply).
/)the owner ofgreater than 5Y6ofthe shares ofthe corporate stock
ofthe applicant(when the applicant ioonnrporation);
8)the legal orbeneficial owner ofany interest inanon-corporate entity
(when the applicant ionot 000rpoogion);
C}anofficer, director, partner,oremployee ofthe applicant;or
D}the actual applicant.
DESCRIPTION OF RELATIONSHIP
Submittedthis__ 0/__day of
Southold Plann Ly gpAK
in—D
Applicant
Transactional Disclosure Form
The To of Southold's Code of Ethics prohibits conflicts of interest on the part of to officers
and aniployces. The purpose of this foral is to provide in(brairilion which can alert,the tomi of
possible conflicts of interest and allow it to take Nvhatever action is nccossa,jy to avoid same.
Your Name� 6k,&-c Ae.- M
Ez7FQ",'rakkilc jaffla,
unless years are applying in the naine else or other entity,such as a company. Ifso,
indicate the other person's or company.i,nama,
Nature of Application: (Check all that apply),
Subdivision or Re-subdivision x Site Plan
Other(Please name other activity) —
Do you par sonkffly(or ehrouoi yo"cei,'plmy,,qpouso,sibling,paf ent M child)have A r0laficM51lip with any officer or
amptoyca of flie Town orsouflw1s.1? "Relnfianship imjudcs by blood,iMlTi2gaar bushiess mierea
astermeam an buqiaess,including a parfrimrship,in Mich d1c,t0mro 011ie-Or tttpl ayes liura evvii a partial
owiwrsh ap of(or ciaplaymcilt by)ij corporation in Which tLc town officer or empjayec own's morc than 5%or 0v�
Shares,
YeaNd1%—
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
DescribL the rej.;qiorasjjjp bct„vNleen yolirself(Che applicam)and the town officer or employee. Either check the
Approjxh,ile line A thraugh DanVor dcsc6be in file!qiscc provided.
The town officer or employee or his or her souse,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)e
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
Dthe,actual applicant
Description of Relationship:
............................ ..
..... .........
.......... ...—------
Submitted this ?/Adayoflz(/-202-0
Print Narric
Disclosure Form
rel'? L e vee e-r
FORM NO. 4
TOWN OF SOUTHOLD
BUILDING DEPARTMENT
Office of the �uilding Inspector
Town Hall
Southold, N.Y.
CERTIFICATE OF OCCUPANCY
No: Z-31191 Date: 10106Z05
THIS CERTIFIES that the building NEW D LLING
Location of Property: 935 FRANKLINV LLS RD LAUREL
(HOUSE NO.) (STREET) (HAMLET)
County Taal Map No. 473889 Section 125 Block 2 Lot 2.2
Subdivision Filed Map No. Lot No.
conforms substantially to the Application for Building Permit heretofore
filed in this office dated JUNE 18 2003 pursuant to which
Building Permit No. 29532-Z dated JULY 1 2003
was issued, and conforms to all of the requirements of the applicable
provisions of the law. The occupancy for which this certificate is issued
is SINGLE FAMILY DWELLING WITH ATTACHED TWO CAR GARAGE & COVERED FRONT
PORCH AS APPLIED FOR.
The certificate is issued to JOSEPH P LEBI=CHER III
(OWNER)
of the aforesaid building.
SUFFOLK COUNTY DEPARTMENT OF HEALTH APPROVAL R10-03-0064 09/27/05
RLEC 'pTCAL CERTIFICATE NO. 1169333 1.0 28 04
PLUMBERS CERTIFICATION DATED 10/13104 RBT. BUGDIN PLUMB.& HEAT.
ACh(xr_ized Signature
Rev. 1/81
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 Bitilding Permits
caul 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. proposed action will„ be evaluated as to its 5iYi*5nt
beneficial and adverse effects Luton the coastal area(which includes all of Southold Tows".
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. Thu& each, answer must be explained, indetaiL listing both su , ortin and none
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 plaices: online at the Town of Southold's website
southoldtown.:northfdrk.niet , the Board of Trustees Office,the Planning Department.all local
libraries and the Town Clerk's office.
B. DESCRIPTION OF SITE AND PROPOSED ACTION
PROJECT NAME .y% . ,f ", , ."`
The Application has been submitted to(check appropriate response).
Town Board El Planning and E9 Building Dept. D Boardof Trustees �I
1, Category of Town of Southold agency action(check appropriate response):.
k Action undertaken directly by Town agency(e.g. capital LI
construction., planning activity,agency regulation,land transaction) I
b Financial assistance)e,g, grant, loan.subsidy)
c) Permit,approval, license, certification: L l
Nature
and extent of action::
Location of action: A/d-y-(_4
Site acreage:,..... A--,r2 S i _... . ;7 are_q
Present land use: a. , "
................
Present zoning classification: � ......................
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: e, —1a,111-11 .,
(b) Mailing address: 0 &,P-K 6 Lf
c Telephone number: Area Code ��o wa 3 3 0
eP ( gym .....�.
(d) Application number, if any _
Will the action be directly undertaken,require funding,or approval by a state or federal agency?
YesE] Nod Ifyes,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, males efficient use of infrastructure, males beneficial use of a coastal location,and',
minimizes adverse effect. of development. See L RP Section Illi– Policies; Page 2 for evaluation
criteria"
F-1 Ye's E] No Not Applicable;
.-.
d , s
Attach additictutl shts if X
Policy 2. Protect and preserve historic and archaeological resources of the Town of Southold. See LNNIR
Section III--Policies Pages 3 through 6 for evaluation criteria
Yes F] No ff Not Applicable
..... .WW....
Attach additional sheets if necessary
Policy 3. Enhance visual quality and protect scenic resources throughout the Town of Southold. See
LWRP Section III—Policies Pages 6 through 7 for evaluation criteria
Yes No [ff Not Applicable
_. ..... ... ....................
Attach additional sheets if necessm
NATURAL COAST POLICIES
Policy 4. Minimize loss of life, structures, and natural resources from flooding and erosion. See LNVRP
Section III—Policies Pag through 16 for evaluation criteria
Yes E No Not Applicable
........ ..... �.
Attach additional sheets if necessary
Policy 5. Protect.and improve water quality and supply in the Town of Southold. See LWltP' Section W
—Policies Pages 16 through 1 for evaluation criteria
❑Yes F] No INotApplicabte
Attach a ' °doral sheets if necessan
Policy 6. Protect and restore the quality and runction of the Town of Southold ecosystems including
Significant Coastal Fish and Wildlife habitats and:. wetlands. LWRP Section IH — Policies; Pages 22
through 32 for eval=plicablle
rih,.
Lj Yes o
Attach additional sheets if necessary
Policy 7. Protect and improve air quality in - Policies
Pages 32 through 34 for evaluation criteria.
Yes F-] No[�KNot Applicable
��W......__. .... _. ....._. .... __ .................
A ad(fitional sheets if n %-s&ir
Policy 8. Minimize environmental degradation in Town of Southold from solid waste and hazardous
substances and wastes. See LWRP Section III—Policies; ` ` .
1:1 Yes 1:1 No 19"Not Applicable
PUBLIC COAST POLICEES
publicPolicy 9. Provide for ` "
resources of the Town of Southold. See LWRP Section III— ; Pages 38 through "for evaluation
criteria.
Yes[] NO ffNot Applicable
_. _.... .
..._..............
Anach 'li . ,
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 M—Policies; Pages 47 through 56 for evaluation criteria.
Yes D No Not Applicable
..... .................. ....................WW
Attach additional sheets if necessary
Policy 11. Promote sustainable use of living marine resources in Long Island Sound,the Peconic Estuary
and Town waters. See LWRP Section III—Policies; Pages 57 through 62 for evaluation criteria.
El Yes 7 No Not Applicable
Attach a .ditiomil shects if necessary
Policy 12. Protect agricultural lands in the Town of Southold. See LW , Section M—Policies; Pages 62
through 65 for evaluation criteria.
Yes 1:1 No1:1 Not Applicable
..............................._....
Attach additin -1 siiects if necessary
Policy 13. Promote appropriate use and development of energy and mineral resources. See LWRP
Section CII--Policies, P es 65 through 68 for evaluation criteria.
Yes 0 No ErNot Applicable
P PAREIIY A TITLE .. — _ DATE 2�,
rrteWed on&105
Full Environmental Assessment Form
Part 1 -Project and Setting
Instructions for Completing Part I
Part I 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 I 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:
tc)�_
Project Location(describe,and attach ageneral location m.
311-1,5-
Brief Description of Proposed Action(include purpose or need).
I Ingo /,; 5
too" /(/u
/000
............
Name of Applicant/Sponsor: Telephone:
0.
E-Mail:
A/
Addres
City/PO State:
,�nv IV 9 C/7 AJY Z�ip/5�4Feic�/ 7
Project Contact(i not as sponsor;give name and title/role): Telephone: 0/1� C/3 3 Z)
64,;� Moore E-Mail: /1(,,"0,9" e Moorra)
Address:
AAa(M oezd
City/PO: State: Zip Code,.
,S,�q U/4 old UY 7
Property Owner (if not same as sponsor): oCtj" Telephone:
E-Mail:
Address:
416tV61-75;tL�J
City/PO: tate Zi
&
�)qo
...............
.............
Page I of 13
FEAF 2019
B.Government Approvals
B.Government Approvals,Funding,or Sponsorship. ("Funding"in of
pp g, ' dudes 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 0 LC 60o&;"/
W ,
Planning Board or Commission
c.City,Town or ❑Yes v❑No
Village Zoning Board of Appeals
d.Other local agencies E]YesEgfTo
e. County agencies es❑No , (- r g ��
f.Regional agencies ❑Yes No
g. State agencies ❑Yes No
h.Federal agencies ❑Yes o
i. Coastal Resources.
i. Isthro'ect site within a Coastal Areaor the waterfront area of a Designated Inland Waterway?project , erwa ❑`c'es o
ii. Is the project site located in a community with an approved Local Waterfront Revitalization Program? 01yeso Cil
iii. Is the project site within a Coastal Erosion Hazard Area? ❑ es a
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 ❑Yes o
only approval(s)which must be granted to enable the proposed action to proceed?
• 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 ❑Ycs
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; es❑No
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. es❑No
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? Yes❑No
c.Is a zoning change requested as part of the proposed action? ❑Yes• o
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? )i;..r
b.What police or other public protection forces serve the project site'?
c.Which fire protection and emergency medical services serve the project site?
MeIA 14-
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? Q acres
c.Total acreage(project site and any contiguous properties)owned
or controlled by the applicant or project sponsor? acres
c.Is the proposed action an expansion of an existing projector use? ❑Ye o
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? ❑ le-s ONo
If Yes,
i. Purpose or type of subdivision residential,industrial,commercial;if mixed,specify types)
ii. Is a c user ctnservatiooti layOUt proposed? [--]Yescca. Number o1lots proposed? o
iv. Miniinuin and inaxin int proposed lest sizes? Minimus �� Maximum
e.Will the proposed action be constructed in multiple phases? ❑Yes o
i. If No,anticipated period of construction: months
H. If Yes:
• Total number of phases anticipated
• Anticipated commencement date of phase 1 (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? ❑Yes[ o
If Yes,show numbers of units proposed.
One Famil Two Family Three Family MuRiple Family four or more
Initial Phase
At completion
of all phases
g.Does the proposed action include new non-residential construction(including expansions)? ❑Yes o
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 E]Yes5iro
liquids,such as creation of a water supply,reservoir,pond,lake,waste lagoon or other storage?
If Yes,
i. I f Purpose r i the impoundment: nd water[]Surface water streams❑Other specify:ii. If a water impoundment,theprincipal source of the water: �� u mmmmmm�mmmm
p Gro..... eci
iii. 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: ..mm� 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? es 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?
u.How much material(including rock earth sediments etc.)is pro p
" (' g posed 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 d plans to use,manage or dispose of them.
iv. Will there be onsite dewatering 11 or processing of excavated materials? Yes No
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? mm acres
What
viii. W the ld be thenmaximum b depth of excavation or dredging? feet
p g
requireg? ... ❑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 rJYCsUKo
into any existing wetland,waterbody,shoreline,beach or adjacent area?
If Yes:
i. 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:
iff.Will the proposed ac ......o �.. ... ..
"' tion cause or result in disturbance to bottom sediments? ❑Yes❑No
If Yes,describe:
iv.Will the proposed action cause or result in the destruction or.. ... ......N.
removal
of aquatic vegetation? ❑Yes❑No
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):
• proposed metho.... . .w..
d of plant removal: ..................
emoval
• if chemical/herbicide treatment will .. ....,w
be used,specify product(s):
v. Describe any proposed reclamation/mitigation following disturbance:
c.Will the proposed action use,or create a new demand for water? ❑Yes O
If Yes:
i. Total anticipated water usage/demand per day: gallons/day
ii. Will the proposed action obtain water from an existing public water supply? ❑Yes❑No
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:
• Source(s)of supply for the district:S ( ) pp y 'ct:
avIs a new water supply district or service area propose
'V. d to be formed to serve the project site? ❑Yes❑No
If,Yes:
• Applicant/sponsor for new district:
• Date application submitted or anticipated
• Proposed source(s)of supply for new district: m
v. If a public water supply will not be used,describe plans to provide water supply for the project: aa.....µ_...
vi.If water supply will be from wells(public or private),what is the maximum pumping capacity:ty: gallons/min
ute.
d.Will the proposed action generate liquid wastes? ❑Yes o
If Yes:
L 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 any existing public wastewater treatment facilities �E
❑Yes❑No
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? ❑ ❑
YesNo
• Is the project site in the existing district? ❑Yes❑No
• Is expansion of the district needed? ❑Yes❑No
Page 5of13
• 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
( g ) formed to serve the project site? ❑Yes❑No
If Yes:
• Applicant/sponsor for new district:
�.aaa
• 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 the project,including specifying
proposed
receiving water(name and classification if surface discharge or describe subsurface disposal plans):
vi. Describe an plans or designs ..e
' � y p or 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 -
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,identify receiving water bodies or wetlands:
• Will stormwater runoff flow to adjacent erti...�.�._..... ....
� properties. ❑Yes❑No
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 C1YesEFo
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. Stationary sources during operations(e.g.,process emissions,large boilers,electric generation)
g.Will any air emission sources named in D.2.f(above),require a NY State Air Registration,Air Facility Permit, ❑Yes EINo
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:
• IIIomlyear(short tons)of Carbon Dioxide(CO-,)
• Jons/ycar(short tons)of Nitrous Oxide(NZO)
• °Tons/year(short tons)of Perfluorocarbons(PFCs)
• Tonslycar (short tons)of Sulfur Hexafluoride(SF6)
• w.. mmm m1 oars/year°(short tons)of Carbon Dioxide equivalent of Hydroflourocarbons(HFCs)
• Tons/year(short tons)of Hazardous Air Pollutants(H s)
Page 6 of 13
h.Will the proposed action generate or emit methane(including,but not limited to,sewage treatment plants, ❑Yc,s ,No
landfills,composting facilities)?
If Yes:
i. Estimate methane generation in tons/year(metric):
ii.Describe .........
any methane capture control or elimination measures included in project design(e.g.,combustion 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 EFS00
o
quant'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 ElycsMNO
new demand for transportation facilities or services?
If Yes:
i. When is the peak traffic expected(Check all that apply): El Morning 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: Existing ..... Proposed Net increase/decrease
iv.Does the proposed action include any shared use parking? []Yes No
v If the proposed action includes any modification of existing roads,creation of new roads or change in existing access,describe:
Vi. Are public/private transportation service(s)or facilities available within'/z mile of the proposed site? ❑Yes❑No
vii Will the proposed action include access to public transportation or accommodations for use of 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-siteµcombustion,on-site renewable,viaWgrid/local utility,or
other):
iii. Will the proposed action require a new,or an.. ......
upgrade,
to an existing substation? ❑Yes❑No
1.Hours of operation. Answer all items which apply. A//A
i. During Construction: ii. During Operations:
• Monday-Friday-,Monday-Friday:
• Saturday:w.� �._.. • Saturday:
• Sunday: _..... �. • Sunday:
• Holidays: • Holidays:
Page 7 of 13
m.Will the proposed action produce noise that will exceed existing ambient noise levels during construction, ❑Yes o
operation,or both?
If yes:
L Provide details including sources,time of day and duration:
ii. Will the proposedaction remove existing natural barriers that could act as a noise barrier or screen? ❑Yes❑
.. Na
Describe:
n.Will the proposed action have outdoor lighting? ❑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 bamers that could act as a light barrier or screen ❑Yes No
Describe:
o. Does the proposed action have the potential to produce odors for more than one hour per day? ElyesgKo
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:
L Product(s)to be stored
H. Volume(s) per unit time (e.g.,month,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 '❑ o
insecticides)during construction or operation?
If Yes:
L Describe proposed treatment(s):
ii.Will thesop �...- eN Pest ... ..� -�..�
osed action use lite prat'. st plana�cmcnt Practices? ❑ Yes FIN
r.Will the proposed action(commercial or industrial projects only)involve or require the management or disposal ❑ Yes o
of solid waste(excluding hazardous materials)?
If Yes:
L 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 No
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 DYes' )
waste?
If Yes:
i.Name(s)of all hazardous wastes or constituents to be generated,handled or managed at facility:
H. Generally describe processes or activities involving hazardous wastes or constituents: ...... .......
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 an hazardous wastes be disposed mmmmmmmm e
......ed a
y p tan existing offsite hazardous waste facility? Yes No
If Yes:provide name and location of facility: ww
If No: describe pr g y to �facility:
' proposed management of an hazardous wastes which will not be sent to a hazardous waste
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 oip adloillitig'uld Ile rdle proIec,t site.
El
11 Fobest an � g culture ElAuat�c'oinmerctal UQOda lslaccify) ualaan) ❑ Rural(non-farm)
ii. If mix of uses,generally describe:
b.Land uses and covertypes on
the project site.
Land use or Current Acreage After Change
Covertype Acreage Project Completion (Acres+/-)
m®mmmmmmmmmRoads,buildings,and other paved or impervious
p ous
surfaces
• Forested
• Meadows,grasslands or brushlands(non-
agricultural,
( -
agricultural,including abandoned agricultural)
• Agricultural
.... - .�.
g 'cultural
incl active orchards,field,greenhouse etc.)
• mm Surface water features
(lakes,ponds,streams,rivers,etc.)
• Wetlands(freshwater o.or tidal)
.......... N .... ............
Non-vegetated .__
(bare rock,earth or fill)
... ... ... .. ... ....
• Other
Describe:
Page 9 of 13
mw .
c.Is the project site presently used by members of the community for public recreation? ❑` 7s No
i. If Yes:explain:
y g elderly,people with disabilities(e.g.,schools,hospitals,licensed �r ...mm
d.Are there an facilities serum children the el � ❑ acs 'o
day care centers,or group homes)within 1500 feet of the project site?
If Yes,
i. Identify Facilities:
�... ......� ...................._............................................... _ .....
proJ
e.Does the ect site contain an existingdam. Yes o
If Yes:
i. Dimensions of the dam and impoundment:
• Dam height: feet
• Dam length: w 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, ❑Ycs , o
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:
iii. Describe any development constraints due to the prior solid waste activities:
Have hazardous wastes been generated,treated �
g. g d, d and/or disposed of at the site,or does the project site adjoin YcS `o
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
...._.....wwwwwwwnt tamination h.t �
history. Has there been a reported spill at the proposed project site,or have any ❑"�rs a
remedial actions been conducted at or adjacent to the proposed site?
If Yes:
L Is any portion of the site listed on the NYSDEC Spills Incidents database or Environmental Site ❑YesNo
Remediation database? Check all that apply:
El Yes—Spills Incidents database Provide DEC ID number(s): ww...
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 any site in the NYSDEC Environmental Site Remediation database? ❑Yes❑No
If yes,provide DEC ID number(s): w
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- ,. n.... .......
limiting property uses? O'Yes❑No
• If yes,DEC site ID number:
• Describe the type of institutional control(e.g.,deed restriction or easement):
• Describe any use limitations:
• Describe any engineering controls
• Will the project affect the institutional or engineering controls in place? ❑Yes❑No
• Explain:
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? ❑Yes o
If Yes,what proportion of the site is comprised of bedrock outcroppings?
... ..
c.Predominant soil type(s)present on project site: 'k ��r°
d.What is the average depth to the water table on the project site? Average: feet
e.Drainage status of...... —Drained:
� .. .. �..
project site soils: yell Drained: "Q 2 %of site
❑ Moderately Well Drained: %of site
❑ Poorly Drained %of site
f.Approximate proportion of proposed action site with slopes: 0-10% _.............................................. ..............._
w-.
p ° lam%of site
❑ 10-15%: %of site
❑ 15%or greater: %of site
g.Are there any unique geologic features on the project site? ❑Yeso
If Yes,describe:
.................... ..
h.Surface water features.
i. Does any portion of the project site contain wetlands or other waterbodies(including streams,rivers, ❑Yes o
ponds or lakes)?
ii. Do any wetlands or other waterbodies adjoin the project site? ❑Yes❑No
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, ❑Yes❑No
state or local agency?
iv. For each identified regulated wetland and waterbody on the project site,provide the following information:
0 Streams: Name Classification
• Lakes or Ponds: Name Classification
• PP
Wetlands: Name,-,, Approximate Size
• Wetland No.(if regulated by DEC)
v. Are any of the above water bodies listed in the most recent compilation of NYS water quality-impaired ❑Yes❑No
waterbodies?
If yes,name of impaired water body/bodies and basis for listing as impaired:
...-.-.. _—- designated .. ;- ❑
i.Is the project site in a ated Floodwa Yes o
the project site in the
J•Is P J e 100-year Floodplain? ❑Yes o
k.Is the project site in the .......
i e 500-year Floodplain? ❑Yes o
1.Is theprojectsite located over,or immediately adjoining,a primary,principal or sole source aquifer? es❑No
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? E]Yes X10
If Yes:
i. Describe the habitat/community(composition,function,and basis for designation):IT�
n. Source(s)of description or evaluation:
W. Extent of community/habitat:
• Currently: acres
• Following completion of project as proposed: m�mm acres
• Gain or loss(indicate+or-}: acres
o.Does project site contain any s............d � �,�; a
��- "�
pees of plant or animal that is listed by the federal government or NYS as Y
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 LJYeS No
special concern?
If Yes:
i. Species and listing: .
q.Is the project site or adjoining area currently used for hunting,trapping,fishing or shell fishing? -❑Yes❑No
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 m
a.Is the project site,or any portion of it,located in a designated agricultural district certified pursuant to ❑'� esNo ..._..
Agriculture and Markets Law,Article 25-AA,Section 303 and 304?
If Yes, provide county plus district name/number: mm
b.Are agricultural lands consisting of high
ghly productive soils present? es❑No
i. If Yes: acreage(s)on project site? 2
ii. Source(s)of soil rating(s):
. c..Does thero... ..... � ........_......
p..ject site contain all or part of,or is it substantially contiguous to,a registered National ❑Yes o
Natural Landmark?
If Yes:
i. Nature of the natural landmark: ❑Biological Community El Geological Feature
ii. Provide brief description of landmark,including values behind designation and approximate size/extent:
d.Is the project site located in or does it a �.
' adjoin a state listed Critical Environmental Area. Ycs o
If Yes:
i. CEA name:
ii. Basis for designation:e.
iii. Designating agency and date:
ww..�...._. ww.. ...�-...�._„
Page 12 of 13
11 contiguous to a bui........1.................. .. . .. ...site....................1..........1..........................................................
e.Does the project site contain,oris it substantially gu w �, building,archaeological
or d'str'ct ❑Yes 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: El Archaeological Site []Historic Building or District
ii.Name::
iii. Brief description of attributes on which listing mmmmng is based:
f.Is the project site,or an portion of it,located in.,,................. �
y p or adjacent to an area designated as sensitive for E1YesMK0
archaeological sites on the NY State Historic Preservation Office(SHPO)archaeological site inventory?
g.Have additional archaeological or historic site(s)or resources been identifiedite?
on the projects ❑Yes rWo
If Yes:
i.Describe possible resource(s)
ii. Basis for identification:
n._........ ...... w.
Is the project site within fives miles of any officially designated and publicly accessible federal, state,or local ❑Yes o
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.): _
i. Is the project site located within a designate ated river corridor unmiles.
Distance between project and resource:
gn der the Wild,Scenic and Recreational Rivers 0)cs _w . o ....
Program 6 NYCRR 666?
If Yes:
i. Identify the name of the river and its designation:
U. Is the activity consistent with development restrictions contained. ............."..."""""."....."". _...........
U
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.
.....
Date
me .`. � lt�.� �" x � �.� ....
Applicant/Sponsor Na ,�' i i
✓ �t .,.
Signature ". :.:. -- - ___...w_. Title. .._.
PRINT F �� Page 13 of 13
THIS IS TO CERTIFY THAT THE FOLLOWING RESOLUTION WAS ADOPTED AT
THE REGULAR MEETING OF THE SOUTHOLD PLANNING BOARD ON
FEBRUARY 14,2011:
WHEREAS, the Southold Planning Board has found that applications for lot line modifications
(re-subdivisions) often involve very minor adjustments of lot lines, or adjustments that result in
no new development potential; and
WHEREAS, the Southold Planning Board,pursuant to §240-56 of the Town Code,has the
authority to waive certain requirements in the subdivision review process; and
WHEREAS,the Southold Planning Board,by way of this policy, intends to simplify and shorten
the application process for certain lot line modification (aka re-subdivision)requests by reducing
the number of agency approvals necessary prior to Planning Board approval;
NOW,THEREFORE, BE IT
RESOLVED that the Planning Board of the Town of Southold hereby adopts the"Lot Line
Modification/Re-subdivision Application Process Policy" as follows:
Lot Line Modification/Re-subdivision Application Process Policy
The following applications for lot line modifications (re-subdivisions) are eligible for a decision
from the Southold Planning Board prior to receiving approval by the Suffolk County Department
of Health Services (SCDHS):
1. The transfer of land from an oversized parcel (larger than the minimum zoning requires)
where the oversized parcel remains above the minimum lot size required, and where no
new development potential will be created in the parcel to which the land is transferred.
2. The transfer of land between two or more parcels, all of which are currently developed
and can produce legal certificates of occupancy, which results in no new development
potential.
3. The transfer of land between two or more parcels, vacant or developed, where the
SCDHS has previously approved the subdivision map, and where the two lots will remain
at or above the minimum lot size required by zoning.
4. Other situations where the Planning Board finds the amount of land being transferred is
negligible will result in no additional residential units being developed, and that there will
be no impact to wetlands or other sensitive environmental features.
The Planning Board shall formally waive the requirement for SCDHS approval by resolution
prior to their decision resolution. The following language shall also be included in every
Planning Board decision resolution containing the waiver of the requirement for SCDHS
approval:
`The Southold Town Planning Board, in waiving the requirement for SCDHS approval
prior to their own approval, is simply waiving a technical requirement of final plat
approval under the Town Code and makes no representations as to whether SCDHS
approval is required. SCDHS approval of this lot line change may be necessary to be in
compliance with the Suffolk County Sanitary Code, and to be eligible for future
construction or renovations.'
The following clause will also be inserted at the end of the resolution and the applicant required
to sign a copy for our files:
`I understand that Southold Town Planning Board approval of this lot line modification
does not grant, guarantee or waive an approval, if required, from the Suffolk County
Department of Health Services. I understand that I will need to apply separately to the
SCDHSfio an apphpable approvals.'
Signature of Applicant
2